Posts Tagged ‘bedsores’

Medicare adopts “never event” policy

We’ve already aired much dissent from the medical profession about whether or not top-notch hospital care can in fact prevent all instances of patient falls, decubitus pressure ulcers (bedsores), hypoglycemia, deep vein thrombosis, delirium, suicide attempts, c. difficile infection, or iatrogenic pneumothorax. Nonetheless, Medicare has adopted its proposal to deny hospitals reimbursement for the cost of treating such events and complications, with likely consequences both for hospital behavior (refusal to admit some patients at high risk of never events), for private insurer behavior and for the climate of medical malpractice litigation. (Kevin Sack, “Medicare Won’t Pay for Medical Errors”, New York Times, Sept. 30). White Coat Rants, who has blogged extensively on the issue in past months, has some predictions (Oct. 1) of things we can now expect to see more of: more patient transfers between hospitals (since Medicare will not punish the second hospital for the first’s “never event”; underdiagnosis of certain conditions and overdiagnosis of others; and, more remotely but no less alarmingly, pressure on some families to serve as ultimate bearers of risk for supposed never events affecting the frailest and most elderly:

Say hello to the Advance Beneficiary Notices. Medicare won’t cover preventative care, so you are going to have to pay for it out of your pocket. If you’re prone to falls or bedsores, you’ll have to pay for a personal nurse to wait on you hand and foot so you don’t develop these never events. If you don’t pay for a personal nurse 24 hours around the clock to keep a never event from happening, you’re personally responsible for paying the costs of treatment if the “never events” occur. You had the opportunity to prevent the events but you were just too cheap to pay for it. I think that ABNs are less likely to catch on, but eventually I think they will become commonplace.

June 9 roundup

  • Florida trial lawyers have funneled millions to Gov. Charlie Crist and GOP state legislators; now guess why Orlando isn’t going to get commuter rail [Bousquet/St. Petersburg Times; Sentinel]
  • What his ex-law firm told the world was “extremely inappropriate personal conduct” was in reality no more than a “brief, consensual kiss” with co-worker, charges attorney in $90 million defamation suit; Kasowitz Benson says it was following zero tolerance policy [American Lawyer]
  • SCOTUS, 9-0, Thomas writing, narrows scope for money-laundering charges over hiding unexplained cash — but will that curb forfeiture abuse? [Grits for Breakfast, Greenfield]
  • After West Virginia high court refuses to review $405 million royalty dispute jury verdict against Chesapeake Energy and another defendant, company scraps plans to build $30 million headquarters in the state [PoL]
  • Even after discounting anti-corporate rhetoric, there does seem to be a story here about aggressive seed patent litigation tactics used by agri-giant Monsanto, a firm known to our readers [Barlett & Steele, Vanity Fair; earlier]
  • Medical liability consequences of much-promoted concept of hospital “never events” [Buckeye Surgeon]
  • Cellphone rage update: Judge Robert Restaino ousted for jailing 46 people after one of the annoying devices rang out in his Niagara Falls, N.Y. courtroom [Buffalo News, earlier]

Pending the abolition of gravity…

…or the universal adoption of round-the-clock patient guards or restraint devices, it’s hard to go along with the notion that hospital falls should be so-called “never events”. (Happy Hospitalist, Jan. 15, Feb. 20). Nor is the concept much more useful when it comes to patient suicide attempts or hypoglycemia, among other misadventures (White Coat Rants, Feb. 5)(via KevinMD). Related: letters section, 2004 (pressure wounds/bedsores).

$12.8M for bed-ridden schizophrenic’s amputation

62-year-old Kenneth F. Morris is both paraplegic and a schizophrenic. He refused to cooperate with the doctors and nurses at other hospitals, and when he arrived at Western Convalescent Hospital, he had infected bedsores, which eventually resulted in the amputation of his leg below the knee. A Los Angeles County jury held the nursing care facility 90% responsible for the injury, and awarded over $12 million in compensatory and punitive damages. “A spokeswoman for the California Department of Health Services, which inspects and licenses nursing homes, said state officials had never received a complaint about Morris’ injuries and had no plans to investigate.” (Jack Leonard, “Abuse Victim Wins Award”, Los Angeles Times, Jul. 2; plaintiffs’ law firm summary). The award will likely be lowered somewhat later in the litigation process, but the trial court is still likely to award between $3 and $6 million.

Batch of reader letters

We’ve posted four more letters from readers on our letters page. Topics this time include Nevada’s trial-lawyer-sponsored Question 5, which should alarm not only doctors but anyone who gets sued; the widely disseminated myth that patients suffer bedsores only when medical care is substandard; the risks of being a soldier; and DirecTV’s campaign against owners of hardware capable of intercepting its satellite signal.