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The CMG Voice

Maternal Mortality Going Down — Except In The United States

Posted Thursday, February 16, 2017 by Gene Moen

Improvements in medicine and public health around the world have helped to reduce the mortality rate for mothers giving birth. From 2000-2015, the maternal death rate fell by more than a third. The reduction has been consistent over time and covering most underdeveloped countries.

That’s why it is so striking that, in the United States, maternal mortality from pregnancy or childbirth complications has risen almost the same percentage. Among the developed countries, only Mexico has a higher maternal mortality rate. The explanation is multi-factorial: increased maternal age, increase in chronic illness during pregnancy, and substance abuse in many communities are some of the reasons.

In the face of this startling statistic, many efforts are being made to reduce or reverse the trend. On both the national and local level many organizations are dealing with the underlying reasons for maternal mortality: The Council on Patient Safety in Women’s Health Care, the Alliance of Innovation in Maternal health, and “Merck for Mothers” are three of the groups focused on reversing the maternal mortality rate in the U.S.

They are sponsoring technical assistance to local hospitals to address some of the major problems, such as obstetric hemorrhage, severe hypertension, and venous thromboembolism. The Merck for Mothers program funds local groups that use community health workers to improve health care system navigation for low-income pregnant women.

The problems have been most persistent in African-American women, who have a four-fold risk of maternal mortality. So some programs are focused on improving health education and outreach in that particular community.

The goal of these efforts is to bring the American mortality to levels comparable to those in Western Europe. At least, the hope is that the U.S. can no longer be next to last among all developed countries. We have the most expensive health care costs in the developed world, and it seems anachronistic that the quality of that health care is in such dire shape.

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Swedish Medical Center Notifies Patients About Infection Concern From Use Of Cardiovascular Surgery Device

Posted Monday, February 13, 2017 by Gene Moen

Swedish Medical Center recently sent letters to all patients who had undergone cardiovascular surgeries where a particular heater-cooler system had been used. The device, manufactured by LivaNova, a London-based medical device manufacturer, is used to warm and cool patients and had been used in 60% of hospitals. The letter from Swedish said “Upon notification by the FDA and CDC, Swedish Medical Center tested its heating and cooling devices and found NTM bacteria in several of the machines.”

The problem is that bacteria from the devices is believed to be found in aerosolized droplets of water from the heating and cooling loops. Dangerous levels of bacteria — Mycobacterium — were found to have grown in the devices and were being released into the air by the exhaust fan. Once released, the bacteria can settle into the patient’s open chest or infect other equipment used in the surgeries. The result can be a very slow-growing infection that may not be recognized for months or even years after exposure.

The FDA reported 32 cases of patient infections arising from the devices between 2010 and 2015, but acknowledged there may be many more that are unreported. The slow growing nature of the infections makes it difficult for doctors to relate it back to the use of a machine many months earlier.

The infections are difficult to treat, may become chronic, and can lead to death. More than 250,000 patients have had surgeries with this particular device, every year, so the number of infections could be substantial. Some lawsuits have already been filed against the manufacturer and these are likely to increase as more infections are diagnosed.

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Hospitals Acquiring Yet More Private Practices

Posted Thursday, February 9, 2017 by Gene Moen

The recent acquisition of Athena Women’s Health in Kirkland by EvergreenHealth Medical Center highlights the growing trend of hospitals to acquire private practices. Athena provides urology and urogynecology services. Evergreen also recently acquired Lakeshore Clinics, a multi-practice clinic providing Family Medicine, Internal Medicine, Pediatrics and Podiatry services in Bothell and Kirkland. The trend is defended as a means of providing better care at lower costs.

Some critics have said that this consolidation of health care services, and elimination of private practices, tends to focus more on the hospitals themselves, rather than on patients. One advantage for an acquiring hospital is that they ensure that patients from the clinics who need hospitalization will likely be sent to that hospital rather than to other, competing hospitals. A major advantage for the acquired clinics is that they can participate in the cost savings in obtaining everything from equipment and supplies to malpractice liability coverage. It may also mean that there will be more physicians in their medical specialties who can provide “cover” when a physician is not available to his/her patients. “Cover” means that if a physician is out of town, or simply has the weekend off, a call to the doctor’s office in an emergency will be referred to the covering physician to answer.

The days of the individual doctor or clinic practice is rapidly coming to an end. Whether that trend is good or bad for the patient, or reduces the cost of providing medical care, is yet to be determined. But one thing seems clear: within a short amount of time, there will only be a handful of hospitals or medical entities providing almost all of the medical services in the Puget Sound area, e.g., Multicare, Franciscan Health Services, Providence/Swedish, PeaceHealth, and the University of Washington.

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What Is A Life Care Plan?

Posted Monday, February 6, 2017 by Gene Moen

In any claim involving catastrophic or permanent disabilities, including medical malpractice claims, it is likely the claimant’s attorney will have a life-care plan prepared. That plan is intended to spell out the future needs and costs associated with the injury-related disability. The plan can be prepared by different professionals: there are many nurses who do such plans, but they can also be done by vocational specialists, physicians (especially physiatrists), and others who have special training or expertise in assessing the future needs of those who suffer life-altering injuries.

The common thread of all such plans is that they all reflect, and are based on, what a physician projects as future medical care needs. If the life-care planner is not a physician, he/she will usually discuss those future needs with a treating physician so that they are accurate and realistic. Other professionals, including nurses, vocational specialists, and housing specialists, may be consulted in the process.

The importance of the life-care plan is to not only project the future care needs but also the cost of meeting those needs. In a case involving permanent disabilities as an element of damages, the costs outlined in a life-care plan will likely be a major part of the damages claim. For example, in a birth trauma case with a child who has hypoxic ischemic brain damage and a long life expectancy, those costs may total in the tens of millions. But even for a case involving an older person who can no longer live independently, the costs of future 24/7 care or special housing costs may be very large.

For most life-care plans prepared for trial, an economist is also needed to calculate the present value of the future stream of costs. Washington law requires that future costs, as well as future income losses, be reduced to present value. If a care plan outlines annual or monthly costs, for example, the amount of money needed to pay those costs will be less than the simple total of the costs. This is because a sum of money, invested today, will provide an income stream that is greater than the amount invested.

Claimants’ attorneys must assess what items of the plan will be accepted by a jury. A life-care planner may think that a swimming pool would be helpful for aquatic therapy for a disabled claimant, but the attorney may decide that a swimming pool would be rejected by some jurors as excessive, even though the need may be defensible. Some attorneys feel that it is important to have a basic plan that meets minimal needs rather than one that meets all of the possible needs that could be projected, i.e., a “Chevy” plan rather than a “Cadillac” one. Sometimes an attorney will have a focus group view possible life-care plans so that potential juror reactions can be assessed.

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Is there a medical malpractice crisis?

Posted Thursday, February 2, 2017 by Tyler Goldberg-Hoss

Recently top Republican politicians have cited the medical malpractice “crisis” as a threat to US health care. This includes frivolous lawsuits forcing doctors out of business, and forcing doctors who do continue to practice to engage in defensive medicine – ordering unnecessary tests and treatment to protect themselves from the threats of lawsuits. All of this ends up making health care unaffordable for Americans.

Can it be true? Let’s look at some facts:

According to The Doctors Company, one of the nation’s largest health care provider insurers, doctors are paying less for malpractice insurance than they did in 2001 – and that’s not even adjusting for inflation. They are straight up paying less.

The number of malpractice claims has steadily dropped since 2003, and now there are half as many claims as back then.

And, while some studies suggest that as much as 3% of the nation’s $3.2 trillion in health care spending is related to malpractice cases and so-called “defensive medicine”, research cited in this blog has found that reducing patients’ civil remedies doesn’t save any money or change physician behavior.

However, top Republicans, including President Trump’s pick for Health Secretary Tom Price, want to make malpractice reform a key ingredient of the overall overhaul of the Affordable Care Act. This would include raising the burden of proof for patients claiming to have been injured, and limits on damages awards for those same victims. Dr. Price – an orthopedic surgeon before becoming a representative from Georgia – has suggested that making such changes to patients’ ability to recover in the civil justice system will save “hundreds of billions of dollars”.

Interestingly, Dr. Price and those like him don’t seem to be factoring in the good that civil lawsuits can do, not only for the particular victims of medical malpractice, but also by holding health care providers accountable, which makes us all safer.

As I often tell potential clients who call, I can’t take their case in part because I don’t think a jury comprised of 12 regular people would likely find against the doctor. The civil justice system is built in large part on the notion that citizens in the community invariably decide disagreements such as malpractice cases. Citizens who tend to like and trust doctors, nurses and other health care providers.

If I took frivolous cases – as Dr. Price seems to think attorneys like me do all the time – I’d soon be out of business. Again, it is because the jury system already works as a check, instead of restrictions like damages caps on a jury’s ability to decide for itself what proper compensation should be.

It can be difficult these days to distinguish between “facts” and “alternative facts”. In my view, “We currently have a medical malpractice crisis” is an “alternative fact”.

You can read a comprehensive article on the issue from the Washington Post here:

Top Republicans say there’s a medical malpractice crisis. Experts say there isn’t.

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