WhiteCoat

Healthcare Update 04-09-2012

Lots more news at the Satellite Editions of this week’s update at ER Stories and at Medbloggers.org. If you’re interested in posting at Medbloggers, drop me an e-mail.

Stinky urine in children linked to urinary tract infections. Really. I’ll bet that runny noses in children are linked to head colds, too. C’mon. Are pediatricians that hard up for things to study?

$8.25 million settlement when 30 week old preemie (born at 24 weeks) dies after receiving dose of saline 60 times greater than prescribed after heart surgery.

Virginia woman sues hospital for failing to make sure that everyone who touched a patient “wore gloves, masks or washed their hands” and to assure that the patient received “clean, bacteria free medical equipment.” While in the hospital for a partial bowel obstruction, the patient had an IV catheter placed, later developed phlebitis at the site, and the localized phlebitis spread to her bloodstream and seeded in one of her knees.
I try to tell people this when they want to be admitted to the hospital – they aren’t safe places.

Las Vegas lawyer settles medical malpractice case for $238,000. Then the fun begins. In the initial distribution of funds, Medicaid was going to get $79,000, the patient was going to get $29,000, and the lawyers were going to get $130,000 – including fees and costs. A judge nixxed the distribution, giving the patient $95,000 and the lawyers $63,000.

Surgeon posts on Facebook that he has been “slaughtering the innocent” while performing surgery. Says it was intended as a light-hearted comment solely for another colleague, but apparently forgot that people other than his colleague use Facebook. Families whose loved ones have died under the surgeon’s care don’t appreciate the comments and complained to the licensing board.

California Center for Healthcare Reporting publishes a five-part series on emergency department “frequent flyers.” It is well done and explains things from both a patient’s perspective and a provider’s perspective. Definitely worth a read.

Wonder why there aren’t any physicians standing by at your marathon? One reason may be that malpractice insurance companies won’t provide them insurance. Although possibly an overblown fear – no examples of a physician sued for malpractice at a race could be found – just another example of how liability and/or perceptions about liability can affect the availability of medical care.

Disease mongering and how pharmaceutical companies earn millions of dollars from engaging in it. If there’s a disease, you must be able to purchase a pill to fix it.

After an LA Times reporter wrote a story about a “$5000 tummy ache” in the emergency department, he follows up with a second article discussing all the stories about how charges for medical care seem to be largely arbitrary. One physician’s daughter had an ultrasound that cost $3200 before insurance and cost $1700 after insurance discounts for his high-deductible plan … and only $250 when he decided to pay in cash and forget the insurance.

DEA busts six Florida Walgreens stores for dispensing too many pain killers (video file). Notice how the DEA is conspicuously not busting the patients that are purchasing the pain killers?

What data might the medical records be hiding due to HIPAA laws? Nick Genes and Kevin Baumlin have a nice article about how hiding data from medical providers can have unintended consequences. Administrators take note.

Patient awarded $3 million after radiologist mis-reads CT scan causing delay in diagnosis of colon cancer.

Another hospital/emergency department closure. This time it is not only lack of funding, but also governmental red tape. The Centers for Medicare and Medicaid Services would not grant the hospital a waiver to continue to operate while it worked to complete CMS certification. Now, the residents of Cheyboygan, Michigan have no hospital medical care. But I’m sure they’re safer – a lack of proper governmental paperwork might have killed them all.

Several states are now considering legislation that immunizes doctors from liability if they withhold information from a patient to prevent her from having an abortion. Doctors would also be shielded from liability if the patient developed an injury from the pregnancy that she would have aborted.
I don’t personally agree with abortion, but I also think a woman has a right to choose what happens to her body. Every patient has a right to be fully informed. Laws like this go too far.



24 Responses to “Healthcare Update 04-09-2012”

  1. DataGirl says:

    My city marathon (a Boston-qualifier) is set up such that medical aspects of the race are headed by a specific physician and his team (and there are also volunteer medical personnel present). Race participants sign waivers for medical services (if needed) ahead of time. So I am not sure why the malpractice thing is an issue. It is so important to have physicians present – too many people get the heat stroke/exhaustion. I have seen it countless times and it is so scary to watch someone succumb to the heat, having neurological issues and finally collapse.

    • ThorMD says:

      My malpractice insurance does not cover volunteer work. A participant signing a waiver does nothing to prevent them or their family from suing me. If they sue me, I must defend myself out of pocket. Even if I win, the defense can cost $100,000 to prove my innocence. Why would I ever consider volunteering? There is zero upside and a HUGE downside. It the event is in my city, then transport the patient to my ER where I can be covered by my insurance and get paid.

      Even though the magazine couldn’t find cases of doctors being sued at sporting events, there are innumerable cases of doctors being sued for volunteering at Summer Camps, for giving free advice to people etc. Which is really no different than volunteering at sporting events.

      I think the doctors who do it just don’t know any better and assume that their insurance covers them. I know plenty of Dermatologist and OB/GYN’s who think it’s fun to volunteer at these things. But I’m not sure I want a skin doctor treating my medical emergency.

      • Matt says:

        “there are innumerable cases of doctors being sued for volunteering at Summer Camps, for giving free advice to people etc.”

        There are?

      • ThorMD says:

        Is your lexisnexis broken?

      • Matt says:

        There aren’t. And I don’t have a national Lexis/Nexis database anyway. Waaayyyy too much money. But a simple Google search doesn’t come up with many actual suits. Lots of fearmongering though.

      • WhiteCoat says:

        Dermatologist who bumbles through an emergency resuscitation for want of knowledge may still be liable for bad faith even with Good Samaritan laws.

        As for legal research, try Google Scholar or FastCase. Lot cheaper than Lexis or WestLaw.

      • Matt says:

        Lexis is ideal for one state federal searches. Google Scholar isn’t ready yet as you can’t Shephardize(check to see if it has been overruled) I don’t believe. FastCase isn’t bad, I’ve just gotten used to Lexis.

      • DataGirl says:

        That really is so sad to hear. We haven’t had any of that happen here (malpractice suit of a doc helping a participant) – and this year we even had two people die at the finish line. I don’t know anything about the laws in terms of this, but perhaps there are differences in laws depending on the State? Anyhow on a long run once I became dehydrated and a doc stopped and gave me his own cytomax bottle. I didn’t sue him. :)

      • ThorMD says:

        I don’t have time to research to Matt’s delight, but I’ve heard Greg Henry talk about this issue many times and have linked in one of his articles. I can remember a case where he defended a doc who had been volunteering at a diabetes camp and was sued for a missed appy. There was another case of a volunteer opinion that resulted in a death and the family sued him. I think he cites another 1-2 in this article as well. I consider Greg an expert in this field and have learned a lot of risk management strategies from him. If he says you can get sued for volunteering and your insurance won’t cover you, then I believe him.

        http://www.epmonthly.com/columns/oh-henry/the-gray-areas-of-good-sam-protection/

      • DataGirl says:

        ThorMD it is sad that we have come to the point that physicians can only practice medicine under the auspices of the insurance carriers and within the confines of the hospital walls – too bad – and really too bad for the poor soul convulsing in the street while a doc stands idly by for fear of litigation.

      • Matt says:

        I think if out of over a million practicing physicians, and who knows how many little leagues, 5Ks, youth sports programs, etc., we can come up with only two cases, based on “someone told me about it”, and neither of which we know if they were successful, perhaps a mountain is being made of this molehill.

      • ThorMD says:

        Datagirl I think you may misunderstand. I would help someone convulsing in the street or someone who collapsed in front of me. I am covered under Good Samaratin laws and wouldn’t think twice about helping. On the other hand, I’m not going to volunteer to be a physician to “cover” a sports event in an assigned capacity as that potentially exposes me to unwanted litigation.

        I care more about the opinion of respected leaders in my field than the opinion an anonymous self proclaimed lawyer trying to bully me on the internet. Matt is giving his opinion to me for free, and it is worth that much to me. I would rather take advice from a lawyer, accountant, and risk manager who I respect and who have my best interests in mind when I pay them. The professionals I have hired in these areas have given me sound advice, and if Matt thinks that I’m making a mountain out of a molehill, then he can shout it as much as he wants because I really don’t care.

  2. That’s interesting about the marathon thing. Over here in the UK, when we cover even a half-marathon we essentially have a mini A&E department in our primary treatment centre (complete with resus bay). The doctor’s there make it a matter of pride that we only send a tiny number of patients to the local hospital.

    It’s a mad world…

  3. Matt says:

    Re: Walgreens. The DEA hasn’t actually busted anyone yet:

    http://articles.chicagotribune.com/2012-04-06/business/chi-dea-painkiller-probe-turns-to-fla-walgreen-stores-20120405_1_prescription-drug-abuse-pharmacies-oxycodone

    “Under the U.S. Controlled Substances Act, a warrant may be issued for “valid public interest” and without the type of probable cause needed under criminal law, according to the warrant filed in U.S. District Court, Middle District of Florida.”

    They’re just investigating it based on volumes of purchases, not informant purchases or anything like that. That statute may not be one you can convict an individual on. What you’re thinking of, WC, is probably covered under state law statutes since the purchase would be an intrastate crime.

    • WhiteCoat says:

      They’re looking at drug diversion and going after the suppliers, which is fine.
      However, the state also has a database of which patients are outliers for receiving narcotic medications. Not hearing too much being done about the ones doing the diverting, though.

  4. Matt says:

    Wonder why a case like that Las Vegas one settled so cheap? That poor kid’s ongoing care has to be in the millions.

    • WhiteCoat says:

      Bad lawyering.
      The appellate court chided the attorneys in the opinion and left both attorneys only $12,000 to divide among themselves after expenses.

      • Matt says:

        Yeah, but the client had to approve the settlement. Fault must not have been that strong.

      • WhiteCoat says:

        Wait. Are you making conclusions on a case without knowing all of the facts? ;-)
        Gotcha.

        I also wonder if the patient and her family just needed the money and wanted to settle as quickly as possible.

      • Matt says:

        No conclusions, I’m purely just engaging in idle speculation. Worth virtually nothing.

  5. Nick says:

    Thanks for the shout-out, Whitecoat!

    But I’ve got to say, this new trend of granting special status to data like HIV status or psych notes isn’t for HIPAA — medical records are already protected.

    Folks who want to sequester special bits of health data from other doctors are going above and beyond what HIPAA requires, and implementing it in a nonstandard way that can really keep us confused or in the dark about our patient’s histories. It could be a disaster for emergency care.

    • WhiteCoat says:

      No need for thanks, it was a very informative article.
      Medical providers have unfettered access to a patient’s medical records under HIPAA laws.
      However, uninformed administrators or IT departments look at Section 164.508 of HIPAA and assume that things such as psychotherapy notes are off limits without authorization. Same thing with staff that refuses to tall a caller whether a patient is in the emergency department, also citing HIPAA laws. That’s why I suggested that administrators should take note.

  6. defendUSA says:

    In 1964, I was born at the gestational age of 24 weeks. My mother had gained 60 pounds from the outset of pregnancy. I weighed one pound, 7 oz. according to her. I was monitored by a team of nurses. The only drug that my mother cam recall me receiving was theophylin(sp) and oxygen. I was breathing on my own, but the nurses periodically had to pinch my feet to remind me to breathe and I was fed intravenously for 2 months. I tripled my weight and home I went.
    I sometimes wrestle with how much intervention can be foisted upon the preemies and wonder if good old fashioned nursing and nurture is better than all the oxygen that can blind, or other drug side effects.
    In this case, how does 60 times more than necessary even happen????

  7. […] Shortage of physician volunteers at marathon sports events, readers of this site can guess the reason [Outside mag via White Coat] […]

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