Well this headline got my immediate attention!
HOSPITAL FINED $300,000 FOR LEAVING A DRILL BIT IN PATIENT’S HEAD. Rhode Island Hospital (RIH) was fined by the state’s Department of Health with the largest penalty in state history and only the 3rd posed against a hospital for surgical errors.
CALIFORNIA HOSPITALS FINED FOR ENDANGERING PATIENT SAFETY
TEMPLE TO PAY (the US Government) $130,000 TO SETTLE DRUG DIVERSION CLAIMS
BOTCHED RADIATION TREATMENTS LEAD TO FINE FOR VA
Yes, states are fining hospitals, the US government is fining hospitals, and the US government is even fining government hospitals for unsafe practices. State, regional and national news publications are breaking the stories and making the public aware of their hospitals’ most costly mistakes. Over the last two decades, more and more states are requiring hospitals to report serious errors and fining them for failing to do so. One way or the other, hospitals pay for serious mistakes and suffer media scrutiny at the same time.
The Rhode Island Director of Health reported “a troubling pattern” of patient safety procedural violations at RIH. On October 15th of this year, a surgical instrument was found in the abdomen of a patient who had undergone surgery three months before. This followed an August incident when a quarter inch drill bit broke off in a patient undergoing brain surgery. While aware the bit was missing, no one in the operating suite investigated where it went. The next day an MRI identified the bit in the patient’s brain. This error placed the patient at serious risk of harm during the MRI. Magnetic forces during the MRI could have moved the metal drill bit causing significant brain injury.
Clinical standards of care require all surgical instruments to be counted at the beginning and end of a procedure. If the count is incorrect, xrays are immediately taken. If found in the patient, the instrument is removed before the conclusion of the procedure. This healthcare industry-wide patient safety procedure has been in place for well over 30 years. The simpe, straightforward procedure was not undertaken according to Rhode Island news reports. In addition, the state found anesthesiologists at RIH don’t wear masks while in the operating room, and no actions had been taken to correct the behavior.
The Director of Health also reported in 2009, RIH was fined $150,000 and ordered to hire a consultant to improve operating suite procedures; shut down surgeries for 1 day to conduct mandatory training; and install audio/video monitoring devices to ensure compliance. This all happened when a surgeon operated on the wrong finger which was the 5th time a wrong body part had been operated on in 3 years at RIH. Things have not improved in 2010. The fines are getting heftier and the Centers for Medicare & Medicaid Services (CMS) as well as state professional licensing boards are now involved. Federal government intervention has only happened one other time in Rhode Island’s healthcare history.
Rhode Island is not alone. As the headlines above show, California, after enacting a new state law in 2007, reports that over $4.8 million in healthcare administrative penalties have been issued with $2.9 million collected to date. California news stories began breaking last January (2010) when thirteen hospitals were fined $50,000 each and another was fined $25,000 four times. In April, seven more hospitals were fined. In May, nine more hospitals $550,000 in penalties imposed.
The deputy director for public health, Kathleen Billingsley, told the press that Californians have a right to receive the minimum level of required state standards. Out of 146 penalties, hospitals were appealing 37 in an April news report. Notable infractions resulting in fines included:
- Man hospitalized with a heart attack died after his cardiac monitor had been disconnected.
- Woman misdiagnosed with an ectopic pregnancy was given chemotherapy drugs. She was not pregnant.
- Two ER nurses without documented clinical competencies or life support training failed to record vital signs in a 5 month old with a temperature of 105.4.
- An operative sponge was left in a patient and discovered a year later. Three operations were required to eventually remove the sponge.
- A wrong knee was operated on.
- Contrast material for radiology was given to a patient with a known iodine allergy resulting in death.
- An oxygen tank became empty during a simple ultrasound procedure resulting in the patient’s death. The patient had waited in radiology over 60 minutes for the procedure allowing the tank to run dry.
- A patient aspirated a laryngoscope plastic blade extender during intubation for an outpatient surgery. It was not discovered until the patient called post operatively complaining of coughing up plastic.
In March, the Department of Veteran Affairs, which oversees the Philadelphia Veterans Affairs Medical Center was fined $227,500 by the Nuclear Regulatory Commission. This was the second largest fine against a medical facility. Between 2002 and 2008, Iodine 125 seeds were placed incorrectly in 97 out of 116 prostate cancer patients. There were inconsistent doses, unintended organs and tissues radiated leading to a myriad of complications for the victims including excessive radiation. Many of the incorrect procedures initially went unreported.
While I applaud these fines and would like to see stronger sanctions, several questions came to mind after reading these reports. Are states and the federal government merely cashing-in and paying-down healthcare deficits, or putting this revenue to good use such as improving patient safety? How much of the revenue is being consumed in hospital appeal proceedings? Is this an effective incentive for hospitals to change or merely perceived by them as a cost of doing business in today’s high paced and burdened healthcare system?
What do you think?