Wrong-side surgery, the Nursing Obligation

It comes down to simple honesty. If you know the surgeon has committed an unconsented surgery and is covering it up you have an obligation to protect the current and all future patients. Simply put that means your moral obligation is to report the event (never-event) to the hospital administration.

Beth Israel Deaconess Medical Center Doc Heading to Lefty-Right K-Grade Rehab

Beth Israel Deaconess Medical Center is again on the hot heat with another doc needing lefty-righty-rehabilitation. Is it an oxymoron when a hospital that markets itself as a teaching institution has surgeons on staff who don’t know left from right? They won’t say who nor have they identified the patient although they did say the patient “was expected to have short-term discomfort, but does not have permanent organ damage or life-threatening problems.”

Can nurses be liable for an unconsented surgery?

What duty does a nurse have to report unconsented surgical procedures? This might seem like an odd question to pose. Since all surgery is supposed to be only by consent, why would anyone ask about a nurse’s duty to report unconsented surgical procedures? In 30 years of practicing law I’ve run into a several cases involving unconsented surgeries. I’ve seen several reports on the IB as well and as taxpayer that is paying for this nonsense I think we all need to question why.

Fifth Wrong-Site Surgery at RI Hospital

This is the 5^th time since 2007. This time the surgical site was the patient’s hand. Apparently, and the reports differ, it was the correct hand, the right finger but the wrong joint. I have to give the hospital credit for publicizing the mistake. It can’t be easy for the hospital’s president Timothy Babineau. Even though the mistake won’t help to make patients comfortable his honesty with the public is refreshing.

So how can patients increase the chances of avoiding a wrong-site surgery? It’s actually pretty simple. By having the doctor mark the surgical site with a surgical marker and reviewing the procedure, the identity of the patient and the body part/location that is to be operated on, mistakes would rarely occur.

Here are two questions that would help.

1.      Have you read the chart?

2.      If so, then describe the procedure to be undertaken and to what part of the body.

You might think this is an embarrassing discussion to have with the surgeon, but it’s your body so get over it.

Here are three articles discussing the Rhode Island Hospital case.

AFTER MAKING A MISTAKE WHY SHOULD PROFESSIONALS APOLOGIZE?

After making a mistake why should medical professionals want to apologize? How about because it’s the right thing to do and you’ll sleep better at night having set the record straight with the person who was injured by your professional mistake. Publicly setting the record straight is important to a good professional reputation. At least it used to be.

But apologizing goes beyond merely the two people involved. There used to be the idea of setting a good example for those who come after us. And then there is the apology shield and what it teaches young doctors and medical students. How do the young people in society interpret what we’ve just done with this legal fabrication? They see it as one more official lie that those in power and those who support it have created. It’s just another double standard that speaks and reeks of hypocrisy. All this says is that those with sufficient earning power can get away with anything, even lying to a jury. And don’t disagree with me on this point because that’s exactly what this is, it’s a license to lie. When a doctor makes a mistake, then apologizes and latter gets to tell the jury he/she did nothing wrong, it’s nothing more than a big fat lie. And at trial it’s officially called lying under oath; but the law allows it. If this were Monopoly it’s the get out of jail free card. If I were a judge, I’d say, not in my court room. You’re not going to lie in my courtroom, neither unofficially or officially. The law is an ass.

THIS IS THE MEDICAL PROFESSIONS WEAPON OF MASS SELF-DESTRCUTION

From now on what happens to the real apologies, the ones that were sincere? They go right up in smoke. No longer can any patient believe any doctor’s apology. We can’t tell who is apologizing because their conscience is bothering them and who’s doing so because the hospital legal staff said, “Go apologize.” The joke is on the medical community. By not speaking out against the apology shield legislation the entire medical community looks and sounds seedy and greedy.

Somewhere along the way the medical community lost some of their sincerity and if they don’t start rethinking about who is in charge they risk losing all self-respect.

You see free apologies really aren’t all that free. A free-market apology costs something or at least places the apologizer at risk. But with this apology right out of a socialist bible there is not a cost to the person who publicly speaks the words of apology. Sort of like an apology from a communist leader who can’t lose your vote even if he/she refuses to say I’m sorry. The apology shield is another sign of America becoming more and more like a Communist country, a Godless regime without a soul. Welcome to the new America, one in which I make every apology.

Apology Shield: Communist Styled, Government Sanctioned Official Lies or "Official News".

I’ve covered the apology shield and today will be my last post on this subject, at least for now. I see it as state sanctioned approval of lying under oath. Some may disagree, but let me demonstrate my point of view with a small hypothetical.

 

HYPOTHETICAL

 

July 8, 2008 – Surgery. Following the surgery the doctor approaches the patient and states how sorry he is that he’s made a mistake and removed the wrong kidney. He explains that he was just too busy to read the chart before starting the surgery room. He further states that no one on the surgical team pointed out his obvious error because they too must have not reviewed the patient chart.

 

September 10, 2008 – The patient visits with an attorney and files suit alleging the doctor and surgical staff violated the standard of care by failing to read the chart and by operating and removing the healthy, rather than the diseased kidney.

 

May 12, 2009 – Trial in Polk County, Iowa. Direct examination.

 

Lawyer's Question: Doctor did you do anything wrong?

 

Doctor's Answer: No.

 

Lawyer: May I approach your honor?

 

Judge: Yes, let’s call a recess and meet in chambers.

 

Lawyer: I’d like to introduce the doctor’s statements that he made right after the surgery apologizing and admitting he made a mistake.

 

Defense Lawyer: Your Honor we object and cite the medical apology shield law that makes the words of apology inadmissible.

 

Lawyer: You’re honor the doctor has denied under oath doing anything wrong, when in fact he’s previously admitted to doing several things wrong.

 

Judge: My ruling is you can’t use the previously inconsistent statements to show he’s lying. The law doesn’t allow it; the law shields the doctor’s previous apology.

 

Lawyer: But your Honor that would then be hiding the truth from the jury. That would mean we are allowing the doctor to perjury himself.

Is this a preposterous scenario? No. We now have state sanctioned lying to juries. What shall we call this, officially sanctioned perjury? Or is it a license to commit perjury? Pick your poison; it’s all the same. What we now have in America is Communist style propaganda. The truth has simply become an inconvenient fact that the government rewrites and that Judges, in the name of abiding by the law, simply rubber stamp. In my mind, a revolution can’t be far off into the future. Good luck America.

IT’S TOO LATE TO APOLOGIZE

WHY THEY ASK FOR THE RIGHT TO LIE WITH A FAKE APOLOGY

An interesting thing about those wanting the apology shield is the emotion that drove them to ask the Iowa legislature to enact the law. They were being greedy and in most situations where greed is the motivating force they will lose what they hoped to gain.

WHAT THEY DON'T KNOW WON'T KILL THEM

Before the apology shield law was enacted, the best thing the defense lawyers had going for them was they could control the doctors and what they said to the patients and those waiting for the patient.  It was easy to just say, say nothing. Doctors are human, and as humans the words they speak are imprecise. Also like most people once they start talking they can’t resist saying one more thing.  And it’s that one more thing that will cause all the problems.

And that’s the interesting thing about the English language, it’s very imprecise. And humans are very unpredictable.

So join me in listening to “Apologize”, by One Republic.

Apology Shield: Detecting Truth with a Broken Lie Detector

WHY IT’S IMPORTANT TO EXPOSE THE FAKE APOLOGY

 

We’ve been covering the apology shield this week and I’m having fun with it, but deep down there’s a serious side to this entire discussion. What is really at stake is the simple dignity of the American way of life. Our dignity should not be for sale and that’s what the apology shield did, it sold manufactured truth to the highest bidder, in this case the insurance industry and medical profession. If we allow anyone to lie to juries, our system of law and order is imperiled. Allowing someone to say to a jury that they did nothing wrong, when in fact they have earlier admitted they did something wrong is government approved lying. Its society saying to the youth of America, that in some instances our government approves of us lying; especially when money is involved. Boiled down to it’s essence we are approving lying when it’s to our economic advantage. Maybe the youth of America could benefit from an official lie register, where all State sanctioned lies could be catalogued.

I did a terrible job or raising my children so I’m no one to talk, but raising children is already too difficult. If we now allow the government to sanction lying to juries chaos can’t be far behind. In this instance the law is as wrong as wrong can be. Those behind this law should be ashamed of what this law promotes. Those legislators who voted for the apology shield should be thrown out of office. As a man who cares about the truth and about the America culture, the lack of shame shown by those advocating for the apology shield shocks me. I’ve said it before and I believe it’s worth repeating. Just because something is legal doesn’t make it right. And not everything that is wrong can be corrected by passing a law that says it’s now right and proper behavior.

Just because something is legal doesn’t make it right. And not everything that is wrong can be corrected by passing a law that says it’s now right and proper behavior.

You can not legislate truth. You can’t create a law that says what is wrong is now right and believe anyone will believe it is right. To do so is just wrong. Condoning lying to save money is foolishness to the nth degree. This goes right back to the Participation Trophy Syndrome. You can’t make winners out of our losers simply by handing out a fake trophy. Winners don’t want a participation trophy, only losers will accept one. Winners want to win one. They want to have earned the right to say they are winners. Losers want to be told they are winners when they acted like losers. Handing out participation trophies encourages internal dishonesty; and in this instance the apology shield is doing just that; it’s encouraging dishonest behavior.

Condoning lying to save money is foolishness to the nth degree.

If that’s what society wants then I want no part of it. I abhor participation trophies because they encourage the wrong ideas and do nothing to build good honest character. Young people and old people alike need to fail to learn how to win. Opportunities to do the right thing will never be recognized and fully appreciated if everyone gets to always feel good no matter how poorly they performed. Pop psychology that wants everyone to feel good about themselves is insidiously self-destructive. The apology-shield is nothing more than a glorified participation trophy. Doctors who want the right to a fake apology are being handed a participation trophy and are acting, no they are losers.

If America is now handing out participation trophies to blundering professionals then doing it right no longer matters. Why should professionals care if they make a mistake? Shame on the State legislatures; shame on the state medical communities that sat back and didn’t resist the temptation for the right to lie to the jury; and shame on all of us for saying nothing in opposition. And you wonder why this next generation seems uninterested in working hard? Why should they be, isn’t it enough that they showed up. “I showed up, where is my trophy?” Winners win and losers lose, that’s a fact of life. For the sake of developing good character we need to teach, which probably requires us to relearn, how to lose with grace and our reputations intact.

If America is now handing out participation trophies to blundering professionals then doing it right no longer matters.

TODAY'S "APOLOGY" - THE ONE THAT NEVER HAPPENED

Today’s apology is one that to my knowledge never occurred. It’s the apology the University of Florida owes to this protester Andrew Meyers. They punished him using a Taser just for speaking his mind. I don't care if there was a single person in the room who agreed with him, in this country we support free speech. Kerry owes him an apology for sitting by without speaking up. Listen as members of the audience laugh as the young man is being shocked. Were they happy he was being punished for just speaking his mind? At that time and still today, it was obvious to me Kerry didn’t have what it takes to be President. If he did Kerry would have stood up, taken the mic and told the officers to step down and to allow the young man to ask his questions. Kerry should have then answered them, assuming they were legitimate questions. If not, Kerry could have declined. Instead Kerry stands by watching this display of what can only be described as a group of campus police acting like common thugs. When a Presidential candidate hasn’t even the backbone to stand up and debate the protester, instead allowing him to be Tased, to shut him up, it’s clear he hasn’t read or understood the United States Constitution. He’s clueless about what makes this country what it is.

And that’s today’s apology; it’s the one that never occurred.

University of Florida Response – The Over-Intellectualized Veiled Apology – Maybe we are sorry and then maybe we aren’t. At the end I’ll include the raw footage from the campus police escorting him out the building and discussing his “inciting a riot”. That’s a waste can charge intentionally mean to be vague and useful in any number of situations where the police need an excuse to make what they did sound legitimate. This is the same mentality to thinks reengineering the facts will make people believe a different version of the true facts. In Wyoming the charge de’ jure is “interference”. [See the comment from Glenrock in The Bush Legacy Paraded in Wyoming: An Intolerant Police State, a new low for America.] And that’s the problem with officially saying it’s alright to apologize for doing something wrong, but then going to court and testifying under oath you did nothing wrong. Gee, for some strange reason this lacks truth, is not genuine and smacks of an untruthful character. A butterfly flying by that distracts an officer on duty is interference.

To read this series on the apology shield follow these links:

Why Should I Apologize?, September 22, 2009

 

"I'm very sorry.", but really I'm not., September 23, 2009

 

An Apology Free From Risk, Isn't Really An Apology, September 24, 2009

 

How To Expose The Fake Medical Apology, September 25, 2009

 

Fixing Medical Malpractice by Fixing the Truth, Todays

 

To read more about American society and the Participation Trophy Syndrome, read Coach Lombardi’s posts on the subject:

Only losers want a participation trophy, winners want to win one. ...

... Only losers want a participation trophy, winners want to win one. ... And remember, only losers want a participation trophy, winners want to win one. ...

 

No Participation Trophy for Either the Hawkeyes or the Cyclones ...

... No Participation Trophy for Either the Hawkeyes or the Cyclones. ...

 

FINANCIAL MISCONDUCT: Is the answer to frivolous Wall Street ...

The Participation Trophy Syndrome Wall Street ... FINANCIAL MISCONDUCT: Is the answer to frivolous Wall Street bonuses, The Participation Trophy Syndrome. ...

 

Rubin Navarrette has it right - Don't rescue those looking for a ...

... Rubin Navarrette has it right - Don't rescue those looking for a participation trophy. Let litigation teach them a lesson. ... Losers want a participation trophy. ...

 

Arkansas Board of Medicine "Sanctions" Surgeon with a " ...

... Arkansas Board of Medicine "Sanctions" Surgeon with a "Participation Trophy". ... A participation trophy in youth sports is a parent's diseased thinking. ...

 

Sarah Palin promised it would not be politics as usual, and ...

... She epitomizes the Participation Trophy Syndrome. Where is my trophy; after all I showed up. ... She wants a participation trophy for showing up. …

 

Tort Reform is leading to more, not fewer personal injury lawsuits ...

... We no longer expect our children to earn a trophy, instead feeling guilty we employ the participation trophy. ... Fact, only losers want a participation trophy. ...

 

Law School Graduation Blues | InjuryBoard Des Moines

... Only losers want a participation trophy. ... She didn't phone the coach demanding he give me a participation trophy to make sure I felt good about myself. ...

 

Tradition is Tradition and Palin Should Bite the Head off the ...

... This debacle demonstrates why Participation Trophies are so wrong. I wonder if the Russians were ever nervous with Governor Palin being so close to Russia. ...

 

American Politics - What can a sewer plant controversy teach us ...

... Participation Trophy Syndrome –. Parents all across ... banquet. Only losers want a participation trophy; winners want to win one. It’s ...

How to expose the fake apology under the Medical Apology Shield

A Patient’s Guide to Dealing with the New Fake Medical Apologies

Today's apology is Chris Matthews apologizing for his characterization of Hillary Clinton's success in politics coming down to her husband's infidelity and that people must have felt sorry for her. It seems genuine to me.

http://www.youtube.com/watch?v=jLIasbt_0xE

Okay yesterday we talked about the importance of an apology and why these new fake apology laws for the medical profession are bad medicine for the community. Today let’s talk about what to do when you’re the patient and are confronted with the fake apology.

FAKING OUT THE FAKERS

Say you’re the patient or the patient’s relative who is on the receiving end of the fake apology. You’re standing outside of the surgical suite, the surgeon emerges looking glum and you hear the surgeon utter the fake apology words, “I’m sorry, but I ______________. “(fill in the blank with your basic never-event medical mistake like wrong-site, wrong-side, wrong-procedure, wrong-patient, wrong-kidney removed, wrong-finger amputate, wrong-leg amputated, wrong-knee operated on, wrong-side of the brain drilled into, wrong-wrong-wrong-wrong-whatever – The list is long and excruciatingly mind-numbing. ). Your immediate reaction is to listen, but at this moment in time, for the sake of your BFF, the patient, you need to be ready to go on the offensive. So listen first then get ready for some follow up questions during the Q&A period. This is important because what you have to know is that not every word spoken may later be classified as part of a fake apology.

My guess is the doctor expects you to first be in shock and then to be forgiving him/her. Those making fake apologies really believe you’re stupid enough to take it at face value and walk with them down to the fake hospital chapel to ask God for forgiveness. What the doctor doesn’t expect is for you to be listening and be ready with a series of questions that go beyond the apology head-fake. An honest and sincerely apologizing doctor will answer your questions; the dishonestly insincere ones will clam up like a jewel thief talking to the cop on the beat right after he’s broken in and is heading out of your apartment.

To fully appreciate this point I need you to be in the right frame of mind. So think about this situation as if the doctor were your teenage son or daughter who violated curfew, brought the car home sans the hubcaps, covered in mud and with the entire passenger side scraped and dented. You know that feeling you get when you hear them say, “I’m sorry, I hope you’re not mad.” It’s that little voice in the back of your head that says, “Not on your life buster/missy, it’s not going to be that easy.” Yes, that one; that’s the frame of mind you’ll need to be in when you hear the apology coming your way from the medical community.

Okay now that I’ve reengineered your thinking let’s go over the questions. As you look the doctor squarely in the eye reach down to your pants pocket and turn on the recorder. You did bring a recorder didn’t you? Okay, I’ll cover that in a later post. You should have a medical apology digital voice recorder that you keep in your pocket. Practice turning it on and off in at home in your living room before ever accompanying someone to surgery. Get a Sharpie and write on the case, “Fake Apology Meter”.

So now the doc has said the words of apology and he/she is looking at you waiting for you to say, “That’s okay my wife didn’t need the healthy kidney anyway. How else can we save you money? Would you like to do surgery on me?” But instead you’re going to ask these questions.

1. What did you do wrong?

2. Who made the mistake?

3. What is the mistake that was made?

4. Did you read the chart before starting the surgery?

5. Why not?

6. You do know your left from your right, don’t you?

7. How much sleep did you get last night?

8. During the surgery were you drunk or on drugs?

9. Was it because you were in a hurry to get to another operation, the golf course or a vacation?

10. Who else is involved with making this mistake?

11. Why didn’t any of other members of the surgical team point out you were operating on the wrong _________? (Again fill in the blank.)

12. Tell me again why the mistake was made that led to my friend’s injury/death?

13. Will you or the hospital be charging the patient for this procedure?

14. Tell me again why the mistake was made that led to my friend’s injury/death?

15. Will you be putting all of this information in your surgical report?

Okay, I realize you can’t ask 15 questions, but you can ask the first 3 and if the doctor is willing to engage with you then keep asking questions. Hey remember, he/she started this apology dialogue, not you. He/she is the one getting paid the big bucks while ruining your BBF’s life. All your family asked for was honest professional medical work, not taking out the wrong kidney along with a head-fake apology.

WHY ASK QUESTIONS

You’ll ask questions because, not every word spoken as an “apology” may later be considered to be part of an apology. The more they say the less likely the judge is to later find it as an apology.

WHY IS THE DIGITAL RECORDER A NECESSARY MEDICAL INSTRUMENT?

In order to protect ourselves every patient and working man and woman who is involved with a surgery needs with them a standard hand-held battery operated recording device as part of your hospital-stay overnight bag. You should pack your family’s medical recording device right in with your toothbrush. It should be a part of every patient’s arsenal that we are using to bring honesty back into medicine. The honest doctors won’t mind, it’s the dishonest one’s who deserve it.

Now tomorrow I’ll tell you why it’s important to our children that we record the fake apology.

Apology Shield Examined - Why we apologize.

After making a mistake why should medical professionals want to apologize? How about because it’s the right thing to do and you’ll sleep better at night having set the record straight with the person who was injured by your professional mistake. Publicly setting the record straight is important to a good professional reputation. At least it used to be.

But apologizing goes beyond merely the two people involved. There used to be the idea of setting a good example for those who come after us. And then there is the apology shield and what it teaches young doctors and medical students. How do the young people in society interpret what we’ve just done with this legal fabrication? They see it as one more official lie that those in power and those who support it have created. It’s just another double standard that speaks and reeks of hypocrisy. All this says is that those with sufficient earning power can get away with anything, even lying to a jury. And don’t disagree with me on this point because that’s exactly what this is, it’s a license to lie. When a doctor makes a mistake, then apologizes and latter gets to tell the jury he/she did nothing wrong, it’s nothing more than a big fat lie. And at trial it’s officially called lying under oath; but the law allows it. If this were Monopoly it’s the get out of jail free card. If I were a judge, I’d say, not in my court room. You’re not going to lie in my courtroom, neither unofficially or officially. The law is an ass.

THIS IS THE MEDICAL PROFESSIONS WEAPON OF MASS SELF-DESTRCUTION

From now on what happens to the real apologies, the ones that were sincere? They go right up in smoke. No longer can any patient believe any doctor’s apology. We can’t tell who is apologizing because their conscience is bothering them and who’s doing so because the hospital legal staff said, “Go apologize.” The joke is on the medical community. By not speaking out against the apology shield legislation the entire medical community looks and sounds seedy and greedy.

Somewhere along the way the medical community lost some of their sincerity and if they don’t start rethinking about who is in charge they risk losing all self-respect.

You see free apologies really aren’t all that free. A free-market apology costs something or at least places the apologizer at risk. But with this apology right out of a socialist bible there is not a cost to the person who publicly speaks the words of apology. Sort of like an apology from a communist leader who can’t lose your vote even if he/she refuses to say I’m sorry. The apology shield is another sign of America becoming more and more like a Communist country, a Godless regime without a soul. Welcome to the new America, one in which I make every apology.

A Patients Understanding of the Medical Apology from Behind the Shield

Yesterday we discussed three recent incidents where an apology was necessary to correct an error of judgment. Those incidents involved Kanye West, Serena Williams and Congressman Joe Wilson. Let’s now look at the apology following a medical mistake that injures or kills the patient. I’m going to start off by making a rhetorical statement.

Who in the medical community cares about its good character?

In the practice of medicine, doctors lament that if after making a mistake they apologize the patient can later use those words of apology against the doctor in a lawsuit. Yeah they probably can just like any person can, like when the other driver apologizes at the scene of an accident. Or the same as when the lawyers make mistakes, look their clients in the eye, apologize and then pay for the mistake. If you care at all about your reputation you should apologize. That’s what a good conscience dictates.

PRE-APOLOGY SHIELD LEGAL ADVICE FROM THE DEFENSE

Before there was an apology shield there was honesty. After medical mistakes were made, the defense lawyers would advise the doctors never to apologize; that way there is nothing to use against them later on should a lawsuit be filed. Some doctors obeyed the lawyers and played defensive medicine and those doctors didn't apologize. Others with a troubled conscience still apologized, and low and behold something incredible was discovered. When doctor’s genuinely apologized many patients forgave the mistake and didn’t file a lawsuit.

Patient's and lawyers, yes even lawyers believe doctors are human and capable of making an honest mistake. This blog post isn't really about the good doctors; it's about the dishonest ones, the ones who wanted this apology shield.

After it was discovered that a genuine apology paid off Big Insurance and Big Legal decided to get greedy and began to shout, "Show me the money!". Big Insurance and Big Legal Defense stepped in, wined and dined state legislators who then across the country passed laws saying if the doctors apologize the patients can’t admit the words into evidence in a later trial. That way all doctors, even the insincere ones, the ones who don’t think they did anything wrong could join the ones that are sincere with a fake-out apology. Thus, with the passage of a law, the apology shield, apology exclusion and fake-out apology were born. And they think this is good. It couldn't be farther from the truth. What they were hoping to do was to create real value in this opportunity with 100% fake apologies resulting in fewer lawsuits. They will in the end get exactly the opposite. But the damage that is being done goes well beyond one small law suit about patient care.

The thing about God is that God didn’t just give the doctors and defense lawyers a brain; patients too have brains and believe it or not they use them. And that’s where the apology shield fails. People aren’t stupid. God created the conscience for a reason and it extracts a genuine cost; with God nothing is for free. God introduced that thing called humility into the whole concept of apologizing. Do you really think just saying the words is enough to generate forgiveness? It isn’t and we’ll all soon be reminded why that is.

ARE POLITICIANS REALLY THIS VALUELESS AND STUPID?

With the enactment of the apology shield state legislatures have thrown honesty and sincerity out the window right along with good character. Have they forgotten how good character is built? Apparently so, because “I’m Sorry Legislation” has been enacted or is pending in Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois (pending), Louisiana, Hawaii, Maine, Maryland, Massachusetts, Missouri, Michigan, Montana, New Hampshire, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas (Texas! I would have never guessed!), Vermont, Virginia, Washington, West Virginia and Wyoming.

Apology shields don’t just invite insincerity, they create it. Patients can no longer trust any doctor to be honest and sincere. They will now assume all apologies are of the insincere type. That’s what is behind, in front of and all over the fake apology law. The idea that apologies don’t have to be sincere is making even the sincerely apologetic doctors suspect. The patients know what is gonig on; the lawyers tell the doctor to apologize and we all know it. The doctor isn’t apologizing because he/she cares, it’s because it’s in his/her financial interest. The patient whose healthy kidney was removed doesn’t want nor does that patient need insincerity. The parent whose child was killed because of administration of the wrong dosed drug gets no relief from a feigned “I’m so sorry”. Behind the shallow words we hear you laughing all the way to the bank and an early retirement. Your biggest mistake was throwing the baby out with the bathwater.

The apology shield like many tort law reforms is more of the new math: our professional mistake that screws up your life minus responsibility equals your problem.

WILL THE FAKE APOLOGY PAY OFF

Absolutely not, in fact the fake apology, the apology shield and all the insincerity it creates will have the opposite effect. Patients will no longer believe any apology, not even the sincere ones. They will hear those shallow words for what they really are, will be offended, become insulted and everyone of them will seek out a lawyer to sue. And who can blame them? Is this the example we hope to set for our children and our children's children? 

As my mother is fond of asking, “What are you stupid?”

Follow the Apology Series here or at the Des Moines InjuryBoard:

 Why Should I Apologize?

Steve Lombardi | September 22, 2009 9:42 AM

WHY SHOULD I APOLOGIZE?

Hopefully our mother’s and father’s taught us that after you do something wrong you should apologize. The apology is meant to communicate a sincere feeling of remorse. We are taught the act of apologizing is a learning tool, for the wrongdoer. The person apologizing does so to affect their own conscience while conveying sincerity to the person wronged. The act of apologizing is a character building event.

But, where the person apologizing has nothing to lose, it isn’t really sincere; meaning for an apology to mean anything there has to be costs, or negatives and risks. That’s how we learn and along the way to build good character and hopefully a solid reputation.

Recently we’ve seen major celebrities in situations that created the need to apologize. Serena Williams could be seen at the U.S. Open Tennis Center verbally assaulting the linesman with curses that I’m sure made her handlers and endorsers must have cringed. She was disqualified by penalty points, which didn’t bring an immediate apology, but the next day she took to the airwaves in a more apologetic mode.

Most of the video on YouTube has been removed. I wonder why? I did find one.

And then there was the Rapper Kanye West’s interruption and outburst when Taylor Swift’s video won at the MTV Video Music Awards that sent him to apologize on the Jay Leno show.

And the last is Congressman Joe Wilson interrupting the President during is address to the Congress. Congressman Wilson later apologized.

Interesting how most of the Serena Williams outbursts were removed from YouTube. I didn’t believe either the Williams or the Wilson apologies. I did believe Kanye West.

So what’s wrong with the Williams and Wilson conciliatory words following their errors of judgment? Kanye West speaks his words and really seems to mean them. The words of neither Serena Williams nor Joe Wilson seem genuine.  Words just aren’t enough. Each seems to lack character.

Tomorrow I’d like to talk about the medical community’s character when it comes to the apology shield. The apology shield is a sign of the widening crack in American character.

Wrong-side surgery article

This article discusses the issues involving wrong-site surgery and how to deal with it. It also discusses the legal principle of res ipsa loquitur, the thing speaks for itself.

Getting Surgery Right

John R Clarke, MD ; Janet Johnston, MSN, JD ; Edward D Finley, BS

Authors and Disclosures

Published: 09/01/2007; Updated: 11/16/2007

Wrong-site surgery is perceived as a medical error that should never happen, not a medical risk that the patient must accept, and therefore a core patient safety problem. Legally, it qualifies under the principle of res ipsa loquitur. The National Quality Forum (NQF) includes wrong-site surgery events on its list of Serious Reportable Events, commonly referred to as never events.^[1] Several states use that list as the basis for reporting patient safety problems. In some states (eg, Minnesota), these reports are made public. Florida imposes fines and disciplinary actions against surgeons for doing wrong-site surgery. As of July 2006, they had disciplined 45 physicians; 3 had been fined $20,000 each.^[2]

The objective of this author is to identify factors contributing to this medical procedure failure or error. As embarrassing as it is the medical profession needs to address the problem while recognizing why it's occurring. Doing too much in too brief a period of time, being distracted, not reading the chart and allowing the system of health care to operate like factory piece work.  Frankly it's not working for the doctors or the patients.  Simply blaming doctors isn't the answer.  We need to fix the system that allows it.

Objective: We sought to identify factors contributing to wrong-site surgery (wrong patient, procedure, side, or part).

Another wrong-site or wrong-side surgery at a Rhode Island Hospital

Placing the surgeon and surgical staff on administrative leave pending the results of an investigation Hasbro Children's Hospital in Providence, Rhode Island is reporting a wrong-site or wrong-side surgery during oral surgery.  It makes me wonder if these types of mistakes, as common as they are, have to do with tort reforms being added to the hurdles patients must straddle to successfully litigate for a favorable verdict. After getting so many breaks a professional begins to expect he or she is invincible or untouchable.

This is an example of what I meant this morning by tort reform increasing the number of personal injury claims. I think doctors are overworked and that hospital systems put too much emphasis on brick and mortar projects rather than patient safety training programs.

Wrong-stie surgery - A new survey sheds light on this dark subject.

More and more doctors are being allowed to avoid paying for their mistakes. At this point in the history of our country fear seems to drive every decision. We are consumed with fear. Lobbying groups have senses this weakness in our culture and seize the opportunity to drive decisions that go against common sense. This one is no different.  Tort reform measures that allow them to avoid paying for malpractice mistakes will attract the wrong kind of doctor to these states. In this report the AAOS outlines broadly the types of medical mistakes you can expect to see more of in the future.

The most common error, making up 29% of the incidents, was equipment errors. 

“Instrumentation was reported to cause an error about twice as often as an implant (63% of incidents compared to 32%). Implant errors usually involved a missing implant (43% of these cases) or having the wrong implant (29%). Implants breaking either pre- or intraoperatively were fairly rare occurrences. “

Being able to affectively communicate remains an ongoing concern. Communication errors accounted for 25% of the reported errors. These errors took the form of written, verbal or dictated information or, in 23% of these cases; it simply amounted to a failure to communicate anything.

One interesting reported problems is described as follows: “19% of these incidents resulted in a near miss involving the patient, and the error resulted in a negative outcome (including delayed surgery or a revision) in 33% of these cases. 47% resulted in no harm to the patient.” Don’t ask because I have no clue what this means. You’d think if patient safety were involved there would be clarity in describing the problem, but this description says it all.

Wrong-site surgeries continue to be problematic. There were 27 reports of wrong-site surgery, which can include the wrong side, meaning left versus right; or just being in the wrong part of the body when they state to cut. These accounted for 59% of these were wrong-side. The other wrong-site problems were being on the correct side but ultimately in the wrong location. Things like operating on the correct hand but the wrong finger.  These mistakes included doing the wrong procedure and operating on the wrong patient.

What the survey described as the most serious of errors were medication errors. There were eight of those; a mistake that results in several deaths and serious permanent injury to the patient.

What is most interesting to note about this study is the “resistance” to change that protects the patient. “The study's authors report that there has been "resistance" to adopting patient safety protocols and that the introduction of these programs can represent a culture shift in some ORs. While this survey shows that about half of all reported errors don't result in any harm to the patient, it also highlights room for improvement in patient safety and helps to illustrate how outcomes can benefit from relatively simple measures.”

As painful as this may be it’s a necessary component of change that will result in a better health care system.

Las Vegas Jury Delivers Andy Griffith Style Verdict for Hospital

A jury in Las Vegas gave the nod to a hospital whose standard of emergent care is to wait 41 minutes to examine a patient complaining of chest pains, and who then dies in the emergency room floor. The jury actually deliberated for 79 minutes longer than it took the emergency room staff to put their hands on this man suffering a heart attack in the emergency room.

Jurors deliberated about two hours Friday afternoon before returning a verdict in favor of the hospital.

The jury found the hospital wasn’t at fault and that certainly would make the blue-suits in the hospital’s front office laugh with delight. Of course this verdict sends the message that a hospital system designed to deliver “emergency room care” at a standard as low as that of a second-world country will be acceptable to an American jury. And you wonder why America’s power is waning?

Las Vegas Andy Griffith Style Verdict Standard

Hopefully that standard will apply when one of these jurors or their relatives shows up in the E.R. complaining of chest pain. Remember, the standard you set as a juror will be applied to you. What goes around comes around. Do unto others as you would have them do unto you.

Waite represents survivors of Morton Scheinbaum, a 59-year-old Las Vegas man who suffered a fatal heart attack in the hospital's emergency department on Nov. 4, 2005. The attorney claimed 41 minutes passed from the time Scheinbaum arrived with complaints of chest pain until he received any hands-on treatment.

Now let’s get serious about what the jury did wrong. The jury failed to follow the law. What the jury should have found was that the hospital violated the standard of care in their community; a finding of negligence for the Plaintiffs and against the Defendants. If the jury truly believed the man’s heart was damaged beyond what current medical care could repair to save his life, then that is a proximate cause issue; not a liability issue. By finding no joy for the blue coats on the issue of liability the wrong message is sent and a standard set so low that we weaken the delivery health care system.

This jury decision shows bias and a lack of understanding of the law. They should be ashamed.

Nurse's offer to pray for patient gets her suspended

Medical News: Offering to Pay for Patient’s Well-Being Gets Nurse Suspended.

Huh? Are you kidding? No, this is for real.

I just wrote a blawg post about a Las Vegas jury that failed to follow the law in finding no negligence when a man enters the E.R. complaining of chest pain, isn’t even examined for 41” minutes and then died of a heart attack on the E.R. floor. No negligence? Are you kidding? What are people thinking? Are they thinking? The more conservative people get the dumber they act. Here is an excellent example of idiocy in action in the medical profession.

This blawg post is about a nurse by the name of Caroline Petrie, from Weston-super-Mare, Somerset who is being disciplined for offering to pray for a patient. That’s all she did. She offered to pray for a 70-year-old patient. She didn’t pray for the patient, she only offered to pray for her to get better. And for that this married mother of two young boys has been suspended. If the 70-year-old patient complained she should be ashamed. For the employer, who should have just listened and gone on about their day, they should be sacked. So what is wrong with what she offered to do? Is there room in medicine for a belief in a God? Or does offering to pray offend the profession? Let’s look at the definition of a nurse and then a few medical miracles followed by the professional standard she is accused to have offended.

A nurse by Merriam-Webster’s definition is a professional who cares for the sick or infirm; specifically: a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and maintaining health. Wikipedia defines nursing is a profession focused on advocacy in the care of individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning. Modern definitions of nursing describe it as a science and an art that focuses on promoting quality of life as defined by populations, communities, families, and individuals, throughout their life experiences from birth through the end of life. Several of my friends and acquaintances in life have been physicians. Some have described patients getting better when the most advanced medical opinions say they should be dead. That said many doctors I know pray for their patients. I’m by no means a Bible thumping Christian, but I do believe in God. If someone close to me were dying I’d pray for them. Medical miracles are nothing new. Here are a few.

Are There Medical Miracles?

The discovery of Penicillin - Penicillin, the first effective antibiotic, was discovered in 1928 almost by accident.

The treatment for Glaucoma - Millions of people owes their sight to Percy Julian, the African American chemist who transcended racial bias to revolutionize the treatment of glaucoma. Born in Alabama in 1899, Julian was barred from the local public school's college preparatory program because of his race. Nonetheless, he excelled academically and gained admittance to DePauw University in Indiana. As he departed for college, his grandfather, a former slave, waved goodbye with a three-fingered hand — the missing fingers had been severed as punishment for learning to read. After earning his doctorate at the University of Vienna in Austria, Julian returned to DePauw. In 1935, he synthesized physostigmine, a natural substance used to reduce pressure in the eyeball caused by glaucoma, which can lead to blindness. The feat cut the cost of the drug from hundreds of dollars per drop to a few cents per gram, making treatment widely available and earning Julian worldwide acclaim. When DePauw declined to appoint him to its faculty, Julian left academia and joined the Glidden Company. There, he used his knowledge of chemistry to make a variety of products from soybeans, including the hormone progesterone and fire-fighting foams used during World War II. In 1948, he developed a new way to synthesize hydrocortisone, still used to treat rheumatoid arthritis.

Birth Control – synthesis of the first birth control pill in 1951.

Discovery lead to treatment for diabetes - In a brilliant collaboration Gerty and Carl Cori studied how the human body metabolizes glucose. Their development of the "Cori cycle," the biochemical process by which the body reversibly converts glucose to glycogen, explained how carbohydrates supply energy to muscles during exercise and how carbohydrates are regenerated and stored until needed again by the muscles. In subsequent decades they made many significant discoveries which clarified carbohydrate metabolism. Their work advanced the understanding of the inter-conversion of sugars and starches and proved particularly useful in the development of treatments for diabetes.

Treatment for tuberculosis - The Waksman team isolated about twenty antibiotics, the most prominent of which was streptomycin, the first effective pharmaceutical treatment for tuberculosis. Unlike the chance discovery of penicillin, streptomycin was isolated in 1943 by Albert Schatz using screening protocols developed by Waksman.

DENVER, Colo. -- Miracles do happen. That's what doctors said about 30-year-old Shannon Malloy. A car crash in Nebraska on Jan. 25 threw Malloy up against the vehicle's dashboard. In the process, her skull became separated from her spine. The clinical term for her condition is called internal decapitation. Oh my God, it's a miracle," said Malloy. "It's a miracle that she was able to survive from the actual accident. It's a miracle that she's made the progress that she's made," said Ghiselli.

Medical Miracle? Woman Wakes After Heart Stops, Tubes Pulled, by Karlie Pouliot

Doctors are calling it a medical miracle. A West Virginia woman, who suffered two heart attacks and had no brain waves for more than 17 hours, suddenly woke up, reports NewsNet5.com. Val Thomas’ doctors say they honestly can’t explain how she is alive today.

“Her skin had already started to harden and her fingers curled,” Thomas’ son, Jim, told NewsNet5.com. “Death had set in.”

Her family said goodbye and doctors removed all tubes. However, Thomas was kept on a ventilator a little while longer as an organ donor issue was discussed. Ten minutes later the woman woke up and started talking.

‘Saving Your Life: Modern Medical Miracles’ - In a weeklong series, NBC's ‘Today’ show features technological breakthroughs in medicine.

Health Care Blog ( I quote )  reporting on a New York Times report of a miracle - On December 7th, Alcides Moreno and his brother Edgar, window washers, fell 47 stories down the side of the Upper East Side apartment building they were working on. His brother was killed instantly, but Alcides survived, consuming 24 units of blood and 19 units of plasma. In a coma, he went through 9 orthopedic operations, and then amazingly - I'm not making this up - awoke on Christmas Day. More incredible still, Mr. Moreno is now on a path to full recovery, at least from the looks of it, walking and talking as he did before his fall. This has prompted Dr. Philip Barie, the chief of the Division of Critical Surgery at the hospital where Mr. Moreno is being treated to comment, “If you believe in miracles, this would be one.”

This one is worth quoting again from the New York Times article as reported by James Barron, ‘Miraculous’ Recovery for Man Who Fell From Sky’, Surrounded by doctors who had helped save her husband, Mrs. Moreno told her story at a news conference at which medical professionals with long years of experience in treating traumatic injuries used words like “miraculous” and “unprecedented” to describe something that seems remarkable: a man who fell nearly 500 feet into a Manhattan alleyway is now talking and, with a little more luck, a few more operations and some rehabilitation therapy, may well walk again. “If you are a believer in miracles, this would be one,” said Dr. Philip S. Barie, the chief of the division of critical care at New York-Presbyterian/Weill Cornell Medical Center in Manhattan, where Mr. Moreno, 37, is being treated.

Try to Explain the Unexplainable

Kim Peek: Idiot Savant – Photographic Memory

Savant Syndrome - Daniel Tammet – Miracle Mathemetician

Savant syndrome, Beautiful minds, Alonzo Clemens – Miracle Sculpturer

Miracle Musical Savants - autism, blindness, pianists

The Human iPod!, as seen on 60 Minutes

Savant Syndrome

Stephen Wiltshire the Living Camera - Savant Drawings

Stephen Wiltshire: the human camera now is in Japan!

So what is the standard she allegedly fell below?

On this occasion, the patient's care giver, who was with him, raised concerns over the incident. Alison Withers, Mrs. Petrie's boss at the time, wrote to her at the end of November saying: "As a nurse you are required to uphold the reputation of your profession.

"Your NMC [Nursing Midwifery Council] code states that 'you must demonstrate a personal and professional commitment to equality and diversity' and 'you must not use your professional status to promote causes that are not related to health'."

Hmmmm… Is this boss trying to justify his job? Get a grip, get a life, and find someone else to pick on. This is a waste of everyone’s time. With all the problems in the hospitals with real malpractice and “never events” you’d think this boss would have better things to do. How about paying attention to wrong site, wrong-procedure or wrong-patient surgeries? Or how about paying attention to stopping Serious Reportable Events?

“The Institute of Medicine estimates that each year in the United States our healthcare system wastes up to 98,000 lives, 2.4 million extra hospital days and $9.3 billion in excess charges due to “serious reportable events”; put plainly, errors/mistakes that were easily preventable.”

Serious Reportable Events

Surgical Events

• Surgery performed on the wrong body part
• Surgery performed on the wrong patient
• Wrong surgical procedure performed on a patient
• Unintended retention of a foreign object in a patient after surgery or other procedure
• Intraoperative or immediately postoperative death in an ASA Class I patient

Product of Device Events

• Patient death or serious disability associated with the use of contaminated drugs, devices or biologics provided by the healthcare facility
• 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 intravascular air embolism that occurs while being cared for in a healthcare facility

Patient Protection Events

• Infant discharged to the wrong person
• Patient death or serious disability associated with patient leaving the facility without permission
• Patient suicide, or attempted suicide, resulting in serious disability while being cared for in a healthcare facility

Care Management Events

 

• Patient death or serious disability associated with a medication error (e.g. errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration)
• Patient death or serious disability associated with a hemolytic  reaction (abnormal breakdown of red blood cells) due to the administration of ABO/HLA – incompatible blood or blood products
• Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a healthcare facility
• Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
• Death or serious disability associated with failure to identify and treat hyperbilirubinemia (condition where there is a high amount of bilirubin in the blood) in newborns
• Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
• Patient death or serious disability due to spinal manipulative therapy
• Artificial insemination with the wrong donor sperm or wrong egg

Environmental Events

• Patient death or serious disability associated with an electric shock while being cared for in a healthcare facility
• Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong
  
  

  Labels: care iowa medical nurses patient praying safety
  1/29/2009
  Nick Lombardi
  Comments (0)

  Patient Safety: What types of dumb medical mistakes can you expect as a hospital patient?

  The Institute of Medicine estimates that each year in the United States our healthcare system wastes up to 98,000 lives, 2.4 million extra hospital days and $9.3 billion in excess charges due to “serious reportable events”; put plainly, errors/mistakes that were easily preventable.  

  “Tens of thousands of lives are forever changed each year as a result of healthcare errors.  There is a critical need to enhance health system capacity, so that all patients will receive care that is safe and effective.”    - NQF President and CEO Janet Corrigan  

  Who pays for SRE’s?

  Who pays for these mistakes? You and I do. The taxpayer does either through taxes to provide governmental medical assistance programs to the poor and aged, through higher rates for private health insurance premiums or generally in higher health care costs.

  What are these serious but avoidable mistakes?

  There is a list of SRE’s, as they are referred to in the medical industry. I’ll include that list below. Most of the SRE’s are easily avoided or corrected.  Others are not; such as the criminal behavior SREs.

  Are civil lawsuits for damages the only way to seek changes to avoid SREs?

  I’d like to say no, but I’m not so sure the general public appreciates how difficult proactive change can be in the health care system.  Traditionally civil lawsuits were the vehicle to right the wrongs. Civil lawsuits come after the SRE either maimed or kills the patient and in that sense it’s simply putting a band aid on the wound that already exists; the lawsuit comes after the insult and doesn’t stop that incident, but suits do have a deterrence effect for the future.  In recent years jurors have become stingier and stingier in awards; a trend that has all but eliminated any deterrence. Defendants feel empowered by jurors that ignore wrongdoing and take the law into their own hands.  Conservative judges who pander to the mentality of jurors awarding little or nothing only extend the empowering of those who do wrong and rationalize their own wrongdoing.  Corporations have no conscience, no heart and no soul.  Everyone in corporations have a job to do and can easily rationalize away systematic wrongdoing simply by saying, “It wasn’t my job.” Or “I was just doing my job.” Jurors who reflect the “it won’t change anything” or “accidents happen” mentality simply ignore reality. Yes what goes around does come around. And no just because you’re now injured doesn’t mean you get treated any different by pandering and uncaring juries. You too get the same attitude from those conservative judges and juries.

  Where does your state stand on SRE’s? Is your state included or not included? If not included then why not?

  Only 25 states have joined the efforts to make the medical facilities in their states safer by avoiding those practices that make up the SRE list.  Iowa, where I live is not one of them. Tomorrow I’ll list those states and you can ponder the difficult question of why your state government would choose to not be a part of changing your healthcare system to avoid SREs.  One has to wonder if lobbyists associated with hospital and health care systems are doing more harm to this country than any civil lawsuit ever did.

  What is the bottom line? How can you be affected?

  Take a good look at the following list of SRE’s and consider if you are the patient how each may impact your life.  When you read this list you are walking through history of health care in which, in the past these mistakes, like many of the patients have been buried, covered up or only whispered about in the hallway, rather than published, discussed and changes implemented to avoid them in the future. Don’t fool yourself into believing they still don’t occur; because they do. The general public seems weary of the law and use of civil lawsuits to implement change; and that’s fine with me, so long as you the public become active in seeking change yourselves. Go back to sitting in front of the television or not wanting to be bothered and you may very well find yourself, your spouse or even your children one of the disabled or dead. It’s your choice, as a juror, choose to honor the civil lawsuit process or get active. There is no free lunch.

  Serious Reportable Events

  • Surgical Events
  • Surgery performed on the wrong body part
  • Surgery performed on the wrong patient
  • Wrong surgical procedure performed on a patient
  • Unintended retention of a foreign object in a patient after surgery or other procedure
  • Intraoperative or immediately postoperative death in an ASA Class I patient

  Product of Device Events

  • Patient death or serious disability associated with the use of contaminated drugs, devices or biologics provided by the healthcare facility
  • 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 intravascular air embolism that occurs while being cared for in a healthcare facility

  Patient Protection Events

  • Infant discharged to the wrong person
  • Patient death or serious disability associated with patient leaving the facility without permission
  • Patient suicide, or attempted suicide, resulting in serious disability while being cared for in a healthcare facility

  Care Management Events

  • Patient death or serious disability associated with a medication error (e.g. errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration)
  • Patient death or serious disability associated with a hemolytic  reaction (abnormal breakdown of red blood cells) due to the administration of ABO/HLA – incompatible blood or blood products
  • Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a healthcare facility
  • Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
  • Death or serious disability associated with failure to identify and treat hyperbilirubinemia (condition where there is a high amount of bilirubin in the blood) in newborns
  • Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
  • Patient death or serious disability due to spinal manipulative therapy
  • Artificial insemination with the wrong donor sperm or wrong egg

  Environmental Events

  • Patient death or serious disability associated with an electric shock while being cared for in a healthcare facility
  • Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances
  • Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
  • Patient death or serious disability 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

  Criminal Events

  • Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider
  • Abduction of a patient of any age
  • 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 form a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility

  
  
  

  Labels: care events hospital iowa Lombardi malpractice medical patient reportable safety serious SRE
  1/29/2009
  Nick Lombardi
  Comments (0)

  Patient Safety: Why does Iowa wish to keep SREs the hosptials dirty little secrets?

  Yesterday I promised the list of states that had joined the efforts to avoid SRE’s.  As I said Iowa is not one of those states with mandatory reporting or SRE’s.

  Where does your state stand on SRE’s? Is your state included or not included? If not included then why not?

  Only 25 states have joined the efforts to make the medical facilities in their states safer by avoiding those practices that make up the SRE list.  Iowa, where I live is not one of them. Today you and I can ponder the difficult question of why our state governments would choose to not be a part of changing your healthcare system to avoid SREs.  One has to wonder if lobbyists associated with hospital and health care systems are doing more harm to this country than any civil lawsuit ever did.

   

  Quality and Patient Safety

  State adverse event reporting rules and statutes*

  Note: States listed here are linked to NASHP's Patient Safety Toolbox and to individual
  state profiles of each state's adverse event reporting system

  California
  Title 22 Division 5 Chapter 1 Article 70737

  Colorado              
  Colorado Revised Statutes, sec. 25-1-124
  The Code of Colorado Regulations, ch. 2, sec. 3.2
  State Board of Health, General Licensure Standards

  Connecticut        
  General Statutes Section19a-127n

  Florida                   
  Fla. Stat. ch. 395.0197 (2003):  Internal risk management program

  Georgia
  Georgia Rules 290-9-7-.07

  Illinois
  Public Act 094-0242

  Indiana
  Executive order 05-10 
  Indiana Department of Health; 410 IAC 15-2.4-2.2

  Kansas                 
  Kan. Stat. Ann. § 65-4923 (2002)
  Kansas Administrative Code, 25-52-1

  Maine                   
  Me. Rev. Stat. Ann. tit. 22, § 8753 (2003)

  Maryland
  COMAR 10.07.06

  Massachusetts 
  105 Code of Massachusetts Regulations 130.331

  Minnesota
  Minnesota adverse events legislation

  New Jersey        
  New Jersey Regulations NJAC 8:43G-5.6
  www.nj.gov/health/quality/pslaw_chap9.pdf

  Nevada
  Nevada Revised Statute (NRS) 439.800-890 
  Nevada Administrative Code (NAC) 439.900-920
  Assembly Bill 59 (AB59)

  New York            
  New York Public Health Law, sec. 2805(L)
  New York Code of Rules and Regulations, Title 10, Section 405.8

  Ohio
  Ohio Department of Health's reporting requirements for 9 specific services
  Revised Code Section 3702.11
  Ohio Administrative Code Chapter 3701-84
  The rules are available at www.odh.state.oh.us

  Oregon
  Oregon law to improve patient safety by reducing the risk of adverse events:
  Section 9, Chapter 686, Oregon laws 2003

  Pennsylvania    
  Pa. Stat. Ann. tit. 40, § 1303.308 (2003)
  Pa. Stat. Ann. tit. 40, § 1303.313
  Medical Care Availability and Reduction of Error Act

  Rhode Island     
  Rhode Island Statutes, section 23-17-40
  Rules and Regulations for Licensing of Hospitals, R23-17-HOSP, please refer to sections 1.41, 1.42 and 34.0

  South Carolina  
  South Carolina Code of Regulations, Regulation No. 61-16, Sec. 206

  South Dakota     
  Administrative Rules of South Dakota 44:04:01:07

  Tennessee         
  Tennessee Rules Chapter 1200-8-1. SB2316
  
  Texas
  Tex. Health and Safety Code Sec. 241.201 - 241.210 (2003)
  Patient Safety Program and Medical Error Reporting - Final Rules (Amending 25 Texas Administrative Code, Chapter 133)

  Utah                    
  Utah Division of Administrative Rules, R380-200
  Health Care Facility Patient Safety Program Rule R380-210

  Washington      
  Washington Administrative Code, section 246-320-145

  *All rules and statutes refer to mandatory reporting except for Oregon, which established a voluntary reporting system.

  
  
  

  Labels: care central Des Moines events hospital iowa malpractice medical patient safety SREs west des moines
  1/27/2009
  Nick Lombardi
  Comments (0)

  Patient Safety: When hospitalized how do you protect yourself from limb amputations?

  Here is an interesting story about a woman’s whose claims against the hospital and physicians were found by a jury to have no merit. The jury found no negligence or liability on the part of the medical team that she alleged misdiagnosed her condition, but saved her life, the condition of sepsis resulting in the amputation of her arms and legs.

  She is Lisa Strong, 45 years of age who shares custody of a 9-year old son and a 10-year old daughter. Following the amputations her marriage ended.

  What was her condition upon admission to the hospital?

  According to the South Florida Sun-Sentinel article -”Despite what she told them, doctors misdiagnosed her condition for several hours. She went into septic shock, forcing her immune system to battle infection by protecting the heart and cutting circulation to her limbs. Doctors had to remove them to save Strong's life.”

  Did anyone admit liability? [i.e., Did any medical care worker admit to making a mistake?]
  
  “Both sides agreed there was an error made. Where they disagreed was over who, if anyone, was responsible, and whether there was negligence or malpractice.”
  
  So what if anything went wrong?

  Apparently upon admission a team of medical personnel examined her, came up with several diagnoses that conflicted to some degree, and no one doctor took over the care. At trial the doctors blamed each other. What appears to have gone wrong for Ms. Strong was no clear channel of authority making medical decisions and forcing the doctors to make the hard decisions.

  Is this an unusual case?

  I wish I could say it is but it isn’t. Brazilian beauty queen Mariana Bridi da Costa, 20, a Miss World recently died after a similar situation. Like Strong, the doctors thought Bridi had kidney stones; she went into septic shock, followed by leg and hand amputations. But in Ms. Da Costa’s situation she died.

  “The Espirito Santo State Health Secretariat said in the statement she died from complications related to a generalised infection, Associated Press has reported.
  
  It was caused by the bacteria Pseudomonas aeruginosa, which is known to be resistant to several kinds of antibiotics.
  
  Bridi had been in the hospital in the city of Serra in south-eastern Brazil since January 3.
  
  She became ill in December and doctors originally diagnosed her with kidney stones, local media said.
  
  Mariana Bridi da Costa had been in a hospital in Serra, in the south-eastern state of Espirito Santo, and on artificial respiration following the procedures, according to several newspapers.”

  Brazilian Model Mariana Bridi has hands and feet amputated

  UTI leads to septic shock then to multi-system organ failure – original diagnosis “kidney stones”

  Playing the finger-pointing-blame-game to create a red herring.

  Defense lawyers use a defense that I refer to as the finger-pointing-blame-game to distract the jury. When the defense case seems hopeless, point the finger at each other, argue the entire case and hope the jury thinks the case so complicated that they find the Plaintiff is lucky to be alive. In this case, if it were used, it was done effectively and worked for the defense.

  “Lawyers for the defendants said they felt compassion for Strong, but argued that the medical case was more complicated than it first appeared and Strong is lucky to be alive.
  
  "Forty percent of the people who suffer what she did, die," said Jim Nosich, who represented the emergency room physician who first saw Strong. "It was a complex medical issue," said Isabel del Cid, attorney for the doctor who admitted Strong to the hospital.
  
  But the two lawyers clashed, each blaming the other's client for botching the diagnosis. Strong's lawyer has filed a motion for a new trial, with the dispute between del Cid's and Nosich's clients at the center.
  
  One of the doctors "led all of the subsequent physicians down the wrong path with a diagnosis of cholecystitis," a kidney infection, Shipley is asserting.”

  The forty-percent die argument is another red herring. Let me explain. I’m not a gambler but had an occasion to visit a casino in St. Louis. On the wall was a sign, “We return 60% of the money gambled as winnings.” Some people look at that sign and understand they have a “good chance of winning”. I looked at it an thought, “Wow, a 40% tax. For every dollar I bet chances are I’ll see less than .60 cents returned.” And so when the defense lawyer points out that 40% of the people who suffer this condition die, he’s just pointing out the negative obvious. It could also be said that 60% of those who enter the hospital with this condition live and had doctors done their job Ms. Strong would not have suffered the fate she did. Apparently in this case the jury didn't think so.

  Was this really a complicated medical issue?

  Knowing I’ve not read the medical records or the deposition testimony I’m cautious about drawing any firm conclusions, but I doubt it. Medicine always involves complicated diagnosis and decisions concerning treatment. So what’s different about this case? Nothing really. It was an infection. Isn’t that what doctors and hospitals are trained to diagnose and treat? If beyond their experience the doctors needed to call in for a consult with a specialist or two, run more tests and listen to the expert medical doctors. Did they? Can’t tell from the article. What did the E.R. doctors do for the hours that passed between admission and the realization amputations would be necessary? Who did they consult with and what additional tests did they run? What were the findings and follow-up?

  What is sepsis?

  Sepsis development and progression

  Was Lisa Strong misdiagnosed? “This isn’t Kansas.”

  10TH LEADING CAUSE OF DEATH IN THE UNITED STATES LARGELY UNK

  How do you recognize kidney stones?

  Kidney Stones: A Sign of Something Worse? (Dramatic Health) – Joeseph Del Pizzo, M.D.

  Dehydration, not enough water and salt and not a sign of underlying kidney disease.

  What is really going on here?

  Doctors have a tough job. Some days they have a thankless job. I don’t know these doctor who tended to Ms. Strong’s care and yes, they had to make tough calls, but that’s what they get paid so handsomely to do. They are supposed to be the best and brightest of the professions. In the end these types of decisions come with the territory.

  So what is the answer?

  Well the answer which many of you won’t want to hear is it’s about tort-reform. The cornerstone of tort reform argues unnecessary tests leading to increased costs and too many lawsuits by injured patients. This case is a good example of the kind of health care we can expect in the future from tort reforming measures. A lack of testing, inconclusive diagnoses, bad results and jury’s who don’t care to put in the time to figure out what went wrong and who look for any excuse to find against the Plaintiff. If the tort-deformers get their way people like Ms. Strong won’t even be able to have their day in court. And neither will you. As you’re reading this don’t think your case will be any different than Lisa Strong’s; it won’t.

  The old saying what goes around comes around seems only too appropriate in this instance.
  
  

  
  
  

  Labels: care death Des Moines doctors hosptial iowa lawyers malpractice medical misdiagnosis reform tort west des moines
  1/27/2009
  Nick Lombardi
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  University of Iowa opens the door to medical conflict information.

  The University of Iowa announced new rules prohibiting physicians from accepting free drug samples and handing them out to patients. Also doctors and other health care workers will be prohibited from accepting gifts and must disclose financial remuneration paid by private medical companies that can create a conflict of interest with reporting research results.

  “At least 25 public and private academic medical centers now have “strong” conflict-of-interest policies, according to a Sept. 3 commentary in JAMA, the Journal of the American Medical Association, by David Rothman and Susan Chimonas of the Institute on Medicine as a Profession at Columbia University.
  
  The institute’s searchable database for conflict-of-interest policies at medical centers and university hospitals, at http://www.imapny.org/coi_database/, shows the U of I’s proposed restrictions are stricter than some, but not the most severe.”

  Des Moines Register, January 22, 2009 - U of I beefs up conflict of interest rules for doctors

  And if you’re wondering how much a physician can be paid take a look at the Des Moines Register’s article on January 23, 2009, U of I to bar free drug samples, gifts.

  “Last year, three U of I orthopedic surgeons were included on a list of doctors across the country who accepted money from the manufacturers of artificial hips and knees.

  Dr. John Callaghan, a U of I surgeon, received $2.6 million in 2007 from DePuy Orthopaedics, a Johnson & Johnson company that makes replacement joints. Callaghan said the payments were above-board royalties for other doctors' use of joint replacement devices he helped develop. The U of I knew of the financial ties, but did not know how much Callaghan made in royalties because the university-wide conflict-of-interest policy does not require employees to report payment amounts.”

  That’s a lot of money. Then again it seems Doctor Callahan earned it with his participation in developing the joint replacement. Or at least someone earned the right to the royalties. What I’ve always wondered is how State of Iowa employees are allowed to get paid a salary by the State of Iowa, use state equipment and laboratories to develop patentable products and then the employee get to keep the royalties. Why aren’t the royalties owed to the State of Iowa?

  
  
  

  Labels: care change conflict doctors gifts health interest iowa medical policy rules University of Iowa workers
  1/24/2009
  Nick Lombardi
  Comments (0)

  Wrong-stie surgery - It is preventable. Stop rushing around.

  Doctors are only human, and as such are subject to making mistakes. That doesn’t mean the patient or the insurance pays when the mistakes are easily avoidable, those known as “never events”.

  Whether it’s a double mastectomy that complicates and killss the patient or the man with his healthy kidney removed, rather than the one with cancer, there is a cure for this type of mistake. It’s called the time-out.

  ”Out of 4,817 serious problems tracked over the past 12 years by the Joint Commission, the chief accrediting organization for hospitals, 625 were wrong-site surgeries. These are the nightmares: A Long Island, N.Y., woman in her 30s who never had cancer received an unnecessary double mastectomy—then died the following day of complications from the procedure. A man in a Brooklyn, N.Y., hospital had his healthy kidney removed—instead of his cancerous one.”

  
  Health News

  
  
  

  Labels: iowa misdiagnosis staff surgery surgical wrong-patient wrong-procedure wrong-site
  1/24/2009
  Nick Lombardi
  Comments (0)

  Preventable hospital errors show increased reporting in Minnesota

  St. Cloud, MN – New serious preventable hospital errors reporting shows past mistakes buried, rather than reported.

  As a hospital patient are you safe? Are you safer this year than last year? Until everyone gets on board with reporting preventable errors the answers to those two questions can’t be taken seriously.  Of the 18 preventable events, which are you likely to encounter on your way to better health? It’s refreshing to see hospitals begin to tackle in an open way, these issues. They can dislike the legal tort system all they wish but until they begin to openly manage preventable errors the public will not tolerate institutional ignorance.

  Minnesota’s new reporting requirements for serious preventable hospital errors resulted in an almost three-fold increase in the number of reported errors from the previous year.

  The number of adverse events in Minnesota hospitals, ambulatory surgical centers and community behavioral health hospitals increased from 125 to 312 in 2008. In the absence of the new reporting requirements, the number of reported adverse events would have been 141.

  In addition to the seven falls and four ulcers included in this year’s report, St. Cloud Hospital had seven “adverse health events” — one more than last year’s, which predated reporting requirements approved during the 2007 legislative session.

  None of the 18 adverse health events reported this year by St. Cloud Hospital resulted in death, according to the statewide report released today by the Minnesota Department of Health.

  If you’re from Minnesota you may wish to read this or other articles about this subject and order the 2008 or the 2007 report.  You should put this report in perspective, more reports doesn’t mean more mistakes; assuming in previous years they were underreported.

  “Preventable adverse events include such things as pressure ulcers, retained objects after surgery, wrong-site surgeries, wrong procedures, death or serious disability from a medication error, and death from a fall. The most frequent events noted in this year’s report were stage three or four pressure ulcers (43), wrong site surgery (24), and a foreign object left in a patient after surgery (25).”

  A full copy of the adverse health events report and additional information can be found on MDH’s Adverse Health Events Web page, at www.health.state.mn.us/patientsafety. More information about hospitals can be found at http://www.mnhospitals.org.

  John Stieger
  MDH Communications
  (651) 201-4998

  As a patient you can search by facility and cross-reference with preventable errors. Be safe, be smart and be proactive in protecting yourself.

  Patient Safety

  As part of its mission to protect, maintain, and improve the health of all Minnesotans, the Department of Health is a leader in promoting patient safety and the prevention of adverse health events. MDH is a partner in the Minnesota Alliance for Patient Safety, a broad-based partnership established by MDH, the Minnesota Hospital Association, and the Minnesota Medical Association and since joined by over 50 stakeholder groups.

  MDH also administers the Adverse Health Care Events Reporting System. This reporting system, established in 2003, requires all Minnesota hospitals, ambulatory surgical centers, and community behavioral health hospitals to report whenever one of 28 "never events" occurs. Reportable events include surgery on the wrong patient or body part, objects retained in a patient’s body after surgery, death associated with a fall, and death or serious disability from a medication error.

  By supporting learning and accountability, this system is helping to improve patient safety across the state, and serves as a model for other states interested in developing mandatory public reporting systems.

  Search facilities' adverse events reporting
  Searchable database that displays reports about individual hospitals.

  Information for consumers, patients and families
  Factsheets and links specifically for consumers and patients.

  Adverse events reporting system
  List of 28 reportable events, links to statute, background sheets and articles.

  Wrong-site surgery
  Minnesota research and recommendations related to prevention of wrong site surgery, retained objects, and other surgical events.

  Patient safety publications
  Current and previous reports on patient safety.

  Patient safety links
  Links to other sites with safety and quality information.

  Patient safety training
  Past and upcoming training.

  
  For more information about this page, please contact the MDH Division of Health Policy at 651-201-3564.

  In Des Moines, Iowa contact Steve Lombardi. In St. Cloud, Minnesota contact Attorney Mike Bryant and in Hawaii, Wayne Parsons.

  
  
  

  Labels: errors hospitals increase iowa patient preventable reporting safety surgery wrong-site
  12/14/2008
  Nick Lombardi
  Comments (0)

  Wrong-site or wrong-side Surgery - Rhode Island Hospital makes changes

  Rhode Island hospitals after being fined $50,000.00 for three wrong-site surgeries at Rhode Island Hospital over the past several months is creating new procedures designed to prevent the same mistake. No details are presented concerning what those new procedures would be.

  
  
  

  Labels: malpractice medical prevent wrong-patient wrong-procedure wrong-site
  12/14/2008
  Nick Lombardi
  Comments (0)

  Wrong Side Surgery

  Surgeon operates on patient's wrong side

  July 6, 2008

  This has to be one of those stories that just makes your heart sink and it is no more personal than to the patient and medical staff, and how do you make it right or take appropriate action to lessen the occurrence?  Difficult answer by all means from every angle and nobody can feel any worse than the patient and the surgeon. 

  Also, read the message from CEO, Paul Levy in awareness in bringing it to the forefront.  As we all are so rushed today it is unfortunate that something was missed along the way.  Hats off to being transparent about the situation and also for keeping the identity of the patient confidential as well, as one little slip through the cracks and the patient could end up being a poster child, with or without their knowledge.  Tough question he’s asking to ponder using videos   Video is capturing half of what we do in the world today so should it be extended to the OR?  Would it offer beneficial information for the learning process? 

  One thing stated though is that more ”time outs” are on the agenda for the future.  Being rushed today affects every industry and creates errors as that is the fast paced world we live in today, and healthcare has it’s share, just read the news, and when something like this happens, it forces us to take time out and rethink about how to balance and prioritize.  Again, a gut wrenching story , and I think “time outs” are something of value that serve to be of benefit in all areas of our lives.  We are all just still humans helping other humans.   BD 

  An experienced surgeon at Beth Israel Deaconess Medical Center operated on the wrong side of a patient this week, a serious medical mistake disclosed in a memo that hospital administrators sent to staff members today via e-mail. State authorities are investigating the errant surgery, which happened Monday during an elective operation. A hospital administrator declined to provide specifics about the operation but said it did not involve removal of organs and did not cause permanent damage to the patient, described as middle-aged.

  Surgeon operates on patient's wrong side - White Coat Notes - Boston.com

  http://ducknetweb.blogspot.com/2008/07/surgeon-operates-on-patient-wrong-side.html

  
  
  

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