Posted by Bill Sandweg on 04 March 2019.
Unbiased information about medical malpractice is often hard to come by. As I have discussed from time to time, there is a veil of secrecy that surrounds malpractice events and claims. Doctors and hospitals don’t want to admit they make mistakes that hurt patients and they make entries in the medical charts accordingly. When sued and forced to settle, they insist that the terms of the settlement remain secret. There is very little opportunity for the public to know what happens behind the veil. From time to time, however, a small window opens which allows us to see some of what is going on and to draw conclusions about the overall scope of malpractice and patient injuries. Recently a report was released that dealt with patient injuries in long-term-care hospitals (“LTCHs”). It is very informative and gives a good peek behind the veil.
Long-term-care hospitals (LTCHs) are inpatient
hospitals that treat patients who are very ill—often
with several acute and/or chronic conditions—and
require care for an extended period. LTCHs
provide continued, acute-level care for patients
following their stays in traditional acute-care
hospitals. Although patients of any age may find themselves in an LTCH, most of the patients there will be elderly and will be Medicare beneficiaries.
The findings reported by the Inspector General of the Department of Health and Human Services concerning the experience of Medicare beneficiaries in these hospitals is shocking in many respects. Fully 21% of Medicare beneficiaries in LTCHs experience “adverse events,” which is the term used to describe serious injuries such as those requiring life-saving intervention or requiring a transfer to an acute care hospital or leading to death. Five percent of the adverse events caused or led to death. An additional 25% of Medicare patients in LTCHs were injured but did not experience lasting harm. To sum up, almost half of Medicare beneficiaries who entered LTCHs suffered injuries. This level was substantially higher than the Inspector General found in hospitals (27%), skilled nursing facilities (33%), and rehabilitation hospitals (29%).
Patient records were first reviewed by trained nurses and then by physicians. On the basis of these double reviews, the Inspector General determined that over half of these harm events (54%) were either clearly or likely preventable. 92% of the preventable harm events were the result of either substandard care or medical errors. In many cases the Inspector General could not state that a harm event was preventable because of the poor health of the patient or because the patient was highly susceptible to injury. Significantly, the report does not establish that the 46% of harm events not determined to be clearly or likely preventable were not preventable. Many of them may have been preventable but the patient’s condition kept the Inspector General from making that determination. A further, obvious finding was that the longer a patient was in a LTCH, the more likely it was that the patient would suffer a harm event.
These findings should scare and shock all of us. The patients who populate LTCHs are among our most vulnerable. They are the oldest and sickest of us. The report demonstrates they receive poor care. Many get helped along into the great beyond by the poor care they receive in these hospitals. Often the staff are underpaid and undertrained. There are not enough of them to meet the needs of the patients in many of these hospitals. Often the staff are poorly supervised. Sometimes, they just don’t care and treat the patients accordingly. Sometimes the patients are victims of sexual or other assault by their caregivers. A recent national news story involved a female patient in a persistent vegetative state here in a Phoenix facility who was raped and who gave birth to a child. Scariest of all is the fact that one day many of us will become patients in one of these hospitals. I for one am not looking forward to the experience.
Those who deny the existence of malpractice or who claim that it is rare ought to be required to read this report and the other reports which found high levels of preventable injuries in regular hospitals, in rehabilitation hospitals and in skilled nursing facilities. Malpractice is common and injures many, although few patients ever make a claim and fewer still are ever compensated for the injuries they suffer.