Indiana Injury Law Blog

The New York Times is running a series of investigative pieces on the alarming numbers of injures caused by radiation errors, and the web of silence that surrounds these. The NYT report focuses on several cases where patients were injured by massive overdoses of radiation or radiation therapy aimed at the wrong site. These medical errors have increased even as radiation therapy has become more sophisticated.

New equipment like linear accelerators now allow oncologists to target radiation only at the cancerous region, leaving the surrounding healthy cells unaffected. This has dramatically changed the face of radiation therapy, and doctors are now able to treat even those cancer patients for who radiation therapy was not recommended earlier. However, the new equipment has come with a shocking lack of technical safeguards that prevent over radiation and other risks.

Some of these systems have only the most basic safeguards in place to warn technicians and staff that the equipment has not been configured correctly. If technicians miss these warnings - and they have on more than one occasion - then there is nothing to stop the patient from receiving dangerously doses of high radiation that could seriously injure or kill him. While these new machines have altered the quality of treatment that patients receive, they have been misused on more than one occasion by improperly trained staff, and faulty operations and processes. Besides, the machines come with few safety devices that can prevent errors.

The New York Times report focuses on hospitals in New York that have been the scene of an alarming number of radiation errors. Last year however, officials at the renowned Cedars Sinai Medical Center in Los Angeles admitted that dozens of patients had been exposed to high levels of radiation from a CT scanner that was not configured properly.

Making matters worse for patients who are injured by such radiation errors is the factor that there is little in-depth knowledge of radiation injuries. Doctors are only aware of the wounds, nausea and other basic conditions that result from over radiation, but there is little knowledge of the severe injuries that can result from over radiation or other serious errors.

The Indiana medical malpractice lawyers at Theodoros & Rooth represent victims injured by radiation errors and other kinds of medical errors, in the Lake County area and around the state of Indiana

For four years, Indiana medical malpractice lawyers and hundreds of patients injured by Dr Mark Weinberger have been waiting for news of the fugitive doctor. Finally came the news they had all been waiting for, when the doctor was arrested dramatically from a mountain top in Italy.

Weinberger is the center of hundreds of malpractice lawsuits filed by patients who claim they underwent needless surgeries performed by Weinberger. Dr Weinberger’s haphazard operations did nothing to cure patient problems, and, in fact, left most of them seriously injured. In 2006, a federal grand jury in Hammond indicted Weinberger of 22 counts of fraudulent over billing procedures that were not necessary or never performed. Five years ago, Weinberger disappeared while he was vacationing in Europe.

He was arrested on the 15th of December on a mountain top near the France-Italy border. The authorities had been tipped off by a mountain guide. Weinberger had been living in a tent, and guides had been curious because it was unusual to see people camping in the freezing northern Italian mountainside this time of the year.

Weinberger’s dramatics didn’t end with his arrest. While he was being arrested, he managed to stab himself in the neck. However, his wounds were not life threatening. Since then, an Italian court has approved an extradition request for Weinberger. He has 300 medical malpractice claims against him. These patients will now have some hope of receiving justice for their medical injuries.

An increasing trend toward the use of surveillance systems to monitor health care professionals in hospitals, is very encouraging to Indiana medical malpractice lawyers. In fact, we would like to see this trend permeate into hospitals in Indiana.

Last month, we blogged about a Rhode Island hospital that has been ordered to have video camera surveillance systems in its operating rooms, after a series of surgical errors. In Maryland hospitals, doctors could soon be the target of specially hired “secret eyes” that would monitor their hand hygiene. In November, Maryland used $100,000 in federal stimulus funds to finance an initiative by hospitals to train “secret shoppers” who would observe if doctors and other health care staff washed their hands after emerging from a patient’s room.

This is the first time that federal funds are being used for this unique experiment. It’s all part of a nationwide trend in which hospitals are trying to reduce the incidence of errors and their exposure to medical malpractice lawsuits by monitoring staff more closely.

As Indiana medical malpractice attorneys, we have been especially concerned at the low rates of hand hygiene compliance by health care staff. Nationwide, these rates fall between 40 and 50 percent. The Centers for Disease Control and Prevention believes that many of the 1.7 million medical infections picked up by patients every year, are caused at least partly by poor hand hygiene.

Manufacturers are catching on to the new interest in surveillance systems. They are putting out surveillance devices using wireless technology, video cameras and radio frequency identification chips. At least one New-York based company is developing video cameras that focus on hand washing areas. The video cameras are connected to lasers that sense motion and begin to record hand washing activity.

However, all this surveillance is raising some concerns that too much snooping could have a counterproductive effect on health care staff, who may feel victimized.

A new study shows that in spite of increased emphasis on patient safety, here are five to ten incorrect surgical errors performed in Veterans Administration facilities every day.

The study focused on 342 surgical problems that occurred in 130 VA hospitals between 2001 and mid-2006. For comparison purposes, researchers divided these problems into those that occurred inside and outside the operating room.

The researchers examined 212 adverse events that included wrong site surgeries, where the wrong procedure was performed, or procedures performed on the wrong patients. The researchers also examined 132 events where the staff was able to catch a problem before beginning the surgery.

• The researchers found that in most cases of surgical errors, failure in communication among the members of surgical team was the most important contributing factor. That fact doesn’t surprise Indiana medical malpractice lawyers, who frequently come across cases where members of the surgical team fail to coordinate.

• The researchers also found that there was an almost equal distribution of errors inside and outside the operating room. 50.9 percent of the wrong site surgeries, wrong patient surgeries and wrong surgeries occurred in the operating room, while the remaining occurred elsewhere.

• Most of these serious errors occurred during ophthalmology and invasive radiology procedures, followed by orthopedics.

• The most serious patient injuries were caused during pulmonary cases, where fluid was removed from the wrong side of the chest or procedures were performed on the wrong side of the chest. However, it may not be fair to blame these high rates of errors on these specialists. There is a possibility that these specialists either report their errors more honestly, or that errors in these fields are just harder to hide.

VA facilities tend to focus harder on patient safety, but are not without their problems, as the report shows. In fact as Indiana medical malpractice attorneys, we are concerned about the high number of surgical errors in VA facilities. If the situation is so worrisome at a VA facility where standards for patient safety tend to be higher, then it’s worth considering what the numbers are like outside VA clinics.

It’s the kind of medical error that Indiana medical malpractice lawyers frequently come across. However, even we have to admit that this particular hospital has taken its fondness for wrong site injuries, a tad far. The Associated Press is reporting that a hospital in Rhode Island has been fined $150,000, and been ordered to install video cameras in all its operating rooms, after the 5th wrong site surgery in its facility since 2007.

Rhode Island Hospital is the largest hospital in the state, and is the teaching hospital for Brown University’s Alpert Medical School. The latest incident at the facility involved a patient who was scheduled for surgery on two fingers last month. However, both the surgeries were performed on the same finger. When the team discovered the error, they asked the patient’s family if they could perform surgery again, this time on the correct finger. However, when the team did perform the surgery a second time, they didn’t bother to take a time out to ensure that they were operating on the right site, even after they had made such a serious surgical error the first time. In 2008, three patients who underwent brain injury had their surgeries performed in the wrong site.

The state health director has been galvanized into action by these errors. It has ordered the hospital to assign an independent clinical employee, who is not part of the surgical team, to be present in operating rooms and observe surgeries at least for 1 year. The hospital has also been ordered to have surgeons mark the surgical site. The hospital will also install video and audio recorders in all its operating rooms to record surgeries. Hospitals will require permission from patient and families before they record surgical procedures.

Wrong Site Surgeries are Entirely Preventable
As Indiana medical malpractice lawyers, we know that wrong site surgeries are the most preventable kind of errors. These surgeries are called “never events,” meaning that they are so preventable, they should never occur in a hospital. When these kinds of errors occur again and again, it is a sign of a deep-rooted malaise in the system, one that we hope the hospital authorities here will be able to correct as quickly as possible.

Every year, approximately 2 million people contract an infection in a hospital. These infections are the cause of approximately 100,000 deaths every year. There’s one fact that Indiana medical malpractice lawyers know when they come across cases of hospital infections - these are all preventable.

The Wall Street Journal has compiled a list of ten steps to prevent hospital infections. The list includes inputs from doctors, nurses, their health care providers, administrators, the Committee to Reduce Infection Deaths, and the Association for Professionals in Infection Control and Epidemiology. The list contains two parts - one for new technologies that promise great success in preventing infections, and the second part comprising basic simple tasks that don’t take much effort, but can dramatically cut down the risk of infection.

New Technologies
• An epidemiologist in Massachusetts has developed a florescent solution that can be sprayed in patients’ rooms after hospital cleaning crews have done their work, to check how many spots were missed. The fluorescent solution has helped increase cleanliness compliance rates from 44 percent to 77 percent.

• A John Hopkins team has developed a shower-like cubicle, containing a fogging mechanism that can be used to disinfect hospital equipment, including electro cardiogram wires.

• Computer software that can catch a sudden spike in a particular infection on one floor, can allow hospital authorities to zoom in on a potential source of infection. Staff can then take precautions to avoid a spread of the infection.

• Studies indicate that a mild antibacterial soap used for washing, can cut the risk of blood infections.

• Currently, 25 states require hospitals to report infection rates. That is a huge incentive for hospitals to take steps to cut down on their infection rates.

Basic Steps
• Hospital and staff must wash hands using alcohol-based hand sanitizers, and these must be available easily and readily.
• Checklists can be used to ensure that hygiene procedures are followed strictly.
• Hospitals have begun to develop portable kits that contain all equipment needed for simple procedures, like changing a dressing. This minimizes the possibility of errors.
• Cleaning patient mouths can prevent ventilator-associated pneumonia which often occurs in the ICU.
• Quick diagnostic testing allows hospitals to identify infections within hours, instead of waiting for days to see the results.

A new report shows that the country's largest malpractice insurers, far from bending under the strain of malpractice payouts, are actually earning profits that are higher than those of most Fortune 500 companies.

The report analyzes the annual financial statements of 10 of the largest insurers, and the results show that:

The average profits of these companies are higher than 99 percent of all Fortune 500 companies.
The average profit of these insurers is 35 times higher than the average for Fortune 500 companies in the same time period
The profit margins of these insurers range between 5.9 percent to a maximum of 74.8 percent with an average profit margin of 31.2 percent

That’s not all. The report also indicates that insurers have been showing lower profits than they actually earned, and higher losses than they actually incurred, in order to create a sense of anxiety about the health of the insurance industry, and to support restrictions of patients' rights to justice. According to the report, insurance companies, over the last five years, have incurred losses that are actually 13.5 percent lower than they first reported. They have also enjoyed 5.1 percent higher profits last year on an average, and 12.4 percent higher profits two years ago.

These figures show how hollow insurers' arguments that high medical malpractice payouts are contributing to high costs of health care, really are. They also underscore what Indiana medical malpractice lawyers have been saying all along - insurers seem to be having the last laugh as they enjoy their hefty bottom-lines, while patients have their rights to justice restricted severely in the form of damage caps.

The death of a female patient, who died in a flash fire in an operating room last week, has had Indiana medical malpractice lawyers and safety experts around the country concerned about the frequency with which these fires occur every year.

65-year-old Janice McCall was undergoing surgery at the Heartland Regional Medical Center in Marion in Illinois, when a sudden flash fire in the operating room caused her serious burn injuries. She was rushed to a Tennessee hospital, but died six days later. Heartland's statement after her death says that there was an “accidental flash fire” in the hospital's operating room, and McCall was injured before the fire was put out. Nobody else in the operating room was injured.

The tragic incident has raised focus on surgical fires, which remain a rare, but deadly, occurrence in our hospitals. According to data from the ECRI Institute, every year there are abut 550 to 650 surgical fires that occur in operating rooms. Out of these, up to 30 result in serious injuries, and one or two cases result in a fatality. According to ECRI forensic investigators, most flash fires occur when high oxygen levels cause material like surgical sheets in the operating room, to ignite. High oxygen levels can often be found under these sheets or drapes. Other common causes of flash fires are alcohol-based cleaners. The cleaner must be fully dried before laying out the electronic surgical equipment. Otherwise, the vapors can ignite, causing a sudden flash fire.

Whatever the cause of surgical fires, experts are unanimous that these are 100 percent preventable. Prevention depends on operating room staff controlling conditions in a room to prevent a fire.

There are several steps that hospital staff can take to prevent a fire.
Alcohol-based solutions must be given sufficient time to dry out. Two to three minutes may be sufficient.
Steps must be taken to prevent oxygen build up under drapes.

The Indiana medical malpractice lawyers at Theodoros a& Rooth represent victims of medical negligence, including surgical errors, emergency room errors, diagnostic failures, medication errors and other forms of medical malpractice in Merrillville, and around the state of Indiana.

Every year 98,000 people die of preventable medical errors in US hospitals. In November 1999, the Institute of Medicine released its pathbreaking report “To Err is Human,” which revealed that preventable medical errors cause more deaths every year than automobile accidents, certain forms of cancer and AIDS. Ten years since the report was published, there hasn’t been much of a reduction in the number of deaths from these errors.

Failure to hold doctors, nurses and other healthcare professionals accountable for errors that impact patient safety is the main reason Indiana medical malpractice lawyers come across so many injured patients every year. According to Peter Pronovost of John Hopkins and Robert Wachter of the University of California at San Francisco, punishments are effective at holding these professionals responsible, and for preventing repetition of these mistakes.

The two recommend sanctions for doctors, e.g., losing their privileges for a week for failure to follow safety standards for hand hygiene. They also suggest a loss of privileges for two weeks, for surgeons who don’t mark the surgical site properly to prevent operating on the wrong site. Currently, hospitals tend to play it safe, and are hesitant to blame any one individual physician for any of these errors. In sum, there is very little individual accountability, and typically, administrators look the other way when they come across, say, a doctor who fails to perform a "time-out" before operating to avoid surgical errors.

Every year 4,000 surgeries are performed at the wrong site. These are some of the most preventable surgical errors, yet they continue to frequently occur in our hospitals. Preventing medical errors doesn’t have to involve a heavy investment in time and resources. Following a simple checklist before operating, for instance, can ensure that the patient is operated on at the correct site. Likewise, there are relatively simple procedures that can be implemented for minimizing the risk of infection, and preventing surgical instruments, sponges and gauze from being left behind in the patient's body after surgery. We believe that healthcare professionals do commit these errors, especially on a repetitive basis, they be held accountable. As Indiana medical malpractice lawyers, we believe that such accountablility will help in reducing these preventable, life-threatening errors.

It’s a fact that Indiana medical malpractice lawyers have long been aware of. Every year, thousands of patients are severely or fatally injured from errors made by their doctors, and a new study shows that there are internal factors that increase the risk of such medical errors.

A study by researchers at the Mayo Clinic confirms that the risk of medical errors made by residents, increases with the doctor's fatigue and stress levels. The study surveyed 430 internal medical residents who were questioned every three months from 2003 to 2008 about any medical errors they made, as well as stress, fatigue, burnout, sleepiness and depression.

• Out of 370 residents who answered questions about medical errors, 39 percent admitted that they had made at least one major medical error.
• There was also a connection between these medical errors and tiredness. The researchers found that for every single point increase in fatigue, the resident's chances of making a medical error increased by 14 percent.
• Also, for every single point increase in the sleepiness score, the chances of making an error increased by 10 percent.
• Besides sleepiness and fatigue, medical errors were also more frequently seen in doctors suffering from depression, or experiencing burnout symptoms.

This much is clear - the overall quality of a doctor's life has much to do with his potential for making medical errors. These risks are not an exaggeration. According to the Institute of Medicine, every year approximately 100,000 Americans die from preventable medical errors. It’s therefore important that we identify measures that can help them manage stress and fatigue better.

There is some good news for Merrillville medical malpractice lawyers, who would like to see more attention focused on this problem. Hospitals are taking the question of stress and fatigue more seriously than before, and some changes have been made to doctor training to address fatigue and stress issues. Although these measures are important, we need to do much more to promote the well being of doctors, and reduce the possibility of errors. Besides, there is also very little attention being paid to older doctors, in the 65 to 70 age group. These doctors may deal with stress and fatigue in different ways, making it important to identify de-stressing measures for them too.

It doesn’t take super smarts to understand that a tired, stressed and depressed doctor is less likely to be invested in the care of his patients. Too many lives are lost every year to mistakes made by doctors, and as Indiana medical malpractice lawyers, we believe we should be giving this problem the attention it deserves.

A survey of nurses and patients taken over the past year shows what Merrillville medical malpractice lawyers have known all along - that hospitals may actually be much more dangerous and unsanitary than we know.

That scary fact comes via a survey of nurses and patients published by Consumer Reports in its September 2009 magazine. Consumer Reports surveyed both nurses and patients about hospital conditions. The differences in the responses of both, were startling.

While 4% of patients reported seeing problems with hospital cleanliness, 28% of nurses reported seeing such problems.
While care coordination was an issue with 13% of patients, it was a problem reported by at least 38% of nurses.
Worse, only 5% of patients reported that hospital staff sometimes failed to wash their hands, but that is a much bigger problem than we think. 26% of nurses reported that doctors and nurses sometimes failed to wash their hands before approaching patients.

The data reveals that patients may often be unaware of unsanitary and inefficient conditions in the hospital. This can be extremely dangerous because when a patient gets admitted to a hospital, he does so with full faith in the hygiene and sanitary conditions at the facility. But all too often, patients are injured by medication errors, contract infections from unsanitary conditions, and have their care otherwise compromised by inefficiency.

The nurses in the Consumer Reports survey have recommended steps that patients can take to ensure a safe hospital stay.

Make sure that you choose the best and right hospital for your illness. The Consumer Reports survey showed that a mere 11% of patients chose a hospital based on its record in treating their illness, while just 2% based their choice on hospital ratings. The nurses recommend choosing a well rated hospital that has a good record of treating your condition.

Less than 2% of American hospitals have electronic record systems, which means that it's more than likely that your hospital maintains its records the old fashioned, prone-to-errors way. The nurses in the survey recommend that you keep a printout detailing your medications, illness history, and any past surgeries, for quick reference by those who are treating you.

Care coordination is often a problem, with 13% of patients reporting disjointed care. This is often the result of several doctors being involved in your case. Take a family member of friend with you to coordinate care with doctors and specialists on your behalf. You can also ask for a case manager or social worker to coordinate care with your doctors.

Check medications before taking them. As Indiana medical malpractice lawyers, we often see that medication errors are some of the biggest contributing factors to patient injuries.

Make sure you understand all your discharge instructions carefully. This includes medication schedules, and other instructions.

As a patient, you also have the right to ask your doctors to wash their hands in front of you before they attend to you. Don’t be embarrassed or shy - your health depends on it.

He might have meant it as a standard operating procedures to placate health care reform opponents, but so far, there is little to indicate that President Obama’s proposal to grant funds to states to help cut down on medical malpractice lawsuits, has huge support.

Last week, the administration announced that it would grant $25 million to states and health care agencies to evaluate means of reducing the number of "frivolous" lawsuits. According to the White House, the money must be used to help identify and evaluate alternative measures that can minimize such lawsuits. For instance, some states have been flirting with proposals that will allow doctors and hospitals to admit errors and apologize for these, to avoid a lawsuit. States would be encouraged to evaluate the success of such measures, and adopt these.

If the President intended to bring both sides of the debate to speak in a single voice, he succeeded, but not in the way he'd probably hoped. The announcement has been criticized by Republicans and tort reform advocates, as well as patient safety groups. Opponents believe that the grants are too small a step to impact what they like to call, an "epidemic" of medical malpractice lawsuits in the country. Patient safety advocates believe that the grants will do nothing to win support for Obama's reforms, and may actually compromise the rights of injured patients to seek justice.

As Indiana medical malpractice lawyers, we have to agree that the vitriol against justice for injured patients and medical malpractice lawyers in the name of tort reform, is not going to dissipate because of these funds.

The fact is that malpractice insurance in this country has barely little to do with inflating healthcare costs. In fact, according to the Congressional Budget Office, medical malpractice payouts only account for about 2 percent of healthcare costs in the country, and that’s a fact.

The $25 million will do little to raise overall quality and care at some of our worst hospitals, and prevent the kind of wrong diagnoses, surgical errors, emergency room errors and other medical mistakes that are responsible for these lawsuits in the first place.

Theodoros & Rooth believes that the best form or Tort Reform is to institute reforms aimed at cutting down on the number of patient deaths and injuries, which have been estimated to be as high as 100,000 per year.

“The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been.”

These are the words of Donald M. Berwick, MD, MPP, President and CEO of Institute for Healthcare Improvement, an organization dedicated to making the "flawed" healthcare system safer and more effective, and ensuring the best possible outcomes for all patients.

In support of its view that the system is flawed, the Insitute cites the following statistics:

The Institute of Medicine estimates that as many as 98,000 people die each year in US hospitals due to medical injuries;

The Centers for Disease Control and Prevention estimate that two million patients suffer hospital-acquired infections each year;

The US spends the most money on health care of all (advanced) industrialized nations, but it performs more poorly than most on many measures of health care quality.

The Institute recognizes that the system is highly complex with many broken parts, but believe that, given remarkable examples of excellence, it is possible to redesign the way patient care is delivered. Unfortunately, these examples are too few and far between. As stated by the Institute of Medicine in 2001, “Between the health care we have and the care we could have lies not just a gap, but a chasm.” Health care does not yet reliably transfer best-known science into action, and processes frequently fail, despite the best intentions of a dedicated and highly skilled workforce. Our system, which intends to heal, too often does just the opposite — leading to unintended harm and unnecessary deaths at alarming rates.

Accordingly, the Institute has launched a nationwide "100,000 Lives Campaign" in an attempt to reduce morbidity and mortality within the healthcare system by introducing proven practices to assist participating hospitas in saving as many as 100,000 lives.

The insitute is recommending that participating organzations implement the following steps:

· Deploy Rapid Response Teams the first sign of patient decline;

· Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction to prevent deaths from heart attacks;

· Prevent Adverse Drug Events (ADEs) by implementing medication reconciliation practices;

· Prevent Central Line Infections by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle"

· Prevent Surgical Site Infections by delivering the correct perioperative antibiotics at the proper time; and

· Prevent Ventilator-Associated Pneumonia by implementing a series of interdependent, scientifically grounded steps including the "Ventilator Bundle"

Visit the Insittute's website for more information. Also, upon your admission to a hospital, inquire as to whether that institution is participating in the Campaign. Whether they do or not could directly affect your outcome. Be an informed healthcare consumer!

ProAssurance, also known as ProNational, is a national medical malpractice insurer that provides insurance coverage to a significant amount of Indiana physicians. In Indiana, they have apparently adopted the strategy of taking almost every case to trial, even if the claim clearly has merit and even if the Medical Review Panel unanimously finds against their insured doctors. I believe this is part of an overall strategy to discourage attorneys from handling medical malpractice cases against ProAssurance insureds because of the large costs and time involved in taking cases to trial. Sometimes, however, the strategy can backfire.

Recently, plaintiffs in a Florida medical negligence claim received a jury verdict or $217,000,000 against ProAssurance insureds. The Tampa Tribune wrote about ProAssurance's response:

"ProNational Insurance Co., that represents the doctors, has filed court documents that say it is not responsible for paying because the doctors gave conflicting testimony in court. Yerrid [the plaintiffs' attorney] said he will go after anyone necessary to collect, starting with ProNational. The Insurance Company offered $300 Before trial, Yerrid said, he tried to get the insurance company to settle for the maximum allowed under the policy - $1 million for doctor Austin and $1 million for the physicians' group. Instead, the insurance company wanted to settle for $300. Yerrid said it offered $100 for Navarro, $100 for his wife and $100 for his 10-year-old son."

So here, ProAssurance refused to settle an obviously indefensible claim in good faith, and when a jury told them that they clearly should have settled the case, the company tries to wiggle out of their obligation. And the reason they use to attempt to avoid responsibility is because their insured doctors testified differently. I can't imagine any ProAssurance doctors would be too happy to learn that their insurance coverage could be dependent upon the way they testify at trial.

Barry Rooth

Because our firm handles a lot medical malpractice cases, I have had the opportunity to speak to hundreds of patients who have had poor outcomes from surgeries, procedures, etc. I've learned that, almost uniformly, when people require a medical procedure, they are rightly concerned about the experience of the surgeon who will be performing the procedure. This should not, however, be their only concern.

When my clients talk about their surgeon, I ask them about the experience and credentials of the anesthesiologist; I ask them about the background of the consultants who will likely be called in; and I ask them about the experience of the radiology and pathology groups that have the contracts with the hospital.

When they respond with blank stares, I explain as follows:

Naturally, it is important to know the qualifications and credentials of the surgeon performing the procedure. And the more serious the operation, the more intensive the questioning should be. However, that physician is only part of the team taking care of you during the hospitalization. If I were having surgery, I would be just as concerned about the credentials of the anesthesiologist who literally holds your life in his hands during the procedure. I'd also be very curious about whether the anesthesiologist will even remain in the operating room or whether the hospital will allow them to hand you over to a nurse anesthetist. This is essential information because If something goes wrong during surgery, it is likely that the anesthesiologist who will be primarily responsible for managing the crisis.

The bottom line is this: If you're going to have surgery, ask about the all of the physicians who will take care of you, not just the surgeon. The strength of your medical team is only as good as its weakest member.

Barry Rooth

Hospitals don't provide all the information you need to know. The following September 12, 2006 smartmoney.com article provides the following Top-10 list of things the hospital won't tell you:

1. "Oops, wrong kidney."
In recent years errors in treatment have become a serious problem for hospitals, ranging from operating on the wrong body part to medication mix-ups. According to a report from the Institute of Medicine, at least 1.5 million patients are harmed every year from being given the wrong drugs — that's an average of one person per U.S. hospital per day. One reason these mistakes persist: Only 10% of hospitals are fully computerized, with a central database to track allergies and diagnoses, says Robert Wachter, chief of the medical service at UC San Francisco Medical Center.

But signs of change are emerging. More than 3,000 U.S. hospitals, or 75% of the country's beds, have signed on for a campaign by the Institute for Healthcare Improvement implementing new prevention measures such as multiple checks on drugs. As of June these hospitals had prevented an estimated 122,300 avoidable deaths over 18 months.

While the system is improving, it still has a long way to go. Patients should always have a friend, relative or patient advocate from the hospital staff at their side to take notes and make sure the right meds are being dispensed.

2. "You may leave sicker than when you came in."
A week after Leandra Wiese had surgery to remove a benign tumor, the high school senior felt well enough to host a sleepover. But later that weekend she was throwing up and running a fever. Thinking it was the flu, her parents took her to the hospital. Wiese never came home. It wasn't the flu, but a deadly surgical infection.
About 2 million people a year contract hospital-related infections, and about 90,000 die, according to the Centers for Disease Control and Prevention. The recent increase in antibiotic-resistant bugs and the mounting cost of health care — to which infections add about $4.5 billion annually — have mobilized the medical community to implement processes designed to decrease infections. These include using clippers rather than a razor to shave surgical sites and administering antibiotics before surgery but stopping them soon after to prevent drug resistance.

For all of modern medicine's advances, the best way to minimize infection risk is low-tech: Make sure anyone who touches you washes his hands. Tubes and catheters are also a source of bugs, and patients should ask daily if they are necessary.

3. "Good luck finding the person in charge."
Helen Haskell repeatedly told nurses something didn't seem right with her son Lewis, who was recovering from surgery to repair a defect in his chest wall. For nearly two days she kept asking for a veteran — or "attending" — doctor when the first-year resident's assessment seemed off. But Haskell couldn't convince the right people that her son was deteriorating. "It was like an alternate reality," she says. "I had no idea where to go." Thirty hours after her son first complained of intense pain, the South Carolina teen died of a perforated ulcer.
In a sea of blue scrubs, getting the attention of the right person can be difficult. Who's in charge? Nurses don't report to doctors, but rather to a nurse supervisor. And your personal doctor has little say over radiology or the labs running your tests, which are managed by the hospital. Some facilities employ "hospitalists" — doctors who act as a point person to conduct the flow of information. Haskell urges patients to know the hospital hierarchy, read name tags, get the attending physician's phone number and, if all else fails, demand a nurse supervisor — likely the highest-ranking person who is accessible quickly.

4. "Everything is negotiable, even your hospital bill."
When it comes to getting paid, hospitals have their work cut out for them. Medical bills are a major cause of bankruptcy in the U.S., and when collectors are put on the case, they take up to 25% of what is reclaimed, according to Mark Friedman, founder of billing consultant Premium Healthcare Services. That leaves room for some bargaining.

Take Logan Roberts. The 26-year-old had started work as a business analyst near Atlanta but had no insurance when he was rushed to the ER for an appendectomy. The uninsured can pay three times more for procedures, says Nora Johnson, senior director of Medical Billing Advocates of America; Roberts was billed $21,000. "I was like, holy cow!" he says. "That's four times my net worth."

After advice from advocacy group The Access Project, Roberts spoke with hospital administrators, telling them he couldn't pay in full. Hospitals frequently work with patients, offering payment plans or discounts. But to get it, you have to knock on the right door: Look for the office of patient accounts or the financial assistance office. It paid off for Roberts, whose bill was sliced to $4,100 — 20% of the original.

5. "Yes, we take your insurance — but we're not sure about the anesthesiologist."
The last thing on your mind before surgery is making sure every doctor involved is in your network. But since the answer is often no for anesthesiologists, pathologists and radiologists, what's a patient to do? Los Angeles-based entertainment lawyer and patient advocate Michael A. Weiss repeatedly turned away out-of-network pain-management doctors on a recent visit to the hospital.
We're not suggesting you go as far as Weiss did to save money, but do ask for someone in your network if you're alert enough. If it's an emergency and you're stuck with an out-of-network doctor, call your insurance company to help resolve the issue. If it's elective surgery, ask a scheduling nurse in the surgeon's office to find specialists in your plan, says South Bend, Ind.-based billing sleuth Mary Jane Stull. And if you know your procedure will be out-of-network, call the hospital billing department to negotiate. It will likely point you to a patient representative or the director of billing. Once you've dealt with the hospital, then try the surgeon or other specialists involved — some hospitals will back you in those discussions, Friedman says.

Continue reading "Doctors and hospitals may commit medical malpractice by not telling patients what they need to know" »

In 1975, the Indiana legislature passed the Indiana Medical Malpractice Act, which severely limited the rights of Indiana Patients. Among other things, the Act required that all claims against health care provider be submitted to a Medical Malpractice Review Panel, who would determine whether or not the defendant committed malpractice. Since 1996, only slightly more than 20% of all Panels formed in the State found malpractice. Once the Panel renders their opinions, the case can then be filed in Court. There are other limitations imposed upon patients in the Act, which will be discussed in other blogs. For now, suffice it to say that the Act is bad for Indiana patients.

Lately, the health care providers' insurance companies and their attorneys have been throwing up additional hurdles to patient's claims. For example, the intent of the legislature in instituting the Medical Review Panel process was to discourage the prosecution of frivilous claims, and promote settlement of those claims that were found by the Medical Review Panel to have merit. However, at least one large physician insurance company has apparently adopted a policy of taking all cases to trial, regardless of whether the Medical Review Panel has unanimously found against the insured doctor. In other words, the defense strategy in each of those cases is to refuse to settle meritorious cases and force the plaintiff to spend large sums of money to try a case to a jury, even though a panel of the defendant's peers has determined that the defendant has committed malpractice. This is apparently a numbers game for the insurance company. They must figure that, given the current political climate, they'll win more than they lose and will save money along the way.

My attitude is this: When I determine that a medical negligence case has merit, I'm willing to go "all the way" for my client, even if that means taking it to trial. In other words, in those cases where it's clear that the defendant's malpractice caused serious injury or death, I'm always willing to trust the collective judgment of the jury, and I have no problem placing my client's fate in their hands. They'll do the right thing many more times than not.

The Indiana Medical Malpractice Act ("IMMA"), I.C. 34-18-1-1, et seq., created a Patient's Compensation Fund for the purposes of collecting and receiving monies to be used to pay patient's claims for medical malpractice. The Indiana Commissioner of Insurance adminsters the Fund..

These monies are received by the Fund in the form of surchages paid by physicians, which are then invested and managed by the Fund, and made available for payout to patients making claims against the Fund.

The Fund publishes annual reports, which provide a substantial amount of data, statistics, and information about the type and number of malpractice cases that are filed and settled in a given time period.

The IMMA requires, among other things, that all claims against health care provider qualified under the IMMA be reviewed by a panel of 3 doctors, known as a Medical Review Panel. The Panel renders opinons concerning the quality of care provided by the defendants. I've always believed that the Panel process has an inherent flaw in that it asks physicians to pass judgment on their colleagues in their home state, or even in their same locale, which would result in less than obejctive Panel reviews.

The Fund's Annual Report for 2005 appears to support this conclusion. The Report discloses that from 1976 through 2005, medical malpractice plaintiffs have filed a total of 20,035 medical malpractice complaints, resulting in 9441 Panel opinions through 2005. Of those opinions, the Panel has rendered 2049 opinions of "malpractice", representing 21.17% of the Panel decisions. I do not believe this number accurately reflects the actual number of meritorious claims filed during this time period and supports the conclusion that the Medical Review Panel process is skewed in favor of physicians.

Barry Rooth