Cardiac Care ICUs Increase Risk Of Death

Martha sat alone on the porch, wondering about the way her life had changed.  Just a month back, everything was normal and happy.  Bill, her husband had just returned home after visiting their daughter at college and they were making plans of going there for her graduation ceremony next year. And then, without any warning, Bill just collapsed.  Luckily for them, the hospital was just a short distance away and Bill was admitted to the ICU, having suffered a heart attack.  After a two week stay, Bill was discharged and came back home.  Last evening, Bill complained of feeling short of breath and before they could reach the hospital, Bill had become unconscious in the car. Immediately admitted to the ICU again, the physician informed Martha that Bill had suffered another heart attack.  This morning, their family physician, consulted with the doctors at the hospital and had Bill moved out of the ICU.  On being questioned about the move by Martha, the doctor explained his reasons, showing her the article in CHEST.

According to a study published in the , patients who suffer heart failure or heart attacks, fare worse in hospitals that rely on their intensive care units to treat them.  While patients who suffer heart attacks or heart failure can be treated in a variety of hospital locations, those treated in the ICU are likely to receive less than half of certain proven tests and treatments.  They are also less likely to survive more than a month after discharge.

The Study

Thomas Valley, M.D., M.Sc., and his colleagues at the University of Michigan Medical School, examined Medicare records of over 570,000 hospital stays that occurred in 2010, to glean the findings that made up the report.  Admission and treatment in the ICU accounted for more than 46% of the 150,000 hospitalizations at over 1,700 hospitals for acute myocardial infarction or heart attacks.  Out of the 400,000 heart failure patients admitted to one of the 2,199 hospitals, 16% were admitted and treated in the ICU.

The researchers used the Hospital Compare website, through which the federal government publicly reports hospital performance; to determine how efficient hospitals were at providing high-quality healthcare.  They also used the website to find out the percentage of patients who either passed away or were re-admitted within a month of their discharge from the hospital.  Based on the data gathered, they divided the hospitals into five groups – depending on their frequency of use of ICU beds.

Although the quality of care across the all the hospitals seemed to be good, the research findings threw up some notable disparities that lead to suboptimal care.  For example, the study shows that those hospitals which had high rates of ICU admissions and treatments were less likely to provide aspirin and other drugs to heart attack patients upon arrival at the hospital – this despite the known improved outcomes that these drugs offered. Similarly, patients suffering from heart failure were less likely to be administered key tests or receive important medications.  There was also the absence of counseling on the benefits of abstaining from smoking.

However, the biggest finding was the disparity in the 30 day mortality post discharge, Cardiac_Failure_expert_witness_indiana_dr-patel
between the low and high ICU usage facilities.  According to the findings, the risk of death within 30 days of discharge for heart failure patients stood at 8%, while for heart attack patients, it was 6%.

These findings only add to the growing evidence about the varied use of ICU beds.  The findings show, for the first time in heart care, that hospitals with high ICU admissions and treatments are the worst performers in terms of health care quality.  According to Thomas Valley, “In this country, we still have an open question of what to use the ICU for, and when, and very little evidence to guide physicians.  Is it for those who were already sick and got worse, or is it a place to send people proactively when we think they might get sicker? And the answer can vary on different days, or based on how many beds are available right then.  We hope to build a body of evidence about how to use this valuable resource in the most effective way.”

Going Forward

The researchers plan to continue their study from data collected from large groups of patients – to help understand which group benefits the most from ICU care and treatment along with finding out the best characteristics of ICU care that can be tried on general hospital floors.  It is possible that specially trained healthcare professionals might be able to administer the same care as in the ICU, thus providing the physician an option of whether to admit the patient in the ICU or not.

Thomas Valley points out that those patients hospitalized for heart failure or heart attack and their families need to be vocal about the patient’s wishes regarding the intensity of care that they want to receive.  According to Valley, “It’s important to understand why you or your loved one are being admitted to the ICU, and talk about whether it’s in line with your or their wishes. It’s important to understand both the benefits and risks of an ICU stay.”


References

  1. Hospitals that send the most heart patients to the ICU get the worst results, U-M study finds. (2016, August 03). Retrieved August 09, 2016, from http://www.uofmhealth.org: http://www.uofmhealth.org/news/archive/201608/hospitals-send-most-heart-patients-icu-get-worst-results-u-m
  2. Thomas S. Valley, M. M., Michael W. Sjoding, M. M., Zachary D. Goldberger, M. M., & Colin R. Cooke, M. M. (2016). Intensive care use and quality of care for patients with myocardial infarction and heart failure. CHEST Journal .
  3. Zimmerman, B. (2016, August 04). Heart patients fare worse in hospitals that rely on ICUs for cardiac care. Retrieved August 09, 2016, from http://www.beckershospitalreview.com: http://www.beckershospitalreview.com/quality/heart-patients-fare-worse-in-hospitals-that-rely-on-icus-for-cardiac-care.html
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Common Medical Mistakes That Cause Litigation

Mistakes are made by all humans.  However, some mistakes prove costlier than others – in terms of either physical or mental damages to the receiver and financially to the maker.  Mistakes made by healthcare professionals fall under this category and result in medical malpractice cases against the professional concerned.  Medical malpractice is said to occur when the healthcare provider has been negligent and the care provided is not up to the accepted standard.  Within the ambit of errors that lead to these malpractice suits, there are certain types of errors that seem to crop up more often than others.  Given below are some of the more common medical errors that may result in malpractice suits.

Delayed or Misdiagnosis

A delayed diagnosis will result in precious time wasted – time during which the patient could have started getting treatment.  This can lead to severe complications or even death, depending on the severity of the problem.  Similarly, misdiagnDelayed_or_Misdignosis_Expert Witness_Indiana_Dr. Patelosis can not only cause delay to the correct treatment for the problem, it can complicate the issue further due to the wrong treatment of the problem.  It is of paramount importance that healthcare professionals ask for further tests or consult other professionals if there is any doubt about the cause of the illness.  Referring the patient for a second opinion is far better than making a mistake in the diagnosis.

Medication Errors

Medication errors are probably the most common of medical errors, resulting in over a million patients suffering from this every year. Medication_Errors_Expert Witness_Indiana_Dr. Patel Medication errors can occur due to a number of causes – bad handwriting, wrong medication due to misdiagnosis, wrong dosage either by the doctor or the administrator of the medicine (if administered by a healthcare professional), malfunction of the equipment used to administer the medication, drugs that have passed their expiry date, the wrong drug administered in a hospital and many other.  It is important to double check the patient’s previous history, their reaction to drugs that might trigger allergies and explain the dosage and method of administering the drug to the patient.

Errors related to Anesthesia

Errors related to anesthesia can be more dangerous for the patient than even surgical errors.  Mistakes made while administering anesthesia can not only cause injuries of a permanent nature like damage to the brain, but can also result in the death of the patient.Errors_related_To_Anesthesia_Expert Witness_Indiana_Dr. Patel  Errors made by an anesthetist can be due to administering the wrong dosage of anesthesia, failure to monitor the patient’s vital signs while the patient is under the influence of the drug, intubating the patient incorrectly or the use of faulty or defective equipment.  Errors also occur if the anesthetist does not investigate the patient’s medical history which may point to complications that may arise with administering anesthesia and also if the patient is not informed of the precautions to be taken both pre and post the administration of anesthesia.

Surgery Errors

Most surgery errors stem from negligence by the healthcare professional/s.  Complications arising during surgery may or may not be solved – and does not constitute a medical error.Surgery_Errors_Expert Witness_Indiana_Dr. Patel  However, operating on the wrong body part, puncturing other internal organs, leaving behind surgical instruments inside the patient, etc., all constitute medical errors and will lead to a malpractice suit.  Negligence during post-operative care also constitutes medical error.  It is important for healthcare professionals involved with surgery to be alert and focused during the procedure and in the care that follows.

Errors relating to Childbirth

Errors relating to childbirth can take place during the tenure of the pregnancy or during childbirth itself.  Negligence, lack of proper care, incorrect medication, misdiagnosis of the mother’s condition is some of the causes for errors in prenatal care. Errors_Relating_to_Childbirth_Expert Witness_Indiana_Dr. Patel Negligence during childbirth can be due to the wrong use of forceps or vacuum extractor,complications arising due to failure to respond to distress signs made by the fetus, not ordering a cesarean when required or even failure to anticipate complications when previous tests indicate that there could be some.

While it is true that no healthcare professional would knowingly harm a patient, it is expected that they would also not allow errors to take place.  There could be multiple reasons why a healthcare professional failed to restrict an error, but that does not generally hold any value in a malpractice suit.  After all, the patient goes to the healthcare professional because they are knowledgeable experts in treating illness and providing healthcare.


References

  1. 12 Most Common Medical Errors (And How to Prevent Them). (2016). Retrieved May 20, 2016, from http://www.pharmacytechniciancertification.net: http://pharmacytechniciancertification.net/12-most-common-medical-errors-and-how-to-prevent-them/
  2. Common Errors by Doctors and Hospitals. (2016). Retrieved May 20, 2016, from http://www.myphiladelphiainjurylawyer.com: http://myphiladelphiainjurylawyer.com/medical-malpractice/errors-by-doctors-and-hospitals/
  3. Michon, K. (2016). Medical Malpractice: Common Errors by Doctors and Hospitals. Retrieved May 20, 2016, from http://www.nolo.com: http://www.nolo.com/legal-encyclopedia/medical-malpractice-common-errors-doctors-hospitals-32289.html
  4. Miller, A. M. (2015, March 30). 5 Common Preventable Medical Errors. Retrieved May 20, 216, from http://www.health.usnews.com: http://health.usnews.com/health-news/patient-advice/slideshows/5-common-preventable-medical-errors/1

Medical Errors – The Third Leading Cause Of Death

Do you think that death certificates should along with stating the cause of death, also figure a column that states whether a preventable complication stemming from the deceased’s care contributed to the death – in simple words, if the death was caused due to a medical error?  In case you are wondering what brought about this question, here is a startling fact – according to a report published in BMJ, medical error is the third leading cause of death in the US.  The first two positions go to heart disease and cancer.

Martin Makary, MD, MPH, Professor of Surgery and Michael Daniel, research fellow, from Johns Hopkins University School of Medicine and authors of the report, believe that medical errors should be the top priority for research and resources.  However, information with regards to death caused due to medical errors is not easily available.  The CDC (Centers for Disease Control and Prevention) uses death certificates to rank causes of death and accordingly establish health priorities.  The cause of death as stated on the death certificate is based on the ICD (International Classification of Diseases) code, which unfortunately does not have any code attached to human or system errors.  Given the fact that 117 countries use the ICD system to code their death certificates and use the resultant data as the primary health status indicator, we can begin to see how difficult it is to collate data regarding death due to medical errors.  It should be remembered that the medical coding system was originally designed to help physicians with their billing and not for collecting health data.  Using data collected from this system to prioritize health status does leave room for error.

How would anyone benefit from knowing the numbers related to death due to medical errors?  Public health priorities and research funding are based on data released by the CDC, stating top ranked causes of death in the country.  Hence, heart disease and cancer, being the top two ranks in causes of death, receive tons of funding and attention, resulting in further research and improvements in trying to reduce their incidence.  Since data regarding death caused due to medical errors does not feature on any recognized and standardized method of collection, the incidence rates in this case have never been a part of the health status priority.  But, if the report is any indicator on the gravity of this issue – death caused due to medical errors should feature on the health status priority list and immediate steps should be taken to create strategies for reducing it.

According to the CDC, heart disease claimed 611,105 lives, 584,881 died due to cancer and 149,205 lives were lost to chronic respiratory disease in the year 2013.  However, examining four studies that analyzed data from 2000 to 2008 on the death rates and using hospital admission rates from 2013, the authors extrapolated that based on the 35,416,020 hospital admissions, 251,454 deaths resulted due to medical errors.  This puts death due to medical errors at 9.5% of all deaths each year and makes it the third leading cause of death in the US.

Suggesting several changes that include making errors more visible, for example by adding them as a reason in the death certificates, would help in understanding and reducing this problem, according to the authors.  Hospitals need to carry out quick and efficient investigation to determine if medical errors played any role in the death of the patient, suggested the authors, adding that there should be a standardized data collection system related to death caused due to medical errors to help build an accurate picture for prioritizing this problem.

According to the authors, “Human error is inevitable, but we can better measure the problem to design safer systems mitigating its frequency, visibility and consequences.  Most errors are not caused by bad doctors but by systematic failures and should not be addressed with punishment or legal action.”


References

  1. Frellick, M. (2016, May 03). Medical Error Is Third Leading Cause of Death in US. Retrieved May 05, 2016, from http://www.medscape.com: http://www.medscape.com/viewarticle/862832?nlid=104512_3901&src=wnl_newsalrt_160503_MSCPEDIT&uac=236862HJ&impID=1084165&faf=1
  2. Martin A Makary, p. M. (2016, May 03). Medical error—the third leading cause of death in the US. Retrieved May 05, 2016, from http://www.bmj.com: http://www.bmj.com/content/353/bmj.i2139

Encouraging Patient Centered Care for Patient Satisfaction

Hospitals are like any other organization – in order to be successful, they have to put their customers, in this case their patients first.  Like in any other organization, hospitals need to constantly innovate and improve on their guiding principles.  Improving patient-centered care or patient satisfaction does not require too many drastic changes.  However, it does require constant monitoring and feedback in order to stay on top of the game.  Remember, a satisfied patient is a loyal patient.

Here are some tips to improve patient-centered care at your facility.

Ensure that the staff is clear about their roles

Passing the buck is one of the biggest problems that can derail your patient-centered care plan.  It is important to make your staff understand that every member is a caregiver.  From the front desk to housekeeping; from the nurses to physicians, from the accountant to the CEO, everyone is expected to put the patient first.  A patient should not have to run from pillar to post to get information, answers or care.

Set goals for each department and for the hospital

Motivation is an important factor to get things moving smoothly and set objectives motivate people both individually and as a team.  One good way to motivate staff at your facility is to set goals for each department, which will lead them towards the goals set for the hospital.  Review the goals every month and chart the progress on a quarterly basis.

Encourage competition and reward the winners

Recognition is a very powerful motivator – watching others getting recognized, more often than not, compel individuals to work harder and achieve recognition themselves.  Use the set goals as a competition for a reward program.  Create a best employee scoreboard, with the metrics for achieving the position based on patient feedback.  Encourage active participation in patient comfort and satisfaction.

Establish clear guidelines to be followed

It is imperative that the staff is absolutely clear about their roles and responsibilities.  Establish clear guidelines by writing up processes and including specific examples on patient-centered care.  Create check lists for all staff members to follow and fill – from the front desk to the billing.  Encourage staff to ask questions about any doubts that they may have regarding their responsibilities and role in the facility.

Important as it is that your staff is geared towards patient-centered care, it is equally important that steps are taken to improve the patients experience at your facility.

Ask patients for feedback

It is important that you are aware of your patient’s opinion about the services and care at your facility.  Putting up suggestion boxes, administering a questionnaire to each patient, following up via mails or phone calls – these are all methods of finding out how satisfied your patients are with your facility.  Knowing which areas require improvement and putting in steps to do so, will result in more patient satisfaction.

Expedite the check-in process

A sick person is not too keen on waiting or answering numerous queries about things like insurance.  Set up a patient portal or ensure that insurance and other details are asked over the phone while confirming the appointment.  Allow appointments to be booked through the patient portal and set up reminders for the patient to follow up on.

Ensure that care provided reflects patient needs and choices

Each patient is different and will have different needs and preference.  Customizing the care plan for each patient will definitely improve patient satisfaction.  Equally important with customizing patient care is making the environment in the facility comfortable for the patients.

Encourage patient’s family to be a part of the care team

Patients are generally in a state of discomfort, pain or fear, and as such are not paying attention to information being provided.  Encourage the patient to identify a family member or friend who will participate in the sharing of information and guidance.  Family and friends are essential supports to a patient – encouraging them to be a part of the care team will make the patient more confident about the procedures and increase their satisfaction levels with the facility.

Remember patient centered care is not only better for the patients; it’s a key factor for your success in today’s healthcare scenario.


References

  1. Amber Taufen, M. (2012, March 16). Five ways to increase patient satisfaction. Retrieved February 26, 2016, from http://www.mgma.com: http://www.mgma.com/practice-resources/mgma-connection-plus/online-only/2012/march/five-ways-to-increase-patient-satisfaction
  2. Hendren, R. (2011, September 06). 10 Ways to Help Nurses Improve Patient Satisfaction. Retrieved February 26, 2016, from http://www.healthleadersmedia.com: http://healthleadersmedia.com/page-1/NRS-270551/10-Ways-to-Help-Nurses-Improve-Patient-Satisfaction
  3. Nock, B. (2015, September 10). 5 Ways Hospital Administrators Can Improve Patient-Centered Care. Retrieved February 26, 2016, from http://www.gebauer.com: http://www.gebauer.com/blog/5-ways-hospital-administrators-can-improve-patient-centered-care
  4. Rodak, S. (2012, October 18). 10 Guiding Principles for Patient-Centered Care. Retrieved February 26, 2016, from http://www.beckershospitalreview.com: http://www.beckershospitalreview.com/quality/10-guiding-principles-for-patient-centered-care.html

SIRVA – The Vaccine Injury

For Latasha George, a nurse in Louisiana, getting a flu shot was nothing extraordinary or a matter of concern.  However, what followed was something that she had not bargained for.  Latasha ended up with SIRVA, a shoulder injury resulting from incorrect vaccine administration.  To compensate for her injury, the National Vaccine Injury Compensation Program awarded her more than $1 million.  Patients with injuries caused due to vaccination are barred from filing suits in state or federal courts.  In order to hear their claims, the government has set up the U.S. Court of Federal Claims Office of Special Masters.  Shoulder problems related to vaccination have been recently added to the list of injuries eligible to receive damages.  The special court has increased accepting the number of claims for this injury and it is now being added to the no-fault system.

What causes SIRVA?

Shoulder pain is a common side effect of being administered a vaccine like a tetanus or flu shot, in the arm.  However, sometimes the pain persists even after a prolonged period and can be accompanied by limited range of motion or other shoulder related injuries.  In its most severe form, this injury is known as Shoulder Injury Related to Vaccine Administration (SIRVA).

SIRVA is a result of injury to the musculoskeletal structure of the shoulder – i.e. tendons, bursa, ligaments etc, which is caused due to incorrect administration of the vaccine.  The most common cases of SIRVA occur in patients receiving a flu shot in the deltoid muscle of the arm.  It is important to remember that the injury is not caused by the vaccine itself, but by the incorrect administration of the injection.  Symptoms of SIRVA start showing in a few days and continues for weeks after receiving the shot.

What are the symptoms of SIRVA?

The most common symptom of SIRVA is severe shoulder pain.  While most people suffering from SIRVA complain of intense and persistent shoulder pain and limited mobility of the shoulder, there are other injuries that can also take place.  These include shoulder bursitis, shoulder tendonitis and adhesive capsulitis.

How is SIRVA treated?

Most cases of SIRVA can be treated with pain medication and physical therapy which helps in alleviating inflammation and improving the mobility of the shoulder.  However, in cases where patients continue to experience pain and/or other symptoms of SIRVA, it may be necessary to operate and repair the damage to the ligaments and tendons.

SIRVA in the news

Any medical treatment or intervention can result in injury – minor or major.  However, that does not mean that medical treatment should be stopped.  There are state and federal courts that take cognizance and allow claims against medical malpractice or injuries.  Similarly, just because vaccines or their administration can result in injuries, it should not dissuade vaccine manufacturers from production or patients from receiving them.  Keeping this in mind, claims against vaccine manufacturers cannot be filed in state or federal courts, but are heard by the U.S. Court of Federal Claims Office of Special Masters, which has no jury.

In order to shield vaccine manufacturers from liability, a trust, The National Vaccine Injury Compensation Program, was set up in 1988.  Funded by charging a small surcharge on vaccines, the fund has paid around $3.2 billion since 1988, to patients for a range of injuries related to vaccinations.  Some of these include arthritis, polio, Guillain Barre Syndrome, encephalitis and even death.  The fund also pays for attorney fees for claimants – within a reasonable amount, of course; to ensure that patients do not have to pay their attorneys out of the awarded amount.

More than $18 million has been awarded to 112 SIRVA patients since 2011; with more than half that amount disbursed in the last year.  An increased awareness of SIRVA and the growing number of immunizations have contributed to this rise in claims and awards.


References

  1. Brandon C. Taylor, M., & David Hinke, M. (2014). Shoulder Injury Related to Vaccine Administration (SIRVA). Retrieved February 25, 2016, from http://www.medscape.com: http://www.medscape.com/viewarticle/837089_2
  2. DUGAN, I. J. (2015, August 24). Vaccine Injury Payouts Rise. Retrieved February 25, 2016, from The Wall Street Journal: http://www.wsj.com/articles/vaccine-injury-payouts-rise-1440430702
  3. Matthew G. Barnes, M. C. (2016). A “Needling” Problem: Shoulder Injury Related to Vaccine Administration. Retrieved February 25, 2016, from http://www.jabfm.org: http://www.jabfm.org/content/25/6/919.full

 

What Physicians Need to Know about Defenses to Malpractice

Practicing physicians are always vulnerable to malpractice litigation.  The threat of litigation, unfortunately, leads to defensive practice, which in turn adds billions to the cost of healthcare.  Defensive practice is also unsafe for patients.  This fear of litigation affects the daily practice of physicians and also the quality of life outside the clinic.

What constitutes Malpractice?

In order to be held liable for a malpractice suit, there are four elements that need to be proved:

  1. The physician had a duty.
  2. The physician breached that duty.
  3. The patient was harmed.
  4. The harm was caused due to the physician’s breach of duty.

The physician cannot be held liable if all the four conditions are not met.  However, there are certain cases where even if the four conditions are met, the physician cannot be held liable for malpractice.

Assumption of Risk

Mrs. Schneider was diagnosed with a breast lump, and was asked to get it surgically removed.  However, she decided to undergo treatment under Dr. Revici, using non-traditional, non-invasive and non-toxic methods.  She subsequently developed breast cancer that spread and required bilateral mastectomy.  Mrs. Schneider sued Dr. Revici for medical malpractice, but the consent forms that were signed by her, stated that she was aware of the risks involved in refusing conventional treatment and agreeing to Dr. Revici’s method of treatment.  The court ruled in favor of Dr. Revici, stating the expressed assumption of risk as a valid defense.

Assumption of risk lies in the adage ‘volenti non fit injuria’– to a willing person, no injury is done.  Under this, the plaintiff’s implied or expressed agreement absolves the defendant from responsibility.  It is very important to communicate the risks involved to the patient and obtain their consent to the line of treatment.  Physicians can reduce the chance of litigation if the patient is aware of the risks, benefits and alternatives before the procedure and then decide to “assume the risk”.

Good Samaritan

Ms. McCain impaled her leg on a rebar at a construction site.  Dr. Baston responded to her call for help and after cleaning the wound, asked her to seek medical care immediately.  However, Ms. McCain waited for a week before going to a clinic and by then she required surgical management for the infected wound.  Dr. Baston was sued by Ms. McCain for poor treatment.  The court did not find Dr. Baston liable for damages, as he had acted as a Good Samaritan.

The Good Samaritan law is made to protect physicians who respond to an emergency situation.  Under this law, a physician responding to an emergency is protected from being held liable for injuries or damages that occur during the emergency.  There are, however, certain caveats in the use of the Good Samaritan law.  It requires the following conditions to be met:

  1. The incident is an emergency.
  2. The act of rendering care is voluntary.
  3. The patient accepts the care received.
  4. The care is provided in good faith, intended to help.
  5. The care provider receives no remuneration for the care provided.
  6. The care provided cannot be grossly negligent.

The Good Samaritan defense was extended to in-hospital settings also, after the McKenna v. Cedars of Lebanon Hospital case.  However, the Good Samaritan defense for in-hospital settings varies from state to state.

Contributory Negligence

Despite being informed by Dr. Hull to delay scalp reduction, Mr. Smith, who underwent hair implants over several years, signed the consent forms and underwent surgery.  Unhappy with the scarring on his head, Mr. Smith sued Dr. Hull for malpractice.  The court ruled in favor of Dr. Hull as according to them, Mr. Smith knowingly underwent the surgery at his own peril, which amounted to contributory negligence.

According to the concept of contributory negligence, a person is responsible for their own action or inaction, which, if contributes to the negligence, then the person should not be awarded damages.  Contributory negligence may be used as a defense when a patient demands procedures or treatments against the physician’s advice.

Comparative fault

Dr. Azzara found Mrs. Ostrowski’s toenail producing draining, red in color and painful to touch.  In the course of her treatment, Dr. Azzara removed he toe nail to facilitate drainage.  However, Mrs. Ostrowski, who was a hypertensive diabetic, had poor weight, diet and health management habit, did not heal and her toe became a non-healing pre-gangrenous wound.  She sued Dr. Azzara and a vascular surgeon testified that removal of the toe nail was unnecessary.  Dr. Azzara, in his defense, was able to prove that Mrs. Ostrowski’s smoking and poor health management contributed to the outcome.  The court found her to be 51% at fault and Dr. Azzara at 49%.  The jury ruled in favor of Dr. Azzara and no damages were awarded.

Comparative fault is similar to comparative negligence, except, that in the case of comparative fault; a patient might be awarded some damages, depending on the percentage of contribution by the patient and the physician to the outcome of the treatment.

What physicians need to know?

Clinical defenses as stated above have been and can be used in malpractice cases, even if the four elements of duty are present.  Physicians need to know about these defenses to optimize and reduce the risk of liability if confronted with a potential malpractice suit, rather than practice defensive medical procedures or treatments.


References

  1. Bowen Berry, J. (2001, January 14). The physician’s guide to medical malpractice. Retrieved January 21, 2016, from http://www.ncbi.nlm.nih.gov: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291321/
  2. Defenses to Medical Malpractice. (2016). Retrieved January 21, 2016, from http://www.injury.findlaw.com: http://injury.findlaw.com/medical-malpractice/defenses-to-medical-malpractice-patients-negligence.html
  3. Michael Jason Hudson, M., & Gregory P. Moore, M. J. (2011). Defenses to Malpractice. Retrieved January 21, 2016, from http://www.medscape.com: http://www.medscape.com/viewarticle/755818
  4. Sandy Sanbar, M. P. (2006). Medical Malpractice Defenses. In MedMal Survival Handbook (pp. 257-267).
  5. Suszek, A. (2016). Types of Defenses in a Medical Malpractice Case. Retrieved January 21, 2016, from http://www.alllaw.com: http://www.alllaw.com/articles/nolo/medical-malpractice/defense-2.html

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.