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The CMG Voice

Multiple Errors Can Result in Medical Tragedy

Posted Wednesday, November 20, 2013 by Gene Moen

A recent blog by a noted nurse-educator about the agonizing death of her grandmother illustrates the opportunity for multiple medical errors in today’s complex medical care system.

What started out as a simple overdose of a medication led to yet more mistakes and errors. She wrote that “no amount of industry knowledge on my part, no amount of elder advocacy and no keen interest in Medicare could have saved Tootsie from a textbook case of error, difficult transitions in care, unnecessary intervention, missed opportunities, and conflicting opinions and prognoses. No matter how good Tootsie’s medical care was, non-clinical factors such as hand-off communication, caregiver coordination and outpatient care management and support were overlooked.”

Here is a link to the full blog post:

Tootsie’s Story: Medical Error Takes a Life

Cases in which a long hospitalization results in death, especially of an older patient, are often very difficult to pursue. Unless a specific negligent act or omission can be identified as the key factor in the bad outcome, it can be impossible to sort out the many clinical and non-clinical issues that contributed to the death. And with so many providers being involved, including nurses, consultants, and various specialized providers, pursuing the case can require many different expert witnesses, thus adding to the complexity and costs of taking on the case.

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Nurses Complain About Electronic Medical Records

Posted Monday, November 18, 2013 by Gene Moen

All health care facilities are, or soon will be, required to maintain a patient’s medical records in electronic form. Almost all hospitals currently use EMR systems. Several U.S. companies are marketing and installing these systems. Using them has helped avoid some problems of hand-written charts, but also has created entirely new problems.

A recent medical blog entry outlined complaints that are being made by nurses about threats to patient safety presented by these EMR systems. Here is a link to the blog:

Another ‘Survey’ on EHRs - Affinity Medical Center (Ohio) Nurses Warn That Serious Patient Complications “Only a Matter of Time” in Open Letter

Complaints include medication errors, scanning issues, difficulty in timely accessing records, inaccurate drop-down menus, inaccurate medication times, an inability of nurses to ensure medications are scheduled correctly, and endless loops of computer prompts that are unable to be dismissed by nurses in an emergency.

Most plaintiff attorneys will also tell you that it is extremely difficult to review these records and accurately determine when key events or notations were made. Often, it is necessary to obtain the “audit trail” for the EMR system to determine when providers accessed the records and what was ordered and by whom.

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Oregon Medicaid program sues beneficiary to recover medical expenses it paid

Posted Monday, October 28, 2013 by Tyler Goldberg-Hoss

Sometimes resolving a medical malpractice or other claim for damages arising from personal injuries is only half the battle. Often the injured person has significant medical expenses due to the negligence of the defendant, and usually the entity that paid for those medical bills wants to be repaid in whole or in part.

This asserted right is called a right of subrogation, and depending on the intransigence of the entity asserting it, can be a barrier even to settlement itself.

See a previous post by Gene Moen on subrogation here:

Subrogation Claims

If no repayment agreement can be reached, unfortunately the insurance plan can sue the injured person to recover these medical expenses. Here is one such example:

Suit disputes Oregon’s claim in malpractice award

It is impossible to know why the parties in this case couldn’t resolve their differences, resulting in this lawsuit. But it serves as a reminder to any injured person with significant past medical expenses considering filing a personal injury claim that his or her insurance company will, sometimes very aggressively, attempt to recover the money they paid.

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Medical Liability Premiums Continue To Go Down

Posted Wednesday, October 16, 2013 by Gene Moen

A recent article in a medical publication stated that malpractice insurance premiums for three representative specialties have gone down for the past two years, albeit by small amounts.

Malpractice Premiums Drop for 6th Straight Year

The reason, it seems likely, is that the number of malpractice lawsuits has decreased steadily over the past five years. Yet the national medical organizations as well as the insurance carriers continue to “cry wolf” and contend that doctors are being priced out of the malpractice insurance market because of frivolous medical malpractice lawsuits.

The real question that should be asked is “why are the number of malpractice lawsuits going down when there continue to be huge numbers of deaths from preventable medical errors?” See my earlier post on this here: Estimates of Annual Deaths From Medical Mistakes Grow Higher.

The answer to that question is simply that malpractice lawsuits are so expensive and risky that most attorneys cannot afford to take on a case with modest damages. Many people who suffer because of medical negligence find that the courthouse doors are effectively shut to them.

The high expenses associated with malpractice cases are the result of two factors: the willingness of malpractice insurance carriers to spend large amounts of money defending even meritorious claims, and the fact that almost all malpractice cases require expert testimony that is becoming increasingly expensive. It is not uncommon for experts in specialties such as neurosurgery or neuroradiology to charge up to $1,000 an hour or more and to require prepayment of $3-5,000 simply to agree to review a potential case. An attorney handling such cases on a contingent-fee basis not only faces the risk of not getting paid for her or his time if the case does not resolve favorably, but also absorbing the out-of-pocket costs of prosecuting the case if, as is common, the clients cannot afford to pay those costs.

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Questions About Robotic Surgery Grow

Posted Thursday, October 10, 2013 by Gene Moen

In the last several years, there has been a huge increase in the number of surgeries performed with robotic devices, usually manufactured by one company that has aggressively marketed them to doctors and hospitals. In a robotic surgery, the doctor sits at a console away from the patient and uses hand and foot controls to move the instruments inside a patient’s body. The doctor can see the anatomy through a video feed.

Although touted as a more precise way of performing many surgical procedures, studies have not shown a significant increase in good surgical outcomes. A major worry is that doctors and hospitals are pressured to buy and use the devices because patients demand it based of the extensive advertising done by the manufacturer. There are also issues related to training on the machines and the number of surgeries needed before a doctor becomes proficient in using them.

Numerous lawsuits have been filed over poor outcomes and deaths that have occurred when the robotic device is used, with some of the lawsuits naming the manufacturer based on the aggressive advertising and marketing that has been done.

Here is a link to a recent article about this:

Robot Surgery Damaging Patients Rises With Marketing

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