Friday, October 22, 2010

Fumbling The Patient Handoff--One Of The Most Common Causes Of Medical Malpractice

The patient "handoff" refers to when one physician or other provider assumes responsibility for the patient from another medical provider. Consider it an intersection of sorts, and is one of the most dangerous intersections for a patient for this reason: An estimated 80 percent of serious medical errors involve miscommunication between caregivers when responsibility for patients is transferred or handed-off.

In other words, the medical left hand frequently does not know what the medical right hand is doing. For example, a patient who has abdominal surgery and developes a post operative infection and pneumonia might be seen by a general surgeon, an infectious disease doctor, a pulmonologist, and a hopsitalist (an internist or general practioner provided by the hospital who serves as the patient's "family doctor" during the hospital stay). When you add nurses and therapists to the list, things can get confusing. Someone has to take responsiblity for ensuring that orders are established, followed and communicated from the transferring medical team to the receiving team.

Some of the most common problems: tests ordered and not performed, and tests performed but not communicated to the patient. These problems surface in both hospital and outpatient settings.

In fact, according to the study..."more than 37 percent of the time hand-offs were defective and didn't allow the receiver to safely care for the patient." That's a horrible batting average when the major issue here is simple communication.


Patients should not consider themselves simply mindless cogs in the wheel of a meandering medical vehicle. When there is a "team" in charge of your loved one, here are some questions to ask:

Who's in charge of the team here?
What tests have been ordered?
Who will be following up on the test results?
How long will it normally take to obtain the test results?
Who is going to report the results and when?
Will "negative" test results be communicated as well as positive ones?
Will we be receiving written confirmation of the test results?

This list is not exhaustive, but here's the point: get in the mindset of asking some basic questions, in a polite and non-accusatory fashion, to your loved one's medical providers. Given the hectic nature of busy hospitals, labs, and teams of professionals, and given an almost 40% patient handoff failure rate, the questions you may ask just may save your providers from themselves, thereby saving you from a preventable medical mistake.

Wednesday, October 20, 2010

Surgical Errors Continue To Be A Malpractice Problem...But Not Necessarily A Lawsuit Problem

Placing a chest tube in the wrong lung. Operating on the wrong side of the brain. 107 surgeries on the wrong body part. 3 prostate removal surgeries on the wrong person. These are just some of the...get ready for this figure...27,370 incidents of surgical screw ups over a 6 year period, according to a comprehensive study released recently.

This didn't happen in some Third World country. Here's the jaw dropping part: this study was limited to Colorado physicians alone! According to one surgical expert:

...the surgical blunders reported in the study are probably "the tip of the iceberg," says the lead researcher, Dr. Philip Stahel, M.D., a surgeon at Denver Health Medical Center. The actual number of patient and site mix-ups is likely much higher, says Stahel, describing those mistakes as "a catastrophe."

Begs the question: if preventable surgical mistakes of this magnitude are occurring in Colorado alone, how many are ocurring nationwide?

How serious were these surgical medical mistakes? "Overall, one-third of the mistakes led to long-term negative consequences for the patient. One patient even died of lung complications after an internist inserted a chest tube in the wrong side of his body."

Now, the medical industry (and The Chamber Of Commerce, insurance and pharmaceutical companies, and certain politicians) would have us believe that we are a "sue happy society" just ready to pounce on the medical profession at every turn and that doctors are under siege, right? Yet, this study, which highlights INDISPUTABLE medical negligence, pointed out that:

Only about 22 percent of the mistakes led to malpractice claims or lawsuits. The database is unusual in that it contains information on all incidents (not just those that resulted in a claim), and for that reason the rate of surgical mix-ups reported in the study is likely more accurate than those in previous studies...

The main reason for these surgical errors: lack of communication. You can add to that the fact that, in my humble opinion, the practice of medicine has become a volume business. And when that happens, confusion and/or complacency eventually sets in, which raises the risk of a preventable mistake.

What's the take away from this study? An strange trinity of medical mistakes that are repeating, serious, and often nothing is done about them by injured patients.
It sure knocks down some popular myths about medical malpractice in America (see "frivolous lawsuits"; "defensive medicine").

And oh, by the way, do you think that all these medical mistakes add to the cost of health care in America? Who do you think pays for all the re-operations and complications? Insurance companies and programs like Medicare and Medicaid...

Friday, October 15, 2010

"What Will Help My Case In An Ohio Accident Claim?"

In no particular order, taking these steps will greatly increase the validity of your accident claim, and the liklihood that it will be brought to a successful resolution:


Some personal injury firms have ongoing referral "relationships" with certain medical providers. These groups regularly refer patients and clients to each other. Insurance companies are becoming increasingly aware of these relationships, and this will often raise a red flag. Why? Because it raises the possibility that the treatment is being "padded" for purposes of the claim. Insurance companies will scrutinize these claims much more closely.

As an alternative, if you've been injured in an auto collision, a good place to start your initial treatment is your family doctor.


If you are still feeling the effects of your collision, get checked out by hospital or a provider of your choosing, and be sure to point out all the problems you're having. It's common that some injuries will not manifest themselves until a few days after the collision; in fact, the standard "discharge instructions" from any hospital emergency room will tell you exactly that. Insurance companies love to argue that there is no cause and effect between your crash and your injuries if there is a gap or delay in your treatment. The longer you wait, the more you play into that argument. Simply listen to what your body is telling you and make sure you follow up with a medical provider, but only if you feel it is necessary to do so.


If you're scheduled for 18 physical therapy appointments and you miss 7 of them, this will be reflected in your medical records, and it will allow the insurance company to argue that you "aren't really hurt" if you missed that many appointments. If you miss an appointment and still feel the need for treatment, make sure you re-schedule it.


If you've been ordered off work due to your injuries, try your best to get back to work as soon as you possibly can. It will do you no good to attempt to delay going back to work just to "build" your lost wage claim. When you can return to work should be a decision solely between your provider and you. If you try to go back to work as soon as you can and it's obvious that you're still having problems, you need to relay this to your provider as soon as possible so he or she can re-evaluate the situation.

Remember, insurance companies essentially view all injury claims the same way: that everyone is an exaggerator or malingerer until proven otherwise. Doing everything you can to get back to your normal lifestyle will "break" that stereotype and separate your claim from those who may be trying to exaggerate their losses. This leads to the final main point, which is...


The worst thing you can do is exaggerate your injuries. Tell your providers all the problems you're having, but also let them know if there is any improvement. Don't tell them that you can't do an activity if it's something you can do but with difficulty. There is a difference between the two so make sure you're clear with your provider about the extent of what you can and can't do after an accident.

The best thing you can do is do your best to try to get your life back to normal as soon as possible. This will serve you well when it comes time for an adjuster--or a jury--to examine your injury claim. If you try your best and fail due to your injuries, it's much better than doing nothing or not trying. You will be seen as exercising "personal responsibility" for your actions. And, above all else, it's the right thing to do.

Wednesday, October 13, 2010

Is Evidence Of A Doctor's Past Drug/Alcohol Impairment Admissible In An Ohio Malpractice Lawsuit?

Answer: it depends, but probably not. In a recent Ohio malpractice case, a dentist was sued for malpractice. Approximately 10 years before the lawsuit, the dentist was suspended indefinitely by The Ohio State Dental Board for "“inability to practice under accepted standards of the profession because of physical or mental disability, dependence on alcohol or other drugs, or excessive use of alcohol or other drugs.”

As part of the suspension, the dentist was required to successfully complete rehab, at which time her license would be reinstated, subject to a 5 year probationary period. Well after she had been completed her probation, she was sued for malpractice.

The issue: was her previous suspension admissible in a malpractice case when she was not impaired at the time of the alleged malpractice? The Ohio Court said no, because this evidence was too prejudicial against the dentist. This makes some sense; after all, if she had straightened her life out and was not impaired at the time of her alleged malpractice, there's a good argument for excluding that evidence. The Ohio Rules Of Evidence should give her or anyone else the benefit of the doubt in that situation.

However, the Court went further and ruled that evidence of her previous suspension was not allowed to be heard by the jury even when she testified that she had an excellent reputation in the community. This is wrong, in my opinion, because it allows her to tout her excellence in front of the jury, yet shield the truth--that, maybe, her "rep" was not so spotless after all.

The moral of the story? The playing field is often tilted in favor of the medical profession in Ohio medical malpractice cases due to rulings like this one.

Wednesday, October 6, 2010

"Zero Tolerance" Punishment In Schools Doesn't Apply To Those Who Molest School Children

We've all heard of school districts' various "zero tolerance" policies that will get your child disciplined or suspended. For example, if your child gets in a fight that he didn't start and defends himself and fights back, he may still be suspended due to a school's "zero tolerance" for fighting. In fact, according to a recent story, a seven year old boy was suspended for a YEAR for bringing a toy gun to school. Most people would consider this over the top, but schools would no doubt claim that stringent zero tolerance policies are required for the protection of children.


Fair enough. But this leads to an obvious related question: what about a "zero tolerance policy" for school personnel who molest schoolchildren? Welcome to Ohio, where school districts enjoy 100% legal immunity for sexual predators who molest schoolkids while masquarading as trusted school personnel. Under Ohio law, there is no liability for school districts if a student is molested by ANY school personnel no matter where it occurs--on the school premises, the school bus, a field trip--you name it. And even if the school district knows or suspects that an employee is abusing children and does not take action, or fails to perform a proper background check, again, no liability.

Now there's some real accountability. Give 7 year old Johnny a year's suspension for that plastic gun, and give school districts a free pass from being sued when they ignore red flags and discover that one of their own employees is doing unthinkable things to vulnerable children who can't protect themselves.