Monday, October 27, 2014

Follow The Money Trail....And You May Find Malpractice....

Recently a woman sued a Chicago area hospital for using improperly sterilized, dirty endoscopes that allegedly inflicted her and as many as 42 other patients with a nasty bacterial infection known as CRE (carbapenem-resistant Enterobacteriaceae).

This "superbug" is usually contracted in medical facilities, and can be fatal if it enters the bloodstream.

How did this happen? According to a recent article, "manual cleaning and high level disinfection" (whatever that is) failed to remove E-Coli and other bacteria.

Ewwww. Disgusting at a minimum that a used, unsterilized endoscope can find its way into numerous patients AND cause potentially fatal harm.

Despite the presence of the CRE bug in perhaps dozens of patients, the hospital claims there were no lapses of protocols. And despite there being no lapses of protocols, the hospital is now including gas sterilization of its endoscopes.

Now, I'm no expert in how to sterilize all the scopes that are used in volume fashion at a hospital or outpatient facility. But why is the hospital now including more elaborate (and presumably more effective) gas sterilization of its scopes? This is just a guess on my part, but I would suspect that gas sterilization is probably more expensive than manual cleaning, which was considered "good enough"....until this happened.

Bottom line: some "protocols" are more expensive than others. Whether the setting is a hospital or a nursing home, many times the ultimate decision on which policies and procedures to implement comes down to the almighty dollar.

Never forget:  most hospitals and nursing homes are just another form of a big business. Budgets and financials are just as important as other considerations. Although this is not a bad thing per se, when they cause safety shortcuts and cause patient harm, they shouldn't get a free pass from our civil justice system.

Friday, October 10, 2014

What If The Death Certificate Is Wrong?

The cause of death on the "official" death certificate read: "Intoxication." One small problem. The "intoxication" that led to the patient's hospitalization for a broken jaw in a one car accident occurred about 10 days earlier. After successful jaw surgery, which included wiring the jaw, the patient was resting comfortably and was soon to be weaned from the tracheostomy tube and ventilator, in preparation  for discharge.

Unfortunately, on post op day 10, a nurse dislodged the patient's trach tube while suctioning it. A cascade of medical errors followed, including the inability to re-insert the trach tube in the patient's trachea or "windpipe." Consequently, the patient suffocated and died.

A medical malpractice case followed. The issue was whether the hospital staff was negligent in dislodging the trach tube and/or failing to timely re-insert it in the patient's airway. All the medical experts in the case--even the doctors' and hospital's--agreed that the immediate cause of death was cardiopulmonary arrest due to oxygen deprivation.

Yet, we had this "official" death certificate that listed "intoxication"--10 days prior-- as the cause of death, which was dead wrong (pardon the pun). The question is: in a medical negligence or any other civil lawsuit, can the cause of death be tossed out or set aside under certain circumstances? Great question--glad you asked! The answer is YES.

In Ohio, the coroner’s factual determinations concerning the manner, mode, and cause of death as expressed in the coroner’s report and death certificate create a non- binding, rebuttable presumption of the actual cause of death, unless there is competent, credible evidence to the contrary. In other words, the coroner's findings are not set in stone, and can be rebutted if there is good evidence to the contrary.

The reason? Coroners, like any other profession, aren't infallible and don't always get it right. The law recognizes this. In our case, the coroner had apparently confused the immediate cause of death (the dislodged trach tube) and the remote cause of death (the car crash.) for reasons I'll never truly understand... 

The case above settled shortly before trial so the Court never ruled on our motion to toss the coroner's "intoxication" cause of death. But given the overwhelming expert testimony that the dislodged tube cut off the patient's oxygen supply, most likely the death certificate would have been inadmissible at trial.