Profiting From Harm: Hospitals and Medical Mistakes

An in-depth study recently published in the Journal of the American Medical Association (AMA) found that hospitals profit when patients suffer from complications or errors after surgery. The reason for this is quite simple: complications and errors mean more tests, procedures and lengthier hospital stays, all of which can be billed to patients’ insurance or Medicare.

The JAMA study examined approximately 35,000 surgical cases and discovered that those with private insurance who experienced surgical errors or complications increased hospital profit margins by 330%. And when it came to Medicare patients experiencing surgical problems or mistakes, hospitals increased their profits by 190%.

This is very troubling data, especially since it comes on the heels of other reports of practices in the medical field that cause harm to patients. Recent research in peer reviewed journals has found the following:

  • Approximately 1 of every 6 deaths in the U.S. is caused by preventable hospital mistakes. Ten to twenty times that many patients will survive the mistakes but have severe injuries. In total, well over 400,000 patients are killed in hospitals annually by preventable errors, and millions of patients suffer serious harm from these mistakes.
  • When physicians become of aware of mistakes made by other physicians, these errors are seldom reported or even brought to light. In fact, one study found that 86% of medical errors that occurred were never reported.
  • Multiple studies have found that when hospitals identify preventable errors that are occurring at their institutions, they seldom implement new policies to keep the errors from recurring.
  • When mistakes made by physicians actually are reported (i.e., the physicians’ hospital/clinical privileges were restricted or revoked), most state medical boards do not take any actions against these physicians. This means that these doctors are free to practice medicine anywhere in the state because their medical licenses remain intact.

When these studies circulated through the media, people were left wondering why hospitals are becoming less safe. One would think that with so much money being spent on research to detect preventable hospital errors and to uncover policies (or lack thereof) that harm patients, something would be actually be done to prevent the needless harm and death of hundreds of thousands of patients.

But implementing new policies throughout a hospital is costly. And when hospitals actually profit from mistakes and errors, one might wonder what the incentive for implementing policies to reduce preventable errors would be. Certainly, the incentive should be less patient injury and death. The sad fact is that hospitals are aware of the troubling research and most have done absolutely nothing to change policies and prevent deadly errors.

This research and inaction on behalf of hospitals nationwide raises many questions. Should the federal government use their power to force hospitals into implementing policies to reduce errors? This would only work for Medicare patients. Pushing hospitals to improve the level of care for privately insured patients would be much more difficult. Perhaps tough legislation could affect change in hospital policies and reduce preventable errors. But the road to this type of legislation would certainly be paved by opposition from the well-financed pro-hospital lobbyists. Still, this type of legislation is possible if the troubling research about the medical field is kept in the media and patient advocacy groups join forces to advocate for life-saving hospital legislation.

Michigan Birth Injury Lawyer Discusses How To Stay Safe In The Hospital

Aside from supporting patient advocacy and lobbying groups, there are many steps patients and their family members can do to try and prevent negligence during a stay at the hospital. Listed below are some steps that can be taken to help prevent errors from occurring:

  • Make sure the patient is given the correct medication and dose.
  • Record, review, and report mistreatment or neglect.
  • Bring a voice recorder, phone or camera.
  • Ask questions and demand answers.
  • Write down the names of caregivers.
  • Review medical records for mistakes.
  • Trust your instincts because if something feels wrong, it probably is.
  • Employ the use of a “patient sitter” or “nanny cam.”

It is very important for the patient to play an active role in her treatment. If the patient is not fully awake and aware of her surroundings, it is a good idea to have someone sitting next to her as often as possible. When choosing a hospital, make sure the facility will allow a patient sitter to be present at all times. Patient sitters can help make sure that medical personnel wash their hands, don’t pull on items that can pull out lines that are in or on the patient’s body, and thoroughly read the chart of the patient. Lack of hand-washing and failure to read a patient’s chart (especially after a shift change) are well documented causes of preventable harm to a patient.

Patients must remember that they are in charge. They have a right to read their charts and medical records whenever they want, and people given permission by the patient also may read the records. If a patient wants a patient sitter, she has the right to have one. Some hospitals may make this difficult, especially during non-visiting hours, which is why it is important to discuss this with the hospital prior to admission. In addition, patients should feel free to ask as many questions as they want. For example, it is important to ask the treating physician or staff member performing a procedure how many times she has performed the particular procedure, test, or surgery.

How To Prevent A Medical Mistake Or Birth Injury From Occuring During Delivery

When a mother is in the hospital for labor and delivery, a very important question to ask is how competent the staff is at interpreting fetal heart rate tracings. It is crucial to make sure that staff is present to review the tracings, and that the staff members, especially the primary obstetrician, have experience and skill in interpreting the tracings. Indeed, a 2013 study from Johns Hopkins found that 80,000 deaths AND 80,000 severe injuries each year are caused by wrong, missed or delayed diagnoses. Even if a physician misses a diagnosis that can affect the well-being of an unborn baby, the baby’s distress will be noted on the fetal heart rate monitor, in most cases. The key is to have a staff member skilled enough to detect even the early, subtle changes that indicate that distress in the baby is imminent. Research shows that a lack of skill in fetal heart tracing interpretation and a breakdown in communication among the medical team are major causes of preventable injury to the baby during labor and delivery.

Close monitoring of a baby’s heart rate is always important during or near the time of birth. This is because the fetal heart rate is often the only indication of how well the baby is doing. If a baby starts to suffer from a lack of oxygen to her brain while in the womb, the fetal heart rate monitor will indicate this.

How Hospitals Profit From Harm | ABC Law Centers

There are many conditions that can occur during labor and delivery that can cause a baby to be oxygen deprived and in distress. Thus, it is also crucial to make sure the labor and delivery unit and physician have the ability to perform an emergency C-section if needed. Of course, it is the duty of the physician to get informed consent from the mother for any procedure performed. This means that the physician must explain the risks, benefits and alternatives of all procedures and potential delivery methods. But when a baby is in distress, a C-section is often the best (and sometimes only) way to quickly deliver a baby to prevent brain damage when she is being deprived of oxygen in the womb. Certain conditions, such as cephalopelvic disproportion (CPD) and total placenta previa, require a C-section delivery.

We have written several pieces regarding how to choose an obstetrician for pregnancy and delivery. Listed below are a few important questions to ask a potential obstetrician:

  • Will my baby have continuous electronic fetal heart rate monitoring?
  • Are you skilled in fetal heart rate tracing interpretation, and how many years of experience do you have?
  • Is there at least one other person involved in my labor and delivery that is skilled at fetal heart rate tracing interpretation?
  • If my baby gets in trouble, do you have the ability to deliver my baby very quickly by emergency C-section?
  • How many years of experience do you have in performing emergency C-sections?
  • Is there an additional physician immediately available in the event that multiple dangerous conditions occur simultaneously, such as my baby and I having difficulty at the same time?
  • Is there proper resuscitation equipment immediately available in case my baby needs to be resuscitated at birth?

Cerebral Palsy, Hypoxic Ischemic Encephalopathy (HIE), And Birth Injuries

Listed below are some events that require a lot of physician skill. If these conditions are not handled properly, a baby can suffer permanent injuries such as hypoxic ischemic encephalopathy (HIE) and cerebral palsy.

  • Placental abruption. In this condition, the placenta tears away from the uterus, either partially or fully. If the tear is at the umbilical cord, the baby could be totally cut off from her oxygen supply.
  • Uterine rupture. This occurs when the uterus (womb) becomes torn, which can cause the unborn baby to enter the mother’s abdomen.
  • Placenta previa. This is when the baby covers the birth canal opening (the cervical os) either totally or partially. If this condition is present at delivery, the baby must be delivered by C-section.
  • Umbilical cord compression. When this occurs, the baby’s cord exits in front of her, which can cause the cord to be impinged upon (squeezed) by the baby’s body and the mother.
  • Nuchal cord. This is when the baby’s umbilical cord is wrapped around her neck.
  • CPD and macrosomia (large baby). CPD occurs when the baby is too large for the size of the mother’s birth canal/pelvis.
  • Premature rupture of the membranes (PROM). PROM is when the mother’s water breaks before she is in labor. This can cause premature birth and chorioamnionitis.
  • Breech or face presentation. These conditions occur when the baby is not in the normal, head-first position. In breech presentation, the buttocks are in a position to exit the birth canal first, and in face presentation the baby’s face presents first.
  • Chorioamnionitis. This is an infection of the placenta and fetal membranes, and if not properly managed during delivery, the infection can travel to the baby’s brain and cause permanent brain damage.
  • Misuse of a vacuum extractor and forceps during delivery. These are risky delivery instruments that attach to the baby’s head. They increase the risk of head trauma and brain bleeds. Sometimes these instruments actually slow down the delivery process, such as when they are being used by an unskilled physician. Furthermore, the instruments frequently are used when the physician should have quickly performed an emergency C-section.
  • Use of Pitocin and Cytotec. These drugs can cause contractions to be too strong and frequent, which can severely deprive a baby of oxygen.
  • Preeclampsia. This is when the mother has high blood pressure, which can cause a decrease in the supply of oxygen-rich blood going to the baby.

Michigan Cerebral Palsy Lawyers Helping Children Who Have Birth Injuries, Hypoxic Ischemic Encephalopathy, And Cerebral Palsy

When labor and delivery are not properly managed, a baby can get brain bleeds or suffer from a lack of oxygen in her brain for other reasons. When a baby goes without sufficient oxygen for too long, permanent brain injury can occur. Babies can end up with cerebral palsy, hypoxic ischemic enecephalopathy (HIE), periventricular leukomalacia (PVL), intellectual and developmental disabilities, seizure disorders, and hydrocephalus. Babies can also become brain damaged if an infection in the mother is not properly managed and it travels to the baby’s brain after birth. Permanent brain damage in a baby can also occur if a baby’s blood sugar or bilirubin levels are not properly monitored and treated when abnormal.

Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children for over two decades. Cerebral palsy lawyer Jesse Reiter, the president of the firm, has been focusing solely on birth injury cases for 25 years. He is currently recognized as one of the best medical malpractice lawyers in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).

How Hospitals Profit From Harm | ABC Law Centers

If your child was diagnosed with a permanent disability, such as HIE or cerebral palsy, the award winning lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation.

 


Sources:

1.  Eappen S, Lane BH, Rosenberg B, et al. Relationship Between Occurrence of Surgical Complications and Hospital Finances. JAMA. 2013;309(15):1599-1606. 2.  James, John T. “A new, evidence-based estimate of patient harms associated with hospital care.” J Patient Saf 9.3 (2013): 122-128.3.  Gallagher, Thomas H., et al. “Talking with Patients about Other Clinicians’ Errors.” New England Journal of Medicine 369.18 (2013): 1752-1757.4.  Levinson, Daniel R., and Inspector General. “Adverse events in hospitals: national incidence among Medicare beneficiaries.” Department of Health & Human Services (2010).5.  Levine, Alan S., Robert Eugene Oshel, and Sidney M. Wolfe. State medical boards fail to discipline doctors with hospital actions against them. Washington DC: Public Citizen, 2011.6.  Woolf, Steven H., et al. “A string of mistakes: the importance of cascade analysis in describing, counting, and preventing medical errors.” The Annals of Family Medicine 2.4 (2004): 317-326.

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