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

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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Emmy Pei works for a technology provider in the medical  industry called Direct Alert (www.directalert.ca).  She was kind enough to share an article with us and we are pleased to include it on our blog. 

Elderly Care with Technology

There exists a looming problem in the healthcare system for our baby boomer population, and that is the shortage of people available to provide hands-on care for the elderly and the aging. Enter...the robots. Or to be more specific, a robot named Pearl.

Developed by a research team at Carnegie Mellon University, Pearl is undergoing a trial run in a Pittsburgh nursing home, guiding residents around the building, helping them get from their rooms to the dining hall, or from the library to their physical therapy session. Pearl is also able to give verbal alerts to remind residents to eat or to take their medications.

Advancements in assistive technology will not only improve the care for elderly people in institutions like nursing homes and hospitals, but they will also help to keep them out of said institutions. Fall detectors, pressure mats, door monitors, and bed alerts and medical alerts all serve to improve home safety, increasing people’s ability to live in the comfort of their homes for much longer.

There are also several new options to address problems such as failing to take medications on time or remembering to take them at all. Smartmeds offers a wireless service that delivers notifications to take medications via cell phone calls. The On-Time-Rx software for Palm pilots provides a similar service, sounding an alarm and displaying a set of instructions at the appropriate time. More 21st century style options include wristwatches with preset alarms as medication reminders, or automatic dispensers which sound an alarm and dispense the pills at the right times. Also featured is the medical alert bracelets which carry the direct alert receiver. These two pieces can be worn with comfort and confidence.

One obstacle to overcome is the intimidation factor. Something as simple as cell phone buttons being too small, or wheel-mouse devices that are too sensitive can prevent some folk from adopting new technologies. Recognizing this potential pitfall, Jeffrey Pepper founded ElderVision in 1999, a company devoted to helping technophobic seniors get online. The Touchtone system replaces the mouse and keyboard with voice and touch-sensitive activation, making computers more accessible to a generation who grew up without them. To send an e-mail, for example, you can simply touch an onscreen photo of the intended recipient, instead of having to worry about typing it out.

Technological developments like these allow older generations to stay more connected, while enhancing their independence. With their health and well being in the hands of people who care and with the proper technological tools, senior citizens can live more relaxed and comfortable lives. And while the age of robots still remains on the horizon, residents of the Pittsburgh nursing home told the Carnegie Mellon team that Pearl is fine, as long as it's not seen as a replacement for human contact
 

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The Philadelphia Inquirer wrote an article about how many errors in health care settings do not get reported.  These errors or mistakes, whatever you want to call them, need to be disclosed so we can figure out how to prevent them in the future.  These health care businesses are more worried about getting caught then preventing them.

The article describes several incidents where patients were not given proper care but the hospitals failed to report the problems such as two patients at Fox Chase Cancer Center in Philadelphia required additional surgery after objects were negligently left inside their bodies or three patients at Mercy Fitzgerald Hospital had to be sent back to the OR last year to stop excessive postoperative bleeding or  At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.

For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But most hospitals aren't complying, undermining efforts to improve patient safety.  In New Jersey, five of the state's 80 hospitals failed to report a single preventable mistake last year. In Pennsylvania, some facilities didn't report any serious events or even the near misses that might have harmed patients.

James Bagian, head of the Department of Veterans Affairs' National Center for Patient Safety, said: "Anybody that is supposed to report close calls and has zero reports is clueless; Management is asleep at the switch and just waiting until they kill someone."  The public can only learn that a hospital isn't reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.

"There is still some underreporting, and we are working directly with the hospitals to understand why," said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services.  Consumer advocates want more transparency so patients can make better health-care decisions.

The numbers suggest underreporting is more than just a passing problem.   Calvin Johnson, the Pennsylvania secretary of health, said only people with their "head in the sand" would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.

While it's important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute.   "We cannot improve care unless we understand the problems," Conway said. "There can't be safety without transparency."
 

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The Philadelphia Inquirer wrote an article about how many errors in health care settings do not get reported.  These errors or mistakes, whatever you want to call them, need to be disclosed so we can figure out how to prevent them in the future.  These health care businesses are more worried about getting caught then preventing them.

The article describes several incidents where patients were not given proper care but the hospitals failed to report the problems such as two patients at Fox Chase Cancer Center in Philadelphia required additional surgery after objects were negligently left inside their bodies or three patients at Mercy Fitzgerald Hospital had to be sent back to the OR last year to stop excessive postoperative bleeding or  At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.

For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But most hospitals aren't complying, undermining efforts to improve patient safety.  In New Jersey, five of the state's 80 hospitals failed to report a single preventable mistake last year. In Pennsylvania, some facilities didn't report any serious events or even the near misses that might have harmed patients.

James Bagian, head of the Department of Veterans Affairs' National Center for Patient Safety, said: "Anybody that is supposed to report close calls and has zero reports is clueless; Management is asleep at the switch and just waiting until they kill someone."  The public can only learn that a hospital isn't reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.

"There is still some underreporting, and we are working directly with the hospitals to understand why," said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services.  Consumer advocates want more transparency so patients can make better health-care decisions.

The numbers suggest underreporting is more than just a passing problem.   Calvin Johnson, the Pennsylvania secretary of health, said only people with their "head in the sand" would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.

While it's important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute.   "We cannot improve care unless we understand the problems," Conway said. "There can't be safety without transparency."
 

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