New York Medical Malpractice

When you enter a hospital for a routine procedure, you expect to come out of there as good or even better than when you entered. However, New York hospitals are becoming more and more unsanitary, and hospital infections “kill more people each year than AIDS, breast cancer and traffic accidents combined”.

Despite historical claims from hospitals that such infections are unavoidable risks associated with surgery, the reality is that most hospital-contracted infections are preventable through adherence to simple hygienic practices. These practices include mandating the hospital staff to wash their hands and properly sanitizing all surgical equipment.

There has been a recent wave of medical malpractice lawsuits against hospitals for hospital-acquired infections. For instance, a jury recently awarded over $2.5 million to a patient who contracted a staph infection during heart surgery. This is just one example of many successful trials around the country.

There has been renewed pressure on hospitals to do something about the problem. For one, New York hospitals are now required to report their hospital-acquired infection rates to the New York State Department of Health. Second, Medicare now refuses to reimburse for certain hospital-acquired infections, a development that means hospitals will be forced to pay the medical costs associated with the treatment of these illnesses.

Following up last week’s news regarding the shuttering of the obstetrics ward at Long Island College Hospital in Brooklyn, the state of New York has decided to fight back. Wanting to close the ward due to rising medical malpractice premiums regarding obstetrics, the state claims the hospital must provide proof that other hospitals in the area can handle the patient load before they can do so. Will they be able to?

New York Methodist Hospital and Maimonides Medical Center told The Brooklyn Paper that their obstetrics departments are already operating at capacity.

“We are not in a position to accommodate a higher volume of maternity cases,” said Eileen Tynion, a spokeswoman for Maimonides, the Borough Park hospital that delivered 7,207 newborns, more than any other hospital in the state last year.

There’s also no room at the inn at Park Slope’s Methodist Hospital.

“We just expanded to meet demand and we are already at capacity,” said Lyn Hill, a spokeswoman for the hospital, which delivered more than 5,000 babies last year.

Local officials are stepping in to voice their opinions on the matter as well.

State Sen. Marty Connor (D–Brooklyn Heights), whose colleagues could force state hearings over the plan to close the birthing wing, called on Continuum to provide honest numbers.

“The service is too important to the community to allow it to close,” he said.

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.

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.

Newsweek highlights the issues plaguing the psychiatric hospital system that lead to the death of Brooklyn resident Esmin Green.  According to the article, poor handling of patients and extreme wait times were not uncommon in what is known as the G Building at Kings County Hospital, including the falsifying of documents to hide massive overcrowding issues.

On June 18, as Green waited for help, the American College of Emergency Physicians released a nationwide survey of emergency-room directors. More than 80 percent of them said psychiatric patients should be placed in dedicated emergency psychiatric facilities, like the ones New York established in the late 1980s. The G Building at Kings County, where Green died, was the city’s largest such facility. But if her story tells us anything, it’s that isolating psychiatric patients from everyone else will not solve the problem. In New York, at least, this approach seems only to have fostered an environment conducive to abuse and neglect.

The incident involving Ms. Green has resulted in immediate reform at Kings County Hospital, but is it enough to make the necessary changes in similar facilities around the country?

Outbursts and other forms of verbal abuse from doctors towards other employees of hospitals is becoming a big problem, especially as it relates to medial malpractice cases. The Joint Commission, which is a national hospital accrediting agency, now claims that evidence of such behavior is pointing to more and more medical errors.

Dr. Mark Chassin, president of the Joint Commission, said growing emphasis on preventing medical errors has made it clear that a culture of intimidation contributes to the mistakes.

"It’s a problem that goes underreported, threatens patient safety and has become so ingrained in health care that it’s rarely talked about," Chassin told reporters Wednesday.

While intimidation only seems to occur in four to six percent of doctors and other hospital staff, that is a huge percentage when it comes to life and death issues. Modifying a system that pertains to strict violations against those who intimidate could go a long way into giving patients better care and prevent medical malpractice issues.

Much has been said in the blawgosphere recently regarding the negligent death of Esmin Green as she waited to be treated at Kings County Hospital. Ms. Green, a Brooklyn resident, had been waiting over 24 hours to be treated when she collapsed to the floor and was unattended to for over an hour. Several staff members of the hospital were caught on surveillance tape walking right past the woman even as she was laying unconscious on the ground. When she was finally attended to, she was pronounced dead.

In a recent report released by New York state Department of Health, it was found that New Yorkers who underwent surgery in the state developed infections at a larger rate than the rest of the country. The study found the percentage to be an overwhelming 37% more infections than any other state.

"The only acceptable infection rate is zero, so hospitals that settle for being below average are dangerous places to be," the founder of the Committee to Reduce Infection Deaths, Betsy McCaughey, said.

State health officials said they could not explain the disparity between infection rates in New York and the rest of the country. But they said in New York City, the rate of central line-associated infections was lower than the rate in upstate hospitals, and they said that upstate infection rates drove the statewide average higher.

Infections can always lead to a much more serious issue, including death, which is unacceptable for something that could easily be prevented.

This fascinating portrait of a Brooklyn, N.Y., hospital is about much more than white coats and beeping consoles – it’s 21st-century America in a microcosm.

A new book, Hospital: Man, Woman, Birth, Death, Infinity, Plus Red Tape, Bad Behavior, Money, God and Diversity on Steroids, captures the whole spectrum of factors that determine what kind of medical care people receive in this country.

Respect – or rather, the lack of it – may be the single most persistent theme in “Hospital.” It’s hard to say that respect matters more to the people at Maimonides than money, because in this market economy, money is increasingly the only way we measure worth. A former chair of orthopedics says that he fell out with Brier because he wanted to give priority in the waiting rooms to patients who paid out of pocket or who had full insurance: “People who pay for health care don’t want to sit in a room with fifty people. They want to be seen in a timely manner. I think that’s very reasonable.”