Tuesday, April 26, 2011


Visiting a Sim Lab

I was invited by an administrator of a large health system to visit their simulation lab. I get very excited with this sort of patient safety education because it is an opportunity for medical professionals to train in team work, cooperation, as well as policy, procedures and communication skills.  After all, pilots don't fly the first time they are in a cock pit.  They start off in simulators.

I just can’t imagine medical training on real people any more. No wonder there are so many errors and miscommunication is one of the biggest pieces.

I often ask a nurse who is caring for the patient I am with “How long have you worked here?” If she says one year or ten years I’m not sure if it matters. But, it helps to know if the nurse is fairly familiar with the surroundings.

We can start asking soon if they have been trained on simulators. That may actually make a difference.

Tuesday, April 12, 2011

Quality of Care

Where is the Quality of Care Going?

I thought I have seen it all, but I can be wrong. I was called to this Long Island hospital by the adult son of an elderly woman. His mom, he told me was in her bed all day at the hospital, had bedsores and he was pretty confident she wasn’t eating because no one helped her eat. He had no other family and since he lived with his mom, he feels obligated to help her stay independent. He worked during the day, went there every night at dinner time to help her eat. He felt it was just short of abuse but he didn’t know what to do.

I showed up at 11:30 AM. She was clean and resting and it turns out the son hired someone to clean her in the morning. A young man came in with a lunch tray and put it on the table at least 2 feet out of her reach. I watched as a young woman went to the patient in the next bed, also an elderly woman, and moved the bedpan from the chair to the windowsill so she can sit down.

I sat for another hour and watched the nurse come in and change her IV bag, never looking at her wrist band (but I assume she would say she knows who she is) so I asked who that medication was for. At that point she looked at the name on the medication.

I came back at 4:30 and the tray of food was never touched. Her bedsores “large enough to put a fist in” were examined by a nurse who unwrapped and then rewrapped the wounds putting the same tape and bandages back on. I asked why she did that since she was struggling with the tape sticking to everything and she said she just measures the wounds – she doesn’t treat them.

 I was there to try to find out who would speak to the son and help coordinate his mother’s care. The case manager said “you have to speak to the doctor”. The doctor is not available in the evening when the son can be there. It became a huge run around in a complete circle. This woman was not getting “care” she was existing - and the hospital was getting paid for this lack of care.

This morning, my first call was from a young woman. She was going to meet with her mother’s doctors at a hospital. The care she said is awful. She is in a dangerous place and she didn’t know what to do.
Yup, same thing.

Monday, April 11, 2011

Using Home Visits

Healing From The Heart

I returned the call late on a weekend evening to a person who is disabled. Her legs don’t work at all and her hands cause her difficulty. She was angry and seemed scared. She was in the emergency room the night before. She was having difficulty breathing and may have a pneumonia she told me. Her doctor wants her back to the hospital but she knows, that if she had the proper medication, she would be fine. “I have a nebulizer” she told me. “I just need a prescription for the medication”. I wondered what the doctor’s choices, if he really cared deeply for his patients could actually be.

It’s not my practice to make referrals but felt I could in this case. I suggested she may want to look at a Nurse Practitioner I know who makes house calls. I know many people who use his services. They all like him but I know him socially, not as a medical professional. He has a background of working with the disabled (his long-time companion is blind) and I have seen him interact lovingly with the elderly. He is someone who is in this job for all the right reasons.

He went to see her at her home and the message I got in the morning is that he was a “godsend”. Imagine if healthcare was always like this?
This woman, about my age, runs a fairly large business. She is bright and charming and very, very well respected in the community she serves. She can articulate her needs, assertive but also gentle. She has lived in her body her entire life and knows her limitations. She did not want to go back to the hospital. In her wheelchair, though electric and responsible, becomes a bother. Why, she wondered can’t the doctor just call in a prescription?

Saturday, April 9, 2011

The Wrongful Death Law

NY State and The Wrongful Death Law

Parents of children who die because of their medical care have, for years complained that they can’t find legal representation because of the “Wrongful death law”. The same is true for the adult children of senior citizens.

New York State strictly limits the types of damages recoverable in wrongful death cases, so careful attention is needed when proving recoverable losses. These recoverable damages can include pre-death conscious pain and suffering and economic or financial damages — these are not limited to actual financial loss. For example, a child’s loss of parental moral, intellectual, physical training and guidance has an economic value.(http://www.yournewyorkinjurylaw.com/wrongful-death/)

Many patients or family members have been turned away because there may not be enough money in the case (it may take more money to explore the case or pay for expert witnesses than could, or would be collected). These survivors are often left with no answers but until the statute of limitations runs out, hold on to a dream that some attorney would take their case and, at the very least, answer the question of “what happened?”

New York State's Estate Powers and Trust Law is considerably narrow in the damages which it allows for wrongful death claims. (http://www.smileylaw.com/Articles/Recovery-Under-NY-s-Wrongful-Death-Statute.shtml)

 Attorneys will tell the family that they have a “good” case but because of the high cost, and very little financial gain from the death of a child or senior citizen, retired with very little income, housewife who does not work outside the home or single adult with no children, it is just not worth their time. So, for years there has been a grassroots interest in changing the “wrongful death law”.

But is there really such a thing? And if so, are there exceptions?

I just received a three page letter from a local law firm that shares some of the cases they were involved in resolving.

• $700,000.00 for a 64 year old woman for damage to a tendon when a steroid was administered and complicated by an infection.

 • Settled on $550,000.00 - A sickly 69 year old man died when he was administered an improper cardiac catheterization.

 • $1,100,000.00 for the undiagnosed lung cancer of a 79 year old man.

• $1,050,000.00 for the death of a single man with no children who died from undiagnosed melanoma.

• A 75 year old woman died during hip replacement surgery. This case settled for $550,000.00.

• For a 2 year old child who died from undiagnosed meningitis the case settled prior to prior to jury selection on $1,175,000.00.

In other states, parents have received compensation for their child’s death and have used that money to start foundations. They have moved their own agenda forward in memory of their family member even without a lawsuit or financial compensation. Families of those who have died because of their medical care have founded organizations, developed programs and have shared their stories graciously to help educate others.

A lawsuit is usually not about the money, it’s about answers but sometimes, families should be entitled to financial compensation with or without a lawsuit. But, I’m not sure I would be comfortable hiding behind the wrongful death law as a reason an attorney won’t take a case.

There are many facts behind these settlements we don't know.  But,  if attorneys are agreeing to take some cases, they need to do something for those cases they turn away.

Thursday, April 7, 2011

Health Affairs Symposium

Health Affairs Symposium Washington DC

The host of today’s program in Washington DC opened the symposium with an introduction about what the next four hours will bring. Leaders in patient safety research were to share their findings as it appears in the papers published by Health Affairs, A leading journal of health policy and research supporting the writings of various health issues and research.

This time it was patient safety and quality healthcare. In her opening remarks, the host said to the audience of, I suppose, writers, researchers and medical professionals “Imagine what the public would think if they knew what we know”. Those words would ring in my ears and set the stage for the rest of the program for me.

When I had an opportunity to speak, I told the audience that of course the patients need to be told. How else can patients make informed decisions when they don’t know the errors that might happen with their treatment? How can there be “informed consent” when the public is not told about ALL the possible outcomes and that means the possibility of mistakes?

The term noncompliant came up a few times. Patients who do not follow the doctors care plan are considered noncompliant. But maybe they are just not trusting because they know they aren’t being given all the information needed to make informed choices.

Speakers were from hospitals, research consulting firms, The Joint Commission and the National Patient Safety Foundation. Each did a research paper, which was published by Health Affairs on some aspect of patient safety or quality. Dr. Mark Chassin, President of the Joint Commission spoke about the recent work with high reliability organizations.

He also said that every week there are still as many as 40 wrong site / wrong patient surgeries – completely preventable by following procedures such as marking the site. This too is something patient’s must be made aware of – over 2,000 wrong procedures a year?

I asked a group of hospital administrators sitting on this panel, how do you know that what you are doing is getting to the bedside. At the top, there are policies and standards set, “I know in many cases they are not being followed at the bedside”. I told them about my many hours at the bedside with patients and simple patient safety policies are not followed. How are they, I asked them, involving patients because that is how to ensure procedures are being followed?

If you really want to see patient safety improve, I suggested that this program goes “on the road” and speak in every community. Share these statistics and numbers and see the groundswell of change come from the public.