A new study of Texas hospitals found that hospitals are actually getting paid money to perform faulty surgeries.  In cases where preventable mistakes occur during surgery, hospitals are getting paid more money by insurance providers, resulting in an over $30,000 additional price tag. In these cases, a preventable mistake, such as a patient contracting pneumonia, or their incision becoming infected, the patient often must stay in the hospital for additional time. What once was a three and a half day hospital stay turns into a fourteen day stay, with a much more substantial price tag that comes at the expense of the patient’s insurance. While insurance companies do provide quite a bit of revenue for preventable mistakes, they do have a ‘never’ list of things that they will not pay for. This list includes leaving a sponge/instrument in a patient, or operating on the wrong body part.   See articles at Politico, Kaiser, and NY Times.

The researchers say that they don’t believe hospitals are intentionally allowing preventable mistakes to occur to gain income, but they do believe that there is no incentive for hospitals to improve their quality of care. If a patient catching pneumonia results in a $30,000 bonus to the hospital, why would the hospital want to reduce the chance of patients catching pneumonia?

To combat these preventable mistakes, some hospitals and doctors are now using checklists. These checklists sound obvious, including tasks like double checking the patient’s identification, body part being operated on, and if they’re allergic to any medications. By using these checklists, doctors and nurses ensure that they know who their patient is, what they need operated on, and what medication they should or shouldn’t have.

Since 2004, the Joint Commission, which accredits American hospitals, has required doctors and nurses to use a short checklist to increase surgical safety and to decrease preventable mistakes. If this checklist didn’t work, how is another supposed to help?
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Doctors vow to do no harm. But when preventable errors occur, sometimes the people who are saving your life can be killing you as well.  In an article and video by USA Today, victims talk about the retained foreign bodies that have cost them so dearly.  Whenever something, like a sponge, is left in the body, it is referred to as a retained foreign body. The body doesn’t welcome the sponge; it begins to fight it, rejecting the sponge. This causes infection and can lead to long term complications, including death. This is preventable and unnecessary. The medical community calls these instances ‘never events’. But these so called never events occur quite frequently.
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San Francisco Gate had an Associated Press article on the attempts of West Virginia legislators to include nursing homes under the tort reform caps meant for doctors who commit medical malpractice.  Nursing home lawsuits do not involve medical malpractice.  The allegations typically include simple negligence of unlicensed certified nurse aides or nursing malpractice.

“The measure explicitly includes nursing homes under the protections of a 2003 law that places limits on medical malpractice suits. The Medical Professionals Liability Act places a $500,000 cap on the non-economic damages for which health care providers are liable.”

The West Virginia Association for Justice, a group representing plaintiffs’ lawyers, called the bill unnecessary. “Nursing homes are already identified as medical providers under West Virginia’s existing Medical Professional Liability Act,” said Scott Blass, the group’s president. “This is an attempt by nursing homes to try to further limit their liability when their patients are harmed.”

 

Oklahoma News 9 reported on a troubling story involving the abuse of an elderly woman at the Quail Creek Nursing and Rehab Center in Oklahoma City. When daughters suspected that their mother, 96 year old Eyretha Mayberry, was suffering physical abuse at the hands of nursing home staff they took matters into their own hands by installing a secret camera in their mother’s room. Mayberry’s daughters caught nursing staff on film abusing 96 year old Mayberry. This video documentation led to the dismissal of staff members involved in the abuse, but the Quail Creek Center has refused to provide the family with medical records, and the investigation into the incident.  Sounds like someone is attempting to cover up the abuse.

Mayberry’s daughters have requested that Quail Creek Nursing and Rehab Center furnish their mother’s chart, which should document the injuries Mayberry sustained through staff abuse. However, the Quail Creek has failed to provide the requested medical paperwork after several requests; first claiming that the medical records had been sent to the “central office”, and then stating that Mayberry’s daughters did not have the proper paperwork to request the records.

More disappointing still is the fact that the Department of Health has failed respond to Mayberry’s daughters’ request for further investigate into Mayberry’s case. When News 9 called the Department of Health to request a statement on the Mayberry abuse case, the Chief of Long Term Case responded that she “could not confirm or deny if an investigation is currently being done.”

Hip implants, which are generally made from metal and plastic, often last for 15 years before they wear out and need to be replaced. Such devices can fail prematurely for a variety of reasons, but the early replacement rate is typically 1 percent after a year, or 5 percent at five years.  However, the New York Times reported that an internal analysis conducted by Johnson & Johnson in 2011 estimated that the all-metal hip implant device would fail within five years in nearly 40 percent of patients who received. The company’s analysis showed that the implant is likely to fail prematurely over the next few years in thousands more patients in addition to those who have already had painful and costly procedures to replace it. “Johnson & Johnson never released those projections for the device, the Articular Surface Replacement, or A.S.R., which the company recalled in mid-2010. But at the same time that the medical products giant was performing that analysis, it was publicly playing down similar findings from a British implant registry about the device’s early failure rate.”

“The episode represents one of the biggest medical device failures in recent decades and the forthcoming trial is expected to shed light on what officials of Johnson & Johnson’s DePuy Orthopaedics division knew about the device’s problem before its recall and the actions they took or did not take.”

“About 93,000 patients worldwide received an A.S.R., about one-third of them in the United States. There are two versions of the A.S.R., one used in standard hip implants and the other used in an alternative replacement procedure known as resurfacing. Only the standard implant was sold in the United States. Both versions of the A.S.R., however, used the same metal hip cup as part of their design.”

 

CNN reported on the Top 10 Medical Mistakes.  “Medical errors kill more than a quarter million people every year in the United States and injure millions. Add them all up and “you have probably the third leading cause of death” in the country, says Dr. Peter Pronovost, an anesthesiologist and critical care physician at Johns Hopkins Hospital.”

The harm is often avoidable.  Surgeons make ‘body-part mix-ups’.  Here’s CNN’s list of 10 shocking medical mistakes and ways to not become a victim:

1. Mistake: Treating the wrong patient
• Cause: Hospital staff fails to verify a patient’s identity.
• Consequences: Patients with similar names are confused.
• Prevention: Before every procedure in the hospital, make sure the staff checks your entire name, date of birth and barcode on your wrist band.
• Example case: Kerry Higuera

 

2. Mistake: Surgical souvenirs
• Cause: Surgical staff miscounts (or fails to count) equipment used inside a patient during an operation.
• Consequences: Tools get left inside the body.
• Prevention: If you have unexpected pain, fever or swelling after surgery, ask if you might have a surgical instrument inside you.
• Example case: Nelson Bailey

 

3. Mistake: Lost patients
• Cause: Patients with dementia are sometimes prone to wandering.
• Consequences: Patients may become trapped while wandering and die from hypothermia or dehydration.
• Prevention: If your loved one sometimes wanders, consider a GPS tracking bracelet.
• Example case: Mary Cole

4. Mistake: Fake doctors
• Cause: Con artists pretend to be doctors.
• Consequences: Medical treatments backfire. Instead of getting better, patients get sicker.
• Prevention: Confirm online that your physician is licensed.
• Example case: Sarafina Gerling

5. Mistake: The ER waiting game
• Cause: Emergency rooms get backed up when overcrowded hospitals don’t have enough beds.
• Consequences: Patients get sicker while waiting for care.
• Prevention: Doctors listen to other doctors, so on your way to the hospital call your physician and ask them to call the emergency room.
• Example case: Malyia Jeffers

6. Mistake: Air bubbles in blood
• Cause: The hole in a patient’s chest isn’t sealed airtight after a chest tube is removed.
• Consequences: Air bubbles get sucked into the wound and cut off blood supply to the patient’s lungs, heart, kidneys and brain. Left uncorrected the patient dies.
• Prevention: If you have a central line tube in you, ask how you should be positioned when the line comes out.
• Example case: Blake Fought

 

7. Mistake: Operating on the wrong body part
• Cause: A patient’s chart is incorrect, or a surgeon misreads it, or surgical draping obscures marks that denote the correct side of the operation.
• Consequences: The surgeon cuts into the wrong side of a patient’s body.
• Prevention: Just before surgery, make sure you reaffirm with the nurse and the surgeon the correct body part and side of your operation.
• Example case: Jesse Matlock

 

8. Mistake: Infection infestation
• Cause: Doctors and nurses don’t wash their hands.
• Consequences: Patients can die from infections spread by hospital workers.
• Prevention: It may be uncomfortable to ask, but make sure doctors and nurses wash their hands before they touch you, even if they’re wearing gloves.
• Example case: Josh Nahum

 

9. Mistake: Lookalike tubes
• Cause: A chest tube and a feeding tube can look a lot alike.
• Consequences: Medicine meant for the stomach goes into the chest.
• Prevention: When you have tubes in you, ask the staff to trace every tube back to the point of origin so the right medicine goes to the right place.
• Example case: Alicia Coleman

10. Mistake: Waking up during surgery
• Cause: An under-dose of anesthesia.
• Consequences: The brain stays awake while the muscles stay frozen. Most patients aren’t in any pain but some feel every poke, prod and cut.
• Prevention: When you schedule surgery, ask your surgeon if you need to be put asleep or if a local anesthetic might work just as well.
• Example case: Erin Cook

 

The New York Times reported that Medicare and Medicaid wants consumers to report medical mistakes and unsafe practices by doctors, hospitals, pharmacists and others who provide treatment.  Federal officials say that medical mistakes often go unreported, and that patients have potentially useful information that could expose reasons for drug mix-ups, surgery on the wrong body part, radiation overdoses and myriad other problems that cause injuries, infections and tens of thousands of deaths each year.   Research shows that at least one-fourth of patients in and out of hospitals experience “adverse events” in their care.

“In a flier drafted for the project, the government asks: “Have you recently experienced a medical mistake? Do you have concerns about the safety of your health care?” And it urges patients to contact a new “consumer reporting system for patient safety.” The government says it will use information submitted by patients to make health care safer.”

A draft questionnaire asks patients to “tell us the name and address of the doctor, nurse or other health care provider involved in the mistake.” And it asks patients for permission to share the reports with health care providers “so they can learn about what went wrong and improve safety.”

Reports would be analyzed by researchers from the RAND Corporation and the ECRI Institute, a nonprofit organization that has been investigating medical errors for four decades.

 

ProPublica investigated why so many people do not report medical errors.  “Many of the people who suffer harm while undergoing medical care do not file formal complaints with regulators. The reasons are numerous: They’re often traumatized, disabled, unaware they’ve been a victim of a medical error or don’t understand the bureaucracy.

It’s a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.  Propublica has collected a staggering number of people harmed while undergoing medical treatment.  “A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people.  “An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”

A July report by the HHS inspector general’s office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.

 

The Wall Street Journal had a great article about the epidemic of medical malpractice in the health care system.  Medical errors kill enough people to fill four jumbo jets a week. “When there is a plane crash in the U.S., even a minor one, it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. Pilots and airlines thus learn how to do their jobs more safely.”  This is not the case with medical errors which are usually not disclosed, or worse, covered up.

Surgeon Marty Makary has his ideas for making American hospitals more transparent about their safety records and more accountable for the quality of their care.
As doctors, we swear to do no harm. But on the job we soon absorb another unspoken rule: to overlook the mistakes of our colleagues. The problem is vast. U.S. surgeons operate on the wrong body part as often as 40 times a week. Roughly a quarter of all hospitalized patients will be harmed by a medical error of some kind. If medical errors were a disease, they would be the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer’s. The human toll aside, medical errors cost the U.S. health-care system tens of billions a year. Some 20% to 30% of all medications, tests and procedures are unnecessary, according to research done by medical specialists, surveying their own fields.

Change can start with five relatively simple—but crucial—reforms.

Every hospital should have an online informational “dashboard” that includes its rates for infection, readmission (what we call “bounce back”), surgical complications and “never event” errors (mistakes that should never occur, like leaving a surgical sponge inside a patient). The dashboard should also list the hospital’s annual volume for each type of surgery that it performs (including the percentage done in a minimally invasive way) and patient satisfaction scores.”

Online Dashboards, Safety Culture Reports, Open Notes, Cameras, and No Gag Rules are the five ideas proposed by Dr. Makary.  Basically, it boils done to Reporting Mistakes and Transparency.

 

New Public Citizen Report finds Medical Malpractice Payments hit record low.  Analysis discredits claim that Medical Malpractice litigation is to blame for health care costs. Medical malpractice payments in 2011 were at their lowest level on record by almost any measure, discrediting the claim that these payments are to blame for the skyrocketing cost of health care.

Public Citizen analyzed data from the federal government’s National Practitioner Data Bank (NPDB), which tracks malpractice payments on behalf of doctors. The report found that the number of medical payments and the inflation-adjusted value of such payments were at their lowest levels since 1991, the earliest full year for which such data is available.

The report found that in 2011:

The number of malpractice payments on behalf of doctors (9,758 payments) was the lowest on record, having fallen for the eighth consecutive year;

The inflation-adjusted value of payments made on behalf of doctors ($3.2 billion) was the lowest on record. In actual dollars, payments have fallen for eight straight years and are at their lowest level since 1998;

The average size of medical malpractice payments (about $327,000) declined from previous years;

Four-fifths of medical malpractice awards compensated for death, catastrophic harm or serious permanent injuries – disproving the claim that medical malpractice litigation is “frivolous”;

Medical malpractice payments’ share of the nation’s health care cost was the lowest on record (just 0.12 percent of all national health care costs); and

Health care costs rose again amid the decline in medical malpractice litigation – debunking the claim that the litigation is tied to rising health care costs or that patients should expect dividends from reduced litigation;

The total costs for medical malpractice litigation for doctors and hospitals (as measured by liability insurance premiums paid) have fallen to their lowest level in two decades. They amounted to 0.36 percent of national health care expenditures in 2010, the most recent year for which such data is available.

There is no evidence that the decline in medical malpractice payments is due to safer medical care, the report said. Studies routinely conclude that there is a high prevalence of medical errors; for instance, the U.S. Department of Health and Human Services found that more than 700,000 Medicare patients suffer serious injuries from avoidable errors every year, with fatal outcomes for 80,000 of these people.

In contrast to the hundreds of thousands of injuries (and tens or hundreds of thousands of deaths) that major studies attribute annually to medical mistakes, fewer than 10,000 medical malpractice payments were made on behalf of doctors in 2011, demonstrating that the vast majority of patients injured by medical malpractice are not being compensated, the report found.

The only sensible response is for policymakers and physicians to dedicate themselves to pursuing patient safety to prevent these injuries and deaths with the same vigor with which they have previously sought to restrict patients’ legal rights.”