It's Tort Reform Again

What is tort reform and why should it scare you?  One explanation off the internet is: Tort reform refers to proposed changes in the civil justice system that aim to reduce the ability of victims to bring tort litigation or to reduce damages they can receive.

In other words it lowers your chances of bringing a lawsuit against someone who harms you or your family.  Tort reform limits or caps the type or amount of damages that may be awarded in personal injury lawsuits.  Let’s call them for the sake of this post, malpractice lawsuits.

What many people hear when you say the word “malpractice” is money and compensation and sue the doctor or hospital because people want money.  Well, just as some people want money, there are some healthcare professionals who should probably not be practicing medicine,  Just because someone completed school, maybe even got great marks and has been in the business for years doesn’t make them good at their job.

So let’s not call it malpractice. Instead think of medical injury.  An injury or death caused by the care one received while under the care of a medical team.  It could be because of malpractice; negligent professional activity or treatment. Or it could be because nurses are too busy and overworked and miss something.  It could be because there is broken equipment, test results not given to the patient or a wrong diagnosis is given by a caring and otherwise competent healthcare professional.  The patient is still in the center of all this and though many people want to protect the healthcare team from a lawsuit, who is protecting the patient?

A Johns Hopkins study reported just last year that medical errors are the third leading cause of death in thecountry.  Many studies before that have reported the dangers in care patients receive.  These studies were not reported by attorneys and they surely weren’t done by patients.  These studies come from some of the most highly respected medical teams and researchers.  Yet the conversation goes back to affording the right to a patient or their family to collect compensation when injured.

Most people will tell me “I don’t want the money” or “I don’t want to sue”.  I tell them that it is about the money because your attorney has a right to be paid to get you the answers you want or need. In many cases the healthcare professionals will not talk to the patient or family and on a few occasions when I tried to intervene I was told “let them sue us”.

For years, through PulseCenter for Patient Safety Education & Advocacy (formerly PULSE of NY) I have been trying to raise the money to continue our free community educational programs and our bedside advocacy services. We need to protect patients and inform them and their family members of the dangers that the people in healthcare are already aware of. 

So as we start hearing the conversation arise about tort reform once again and the lawyers and doctors fight it out – think of who is informing the patient and helping the family navigate this system.

Some very final thoughts:  

• How much is your family member's life worth and should the state decide their price ahead of time?
• Should this energy be spent on improving medical care by informing the public with patient safety information?  After all isn't it the patient who has the most to lose?
• Why are we talking about capping payments when there are still such a call for improving patient care?
• Why are lawsuits looked at as so awful when this is often the way to get answers.
• Why are the attorneys looked at as the bad guy when it is the healthcare professionals they hire who decide if there is actually a lawsuit / malpractice.
• Thousands of lawsuits or complaints are turned away because there was nothing that would have changed the outcome and that goes for someone who was ill, elderly or very young too.

Addiction - The Big Circle

The Big Circle of Addiction and Dependency

A friend who works in healthcare recently shared an experience of a patient screaming that the patient was in pain and needed pain medication.  My friend knows the history of the patient.  The patient is often called a “drug seeker”.  Someone who is addicted and wants “drugs”.

People in healthcare, my friend explained, rarely have sympathy for drug seekers especially when they are disruptive and loud as this patient was.  The people who were working needed to tend to other patients and the other patients needed peace and quiet – not a screaming drug addict.

I listened and understood what I was hearing, yet I don’t like it. 

We can’t force someone to feel bad for others.  Although we can expect people to treat people with dignity.  I assume this happened.  Let me share my point of view.

In many case (of course not all) people become addicted or dependent following an injury, surgery or other medical reason.  I have been with patients at discharge when they were handed a prescription for pain pills with no discussion about the potential dangers of becoming addicted.  The patient is taking the medication and becomes addicted.  Now they are back in the hospital looking for more. It’s a big circle of blame the patient.

When I hear about high school education teaching young people about becoming addicted to drugs, I am confident that no one thinks it can happen to them.  (I know I don’t believe I would become addicted even though I was addicted to cigarettes and swore I could quit for years before I was able to).

What we can be teaching young people, as I have been doing, is about medication “errors” - mistakes in medication such as look-alike sound alike drugs – nail glue vs eye drops, Clearasil looks like teeth whitener, and generic vs. name brand and yes, pain pills available that you may not need.

In the news I hear over and over someone mention that they started on the road to addiction after root canal, surgery or a broken bone.  It’s never discussed further. Education must start BEFORE the prescription is written.  Or yes, they will be back.

It looks like I have some new material for the Family Centered Patient Advocacy Training coming in October.

Lavern's Law

Changes Needed

Imagine having terrible pain in your leg and going to the doctor who tells you to take some medication and get some rest.  When that doesn’t work you go to physical therapy and then a new medication and more rest.  You follow these instructions and feel worse in the months that follow.  Finally, you wait for another appointment with a doctor a friend recommends who recommends another doctor who sends you to a specialist. 

It takes a few months to get that appointment, work through insurance and finally, a full 18 months following the original misdiagnosis, you get the correct diagnosis that the cancer in your leg has spread throughout your body.  You begin months of treatment concentrating only on saving yourself but it’s too late.  Eight months after the correct diagnosis you find that the treatment, as well as the original diagnosis has been all wrong. Now,  three years after the incorrect diagnosis, you succumb to the cancer leaving your three children under ten years old with no mother.

Your grieving family doesn’t want to sue but they want answers.  No one answers their questions. The doctors or medical practice.  Not even the hospital who cared for you at the very end.  No one responds to phone calls or to letters requesting a meeting.  Now, you need to search for a lawyer and can’t find one.  Read why here:  

http://www.nydailynews.com/opinion/legislative-malpractice-lavern-wilkinson-article-1.3216684  

Have a comment?  Want to get involved?  Send your messages to info@pulsecenterforpatientsafety.org

Transparency?

Punish or Fix America’s Healthcare Facilities

A nurse who is involved in patient safety commented on Facebook that a local hospital is “closing their OB/GYN services. They are a remote town, downeast just over the border.”

She went on to explain “This closure puts pregnant women in danger. I hope the people downeast fight this one tooth and nail.”  

I felt the need to comment on that post and ask: Isn’t this what people who lose loved ones from a medical error want? If they were injured because of the care they received, don’t they want to see regulatory agencies close the doors?  Could it be that a wrong medication, an infection, or a baby born with disabilities was the start of that facility closing the doors to the thousands of patients they serve?

I get it. When my son died I wanted the doctors fired, the hospitals closed and the investigation (if there ever was one) made public.  Now, many years later, I want clinicians, hospitals, nursing homes and rehabs to do better, not close down. I don’t want to see jobs lost and people die from no available care.

The agencies that review patients’ charts, investigate complaints and inspect facilities are not the reason for the problems.  The problems come from the people who are overworked and making mistakes.  Still, are they to blame?  Isn’t it the system (run by people) really to blame?

I know many people want the oversight agencies that inspect, review and fine facilities to make their records public.  I could understand a government-run agency such as our state Department of Health doing that.  After all, it is government-run and I want to know what my government is doing for me.  As for other agencies that may be involved in fixing the problem, why do we need to know the details of the problems when — I hope — we just want them fixed?  If there are fewer infections at one hospital, does that mean another, best-graded hospital has no infections?  I can’t believe that the public thinks that if a hospital was found to be spotless, a nurse can’t injure a patient with the wrong medication.  What about a nursing home that shows no bedsores and reports of low infection rates; does that mean there aren’t patient falls each year with broken bones?

Why is there such insistence that organizations that inspect, survey or grade hospitals report their findings?  Why aren’t hospitals and nursing homes themselves required to report to the public directly?  •Three days since our last injury from a fall!  •Two days since our last surgical site infection!  •Only three wrong site surgeries this year!  •Just two deaths from medication errors this year!

Imagine if the hospital, nursing home other healthcare facilities started to share their data with those of us who pay for their service?  Who would really come out on top?

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Ilene Corina is the President of Pulse Center for Patient Safety Education & Advocacy a community based patient safety organization located in New York. 

Contact Ilene Corina: icorina@pulsecenterforpatientsafety.org or (516) 579-4711

Hospital Report Cards Out Again

Long Island Hospitals’ Grades in Latest Patient Safety

If you are wondering whether I have an opinion about the recent release of safety report cards on Long Island hospitals,  I do. 

Hospitals may do better or worse on such evaluations, (and many LI hospitals didn’t fare very well) but in the end it’s mostly down to individuals.

Another tool for rating your hospital is welcome, but what can we actually do with this information?  We can’t really do much to change the hospitals, so for the past 20 years I have been swimming upstream to change us — the patients and our families who support us.  Patient safety is a lonely commitment.  It’s not warm and fuzzy like toys for kids or snuggling with pets.  It’s not helping those already struggling with a disease that is no one’s “fault.”  Patient safety is about preventing harm when simply using the healthcare system.  It’s not unlike wearing a seatbelt even though it won’t be your fault if a car hits you. It’s about protecting yourself from the other driver who might fall asleep at the wheel – not illegal, just an accident.

Let’s think about measurement of hospital safety. Does this mean you won’t be injured at one of the best hospitals? Maybe not. Hopefully you won’t be injured at any of them, but there are never any guarantees. No matter how good a hospital’s patient safety culture may be, there will always be a risk from individuals who are casual in their adherence to the hospital’s error-prevention practices.

Think about the patients at these hospitals: some are at greater risk of adverse outcomes than others.  Are the hospitals with the best “report cards” serving a high percentage of immigrants who don’t speak English and maybe have not seen a doctor in five, ten or 20 years?  Are they serving a person who weighs 400 pounds, is an alcoholic and doesn’t see a doctor for his high blood pressure?  Are the patients at these hospitals young girls giving birth with no prenatal care? Maybe, maybe not . . . . but patients’ backgrounds and histories affect their outcomes.

Are the hospitals with lower ratings seeing the gunshot victims, dealing with angry and unruly families, or patients with no health insurance? Again, it’s a possible factor.

We don’t want to blame the hospital, if it has a culture of safety. I have had a number of experiences suggesting that even in such hospitals there are individuals at the bedside who just don’t get it. Where is this reported?

When a surgeon was asked, “Can you please wash your hands before examining the surgery site?” the surgeon responded dismissively, “I did wash and I showered today too”.  I know that this facility takes hand washing very seriously.  Yet an individual employee had no problem not supporting the patient’s right to safe care.

I asked a nursing assistant and nurse to please be sure a patient’s tray table was close by, so she wouldn’t fall trying to get it.  Whenever I visited, it was again out of reach.  The family noticed that she was not eating: that was the reason.

A doctor came in through the swinging doors leading from outside with his coat still on and a stethoscope around his neck, walked over to the (bleeding) patient I was with, and attempted to examine him.  I stopped him and asked the patient to refuse care until the doctor washed.  When the doctor refused I went to the desk in the emergency room and asked for a different doctor. The staff knew of this doctor’s attitude and accommodated us. This could have happened even at the hospitals receiving top safety grades.

When I asked a nurse to state whom a medication was for before putting it in a patient’s IV, the nurse’s reply was “It’s for her. Did you think it was for you?”  Then the nurse called the same patient by the wrong name. It could happen in nearly any hospital.

Hospital report cards are one way of knowing more about the inner workings of what happens on a larger scale.  There are also the NY State Department of Health and the Joint Commission keeping watch on safety for us – but if each one of us took responsibility for the patient’s safety — our own, our families’ and our friends’ — maybe we could help Long Island’s three million residents get the best care possible.

Politics and Patient Advocacy

What does today’s politics have to do with being a patient advocate?

In our Family Centered Patient Advocacy Training which is based on being a Patient Safety Advocate for friends, family or becoming a professional, we stress the importance of being a good listener and being objective.  This past election year and the past weeks have become a great test for these skills.

As I listen to the news, I hear opposing comments and ideas. Depending on what channel I watch there can be very strong opinions one way or another. One reporter or speaker won’t make me change my mind, won’t make me feel differently, but it gives me the skills to try to understand that what is being said is  important to the people saying it and the people supporting them.

I am glad that there are people speaking out on their beliefs.  That is important to our country.  It has never been OK to call names and poke fun of people’s looks or behavior when that is not the focus of the issues.  It loses credibility when I hear about the way a person dresses, walks or laughs and that becomes part of the discussion.

Being a patient’s advocate means being able to focus on facts and what really matters to the patient. Being objective which may mean putting your own feelings aside to listen and then allow a patient to make their own decisions, even if it’s not what you would want for yourself - or them. 

If you are a friend or family member acting as an advocate for a loved one who wants to have surgery but you don't think its a good idea, it means listening carefully and trying to understand what they want and why they want it that way. If you can’t get past your own needs then you may not be the best advocate.  Find an advocate that can be objective and right for the whole family. 

As I watch what looks like a civil war starting on our own soil, I want to get some good out of this.  It may be to just practice my listening.

When One Door Closes

A Letter to My Doctor

Today I sent the following letter to a doctor.  I hope others are encouraged to share why they leave a practice before they go.

Dear Dr. XXXXXXXX

I am requesting that my medical records be forwarded to XXXXXXXXXXXXXXXXX

I will not be able to use your services any longer.  Please allow me to explain why.
First, I should explain how I chose you as a physician — and possibly a surgeon — that I would use.  I put a call out to friends and family for a recommendation.  Your name came up.  Even though our state physician profile lists you as having made five malpractice payments in the past six years, three payments above average, I did recognize that your membership of five prestigious organizations such as the American Medical Association, the Medical Society of State of NY and the Nassau County Medical Society might mean patient safety was important to you. 

I thought it would be important to share with you why I am leaving and can’t recommend your practice.

      1.  I found it offensive and disturbing that my reason for seeing you was discussed at the front desk.  I knew why other patients were there because it is asked when signing in, and written down where the next person can see; also, the receptionist confirmed aloud what my appointment was about.  Although this is not a HIPAA violation it would be a breach of privacy were there someone present from my circle of friends or family with whom I didn’t want to share my business. Imagine if a gynecologist’s receptionist asked whether a patient was there for a pap test or a yeast infection, or to see if she were pregnant.  These discussions belong inside your office.

     2. Although your x-ray technician was very nice, he seemed rushed and impatient with other staff.  He told your PA that he was waiting for me for a half hour.  I was not even there for 10 minutes.  He also did not describe what was happening to me, what he would do, or why he would do it.  He said almost nothing to me.  A brief explanation of what would be happening while he was working – thus taking no extra time — would have been helpful, especially if I were someone feeling scared or alone. It also would have made a great impact on my experience.

     3. I don’t appreciate being called “Doll” after every sentence by a staff person who is half my age (or any staff person).  If she couldn’t remember my name, there are safer ways of confirming she has the correct person.

     4. An unknown, elderly woman in a wheelchair was wheeled into my room while I was waiting for you.  I had to stop the staff person from bringing her in.  He apologized and said he had the wrong room.  This gives the impression that your office is in some disarray and there are on-going problems.

     5. On my first visit with you, you were obviously very sick with a serious head cold and let me know that.  I understand that it is not easy to take off from work, yet you never washed your hands and even after blowing your nose you went back onto the computer in your room without cleaning your hands.  Then, you left the room touching the door knob.
   
 Dr. XXX, this letter is not being sent as an official complaint to the Office of Professional Medical Conduct, but instead offers an opportunity to review practices that can be viewed as potential hazards to your reputation, your staff, and most importantly your patients. It is very difficult for me to write this letter but I think it is very important that these issues of respect, courtesy and safety are addressed.

Thank you for your time.

Sincerely,
Ilene Corina, Patient Safety Advocate

CC:
American Medical Association
Medical Society of State of NY
Nassau County Medical Society

Senator Hannon's Senior Health Fair

Table at the Fair

I set up a table at Senator Kemp Hannon’s Senior Health Fair to distribute literature to the people (mostly over 60) who might be interested in patient safety.  PULSE of NY, now called Pulse Center for Patient Safety Education & Advocacy, has had a table there for many years and it has proven to be a wonderful networking event.  We have always been grateful to Senator Hannon for including us in this lively community event.   

For years it was a great opportunity for me to spend time with my parents who have been volunteers for 20 years, then just my mother, and now with them in Florida, it’s a chance to spend time with other Pulse volunteers as we meet the community.

Ideally, I suppose, we are supposed to be making the community aware of our services and how we can help. Instead each year it seems to be a bigger and better event for older folks to go trick or treating.  Just before Halloween the tables are piled with give-aways like pens, back scratchers, hand sanitizers and yes, lots of candy.  Some of the merchants even joke about who has the best candy and we find it fun to swap!

After all these years of setting up tables at fairs, it’s hard to imagine the best way to approach people about patient safety.  Why isn’t the public more interested in becoming an involved patient?  The people on either side of me who worked for an insurance company and another nonprofit each had personal stories of medical care that would fall under patient safety or medical injury.  They got it - but had no plans to share their experience so others could learn from it.  They suffered in silence.  What is the shame?

If we say “medical error” is there automatic blame?  I can assure you that when there is a medical injury, 100% of the time there is a patient involved but yet still patients are left out of the conversation.  That has to change!  Always looking for suggestions how.

Be an Ally

Why is Being an Ally Important?

Why is being an ally important to the LGBT community or any community that needs a voice?

I remember when I did a program at a hospital about sensitivity of working with people who have various disabilities such as using a walker or in a wheelchair.  During the open discussion someone in senior leadership said that they don’t have enough staff to work with people “like that.  “They” take extra time and the rooms are not meant to accommodate their equipment.

If I were in a wheelchair, I’m confident that those words would never have been spoken.  If you think that’s good, I disagree.  They need to be spoken and discussed.  If that VP carried her feelings out of the room and to her staff, it would be a ripple effect and the negative comments and feelings would reach a patient – somewhere.  Now that this is on the table we were able to discuss it, find the appropriate words she can share with her staff (who may feel the same way) and then make accommodations and plan appropriately.  The elephant in the room needs to come out for discussion and to learn what to do.  Keeping this bottled up helps no one.

The same with people who are gay or lesbian or transgender.  A bearded woman may make someone feel uncomfortable but isn’t it her right to grow a beard?  In healthcare it does matter because when toileting or body parts that are different on a male or female.  Should healthcare professionals ask men and women (who are presenting as one or the other) their last menstrual cycle, if they are pregnant or if they have had a prostate exam?  I know of a transgender woman asked her last menstrual cycle in an emergency room and instead of coming “out” she gave a date.

When people have been frustrated over questions and mistakes in pronouns their whole life or people who may seem insensitive to needs, it is the ally who can step up and help with the questions and education.

Yes, I will go to the bathroom with you and gently tell someone to mind their own business if they comment while you get angry.

Yes, I will help you with your wheelchair and ask people to give you room in the hallway. I will help you with your English or help get you an interpreter.  I understand that my friend doesn’t read well and I will help with the consent forms or admission packet.  As an ally, there are many places we can step up and help.  We need to be open to learning from those who want us, what they want from us and then do it.

To those who are living in the world that I don’t know or understand, I ask you to be patient and remember each person you meet does not know the lifetime of struggles you have had.  We make mistakes and may seem inconsiderate because we don’t know.  If you shut us out in your frustration, we will never understand each other.

High Cost of EpiPens

Epi Vs Narcan

These past few weeks the high cost of Epinephrine (or EpiPens) has made the news.  It’s not that new.  In March a story came out in ModernHealthcare about the high cost of this life saving drug.  Around the same time I was working with teens who sat at my dining room table and we talked about patient safety and being an Involved and Informed patient.  A young man at 16 years old with nu allergies questioned why Narcan is free to the public and his EpiPen is so expensive. 

We know that many more people will die from drug overdose than allergies but isn’t that the system once again using “measurement” to decide who lives and who dies?  If I had serious allergies and in my financial situation I might be hoping that prayer could work just as well.

Then I realized that if the pharmaceutical companies make a lifesaving medication, people who die from overdosing can come back and buy more medications from the pharmaceutical companies – look who gets rich off this.

What we really need is to encourage Jiff and/or Skippy and/or Peter Pan to go into the business of making EpiPens so those people who are allergic to nuts can eat them.