Friday, April 4, 2008

Health Care and Medical Mistakes

What word is the probably most feared by patients when they are under medical treatment? "Oops!" Possibly only worse would that then be followed by "Oh, my God!" When you hear your doctor say either of these phrases, you likely are in for a bad day. No one wants to go into a provider's office, clinic, ER or hospital and hear these words come from the lips of any medical practitioner. But mistakes happen. Sometimes, the errors are simply a small oversight such as putting the patient's information on the wrong form.

It is more serious when the medical office lists someone on a regimen for recovery that was scheduled for another person such as prescribing the wrong medication. An example of major malpractice would take place if the patient was under anesthesia for an operation, and the surgeon forgot to remove a sponge or instrument left inside the body cavity. Accidents like these can cause grave consequences that end in more life threatening circumstances or death, and the damage is done. At this point, difficult choices must be made by the physician and medical facility to reverse course and do damage control. This kind of situation can get very ugly very fast. The ability to handle medical crises takes significant management ability.

What happens when medical errors need resolution, and who pays for the care when mistakes happen? FierceHealthCare reported this month that some insurers are refusing to pay for care as a result of medical errors. WellPoint has just announced that they are not going to pick up the tab for the blunders made by providers in the medical community. The insurance company has identified three primary reasons not to pay: foreign objects left in patients after surgery, operating on wrong body parts, and operating on wrong patients. And, WellPoint will refuse to pay for hospital-acquired injuries, air embolisms, blood incompatibility, vascular catheter-associated infections, catheter-associated urinary tract infections, some chest infections, and pressure ulcers. Additionally, the Blue Cross and Blue Shield companies are considering similar steps according to FierceHealthCare.

HealthGrades reported this month that patient safety incidents cost Medicare almost $9 billion during the years 2004-2006 and resulted in over 238,000 potentially preventable deaths. Of the 1.1 million patients who experienced a medical error during these years, about 20% had a chance of dying. The greatest number of incidents--over 63%--were bed sores, failure to rescue, and post-operative respiratory failure. Over two billion dollars in costs could have been avoided during this time.

The insurance industry, beset by huge increases in costs, especially for certain medical procedures and expensive hospital treatment, are following Medicare's lead to refuse to pay for these medical errors. A huge question instantly comes to light when this happens--Who pays for care when the medical provider or hospital makes a mistake. Most Americans are not able to handle the costs associated with catastrophic healthcare. One incident can throw the average family into bankruptcy if there is no coverage available, especially if their insurance plan will not pay for the event. A patient gets the bill if the insurer refuses to pay and the medical provider disputes the error. A host of other more intricately confusing possibilities can happen including lawsuits, complaints of malpractice and negligence, state regulations regarding patient care, and more.

Currently, according to, eleven states will waive the fees for the worst mistakes. However, most of them will charge the patient or the insurer. These "never events" are rare and should never happen at all according to medical experts, but they do happen. The Archives of Surgery has identified up to 2,700 "wrong site" procedures per year that are performed. Physicians operate on the wrong person, the wrong place, or the wrong body part. A health safety advocacy group called the National Quality Forum has identified 28 medical errors that range from leaving objects inside the body after surgery to giving a mother the wrong newborn baby. However, there are still 39 states that leave the door open for billing to the patient or the insurer to pay up, even if the medical incident is a huge, glaring error.

Hospital administrators and physicians anticipate that if fees are waived for these mistakes, the admission of liability will punish them in court. There are currently efforts being pushed in the medical community to develop a national standard of universal guidelines for providers, insurers, and patients to address this issue. The current format of waiving medical billing is typically done on a case-by-case basis for medical errors. Healthcare advocates have campaigned for years that patients should not be billed when medical providers make mistakes. Patients end up either in court or in bankruptcy when faced with outrageous expenses that resulted from errors in the hospital or doctors' offices. In some cases, malpractice attorneys refuse cases, and the patient has no resources to litigate on their own.

Research conducted by the Harvard Medical School and released in February, 2008, indicated that medical errors are often caused by resident physicians in U.S. hospitals due to the following reasons: burnout, sleep deprivation, depression, mental and physical exhaustion, stress, and personal detachment to patients. Doctors suffering from any of these symptoms were over six times likely to mis-diagnose patients' needs resulting in medical errors. However, due to patient load and over burdened health care facilities, medical providers are struggling to keep up with quality patient care.

Chances are, you may know someone who has suffered an incident to error by a health care provider. Mistakes can be fatal. Our job is to make sure that proper protocols and procedures are always followed. Each person or caretaker has a personal responsibility to question every decision or action undertaken by a health care provider, hospital, and physician. As a patient, you don't want to end up as a statistic or appear on the 6 o'clock news as the next victim of medical malpractice.

Until next time. Let me know what you think.

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