Indiana Injury Law Blog

Computerized Physician Order Entry systems are being introduced in more and more hospitals in order to streamline processes and reduce medication errors. However, according to a new Leapfrog report, these systems may actually miss approximately half of all routine medication orders, and approximately one in three of all potentially fatal medication orders.

Those results came out of a study that Leapfrog conducted to test how CPOE systems were able to detect errors. Leapfrog invited 214 hospitals to test their CPOE systems using a web simulation program it developed. The program showed that these systems missed an average of about 50% of routine medication orders and about a third of all potentially fatal orders. The tests were conducted between June of 2008 and January 2010.

According to Leapfrog, even though this was a simulated test, the results should be a warning to hospitals around the country that are using CPOE systems. In far too many hospitals, the systems are simply installed under the false belief that they will automatically catch medication errors and improve patient safety. The Leapfrog people are recommending that hospitals and CPOE vendors work together to ensure the continued effectiveness and efficacy of the CPOE systems.

However, the Leapfrog report also found that when the hospitals adjusted their protocols and processes, and then retested using the same simulation program, they saw a significant improvement in the performance of these systems. Leapfrog is recommending that every hospital that uses the systems include evaluation and testing as part of its overall quality control processes.

More hospitals are moving to install CPOE systems lured by the promise of federal financial assistance to hospitals that do so. Leapfrog is asking that federal legislation incorporate quality control monitoring of the systems in order to be eligible for financial aid.

The Indiana medical malpractice attorneys at Theodoros and Rooth represent injured victims of surgical errors, misdiagnoses, failure to diagnose, emergency room errors, medication errors and other forms of medical malpractice around Indiana.

A new study indicates that black patients may be more likely to develop deadly hospital-acquired bloodstream infections like sepsis, than people of other races. Not only are black patients more vulnerable to the development of such infections, but they're also more likely to die from these.

Sepsis is a common bloodstream infection that's picked up at hospitals. These usually occur as a result of central line infections when proper sterility procedures are not maintained. Central lines are used to deliver nutrients and medicines quicker to a patient. This also means that when the lines are contaminated, infections also set in much quicker. Once the infection sets in, it leads to the formation of blood clots that restrict the flow of blood to the organs. Organ failure, and ultimately death, can result.

Scientists at the University Of Pittsburgh looked at hospital discharge data from seven different states, as well as emergency department visits between 2003 and 2007 from the National Ambulatory Care Survey. They found that out of a total of 8.6 million hospitalizations during this period of time, there were more than 2.2 million infections. Of these, 17% resulted in organ failure, which is often seen as a result of sepsis infections.

The researchers noted that black patients seemed to be at a 67% percent higher risk of sepsis hospitalizations, compared to non-Hispanic whites. Among blacks, the incidence of sepsis hospitalizations was about 9.4 per 1,000 persons. For whites, it was just 5.6 for every 1,000 persons. The survey also found that black patients had an 80% higher chance of dying from such infections.

So, what is causing this disproportionate rate of deadly sepsis infections in the black population? The researchers believe that black patients have higher incidences of diabetes and chronic kidney disease, both of which contribute to the development of sepsis. Other studies have indicated that black patients are more at risk for general infections, which increases their vulnerability to sepsis.

The researchers are recommending better management of diabetes and kidney disease in black patients, as well as better infection control, to reduce their sepsis risk.

TheIndiana medical malpractice lawyers at Theodoros and Rooth represent injured victims of misdiagnosis, failure to diagnose, emergency room errors, surgical room errors and other forms of medical malpractice around Indiana.

The next generation of hospital cleaning products could come from a prominent feature in your living room. Researchers in the UK have managed to convert compounds commonly found in LCD television sets, into antimicrobials that can kill common germs and organisms found in hospitals.

Scientists at the York Green Chemistry Center of Excellence at the University Of York Department Of Chemistry have found that when PVA of LCD TVs is cooled, and then dehydrated with ethanol, it produces a high surface area mesophorous material. This material can be used to great effect in biomedicine. When the researchers added silver nanoparticles, it enhanced the material’s antimicrobial properties. The resulting material was found to be strong enough to attack bacteria.

These silver nanoparticles can be used in hospitals and other settings that see substantial microbial activity. The compound has been found to be effective at destroying organisms that are commonly found in hospitals, like Staphylococcus aureu and Escherichia coli. The researchers now plan to compare the dehydrated PVA substance with commercial cleaning compounds in order to determine the effectiveness of the substance in attacking germs. They will then move on to seek regulatory approval.

What makes this research even more intriguing is the fact that there will be no shortage of affordable raw material for these compounds. LCDs are expected to be the fastest-growing electronic waste in the Western world, and in Europe alone, it is estimated that approximately 2.5 billion LCDs are nearing the end of their life. That means there will be plenty of raw material to manufacture anti-bacterial compounds.

The Indiana medical malpractice lawyers at Theodoros and Rooth represent victims of misdiagnosis, failure to diagnose, emergency room errors, surgical room errors and other forms of medical malpractice around Indiana.

Earlier this month, the Seventh Circuit Court ruled that a stay on a medical malpractice case involving Indiana ear, nose and throat surgeon Mark Weinberger, would be lifted.

Weinberger is facing more than 300 medical malpractice claims. In fact, the Indiana medical malpractice attorneys at Theodoros and Rooth are representing several clients who were injured by the doctor's negligence. His medical insurance provider, Medical Assurance Company has been conducting Weinberger's defense in all these medical malpractice claims.
In 2004, Weinberger disappeared, and was found five years later in December 2009 in the Italian Alps.

During Weinberger's disappearance, Medical Assurance Company petitioned the Northern Illinois District Court with an injunction that would relieve it of its responsibility to defend the doctor in his medical practice claims. The company based this injunction on what it alleged, was a breach of its policies that requires cooperation between the insurance company and the insured party. This clause provides for denial of coverage to an insured party that does not comply with legal proceedings.

That court issued a stay at least until the medical malpractice claims against Weinberger were resolved. However, the Seventh Circuit Court has now ordered the removal of the stay. The seventh Circuit Court has said that the district court exceeded its legal discretion in ordering the stay. The case has now been remanded to the District Court. Medical Insurance Company will now have to show that the doctor’s disappearance and his absence from medical malpractice hearings contributed to the actual prejudice.

The Indiana medical malpractice lawyers at Theodoros and Rooth represent injured victims of medical malpractice, including emergency room errors, surgical errors, failure to diagnose, medication errors, misdiagnosis and other forms of medical malpractice across Indiana.

A vast majority of all surgical procedures that are currently being performed in the US, are performed at ambulatory surgical centers or outpatient surgical centers. These centers are ideal for those patients who need to have a small procedure performed, but would rather not have the delays and formalities involved in an overnight hospital stay. In an outpatient surgical center, the procedure is performed and the patient is out of the hospital within 24 hours. Considering how many patients visit these surgical centers every month, it was very disturbing for Indiana medical malpractice lawyers to learn of a new report that shows that infection control standards at these centers, are disturbingly low.

The Centers for Disease Control and Prevention conducted a review of approximately 68 ambulatory surgical centers situated in three states. 32 centers were situated in Maryland, 16 were in North Carolina and 20 in the state of Oklahoma. The researchers focused on five separate areas to measure compliance rates. They looked at hand hygiene, environmental cleaning, equipment reprocessing, injection safety and medication handling and blood glucose monitoring equipment handling.

The researchers found that out of the 68 centers that were studied, 46 had lapses in at least one area. That makes it close to 68% of the centers with at least one lapse. 12 had lapses in three or more of these areas, making it approximately 18% of the facilities. Out of the 68 outpatient surgical centers, 39 centers went on to be cited for infection control lapses, while 20 went on to be cited for medication administration lapses.

The most common lapses were seen in failure to follow best practices for equipment reprocessing and handling of blood group glucose monitoring equipment, as well as the use of single dose medication vials for more than one patient.

We don't hear much about infection control at outpatient surgical centers, unless there's a major catastrophe like the one that occurred at a Las Vegas outpatient surgical center, which exposed thousands of patients to hepatitis and HIV. Hopefully, this report will lead to increased oversight of outpatient surgical centers to bring down these infection rates.

Huffington Post is drawing attention to the underlying risks as hospitals around the country embrace electronic medical record systems.

For years now, health safety groups have advocated a complete shift to electronic medical records. A system like this, it is believed and Indiana medical malpractice lawyers would agree, would substantially reduce the risk of human error contributing to patient fatalities. However, in far too many instances, there have been fatalities or serious medical injuries caused by the use of these systems.

The kinds of errors made, have differed greatly. In one particular instance, staff misread the fine print on a computer screen, and ended up dispensing more than 10 times the patient’s prescribed medication. As a result, the patient suffered a heart attack. In another instance, a patient died after there was a breakdown of the Computerized Provider Order Entry, which is a central function of the system.

There have been other reports of delayed information, misinformation, and delayed treatment linked to the use of electronic medical records, and with serious consequences. For instance, in one hospital, the computer failed to inform the staff that the patient had been shifted from the intensive care unit to a ward. Nurses were not aware of the patient’s presence in the ward, and failed to attend to him, even as he suffered seizures through the night.

Huffington Post’s Investigative Fund accessed data from the Food and Drug Administration, and found at least 237 reports of “adverse events” associated with the use of electronic medical records over the past two years. Most of these glitches resulted in wrong dosages of medications, while other software bugs delivered wrong test results.

What's worse is that these 237 events may be just the tip of the iceberg. Because the systems are so new, it's hard for hospitals to document how many of these errors have occurred. It doesn't help that the FDA lacks the resources necessary to ensure a smooth transition from paper records to electronic ones.

The federal administration is encouraging hospitals to speed up the shift from paper files to electronic records. The Obama administration is investing more than $27 billion in funding to encourage doctors and hospitals to phase in these systems. However, these funds will be available to those hospitals that can speed up the process of installing these systems. Critics believe that the system is being introduced far too quickly at many hospitals, and without sufficient staff training in the proper use of these systems.

As Indiana medical malpractice attorneys, we believe that speed in installing these systems without focusing on staff training, could actually end up causing more problems than they were meant to solve.

I never get used to the joy of helping victims of medical evidence received the justice they deserve. This week, a jury in Elkhart County awarded my clients a verdict of $1.2 million in total in the death of a woman from cancer.

Nicole Manhart had a Pap smear performed in February of 1998 at the South Bend Medical Foundation.. The smear was wrongly interpreted by technicians at the hospital, as normal. In 1999, Manhart began to suffer severe bleeding. She initially attributed the bleeding to the use of birth-control pills. However, when the bleeding continued even after the birth control pills had been changed, she went in for a medical examination. An ultrasound revealed that she had a large tumor. By the time, Manhart had discovered the tumor, it was already in the third stage. By 2000, Manhart was dead.

This week, an Elkhart County Superior Court jury awarded Manhart's husband and her twin sons total damages of $1.2 million. Her husband Grant Manhart was awarded $200,000, while her twin sons were awarded $500,000 each. The trial centered on whether staff at South Bend failed to read the Pap smear results accurately.

However, an independent medical review board confirmed that the smear slide showed the presence of cancerous and abnormal cells.

The Indiana medical malpractice lawyers at Theodoros and Rooth represent injured victims of medical negligence, including surgical errors, misdiagnoses, failure to diagnose and emergency room errors, in medical malpractice litigation.

If hospitals in Indiana and around the country have begun to feel the heat on their high infection rates, you have medical malpractice lawyers to thank for it. According to a government report released last week, there has been progress in this area, but some kinds of infections continued to increase.

According to the report by the Agency for Healthcare Research and Quality, infections like postoperative blood stream infections and urinary tract infections associated with the use of catheters, have risen over the past year. There was an 8% rise in the case of bloodstream infections. These are serious infections that can lead to a condition called sepsis, marked by high fever, shivering and seizures. There's also been an increase of 6% in catheter-related urinary tract infections in hospitals. Postoperative pneumonia rates were down by 4%, and rates of bloodstream infections caused by placing of catheters in central veins, were the same as the year before.

According to the Agency for Healthcare Research and Quality, progress in controlling hospital-acquired infection rates has been too slow. The problem has been in getting hospitals, doctors, nurses and other healthcare professionals to abandon their rigid approaches to infection control. Studies have shown that simple steps like hand hygiene, sterilization of equipment and use of checklists can prevent hospital-acquired infections. However, in many hospitals in Indiana and around the country, things are still done the way they were a decade ago.

This much is clear - If your hospital invests in sophisticated and aggressive new methods of infection control, you are less likely to have high infection rates in your facility, or come up against Indiana medical malpractice lawyers.

As Indiana medical malpractice lawyers see, there can be plenty of factors responsible for a patient having to be readmitted into a hospital a few days after discharge. A provision buried in Pres. Obama's healthcare reform package will cut reimbursement for hospitals in certain types of readmission. That should be enough motivation for hospitals to look closer at their facility’s readmission rates. One Hospital in Chicago has undertaken a pilot program to understand the reasons for such readmissions. The hospital found that the reasons for such readmissions were extremely complex.

Rush University Medical Center in Chicago initiated a pilot program in 2007. The program came in response to the discovery that readmissions were high because of several complex social factors. Patients who live alone, or lack emotional and physical support were much more likely to develop complications that required them be readmitted back into the hospital.

To tackle these issues, Rush University Medical Center established a program in which social workers would follow-up with patients after discharge. The social workers would focus on patients who had a high risk of readmission. This included those above 65 years of age, or those patients who were on seven or more medications or lived alone at home. Out of the 1,248 patients that were followed up via telephone, 60% were found to have confusion about the medications or had other such unresolved problems.

Post discharge care is a much neglected part of patient safety. The unfortunate fact is that too many patients suffer from a lack of knowledge about post-discharge care. There may be confusion about medications and side effects. Besides, elderly persons who live alone are much less likely to take their medications on time. Hospitals must be more proactive, and get involved in how their patients are faring after they leave the hospital.

The Indiana medical malpractice lawyers at Theodoros and Rooth represent injured victims of surgical errors, misdiagnoses, delayed diagnoses, emergency room errors, medication errors and other medical errors in the Lake County area, and across the state of Indiana.

Last week saw a tremendous moment for trial lawyers and medical practice attorneys around the country. The Supreme Court in Georgia overthrew a cap on non-economic damages in medical malpractice lawsuits.

The decision came in an appeal filed by an Atlanta hospital against a patient who was left severely injured and scarred by a plastic surgery procedure gone horribly wrong. The woman suffered open wounds on her face after she underwent a plastic surgery procedure performed to remove bags under eyes. The woman sued the hospital, and was awarded $1.15 million in non-economic damages. The hospital appealed that verdict, saying that it contradicted a cap on non-economic damages at $350,000 imposed by Georgia's legislators in 2005.

The hospital lost its appeal, and the matter ended up before the Supreme Court of Georgia. That court has decided that allowing a cap on damages in medical malpractice lawsuits, is unconstitutional, and robs a citizen of his right to trial by jury.

As Indiana medical malpractice lawyers, we couldn't agree more. However, around the country, doctors and hospitals have had some amount of success in getting legislators to place limits on the amount of compensation injured victims of medical malpractice can recover. Such efforts have frequently ended up before the highest courts in these states. In January this year, the Illinois Supreme Court also struck down a cap on damages in medical malpractice lawsuits, dealing a blow to the tort reform lobby in that state. Now, Georgia’s SC has followed. As Indiana medical malpractice attorneys, we hope that Indiana will be next.

The Indiana medical malpractice lawyers at Theodoros and Rooth represent injured victims of medical malpractice in Merrillville, Lake County, and across Indiana recover their rightful compensation.

It’s always encouraging when you come across a hospital anywhere in the country that has achieved dramatic success in reducing infections. Just two years ago, Mount Sinai Hospital in Los Angeles was battling with a centerline infection rate that was more than double the national average rate for such bloodstream infections. Today, that rate has dropped to zero, thanks to aggressive infection control strategies adopted at the hospital.

Approximately 250,000 people contract deadly central line infections every year. The risk for such infections is especially high in intensive care or surgical care units where healthcare personnel are required to act quickly, leaving ample room for unsanitized and unhygienic practices. The intravenous tubes allow nutrients and drugs to reach patients much faster than traditional IV lines. The flipside to that is that any deadly bacterial infection also spreads into the patient's bloodstream equally fast.

In 2008, Mount Sinai was battling high intravenous tube infection rates. Hospital established a series of measures to control these rates. A special infection control nurse was brought in to help implement these strategies.
• Sterile gowns, caps and other accessories were bundled into a single package to allow easy access to all gear.
• Special carts were introduced to allow nurses and doctors access to catheters and other supplies to set up an intravenous tube line, with minimum fuss.
• The hospital set into place a procedure in which doctors and nurses were required to take a “timeout” to go through a checklist before inserting catheters.
• Mount Sinai also made a switch from common alcohol-based disinfectants to a more effective chlorhexidine-based antiseptic, which has been shown to be much more effective in preventing infections.

The results were very encouraging. Within a few months and by the end of 2008, central line infections at the hospital had dropped to zero.

As Indiana medical malpractice lawyers, we hope more and more hospitals around the country adopt such practices to neutralize the chances of patients developing such dangerous infections.

As medical malpractice lawyers representing victims of negligence in Indiana, minimizing hospital infection rates has been high on our wish list. It therefore disturbs us that there is a growing trend in the healthcare industry to reuse single-use medical products like catheters, scissors and compression sleeves.

The healthcare industry is facing mounting pressure from the green brigade to cut down on the amount of waste it generates every year. Part of these efforts includes cutting down on the number of medical products that are used in hospitals every year. This has led to more and more hospitals choosing to reuse compression sleeves, surgical scissors and ultrasound catheters. These are meant to be single use products that must be discarded after the first use. However, as many as a quarter of all hospitals in the United States currently engage in reusing such products.

These measures have widespread support from environmental groups, because they reduce consumption and help minimize waste. Hospitals also encourage these moves because they translate into more cost savings. As usual, it falls back on medical malpractice attorneys in Indiana and around the country to object to practices that place patients at a high risk of contracting infections.

The pro-reuse lobby insists that if proper practices of sterilization and reuse are followed, these products can be used again with zero risk of infection. Unfortunately, as Indiana medical malpractice lawyers, we often see that inculcating safety and hygiene practices among hospital staff is a long and intensive process. Hand washing rates among doctors continue to be low in spite of sustained efforts by watchdog groups and health experts. In a situation like this, training staff to use the right sterilization and reuse processes is going to take a really long time.

Cutting costs must not come at the expense of patient safety. There are other ways to cut costs and minimize waste, and the healthcare industry must be investing in efforts to develop and refine these.

Every year, more than 98,000 people are killed because of medical errors. Those numbers have not decreased significantly, although there has been a dip from the use of checklists before surgeries. Patient safety practices can be enhanced if we invest in a new generation of doctors who are as committed to patient safety.

The New York Times published a report last month which discussed how more and more medical schools are introducing patient safety subjects in their medical curriculum. In 2008, a study by the Liaison Committee on Medical Education reported that appropriately 2/3rd of medical schools reported including patient safety as part of the curriculum for their students. However, another study conducted by the Institute for Healthcare Improvement found that 4 out of 5 students felt that their exposure to patient safety had been “fair” at best.

There is much that medical schools can do to inculcate better patient safety practices in order to prevent medical errors and minimize error rates. However, for many medical schools, patient safety has been low on the priority. One of the reasons for this is that a medical course includes large amounts of material that have to be covered before the program ends. Concepts of patient safety seem to lose out to seemingly more important medical topics.

There are indications that this attitude is changing. One medical school now invites parents of victims of medical errors to speak to students about their experiences. Another school allows students to participate in debriefing sessions with doctors whose job is to respond quickly to emergencies. Also very encouraging is the fact that more and more medical school students, who see the national discussion over medical errors, are willing to speak up and broach this hitherto forbidden subject.

Developing a stronger awareness of the hundreds of things can go wrong before, during and after a procedure, and establishing means to prevent these, must begin right in medical school. We hope more schools realize this, and make time for patient safety discussions in their programs.

The Indiana medical malpractice lawyers at Theodoros & Rooth represent persons injured because of surgical errors, emergency room errors, failure to diagnose , misdiagnoses, and other forms of medical negligence.

The New York Times is reporting on fearsome and deadly new bacterial infections that are highly resistant to drugs and antibiotics. While most talk of hospital infections centers around the dreaded MRSA methicillin-resistant Staphylococcus aureus, new drug-resistant varieties are quickly emerging, posing a serious threat to patients and a challenge to doctors.

Every year, MRSA infections leave thousands of patients seriously ill, and kill several others. As dangerous as these infections are, these organisms do respond to antibiotic therapy. What's worrying doctors across the country is the development of new strains of bacteria that are even more deadly because they're resistant to the antibiotics currently being used. According to the figures, the numbers of people being killed by these drug-resistant bacterial infections possibly runs into the tens of thousands of patients annually.

One such organism is Acinetobacter baumannii. Acinetobacter baumannii and other such drug-resistant bacteria belong to a group called Gram Negative bacteria. The name comes from their negative reaction to the Gram stain test. Yet another Gram negative organism is Klebsiella pneumoniae. This organism seems to thrive especially well in the crowded hospitals of New York.

These so-called super germs are now spreading across the world. Studies into injury and fatality rates from Gram-negative bacterial infections are not sophisticated enough for us to know how many people are killed from these infections every year. To be honest, MRSA kills more people than any other kind of orgasm. MRSA also continues to be more dangerous because it can spread even outside the hospital. In contrast, gram-negative bacteria attack people who have a weakened immune system, and only thrive in a hospital setting. These germs breed on surfaces in a hospital, and are introduced into the body through open cuts and contaminated medical products, like catheters.

Because treatment is so difficult and available antibiotics have a high risk of leaving patients with kidney damage, the best cure for these infections is prevention. This makes it all the more necessary that hospitals take up their infection control programs on a war footing.

The Indiana medical malpractice lawyers at Theodoros & Rooth represent persons injured because of surgical errors, emergency room errors, failure to diagnose , misdiagnoses, and other forms of medical negligence.

A new study estimates that approximately 48,000 people are killed every year from hospital infections. Most of these deaths occur from two of the most common and deadliest hospital infections - pneumonia and sepsis.

The researchers in the study looked at discharge records between 1998 and 2006 across 40 states. They found that pneumonia and sepsis accounted for most of the fatalities, and that these infections resulted in treatment costs of $8.1 billion. This means that treatment costs for hospital-acquired infections amounts to approximately 1% of the total expenditure on health care in the country.

That isn't good news for patients waiting to get admitted into a hospital, but it also doesn't mean that you have absolutely no control over your health during and after your hospital visit. Experts advise that you arm yourself with information and knowledge in order to reduce your risks of contracting dangerous bloodstream infections like sepsis, or deadly respiratory infections like pneumonia during your hospital stay.

• Ask your doctors what kind of infection control and prevention strategies they use.
• Ask your doctors if it would help if you were screened for MRSA.
• Ask if you will be given antibiotic therapy before your surgical procedure to prevent infections.
• Insist that doctors and nurses wash their hands where you can see them before they proceed to examine you.
• Ask your doctors if they follow a surgical checklist that has been proved to dramatically reduce the risk of contracting a bloodstream infection. The checklist was developed by Dr. Peter Pronovost of John Hopkins, and has been found to cut infection rates by more than 60%.

Asking questions like these informs your doctors, nurses and other healthcare professionals that you are aware of patient safety protocols, and reminds them of their duties and responsibilities. Informed patients can bolster infection prevention efforts.

The Indiana medical malpractice lawyers at Theodoros & Rooth represent persons injured because of surgical errors, emergency room errors, failure to diagnose , misdiagnoses, and other forms of medical negligence.

As medical malpractice lawyers in Indiana, we regularly track patient safety issues that affect our clients and readers. Consumer Reports magazine has published a comprehensive report on the deadly bloodstream infections that kill close to 30 percent of the 99,000 people who fall victim every year to hospital infections. The report outlines how hospitals around the country are seeing substantial success in minimizing their infection rates just by following simple safety steps included in a checklist.

Bloodstream infections, also known as central line infections, are contracted when bacteria contaminate the central lines that are used to deliver food and drugs to patients in intensive care. The central lines are far more convenient, and allow for faster delivery than IV lines, but this also means that any infection contracted through the central line spreads rapidly. Body stream infections can result in a conduction called sepsis, whose symptoms are a lot like flu (fevers, chills etc.) but much, much worse. These infections are very often fatal.

However, as the Consumers Report piece shows us, these rates can be brought under control. All it takes is for doctors, nurses and other professionals in charge of handling the central line to take some basic steps to prevent infections. A checklist developed by Peter Pronovost of John Hopkins, if followed stringently, can help prevent these infections.

The checklist isn’t exactly rocket science. It recommends
1. Washing hands well before handling the central line
2. Disinfecting the skin before touching it
3. Using all precautions while handling the patient. This includes wearing a mask, cap and sterile gloves and covering the patient’s body with a sterile sheet.
4. Removing any non-essential catheters
5. If possible, trying to avoid placing catheters in the groin region where they may be at a greater risk of infections

Preventing central line infections is not impossible. If fact, by following the checklist, many hospitals around the country have been able to bring down their infection rates by more than 66 percent.

If a loved one is in intensive care, you can increase his/her chances of avoiding a bloodstream infection by asking the doctors and nurses to follow the steps in the checklist.

The Indiana medical malpractice lawyers at Theodoros and Rooth represent victims of surgical errors, misdiagnoses, emergency room errors, and other forms of negligence by doctors, nurses and other healthcare personnel.

Assessing the risks of surgery is much more precise than it used to be. For years, doctors have found it a challenge to calculate and discuss the risks of various surgical procedures with their patients. Now, there are ways to calculate the risks of a surgery more accurately, and doctors are using these more and more often to assess potential complications and counsel patients about these risks.

Risk calculators are not a new means of risk assessment. For years now, these have been used for heart surgeries, but now these are being used in other medical specialties too. For instance, the American College of Surgeons has developed risk calculators for colon and pancreas surgery too. The ACS is also in the process of developing several other such calculators for hernia repair and gastric bypass. With a calculator, a doctor can enter a patient’s specific variables like his medical condition and age, and receive a report about the kind of complications likely.

Hearing about the risk of complications or even death from your surgeon is not a pleasant thought, but patients find that the information they receive from these risk calculators can help them make an informed choice about the surgery. The data can also help them prepare themselves for the procedure, and may make them more confident about the decision to have the procedure. Earlier, patients would be wheeled into surgeries after signing a piece of paper that many of them would likely have not even bothered to read. Having all the risks explained to you beforehand can give you the tools to make the right decision.

The Indiana medical malpractice lawyers at Theodoros and Rooth represent victims of surgical errors, misdiagnoses, emergency room errors, and other forms of negligence by doctors, nurses and other healthcare personnel.

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