Articles Posted in Hospital Deaths

A story published this week in The Oregonian focuses on the suicide of a teenage boy who was living in a Corvallis residential treatment facility and on accusations that the facility falsified care records in an attempt to evade responsibility for its actions. There are broader issues also raised by the case, however, and I would like to take a few moments to examine both the issues raised by the newspaper and the ones that also merit our attention.

According to The Oregonian the boy, age 15, died last August. A state investigation showed that he was supposed to be closely monitored while in the facility, with staff checking on him every 15 minutes. Though the care center’s records indicated he had slept through the night, a state investigation showed that he had been left alone for 40 minutes at one point that evening despite having “told staff earlier in the evening that he was suicidal and had been bleeding from self-inflicted arm wounds.” The newspaper adds that the investigation turned up other instances in which “patients told regulators they also had gone without scheduled check-ins by the center’s employees.”

The focus of the newspaper story is on the alleged falsification of records and this is obviously a serious issue. If proper, legally required, records are not kept by caregivers and facilities it is impossible for patients to get the treatment they need and extremely difficult for cases of medical malpractice or nursing home abuse and neglect to be proven either while they are unfolding or after the fact. To be clear: this is an extremely important issue and one where it is critical to everyone’s health and well-being that federal, state and local regulators do their jobs.

The Oregonian reports that a Beaverton nurse was allowed to continue working with patients while under investigation for sexual misconduct on the job and allegedly committed a similar offense during that time. The incident, if the facts are as reported, raises serious questions about how the nurse’s employer, Kaiser Permanente, deals with abuse allegations among its employees. The result is a case which concerns both hospital malpractice and sexual assault.

According to the newspaper the 37-year-old North Plains man was indicted earlier this month “on one count of first-degree criminal mistreatment, three counts of invasion of personal privacy, two counts of computer crime and four counts of third-degree sex abuse, police said. The charges relate to three alleged victims, but detectives have identified two more and are investigating their claims.”

The claim that the man was allowed to keep working is particularly striking when one considers how quickly the case has moved. Far from being something that has dragged on for many months or years, The Oregonian reports that “police first started investigating (the nurse) on Jan. 28 after a woman reported that he made sexual statements to her and sexually touched her during a visit to the Beaverton clinic two days earlier.” In other words, this case has gone from initial allegations to a wide-ranging indictment in about nine weeks – a case of the criminal justice system moving fairly quickly. Despite that, however, it is hard to imagine another workplace context where an employer would regard it as OK to keep an employee accused of sexual assault in a position to recommit the alleged offenses.

A harrowing story in the magazine Pacific Standard highlights how loosely regulated midwife-supervised births often are, and the tragic consequences that can result. As the article’s sub-head notes: “in 30 states, Certified Professional Midwives are licensed to practice medicine with virtually no medical training.” This, in turn, can lead to serious injuries to children and even, as in this case, to deaths.

The article focuses on the experience of a Nevada couple whose baby died a few minutes after being born. As it lays out in detail, the warning signs about this particular pregnancy were clear for any trained professional to see. The problem was that by hiring a midwife in a state with particularly lax regulation the parents were left getting advice from someone fundamentally unqualified. “Had (the baby) been born in a hospital under the care of a nurse-midwife or physician, he almost certainly would have lived,” the magazine concludes.

The article goes on to note that it was only after matters had gone too far that the parents discovered that the ‘supervising physician’ listed by the midwife had never met her, and that the woman in question had moved to Nevada to evade a license suspension in California.

The death of a patient at the Oregon State Hospital one year ago next week has led to the filing of a lawsuit, according to a recent article in the Salem Statesman-Journal. The case raises noteworthy Oregon wrongful death issues, and is worth exploring here.

According to the newspaper, the man’s family alleges that his “death was the direct result of hospital staff retaliating when he alerted police and the media to patient sexual abuse in the hospital.” The 48-year-old man died last January “after telling friends and family he feared for his life.”

The newspaper reports that in August 2013 the man had alerted hospital officials to an alleged case of sexual abuse involving a nurse and a patient. When the man felt the hospital did not react appropriately he “told the Oregon State Police, the Statesman-Journal and The Oregonian.” Shortly afterwards the man was allegedly moved to a different ward, put under round-the-clock watch by the hospital staff and given medications that “put him in a state of near-constant sedation.” The lawsuit filed by his family alleges that all of this was unnecessary and significantly contributed to the man’s death.

When July began on Tuesday an important new Oregon law also went into effect. As reported by The Oregonian a new “mediation program… (gives) patients and their families an option besides suing when medical errors happen.”

The measure was a priority for Gov. John Kitzhaber and, as the newspaper notes, became law following input from both trial lawyers and the Oregon Medical Association. The new law “is intended to cut down on lawsuits and boost the reporting of medical errors to help improve health care practices.”

Some practical details remain to be worked out, and it will take months if not several years before we can say with certainty how well the program is working in practice, but as a public health matter we should all hope that the Early Discussion and Resolution Program, as it is formally known, performs as expected. As I have written in this space as recently as last month, medical mistakes remain far too common in our state and reducing or eliminating them is made more difficult by a reporting system that remains, to a great extent, voluntary. As a result, doctors and patients alike are often working from inadequate data. A system that improved both the volume and the quality of data on medical mistakes would be a huge boon to everyone.

A story earlier this week on Oregon Public Broadcasting began with a stark statistic: “Oregon’s health care facilities reported more than 650 adverse events last year, 44 percent of which ended in serious harm or death, according to a new report by the Oregon Patient Safety Reporting Program.” Forty-four percent means that, as the article’s headline put it: “285 medical mistakes ended in serious injury or death in Oregon last year.”

For a state our size this is a shocking, and frankly unacceptable, number. “Adverse events include medication mix-ups, falls, infections, and erroneous surgeries being performed,” according to OPB. The number in the study is the largest reported in Oregon’s history, though the people who compiled the study say that can be attributed, in part, to a higher participation rate (the study was voluntary, since “the state doesn’t require health care facilities to report such mistakes,” OPB notes.)

The important thing to take away from the study, however, is how critical it is for doctors to take extra care when prescribing drugs and ordering treatment. Mistakes are simply less likely to happen when fewer and more carefully considered treatments are ordered, a fact that our current system, in which doctors get paid for each procedure they order, does not always encourage.

We have all heard stories of medical price-gouging, but an investigation published earlier this week by the Tampa Bay Times shows that in Florida hospitals have taken the practice to a new level.

According to a lengthy investigation by the newspaper, a change in Florida law several years ago allowed hospitals to charge special fees for the use of trauma centers. The centers are specialized facilities within emergency rooms and hospitals have long argued that establishing and maintaining them incurs unique costs which the institutions ought to be able to pass along to patients and insurance companies. For such fees “a fair cost, according to the federal government’s Medicare program, is just under $1000.” According to the newspaper, however, because the fees are not regulated “the average fee today tops $10,000; the most expensive hospital regularly charges $33,000.”

To be clear: these fees are in no way related to actual services rendered. They are, as the newspaper puts it, a “cover charge.” The paper recounts numerous instances in which patients “were charged more in trauma fees than for their actual medical care.” Since the fees are both unregulated and unrelated to the actual medical services a patient receives, the hospitals have an obvious incentive both to raise the fees as much as they can and to admit patients to the trauma center regardless of whether or not they actually need to be there. In one particularly shocking case, “an uninsured woman… was charged $33,000 even though she only needed someone to treat superficial cuts.”

The tragic death of an infant last year at a Seattle day care center is spurring calls to action in the state legislature. According to an Associated Press report reprinted in The Oregonian, Washington legislators will soon debate a proposal to “require formal investigations at child care centers when a death occurs, even if the child appears to have died from natural causes.”

“The proposal is named for a 5-month-old girl who died last year while napping in a Seattle home day care center where another death occurred in similar circumstances more than a decade earlier,” the news agency reports. The May 2013 Washington child death has been attributed to Sudden Infant Death Syndrome, or SIDS, which AP describes as “a major cause of death for children 2 and under in child-care settings.”

SIDS deaths can often be prevented with proper infant care techniques including the careful monitoring of sleeping children, but much about SIDS remains unknown and controversial. For those reasons it is surprising that Washington law does not, right now, require an investigation of this and any similar deaths. Common sense would seem to argue that any Washington child death or serious injury should be thoroughly investigated even when it appears to be from natural causes. Only by looking thoroughly at the circumstances surrounding each such tragedy can we learn from it.

State and federal lawsuits filed last week in California are seeking to change current legal thinking and make it harder for medical device makers to avoid responsibility for defective products. According to an analysis published in the Wall Street Journal the suits “could challenge the broad liability protection that medical device makers have enjoyed since a key Supreme Court ruling in 2008.”

The target of the suits is St. Jude Medical, the maker of the Riata line of defibrillators. According to the Journal, the plaintiffs in the suit claim “that problems with the manufacturing and oversight of Riata defibrillator ‘leads’ injured or killed more than 30 patients. Faulty leads, which connect the heart to defibrillators that zap irregular heart rhythms back to normal, caused the devices to fail or needlessly deliver blasts of electricity, the suits allege.”

It might seem obvious that here in Oregon, in Washington or anywhere else in the country companies have an obligation to ensure that the products they sell are safe and function properly, but manufacturers of unsafe medical devices gained unprecedented liability protection via the Supreme Court’s 2008 Riegel v Medtronic case. That ruling, as the Journal reports, granted medical device makers immunity from state unsafe product liability laws on the grounds that medical device safety is a federal issue.

An editorial published last month by the New York Times raises important questions about the legal and moral responsibility medical device manufacturers have, or ought to have, concerning their products.

The newspaper focused on all-metal hip implants in general and the actions of DePuy Orthopaedics in particular. DePuy is a division of pharmaceutical and medical supply giant Johnson and Johnson. The paper writes that “about 93,000 patients around the world” received DePuy’s all-metal Articular Surface Replacement (ASR) model hip implant until it was recalled in 2010. However, the paper notes, “documents show that as early as 2008 DePuy executives were told by a number of surgeons, including its own consultants, that the device appeared flawed.” The article goes on to note: “That was never disclosed to doctors who were putting the device into patients, nor were other unfavorable internal studies.”

In response DePuy’s president wrote to the Times this week to take issue with the editorial, noting that the ASR had been approved by federal regulatory authorities and that when data indicated that numerous patients were requiring early replacement of their implants the company “recalled the product and immediately supported patients with a reimbursement program for their medical costs.”