Our Michigan birth injury attorney has written extensively about the epidemic of preventable medical errors, much of which causes death. Medical errors are the third leading cause of death in the U.S., and this month, patient safety leaders told a senate panel that these errors are not decreasing. In fact, hospitals are no safer now than they were 15 years ago. In the last 15 years, there has been significant, well-published research discussing the crisis of preventable hospital deaths and injuries. There have been dozens of congressional hearings on this subject. Health care policy experts have published numerous articles on measures hospitals can take to decrease medical mistakes. Yet, hospitals, state medical boards and the federal government are failing to implement policies to reduce medical mistakes and make hospitals safer, leaving medical mistakes as one of the top 3 causes of death in this country, alongside heart disease and cancer.
One out of every six deaths in the U.S. is caused by a medical error. Ten to twenty times that many people will survive these mistakes but have severe injury. Every year, over 400,000 premature deaths are caused by preventable hospital errors, and millions of people are severely injured. These numbers are from research reported in the Journal of Patient Safety, published in 2013. The study found that a baseline of 210,000 preventable deaths occurs every year, but that the actual number of deaths caused by hospital error is estimated to be 440,000 because the study didn’t capture diagnostic errors, errors in which treatment should have been provided but was not, and because medical records sometimes miss evidence of harm.
Indeed, hospitals and policy-makers have been aware of the epidemic of preventable hospital deaths: in 1999, the Institute of Medicine shocked the medical community when it reported that up to 98,000 people die each year due to medical mistakes. In 2010, the Office of Inspector General for Health and Human Services found that negligent hospital care contributed to the deaths of 180,000 Medicare patients in a given year.
At this month’s hearing by the Senate Subcommittee on Primary Health and Aging, Harvard School of Public Health professor Ashish Jha informed the panel that if the question is “are patients clearly safer in U.S. hospitals today than they were 15 years ago, the unfortunate answer is no.” Dr. Jha said, “We have not moved the needle in any demonstrable way overall. No one is getting it right consistently.”
ERROR GO UNREPORTED, NEGLIGENT PHYSICIANS SELDOM HAVE LICENSES REVOKED, & HOSPITALS ACTUALLY PROFIT WHEN ERRORS AND COMPLICATIONS OCCUR
Given the evidence of such an alarming number of preventable deaths and injuries caused by hospital error – as well as the widespread media attention this subject receives – why aren’t hospitals getting any safer? The New England Journal of Medicine (NEJM) recently published a study that shows that when physicians become aware of errors made by their colleagues, these mistakes are seldom reported or brought to light. In fact, in a large study of Medicare patients, investigators found that 86% of all medical errors went unreported. Another study found that when hospitals identify the preventable errors that are occurring at their institutions, the hospitals’ policy makers rarely implement new policies and procedures to keep the errors from recurring. Making matters even worse is the fact that when physician errors actually are reported (e.g., a physician has clinical privileges removed or restricted) most state medical boards take absolutely no disciplinary action against the offending physicians. This means that physicians who have been disciplined by or fired from their hospitals are free to work at any medical institution in their state.
Shortly after the Journal of Patient Safety reported the large number of preventable hospital deaths and injuries occurring in the U.S., a study was published in the Journal of the American Medical Association (JAMA) in which researchers found that hospital profits actually increase when patients suffer complications or errors after surgery. Investigators reviewed approximately 35,000 surgical cases and discovered that patients with private insurance who experienced surgical complications or errors increased hospital profit margins by 330%. When Medicare patients suffered from surgical errors and complications, hospital profits increased by 190%. The reason errors and complications cause hospital profits to rise is simple: patient complications cause an increase in the number of tests and procedures performed, as well as lengthier hospital stays, all of which can be billed to patients’ insurance or Medicare.
Implementation of new policies throughout a medical institution is costly. And when hospitals actually profit from mistakes and complications, one might wonder if that can affect a hospital’s sense of urgency in implementing policies to make the medical center safer. A sad fact that cannot be denied is that hospitals have been aware of the very high number of deaths and injuries caused by medical error and most institutions have done absolutely nothing to change policies and prevent these deadly mistakes.
STEPS TO HELP YOU STAY SAFE DURING YOUR HOSPITAL STAY
Regardless of the reasons policy-makers have failed to implement meaningful plans to curtail the incidence of preventable hospital mistakes, the high rate of death and injury caused by these errors means that it is crucial for patients to be active participants in their health care. There are many steps patients and their family members can take to help prevent mistakes from occurring during a stay in the hospital. These steps include the following:
- Make sure medical personnel wash their hands when entering the patient’s room
- Make sure items that are used on multiple patients, such as a stethoscope, are wiped off with an alcohol swab before being used on the patient
- Make sure the patient is given the correct medication and dose
- Record and report mistreatment or neglect
- Bring a voice recorder, phone or camera
- Ask questions and demand answers
- Write down the names of the patient’s caregivers
- Review medical records for mistakes
- Employ the use of a “patient sitter” or “nanny cam”
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. In fact, a patient sitter is always a good idea. Potential hospitals should be vetted. When choosing a hospital, make sure the facility will allow a patient sitter to be present at all times. Patient sitters can ensure that caregivers 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 at any time, 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. Hospitals may make this difficult, especially during non-visiting hours, which is why it is important to discuss this with the medical center before admission. 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 operation.
HOW TO PREVENT MEDICAL MISTAKES & BIRTH INJURIES FROM OCCURRING DURING DELIVERY
When a mother is in the hospital to give birth, an 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. The key is to have a staff member skilled enough to detect even the early, subtle changes that indicate that distress in a 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 a baby during labor and delivery.
Close monitoring of a baby’s heart rate is always important during or near the time of delivery. 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.
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 physician has the capacity 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 her 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:
- Are you skilled in fetal heart rate tracing interpretation, and how many years of experience do you have?
- Will my baby have continuous electronic fetal heart rate monitoring?
- 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 becomes distressed, do you have the ability to deliver her 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 right after delivery?0
BIRTH INJURIES, CEREBRAL PALSY & HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE)
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.
- Uterine rupture – This occurs when the uterus (womb) becomes torn through all of its layers, which can cause oxygen deprivation in the baby, and the baby may even leave the womb and enter the mother’s abdomen
- 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
- 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 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, such as meningitis
- 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
- 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
- Use of Pitocin and Cytotec – These drugs can cause contractions to be too strong and frequent, which can severely deprive a baby of oxygen
MICHIGAN BIRTH INJURY ATTORNEY HELPING CHILDREN WHO HAVE HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE) & CEREBRAL PALSY
When labor and delivery are not properly managed, a baby can suffer from brain bleeds or 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 at 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. Birth injury lawyer Jesse Reiter, president of the firm, has been focusing solely on birth injury cases for over 28 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).
If your child was diagnosed with a permanent disability, such as a seizure disorder, 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. Our award winning attorneys are available 24/7 to speak with you.