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The CMG Voice

Medical Malpractice Litigation Makes Patients Safer

Posted Thursday, May 23, 2013 by Tyler Goldberg-Hoss

Many, particularly those in the health industry, believe a major barrier to the openness and transparency necessary to reduce medical errors is malpractice litigation. However, it seems the opposite is true: malpractice claims are seemingly improving hospital transparency and reducing medical errors.

So says Joanna C. Schwarz at the NY Times. She concludes, after surveying more than 400 hospital risk management, claims management and quality improvement personnel throughout the country, that limiting this litigation may “actually impede patient safety efforts.”

Read the full article here:

Learning from Litigation

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Operative and Post-Operative Infections

Posted Monday, May 20, 2013 by Gene Moen

It is not uncommon for a patient who undergoes surgery or any invasive procedure to develop an infection. Although operating rooms are meant to provide a sterile field for a surgery, there are many ways in which a bacterial organism can invade the body through an opening.

A staph infection (staphylococcus aureus) is the most common, because this organism is present on everyone’s skin and no surgery prepping can completely eliminate it. In general, a staph infection that develops immediately after a surgery is not sufficient evidence of negligence on the part of the OR personnel or the hospital. Unless a specific negligent act or failure can be identified as the source of the infection, it is rare that a medical malpractice action is viable. This is also true for a MRSA infection, which can be much more serious and usually occurs in a hospital and not in the community.

In some cases, there may be several patients who suffer a similar infection during the same time period in the same OR, and this could indicate some breakdown in sterile procedures on the part of the hospital. Most often, however, the patient who develops an infection won’t know of other patients who had a similar infection. If that knowledge does exist, an investigation may find that there were problems with sterile procedures in that particular OR, or problems with the ventilation system.

A strep infection (group A streptococcal) may be different, since that organism usually comes from an infected person in the OR. If a patient develops a strep infection that appears to come from the OR, hospitals will usually investigate to determine if a carrier of that organism was present in the OR. Sometimes there will be a cluster of such infections and they can be traced to a surgeon or nurse who has the organism in his/her nasal cavity.

Fungal infections can also be different, because they are relatively rare (and can be quite serious because they are typically more difficult to treat). If it appears that an unusual fungal organism invaded an operative incision, it may come from the uncovered shoes of OR personnel who tracked in dirt with that particular fungus, or a faulty ventilation system that may be drawing in dust from, for example, a construction site at the hospital.

Most operative and post-operative infection cases are based not on the fact an infection occurred, but rather on a delay in diagnosing and treating the infection. A patient may call the surgeon to complain about a surgery site that is painful, swollen, or red, all of which are potential signs of an infection. If the doctor fails to see the patient promptly, or antibiotics are not prescribed, the infection may spread and cause a surgery to fail or result in other serious medical problems.

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Hindsight Bias in Radiology Miss Cases: A Get-Out-Of-Jail-Free Card for Negligent Radiologists?

Posted Thursday, May 16, 2013 by Tyler Goldberg-Hoss

Alleging a radiologist missed something on a film and caused you harm can be tricky. Often the “miss” is not obvious to the untrained eye (otherwise they wouldn’t have missed it), and the defense is usually that, only with the benefit of hindsight, can you now “see” the finding.

Here is an article that recently appeared in Trial News on the subject:

Hindsight Bias in Radiology “Miss” Cases: A Get-Out-Of-Jail-Free Card for Negligent Radiologists?

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Robotic Surgery is here. Is it safe?

Posted Wednesday, May 8, 2013 by Tyler Goldberg-Hoss

That question is currently being asked in a courtroom in Kitsap County. Intuitive Surgical, the maker of the da Vinci surgical system, is defending itself from accusations that it isn’t safe when the company’s profits drive surgeons and hospitals to use it without proper training.

This current case involves a prostatectomy performed in 2008 on Fred Taylor with the aid of the da Vinci robot. The robot acts in much the same way as a typical laparoscopic procedure, insofar as small holes are made to pass tools through, eliminating the need to make a bigger cut, otherwise known as an “open” procedure.

What’s different is that, instead of the surgeon holding onto the tools him or herself, the surgeon is sitting at a console away from the patient, controlling the robotic arms and tools that are inside the patient.

Unfortunately, there were complications during Mr. Taylor’s surgery, and he suffered significant injuries. He died some time later, and the plaintiff in the case, his widow Josette, brought this lawsuit.

Much of the plaintiff’s case centers on the idea that the company’s profits - and not the safety of the people upon which robotic surgery was performed - dictated the use of the robot. Hospitals are pushed to purchase the robot lest they are left behind technologically. And doctors are pressed to use them by Intuitive salesmen who profit on each surgery performed, even when the doctors are insufficiently trained.

The trial is expected to last into next week. Bloomberg News is covering the events. Here is a link to their most recent story:

Intuitive Salesman Says Robotic Surgeries Drove Salaries

CNBC has also done an investigation on the da Vinci. Here’s a cite to the first of four videos:

CNBC Video #1

Finally, the Seattle Times published this last Friday:

Failed robotic surgery focus of Kitsap trial

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Hospital Equipment Alarms

Posted Monday, May 6, 2013 by Gene Moen

In modern hospitals the health care providers rely more and more on machines. A patient’s well-being is maintained through monitoring devices (picture the screen above the patient’s bed showing a pulse), breathing-assistance machines, and drug dispensing methods. The failure of any of these devices, or a malfunction, can adversely affect the patient’s well-being or even cause a death.

Almost all of these machines have alarms or other means of alerting the provider when the machine isn’t working properly. But the machines and their alarms also have to be regularly checked and tested to be sure the alarms are working properly. In a hospital’s basement or other out-of-site location are the technicians who do this. Often the manufacturer of the devices will also periodically check the machine’s performance, including the alarm systems.

A hospital is required to keep meticulous records of a machine’s maintenance and regular testing. Sometimes a case against a hospital will depend on those records, rather than the patient’s regular medical records, to show that a hospital was negligent in its equipment maintenance or testing and it caused harm to a patient.

A recent article published by The Joint Commission includes a number of recommendations for hospitals to ensure that their alarms are well maintained and working properly. Here is a link to the article:

Joint Commission Alert Addresses Medical Device Alarm Safety in Hospitals

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