New York Medical Malpractice

High medical malpractice premiums have forced a Brooklyn hospital to completely shutter their obstetrics ward, which currently staffs 350 people. Long Island College Hospital in the Cobble Hill section of Brooklyn has taken on roughly $170 million in debt with 33% of that coming from the obstetrics department which has higher malpractice premiums than most others.

In New York, doctors and hospitals pay malpractice insurance premiums that are among the costliest nationwide. Last year, following a 14% rate increase, Governor Spitzer charged a task force with investigating and addressing the state’s high medical malpractice costs. The group did not produce a final report, and earlier this month, instead of raising rates again, the state’s Superintendent of Insurance, Eric Dinallo, announced a delay in the setting of new rates to give lawmakers time to address the situation.

"The bottom line is, I’m not surprised that one major hospital that does a significant number of deliveries is discontinuing their obstetrics service," the executive director of the New York chapter of the American College of Obstetricians and Gynecologists, Donna Montalto, said. "That speaks volumes to the maternity crisis."

Many believe this move will send patients to competitor Beth Israel.

Some very disturbing news today out of Massachusetts regarding wrongful surgeries done in the state. From Boston.com:

Surgeons in Massachusetts have operated in the wrong location on patients 38 times since 2006, with botched spine surgeries accounting for more of the mistakes than any other type of operation, according to a Globe review of state documents.

A single hospital, New England Baptist, accounted for four of the 11 bungled spine surgeries in the state, with the errors happening during a 10-month period. No deaths or severe disabilities resulted from any of the faulty spine surgeries, state health authorities said. In some of the 11 patients, the wrong vertebrae were fused; in others, the wrong bulging disc was removed.

While we all know that money talks, I found this to be the most interesting excerpt from the story:

And private health plans and government programs such as Medicare have declared they will no longer pay for costs associated with preventable errors.

The federal government released a report this week regarding the costs of medical malpractice as it relates to extra care after mistakes are made in hospitals. From ABC.com:

The records indicated that one of every 10 patients who died within 90 days of surgery died because of a preventable error and one-third of the deaths occurred after the patient was discharged.

A patient who developed acute respiratory failure after surgery cost insurers $28,218, or 52 percent extra, while an infection cost $19,480 or 48 percent more, agency researchers William Encinosa and Fred Hellinger found.

Errors related to nursing care, such as pressure ulcers and hip fractures, added $12,196 to the average bill, they found.

"Eliminating medical errors and their after effects must continue to be top priority for our health care system," AHRQ Director Carolyn Clancy said in a statement.

Can being nice save malpractice? The tgllaw.com blog raises some interesting questions that stem from an article in the New York Times. Both pieces are worth a read, but this is what tgllaw.com had to say:

Can you put a dollar value on being nice? In essence that is the question posed by the Joint Commission on Accreditation of Hospitals in their “sentinel event alert” which warns hospital personnel against “all contumelious and sarcastic remarks”. Bad behavior amongst doctors and nurses towards their patients is causing quite a stir, and some claim that it is even the reason behind some medical malpractice suits. The Joint Commission has set out to create a code of conduct which will require medical facilities to adhere to certain mandates.

But is just “playing nice” enough? Or are their deeper flaws in the medical system that cause some malpractice issues to arise?

ABC is currently running a six part series entitled “Hopkins”, where doctors at Johns Hopkins hospital in Baltimore are profiled showing their everyday lives as caregivers and major life and death decisions they have to make on the fly. In this video clip, we see a doctor make his first mistake on the job, and the consequences he has to face regarding his patient’s care in the aftermath. Do you think this qualifies as malpractice?

A 15 year old Boston teen was killed recently when a power outage caused his ventilator to fail, prompting an investigation into the failure. In an interesting move, the Boston Police Department and the Suffolk county district attorney’s office decided to turn the ventilator over to the manufacturer to be examined. The particular ventilator fell in a serial number batch that was known for having back up battery issues. The district attorney’s office defended their decision:

Josh Wall, first assistant district attorney, said police and prosecutors gave the device to the company so trained engineers at Pulmonetic could confirm that the ventilator shut off during the power outage, and determine why.

Police have said their preliminary investigation indicates the backup battery to the ventilator failed during a two-hour power outage Friday morning.

Wall said the engineers could retrieve the information without disassembling the device, which he described as a sort of "black box" that may have recorded any alarm that went off. The company will videotape the retrieval of the data, Wall said.

"The company does have experience in obtaining this information," he said. "We have no reason to think that the company is interested in committing a crime in obstructing justice. If we had reason to think that the company would expose itself criminally to protect itself civilly we would not have taken this action."

The ventilator company is awaiting a videographer to arrive at their corporate headquarters to document the investigation of the machine.

Many physicians, especially those in the field of obstetrics, are having to make huge career changing decisions in the last few months because of skyrocketing medical malpractice premiums. Doctors in the Lower Hudson Valley area of New York is being especially hard hit, and even more say they will change their practice if state lawmakers don’t intervene.

The silent, decades-long battle between doctors and their liability insurers reared its ugly head in recent months because of a proposed $50,000 surcharge on top of the more than $137,000 each OB/GYN must pay yearly.

As doctors wait to hear whether their costs will go up, they are forced to make tough decisions that may cost patients more or compromise safety, advocates say.

The massive proposed surcharge is not only driving a lot of New York doctors out of the practice of obstetrics, but making many flee the state as well. With the numbers rapidly declining, many doctors wonder what will be in store for the next generation.

In the past, physicians have received notifications from the FDA regarding safety alerts to various medications on paper. Now, the recently launched Health Care Notification Network will send any safety alerts to doctors and hospitals via email. The new system is believed to bring down the risk of malpractice litigation.

“The majority of U.S. liability carriers are asking their physicians to enroll today. Delivering product re-calls and warnings immediately online has the potential to directly improve patient safety and reduce malpractice claims—and, ultimately, decrease malpractice insurance premiums,” said David Troxel, MD, an iHealth Alliance board member and medical director of The Doctors Company, the nation’s largest physician-owned liability carrier.

The newly formed HCNN is a joint effort between the FDA, medical societies, health plans and the pharmaceutical industry.

AmericanProgress.org weighs in on medical malpractice lawsuits:

Myth: Medical malpractice lawsuits are little more than predatory lawyers destroying honest doctors; caps should be set on the amount awarded to accusers.

Truth: Although the malpractice system is deeply flawed, setting caps deflects attention from patient safety and would likely not reduce frivolous lawsuits or costly premiums.

Medical malpractice liability is in need of reform, but claims of a nationwide crisis are overblown. Malpractice claims and insurance premiums vary by specialty and geographic area—doctors in obstetrics or surgery tend to pay higher premiums, for example. What increases occur in malpractice premiums can be linked primarily to a sluggish economy. In fact, malpractice costs represent less than 2 percent of total health care spending. There is little correlation between malpractice claim increases and premium increases.

Enacting caps on awards threatens individual rights to compensation for harm resulting from preventable medical error, mostly because so-called frivolous lawsuits represent only a small portion of claims and awards by juries. Focusing on tort reform deflects attention from patient safety in a system where victims are not fairly compensated and errors are not properly prevented. The solution to rising costs should instead consist of more emphasis on evidence-based medicine, independent screening, immediate disclosure of errors, and even a no-fault system of compensation.

A Niagara County jury recently awarded a $9 million malpractice settlement to the family of a woman who died in 2004, making it the largest sum to ever be awarded by the court. The physician in question is a highly esteemed Western New York surgeon by the name of Nancy J. Stubbe, who was cited for negligence in the death of 33 year old Suzanne Crane.

The total, $9,057,000, includes retroactive damages and other “pecuniary” compensation for the period of time following Crane’s death to the present, and into the future, according to documents filed with the Niagara County clerk.

Of 10 separate allocations set for distribution among the three family members listed in the suit and Crane’s estate, the largest single figure is to her husband, Raymond Crane, for future losses in the amount of $3,030,160.00.

Dr. Stubbe had an illustrious career with accolades such as Woman Physician of the Year in 2000 by Kaleida Health System.