WhiteCoat

Healthcare Update — 10-06-2010

The self-service emergency department. If they have a vending machine for Percocets, they may be on to something.

Hospital staff fails to realize umbilical cord wrapped around newborn’s neck during labor, allegedly causing oxygen deprivation and severe brain damage. Mother and father each awarded $5 million by federal court after child’s death.

Crime or no crime? Man gets upset in emergency department, rips out his IV, and runs about the ED spraying blood over other patients. Eleven year old boy with a laceration gets blood on him. Dad wants to press charges.

Malpractice or no malpractice? Patient with chronic brain shunt for hydrocephalus goes to emergency department for evaluation of headache. She gets transferred to neurosurgeon who evaluates her and discharges her. She sees several physicians in follow up. Five months later, the patient develops a brain infection. Would a brain infection for 5 months not have killed the patient? The issue never got to a jury because the case was settled for $9 million. A court of appeals upheld the settlement.

Survival in an Emergency DEPARTMENT. A NY Times photographer spends a week in a Brooklyn, NY emergency department and gets a nice set of pictures.

Its all about the Benjamins. Minnesota’s Hennepin County Medical Center will begin turning away poor and uninsured patients who live outside Hennepin County and who present to its emergency department for nonemergency treatment. By doing so, the hospital estimates that it will save about $600,000 per year. Between 2008 and 2009, the hospital lost $6.6 million treating more than 11,000 patients who lived outside Hennepin County. If you’re an illegal immigrant, you’ll still get care, though. The County board voted down a proposal to limit care to U.S. citizens or immigrants with a green card.

Iowa seniors getting dumped by insurance companies. Insurance companies in Iowa will no longer provide private Medicare Advantage plans after the end of this year. Seniors will be required to either find a different Medicare Advantage plan or to go back into the government insurance plan. Wonder why this is happening?

Should evidence of a $1.4 million life insurance payout and social security payments of $3,300 per month be admissible when a jury is determining liability in a medical malpractice case? Plaintiff attorneys call such disclosures “prejudicial.” I tend to agree that collateral source payments don’t have a lot to do with determining whether malpractice was committed, but they have everything to do with the amount of damages awarded — and therefore with the plaintiff attorney’s contingency fee. Now a Wisconsin appeals court gets to decide the issue.

More violence in the emergency department. Shooting from night club carries over to hospital. Twenty year old man fatally shot in the entrance to the emergency department.

Sometimes you just can’t win. First the radiologists bash us for doing too many CTs in the emergency department. Now they put out a study suggesting that more CTs in the emergency department is a good way to rule out cardiac disease. A year from now, we’ll be the bad guys again because the number of CT scans in the emergency department will go up even further.

Truth is stranger than fiction. Man shoots his girlfriend in the head in hospital parking lot, then checks into the emergency department to be evaluated for back pain. His family members pick him up from the ED and take him home. Twelve hours later he calls police to confess, then barricades himself in a shed and refuses to come out alive.

Right idea, wrong conclusion. Dr. Danielle Ofri calls emergency care the new primary care and states that “providing health insurance for all its people is an obvious basic tenet of civilized society.” Great. Give everyone Medicaid “insurance.” Then watch how all the patients with “health insurance” still can’t get the care they need. It’s all about the access. Health care insurance doesn’t mean access to medical care any more than car insurance means you have access to a car.

14 Responses to “Healthcare Update — 10-06-2010”

  1. SeaSpray says:

    Well …if either the father or son got AIDS or hepatitis …what was it an act of God?

    I guess one of those freak things. If the patient is mentally challenged for whatever reason …then how do you prosecute that?

    If the man’s mental status/lack of mental competence wasn’t obvious to the staff ..how could they be held accountable?

    But if the boy or father contracted a disease because of the out of control situation …well how would anyone feel about that? It would seem something should be done.

    But if the patient tested negative ..they should just drop it. Be glad it was negative and nothing to worry about.

    I would wonder about hospital security. Although ..they aren’t mind readers and still have to get the call to get in there.

  2. Matt says:

    ” I tend to agree that collateral source payments don’t have a lot to do with determining whether malpractice was committed, but they have everything to do with the amount of damages awarded — and therefore with the plaintiff attorney’s contingency fee.”

    You’d have a better argument in this case if we were talking about bills paid by a health insurer. But we’re not.

    We are talking about life insurance, which pays regardless of the cause of death (excepting suicide usually). People take out life insurance often for very specific purposes – such as paying off a house, or paying a loan related to a business. That has nothing to do with the damages in a medical malpractice case.

    Likewise with Social Security – she would have received that money anyway upon his death. Has nothing to do with the damages resulting from medical malpractice.

    You should stick with making the collateral source argument with regard to medical bills paid by a third party. It’s not a great argument, but it’s better than these two sources.

    • Matt says:

      The other question is why should someone who causes a harm not pay the full amount of the damages caused by their harm?

      Typically, when we’re dealing with health insurance – the usual source of collateral payments, there is a subrogation right anyway, so there is no double benefit to the plaintiff. The only real benefit they get is they don’t get harassed by collection agencies for medical providers. And they don’t go on the public dole – which is a benefit to the rest of us.

    • VA Hopeful says:

      I think it would depend on what you’re awarding money for. Often it is for future costs/lost wages, usually medical. If that is the case, then I think other sources of payment would factor in. Likewise for pain and suffering. If we determine that X outcome is worth X dollars in pain/suffering, and plaintiff has received Y dollars, then I don’t think its unreasonable to subject Y from X since it is a set amount of money to offset whatever badness happened. It seems to me that the source of the money shouldn’t matter. Obviously this wouldn’t matter if the damages were punitive.

      • Matt says:

        Why should they factor in? If I run you over today, why should I get a break on the damages because you had the good sense to have health insurance?

        It’s really a moot question with insurance, anyway, because the health insurers have a right of subrogation. That shouldn’t come into evidence if I have to pay it back out of the award.

  3. No crime was committed? Spraying me with blood is battery. That may not be prosecuted in cases where no serious harm occurs, but it’s still a crime.

    If the patient was nuts, this simply adds on to the list of “dangerous to others” reasons to lock him up rather than leaving him wandering around to repeat.

    • Aaron says:

      I’m going to have to agree with battery, especially since the boy tested positive.

      • Steve says:

        The boy didn’t test positive…it sounds like they did prophylactic treatment to prevent infection pending the results of the man’s HIV test

        This seems odd for two reasons- first, it shouldn’t take that long to get an HIV test- the rapid ones can be done in 10 minutes, at the most an hour if it has to be sent to the lab.

        Second- that sounds like a pretty low risk exposure to me- I am surprised that the HIV medications to prevent infection in the boy were even indicated. It’s not like it was a large bore needle from a vein or artery that penetrates deeply into skin which is generally considered the highest risk for infection. Blood on an open cut is pretty low risk

    • WhiteCoat says:

      Much of this goes to a question of intent.
      If the patient ran about the emergency department shaking his arm trying to get the tape off, he may have negligently sprayed blood on other patients, but he didn’t have the intent to get the blood on them that is required for battery. Maybe he was struggling with the police when the splattering occurred. Still no intent.
      If the patient looked at the kid, stopped, and flung blood on him, then battery occurred. From the description in the article, I don’t think this occurred.
      In terms of testing, immediate tests are done to make sure that the person exposed doesn’t already have the disease, not to see whether they caught the disease from the exposure. It usually takes weeks to months for tests to turn positive – depending on the disease.

      • DensityDuck says:

        Intent isn’t necessarily required for charges like battery or ADW. If you knew that shaking your arm around might spray blood, and that spraying blood on someone might transmit infection, then you can be charged and convicted; even if you didn’t intend to spray blood on a specific person, or even on any persons at all.

        It’s like throwing a brick off a bridge. Maybe you won’t hit the car driving by, maybe you won’t hit any cars at all, but you’re still throwing a brick where it might hit a car.

  4. SeaSpray says:

    The boy tested POSITIVE?

  5. Miss Chevious says:

    “Health care insurance doesn’t mean access to medical care any more than car insurance means you have access to a car.”

    Love it! I wish more people understood this!

  6. Chris P says:

    I was talking the “Health Insurance” issue over with a friend of mine the other day and had a bit of an epiphany, so I’ll see what everyone else thinks of it.

    The problem is that we call it ‘Insurance’. It is not insurance like other forms of insurance, where we are essentially paying a small amount now to allow someone else to assume the (low) risk of something bad happening with a large bill. Think of car insurance, homeowner’s, life, disability, etc. All fairly low risks of events.

    Health “Insurance”, on the other hand, is expected to pay for things that are more likely to happen (colds/flu/pregnancy), more predictable (age-related health issues, etc.), and in some cases even expected (office visits), yet we call it ‘insurance’ and expect that patients should be able to pay a low (relative) price for this service, which, as technology has progressed, has become more and more capable and at the same time more expensive.

    I don’t know the solution, but maybe if we stopped calling it ‘insurance’ we would have a better handle on the real problem.

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