Medical Malpractice News and Views

Welcome to our blog where we discuss current issues in medicine and law. We welcome your comments.

Hospitals Are Still Unsafe

March 20, 2023

The medical profession knows that there is a patient safety problem.  Every time they examine patient safety, they find the same thing.  People in hospitals are injured at an unacceptable rate and the doctors and hospitals seem to be unable to do anything about it.

New England Journal Of Medicine Takes Stance On Presidential Election For First Time Ever

In January, another study of hospital safety was published in the prestigious New England Journal of Medicine.  The study was funded by two malpractice insurance companies.  The authors were a number of doctors who wanted to see what the most recent data showed about patient safety in hospitals.  They examined randomly selected patient charts for almost 3,000 hospitalizations, which took place during calendar year 2018 at 11 Massachusetts hospitals.

Trained nurses examined the charts and flagged those that had trigger events recognized as being indicators of adverse events.  Adverse events occur when medical care causes harm unrelated to the underlying medical condition.  The doctors then examined the flagged charts and decided whether there had been an adverse event, whether the adverse event was preventable, and just how much damage had been done to the patient.  The results were not encouraging for the public or the malpractice insurance companies that paid for the study.

Almost 25% of the admissions involved at least one adverse event.  Some poor patients experienced multiple adverse events.  A third of the adverse events resulted in a serious injury to the patient.  Serious injury was defined as one that required substantial medical intervention, or a prolonged recovery, or worse.  Seven patients died as a result of their adverse events.

Almost 20% of the adverse events were determined by the doctors to be preventable.  A preventable adverse event occurred in 6.8% of all admissions.  A preventable adverse event that caused serious harm or death occurred in 1% of all admissions.  The most common form of adverse event was related to medication.  The second most common was related to surgery or other hospital procedures.  Next came patient care problems usually related to nursing care and lastly infections.

Think about what this means for a moment.  If you have to go to the hospital, there is a one in four chance you will be injured.  There is an almost 7 in one hundred chance that you will be injured by medical malpractice.  There is a one in one hundred chance that you will be seriously hurt or killed as the result of medical malpractice.

There were over 33,000,000 hospital admissions in the United States last year.  You do the math.  It works out to 330,000 serious injuries or death caused by malpractice last year alone.  Far from being a rare thing, serious injuries caused by medical malpractice in hospitals occur every day and to almost 1,000 patients a day.  If you add back in the injuries caused by medical malpractice that were significant but not considered serious, the number balloons to almost 2,000,000.

As was noted in last week’s blog post, very few of these injuries caused by malpractice will ever become a claim.  Often it is because no one ever tells the patient or the patient’s family what really happened.  They are left to figure out on their own why their loved one was seriously injured or died and they are never able to do so.  In a smaller number of cases, the patient or the family just want to put the tragedy behind them.  If they do make a claim, as I discussed last week, they likely to be met with a ferocious defense and a jury that has bought the myth that most medical malpractice claims are frivolous and not deserving of compensation.

If the medical profession is not going to fix the system to keep patients safe, the least it can do is identify the patients it is harming and compensate them for their injuries.

Posted in disclosure of medical mistakes, Doctors, Hospital Negligence, Hospitals, Infection, Lawsuits, medical errors, medical ethics, Medical Malpractice, medical malpractice claims, medical malpractice lawsuits, medical mistakes, Medication Errors, Nurses, Secrecy, Surgical Errors |

The True Scandal of the Medical Malpractice System

March 13, 2023

There is a comfortable myth in which doctors love to wrap themselves.  It is the myth that most medical malpractice cases are frivolous attempts to extort money from doctors.  According to the myth, doctors are the good guys and lawyers representing patients are crooks and shysters.  The public never really gets to see the facts that would let them decide if this myth is true or not.  The true facts are hidden behind a wall of secrecy and non-disclosure agreements that doctors use when they settle claims against themselves.  Every once in a while though, someone does get access to the facts and what they find blows the myth to smithereens.  Such was the case in 2006 when a team of trained physicians examined malpractice insurance company closed files as part of an investigation to see just how many frivolous cases there actually were.  What they found will certainly be surprising to the average member of the public.

A Doctor Confronts Medical Errors — And Systemic Flaws That Create Mistakes  : Shots - Health News : NPR

The results of their investigation were published in the New England Journal of Medicine (NEJM), one of the most prestigious medical journals in the United States.  The study was extensive.  The physicians reviewed almost 1,500 closed files from five different companies insuring doctors for medical malpractice.  These files each showed the claims made against the doctor or doctors, what the claimed injury was, the medical evidence in the case, whether any money was paid on the case, and what expenses were paid defending the case.  For geographical balance, companies were chosen which insured doctors all over the country.  Highly trained obstetricians reviewed files involving obstetrical claims.  Internists reviewed files involving internal medicine claims and surgeons reviewed files involving surgical claims.  The files were randomly selected.  Each claim was evaluated and scored 1 to 6 as to whether there had been a medical error and whether that error had caused an injury.  Claims that received a score of 4 or more from the doctors were considered to have been cases in which the injury was caused by a medical error.

Before analyzing the claims that were made, the investigating physicians recognized that only a few of the patients injured by medical errors ever make a claim.  As they noted, “Previous research has established that the great majority of patients who sustain a medical injury as a result of negligence do not sue.”

When they did get to the claims data, there were some very significant findings.  The first of these was that there were only a small number of claims for which there did not appear to be an injury or for which the injury was a psychological one.  The rest of the claims involved a physical injury, usually a severe one.  Eighty percent of the claims involved an injury which caused major disability or death.

The investigating doctors concluded that 63% of the claims involved an injury caused by a medical error.  Very few of the claims which did not involve error received any compensation and, when they did receive compensation, the amount was small.  Strikingly, however, many claims which the doctors concluded were injuries caused by a medical error did not receive any payment.  In fact, there were more cases of a meritorious claim being denied any payment than there were cases of a non-meritorious claim receiving payment.  One in six of the reviewed claims involved an injury caused by medical error for which there was no payment made.

Another striking finding was how much money was spent on lawyers and administrative costs in defending against claims that the physician investigators believed involved serious injury caused by medical error.  Insurance companies and their lawyers are doing well under the current system even if patients injured by medical errors are not.

The investigating physicians concluded that “portraits of a system that is stricken with frivolous litigation are overblown.”  Because of meritorious claims that were heavily defended and went unpaid, the victims of medical errors were left to “shoulder the substantial economic and noneconomic burdens that flow from preventable injury.  Moreover, failure to pay claims involving error adds to a larger phenomenon of underpayment generated by the vast number of negligent injuries that never surface as claims.”

Additional negative findings were that claims took on average five years to resolve, and some took even longer.  The costs for both claimants and defendants were “exorbitant.”  The fact that 80% of the administrative costs were expended in defending what the investigators considered to be meritorious cases suggested that moves to combat frivolous cases will do little to reduce the system’s overall costs.

One of the largest problems was the meritorious claims that went unpaid because the insurance companies and the doctors fought them so tenaciously.  Not only was it unfair but it was not cost effective.  As the authors noted,  “Substantial savings depend on reforms that improve the system’s efficiency in the handling of reasonable claims for compensation.”

We need a system that fairly and promptly evaluates claims, sends away those who do not have a meritorious claim, and pays those who do.  What we have is a system that protects doctors but at the same time allows them to picture themselves as victims.  It is time for a change.

Posted in disclosure of medical mistakes, Doctors, Lawsuits, Malpractice costs, medical errors, Medical Malpractice, medical malpractice claims, medical mistakes, Secrecy, tort reform |

The Medical Malpractice System Is Stacked Against You

March 06, 2023

If you have been injured by medical malpractice, you have a very difficult road ahead of you.  In the first place, you are going to have to figure out, usually on your own, that you have been the victim of malpractice.  Then you have to find a good attorney, who is experienced in malpractice cases and who is willing to take your case.  As I have discussed on this blog before, there are many good reasons why an attorney may not be able to take your case, even when you have been malpracticed upon.  At our firm, I am able to accept only about one out of every one hundred cases that come to me, even though many of the people I must turn down have been victims of malpractice.

Medical Malpractice Lawsuit Guide 2023 – Forbes Advisor

One of the reasons I sometimes have to turn down a case is that there are so many possible defendants that it is difficult and extremely expensive to figure out who is at fault.  The more doctors you sue, the harder the case is to prove and the more expensive it will be.  Another reason I may not be able to take the case is that the client may have made a pretty good recovery from the malpractice.  In my experience, no matter how bad the hell you went through due to malpractice, if you have made a pretty good recovery, the jury will not make an award to you.  Or there may be too many other medical conditions involved.  The more medical conditions a client has, the easier it is for the defense to argue that whatever happened was related to the other medical conditions and not to any conduct by the defendant.  Sometimes, the injury may be what is called a risk of the procedure.  This means that the injury can occur even if everyone does everything right.  When the injury is a risk of the procedure, it makes getting a recovery from a jury even more difficult.

Medical malpractice cases are so difficult for a number of reasons.  Doctors and hospitals win 80-90% of all cases tried in Arizona.  One of those reasons these cases are so difficult to win is because of the Arizona legislature.  The legislature has been run by Republicans for many years and it is a matter of Republican political orthodoxy that medical malpractice cases are mostly frivolous attempts to extort money from good doctors.  Our Arizona Constitution prevents the legislature from capping the amount of money a malpractice victim can recover as many other states have done or from prohibiting certain types of cases.  As a result, the Arizona legislature has passed a number of laws that apply only to malpractice cases and that make it hard or expensive or both for a victim to win in court.

The jury system is another reason it is hard to get justice for medical malpractice victims.  Juries want to do the right thing but they have been bombarded for years with stories about personal injury plaintiffs who ask for millions in compensation when their injuries were actually their own fault.  Insurance companies, corporations and the business community have done an effective job publicizing these stories when they occur and creating fake ones when there are not enough real ones to publicize.  The McDonald’s coffee cup lady is a true story they never tire of discussing, even though she suffered a real injury as a result of some carelessness by McDonalds and the legal system reduced her jury award to a relatively small number.  One of the fake stories they circulate is about a burglar who somehow gets into the garage of a family on vacation and cannot get out.  He is forced to live on candy bars and soda he finds in the garage until the family returns from vacation.  He then finds a shady lawyer to represent him and sues the family for wrongful imprisonment.  The theme is “Can you believe it?”  The subtext is that most claims are like that and these people with their hands out should not be rewarded.

It is also difficult for jurors to believe that doctors and hospitals kill and injure people.  It is easier and less threatening to believe that the injury was just one of those things or that somehow the patient brought this upon herself.  If you are catastrophically injured and need the jury’s help going forward with your life, you may be able to convince the jury to find in your favor.  If not, it is just easier for them to find for the doctor.

The saddest thing about all these obstacles that prevent victims of malpractice from receiving justice is that there is so much medical malpractice out there.  Hundreds of thousands of Americans die each year as a result of malpractice and far more are seriously injured.  If you think you are one of these victims, find a competent, experienced malpractice lawyer and let him or her look at your case.  It may be a long shot but you owe it to yourself and your family, especially if you have been badly injured.

Posted in disclosure of medical mistakes, Doctors, Finding a Medical Malpractice Lawyer, Hospital Negligence, Hospitals, Lawsuits, Malpractice caps, Malpractice costs, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical malpractice damages caps, medical malpractice lawsuits, medical malpractice lawyers, medical mistakes, Medical Negligence, plaintiff, Secrecy, trial |

Greed In Health Care Harms Patients

February 27, 2023

Last month I wrote about how greed in health care led to selling drugs and fleecing Medicare.  Today’s post is about practices that are even worse and harm far more people.  It relates to the purchase by private equity of many providers of health care from doctors’ practices to emergency departments to nursing homes.  Private equity has invested trillions in the purchase of health care providers and wants a return on its investment.  This is bad news for all of us.

The Art of Sales XII: #Greed drives wealth from sales

When there is a drive for profit and return on investment, patient care must, of necessity, take a back seat.  One of the most common tactics private equity uses to increase “efficiency” in a medical practice is to insist that the doctors and staff see more patients.  It is already difficult for patients to get enough time with a health care provider without the corporate bosses demanding that even more patients be run through the system.  Anyone not willing to help push more patients through is shown the door.

Another tactic to increase “efficiency” is to reduce staff.  Another is to replace highly trained staff with less experienced and less well-trained people who don’t need to be paid as much.  Fewer staff and less well-trained staff mean lower quality of care for the patients.

Still another way to increase returns is to “upcode” the visit.  “Upcoding” refers to the practice of making the visit and the treatment given sound more complicated than it really was.  To make billing easier, there are billing codes used to describe what went on.  There is a fixed reimbursement amount for each treatment code.  By using a more expensive code to describe what was done will result in a larger reimbursement.

Our old friend “unnecessary care” is never far away when people are looking for a way to make more money from health care.  We are used to being upsold when we go to the car lot or when talking to insurance salespeople.  We expect it and we are ready for it.  We know to say “No.”  We are not expecting it at the doctor’s office so when we are told we need this medicine or that medical procedure, we usually trust the doctor and say “Yes.”  A little two-year-old Yuma boy died not too long ago after his parents were convinced to allow a dental group to do root canals on his baby teeth and to put crowns on six of them.  The death was due to a failure to monitor him after anesthesia but he never should have had the procedures and never should have needed anesthesia in the first place.

Pregnant and in labor?  At some hospitals now before they will let you enter the Labor and Delivery unit, they will insist you stop by the emergency department for a quick examination to make sure you are really in labor.  How thoughtful you think until you get the bill for an emergency department visit that you did not need and did not expect to be separately billed for.

In some cities, private equity has purchased so many of the anesthesia practices or gastroenterology practices that they can raise prices without worrying about another doctor group offering to do the same thing for less money.  The care has not improved but what we pay for it has gone up.

There is big money to be made from older Americans and from the nursing homes in which so many of them are living.  Private equity has been buying up nursing homes and making them more “efficient.”  Staffing cuts and other cost saving measures were almost certainly a contributing factor to the high death toll at nursing homes across the country during the early stages of the pandemic.  Poorly trained and short staffed nursing homes are no place to live and give rise to horror stories about residents left in their own body waste and bed sores that go all the way to the bone.

We deserve better.  We will only get it when we demand more from our providers and from the politicians who are supposed to be protecting us from the worst impulses of the free market.

Posted in Doctors, Fee for Service, Fraud, Health Care Costs, Hospitals, Medical Costs, Medical Devices, medical ethics, Medicare |

An Unusual Medical Malpractice Verdict

February 20, 2023

Today’s blog post is about an unusual medical malpractice verdict.  The first thing that makes it unusual is that the jury found in favor of the plaintiff.  That just does not happen very often.  Here in Arizona and across the country, doctors win 85% to 90% of medical malpractice cases that go to trial.

The second unusual thing about the verdict was its size.  The jury awarded $43.5 million.  That is a lot of money in any case, but especially in a medical malpractice case that did not involve brain damage and the future cost of long-term care.

The third unusual thing about the verdict is that it was an orthopedic surgery case.  Orthopedic cases are among the most challenging medical malpractice cases.  They usually involve, as did this one, an injury to a joint.  This was a knee injury case.  There are so many reasons why a patient with a joint injury might not get a good result that have nothing to do with malpractice by the orthopedic surgeon.  It is very easy for the jury to conclude that the surgeon did his or her best and that the injury was just too much for the surgeon to be able to repair.

The fourth and final unusual thing may very well explain the other three unusual things.  The plaintiff was a member of the Philadelphia Eagles football team, who contended that team physicians mishandled his knee injury and that their missteps cost him the final years of his football career.  The case was tried in Philadelphia in the weeks leading up to the recent appearance by the Eagles in the Super Bowl.  Former Eagles stars testified what a great guy the plaintiff was and how valuable he had been to the team.  In my experience, celebrities, and this man was a celebrity to the Philadelphia jury, get special treatment from juries and are more likely to win their cases than you or I would be under the same circumstances.

When I read the facts of the case, it had all the earmarks of a classic defense verdict.  The injury was to a joint.  The injury involved a surgery.  The plaintiff’s expert was not as well-qualified as the experts who testified on behalf of the defendants.  There were questions about whether the injury that ended his career occurred after the surgery in question so that it could not possibly be the fault of the defendants.  There were questions about how much longer the player could have remained in the NFL given his age and previous injuries.  Lots and lots of issues that usually signal a defense verdict.

The player’s lawyers claimed he would have received an $8 million dollar contract, had the defendants taken proper care of his knee.  The jury gave him the $8 million and another $35.5 million.  That almost never happens.  The jury clearly liked this “local hero” and wanted to do something nice for him.

Order may be restored to the universe, if this case goes up on appeal, as verdicts of this size almost always do.  If things finally revert to the usual, the plaintiff will get some money from this, but it will not be the $43.5 million the jury awarded him.  It will be some much smaller amount and the reduction in the award will not get anywhere near the publicity the jury’s verdict did.  Stay tuned.

Posted in Doctors, Lawsuits, medical errors, Medical Malpractice, Medical Malpractice Case Value, medical malpractice lawsuits, medical mistakes, Orthopedics, plaintiff, Surgical Errors, Verdicts |

Do I Really Need That Surgery?

February 13, 2023

Many patients have wondered what to do when the surgeon tells them they need surgery.  One thing you should not do is just say, “OK” without first asking some questions.

Surgery | Definition, History, Type, & Techniques | Britannica

Of course, not all surgeries are the same.  Some are necessary and must be performed right away to save the life of the patient.  Some are elective and are not essential to the health of the patient at all, such as most cosmetic procedures.  Except in the case of the life-saving surgery which must be performed immediately, take the time to ask some questions.

How necessary is this surgery?

If I do not get this surgery, what is likely to happen to me?  Will the problem get worse or will it pretty much stay the same?  How is the problem likely to affect me, if I don’t choose to have the operation?

What are the risks of the procedure and how likely are they to occur?

No surgery is without its risks.  Depending on your age and health status, a surgery may be extremely routine or it may have a lot of risk associated with it.  Some risks, such as infection, are present in every surgery.  Some are procedure specific and apply only to that kind of surgery.  Risks will include minor problems such as a little extra bleeding and can go all the way up to death.  How often one of these adverse events occurs is important too.  Only one in 10,000 patients having this surgery may die during the procedure but that is of little comfort, if you are the one.  You can pretty reliably expect the surgeon to play down the risks.

What are the benefits of the surgery and how likely am I to see those benefits?

The expected benefits are the whole reason for the surgery.  What are they and how likely is the surgery to provide them?  Is it a 50-50 chance or a 90% chance that things will go well and the surgery will be a success?  If the surgery is a success, how will it improve my life or my condition?

If the surgery is not successful, what can I expect?

Even the best of surgeons doesn’t always get a great outcome.  Sometimes matters are beyond her control or she finds something unexpected during the course of the procedure.  Sometimes the surgeon makes a mistake which can harm you or result in an unsuccessful surgery.  Before you agree to have a surgery which is not life-saving, you need to know what will happen, if the surgery is not a success.

The balancing test.

Whether to go forward with a surgery is always a question of balancing the risks of the surgery with the expected benefits.  The surgeon is supposed to have already compared the risks with the benefits before recommending the surgery to you.  It is unethical for a surgeon to recommend a procedure when she thinks the risks outweigh the benefits but it happens and you need to be aware of it and protect yourself against it.

If I don’t need the surgery immediately, what can I do to get ready?

When surgery does not need to be done right away, you need to ask if there is anything you can do to increase the chances the surgery will be successful.  For example, if you have not yet stopped smoking, this is a perfect excuse for doing so.  Smoking affects your lungs and your ability to heal after surgery.  Make sure your blood sugars are under control.  If you are carrying extra weight, try losing some of it before surgery.  It is never too late to begin a walking program to improve your cardiovascular status.  Your surgeon may have other suggestions for you.

Good luck with your surgery.

Posted in Doctors, General Health, healthy living, Hospitals, Infection, Informed Consent, medical ethics, medical mistakes, Surgical Errors |

A Large Malpractice Award Was Justified.

February 06, 2023

Large awards for medical malpractice are not nearly as common as the medical profession and its insurers would have you believe.  Juries are reluctant to hold doctors responsible for injuring patients.  They don’t want to believe that doctors make mistakes that kill and injure people.  When there is a large award, a review of the facts almost always shows that it was justified.  Today, I will discuss the facts that led a federal judge to award $14.2 M to an 8 year-old child and his parents in their claim against the federal government for medical malpractice.

Children Traumatic Brain Injuries

During his first year of life, the child developed asthma.  He had frequent ear infections, upper respiratory infections and was frequently hospitalized for these and his sickle-cell disease.  His pediatrician referred him to specialists at Walter Reed National Military Medical Center for evaluation.  The pediatrician thought he might be a candidate for ear tubes to reduce the likelihood of ear infections and for a procedure to remove his adenoids, to address snoring complaints and reports of mouth breathing.

At Walter Reed, the child was evaluated by an Ear, Nose and Throat Surgeon, who concluded he was a candidate for the two procedures.  After consulting with the surgeon, the parents agreed to the surgery.

The day before the surgery, the anesthesiologist, who would be delivering anesthesia care during the surgery, reviewed the child’s records and concluded that he was a high risk patient because of his asthma and sickle cell disease.  She believed he was at risk of brain injury and death.  She recommended he be admitted before the surgery to receive IV hydration to reduce the surgical risks.  No one listened and the child was not admitted or infused with fluids.  On the morning of the surgery, she repeated her concerns to the surgeon who disagreed and said the surgery had to go forward.  The parents were never informed of the anesthesiologists concerns or of the risks she thought were present.

During the surgery, the child began to experience low oxygen levels.  His heart rate went high and then began to decline precipitously.  His blood pressures dropped and his heart stopped.  After ten minutes of CPR, the doctors were able to restore a heart beat but by that time the child had suffered a permanent brain injury due to lack of oxygen.

The child is now confined to a wheelchair or to bed, must have 24 hour nursing care and is ventilator dependent.  He takes 32 different medications and has a feeding pump.  He has multiple seizures on a daily basis and his life expectancy has been reduced to only 21 years of age.  He will never live independently or be gainfully employed.

The parents brought suit for medical malpractice and a failure to advise them of the risks the surgery presented to their child.  Because the suit was one against the federal government, it was governed by the Federal Tort Claims Act, which mandates these cases be tried to the court and not to a jury.

The federal district court judge who heard the evidence found that the surgeon and the anesthesiologist were both guilty of malpractice in the manner in which the surgery was performed.  He awarded the child and the parents just over $14 million dollars for past and future medical expenses, for loss of earning capacity, and some money for non-economic damages.  The vast majority of the award, $11,000,000, was for future medical expenses.

What should have been a short and routine operation spiraled out of control because the doctors involved did not properly evaluate the risks of the surgery and did not stop the surgery when things began to go wrong.  A young life was ruined and the parents were devastated by the injury to their child.  Were there not a cap on non-economic damages, the award would likely have been much larger.  Think about these facts next time you hear someone complaining about large awards in malpractice cases.


Posted in Doctors, Informed Consent, Lawsuits, Malpractice caps, medical errors, medical ethics, Medical Malpractice, Medical Malpractice Case Value, medical malpractice cases, medical malpractice damages caps, medical malpractice lawsuits, medical mistakes, Medical Negligence, Surgical Errors, trial, Verdicts |

Covid and the Bad Doctor

January 30, 2023

A Utah plastic surgeon has been charged by the United States with health care fraud and conspiracy arising out of a year-long scheme to sell fake Covid vaccination cards.  The cards were sold for $50 each.  It is unclear exactly how many cards were sold.

Did you lose or misplace your Covid-19 Card? | Punxsutawney Area Hospital

In addition to selling the fake cards, the doctor and members of his office staff also destroyed over doses of vaccine that they received that were worth over $28,000.  They pretended to administer these destroyed doses, but did not.  In some cases, children were injected with saline rather than actual vaccine.  The saline injections were at the request of the children’s parents.

The scheme was apparently part of the anti-government, anti-vax movement to stop vaccine administration as well as to defraud the government and “get the government out of health care.”

The fake vaccine cards allowed people who purchased them to enter places that required vaccination where they would be able to mix with and infect unsuspecting citizens, some of whom may have been immunocompromised.

These people are not alone in selling fake or forged vaccination cards.  According to an article in the New York Times, two nurses on Long Island made over $1.5 million selling forged vaccination cards.

It is one thing to be skeptical of the benefits of vaccines and to refuse to take them.  It is quite another to pretend that you have been vaccinated and to enjoy the benefits of vaccination while exposing others to disease.

Posted in Fraud, General Health, medical ethics, Vaccines |

A Case of Hospital Malpractice

January 23, 2023

Hospitals are where the germs are.  Hospitals are also where the worst germs are.  Sick people are constantly coming to the hospital and bringing their viruses and bacteria with them.  In spite of the best efforts, and sometimes less than the best efforts, of the nurses and staff, bacteria and viruses get passed from one patient to another.  This is the story of one of those less than best efforts that left three newborns dead and one badly brain damaged.

The NICU & your baby: what to expect | Raising Children Network

The deaths and injuries occurred in a good-sized hospital in central Pennsylvania.  It had an excellent reputation in the community and had received national recognition as one of top hospitals in the country.  Of course, none of that matters when a tragedy such as this occurs.

The deaths and injuries happened in the Neonatal Intensive Care Unit (NICU).  Premature babies and babies who are very sick are sent to the NICU, where they are expected to receive care from highly experienced and highly trained nurses and doctors.

Medical professionals who care for newborns recognize that breast milk is the best form of nutrition.  If the mother can nurse her baby while the baby is in the NICU, that is wonderful.  Sometimes, however, that is not possible for a number of reasons.  When actual breastfeeding is not possible, mothers may pump their breasts to get milk to be fed to their babies.  Alternatively, someone may donate breast milk to a milk bank, which will assure it is disease-free and then deliver it to the NICU.  The deaths and tragic injuries arose out of the handling of this donated breast milk.

One of the bad bacteria that is often found in hospitals is pseudomonas aeruginosa.  Although it is common in the soil and environment outside of the hospital, the version that is found in hospitals has often developed resistance to many of the drugs that are used to kill off other bacteria.  It can cause pneumonia, among other infections.  Thousands of deaths occur in hospitals in this country each year due to infections by multi-drug resistant pseudomonas.  It is spread from person to person through incomplete handwashing, incomplete cleaning of contaminated surfaces and contaminated equipment.

At the Pennsylvania hospital, pseudomonas contaminated some of the containers and equipment used to prepare the donated breast milk to be given to the newborns in the NICU.   While it should not happen, contamination is a fact of life in hospitals and nurses and other staff should assume that all surfaces and objects are contaminated and take the necessary steps to be sure they are clean and bacteria free before they are used for patient care.

The contamination at this hospital was not a one time thing due to a single mistake.  Later investigation found that for a period of three months, hospital staff failed to properly disinfect the equipment used to prepare the donated breast milk.  For those three months, pseudomonas bacteria infected the equipment and the babies who received the breast milk.

It is surprising that the problem was not recognized sooner than it was.  Eight babies suffered serious pseudomonas infections, with three deaths and one case of severe brain damage.  Patterns like this are highly unusual and are very likely to be related.  In any event, at the end the hospital did the right thing.  It admitted responsibility, apologized to the parents and to the public and settled the malpractice claims arising out of the infections.  It also instituted changes to the way in which it sterilized equipment so that similar infections could not occur.

While it is always good to see a hospital publicly accept responsibility (they almost never do) and make positive changes, it would be even better for good practices to prevail from the outset so that apologies and settlement payments don’t need to be made.

If you have a child who suffered a serious injury in the NICU, give us a chance to review the records and make sure the care your child received was appropriate.  If your child was the victim of malpractice, you can count on the fact that no one at the hospital is going to tell you about it.  You are going to have to discover it for yourself.  If your child is going to need a lifetime of care, it is only fair that the persons responsible should be the ones to pay for that care.

Posted in antibiotic resistant bacteria, blood infections, disclosure of medical mistakes, Doctors, Finding a Medical Malpractice Lawyer, Health Care Costs, Hospital Negligence, Hospitals, Infection, Medical Malpractice, medical malpractice claims, never events, Nurses, Sepsis |

When Thinking About Hospital Bills, Remember Your Old Monopoly Game.

January 16, 2023

It is no secret that the cost of medical care is rising and rising at a rate faster than inflation.  This wave of rising costs is being led by an even larger rise in the cost of hospital care.  Hospitals receive $1 out of every $3 spent on health care in this country.  How can hospitals get away with this?  The answer is found in our old Monopoly game.  Remember how the more of a property you owned, the higher the rent you charged?  As hospital chains grow larger, they reduce competition in their areas and reduced competition almost invariably leads to increased prices.

Monopoly board game

In the United States, we pride ourselves on having a free market.  Those of you who have taken Economics are familiar with the push and pull of supply and demand and their roles in setting prices.  Buyers survey the supply of goods and decide if they want to buy at the price at which the goods are being offered.  If buyers are reluctant to buy, suppliers respond with reduced prices.  If demand is high, sellers may raise prices or produce more goods.  Our system works best when buyers can see and compare prices and the goods are substantially the same.  It also works best when sellers are independent of each other and cannot control prices.  Hospitals are run by smart people who understand these economic principles and actively work to thwart them.

One of the ways in which hospitals actively thwart the free market is through consolidation.  Instead of 20 independent hospitals in a metropolitan area offering their services, there may be only three or four chains which control all of the 20 hospitals.  Banner Health is the largest private employer in the state of Arizona.  While hospital chains may not secretly consult with one another to set prices, which is illegal, they each know pretty much what the others are doing and use that information to keep their prices high.  As the Director of Public Affairs for the Federal Trade Commission has stated, “Too many hospitals mergers lead to jacked up prices and diminished care for patients most in need.”  If no other hospital is undercutting your price, you can keep the price high and still sell your services.

Another tactic by which hospitals thwart the free market is by keeping their prices as hidden as possible.  New government regulations require hospitals to post the prices of their most common services in a way that the public can see them but some hospitals ignore the requirement and some that do post their prices do so in a way that makes it very difficult to find them.  If a patient does not know the prices, she or he cannot make an informed choice between providers.

Still another tactic used by hospitals is related to consolidation.  Hospitals are buying the practices of doctors in their areas and, sometimes gently and sometimes not, requiring the doctors to send their patients to the hospital which owns the practice.  After a doctor’s practice is purchased by the hospital, she may find that her compensation is at least in part dependent upon how often her patients use the hospital.  Also, the purchase of doctor practices allows the hospital chains to begin to monopolize outpatient care as a companion to their inpatient care.  Hospitals with doctor practices compete with independent doctors and benefit from federal subsidies and assistance given to hospitals but not to individual doctors.

Given the outsize role that hospital spending plays in overall health care spending, there is no shortage of solutions recommended to reduce hospital billings and force hospitals to become more efficient.  Among the suggested solutions are enforcing anti-trust laws to reduce consolidation, forcing hospitals to actually disclose prices, cap amounts hospitals can charge for particular procedures, and create networks of hospitals that agree to keep prices down to name but a few.

As with most other areas of health care spending, hospitals make big money and are willing to spend a lot of it to keep things the way they are.  Armies of lobbyists supported by large campaign contributions are very effective tools in keeping reform at bay.  We just have to keep trying.


Posted in Doctors, Fee for Service, Health Care Costs, Hospitals, Medical Costs, Medicare |