In the recent case, which occurred in a surgery carried out in a St. Louis hospital to attend to a woman's brain injury, the surgical team somehow prepped and operated on the right side of the woman's brain, despite the left side having been clearly marked prior to surgery.
]]> The woman's attorney finds that outcome flatly inexplicable and has filed a medical malpractice lawsuit on her behalf.He doesn't mince words when describing the operation. "I think everybody in the operating room screwed up," he says.
It would certainly seem hard to argue otherwise, given the plethora of pre-surgical safeguards that are recommended to be routinely followed by surgical teams prior to operations. Those recommendations are comprehensively known across the industry and stringently pushed by health regulators and organizations.
And yet such errors continue to occur. Tragically, they are entirely avoidable in the absence of negligence and when a medical team simply performs its duties in a reasonably professional manner, and that is what is maximally frustrating to medical officials and governing bodies.
The Joint Commission plays a preeminent role in accrediting hospitals across the country. It notes that it reviewed 109 cases last year alone that featured wrong-patient, wrong-procedure and wrong-site surgery. What is unduly alarming is that those reviews pertained to only mistakes that were voluntarily reported by hospitals.
In reality, the number of never events is certain to be much higher.
Source: WTSP 10 News, "Doctor Armond Levy, St. Louis hospital sued for wrong-side brain surgery," May 3, 2013
]]>The loud fanfare that accompanied their arrival has for some time now been appreciably muted, with legions of critics now readily noting the problems that come with the systems and, for many hospital staff members, seemingly wipe out the gains realized from the new technology.
It is uncontroverted that medical malpractice acts and omissions have resulted from use with EHR systems. Doctors and nurses sometimes do not enter critically important data, especially patient updates. Medical teams in different locales do not communicate well via the EHR interface. Medication errors are made. Users frequently complain about the difficulty associated with using the systems and software that is unresponsive, frustrating and error-prone.
]]> One commentator, Kimberly Martini, is an executive with a company that works with medical facilities to implement EHR systems. Martini says that the problem is not so much with the technology itself as it is with the underestimation of administrators regarding how much time and hands-on assistance is required to train staffs to use EHR processes.She says that has been a problem from the outset and that, with a lack of training and guidance, many medical professionals have soured on EHRs and now think they are a wash at best. User satisfaction is consistently shown to be quite low, with many users saying that EHR programs actually decrease the quality of patient care.
The AMA recently stated that the government needs to "take a breather" in its EHR push to evaluate in good faith what has worked and what hasn't thus far.
Source: Government Health IT, "EHR dissatisfaction: a tech or people problem?" Kimberly Martini, May 6, 2013
]]>On the one hand, people believing that medical professionals necessarily need to be held to a standard of care that promotes patients' interests and that truly seeks to do no harm endorse payouts to injured individuals and families that have suffered through medical incompetence. A widespread public view stresses that negligence and any clear divergence from competently practiced medicine needs to be identified and remedied. Not doing so rewards bad doctors and virtually ensures increased patient harm in the future.
]]> Critics of that reasoning -- unsurprisingly, medical associations, hospital administrators and MD-related groups and affiliations -- counter that large jury awards are essentially bankrupting the system and that the fear of malpractice payouts is forcing good doctors out of the industry and inexorably driving up costs.That latter view is close to total nonsense, concludes a research team of Johns Hopkins doctors, who say that large payouts are rare and account for only a tiny fraction -- actually, less than one percent -- of medical expenditures in the United States each year.
Conversely, say the researchers, what is clearly driving up costs are the millions of diagnostic tests ordered up annually by doctors in all hospitals across the country. Those inflate expenses just in themselves and, additionally, contribute to preventable medical error in many instances through so-called "false-positive" interpretations that spur further unnecessary treatment.
The Hopkins team's central recommendation: Focus on limiting the practice of what has been termed "defensive medicine" and not the capping of malpractice awards.
Source: HealthCanal, "'Catastrophic' malpractice payouts add little to health care's rising costs," May 3, 2013
]]>One newly enacted law, which will take effect from July 1, is aimed at compounding pharmacies, which have been thrust into the national spotlight in a tragic way following last year's meningitis outbreak killing scores of people and seriously sickening hundreds of others. Maryland was one of the 23 states to which tainted steroid medications were shipped. Three people died in the state from injections.
The new legislation mandates that any company making or distributing compounded drugs first obtain a state permit to do so.
Two other patient safety laws were also passed. One of them targets staffing agencies that find temporary jobs for health workers. The passage of that bill was motivated by the now well-chronicled sojourn of a health-care technician with a drug problem who traveled across the country, finding employment in facilities in several states, including Maryland. That worker was infected with hepatitis C and passed it along to a number of patients through contaminated syringes. As a result of that episode, new legislation will now require all temporary staffing companies to be licensed by the state's health department.
The same will also be required going forward of cosmetic surgery centers, with state regulators finding that many of them have been deficient in controlling post-procedure infections.
Maryland's actions have been broadly noted and could potentially help serve as a model for change and tighter controls in some other states, as well.
Source: Washington Post, "Three new MD health laws offer more patient protection," Lena H. Sun, May 2, 2013
]]>Although those causes are certainly common enough, researchers from Johns Hopkins Hospital who have sifted through decades of malpractice-related material say that they are easily eclipsed as catalysts directly leading to fatal and serious injury by something else, namely this: failure to diagnose a serious disease or illness.
]]> And it's not even close.Missed, delayed and wrongly diagnosed conditions are an unfortunate staple of the medical industry, with hundreds of thousands of patients being on the wrong end of a faulty conclusion.
And notwithstanding their common and too-often deadly results, errors in diagnosis are not sufficiently appreciated and responded to, say the researchers.
"Despite their significant impact, diagnostic errors have received relatively limited public and scientific attention, even from the patient safety community," says an author of the Hopkins study team.
What the team found from examination of nearly 25 years of malpractice data on file in a national database is that diagnostic error is repeated time and again, with deadly consequences in scores of thousands of cases. The researchers say that diagnostic mistakes lead to patient deaths more often than any other medical cause, making them the most dangerous element in medicine in the United States.
Proof is in the numbers, with the National Practitioner Data Bank showing that nearly 30 percent of all malpractice payouts over the past quarter century have been in response to physicians' mistakes in properly diagnosing a condition.
And, say researchers, that impact could be understated in reality, with economic and social costs relating to diagnostic mistakes being double what has been estimated.
Properly diagnosing patients is "a critical health policy issue," say the study authors.
Source: MedPage Today, "Diagnosis error is costliest medical mistake," Kathleen Struck, April 22, 2013
]]>As a young doctor, beginning with the first day of medical school and reinforced on a daily basis in my internal medicine residency, was the concept of differential diagnosis. Differential diagnosis involves listening to what a patient tells you, asking the patient directed questions, taking vital signs, doing a physical exam and developing a list of possibilities as to what might be wrong. It is important that the list cover every organ system that might be involved. It is also important to "put the worst first." That means if five different things might be wrong with a person, it is imperative to make sure that what is wrong is not a fixable illness that will kill or permanently injure if there is delay. This involves thinking of all possibilities and putting patient safety first. It does not involve guessing or gambling.
Example: a 57-year old woman came into my office complaining of 3 hours of pain right below her ribs associated with burning and burping. The pain was worse when she lay down. She noticed that walking fast made the pain a bit worse. On exam her vital signs were all normal (blood pressure, pulse respiratory rate and temperature) and a careful and complete physical exam including heart, lungs, abdomen, pelvic and rectal revealed nothing-all normal.
Now the ODDS are that this woman had indigestion. Sadly, there are many doctors who would have sent her home with a pat on the head and an antacid. But to decide that a person has indigestion based on ODDS is dead wrong and can lead to a disaster. The doctor needs to ask herself, "what is possibly wrong and, of those possible things what can kill?"
Rather than jumping to a conclusion, the doctor makes a list of possibilities. In the case I just described, the list included HEART ATTACK, gallbladder disease, ulcer, internal bleeding, infection etc. Directed tests were ordered. In this case an EKG was immediately obtained and it showed an inferior wall myocardial infarction! Good thing she did not get sent home with a pat on the head. She went racing to the hospital in an ambulance-she was having a heart attack.
A certain kind of heart attack is often indistinguishable from indigestion!
The same is true for any kind of problem, from headache, to abdominal pain, to vomiting. Be sure that your doctor listens to what you say and takes the time to consider (and share with you) the possibilities and makes a plan how to rule things in or out in a timely fashion.
]]>And although that might make them an occupational group that is comparatively fit compared to other professions, it also has downside implications for medical malpractice and medical error.
]]> Research recently published online in the Journal of General Internal Medicine concludes from study of the working habits of first-year interns at Johns Hopkins School of Medicine and Johns Hopkins Hospital in Baltimore that they flatly spend too little time with patients.In fact, findings from scrutiny of nearly 900 tracked hours indicate that only 12 percent of their working day, on average, is time spend interacting with patients. On some days, it is even less than that, as evidenced by the study's lead author, Dr. Lauren Block, who laments that, "[E]ight minutes a day with each patient just doesn't seem like enough time to me."
The data compiled show that the interns spend about the same amount of time walking from task to task as they do speaking with and examining patients. They also spend much of their day engaged in away-from-patient activities such as working with electronic health record (EHR) systems and placing orders.
That skewing of priorities presents a definite downside for patients, say a number of doctors who worked on or otherwise issued comments regarding the study.
"Our systems have squeezed this [patient interaction] out of medical training," notes one.
Adds Block: "Getting to know patients better can improve diagnoses and care and reduce medical errors."
Source: U.S. News & World Report, "Interns' schedules shortchange patients, study suggests," April 26, 2013
]]>More than technology, facility infrastructure or any other factor, a study conducted by a large insurance company indicates that the employees themselves -- how they interact, how well they work together, the effectiveness of their professional communications, their forged workplace culture, or lack of all those things -- determine more than anything else the overall effectiveness of the patient care delivered by a medical facility.
Put another way: A strained workplace culture and professional interaction among medical staff members will absolutely contribute to a higher level of medical malpractice and patient harm.
]]> That is the predominant conclusion that emerges from a survey conducted by the mammoth insurer American International Group Inc. (AIG). The result is soundly grounded in the company's scrutiny of answers provided by 100 risk managers and 250 hospital executives and administrators, who routinely cited human factors in the context of patient safety and better bottom-line cost results.Inadequate teamwork increases medical errors. A soured work environment marked by negativity has the same result. Respondents flatly told AIG representatives that better camaraderie among doctors, nurses and other hospital workers drives down risk factors and has an attendant effect on lowering facility costs.
Although hospital administrators routinely say that patient safety is their overriding concern, it is clear that they duly note the last part of the above message, that is, the cost part of the equation.
"Improvements in patient safety will provide a quick return on investment," says a risk manager at AIG.
Source: Bloomberg, "Hospital safety hurt by teamwork lapses, AIG study shows," Zachary Tracer, April 19, 2013
]]>Consider, for example, the topic of "never events," something that this blog has alluded to in the past. In a nutshell, and despite both modern technology and constant calls for improvement, surgeons commit egregious medical malpractice acts such as operating on the wrong patient or body part multiple times in American hospitals each day.
]]> People, too, are left to contemplate how on earth the many surfacing problems associated with compounding pharmacies can exist, given both state and federal regulators. Where is the oversight?Electronic health records (EHRs) also come in for more than a modicum of criticism. They have been hailed by advocates as catalysts for improving patient care, yet over the past years they have shown sharp growing pains that have led in many instances to medication errors, physicians' miscommunications and other problems.
Perhaps the supreme irony has just been revealed through the conclusions of a study carried out jointly by several medical groups, including Harvard's schools of medicine and public health. The findings, published last week in the Journal of the American Medical Association, shockingly state this: Hospitals make more money when they screw up than when they perform competently
Put in other words: When patients suffer from in-house preventable errors such as facility-acquired infections and post-operative pneumonia, hospitals receive additional money from insurers relating to the treatment of those errors and patients' extended stays in the hospital.
The study found that the length of the average patient stay owing to such mistakes quadruples and typically brings in about $30,000 more than would be the case for a mistake-free stay.
In an editorial accompanying the study, a commentator from Princeton University called the findings "troublesome but not surprising." He stated that the current payment scheme "can tempt otherwise admirable people into dubious conduct."
Source: New York Times, "Hospitals profit from surgical errors, study finds," Denise Grady, April 16, 2013
]]>Under a federal law, the reporting facilities are immune from prosecution for medical malpractice, wrongful death and other claims. The program's core rationale is that the freedom to report without repercussion promotes candor and remedial efforts to eradicate medical errors.
In looking at data flowing in from 36 select hospitals, ECRI researchers are sounding warning bells concerning one aspect of the industry that they say is flatly troublesome, namely, electronic health records (EHRs). What has been proclaimed by many as a near panacea in the industry is, instead, say ECRI officials, a technological hotbed for serious and fatal error across a wide spectrum of matters.
The sheer number of reported problems with EHR systems is "an awareness raiser," says the institute. Moreover, say researchers, the high number of troubling incidents related to EHRs that are being voluntarily reported almost certainly indicates that the actual number of problems is much higher.
The problem in a nutshell is this, states the institute: The implementation of such systems is proceeding too quickly and with not enough continuing oversight. Incompatible systems are being wrenched together, different vendors are being incorporated across departments that use the same system in common, various aspects of a program are being upgraded while others are not, and people are simply making mistakes.
The institute says that more reporting is crucial for identifying errors and making fixes. Additionally, researchers say that continuous checking and monitoring of EHR systems is of critical importance in ensuring their accuracy.
Absent rigorous planning and ongoing oversight, states ECRI, patient deaths and injuries will increase.
Source: Health Leaders Media, "HIT errors 'tip of the iceberg,' says ECRI," Cheryl Clark, April 5, 2013
]]>In past select blog posts, we have traced the story and its relevant details, as well as noted the burgeoning product liability, medical malpractice and wrongful death litigation associated with it.
]]> The FDA has been a central -- though often unwilling, sometimes even cringing -- actor in the tale, with a number of critics in the wake of last year's tragedy questioning how oversight of the specialty pharmacies could have become so emasculated and irregular over many years.As we noted, compounding pharmacies were originally intended to serve as purveyors of specialty drugs and medications for a small number of customers. Over time, many of them morphed -- seemingly without much regulation or oversight at all, at either the state or federal level -- into giant drug-dispensing entities.
The FDA has consistently said that its regulatory hands have been tied in dealing with the pharmacies, since they are regulated by state boards. Some legislators accept that and say that federal regulatory oversight needs to be beefed up going forward. Other lawmakers say that the FDA simply dropped the ball and is using excuses to deflect its own negligence.
Things will be interesting going forward. Federal inspectors just finished what has been called "a crash inspection program" of 31 compounding pharmacies. Ominously, they report that they found problems relating to safety and sterility in 30 of them. Some pharmacies, they note, initially resisted inspection. One of them demanded a court order.
A House subcommittee will hold a hearing tomorrow, during which Dr. Margaret A. Hamburg, the FDA commissioner, is expected to be questioned.
Source: New York Times, "Checks find unsafe practices at compounding pharmacies," Andrew Pollack, April 12, 2013
]]>A gigantic change occurred soon after I finished my internal medicine residency training at Cornell in 1985 because of the "Libby Zion" case in N.Y.C. The case involved a young woman, Libby Zion, who was admitted to the hospital with a fever and agitation. Unbeknownst to the doctors-in training (interns and residents) who admitted her, Ms. Zion was on a variety of psychiatric medications. She was given a medication by the doctors-in-training that may have interacted with one of her psychiatric medications and she died. The exact cause will never be clear. A giant medical malpractice lawsuit resulted. The allegations were that the doctors-in training had worked too many hours and were addled as a result. A major result of the case was that the hours interns and residents are allowed to work nationally was greatly reduced. Currently, it is a violation of rules of the Accreditation Council for Graduate Medical Education for doctors in training to stay awake or be on call for long stretches. It was/is thought by some that proper rest is required for a doctor to have good judgment. Personally, for me, the Libby Zion case had a lot of impact because it involved individuals in my training group -- I knew everyone involved. Not only was it tragic for everyone there, it has also been a sort of a tragedy for doctors who trained after the rules changed.
As a lawyer who sues doctors for medical errors, I spend most of my time reviewing medical records, taking depositions of doctors and analyzing their actions. What I see is that the new generation of doctors has a marked decrease in basic knowledge and understanding of various disease states when I compare them with their older counterparts. I attribute this to lack of exposure to sick people due to shorter training hours. More importantly, younger doctors also seem to lack the discipline required to take care of sick people in the real world. By that I mean that I find doctors often stay in bed, play golf, finish meals etc. rather than promptly going in to the hospital to see a sick person who needs them. I attribute this to doctors never being forced to learn ethical and necessary, disciplined work habits. Patients do not get sick between 9 am and 5 pm. A doctor must learn the hard way that you need to stay awake and provide assistance even when it is uncomfortable or inconvenient. I know of no good way to learn this unless you are forced to do it through long, grueling working hours. The real world for a committed doctor needs to involve more bedside and less bed.
]]>Readers of this blog were able to track the material developments in the matter in our February 27, 2013, post entry. We provide an update here, given the trial's conclusion and the jury's verdict.
]]> The trial was held in a Nevada state court, with two units of UnitedHealth Group Inc. facing charges that they failed to properly monitor Dipak Desai, an ex-gastroenterologist. Nevada law requires that insurers undertake that task.Two plaintiffs brought the case, alleging that they were infected with hepatitis C in colonoscopy procedures that was caused directly by shoddy practices at Desai's clinic, which included reusing vials of a potent anesthetic and failing to change disinfectants. Trial witnesses also stated that Desai performed complex medical procedures in mere minutes, seeing as many as 20 patients within three hours.
The case is expected to be followed by many others. Nevada health authorities have notified about 50,000 former patients of Desai that they might also have contracted the virus after undergoing procedures at Desai's clinics.
The jury awarded $24 million in compensatory damages to the plaintiffs, with attorneys saying that the lack of medical oversight was so egregious that they will be seeking "the largest verdict ever in Southern Nevada" for punitive damages. The amount: $1 billion.
Source: Bloomberg, "UnitedHealth Units to pay $24 million in hepatitis case," Valerie Miller and Jef Feeley, April 4, 2013
]]>Where medical malpractice or professional negligence becomes an issue, it is usually associated with the individuals in the industry who are most closely tied to the actual practice of medicine. In other words, it is hardly surprising to see a story about surgical error or medication mistakes resulting from a doctor's incorrectly prescribed medicine.
]]> Other acts that do not readily constitute malpractice in the minds of most people still do qualify, though, as acts that are arguably in the realm of wrongdoing.Take the price gouging of prescription drugs in select pharmacies that many critics say is rampant across the country. Some pharmacy owners knowingly -- and in a manner they consider to be best business practice -- charge flatly exorbitant prices for their drugs, even while knowing that many consumers have limited means and the same medications are available elsewhere for a fraction of the cost.
That may not be legally actionable, but is it right?
In what was termed "a secret shopping study," a Consumer Reports team checked prices on drugs available as generics at more than 200 pharmacies nationally.
What they found was revealing. At pharmacy giant CVS, for example, Generic Lipitor -- the widely popular cholesterol medication -- cost $150 a month. At Costco, it was $17.00. Similar outcomes were seen with drugs ranging from the diabetes medication Actos to the asthma pill Singulair.
Given their findings, the Consumer Reports team strongly recommends that any person regularly taking medications do some serious research about where to buy them. As a first step, a frank discussion with the prescribing doctor is in order as to available generics, drug alternatives and buying sources.
Source: ABC News, "Cheap prescription drug secrets revealed by consumer group," Katie Moisse, March 28, 2013
]]>Many patients who had services performed at one oral surgeon's dental clinics in Oklahoma were routinely assured by what they regarded as a thoroughly modern and problem-free office.
"I know what a professional office looks like," says one patient who had dental work done at the office of Dr. W. Scott Harrington in Tulsa. "His was just as professional as anybody [sic]," she adds.
]]> Outwardly that may have seemed true, but health authorities are now saying that a wide spectrum of woes in Harrington's two offices over a multi-year period potentially resulted in the exposure of thousands of patients to hepatitis B, hepatitis C and the virus that causes aids.Understandably, the medical malpractice acts that health regulators say regularly occurred at Harrington's workplaces, coupled with professional negligence that routinely put patients at great risk, have greatly unnerved the patients that visited his offices in recent years.
Many of them are now asking one pointed question: How could the cited problems have gone on for so long without being discovered, reported and remedied?
Health authorities sent out letters last Friday to 7,000 patients who have seen Harrington within the past six years, informing them that they need to be tested to determine whether they were exposed to the viruses. Hundreds showed up for testing on Saturday, with thousands more expected to be tested this week.
Among the problems noted were these: reused needles; expired medications; unlocked drug cabinets; drugs being unlawfully administered by assistants rather than by Harrington himself; and ineffective sterilization of equipment.
An April 19 license revocation hearing has been scheduled for Harrington.
Source: USA TODAY, "Patients of Okla. Dentist line up for HIV tests," March 30, 2013