This Makes Me Sick

UC Irvine Hospital's Diagnosis: Denial

For more than a decade, UCI officials have repeatedly ignored red flags, downplayed serious problems, misrepresented facts and punished or fired people who exposed wrongdoing. Luckily, the hospital's woes keep peppering newspaper headlines and the courts.

"I don't think we're dealing with isolated problems and bad actors only," said new UCI Chancellor Michael V. Drake. "There are times when we have not lived up to our values."

Some recent scandals: 32 patients died awaiting liver transplants because no full-time surgeon was on staff and viable organs were turned down; Three whistle-blowers were paid a total of $900,000 in settlements that required them not to talk about hospital's fertility clinic problems. We wish you good luck, Chancellor. Read [LA Times]

EXPOSED Last year's reform of medical malpractice lawsuit rules in Georgia as becoming the whipping boy of this year's legislative session and the press. READ [Rome News-Tribune]

WARNED As approaching red alert status, the trauma care in Florida's Marion county. The usual suspects of physican shortages and rising malpractice rates are mentioned. READ [Ocala Star-Banner]

EXPLORED The steps hospitals take

to prevent wrong-site surgery--operating on the wrong area of a patient, or operating on the wrong patient. READ [Orlando Sentinel]

Huh? Federally Insured Docs and Nurses Can't Go National

When Katrina wrecked havoc along the Gulf Coast in 2004, medical workers from across the US headed down south to help. But many were turned away and went home. The reason: their federal medical liability coverage was only good in their home state. No coverage, no good Samaritan gestures. A new bill by Congressman Joe Schwarz (MI) would permit these medical employees to automatically retain coverage while working in a declared disaster area. Read [Toledo Blade]

Doctors AND Lawyers Devise Malpractice Cures

We've closely watched the drama, mud-slinging, and failed ballot initiatives in Washington State and are happy to announce that the warring parties have agreed to changes in the state's med-mal system.

Gov. Chris Gregoire hailed the legislation. "No one got everything they wanted - myself included. But that's the nature of negotiations." The resolutions, please:

• Allowing doctors to apologize in the immediate aftermath of medical mistakes without worry that these statements will be used as admission of negligence in court.




• Expanding the authority of the state's insurance commissioner by requiring prior approval of malpractice rate increases and broader reporting of resolved claims.




• Informing civil juries of compensation or payments that a malpractice plaintiff has received, and requiring statements that a malpractice lawsuit probably has merit.




• Providing for voluntary binding arbitration for civil cases involving up to $1 million in damages. The intent is to wrap up most cases within a year.




Cheers to the great state of Washington for taking steps forward. Read [The Daily Herald]

Liability Fears Cloud Use of Stroke Drug

A stroke victim arrives at Massachusetts General Hospital in Boston. She can't speak or move and is given a CT scan and then a clot-busting drug (Tissue plasminogen activator - tPA). Ninety minutes later, she's able to move and talk again. Unfortunately, tPA is rarely used, though it's been approved by the FDA for ten years. "The number of acute stroke victims who are given tPA is very low -- 94 to 97 percent of stroke patients do not get the drug," said Dr. Eric Smith. Two reasons: tPA can only be given within three hours of the onset of stroke, because the risk of hemorrhage is too high after that time; patients must have a CT scan before receiving the drug because tPA is only effective in treating ischemic strokes, which are caused by a blood clot. And that sneaky third factor: some doctors fear potentially fatal hemorrhaging in about 5% of those patients who get the drug. What can be done about this? Read [Atlanta Journal-Constitution]

Med-mal caps aren't the answer?

"Caps on damages or other avenues of tort reform have often been suggested as a means of addressing the liability crisis. Caps may slow the growth of insurance rates, but they do not address the underlying problems with our adversarial tort system and do nothing to improve patient safety."

We pulled this quote from a recent opinion piece in the Boston Herald pushing for special Health Courts. Our support for this solution is noted. However, what struck us was hearing not that caps stick it to patients or keep docs in business, but that they fundamentally do nothing to deal with root of the problem. Interesting, no?

What Exactly is Sorry Works?

We get this question quite a bit at The Sorry Works! Coalition. Sorry Works! is a term used to describe a process of communication and reconciliation between healthcare providers, patients, and families. And Sorry Works! is more than "sorry"….it’s also about admitting fault, explaining what went wrong and how it will be fixed so another patient doesn’t suffer the same injury, and offering fair, upfront compensation to patients and families.

The process we call Sorry Works! was originally developed at the VA Hospital in Lexington, Kentucky by Dr. Steve Kraman and VA attorney Ginny Hamm in the late 80’s. Their process has been successfully implemented in many other hospitals and healthcare organizations across the country and around the world.

In short, here’s how Sorry Works! works. After a bad medical outcome or adverse event, the healthcare providers and risk management staff perform a root cause analysis as quickly as possible to determine if the standard of medical care was met – or not. If the standard was not met and there was an error, the healthcare and risk management staff contact the patient and/or family, advise them to retain legal counsel, and schedule a neutral place to meet. At the meeting, the healthcare providers will apologize, admit fault, explain what happened and how they will strive to make sure it doesn’t happen again, and offer, fair upfront compensation to the patient and/or family. This honesty and candor removes anger and the urge to financially punish doctors with a lawsuit.

On the flip side, if there was no error, the healthcare providers still meet with the patient and/or family and explain their findings, open medical charts, and basically prove their innocence. They emphasize with the patient and family, but no compensation is offered. The patient, family and their legal counsel is encouraged to have their own experts review the charts. This openness reduces the filing of non-meritorious lawsuits. Furthermore, Sorry Works! hospitals never settle cases in which they believe their staff committed no error.

That’s Sorry Works! in a nutshell. Almost sounds too simple, but it is the most effective and meaningful way to reduce medical malpractice lawsuits, strengthen doctor-patient relationships, and reduce the chances of future medical errors. Learn more!

Cleaning up the justice system

Eric Novack, MD is host of “The Eric Novack Show,” a weekly radio program dedicated to examining healthcare policy and politics. Sundays on KKNT960 AM Phoenix.

An interesting article appeared in the February 11, 2006, edition of the Wall Street Journal. “Trial Bar Cleanup” examined how, with help from judges, the justice system can provide better and more justice:

It's amazing what a little courage from the bench can do to clean up the justice system. Now that word is out that most silicosis lawsuits are shams, ever more judges are helping to expose the corruption.

The latest is Florida state Judge David Krathen, who in a recent hearing rebuked plaintiffs lawyers for inventing silicosis suits, and declared "mind-boggling" the effect that phony suits were having on the "economic well-being of this country." He vowed to ride herd on the claims in his court, separating the good cases from the fake.

This isn't the way trial lawyers are used to being treated, and credit for this tougher approach goes in part to Texas federal Judge Janis Graham Jack. Judge Krathen made specific reference to the litigation Judge Jack presided over last year, in which she exposed how lawyers, doctors and X-ray screening companies had "manufactured" some 10,000 bogus silicosis suits "for money."

FYI: We held onto your placenta

As many as 700 women along the West Coast were not told that the Cascadia Placenta Registry--financed by hospitals and the insurance industry--kept their placentas after giving birth in order to protect doctors and hospitals from potential lawsuits. While legal experts say no state or federal laws were violated, the ol' question of ethics has surfaced. One mother found out about Cascadia in court when she sued a Portland hospital, because her daughter had a seizure after birth. "We were never asked. It's such a violation of privacy," she said. Proponents of Cascadia say placental analyses are conducted for 'patient care' and consent forms signed by patients when they were admitted gave the hospital authority to perform any necessary pathological exams. Thoughts? Read [The Oregonian]

The case for health courts

Philip K. Howard, Chair of Common Good, the nonprofit legal reform coalition, makes the case for health courts.

America needs a new system of medical justice. Justice in healthcare today is virtually random—most people who are injured by medical errors get no compensation, and far too often, especially in tragic circumstances, doctors who did nothing wrong are held liable for millions of dollars. This unreliability has infected healthcare with a debilitating distrust—driving up healthcare costs through defensive medicine, and causing thousands of tragic errors because doctors and nurses are no longer open with each other about uncertainties or mistakes.

The flaw is that justice today is ad hoc—decided jury by jury without any consistency or precedent; tolerating widely disparate results for similar circumstances. By most measures, the current system is a failure:

—The Institute of Medicine says: "The legal liability system does not adequately fulfill either of its two main objectives—to encourage enhanced safety and quality and to provide timely and fair compensation to injured patients."

—The Progressive Policy Institute says: "It does not give most injured patients access to justice, and it does not send clear signals about standards of care that would help healthcare providers avoid medical mistakes."

—The Joint Commission on Accreditation of Healthcare Organizations says: The current system is "not a 'real system,' but rather a patchwork of disjointed and inconsistent decisions with a limited ability to inform the development of improved healthcare practices."