Improving Patient Safety the Danish Way

Richard and Susan had no reason to believe that the doctor treating their child would make a mistake.  Yet, when Anna’s fever showed no signs of reducing, they went in for a second opinion, only to learn that Anna had been given the wrong medication.  It took just two days for Anna’s fever to subside with the new medication, but by then she had missed not only 10 days of school, but also her chance of making the cheerleader team, as she also missed out on the trials.  Looking at a distraught Anna, Susan wanted to file a medical malpractice case against the first doctor, but Richard explained that nothing would come out of it.  The cost of filing and pursuing the lawsuit would be more than the compensation, if any, that they would get.  At this point Anna looked up and said that it might have been better if they were living in New Zealand or Denmark.  Richard and Susan were both surprised at her remark and wanted to know why she felt that way.  Anna opened her laptop and showed them an article about Denmark’s approach to medical errors.

A Different Approach

Denmark has a comprehensive national program in place that compensates patients, who are harmed due to medical negligence or malpractice.  The primary focus of this program is to help patients who have been hurt by the health care system.  The compensation program in turn, makes available all data from these claims to hospitals and researchers.  However, this data is not used for rating healthcare facilities and personnel in the public domain, but allows the system to flag healthcare providers who have repeat errors and thus may pose a risk to the patient and the healthcare system.

Started in 1992, Denmark’s compensation program replaced the lawsuit-based approach, which was similar to the system followed in the US.  A series of high profile court cases, where the patients were unable to get compensation because it was too difficult to prove that the doctor did something wrong, triggered the change in the system.  Following the system used in Norway and Sweden, the Danish parliament took action and adopted the compensation program.  Under this system, medical injury claims are reviewed by medical and legal experts, where patients can participate in the review process and get answers, irrespective of whether they get the monetary compensation or not.  There are no charges for filing a compensation review claim and the patient’s are assigned a caseworker to help them through the process.  The detailed response, which the doctor or hospital have to file, can be rebutted by the patients, who have access to their medical records as well as the detailed explanation of the reviewer’s decision, through an online portal.

In case their claim is rejected, the patient may file an appeal, with no cost to the patient.   The appeal is reviewed by a seven member board comprising of doctors, two representatives of the Danish healthcare system, the patients representative and an attorney.  A patient may also request a district court review, although that has happened in just 2 percent of claims.  In case of medical negligence, a patient can file a report with a parallel system for professional discipline.

One of two criteria is most often applied by reviewers to patient claims of medical injury.  The first of these criteria’s is the “specialist rule” – which compares the treatment provided to that which an experienced specialist would provide.  Compensated if the treatment is found lacking, the patient can also be compensated despite the healthcare provider doing a good job, but not up to the specialist level.  The second criteria commonly applied by reviewers is the “fairness rule” –  where the patient is eligible for a compensation, if the patient has experienced a severe medical event that occurs less than 2 percent of the time.  Data shows that about one third of claims filed, result in compensation, paying out an average of $30,000.

The Advantages of this System

  • Although the average paid out is just about 15% of the average amount awarded in the US, more than 7 times as many claims are filed per capita in Denmark with 4 times as many patient’s per capita receiving some compensation.
  • Although the average compensation amounts may be low, the Government helps in cases of physical disabilities caused due to medical errors, by providing aides to help with the patient’s household chores.
  • Patients do not need to have claims running into millions of dollars.  Even claims of a few thousand dollars are worth filing, as there are no costs for pursuing such claims.
  • Information and compensation is provided to patients regardless of whether negligence is involved, resulting in providers being open about what took place.  This provides incentive for healthcare providers to apologize to patients, while also report errors that might show a pattern of mistakes.
  • About 10 percent of claims filed are by doctors on behalf of their patients.  With no threat of malpractice hanging over their heads, healthcare provides are very helpful to patients who have been harmed.
  • Danish healthcare providers are legally required to inform the patient if they have been harmed during their medical care.  The current system makes it possible for healthcare providers to do so, as there is no fear of being sued for monetary compensation.
  • Data collected and analyzed helps the healthcare providers to understand patterns of errors and take steps to rectify them.  With no threat of being sued or publicly humiliated, healthcare providers are forthcoming in providing data on mistakes committed by them.

The Danish system of pursuing medical claims is not foolproof, but it has resulted in a better and safer healthcare delivery system.  The program costs Denmark far less than the $10 billion that US providers spend on medical malpractice payouts and administrative costs.  The biggest advantage of the system is that patients and healthcare providers see themselves on the same side of the page, thus building a trust between them, which unfortunately is lacking in the US.

Richard and Susan could find no reason to disagree with Anne’s statement – at least in this case of Anne’s medical fiasco.


References

  1. Allen, O. P. (2016, January 03). How Denmark Dumped Medical Malpractice and Improved Patient Safety. Retrieved January 18, 2016, from http://www.truthdig.com: http://www.truthdig.com/report/item/how_denmark_dumped_medical_malpractice_and_improved_patient_safety_20160103
  2. Budryk, Z. (2016, January 11). Medical malpractice overhaul could save millions of dollars and improve patient safety. Retrieved January 18, 2016, from http://www.fiercehealthcare.com: http://www.fiercehealthcare.com/story/medical-malpractice-overhaul-could-save-millions-dollars-and-improve-patien/2016-01-11
  3. Transcript: January 25, 2013. (2013, January 25). Retrieved January 18, 2016, from http://www.pbs.org: http://www.pbs.org/wnet/need-to-know/transcripts-full-episode/transcript-january-25-2013/16159/
  4. Ulrich, A. (1994). An Evaluation of the Danish No-Fault System for Compensating Medical Injuries. Annals of Health Law , 1-40.

Why Doctors get Sued – the 2015 Malpractice Report

About 4000 primary care physicians and selected specialists were surveyed by Medscape in order to find out about the cause and effects of malpractice suits.

 

Top Reasons Doctors Get Sued

Top-Reasons-Get-Sued_IN_Dr.Patel

The survey covered areas like, if and why they were sued; the effect on their career and patient care decisions due to the lawsuit; and these doctors were asked to suggest methods to reduce the number of lawsuits.  The report shows the long-term effects, both emotional and financial, of malpractice suits on vulnerable doctors.

Have You Ever Been Named in a Malpractice Suit?

Have-You-Ever-been-in-Malpractice-Suit_IN_Dr.PatelThe survey showed that 59% of respondents have been named in at least one malpractice suit.  While nearly half (47%) were named in the suit along with others, 12% were the only parties sued.

Among the specialties surveyed, some were sued more than others; however, no physicians are immune to malpractice suits.

 

Percent of Physicians Sued

According to recent studies, the most likely to be sued among all physicians are obstetricians/ gynecologists and surgeons.  This was collaborated by the Medscape survey which found that Percent-of-physician-sued_IN_Dr.Patel85% of obstetricians/ gynecologists, 83% of general surgeons, and 79% of orthopedists have been sued.  

However, general surgeons and orthopedists had the highest percentage among specialties surveyed of being the only parties named at 23% and 26%, respectively; while obstetricians/ gynecologists came in third at 18%.

Nature of the Lawsuits

Nature-of-the-lawsuit_IN_Dr.PatelRespondents were asked to check as many options as were relevant, to the question about the nature of their lawsuits.  The highest numbers of suits (31%) were related to a failure to diagnose and patient suffering abnormal injuries.  Failure to treat (12%) came in at third place and was far behind the first two.  Less than 5% of respondents cited poor documentation or medication errors (both 4%) or failure to follow safety procedures or obtain informed consent (both 3%).

How Likely Are You to Be Sued By the End of Your Career?

64% of the physicians who responded to this survey had experienced atSued-by-the-end-of career_IN_Dr.Patel least one malpractice suit by the time they were 54 years old. With physicians at 60 years of age, this percentage rose to about 80%.  However, those who responded to this question, tended to be in specialties that had a higher likelihood of being sued.  As one respondent in the Medscape survey wrote, “The older you get, the more you have to lose.”

Are Men More Likely to Be Sued Than Women?

Are-men-more-likely-to-be-sued-than-women_IN_Dr.PatelWhile nearly two thirds (64%) of male respondents were sued as compared to less than half of women (49%); men were also sued more as the only named defendant in a suit (14%) as compared to women (8%).

The study indicated that women are sued less than men, regardless of the specialty.

How Often Does Malpractice Treat Influence Thinking or Action?

54% of physicians, who had been named in a lawsuit, responded that the Malpractice-Threat-Influence-Thinking-or-Action_IN_Dr.Patelthreat of another lawsuit affects them either always, with every patient (18%) or almost all the time (36%).  19% percent were rarely bothered, unless something went wrong with the patient or there was a trigger event.

The survey found that only 1% was never bothered by the possibility of a lawsuit.

Are Medical Organisations Doing  Enough to Reduce Lawsuits

Medical-Organisations-Doing-Enough-to-Reduce-Lawsuit_IN_Dr.Patel

While 24% of physicians felt that medical organizations were active and somewhat successful in reducing lawsuits, the rest felt that these groups were either pretty inactive, or just not doing anything at all.

 

 

Best Ways to Discourage Lawsuits

The survey allowed respondents to choose multiple options for best ways to discourage lawsuits.  81% felt that malpractice cases should be screened by a medical panel for its merit, before they can proceed.  Best-Ways-to-Discourage-Lawsuits_IN_Dr.PatelRoughly about half (48%) believed that cases should be tried before a health court.  Among verbal suggestions, unsurprisingly, many urged tort reform.  However, by far the most popular suggestion, particularly among male respondents, was to make the losing side pay.  A larger number of women respondents as compared to the men mentioned improved communication with patients as a way to discourage lawsuits.

Does “Choosing Wisely” Lead to More Lawsuit?

Choosing-Wisley-Lead-to-more-lawsuit_IN_Dr.Patel

Over a third (37%) of respondents believe that the Choosing Wisely initiative will lead to more lawsuits as compared to 24% who explicitly believe it will not.  The rest are unsure.

 

 

When I Learn That a Case Involved Real Errors, I Think…

When-I-Learn-That-a-Case-Involved-Real-Errors_IN_Dr.PatelMost physicians showed sympathy for colleagues who are sued, even in cases that involve actual errors.

While 64% felt that doctors are human and sometimes make mistakes, 41% admitted that some doctors were negligent and incompetent.

 

I  would Sue Another Doctor Whose Error Harmed Me

I-Would-Sue-Another-Doctor-Whose-Error-Harmed-Me_IN_Dr.Patel

While over 25% of oncologists, anaesthesiologists, and radiologists would sue a colleague, only 15% of obstetricians/ gynaecologists and 17% of primary care physicians would do so.

 

Work Setting and Risk for Lawsuit 

Work-Setting-and-Risk-for-Lawsuit_IN_Dr.PatelMalpractice suits in office-based solo practices (70%) or single-specialty groups (64%) were found to be the highest.  The second lowest percentage (53%) reported were in office-based multispecialty groups. Surprisingly, the least likely to face lawsuits (47%) were outpatient clinics.

 

Were You Surprised to Be Sued?

Were-you-surprised-to-be-sued_IN_Dr.Patel

70% of physicians were surprised when they were sued.Around 27% suspected this threat, whileonly 3% were sure that they would be sued.  This shows the difference in the perception of malpractice between physicians and patients.

 

What Would You Have Done Differently?

What-would-you-have-done-differently_IN_Dr.Patel

More than half of the respondents believed that they would not change anything as their work was as per the standard of care.

 

 

Would Saying “I’m Sorry” Have Helped?

Would-Saying-I-Am-Sorry-Have-Helped_IN_Dr.Patel

Most physicians reported that they didn’t say sorry because it wasn’t their fault, or they were among many others named and hadn’t even met the plaintiff. Those who reported that they had expressed sorrow said that it would not have made a difference.

 

 

Your Experience of Being Sued

Your-Experience-of-Being-Sued_IN_Dr.PatelWhen asked to verbalize their experiences, physicians typically described feelings of betrayal by patients, humiliation, and disillusionment with the legal system. As one physician said, “The evils of human nature on display: greed, dishonesty, corruption. Clever arguments in the court trumps truth.”

Long-term Emotional and Financial Effects of the Lawsuit

Long-term-Emotional-Financial-Effects-of-the-Lawsuit_IN_Dr.PatelWhile less than half of respondents reported no long-term emotional or financial effects,the malpractice suit had a negative effect on trust for 30% of physicians.Some expressed their desire to improve professional behaviour, more documentation and connecting better with patients.  A large number of physicians mentioned long-term anxiety, depression, and suffering in general as fallout of being sued.

 

Long-term Effects of Being Sued and Tried

Long-term-effects-of-being-sued-and-triedOf all of the long-term effects expressed in this survey, perhaps the most disturbing was the negative impact lawsuits have on the physician-patient relationship.  Most physicians said that they had stopped trusting patient’s responses to their quality of work.

 


References:

  1. Peckham, C. (2015). Medscape Malpractice Report 2015: Why Most Doctors Get Sued.

 

 

Malpractice Claims against Anesthesiologists go Southwards

While cumulative spending on malpractice payments against anesthesiologists has decreased in recent years, there has been an increase in the number of claims occurring in outpatient settings, which is consistent with the increase in outpatient anesthesia services.  According to a new study, which included data from the National Practitioner Data Bank, spending on malpractice payments against anesthesiologists has fallen from $174.4 million in 2005 to $91.1 million in 2013.  With increased outpatient utilization, the number of claims for outpatients has increased in comparison to claims for inpatients.  However, as the amounts being paid for outpatient claims are smaller, the overall medical malpractice claims have decreased since 2005.

Presented at the 2015 annual meeting of the American Society of Anesthesiologists, the study examined the change in anesthesia related outpatient malpractice payments.  Using data like patient demographics, payment size and clinical outcome to compare inpatient and outpatient malpractice claims, the researchers included 2,408 anesthesiology related malpractice payments attributed to physician providers.  However, despite the shift towards outpatient services, little is known about the effect of practice setting on malpractice payments in anesthesiology.

According to the findings of the study, out of the 2,408 payments made, 1,841 (76.5%) were for inpatient claims while 567 (23.5%) were for outpatient events.  However, the study found that the frequency of anesthesia related payments decreased over the 9 year study period, with inpatient payments decreasing by 45.5% and outpatient payments decreasing by 24.3%.  Average malpractice payments for anesthesiology related claims was $245,000, however, payments towards inpatient claims were larger ($21,742) as compared to outpatient claim payments ($189,349).

While the study indicated that malpractice payments for inpatients were larger, the percentage of outpatient payments was more out of the total spending.  This is due to the increase in outpatient surgery in the last few years.  The largest claims were for death of the patient in both inpatient and outpatient settings.  However, outpatient claims involved more of minor injuries to the patient.  The majority of claims were from female patients and the average age was between 40 and 59 years.  The study concluded that with the overall spending on malpractice payments reducing by $83.3 million, it meant that anesthetists were on the right track in their practice.

The moderator of the session, however, suggested that the increase in outpatient payments could be attributed to more than just an increase in the number of outpatient procedures.  He stated that an increase in the complexity of outpatient procedures could be pushing up the malpractice payments.  The researchers admitted that one of the drawbacks of the data collected was the lack of detail regarding the claims.  While death was the largest reason, the second largest number of claims was for improper management – which generally includes a large number of malpractice issues.


References:

  1. BRUNK, D. (2015, October 25). Anesthesia-related medical malpractice claims falling in the U.S. Retrieved December 23, 2015, from globalacademycme.com: http://www.globalacademycme.com/conference-news-videos/single-article/anesthesia-related-medical-malpractice-claims-falling-in-the-us/5302d12f55a2fcdadac955bba5af04c4.html
  2. DO ANESTHESIOLOGISTS HAVE THE HIGHEST MALPRACTICE INSURANCE RATES? (June, 11). Retrieved December 23, 2015, from 2012: http://theanesthesiaconsultant.com/2012/06/11/do-anesthesiologists-have-the-highest-malpractice-insurance-rates-2/
  3. Doyle, C. (2015, December). Medical Malpractice Claims Against Anesthesiologists Decrease and Shift to Outpatient Anesthesia Services . Retrieved December 23, 2015, from anesthesiologynews.com: http://www.anesthesiologynews.com/ViewArticle.aspx?d=Policy%2B%26%2BManagement&d_id=3&i=December+2015&i_id=1256&a_id=34419
  4. Nelson, R. (2014, October 13). How Anesthesiologists Reduced Medical Errors by Learning from Malpractice Suits and Adopting New Technology. Retrieved December 23, 2015, from lieffcabraser.com: http://www.lieffcabraser.com/blog/2014/10/reducing-the-cost-of-medical-care-by-learning-from-malpractice-suits.shtml

 

 

Steps for Hospitals to Prevent Malpractice Suits

Hospitals are institutions that a person turns to when they are not well, with the hope that they will be treated and thus become healthy again.  However, there are situations where negligence on the part of the healthcare provider can cause harm to the patient, sometimes even resulting in their death.  This leads to medical malpractice suits being filed against the healthcare provider by the patient or their families.  While the suit may lead to a claim payment or it might not, it does cause a dent in the reputation of the healthcare provider.  Although hospitals make every effort to treat each patient correctly, however, there are many areas where things can go wrong.  A little effort and setting up a series of strategies to combat medical negligence can help healthcare providers avoid medical malpractice suits.

The Journal of the American Medical Association states that medical negligence is the third leading cause of deaths, and more than 85,000 medical malpractice suits are filed in the US every year.  About 12,000 patients lose their lives during an unnecessary surgery, while nearly 7,000 patients die due to medication errors.  The primary cause of medical malpractice suits are prescription mistakes and procedures – these can always be prevented by following some simple yet effective strategies.

Faulty Communication

Patients require explanations.  According to research, patients who feel that their healthcare provider has their best interests at heart are more forgiving of errors.  One of the best ways to mitigate risk is to clearly communicate with the patient and explain what’s important.  However, some circumstances do call for a formal apology, and these should be immediately forthcoming.  In fact, for some patients, it is helpful to know that a doctor has learned from their medical error so that another patient won’t suffer similar consequences.

Patient Consent

Obtaining the consent of the patient for any and all procedures that will be performed (once that a patient has received proper explanations) is crucial.  This also allows the patient to ask further questions in case they are not clear about some part of the treatment.

Being Aware

It is crucial that doctors and other medical staff stay updated with new developments and specialties.  This is especially important as more and more offices transition to having electronic records.

Follow up

A lot of things can happen to tests that are ordered by the doctor.  The patient may not follow through and get the tests done; the tests may not end up with the physician, the doctor may not look at the test results right away.  It is very important to follow up on every level to ensure that there are no mistakes or exclusions in the treatment procedures.  Following up after the visit is also important if a doctor sets up an appointment for their patient with a specialist.

Variations in Policies

When policies and procedures frequently change from physician to physician within one office, it is easy to overlook important details.

Unnecessary Surgeries

Implementing a quality control procedure which consists of a visit by a third party to obtain answers from the patient to a short questionnaire, after they have gone through their medical procedure.  If the patient is happy and satisfied with the medical procedure and says so, their answer can help avoid a malpractice suit in case their condition worsens at a later stage.  The data collected will also help the hospital to understand patterns of substandard care or weed out unresponsive staff.

Reduce Medication Errors

Most medication errors stem from overworked or tired staff.  It is very easy to overlook details when physical and mental tiredness creeps in.  If you cannot increase the staff or decrease the work hours for the existing ones, it would be beneficial to create an oversight department that would be responsible for monitoring and enforcing maximum working shifts for the staff.  A tired mind is a careless mind – make sure that staff have an avenue to refresh and recharge themselves after every few hours.

Finally, a little empathy and a friendly demeanor will go a long way in keeping your patients happy and your hospital away from malpractice suits.


References:

  1. Avoiding Medical Malpractice. (2015, August 19). Retrieved December 23, 2015, from harrell-nowak.com: http://harrell-nowak.com/2015/08/avoiding-medical-malpractice/
  2. Frank Sloan, L. C. (2015). From Medical Malpractice to Quality Assurance. Retrieved December 23, 2015, from issues.org: http://issues.org/24-3/sloan/
  3. Ocano, S. (2015, August 15). How hospitals can avoid medical malpractice suits. Retrieved December 23, 2015, from businessreviewusa.com: http://www.businessreviewusa.com/finance/5070/How-hospitals-can-avoid-medical-malpractice-suits

 

Defensive Medicine Reduces Chances of Medical Malpractice Claims

According to a study published on November 4, 2015, by the British Medical Journal, medical professionals who spend more resources, time and money on patient tests and procedures, generally get sued less for malpractice / negligence.  The study was conducted by a team of researchers from Harvard Medical School, Stanford University and the University of Southern California.  The researchers state that “defensive medicine” means “doing more for patients because they believe it reduces liability risk.”

Defensive Medicine can Undermine Healthcare Reforms

According to Seth Seabury, one of the authors on the study from the University of Southern California Schaeffer Center for Health Policy and Economics, this lower risk of malpractice liability could undermine healthcare reforms.  The reforms rely on medical professionals to eliminate wasteful spending in healthcare.  However, if the medical professionals start believing that reducing spending might make them more vulnerable to malpractice suits; they will have no incentive to do so.

Data Collected for the Study

Analyzing data from Florida hospitals and malpractice cases, the study confirmed that medical professionals use defensive medicine and that it does protect them from liability.  24,637 physicians, 154,725 physician years and 18,352,391 hospital admissions were involved in the data collection, along with information gathered from 4,342 malpractice claims.  The study found that across specialties, greater average spending by physicians was associated with reduced risk of malpractice claims.  Among interns, the probability of an alleged malpractice incident ranged from 1.5% in the bottom spending fifth to 0.3% in the top spending fifth.  The researchers focused on obstetrics, gathering information from admissions to Florida acute care hospitals between 2000 and 2009, where according to them, the choice of caesarean deliveries was influenced in large by defensive medicine.

The Dangers of Defensive Medicine

According to Tomas J Philipson, professor of Public Policy Studies at the University of Chicago and a healthcare director at the Becker Friedman Institute, the study raises important questions about the costs and benefits of the medical malpractice system.  While it makes medical professionals spend more to avoid liability, this liability comes from bad health outcomes and thus must be weighed against the improvements in patient health that this spending enables – how productive is this additional spending in terms of improving patient outcomes.

According to some professionals in the healthcare industry, defensive medicine has become necessary despite the harm caused by it in the long term.  Dennis Hursh, managing partner of Pennsylvania physician’s law firm Hursh&Hursh PC,  feels that defensive medicine is absolutely required to protect physicians from an out of control judicial system.  According to him, healthcare professionals feel forced to order tests and procedures despite knowing that they will be of marginal value to the patient as any failure to do so might invite a malpractice suit.  He feels that many physicians would forgo these tests and procedures that do not benefit the patient if they did not have the threat of being second guessed by lawyers and judges.

John R Patrick, author of Health Attitude: Unraveling and Solving the Complexities of Healthcare, does not find the outcome of the study surprising.  He believes that it is a logical conclusion, but not necessarily a good thing.  Defensive medicine is driving up the cost of healthcare and with 10,000 people turning 65 years of age everyday and joining Medicare, the cost of current spending per person is becoming prohibitive.  Studies have revealed that the cost of these unnecessary tests and procedures have reached up to $1.5 trillion.  At this given rate the country will go bankrupt if heath care spending is not reduced.


Reference:

  1. University of Southern California, Harvard Medical School and Stanford University. (2015). More Doctor Spending Linked to Fewer Malpractice Risks. British Medical Journal.