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LOS ANGELES, CA, March 21, 2012
/24-7PressRelease/ -- Hundreds of thousands of patients are injured every year as a consequence of preventable medical errors. The number of people killed as a result of these errors is equivalent to a fully loaded 747 crashing every single day of the year. Preventable medical mistakes are the sixth largest cause of death - more than auto accidents, diabetes or breast cancer.
Awareness of the most common errors doctors and hospitals make (listed below) can save your life.
Issues related to HMOs
HMOs usually have agreements with physicians or medical groups called capitation contracts. These agreements pay the physician a very small amount (ex. $10) for each HMO patient enrolled in that physician or groups' medical practices. This is a flat rate regardless of the time spent by the physician, the number of times the patient is seen in a month or the complexity of the complaint. The physician benefits by seeing a high volume of patients. The time that he or she has available to see each patient is reduced because of the volume. This is very different than physicians who have a much lower volume of patients, i.e., a fee for service plan, where the amount of time and thoughtfulness put in to the evaluation of each patient depends on the complexity of the condition. Serious conditions are underdiagnosed and inadequately treated as a result of these perverse incentives. HMOs have created the fast food of medicine (5 cents a burger, but a billion burgers).
If a patient needs a specialist referral, the HMO may mandate that a doctor see the patient whose not the appropriate specialist for that condition. For example, an HMO required that a colorectal surgeon operate on a child with a thyroid tumor instead of providing a pediatric ENT specialist. This resulted in an injury to the child's vocal chords necessitating life-long care.
Is the state medical board protecting you?
The answer is no. Medical boards are political bodies, many of whose actions are kept from the public. The occasional publicly announced sanction against a physician may be the tip of the iceberg. For example, you may never know that the doctor operating on your child:
- Was suspended by another hospital.
- Had documented substance-abuse issues.
- Failed their medical specialty board examination multiple times (we've seen as many as 8).
- Was kicked out or suspended from their residency program.
- May have attended an off-shore for-profit medical school.
- May never have graduated from college.
Also, unfortunately, not all arbitration awards or judgments against your doctor are disclosed publically by the medical board. Budget problems and priorities have made the overseeing medical board even less effective.
How hospitals can cause you harm?
Some hospitals recruit sub-par doctors for financial reasons. The physician, regardless of their credentials, may bring in with them many patients who he/she cares for in his/her office. For example, an obstetrician who has failed the boards multiple times and never passed, and who had multiple accusations of sub-standard care, was given the post of Chief of Obstetrics at a community hospital because he brought in nearly 100 deliveries a month resulting in millions of dollars to that hospital.
The hospitals try to avoid responsibility for physicians they recruit to their staff by having the patient or his/her family sign an acknowledgment that the physician is "independent." The legal implication the hospitals try to enforce is that they are not responsible for the misconduct of that physician.
This language is disguised by hospitals in their initial paperwork by combining it with paragraphs that deal with billing, insurance, etc. You are asked to sign this paperwork and not given any opportunity to knowledgably read and understand the documents put in front of you.
Hospitals provide most of the hands-on care to patients through their nursing and other staff. The number of nurses the hospitals provide varies a great deal as does the training of these nurses. Some hospitals are clearly understaffed and others hire nurses who come from an agency. They may not be adequately screening these traveling nurses.
Hospitals are required to have their nurses attend continuing education courses, most of which are presented at the hospital. However, whether the nurses absorb any of the information at these classes is dubious. Many times, in Michels & Watkins hundreds of cases, we've seen nurses that have no idea of the medical knowledge needed to care for their patients.
Currently, California hospitals are required to report adverse events to the state, however, not all adverse events are being reported and the spin on these adverse events may be favorable to the hospital.
Misdiagnosis or delayed diagnosis
A woman feels a lump in her breast but the doctor says nothing is there. A year later, she is diagnosed with cancer. A man gets a PSA-level that's abnormal but is not told about it. Years later, his cancer has spread. A doctor takes a chest x-ray showing cancer, but the patient is not told about it. Years later, the patient's cancer has spread all over.
What these cases have in common is poor communication between the doctor and the patient, or insufficient attention to obvious problems. The result of this poor communication and inattention is the progression of illnesses that could have been more successfully treated early on.
To help patients protect themselves, always get a copy of the report of an x-ray, mammogram, Pap smear or any other test. Obtaining these records is your right and they belong to you. Get a second opinion when concerned and discuss with your family. Also, check out to see if your doctor is board certified. The resources you can use are: Medical Board of California License Look-Up System or American Board of Medical Specialties, or Federation of State Medical Boards.
Childbirth mistakes
Medical mistakes frequently occur during prenatal care, labor, delivery and neonatal care.
Prenatal-care mistakes that obstetricians commonly make include:
- Failure to diagnose a medical condition of the mother, such as preeclampsia, Rh incompatibility, gestational diabetes, infection, hypertension, etc.
- Failure to identify a potential birth defect or perform appropriate genetic or metabolic screening.
- Failing to detect a growth abnormality of the fetus.
The most common mistakes during labor and delivery include:
- Failing to detect fetal distress on the electronic fetal heart monitor strip.
- Failing to recognize and respond to abnormal labor patterns or dysfunctional labor.
- Failing to realize when the fetus is too big for the mother to deliver vaginally.
- Improper use of vacuum extractor or forceps resulting in traumatic deliveries.
- Delay in calling for cesarean section.
- Improper use and monitoring of labor epidural anesthesia.
- Failure to promptly recognize and respond to emergency conditions (placenta abruption, uterine rupture).
- Inappropriate attempt at vaginal delivery after prior cesarean section.
Common mistakes with neonatal care, include:
- Delayed or improper resuscitation of newborns at delivery.
- Delay in diagnosis of sepsis.
- Delay or misdiagnosis in newborn illness or condition.
Medication errors
According to the Institute of Medicine of the National Academies, in any given year 1.5 million people are harmed by a medication error.
Many medication errors occur due to confusion about similar sounding medication names, and misreading of the doctor's poor penmanship on a prescription. Patients can help safeguard against this by keeping records of the medication dosages and frequency on all of their medications; making sure that the physician is informed of all drugs being taken; and any changes in the drug regimen from prior visits. Patients should also request that doctors explain side effects and drug interactions related to the prescriptions they have been given.
Anesthesia mistakes
The greatest risk of surgery isn't surgery itself - it's anesthesia. Even a small error by an anesthesiologist can result in permanent injury, brain damage or death.
Ways anesthesiologists can slip-up before surgery include:
- Inadequate review of a patient's medical history.
- Failure to properly evaluate the patient's airway.
- Choosing the wrong method of delivery and drugs to be used.
In the operating room, anesthesiologists can mistakenly:
- Improperly intubate patient by inserting the tube in the esophagus instead of the trachea.
- Fail to prepare for complications.
- Administer too much anesthetic.
- Fail to monitor a patient's vital signs.
- Not having the equipment immediately available.
- Poor communication with the surgical team.
Surgical errors
Surgical errors can happen both in the operating room and after a procedure.
During surgery, a surgeon can:
- Operate on the wrong body part or site.
- Fail to recognize and repair a cut blood vessel.
- Injure the spinal cord or other nerve.
- Inadequately remove tumor.
- Puncture an internal organ.
- Leave a surgical instrument or foreign object (sponge, drain, etc.) inside a patient's body.
- Allow medical students, interns and residents to inappropriately operate on you.
According to the Archives of Surgery, up to 2,700 "wrong-site" surgeries are performed in America each year. The Joint Commission, an independent healthcare accreditation organization, counsels patients to discuss their procedure in detail with their doctor and ask for the surgical site to be marked on their body with permanent marker.
Checklist to protect yourself:
Choosing your doctor:
- Get referrals from other reputable sources
- Avoid picking a name from your preferred provider handbook based on location or other unimportant reasons
- Research your doctor:
- Is he/she board certified?
- Do they or have they had lawsuits against them?
- The resources you can use are: Medical Board of California License Look-Up System or American Board of Medical Specialties, or Federation of State Medical Boards.
- Ask around - friends, colleagues and other physicians
- Is your doctor on a faculty at a University medical center?
For all operations:
- Get second opinions and if needed, third and fourth opinions
- Especially when you have a biopsy taken
- When you are going to the hospital, never go alone. Always have friends or family with you most if not all of the time. You need an advocate to remain safe in a hospital.
- Speak up. Do not be intimidated by inattentive and rude nurses or arrogant doctors.
- If you are in the hospital and a nurse comes to give you medication, make sure that medication is the proper medicine and dosage. Have the nurse double-check.
- Ask for explanations in detail.
- Don't be afraid to ask for help.
Don't think that they know it all, they do not. Your health and safety can be in jeopardy.
Website: http://www.michelswatkins.com
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