Posts Tagged ‘hospitals’

Microblog 2008-10-11

  • Would single-payer fix malpractice woes? Not likely given trial bar political clout [KevinMD] #
  • Prosecuting candidates for crowd-inciting campaign speeches? Now there’s a truly bad idea [Point of Law] #
  • Her busy docket: “For people like Oprah, lawsuits are a part of life” [Roeper, Chicago Sun-Times] #
  • Nebraska hospital sues patient for refusing to leave [Happy Hospitalist; related earlier] #
  • Community covenant craziness: “Dad’s in prison because we can’t afford to sod the lawn” [St. Petersburg Times] #

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.

L.A.: Hospitals can’t discharge homeless patients

Thanks to a new city ordinance, they get to provide some of the world’s most expensive free hotel service to patients who are well enough to leave but refuse. (WSJ health blog, Aug. 4).

More: Numerous interesting comments from readers including this from Throckmorton:

This is not just in L.A. but happens all around the country as well. Our area saw this increase with the rise in nursing home suits. Nursing homes are now very reluctant to accept patients who are at risk for decubitus ulcers, etc. This combined with the declining revenue has led to the situation where there are no places that will accept transfers from the hospital. As more and more patients fill the wards awaiting placement, the hospital has no choice but to divert those that need urgent care.

You may not be able to get a nursing home patient out of the hospital, but at least you will not have a problem finding them an attorney.

Missouri hospitals’ tobacco-recoupment suit

Around the country, courts have thrown out suit after suit by private hospitals, health insurers and benefit funds seeking to tag tobacco companies with the cost of smokers’ illnesses. A suit on behalf of various Missouri hospitals still hasn’t flickered out and is being litigated expensively, with Richard Daynard’s Northeastern University-based Tobacco Product Liability Project doing its customary cheerleading. (Heather Ratcliffe, “Hospitals’ suit against tobacco industry is large in every dimension”, St. Louis Post-Dispatch, Sept. 15).

No conscience clause for California fertility doctors

They’ll have to assist unmarried women in giving birth even if doing so violates their religious scruples, according to a new California Supreme Court decision involving a lesbian applicant. As Bookworm Room points out (Aug. 19), and as we noted in the earlier Bay Area conscience controversy over gender-switch breast surgery, it makes a practical difference (if not one of libertarian principle) that there are plenty of other fertility clinics around San Diego that would be happy to step into the gap. The doctors in the case at hand might still escape liability because a ban on marital-status discrimination as such was not yet part of state law at the time they rejected Guadalupe Benitez; Benitez will win if she shows that the true motivating factor was her lesbianism. (Egelko, SF Chronicle, Recorder). The ruling also allows doctors to excuse themselves on the basis of religious scruples if there is a second doctor within the same practice — but not, apparently, a doctor across town at a different practice — willing to perform the work in question. And of course the legislature in Sacramento could readily help bring peace to the culture war by inserting into the law a generously drafted conscience clause — if it wanted to. More: Miller, IGF; opinion, PDF.

White Coat Rants on “never events”

Blood should never clot, microorganisms should never happen, and one doc-blogger is on a tear (Aug. 14, more, Aug. 17) over the sometimes absurd hype being given to the concept:

“Never events” are and always have been “all about the Benjamins.” Look at this news release. The “background” section states that the “never events” were “required” pursuant to Section 5001(c) of the Deficit Reduction Act. Medicare wants to stop paying for things not because they “should never happen” but because it’s trying to save money. The whole “never event” moniker is just a spin they put on the cuts to make it look like someone else’s fault. Do “never events” never occur at government run hospitals? We’ll never know because CMS doesn’t even include government run hospitals on the “hospital compare” list.

“Lack of Minorities Closes Boise Bone Marrow Center”

So now everyone will be happy dept.: The only bone-marrow donor program in Idaho’s capital of Boise is closing down. It seems the National Marrow Donor Program has enacted regulations requiring local programs either to recruit at least 1,000 minority donors a year or to hire a full-time recruiter by way of showing a good-faith effort toward that goal. But there aren’t enough minorities in the Treasure Valley to hit the numerical target and the program at St. Luke’s Mountain States Tumor Institute isn’t big enough to support the full-time hire, so now the nearest local option for potential donors will be an institution in Spokane, Washington. (Idaho Statesman and more, Idaho Business Review, Seattle Times) (via Taranto).

More: The national program, however, denies that its regulations require the hiring of a recruiter and says its local minority recruitment goal is 575, not 1,000: Taranto, Aug. 11.

Update: Lawrence Poliner v. Texas Health Systems appeal

We hear frequently that the medical profession doesn’t do enough to police its own. Cases like that of Lawrence Poliner might explain why. In 1997, in response to complaints by nurses at Presbyterian Hospital of Dallas, and the allegation by a doctor that Poliner had performed an angioplasty on the wrong artery, the hospital asked Poliner to stop work while they investigated. These limited privileges lasted 29 days, followed by a unanimous decision to suspend, a five-month suspension from echocardiography privileges, and then reinstated Poliner five months later subject to conditions that he consult with other cardiologists.

For this, Poliner sued for defamation and under federal antitrust law, alleging that other cardiologists were trying to dominate the market and prevent his competition. The five-month suspension had federal immunity under the Health Care Quality Improvement Act, 42 U.S.C. § 11101 et seq. (just one of many federal tort reforms that promote safety), but the trial court held that the 29-day limited-privileges created a cause of action that should go to a jury. Poliner lost $10,000 in income over that time “but was awarded more than $90 million in defamation damages, nearly all for mental anguish and injury to career. The jury also awarded $110 million in punitive damages”–despite the fact that Poliner would have to prove damages were caused by the allegedly unprivileged temporary limitation rather than by the five-month suspension. We covered the initial $366 million verdict in 2004, the outraged medical blogosphere reaction, and the remittitur to a still ludicrous $22.5 million in 2006.

Read On…

Hospital probed after calling cops on patient

Yesterday the New York Times reported on the longstanding problem of patient assaults on medical personnel, particularly in psychiatric care: citing Bureau of Labor Statistics numbers, it said “half of all nonfatal injuries resulting from workplace assaults occur in health care and social service settings”. (David Tuller, “Nurses Step Up Efforts to Protect Against Attacks”, Jul. 8). So it’s worth noting what happened to Northfield City Hospital in Northfield, Minnesota when a man showed up at the emergency room at 2 a.m., ranting and yelling in an increasingly agitated manner. Hospital staff finally called the police, who arrived on the scene at 7 a.m., assessed the situation and tasered the man. (He was uninjured otherwise and was subdued without losing consciousness.) “Now federal and state health officials have cited the Northfield hospital for violating the patient’s rights,” a development that has outraged hospital officials in the state. The state health department says it believes that staff at the facility, a small one with fewer than 100 beds, “needs more training in deescalation techniques”. The hospital has hired two security guards and is negotiating other steps with the state (Maura Lerner, “Hospital calls cops and feels the sting”, Minneapolis Star-Tribune, Jun. 15). A commenter at KevinMD asserts:

A few years ago, Medicare tried to prohibit physicians from discharging a patient for any reason, up to and including physical attacks on physicians and staff.

Just as the doctors were required to hire translators at the doctor’s expense, they would be required to hire security at the doctor’s expense.

They backed off then, when they physicians called them on it. Not surprised they would try again.

Hospital bill-collecting and med-mal claims

The recent flurry of press attention to medical apology prompted this anecdotal recollection from Michael O’Hare at Same Facts (May 18) of his work 25 years ago on a Massachusetts state commission to address the malpractice issue:

The story was that soon after [in-house hospital lawyer] Fred arrived, he was assigned to get on top of malpractice claims, and he sat down with six months’ worth of files. All of them, he discovered, began with a collection action for non-payment of a bill. So he ordered the accounting office to send him every overdue account before any efforts at collection, and invited the deadbeat patient into his office for a conversation. Invariably, the patient was withholding payment because he thought he had been mistreated. Often, the patient was right. The next meeting was with the practitioner accused of having screwed up, and the outcome was sometimes an apology and a promise to fix the problem for free (for example, another operation at no charge to retrieve the forgotten sponge), sometimes an expression of regret for a bad outcome with an explanation that the hospital hadn’t actually erred: not everything in medicine works every time. Of course this required that Sanders and Fred drive out fear, so the staffers could be honest and sympathetic.

The result of this was a really spectacular reduction in malpractice costs, even counting in the “warranty service” repairs; I don’t remember the numbers but it was on the order of more than half, partly in fees to defense lawyers, partly in claim payments. Frequently the bill even got paid. The reduction in lawsuits occurred both when the hospital was wrong and said so, and when it was right and said so; it turned out a lot of the injured patients just wanted to tell a live person what had happened to them and get an apology. Of course the public relations benefits are enormous, if hard to measure. And quality always goes up when your own people aren’t afraid to talk to each other about instructive mistakes.

It’s notable that Fred’s pay didn’t depend on how many cases he litigated….

Full post here. More thoughts on medical apology: Melissa Clouthier, May 19.