South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Society of Actuaries is an educational, research and professional organization dedicated to serving the public, its members and its candidates. The SOA's mission is to advance actuarial knowledge and to enhance the ability of actuaries to provide expert advice and relevant solutions for financial, business and societal problems. The SOA's vision is for actuaries to be the leading professionals in the measurement and management of risk.

Findings from a new study released by the SOA estimate that measurable medical errors cost the U.S. economy $19.5 billion in 2008.  The study shows how 1.5 million medical errors compromise quality of American healthcare and cause unnecessary waste in the system

Commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman, Inc., the report used claims data to provide an actuarially sound measurement of costs for avoidable medical injuries. Of the approximately $80 billion in costs associated with medical injuries, around 25 percent were the result of avoidable medical errors.

Jim Toole, managing director of MBA Actuaries, Inc., said  "Of the $19.5 billion in total costs, approximately $17 billion was the result of providing inpatient, outpatient and prescription drug services to individuals who were affected by medical errors. While this cost is staggering, it also highlights the need to reduce errors and improve quality and efficiency in American healthcare."

Medical errors are a significant source of lost healthcare funds every year. For example, the study found that $1.1 billion was from lost productivity due to related short-term disability claims, and $1.4 billion was lost from increased death rates among individuals who experienced medical errors. According to a recent SOA survey, which identified ways to bend the national healthcare cost curve, 87 percent of actuaries believe that reducing medical errors is an effective way to control healthcare cost trends for the commercial population, and 88 percent believe this to be true for the Medicare population.

"We used a conservative methodology and still found 1.5 million measureable medical errors occurred in 2008," says Jonathan Shreve, FSA, MAAA, consulting actuary for Milliman and co-author of the report. "This number includes only the errors that we could identify through claims data, so the total economic impact of medical errors is in fact greater than what we have reported."

Key findings from the study include:

There were 6.3 million measureable medical injuries in the U.S. in 2008; of the 6.3 million injuries, the SOA and Milliman estimate that 1.5 million were associated with a medical error.
The average total cost per error was approximately $13,000.   In an inpatient setting, seven percent of admissions are estimated to result in some type of medical injury. The measurable medical errors resulted in more than 2,500 avoidable deaths and more than 10 million excess days missed from work due to short-term disability.

The study also identifies the 10 medical errors that are most costly to the U.S. economy each year. Approximately 55 percent of the total error costs were the result of five common errors:

Pressure ulcers
Postoperative infections
Mechanical complications of devices, implants, or grafts
Postlaminectomy syndrome
Hemorrhages complicating a procedure

The SOA and Milliman findings were based upon an analysis of an extensive claims database. Measureable costs of medical errors included increased medical costs, costs related to increased mortality rates, and costs related to lost productivity of an error.

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The National Quality Forum has studied and evaluated medical errors.  They have created a limited number of "never events" meaning, of course, that they should never happen.   See article here.   Most of these mistakes happen while a patient is being cared for in a nursing home.

Here are some that you often see in nursing home litigation: 
-Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended 
-Patient death or serious disability associated with patient disappearance for more than four hours 
-Patient death or serious disability associated with a medication error 
-Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility 
-Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility 
-Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
-Patient death associated with a fall while being cared for in a healthcare facility
-Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility 
-Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider 
-Sexual assault on a patient within or on the grounds of a healthcare facility
-Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility

To learn more about this list, and the criteria for including a medical error on this list, visit the Center for Medicaid and Medicare Services website.

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Milwaukee-Wisconsin Journal Sentinel had an article about the horrible care and fraudulent documentation at Mount Carmel Health and Rehabilitation including 35 violations of regulations for minimum care.  "Records also show, however, that the 35 citations issued so far this year to Mount Carmel are close to the 40 citations issued in all of 2009 and more than the 25 issued in 2008, according to the state Department of Health Services."

Staff at the state's largest nursing home recorded on charts that a 41-year-old brain-damaged resident was in his bed watching TV when he was sitting in jail. The man spent five days in custody,  Staff had continued to mark on charts that he was at the facility through the night and into the morning of May 17. 

The man wandered away from Mount Carmel and was arrested for "prowling" more than four miles away.  The nursing home was aware that he was a wandering risk and were ordered by phyisicians to check on him every 15 minutes. The other violations cited this year include failing to communicate with a recent amputee and failing to provide for five residents at risk of falling, including one who was hospitalized for a broken jaw after falling out of his wheelchair.

Licensed for 473 beds, Mount Carmel is the largest of the 397 nursing homes in Wisconsin, according to the Department of Health Services. In January 2009, Kindred Health Care, a Louisville, Ky., for-profit company resumed operation of Mount Carmel. After operating with a probationary license for one year, Kindred was given a full license in January of this year.

The citations issued this year include two identifying "actual harm" to residents and five for violations that constitute a "direct threat to health, safety and welfare," state records show.

Other citations
Among other things, Mount Carmel was accused of:

• Failing to provide appropriate supervision and assistive devices to five out of 10 residents identified by Mount Carmel as being at risk for falls.

Three of the five had fallen since last December, including one who suffered a broken jaw and an eye socket "blowout." A hospital that treated the woman reported the incident to the state but Mount Carmel, which was required to report the incident, did not.

• Failing to assess and treat pain, depression and other problems experienced by a 51-year-old woman.

• Sixteen of 32 residents reviewed were not treated "in a manner that maintained their dignity."

Two were kept in a small alcove near an exit; at least six were kept in an old nursing station or in a hallway for extended periods; and an incontinent resident said staff turned off his call light four times after he sounded it and had a bowel movement before any staff took him to the toilet.

The September inspection also found that after a resident complained of hip pain, Mount Carmel did not notify a physician for two hours and 15 minutes. The doctor ordered an X-ray, but the order was not relayed by a nurse for 2 1/2 hours. The X-ray revealed a broken hip.

The article had a Summary of violations Mount Carmel Health and Rehabilitation Center in Greenfield was cited for 35 state and federal violations so far this year. Among them:

March 2010: A 51-year-old resident who had her right leg amputated below the knee in December 2009 did not have staples removed as of March and no adequate assessment or treatment of the resident's "phantom pain" in the leg had been done.

Mount Carmel also was cited for failing to communicate with the resident, who did not speak English, in Spanish. Among other things, staff was not aware that the resident experienced phantom pain and that she had been dropped by staff. A registered nurse told an investigator she didn't need a Spanish interpreter because relied on documents and the resident's gestures and facial expressions.

Also in March, an investigator found that 16 of 32 residents reviewed were not treated "in a manner that maintained their dignity." Two had been transported in shower chairs with bare legs or buttocks exposed; two were kept in a small alcove near an exit; at least six were kept in an old nursing station or in a hallway for extended periods; an incontinent resident said staff turned off his call light four times after he sounded it and had a bowel movement before any staff took him to the toilet.

January 2010: A federal investigator finds that, going back to December, five out of 10 residents identified by Mount Carmel as being at risk for falls did not receive appropriate supervision and assistive devices, and that three of them fell. A 92-year-old resident who needed supervision was dropped off at a medical appointment by herself. .

Dec. 3, 2009: A resident who lacks the ability to move in bed, is found on the floor next to her bed. She suffers a broken jaw and an eye socket "blowout," according to a federal investigator. The hospital reported the injuries to the state Office of Caregiver Quality, but Mount Carmel, which is required to make a report, did not. When the investigator asked a Mount Carmel administrator on Jan. 11, five weeks after the incident, whether Mount Carmel had reported the incident to the state, the administrator said no report had been made because Mount Carmel "felt they knew how the incident occurred."

Nov. 5, 2009: Resident suffers laceration to left palm requiring sutures in a hospital emergency room. Hospital reports the injury to the state, but Mount Carmel did not. Mount Carmel could not determine how the incident occurred.

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I ran across a couple of articles on Crystal Rader.  Born with muscular dystrophy, Rader requires a motorized wheelchair to get around.  Rader enjoys leaving the nursing home for activities and the wheelchair is the only way she can participate.  Her current wheelchair is six years old and ready to break down.   Rader bought it for $35,000 (with assistance of Medicaid) six years ago,

She applied to Colorado's Medicaid program for assistance for a new wheelchair. Medicaid denied her request, claiming in its rejection letter that the wheelchair is unavailable to her under the state's Durable Medical Equipment Program because she lives at the Fort Collins Health Care Center, a nursing home owned and operated by Sava Senior Care, therefore, the nursing home should provide the wheelchair and then presumably get reimbursed by Medicaid later.

"If they live in a long-term care or nursing facility, we do not pay for durable medical equipment unless that person is within 14 days of discharge," Department of Health Care Policy and Financing spokeswoman Joanne Lindsey said.   The state pays the Fort Collins Health Care Center for medical and equipment costs.

Rader said she isn't confident the Fort Collins Health Care Center, which is owned by Atlanta-based Sava Senior Care, will help her get a new chair.

"For a 26-year-old to be stuck in bed is horrible," Rader said. "It scares me. I lose all my activities I like to do."

I wonder why the local Ombudsman isn't involved?
A fund has been set up to help Crystal Rader replace her aging motorized wheelchair. 

See articles from the Coloradoan here and here.

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The Providence Journal had an interesting article about the neglect and poor care provided at Summit Commons nursing home.  Rhode Island's Department of Health has found that Summit Commons provided neglectful and substandard care to a patient.  DOH ordered the nursing home to install electronic-medical records to prevent future such problems.

The order against the Summit Commons Skilled Nursing and Rehabilitation Center marks the first time the Health Department has imposed such a mandate on a nursing home.  Through a series of negligent mistakes, Summit Commons failed to check the blood sugar of a diabetic patient for three weeks, even after prescribing a drug that can cause blood sugar to go up. The nursing home also continued to give the patient stool softeners after he developed diarrhea.

The patient was admitted to Summit Commons on March 16 with doctor’s orders to check his blood sugar twice a day and give him insulin as necessary. But the nurses failed to transcribe those instructions onto the patient’s medical chart, and failed to catch the error when checking later, Gifford said. Electronic-medical records would automatically generate such orders and nurses would not have to transcribe them, Gifford said.  Later, the patient was prescribed prednisone to treat arthritis. Prednisone can elevate blood sugar, and that prescription should have triggered tests of blood sugar, Gifford said.

The patient was eventually admitted to Memorial Hospital of Rhode Island with shortness of breath, congestive heart failure, low blood pressure and dangerously high blood sugar.  The patient was sent home with hospice care and died soon after.

The patient was hospitalized, the nursing home failed to notify the Health Department as required. The Health Department conducted an inspection on April 20 after relatives of the man reported the incident and requested an investigation.  It’s the second time in less than a year that Summit Commons has run afoul of health inspectors. In August, the state declared that patients were in “immediate jeopardy” because of the nursing home’s failure to treat bedsores.

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Fewer medical malpractice payments were made on behalf of doctors in 2009 than any year on record, according to the National Practitioner Data Bank.

This finding contradicts claims that medical malpractice litigation is to blame for rising healthcare costs and that changing the liability system to the detriment of patients will not curb costs.

The value of malpractice payments was also the lowest since 1999. Adjusted for inflation, payments were at their lowest since 1992, a Public Citizen analysis of the NPDB shows.

This, once again, proves that there is no reason for more "tort reform" to protect doctors or other healthcare practioners from neglect, abuse, and negligence that causes injury and death.

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Fox News ran a NY Post article on the verdict against a Brooklyn nursing home.  Brooklyn Queens Nursing Home will have to compensate the family of a 76-year-old patient neglected so badly that he left with more than 20 bedsores. The verdict of nearly $19 million, handed down by a jury, is the first in the state against a nursing home that includes punitive damages.

"It was horrible," said Margaret Whitehurst, who pulled her father, John Danzy, from the home after just nine months. "He walked in on two legs and a cane. He was 237 pounds. When we got him back, he was 148 pounds and he had holes all over his body."  She and her siblings moved Danzy, a retired truck driver and butcher, to another nursing home. He died as a result to an infection caused by the bedsores.

A Brooklyn jury deliberated two full days following the four-week trial before finding the Cypress Hills facility delivered substandard care.  The panel awarded $3.75 million for Danzy's pain and suffering, but tacked on $15 million in punitive damages, based in part  that the home had doctored records to try to cover up the neglect.

An FBI expert testified that about 100 different skin-check notes showing "G" for "good" had been penned over to show "B" for "broken" — an effort by the home to claim it hadn't missed the horrific sores.  "Someone went back and wrote B's over the G's to cover their tracks, so they falsified the records, he said. "We believe that once they found out they were being sued, they went back and said, 'How could we have G's here when they guy has 20 sores?' "

The nursing home restrained the Alzheimer's-stricken Danzy to keep him from wandering off, but left him alone for long periods.  Medical standards require that bedridden or restrained patients be moved every two hours to prevent such sores, but that Brooklyn-Queens only moved Danzy every four hours — if at all.

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I have seen two lists that discuss the highest paid jobs.  One list is based on the Bureau of Labor Statistics and the other is from Forbes Magazine.  Both are dominated by health care professionals and show that there is clearly no need for tort reform.

1. Anesthesiologists: $197,340. (And anesthesiologists make more money in the state of Washington than in any other U.S. state)

2. Surgeons: $206,150. (Highest-paying state: Wyoming.)

3. Obstetricians and gynecologists: $192,040. (Highest-paying state: New Hampshire.)

4. Orthodontists: $194,900. (Highest-paying state: Wisconsin).

5. Oral Surgeons: $190,760. (Again, the highest-paying state is Wisconsin.)

6. Internists: $176,860. (Highest-paying state: Louisiana.)

7. Prosthodontists: $169,940. (Highest-paying state: Virginia)

8. Psychiatrists: $154,990. (Highest-paying state: Idaho.)

9. General Practitioners: $161,850. (Highest-paying state: Kansas.)

10. Chief Executive Officers: $144,600. (Highest-paying state: New Jersey.)

11. Dentists: $154,950. (Highest-paying state: Maine)

12. Physicians/Surgeons: $169,220. (Highest-paying state: Utah.)

13. General Pediatricians: $153,440. (Highest-paying state: Louisiana.)

14. Pilots/Co-pilots/Flight Engineers: $140,380. (Highest-paying state: Illinois.)

15. Podiatrists: $125,500. (Highest-paying state: Oregon.)

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David Leonhardt had a recent article in the NY Times discussing the need to lower medical malpractice as away to lower medical malpractice litigations. Seems like common sense to me.

The direct costs of malpractice lawsuits — jury awards, settlements and the like — are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn’t mean the malpractice system is working.

The fear of lawsuits among doctors does seem to lead to a wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the AAJ — says about 3 percent of overall medical spending, is a reasonable upper-end estimate.  At the same time, though, the current system appears to treat actual malpractice too lightly. Trials may get a lot of attention, but they are the exception. Far more common are errors that never lead to any action.

After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim.  Medical errors happen more frequently here than in other rich countries, as the Robert Wood Johnson Foundation recently found.  Only a tiny share of victims receive compensation.  Among those who do, the awards vary from the lavish to the minimal. 

All told, jury awards, settlements and administrative costs — which, by definition, are similar to the combined cost of insurance — add up to less than $10 billion a year. This equals less than one-half of a percentage point of medical spending. 

Research — into various surgical operations, for instance — has found less of evidence of defensive medicine.   The problem is that just about every incentive in our medical system is to do more. Most patients have no idea how much their care costs. Doctors are generally paid more when they do more. Similarly, you would want to see more serious efforts to reduce medical error and tougher discipline for doctors who made repeated errors — in exchange for a less confrontational, less costly process for those doctors who, like all of us, sometimes make mistakes.

The goal, remember, isn’t just to reduce malpractice lawsuits. It’s also to reduce malpractice.

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Consumer Affairs had a revealing article about the dramatic decline of medical malpractice payments to victims of malpractice.  This proves once again that there is no need for tort reform or taking away consumers rights to a jury trial and adequate compensation.

The article mentions that medical malpractice payments were at or near record lows in 2008.  A study released by Public Citizen suggests the decline indicates that a lower percentage of injured patients received compensation, not that health safety has improved.

Medical malpractice is so common, and litigation over it so rare, that between three and seven Americans die from medical errors for every one who receives a payment for any malpractice claim, according to Public Citizen’s analysis of medical malpractice payment data and the best available patient safety estimates.

For the third straight year, 2008 saw the lowest number of medical malpractice payments since the federal government's National Practitioner Data Bank began tracking such data in 1990. The 11,037 payments in 2008 were 30.7 percent lower than the average number of payments recorded by the NPDB in all previous years.

Ratios of payments per capita and per physician have fallen even lower compared with historical norms. There were 13.5 payments per million physicians in 2006 (the most recent year for which the number of physicians is available), which is 29.2 percent lower than the average in previous years

The value of payments in 2008 (as distinct from the number of payments) was the lowest or second lowest on record, depending on the method used to adjust for inflation.

The cost of the medical malpractice liability system -- if measured broadly by adding all malpractice insurance premiums -- fell to less than 0.6 percent of the $2.1 trillion in total national health care costs in 2006.

The cost of actual malpractice payments fell to 0.18 percent -- one-fifth of 1 percent -- of all health care costs in 2006. Annual malpractice payments have subsequently fallen from $3.9 billion in 2006 to $3.6 billion in 2008.

"Any way you measure it, medical liability accounts for less than 1 percent of the country's health care costs, and the vast majority of victims receive no compensation whatsoever," said David Arkush, director of Public Citizen's Congress Watch division. "These are people who died or were left with serious permanent injuries -- out of work, with enormous medical costs for the rest of their lives -- and they and their families are getting nothing from the doctors and hospitals responsible."

Despite the hysteria surrounding debates over medical malpractice litigation, experts have repeatedly concluded that several times as many patients suffer avoidable injuries as those who sue.

The best known such finding was included in the Institute of Medicine's (IOM) 1999 study, "To Err Is Human," which concluded that between 44,000 and 98,000 Americans die every year because of avoidable medical errors.    Fewer than 15,000 people (including those with non-fatal outcomes) received compensation for medical malpractice that year, and in 2008, the number receiving compensation fell to just over 11,000.

The Joint Commission learned about 116 occasions in which surgeons operated on the wrong part of a patient’s body in 2008 and 71 times in which foreign objects were left inside patients’ bodies. Health experts call these "never events," meaning that they simply should not happen at all.

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