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The CMG Voice

Why is Washington’s AG suing hospitals for withholding charity care from low-income patients?

Posted Friday, October 6, 2017 by Tyler Goldberg-Hoss

In the last few weeks, Attorney General Bob Ferguson has filed lawsuits against two hospitals for failing to provide charity care to low income patients. The lawsuits against St. Joseph Medical Center in Tacoma and Capital Medical Center in Olympia are based on the responsibilities of hospitals in Washington to provide free care to patients below the federal poverty level, and discounted care to patients with incomes up to twice the poverty level.

The law mandates that hospitals have to be proactive at the outset of determining whether a patient is eligible for charity care, and must provide notice in writing to patients that free or discounted care may be available. Hospitals also have the responsibility of interpret the information for patients for whom English is not their first language.

The lawsuit against St. Joes alleges that it has withheld charity care from tens of thousands of low-income patients since 2012. This includes making it harder for patients to get assistance, and billing patients for care that should be free or discounted.

The case against Capital Medical Center alleges that the hospital trained its staff to pressure patients for upfront payments without notifying them of the possibility of charity care or screening them for eligibility. In particular, the law requires that a patient only needs to verify his or her income with one form, such as a pay stub or tax statement. The lawsuit alleges that Capital required up to eight forms to verify income, creating an unnecessary hurdle to receiving charity care.

St. Joes and Capital Medical Center are not the only two hospitals that appear to be failing in this regard. Columbia Legal Services recently released a report on the subject. You can find it here:

Access Denied: Washington’s Charity Care System, Its Shortfalls, and the Effect on Low-Income Patients

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American Academy of Pediatrics recommends weighing all patients in Kilograms to prevent medication errors

Posted Monday, October 2, 2017 by Tyler Goldberg-Hoss

Recently the American Academy of Pediatrics (AAP) signed on to a statement by the Emergency Nurses Association that calls for the use of kilograms in the Emergency Department.

The announcement comes in the October issue of Pediatrics, and cites the sobering statistic that 40% of fatal medication errors can be traced to an error in dosing, with children being especially vulnerable.

The Nurses’ Statement includes the following recommendations:

You can read the full article in AAP News here:

To reduce errors, ED staff should weigh patients in kilograms

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Doctors Disagree About Whether Steroid Injections Increase Cartilage Loss In Knee Arthritis.

Posted Tuesday, September 26, 2017 by Gene Moen

It’s a common scenario. If you have chronic knee pain but want to avoid the cost and risk of knee surgery, you have periodic injections of corticosteroids. However, a recent study published in the May 16 issue of the Journal of the American Medical Association (JAMA) found that such injections can increase cartilage loss of the course of two years with minimal clinical benefit.

The study was a randomized controlled trial in which researchers compared outcomes between two groups of 70 patients. The average age was 58, and with symptomatic knee osteoarthritis identified through ultrasounds. The subjects underwent MRIs at the beginning and end of the study to see the effects on cartilage. Those who received the injections lost about two times as much cartilage as those in the placebo category (the latter received only saline injections).

Many physicians criticized the study and its findings. One physician commented that the measurable loss of cartilage over a 20 year period would be minimal (the thickness of a fingernail) and should not be a basis for discontinuing such injections. “If the knee is already badly damaged and the patient is not ready or safe for a total knee replacement there is a role for quarterly steroid injections.” Another physician wrote that he has given such injections for more than 20 years, and has thousands of patients who have had great improvement in their symptoms and ability to function.

The study was of quarterly injections given over two years, and one physician commented that this frequency of steroid injections exceeded the guidelines. “If I give you enough of anything it will make it appear dangerous. What’s next? Water can kill you, news at 11.” But yet another physician commented that steroid injections only provide temporary relief, and should not be given unless one wants to pay the price with cartilage damage over decades. He noted that veterinarians know that these injections should be avoided by anyone who wants to preserve their animal rather than replace them.

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Does A C-Section Mean Greater Hysterectomy Risks In The Future?

Posted Thursday, September 21, 2017 by Gene Moen

A large Danish study found that women who undergo C-sections are more likely to have future surgical complications from a hysterectomy. The study was published in JAMA Surgery. The conclusions were that there were higher rates of reoperation and other post-operative complications if a woman had a previous C-section.

The study authors hypothesized that a cesarean delivery resulted in more intra-abdominal adhesions or scarring, which “may complicate future surgery, leading to longer operating time and an increased risk of adverse events.” The adverse events included lower urinary tract injuries, increased need for blood transfusion, and readmission with 30 days. They noted that these same problems may arise in other types of pelvic and abdominal surgeries besides hysterectomies.

Examining the records of more than 7,600 women, the study found that about 12% of women who had cesarean sections before their hysterectomies had surgical complications within 30 days, including bleeding, infection, and perioperative lesions. There was a 30% increased risk of these complications for women who had two or more C-sections. One limitation of the study was noted: it did not control for obesity, and it only included women with a hysterectomy within 19 years of their first birth.

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What Does The “National Practitioner Data Bank” Have To Do With Your Case?

Posted Monday, September 18, 2017 by Gene Moen

In years past, there were stories about doctors who got in trouble in one state, and then moved on to the next, and then to the next, repeating their bad actions or negligent care. There was no way a hospital or insurance company could easily find out the history of a bad doctor. That is why the National Practitioner Data Bank (the “data bank”) was enacted into federal law. Now, every adverse action involving a doctor, whether payment of a malpractice claim or a state disciplinary action, must be reported to the data bank.

The public does not have access to the data bank, but hospitals, healthcare plans, licensing agencies, etc., can get information about past medical malpractice payments or other adverse actions affecting the doctor. So every doctor knows that, if he settles a claim — even for a nominal amount — that information will be accessed whenever he applies for admitting privileges at a new hospital or seeks liability insurance coverage from a new carrier.

What does this have to do with your medical malpractice claim? Almost all medical liability policies include a “consent to settle’ clause. That means the insurance company can’t even discuss settlement with your attorney unless the doctor consents to settlement. That is true even if the insurance company thinks there is liability and wants to settle to avoid additional costs and risks.

The doctor, on the other hand, knows that consenting to settlement will likely lead to some payment and therefore a notice to the data bank about the settlement. What used to be confidential, any settlement now is a “black mark” on the doctor’s record. Needless to say, this discourages the doctor from consenting to settlement.

Many policies have provisions allowing the insurance company to over-ride the doctor’s refusal to consent, but these are rarely utilized. No company wants to have a reputation that it puts its own interests ahead of its insured’s interests, because selling malpractice insurance is a competitive business. There is also some leeway in terms of whether a claim involves allegations of negligence against a particular doctor or whether it is an “institutional” claim against a hospital or clinic. For example, a failure to provide an adverse test result to a patient may be negligence on the part of the doctor, but may be largely a problem with a hospital’s policies and practices about how such results are handled.

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