DC Medical Malpractice & Patient Safety Blog

Without a license to practice medicine or surgery or nursing or whatever, no health care practitioner can touch a patient. So the state licensing boards that issue -- and are authorized by law to take away -- licenses are important watchdogs for patient safety and accountability.

Which is why a year-long investigation by reporter William Heisel makes you want to cry.

He found ... well, let's borrow the introduction to his new article:

Medical boards from coast to coast are inconsistent, inefficient and ill equipped to monitor the hundreds of thousands of doctors licensed under their watch, Antidote’s investigation of every state board has found. There are some standouts, but, overall, they do a terrible job protecting patients and informing the public.

It bears repeating that most doctors do a great job and are focused on one thing: helping their patients heal and lead healthier lives. The mission of this tour was to explore what happens to that minority of doctors who don’t follow the rules.

One example in the story: Licensing boards that think they're doing a good thing when they restrict a doctor convicted of sexual molestation from seeing a certain age group of patients, naively failing to realize that the doctor will just "pivot his practice" to prey on a different age group.

Another issue: So many malpracticing doctors getting shunted to places where the patients are already vulnerable: poor towns, prisons, and addiction treatment centers.

Read the rest of his piece here.

An Arkansas medical malpractice lawsuit ended in mistrial in federal court in Jonesboro when the doctor being sued treated an ill juror in the courtroom in front of other jurors. The juror, who was not named, became ill during opening statements of the lawsuit against Dr. Stephen Eichert. The nature of the illness also was not disclosed.

Eichert is being sued by Cristina Renee Chaffin for allegedly not performing proper tests before operating on Chaffin's back and failing to tell Chaffin of the risk of surgery. Chaffin is asking for $75,000 for the costs of two surgeries and follow-up visits and lost wages plus an amount to be determined by a jury for pain, suffering, and mental and emotional anguish.

Chaffin's attorney asked for the mistrial and Eichert's attorney agreed.

This issue comes up more often than you would think. Any time a doctor can show off his treatment skills in court, that can tilt the balance in a close case in favor of the doctor, even if the treatment has nothing to do with what is at issue in the lawsuit. So it's standard practice for the patient's lawyer to ask to stop the trial if someone in the courtroom gets sick and the doctor defendant gives treatment.

Source: Insurance Journal

Why do patients who need focused, precise doses of radiation get walloped with huge overdoses that cause serious and even fatal injuries? A deadly combination of non-user-friendly radiation equipment, incompatible software when machines from different manufacturers are cobbled together, user error by the technicians administering the radiation, and lax regulation by federal authorities: All these are major issues in the ongoing expose by the New York Times of malpractice issues in radiation therapy.

In the latest installment, the team led by reporter Walt Bogdanich focuses on linear accelerators, machines that originally were intended to give broad-beam radiation doses to large swaths of the body, but now are increasingly modified to deliver what are supposed to be precise, focused radiation beams. The therapy is called stereotactic radiosurgery, and it allows hospitals who lack the more expensive competitor device, gamma knife surgery, to compete for radiation therapy business when the patient needs a very focused, intense dose to sensitive tissue -- such as a nerve deep in the brain.

But without proper setup, and without an easy way to see when the machine's beam has not been focused properly, tragedies can happen, as the reporters document.

One issue that this blog has focused on in other contexts with medical devices: The lack of a mandatory public registry to gather prompt reports of injuries and errors so that problems can be nipped in the bud rather than injuring patient after patient. The society of radiation oncologists is now asking for the creation of such a registry by the Food and Drug Administration. But the FDA lacks legal authority to force anyone other than a manufacturer to make a report.

How can patients protect themselves? Make sure the radiation unit you go to is well established, not brand new, and that the technicians are certified in the field of medical physics. More tips can be found in our previous article on the subject here.

The Oregon Court of Appeals recently reversed a decision by a lower court to reduce a malpractice award because of the plaintiff’s “comparative fault” in the case. In doing so, the court pronounced a new rule that, “as a matter of law, conduct that merely creates the need for medical treament cannot cause the type of harm at issue in medical malpratice cases -- the injury resulting from the malpractice.”

In the case -- Son v. Ashland Community Healthcare Services (AHCS) -- Sara Burns died while under the medical care of AHCS following an attempted suicide by drug overdose. Her mother, as personal representative of Sara’s estate, brought a wrongful death action against ACHS alleging professional negligence in its treatment of Sara.

ACHS raised the comparative fault defense, alleging that Sara failed to inform ACHS of her ingestion of a particular drug that would have changed ACHS’ treatment plan and likely would have prevented her death. The jury returned a verdict for the plaintiff of $740,000, after which the court reduced the award by a percentage because of Sara’s comparative fault.

Sara’s mother than appealed, and the Oregon Court of Appeals reversed the decision, addressing for the first time the comparative fault defense in the context of medical malpractice cases. The general rule for comparative fault comes from Fazzolari v. Portland School Dist. No. 1J and has been stated as “whether facts of the case indicate that the plaintiff took some action or failed to take some action which a reasonable person could have foreseen would increase the risk of harm to the plaintiff, and that the plaintiff did indeed suffer harm of the type which could have been foreseen.”

The appeals court narrowed the rule in medical malpractice cases to the injury caused by the negligent treatment, not the original injury that necessitated the need for treatment. Here, the court found that Sara’s negligent conduct occured prior to ACHS’ negligent treatment and was therefore not eligible to be considered as comparative fault.

The distinction is important in many malpractice cases, not just those involving suicide attempts. For example, this decision puts off-limits in a lung cancer misdiagnosis case any defense that the patient was partly at fault for being a smoker. But if the same patient neglected to follow the doctor's advice to return for a followup visit, that could potentially count against the patient.

Source: Oregon Business Report

You can view the full text of the decision here.

Patients in Texas whose health has been ruined by incompetent decisions by ER physicians are having a hard time finding malpractice attorneys to represent them, even when the lawyers admit they have a great case. The reason: The tort reform state lawmakers passed in 2003, which made it more difficult for patients to win damages in any health care setting, but especially in ERs.

The “reform” capped medical liability for noneconomic damages at $250,000 per health care provider, with a maximum award of $750,000. But it also safeguarded emergency physicians from civil damages unless it could be proved that they acted with “willful and wanton” negligence (i.e. that they not only put the patient in extreme risk but knew they were doing it.).

According to Jon Powell, a malpractice and personal injury lawyer based in San Antonio, this is a near-impossible threshold to meet. “You’d have to be a Nazi death camp guard to meet this standard,” Powell says.

Tort reform advocates disagree, noting that patients in Texas continue to sue doctors and hospitals over emergency care. And, they say, the “willful and wanton” language, as well as the damage caps, have driven down malpractice insurance rates by nearly 30% and attracted more emergency room doctors to Texas.

Malpractice lawyers say these developments have come at the expense of patients. They argue that the “willful and wanton” rule means emergency room care in Texas is some of the most dangerous in the country. And a preliminary study shows that malpractice claims dropped by 60% between 2003, when the law was enacted, and 2007.

Source: The Texas Tribune

Invisibility, inertia and income. That's the answer from one health care expert.

I'm borrowing this guest column from the blog of the prestigious Health Affairs journal. It's by Michael Millenson, an expert consultant and author in patient safety.

You can read comments from readers and his original article here.

A recent front-page article in the New York Times conveyed grim news about patient safety. The first large-scale study of hospital safety in a decade concluded that care has not gotten significantly safer since the Institute of Medicine’s 1999 estimate of up to 98,000 preventable deaths and 1 million preventable injuries annually.

What for me struck a particularly jarring note was not just the absence of improvement, but the reluctance of the health care leaders interviewed to speak candidly about why progress has been so slow. Instead, they offered nostrums about the need to “do more” or opined that “openness” or better “coordination” would somehow turn the tide.

But tucked in the actual study’s conclusions section, between bland boilerplate about “further study” and a “refocusing of resources,” some carefully worded candor cautiously peeked through: “[T]he absence of large-scale improvement is not evidence that current efforts to improve safety are futile,” wrote Christopher Landrigan and colleagues in the Nov. 25 New England Journal of Medicine. “On the contrary, data have shown that focused efforts to reduce discrete harms, such as nosocomial infections and surgical complications, can significantly improve safety.”

In plain language, we know how to prevent many of these patient deaths, but we don’t. That makes, “Why?” a lot tougher question.

It is a question that has haunted me since I discovered that clear descriptions of the medical error problem, its human cost and the corrective actions needed began appearing in the medical literature in the 1950s. The first large-scale study of hospital safety, by Don Harper Mills in California, was published in 1978. My extrapolation of its findings showed a preventable national death rate of about 120,000 patients annually. That’s roughly the same as the numbers from the oft-quoted Harvard Medical Practice Study published in 1991 that the IOM relied upon in its 1999 To Err is Human report. In human terms it means that 2.5 million men, women, and children died preventable deaths in U.S. hospitals during the 21 years between 1978 and 1999. A staggering seven to 17 million suffered preventable injuries.

The Silence Continues

I laid out those numbers in a March, 2003 Health Affairs article that challenged the profession to break a silence of deed — failing to take corrective actions — and a silence of word — failing to discuss openly the consequences of that failure. This pervasive silence, I wrote:

continually distorts the public policy debate [and] gives individuals and institutions that must undergo difficult changes a license to postpone them. Most seriously of all, it allows tens of thousands of preventable patient deaths and injuries to continue to accumulate while the industry only gradually starts to fix a problem that is both long-standing and urgent.

Nearly eight years later, medical professionals now talk freely about the existence of error and loudly about the need for combating it, but silence about the extent of professional inaction and its causes remains the norm. You can see it in this latest study, which decries the continuing “patient-safety epidemic” while failing to do next what any public health professional would instinctually do: tally up the toll. Instead, we get dry language about the IOM’s goal of a 50 percent error reduction over five years not being met.

Let’s fill in the blanks: If this unchecked “epidemic” were influenza and not iatrogenesis, then from 1999 to date it would have killed the equivalent of every man, woman and child in the cities of Raleigh (this study took place in North Carolina) and Washington, D.C. Does a disaster of that magnitude really suggest that “further study” and a “refocusing of resources” are what’s needed?

Why are we still killing so many patients? Call it the “three I’s”: invisibility, inertia and income.

The invisibility issue is commonly articulated this way: while airplane crashes kill a lot of people at once in a very public manner, medical error kills a few people at a time in private, spread out among thousands of hospitals. Moreover, most deaths occur among those who were already very sick, and only a small proportion represent negligence. This is inadvertent harm; there are no villains here. In any event, medical care is complicated. As a result, as a 2009 JAMA commentary pointedly noted, “Clinicians have labeled virtually all harm as inevitable for decades.”

That conviction is conveyed to and largely believed by patients. Why else would the advocacy groups for the sickest patients, such as the American Cancer Society or American Diabetes Association, pay so little attention to treatment-caused harm? Absent public or peer pressure, doctors and hospitals are reluctant to adopt interventions whose efficacy they mistrust to prevent an epidemic they really don’t see and which is profoundly discomfiting to confront.

Letting Children Die Unnecessarily

There are many examples of the inertia these beliefs produce, but one I cannot get out of my mind concerns sick children. At the 2009 AcademyHealth meeting, Dr. Richard Brilli of Nationwide Children’s Hospital presented data showing how a collaborative backed by some of the most respected organizations in pediatric care had slashed the rate of catheter-associated bloodstream infections (CA-BSIs). CA-BSIs are relatively common, very expensive and can be quite deadly (up to one quarter of victims die). Brilli said his collaborative had tried to recruit 330 pediatric intensive care units to join the initial participants, but after three years, just sixty had accepted. The reasons Brilli said he’s been given indicated to me that few had taken the time to examine the collaborative’s methodology or results. Instead, respondents asserted that their patients were sicker, their hospital was busier than the others in the study, that joining would make them look bad to others, or that the mortality reduction didn’t apply because “I am in a world famous center.”

Now fast-forward to the February, 2010 issue of Pediatrics, in which the collaborative concluded: “CA-BSIs are a preventable cause of patient harm to critically ill children.” What you can’t see in the peer-reviewed literature is this context: at literally scores of hospitals which declined to participate in the collaborative, hundreds of sick children likely were injured or killed who probably would not have been harmed had the hospital been a collaborative member. Those harmed were tended to by dedicated staff who thought they were doing everything they could to help the kids in their care. They were dead wrong, but even today they may not know it. Certainly, their patients and the public do not.

I’ll cite just two other examples of inertia and invisibility interacting to impede change. When the Institute for Healthcare Improvement launched its “Save 100,000 Lives” Campaign on the fifth anniversary of the IOM report (the delay speaks for itself), four out of 10 U.S. hospitals still declined to participate. No policymakers or commentators questioned why 40 percent of hospitals would sit out this opportunity to improve care.

Another example: the Centers for Disease Control and Prevention published its first hand-washing guidelines in 1975. Yet nearly 35 years later, when the Joint Commission launched an improving hand hygiene project, the eight hospitals that volunteered had a baseline hand hygiene rate typical of hospitals nationwide: 48 percent. That’s worse than the worst rate at the worst big public men’s room in the United States, according to one recent survey. But rather than giving providers an ultimatum, we launch campaigns to ask patients to ask providers to please wash up.

Most lethal of all is when invisibility and inertia interact with income. Ironically, the modern patient safety movement owes its foundational data to providers’ belief that malpractice insurance premiums were too high. The landmark studies of medical error published in 1978 and 1991 were backed by physician groups which hypothesized that unjustified lawsuits, not actual medical problems, were driving up premiums. In the event, research demonstrated that only a small percentage of errors resulted in lawsuits and an even smaller percentage in judgments. By that yardstick, the most recent study represents progress, since it was motivated by care improvement rather than income protection. Still, provider fear of being unjustly sued no doubt obstructs needed sharing of information and argues for malpractice reform.

Confronting The Belief That Complications Bring Extra Income

But there’s another elephant in the room that makes providers squirm even more. Put bluntly, many hospital executives believe they make money from complications. (Not from deaths, of course, because those shorten length of stay). Frustrated clinicians have personally told me this many times over the years, and as recently as a few weeks ago. The evidence has even made its way into the medical literature.

To cite just one example, let’s go back to those expensive bloodstream infections that affect the most vulnerable of patients, critically ill children, being cared for at the most eleemosynary of institutions, children’s hospitals. Even here, clinicians find themselves forced to argue that there is a “business case” for reducing CA-BSI’s in the pediatric intensive care unit.

In a recent journal article, the authors framed their case this way: Yes, infections increased the hospital stay by an average of nine days, and yes, insurers saved more money than hospitals by eliminating them. However, if a hospital filled the beds vacated by non-injured patients, it actually made more money because new patients provided more revenue in the first few days than tacking on those days to the hospital stay of patients already in the ICU. A clinical and financial win-win!

The Unknown Success Story Of Ascension Health

The ultimate irony about the silence surrounding patient safety is that one of the most extraordinary success stories in preventing harm has largely gone unheard. Ascension Health looks like most of the U.S. health care system, operating 65 community hospitals with independent medical staffs. Yet its program to eliminate all preventable injuries or deaths has been highly effective. They have carefully documented how they reduced infections, falls, complications of childbirth and a host of other common causes of patient harm to a fraction of national norms and saved more than 2,000 lives every year.

The clinical and administrative leaders of Ascension Health, one of the nation’s largest Catholic health systems, made the invisible visible, and found that errors were far more prevalent than they thought. They declared that inertia would not be tolerated; all their affiliated hospitals had to participate. And they were willing to risk hospital income to prove that they were serious about change.

It is a story that so far seems to have excited only a few conference goers and regular readers of theJoint Commission Journal, which has been publishing articles about Ascension’s results since 2006.

As a society, we know what combination of social pressure, economic incentives and provision of tools to enable new behavior lead to transformational change. In patient safety we are using all of them, including various public and private programs to refuse payment for preventable error and publicize hospitals’ safety records. But at the front lines of patient care, it is all too clear that these efforts have yet to make much of a difference, as well-intentioned professionals silently turn away from the preventable harm we are still inflicting on those we are working so hard to help.

With the exception of cancer care, university hospitals generally do not provide higher quality of care than other hospitals, according to a recent study that evaluated data from 118 university hospitals and compared them with data from general, acute and non-federal U.S. hospitals.

The study, titled “An Assessment of the Quality of University Hospital Care in the U.S.,” found that although university hospitals do very well as a group in cancer care and in overall medical care, in many clinical categories they either performed the same as non-university hospitals or sometimes far worse. For example, 89% of university hospitals fall below the national average in orthopedic care and 85% fall below the national average for general surgery.

"Most people assume that a university hospital will provide better quality care because these institutions typically conduct cutting-edge academic research, have lofty reputations and adopt the latest treatment protocols and technologies," says Dr. Thane Forthman, managing principal of The Delta Group, which produced the study. "We were especially surprised to see the study reveal that some of the nation's best-known university hospitals scored in the bottom quartile of all hospitals nationally for overall quality of hospital care."

Forthman focuses attention on university hospitals’ reliance on interns and residents. "Certainly more research is needed, but at university hospitals you have a large population of interns and residents who are still being trained. While under the supervision of an attending physician, they have the autonomy to make rounds, order lab tests and make clinical decisions, even though they lack time-tested, hands-on experience," says Forthman.

"More importantly, interns and residents often work extended shifts of up to 80 hours per week, which empirical research has shown dramatically increases fatigue-related medical and diagnostic errors, medication errors and other adverse events."

Other key study findings included:

* University hospitals appeared more frequently in the top 10% of all hospitals nationally in cancer care : 43% of university hospitals studied performed in the top 10% nationally for cancer care.

* Many highly-regarded university hospitals performed in the bottom 25% of all hospitals nationally for overall quality of hospital care, including: Emory University Hospital, Dartmouth-Hitchcock Memorial Hospital, George Washington University Hospital, Georgetown University Hospital, Hospital of University of Pennsylvania, Stanford Hospital, Shands Hospital at the University of Florida, The Johns Hopkins Hospital, The University of Chicago Medical Center and University of North Carolina Hospital (Chapel Hill).

* Of the 118 university hospitals evaluated, 17 were in the top 10% of all hospitals nationally for overall quality of care in three or more clinical categories:

* University hospital quality scores fall disproportionally below the national average for the majority of clinical categories: Orthopedic Care (89% fall below the national average); General Surgery (85% fall below); Major Orthopedic Surgery and Neurological Care (78% fall below, respectively); Overall Hospital Care (74% fall below); Overall Surgical Care (73% fall below); Major Neuro-Surgery (67% fall below); Cardiac Care (63% fall below); Major Cardiac Surgery (62% fall below).

You’ll find more information on the study here.

You can view the study in its entirety here.

Patients naturally assume that when a sophisticated metal implant like a hip replacement is surgically placed into their bodies, it must have been thoroughly tested before wide use. The now-recalled DePuy ASR hip replacement shows how wrong that assumption is.

A medical device manufacturer in the United States can cobble together new components into an old, already-approved device, and the new hybrid device is essentially grandfathered into government approval since it in theory closely resembles the old device.

As explained by New York Times reporter Barry Meier in a long outtake:

Unlike new drugs, many of which go through a series of clinical trials before receiving approval from the Food and Drug Administration, critical implants can be sold without such testing if a device, like an artificial hip, resembles an implant already approved and used on patients.

That way, manufacturers can rapidly make small changes to a device to improve it. But those simpler procedures have also effectively created a loophole, experts say, that lets producers bundle a component from an unapproved implant into an existing design and sell a device with minimal testing. With the A.S.R., that process unfolded with devastating results.

Read more here.

One reason the medical industry keeps pushing for lawsuit "reforms" is that if it's harder for patients to sue doctors for malpractice, doctors will then practice less "defensive medicine" and that will save a lot of money with fewer unnecessary tests and treatments. Turns out that theory doesn't match reality.

One main reason, according to a new study funded by the Robert Wood Johnson Foundation, is that doctors have a high fear of lawsuits even in jurisdictions where most of the fear of litigation has been removed by legislative action. And therefore so-called tort reforms carry little bang for the buck in saving health care dollars -- since they don't affect physician behavior.

The researchers ranked objective lawsuit risk by the rate of claims actually paid and by the insurance premiums paid by doctors, on a state-by-state basis. They found that doctors in low-risk states had almost the same levels of anxiety about lawsuits as those in high-risk states, even when the objective risk was three-fold different.

The researchers concluded, according to a release from the University of Iowa where the study originated:

Overall, the study suggests that current tort reform efforts aimed at reducing malpractice risk would be relatively ineffective in alleviating physicians' concern about lawsuits and therefore may not alter defensive medicine practices.

More information is at the U of Iowa website here.

Here's a real irony: Other recent studies of actual risk of malpractice events at hospitals find that patients experience preventable harms from medical error at an alarming rate.

For example, a major study of ten hospitals in North Carolina finds a one-in-four chance of being hurt by medical care, a rate that hasn't improved in the ten years since a landmark study said that 100,000 Americans were killed by malpractice and medical error each year.

The study, published in November in the nation's leading medical journal, the New England Journal of Medicine, looked at 2,300 randomly chosen admissions in the ten hospitals. North Carolina was chosen for the study because it has a high rate of participation in hospital safety efforts.

But the results were discouraging. One in four hospital admissions included harm to the patient due to medical care, and two out of three of those harms were judged to be preventable. (Read the whole study here.)

All of which suggests that a more effective way to solve the malpractice problem would be to make hospitals safer places. Then the irrational fear of lawsuits by doctors would go away because patients wouldn't be harmed so often.

Article first published as Doctors' Fear of Lawsuits Is Often Irrational on Technorati.

The Third Circuit Court of Appeal in Louisiana has ruled the state’s $500,000 malpractice cap to be unconstitutional.

Joe and Helena Oliver had sought relief from the Louisiana Medical Malpractice Act, which shrank the damage award their daughter received for disfiguring injuries from $6.2 million to $500,000.

Their daughter, Taylor, developed severe injuries after she was treated by a “grandfathered” nurse practitioner who was practicing with only a high school diploma. Susan Duhon, a registered nurse practitioner and sole owner of the Magnolia Clinic, treated Taylor for vomiting, nausea and diarrhea. Taylor visited the clinic 32 times, and Duhon prescribed more than 30 medications. Duhon had a statutory duty to consult a physician, but Taylor never saw one during any of her visits.

When Taylor was 14 months old, another hospital diagnosed her with neuroblastoma, a childhood cancer. One of the signs is severe bruising around the eyes, a symptom Taylor had presented with at the Magnolia Clinic when she was 6 months old.

If neuroblastoma is diagnosed within the first year of life, the child has a 90 percent chance of an event-free recovery. But because of the delayed diagnosis, the quality of Taylor's life has been severely diminished. Though she survived the cancer, the tumor caused her head to become misshapen. In addition, her eyes are abnormally large and she is legally blind.

The Olivers won their medical malpractice lawsuit, but their $6.2 million award was cut to $500,000 under Louisiana state law. The appeals court ruled that the cap on malpractice damages is unconstitutional, noting that “the cap discriminates against Taylor and her parents by limiting their general damage recovery to a single $500,000 payment, while allowing other less severely injured victims to fully recover their general damage awards."

In another case, the same appeals court reversed a jury decision and awarded $400,000 in damages to a man who lost all vision in one eye after a cataract operation. The case involved cataract surgery performed in 2002 by ophthalmologist Ernesto Kufoy on Ronald Bianchi. During the surgery to remove the cataract and implant an artificial lens, the lining of the old lens was torn and a second artificial lens was implanted.

After the surgery, Bianchi reported worsening pain and vision loss. After a malpractice suit was filed in 2002, a medical review panel found malpractice on Kufoy’s part. (Kufoy did not chart his treatment of Bianchi and had no medical records to support his testimony.)

A jury trial in December 2009 determined that Kufoy had breached the standard of care, but the jury did not award damages because it did not find proof of cause. However, the Third Circuit Court of Appeal found there was no factual basis to support the jury’s verdict and called it “manifestly erroneous.”

The court overruled the jury’s verdict and awarded Bianchi and his wife $100,000 for past and future medical expenses and $300,000 in general damages. The cost of the appeal also was assessed to the defendant.

Sources: Beauregard Daily News for the Bianchi case.

Courthouse News Service for the Oliver case.

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are warning healthcare professionals that sharing blood glucose monitoring machines carries the risk of transmitting the hepatitis B virus (HBV) and other infectious diseases. Their simple advice: One monitor per diabetic patient.

In recent years, the number of reported HBV outbreaks linked to blood glucose monitoring has increased, particularly in nursing homes and assisted-living facilities, but also in any setting (e.g. clinics, health fairs, schools, camps and senior centers, among others) where blood glucose monitoring equipment is shared, or where those performing the monitoring do not follow basic infection control practices.

While stressing that reusable fingerstick lancing devices should never be used for more than one person to avoid the risk of transmitting bloodborne pathogens, the FDA and CDC also maintain that the glucose meters themselves can also pose an infection risk, since it can be difficult to ensure that blood has been completely removed from these devices. They point to a 2005 multicenter survey that indicated that 30% of blood glucose meters used routinely in the surveyed hospitals had detectable blood on their surfaces.

Therefore, the FDA and CDC advise that whenever possible, blood glucose meters should be used for one patient only. Otherwise, meters should be cleaned and disinfected after every use to prevent carry-over of blood and infectious agents. In addition, hands should be washed and gloves changed between patients.

Source: FDA Patient Safety News

The Center for Justice & Democracy has a new fact sheet on recently published studies on medical malpractice, hospital errors and preventable injuries.

The depressing findings:

* Preventable injuries continue at very high rates. This is according to recent studies from Medicare and from a big study published in the New England Journal of Medicine. Much of this data has previously been reported on this blog.

* Reporting of errors is seldom done.

* Malpractice lawsuit rates are dropping and comprise only a small fraction of the civil lawsuit caseload in most jurisdictions -- typically under 5 percent of cases.

Read more at the Center's website and download the full fact sheet here.

Quick triage of patients who arrive at the Emergency Department isn't just important for patient safety. It makes hospitals a lot more popular with their consumers, as one hospital has found.

The emergency department at Texas Health Presbyterian Hospital in Plano launched a policy called the 30-Minute Promise in October 2009, pledging to treat patients within a half-hour of arrival. The result: the hospital’s patient satisfaction scores in the Emergency Department rising above the 90th percentile of hospitals nationwide.

Last month, the Texas State Board of Nursing highlighted the service in its monthly newsletter as a best practice in patient safety.

According to Michael Webb, RN, BSN, performance improvement project manager at Texas Health Plano, “the process we have implemented for rapid triage and bedside registration allows patients to be brought back into the emergency room where they can receive the care they need from clinical staff. The radiology and lab team members interrupt nursing staff in patient rooms if needed to expedite critical testing.”

In addition,Webb writes, “team-based care defined by zones in the ED increases communication among staff members, physicians and, most importantly, patients.”

The hospital also opened the “back door” of the ED by tracking and trending the discharge order times of their physicians with the highest in-patient volume to increase internal capacity. In-patient nursing staff are responsible to ensure that discharge planning is initiated early in the hospitalization and the patient is discharged in a timely manner when clinical criteria are met.

Source: Texas Board of Nursing newsletter, page 4

The cap on awards for malpractice lawsuits in Virginia will go up $50,000 a year for the next 20 years, following a recent compromise between trial lawyers and physicians in the Commonwealth.

Incremental increases to the cap had been made previously. But once the cap reached $2 million, physicians argued that further increases would result in higher malpractice insurance premiums, while the state’s trial lawyers, who represent injured patients, disputed that one would automatically follow the other.

To break the impasse, two state legislators threatened to impose a decision in the General Assembly if the Medical Society of Virginia and the Virginia Trial Lawyers Association didn’t reach a compromise. Last month, they did just that, settling on $50,000 annual increases to the cap starting in 2012.

Physicians can live with the increases, says MSV President Cynthia Romero, MD, because it will stabilize premiums for doctors, thereby bringing more insurers and physicians to the state. In a letter to MSV members, Romero said the agreement:

Retains Virginia’s total cap

Establishes an agreement for a long period of time

Minimizes the risk of large premium increases

Delays the effective date of any increases.

In addition, says Romero, the deal ensures that there will be no legislative efforts by VTLA to eliminate the total cap, amend the cap to apply only to non-economic damages or create a second cap within the total cap.

Source: WTVR

To view the MSV president's letter to members, go here.

Merrill Goozner has an excellent blog on the medical industry. Here's his take on the cardiac stent "mill" in Baltimore, and how it has come to light and reached some measure of accountability.

He writes on his "Gooznews" blog:

... let us point out a few interesting aspects of this still evolving story.

First, it was officials with access to patient billing records at the Centers for Medicare and Medicaid Services who launched the investigation. Yet we read this morning in the Washington Post a story by Kaiser Health News about pushback from the American Civil Liberties Union and others against the creation of comprehensive electronic database containing records from the Federal Employees Health Benefits Program, which covers millions of federal workers. One of the purposes of such a database would be to conduct investigations like the one carried out by CMS.

Second, it was local reporters at the Baltimore Sun, after learning about letters sent from the hospital to patients advising them about their possibly unnecessary operations, who brought the story to light. Individual cases highlighted in today’s New York Times story on the Senate report came from trial lawyers suing the hospital on behalf of those patients.

There’s talk these days about cutting Medicare budgets by making seniors pick up more of the tab. Having “more skin in the game” will lead consumers to think twice before buying unnecessary medical services. There is also a lot of talk about limiting patients’ right to sue in order to stop physicians from practicing defensive medicine.

Can individuals without legal rights whose every second opinion will require another payment out of pocket be able to stop rogue physicians from practicing money-driven medical practices like those at the Baltimore hospital? ...

Not much of a chance that that will happen, Merrill.

Here's our report on the consumer groups pushing back on the deficit commission proposals to save money on medical care by wiping out patients' rights to get legal accountability when they are injured by poor medical care.

With lucrative fees for doctors, little oversight, and much disagreement about who needs stents in their heart arteries, it was perhaps inevitable that malpractice allegations of unnecessary surgery would explode into hundreds of lawsuits against a single cardiologist in Baltimore.

But now a new report from the U.S. Senate Finance Committee, which oversees the federal Medicare program, says the Maryland cases against Dr. Mark Midei may be only the tip of a very large iceberg.

Medicare spends $3.5 billion a year on cardiac stents, the tiny wire mesh tubes that are intended to prop open clogged arteries feeding the heart muscle.

In a long story in the New York Times, Dr. Steven Nissen, chief of heart medicine at the Cleveland Clinic, said:

"What was going on in Baltimore is going on right now in every city in America. We’re spending a fortune as a country on procedures that people don’t need.”

Dr. Nissen said he routinely treats patients who have been given multiple unneeded stents by other doctors.

I wrote about unnecessary cardiac procedures in my patient safety newsletter last summer. You can read it here.

A good resource for readers is the Harvard Medical School newsletter on cardiac care. The bottom line for most patients, the Harvard doctors say, is that if you're not having symptoms, you should be very wary about anyone proposing to put stents in your heart.

Half of all graduating medical residents or fellows trained in Illinois are leaving the state to practice elsewhere, according to a new study, which seems to indicate that as many as 50% of the state’s medical school graduates are turned off by the “toxic” malpractice environment. Critics, however, say the study is just another attempt by the health care industry to blame its problems on malpractice claims.

The study, which was funded by the Illinois Hospital Association and the Illinois State Medical Society, asked 561 medical students where they intended to practice after graduation and why. Students who said they planned to leave Illinois cited salary, opportunities to work in their specialty and proximity to family as the most important factors driving their decision. The survey also found that for nearly 70 percent of these students, their perception of Illinois' liability environment -- based on the state's high medical malpractice insurance premiums compared to its neighbors, as well as the Illinois Supreme Court's recent decision to remove caps on damages for medical lawsuits -- also played a role.

But are malpractice claims really driving new physicians from Illinois?. Patrick Salvi, a Chicago-based malpractice attorney, doesn’t think so. “There could be many reasons to explain an impending physician shortage in Illinois, including a general population shift, so it's utterly wrong to say it's solely because of medical malpractice claims,” Salvi says. “The fact is that medical negligence litigation comprises a very small fraction of costs within the health care industry, and those costs would not have been accrued if a physician had not made a terrible mistake that led to the injury or death of a patient.”

Salvi also points to a report by the American Association for Justice which, using data from the American Medical Association, showed that the number of physicians per 100,000 residents was 21 percent higher in states without caps on medical liability damages than in states with caps.

Source: Chicago Sun-Times

You can view or download a PDF of the complete Northwestern Report here.

Go here for more on the critique of the Northwestern report's conclusions.

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There is growing concern among pharmacists in developed countries, including the U.S., that drug counterfeiting is a serious problem that current policies and technology have been unable to solve.

In a recently published survey commissioned by Pfizer and the International Pharmaceutical Federation (FIP), 63% of 2,000 community, retail and hospital pharmacists in the U.S., Europe and Australia believe current policies and technologies are insufficient to deal with drug counterfeiting, while 61% of those surveyed also say the prevalence of counterfeit medication is a serious issue in their country.

Long a problem in Africa and Southeast Asia -- where the World Health Organization has estimated that anywhere between 25% and 50% of medicines may be counterfeit – the number of these fake medications in the U.S. market has increased dramatically in recent years. In 2009, the U.S. Customs and Border Protection Agency stated that the value of seizures of counterfeit pharmaceuticals had increased by 500 percent over the previous 3 years. By some estimates, annual earnings from fake and substandard medicines worldwide is more than $32 billion.

A counterfeit drug is a pharmaceutical product produced and sold with the intent to deceptively represent its origin, authenticity or effectiveness. Generic drug products or drug products whose only violation is that of patent laws are not counterfeit drug products. A counterfeit drug may contain inappropriate quantities of active ingredients, may be improperly processed within the body (e.g., absorption by the body), or may contain ingredients that are not on the label (which may or may not be harmful), and is often sold with inaccurate, incorrect, or fake packaging and labeling.

Source: HealthcarePackaging.com

You'll find information on how to access an indepth study of the global drug counterfeiting problem here.

The federal "debt commission" proposals have a variety of features that would allegedly make medical care more affordable by hurting victims' right to financial redress if they are hurt by the ongoing epidemic of hospital malpractice and other incidents of preventable medical error.

Fortunately consumers are speaking out against these "blame the victim" proposals.

Here's the text of a letter just sent to the debt commission from a coalition of consumer groups:

December 2, 2010

National Commission on Fiscal Responsibility and Reform
1650 Pennsylvania Ave NW
Washington, DC 20504
via email: commission@fc.eop.gov

Re: Commission recommendation 3.3.12 medical malpractice liability reform

Dear Chairmen Simpson and Bowles and Members of the National Commission on Fiscal
Responsibility and Reform:

We, the undersigned consumer and patient safety advocacy organizations, strongly oppose the
Commission’s recommendation 3.3.12 in its “Moment of Truth” report. The recommendation to
impose cruel liability restrictions on patients injured by the medical errors of private medical
workers and institutions demonstrates a significant lack of forethought about the consequences to the country’s health care system as well as its fiscal health.

Last month, we expressed our concerns to the Commission regarding Chairmen Alan Simpson
and Erskine Bowles’ previously released deficit reduction proposal, which dedicated a vague
paragraph to recommending medical liability restrictions. Unfortunately, instead of removing the
recommendation, the Commission’s report identifies specific liability proposals and principles,
each of which we discuss and disprove in the accompanying analysis. We urge all
commissioners to reject the report if medical liability restrictions are included, and to offer
proposals that represent true health care cost savings, such as efforts to reduce unnecessary
medical errors.

The prevalence of medical mistakes continues to be an ongoing health care crisis, which is
quickly turning into a fiscal crisis as well. In fact, a few days after the release of the cochairmen’s proposal, the Department of Health and Human Services Inspector General (HHS)
released a patient safety report illustrating that the frequency of medical errors in the U.S. health care system is a big contributor to the expanding deficit. HHS found that 1.6 million Medicare patients suffer injuries every year from medical mistakes, amounting to an annual taxpayer price tag of at least $4.4 billion. While the Commission claims that limiting providers’ liability would save $17 billion through 2020, eliminating avoidable medical errors could potentially save $44 billion over the same period.

Limiting patients’ legal rights in the middle of these urgent circumstances will only worsen the
safety and fiscal problems. Injured patients will be further restricted from seeking compensation
from the private parties who caused the harm and the associated costs will shift to others. State
and federal governments will have to be prepared to bear the brunt of covering patients’ health
care costs because the actual culprits will be let off the hook.

As the HHS study indicates, Medicare already bears a substantial amount of the burden of paying for others’ medical mistakes. If the restrictions are implemented, it will be forced to pay significantly more. Finally, medical providers, shielded from accountability as this proposal promises to do, will have no impetus to improve patient care, which will again increase medical mistakes and their associated costs.

We support the federal government’s effort to practice fiscal responsibility, however, the medical
liability recommendation only promises to be ineffective and dangerous. If the commissioners
fully consider the consequences of these restrictions that shield negligent parties and shift the
costs of care to government entities, they will reject the present proposal contained within the
report.

Sincerely,

Alliance for Justice
Center for Justice & Democracy
Consumer Watchdog
National Consumer Voice for Quality Long-Term Care
Public Citizen
Citizens for Patient Safety, Denver, CO
Coalition For Patients’ Rights, Baltimore, MD
Connecticut Center for Patient Safety, Harford, CT
Empowered Patient Coalition, San Francisco, CA
HealthCare PSI, Springfield, MO
James’s Project, Wayne, PA
Mothers Against Medical Error, Columbia, SC
MRSA Survivors Network, Hindale, IL
New Hampshire Patient Voices, Bow, NH
Ohio Infectious Disease Forum, Raleigh, NC
Patient Safety America, Houston, TX
Patients Right To Know, Centennial, CO
Save The Patient, Chicago, IL
South Carolina Voices for Patient Safety, Chesterfield, SC
Texas Watch, Austin, TX
Voice4Patients, Warren, ME
Woodymatters, Minneapolis, MN

Read more here from the Center for Justice and Democracy.