Tort Reform or Just Plain Medical Care Reform: the debate continues as thousands are injured annually in US hospitals

This post was authored by Sharon Stabile and posted to The Eye Opener on October 25th, 2010.

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HEADLINES AND EXCERPTS

Wall Street Journal, September 28, 2010, diagnostic errors kill 40,000 to 80,000 patients annually based on autopsy studies over past 4 decades.

American Medical News, August 23, 2010, an estimated 1.5 million medical errors cost the US economy $19.5 billion in 2008.  

CNBC.com, October 19, 2010, the Colorado Physician Insurance Company found between 2002 and 2008, 25 surgeries were performed on the wrong patient, and another 107 surgeries were performed on the wrong body part. One-fourth, approximately 6 patients suffered significant injury. There was 1 death.

News from the National Academies, October 21, 2006, medication errors injure 1.5 million people annually. 400,000 injuries occur in hospitals; 800,000 occur in longterm care; and 530,000 occur in Medicare outpatient clinics. Estimates were conservative.  Treatment of hospital injuries cost more then $43.5 billion annually. Lost wages, productivity, or additional healthcare costs were not included.

HealthGrades, April 2008, published 3 years of Medicare data from 2004-2006 in their 5th Annual Patient Safety in Hospitals Study. They found 1.12 million patient safety incidents occurred representing a 3% incident rate; and 270,491 in hospital deaths were directly attributable to an incident. The incident rate was unchanged from the 4 previous annual reports.  The incidents accounted for $8.8 billion in excess cost.

HealthGrades, April 2009, also reported improved data in the 6th Annual Patient Safety in Hospitals Study.  Inpatient Medicare admissions from 2005 to 2007 were studied. Only 913,215 patient safety incidents occurred with an associated $6.9 billion in excess costs. Instead of a 1 in 5 chance of dying from a safety incident in 2004-2008; patients’ odds improved to 1 in 10 chance of dying from an incident by 2007.

Institute of Medicine of the National Academy of Sciences, 2000, estimated medical errors kill up to 98,000 US hospital patients each year.

_______________________________

I decided to write about patient injuries in American hospitals 2010 because – frankly – my career in healthcare quality assurance and risk management was launched as a direct result of a landmark study released in 1978.  Don Harper Mills, M.D. published a study known as the California Medical Insurance Feasibility Study (CMIFS). In 1978, no one knew how many people were actually being injured in hospitals. There was a crisis of available liability insurance for physicians and hospitals, and as a result, compensation alternatives were being considered. In order to fund compensation alternatives for patient victims, actual injury data was needed.

Dr. Mills and his colleagues manually reviewed 20,864 hospital patient medical records from 23 representative California hospitals for the year 1974. They found 970 patients were directly injured by a medical mistake. This was 4.5% of the entire records sampling.  What shook the healthcare industry to the core in 1978 was the following:

When expanding the study sample size to the full statewide population, the data showed there were:

  • 6.5% minor permanent injuries – 9,100 patients;
  • 3.8%  major permanent injuries – 5,300 patients; and
  • 9.7% suffered death – 13,600 patients.

If all of these patients were to be fully compensated under full disclosure and/or no fault insurance plans, the state would not have been able to fund the approach. Insurance companies and states across the country began looking at closed medical malpractice claims, statewide data, medical records that showed the same trends were a national and not just a “California” problem.

Throughout the early 1980’s, we saw state and federal regulations mandating hospitals implement physician peer review and quality assurance programs. Medical malpractice insurance companies and brokers sent consultants into hospitals to begin teaching staff how to set up systems for monitoring care and correcting/improving systems.

The American Society of Healthcare Risk Management was born creating national and state-based initiatives to reduce injuries. The American College of Surgeons published their first Patient Safety Manual for medical staff leadership.

Initiatives from the Joint Commission for the Accreditation of Healthcare Organizations continued into the 1980’s and 1990’s with expanded quality improvement standards.

This great computer age has allowed more sophisticated and widespread comparison of insurance, state and national data than ever before. The data tragically continues to reveal dismal results despite decades of government, state, regulatory, and social pressures for hospitals, physicians, and healthcare professionals to improve.

THE DEBATE RAGES ON …WHAT WILL FIX IT?

While the AMA continues to whine about being sued too often and the tragic impact on physicians, as you see the data show that for decades, patients continued to be significantly injured. A study by Harvard researchers, who reviewed 1452 medical malpractice closed claims in 2006, reported 75% had legal awards consistent with their merit. Two reports by Dartmouth economists in 2005 and RAND in 2004 found awards were consistent with the rising costs of medical care and average awards grew less than real income. The more costly medical care was responsible for more then half the jury awards. A study of American insurance data between 2001 and 2004 showed malpractice awards per doctor were stable or fell, and premium increases were not connected to awards.

In 2009, the Canadian Medical Association Journal reported there was no evidence US doctors were experiencing increasing numbers of lawsuits during 2001-2004.  Over 15 years, states had reported physician insurance premium rates were flat or declined relative to economic and population changes.  The article cited opinions that the problem was not litigation; the problem was malpractice.  However, the AMA is persistent in claiming financial relief is needed. One means they propose is to limit of non-economic damages for pain and suffering nationally to $250,000.

Very recently, American Medical News (amednew.com) issued a summary of 20 new grants issued by the Dept. of Health and Human Services at a cost of $25 million. The grants are to find ways to cut medical errors and improve communication between doctors and patients.  Highlights were:

  • New patient safety programs that include data designed to link with medical liability claims.
  • New York won $3 million to expand and test a judge-directed negotiation program for surgery and obstetrical injured patients.
  • The University of Washington in Seattle won $2.97 million to train physicians, nurses, and pharmacists to communicate.
  • Ohio State University of College of Medicine won $186,214 to establish a statewide database on pregnancy-related deaths for study towards improving outcomes.
  • South Dakota and Sanford Health won $299,995 to develop a state model for collecting medical error data and to design a patient complaint reporting system.

Ironically, the Wall Street Journal article (September 28, 2010) reported physicians were learning from reviewing closed lawsuit claims data. As a result, “Some doctors are using electronic alerts and reminders to order tests, follow-up lab data, and communicate with referral specialists.”

WHY AREN’T THEY ALL DOING THIS?

This June’s Archives of Internal Medicine reported 91% of doctors practice defensive medicine and order too many tests adding huge unnecessary costs to the healthcare system.  The Wall Street Journal article reported a better solution is to  improve larger system failures and prevent errors. Kaiser Permanente uses medical malpractice data for education, but also focuses resources on technology to reduce patient injuries, i.e. close tracking and follow-up of patients with abnormal testing results. The VA is doing the same through an electronic medical record system. This is encouraging.

The insurance company representing Harvard University affiliated hospitals and doctors uses lawsuit data to focus on improvement strategies. Again, from my perspective having worked in the past for a large insurance broker, a statewide project funded by an insurance company, and a medical malpractice insurance company, this is NOTHING NEW.  Out of 456 high severity cases resulting in serious harm to patients, most were diagnostic errors. The insurance executive for the Harvard account is hoping to spur changes in systems and procedures and reduce this finding.

I am hoping he will see results. I trust the headlines will continue to print those results and trends for us to follow.

We can only hope that the coming years will see a dramatic reduction in these preventable medical injuries.

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