Medical Malpractice Cases

Hammurabi was a ruler of ancient Babylon from about 1790-1750 BC. He’s most famous for writing down one of the first and most comprehensive listing of laws that existed during his reign. Hammurabi’s writings covered both civil and criminal law ranging from general to quite specific. His code isn’t a code in the legal sense that we’ve come to think of; the laws are not broken down by subject area and some refer to fees to be paid to specific occupations.

His code was published in every city that he ruled and believe it or not, was not the only set of laws in existence in that time period. Just about every king or ruler promulgated their own laws (but didn’t have the Commerce Clause of the U.S. Constitution to even out trade). The Code of Hammurabi wasn’t just his own proclamations, it also codified common laws that existed during that time.

Several copies of the Code of Hammurabi exist, but the most complete and most famous is in Paris, safely ensconced in the Louvre. That specific stele was discovered, in what is now Iran, in 1901 by Gustav Jequier. It didn’t originate there, it had been taken to Iran as plunder during the 12th century BC. Not only did we have collections of laws during that period but we also had early art collectors.

The Code of Hammurabi

Louvre Museum Paris

What makes the Code of Hammurabi interesting to me and hopefully to Certified Legal Nurse Consultants, is that Hammurabi caused some of the first personal injury, medical malpractice and wrongful death laws to be “written in stone,” so to speak. Laws, which if they were on the books today, might make some doctors and nurses think twice about the quality of their practice. Disciplinary procedures for healthcare providers were pretty tough in those days!

Here’s some of my favorite examples from L.W. King’s 1910 translation of the Code of Hammurabi:

Personal Injury:

• If a man put out the eye of another man, his eye shall be put out.
• If he break another man’s bone, his bone shall be broken.
• If he put out the eye of a freed man, or break the bone of a freed man, he shall pay one gold mina.
• If he put out the eye of a man’s slave, or break the bone of a man’s slave, he shall pay one-half of its value.
• If a man knock out the teeth of his equal, his teeth shall be knocked out.
• If a free-born man strike the body of another free-born man of equal rank, he shall pay one gold mina.
• If a freed man strike the body of another freed man, he shall pay ten shekels in money.
• If the slave of a freed man strike the body of a freed man, his ear shall be cut off.
• If he knock out the teeth of a freed man, he shall pay one-third of a gold mina.
• If during a quarrel one man strike another and wound him, then he shall swear, “I did not injure him wittingly,” and pay the physicians.

Wrongful Death:

• If the man dies of his wound, he shall swear similarly, and if he (the deceased) was a free-born man, he shall pay half a mina in money.
• If he was a freed man, he shall pay one-third of a mina.
• If a man strike a free-born woman so that she lose her unborn child, he shall pay ten shekels for her loss.

Medical Malpractice:

• If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.

Hammurabi also created the first medical care reform system by regulating the pay doctors would receive for certain operations.

• If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
• If the patient be a freed man, he receives five shekels.
• If he be the slave of someone, his owner shall give the physician two shekels.
• If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
• If he were a freed man he shall pay three shekels.
• If he were a slave his owner shall pay the physician two shekels.

Finally, Hammurabi also dealt with judicial or legal malpractice.

• If a judge try a case, reach a decision, and present his judgment in writing; if later error shall appear in his decision, and it be through his own fault, then he shall pay twelve times the fine set by him in the case, and he shall be publicly removed from the judge’s bench, and never again shall he sit there to render judgment.

It seems to me that Hammurabi in some respects was a man ahead of his time.

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Just about every doctor and nurse in hospitals own a Sharpie^® at one time or another. Some use them for marking patients and others to label their lunch. It turns out that two different studies on infection risk found that good old fashioned Sharpies out-perform surgical markers in protecting patients from the risk of infection.

The 2008 study was conducted in Canada at the University of Alberta followed in 2009 with a study on reducing surgical site infections (SSIs) at Duke University in the U.S.

So long as an alcohol-based Sharpie is capped (and the outside properly swabbed) between uses on patients, the risks of passing on four common resistant bacteria – Staphylococcus aureus (MRSA), E. coli, vancomycin-resistant Enterococcus faecalis (VRE) and Pseudomonas aeruginosa – are much lower with a Sharpie than with a surgical pen.

Changing from surgical markers is a great way to do some cost-cutting at your facility while keeping down the risk of wrong-site surgeries. Why not kill two birds with one stone and still have a pen to make your more subtle points?

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One thing every Certified Legal Nurse Consultant knows is that a simple apology by a healthcare provider often goes a long way in disarming anger in patients. But what if a doctor or representative of a healthcare facility were to apologize to a victim of medical malpractice? Do you think that might reduce the number of lawsuits and the associated costs of litigation? It actually does (and that saves us all money)!

“Sorry Works!,” a self-professed “advocacy organization for disclosure, apology (when appropriate) and upfront compensation (when necessary) after adverse medical events” has been successfully implementing laws in 34 states which allow doctors and/or facilities and their representatives to make apologies for medical errors. Those same laws make those apology statements inadmissible in court in order to encourage settlements. Admitting a mistake to keep someone from suing you seems a little odd, but experience and research proves it actually works.

Providers disclosing medical errors to patients and, at the same or a later time, offering a sincere apology, and often compensation, results in decreased numbers of lawsuits. The New York Times reported that as little as thirty percent of medical errors are disclosed to the patients (or their survivors). It is often the concealment of the error and an accompanying unrepentant attitude that feeds the injured party’s anger and results in the filing of lawsuits.

The “apology” program proved successful at the University of Michigan Health System – lawsuits were reduced 68% over the period tracked and at the University of Illinois – lawsuits were reduced almost 50%. Both facilities also experienced drops in legal-related expenses (including settlements). The National Quality Forum in 2009 published an updated practice statement of safe practices that included standards for disclosure of unanticipated outcomes. In a terrific review article, the New England Journal of Medicine has discussed the effectiveness of such disclosures and even the Joint Commission, as far back as 2001 (when they were still JCAHO) adopted the first standards for disclosure. Since then, similar standards and guidelines have been adopted by organizations and facilities across the country. (Here’s a bibliography of articles on disclosure from the Joint Commission.)

So why aren’t more facilities allowing doctors to apologize in order to deter litigation? Part of it is reticence. Would it surprise you to know that according to the Journal of the American Medical Association doctors are either unwilling or afraid to apologize? Insurance companies and facilities still prefer to “deny and defend.” Also defense law firms, whose livelihoods depend on continued and protracted litigation, have no incentive to quickly settle a potential lawsuit.

As a legal nurse consultant working with a case involving an injured plaintiff you will want to discover whether a defendant facility had a disclosure policy in place and whether or not that policy was followed. As a defense CLNC^® consultant you may wish to do the same. It may also be time to involve your facility in this type of program as a cost-savings measure.

Here’s an interesting thought, if these types of programs work so well in medical-related cases, what other types of cases might be able to use an apology system? Perhaps you might see this in toxic torts (chemical spills) or products liability (medical-device) cases? How about simple personal injury cases? The possibilities are endless.

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P.S. Comment and share your opinion on “Sorry Works.”

Every Certified Legal Nurse Consultant knows that after a patient has a stroke, the care they receive in the first 3-4 hours is the most crucial. The type of stroke influences the treatment so proper recognition and diagnosis are essential. Despite this knowledge, the National Quality Forum (NQF) recently rejected a proposed guideline that would have called for a CT scan within 45 minutes of a patient presenting to the ED. Why is this important? The NQF sets the medical guidelines that are used by the Centers for Medicare & Medicaid Services (CMS) to evaluate (and reimburse) hospitals. So, with no reimbursement, the likelihood of a patient getting a CT scan drops pretty dramatically.

Hospitals receiving Medicare funding will soon be reporting how well they comply with guidelines for stroke treatment, even though one of the most important diagnostic tools for stroke (a CT scan) was not done.

The American Association of Neurology pushed strongly for the guideline and the American Stroke Association’s (ASA) guidelines for stroke care include the recommended 45-minute standard for scans. According to the ASA nearly 700,000 Americans incur a stroke annually, with 170,000 fatalities. In other words, an American suffers a stroke every 45 seconds and every 3 minutes, one of these stroke victims dies, so it’s very likely you’ll run into a case involving a stroke at some point in your legal nurse consulting career. As a CLNC^® consultant working on stroke cases, you should establish whether the standards of care for diagnosing and treating stroke were adhered to by the potential defendant hospital and healthcare providers. Establish not only whether or not a CT scan was done, but how timely it was ordered, completed and interpreted. Despite NQF, who looks like they had a stroke (not a stroke of genius) reputable testifying experts will be testifying in medical malpractice cases that a CT scan within 45 minutes of presenting to the ED is the standard of care.

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P.S.     Comment and share your vote on NQF’s decision.

Making a list,

Checking it twice,

Don’t want to kill a patient,

That wouldn’t be nice…

According to Dr. Atul Gawande, the average patient in an ICU requires “a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them poses risks. Substantial parts of what hospitals do – most notably, intensive care – are now too complex for clinicians to carry them out reliably from memory alone. ICU life support has become too much medicine for one person to fly. Any of us who’ve worked in the ICU shouldn’t be surprised by Dr. Gawande’s assertations. But what to do about it?

Here at Vickie Milazzo Institute we use checklists for everything. There’s not a major project, including the National Alliance of Certified Legal Nurse Consultants (NACLNC^®) Annual Conference (801 action items) that doesn’t have a major checklist. We find it not only keeps us from reinventing the wheel each time we start a new project (saving us time and money) but it also ensures that no moving parts are missed when we put something together. We even joke that we have checklists to make sure we have all our checklists!

Think about your life – you probably send your hubby to the grocery with a checklist. (Car keys – check. Checkbook – check. Grocery list – check). You (at least I do) pack for a trip with a checklist. (Bathing suit – check. Sunscreen – check. Mirrored shades to check out the hunky lifeguards – check). Checklists are part of everything I do and probably a large part of what you do on a daily basis also. Tom even has a checklist to make sure that he’s included all the proper clauses in the contracts that he writes (yawn).

How about using checklists to ensure safety instead of making sure you’ve got the loaf of bread, pound of pastrami and jar of mayo? This really isn’t a new idea. Since 1935 pilots have been using checklists to cover just about every aspect of flying an airplane, starting with the pre-flight inspection, taxiing, take off and landing. (Wings on – check. Wheels down – check. Dinner reservations at destination – check). Millions of passengers are delivered safely to their destinations each day thanks to simple checklists.

Now ask yourself as a Certified Legal Nurse Consultant, “how many patients are harmed because doctors (and maybe even nurses) don’t use checklists when doing complex medical procedures or simply treating patients?” The answer is, too many. Consistent protocols for patient care have been advocated by physicians since 1600 B.C. (Linen robe on – check. Snake-headed staff in hand – check. Leeches on patient – check.), but it wasn’t until 2003 that Dr. Peter Pronovost came up with a simple checklist to help reduce line infections in the ICU. That list was so successful that line infections in his hospital were reduced to almost 0%. Buoyed by this success he created other checklists which eventually were adopted by the state of Michigan for use in its ICUs. The results from implementation of those lists were so successful that Dr. Pronovost ended up publishing them in The New England Journal of Medicine in 2006.

In the almost three years since that study, not much else has happened with checklists. Apparently simple common sense just isn’t exciting enough for cutting-edge healthcare providers. You’d think that the medical and nursing professions would have expanded the use of checklists, but this hasn’t happened on a wide scale other than when you check-in at the hospital. (Insurance card – check. Ability to pay – check.)

That might be about to change though. The New England Journal of Medicine recently published the results of a study that involved using a simple, 19-item surgical checklist. The results were stunning: mortality rates in surgical patients were reduced by almost 50% and the same reduction was mirrored in nonlethal complications. With these sorts of results I hope that we’ll see a profusion of checklists in healthcare. The cost savings alone should get the attention of somebody. Perhaps checklists might be a simple way to reform healthcare. (Patient on table – check. Correct patient on table – check. Anesthesiologist sober – check.)

We know here at the Institute that a simple printed list can make a big difference, in time and money. Now healthcare providers are learning that checklists can save lives too. It’s time for healthcare to catch up with grocery shoppers. Next time you work up a case, have your attorney-client ask the healthcare providers for any checklists used in treatment of the patient. They should also ask each provider during deposition, how they ensure that they take each and every one of the proper steps in treating that patient. With such a line of questioning I can guarantee the jury will wonder why, in a world where a pilot won’t land an aircraft based solely on “memory,” a healthcare provider would do a risky procedure (e.g. brain surgery) on memory alone.

When you are consulting with attorneys on medical-malpractice cases helping to prepare interrogatories, requests for production and deposition questions be sure to ask about the use of relevant checklists in the healthcare setting.

Success Is Inside!

P.S. Comment and share checklists used in your healthcare facility.

P.P.S.

Mother’s Day is just around the corner and I’m feeling nostalgic. Here’s an article I did for my Legal Nurse Consulting Ezine in 2008: What, Only One Day a Year for Mom? How CLNC® Moms Can Squeeze Out Time to Pursue Their Personal Passions. Remember to give your mom the perfect gift.

When I was a young girl, my father didn’t eat leftovers (still doesn’t). That caused my mom to be very careful about how much food she would prepare for meals. My sister, Karen, still jokes with me that mom would prepare only five pork chops (one of our favorite dishes) and not one more (despite our pleas). I hadn’t really thought about pork since my letter to President Obama or pork chops since the last time Karen and I talked about Mom’s pork chops.

That all changed this week when I was having a skylight repaired in my bathroom. The ceiling is pretty high so it required a long ladder and two repairmen – one to do the work and one to steady the ladder. Naturally the guy holding the ladder got bored quickly and became quite chatty. At one point, apropos of nothing, he mentioned that he couldn’t wait for lunch. I overheard him and asked him if he’d had breakfast (healthy green tea and a healthy breakfast is an important way to start your day). He told me he’d had a small one – his wife didn’t cook him any bacon to go with his eggs. I replied that he was lucky on two fronts: (1) his wife cooked him breakfast (I was glad Tom didn’t hear him say that) and (2) she’s helping him watch his diet.

He replied that it wasn’t his diet she was worried about, it was catching swine flu from the bacon. I laughed and told him he could safely tell his wife that you can’t get the swine flu from eating bacon or other pork products. In fact, I went on to tell him that unless she was sleeping with an infected pig or had a sick pig running around the house she was safe. Just as I was getting started on a lecture regarding the facts surrounding swine flu, I noticed his eyes began glazing over (just like an attorney’s do when a legal nurse consultant goes on too long about their services without engaging in their positioning strategies). I cut to the chase and said, “Tell your wife that the best way to beat the H1N1 Influenza A virus (we can’t call it swine flu anymore because we’re apparently offending pigs) and just about any superbug, is to follow the hygiene practices championed by that 19th Century nurse, Florence Nightingale. Her practices are still valid today: vigilantly wash your hands and stay clear of anyone who is ill.”

For attorneys who are reading this blog, before you call our office, any Certified Legal Nurse Consultant can tell you there is no product liability suit against a pork producer for an H1N1-infected piggy. Those same Certified Legal Nurse Consultants also know that there might be a medical malpractice case for failure to diagnose, since the symptoms of H1N1 Influenza A are so close to those of “normal” flu.

As RNs we can and should contribute to this public health issue by reminding everyone around us (not just our spouses and children) to wash their hands. We should also remember that nursing and medical personnel can be a source of infection.

I’ll be washing all the way up to the elbows for a long time to come. Stay clean and healthy!

Success Is Inside!

P.S. When I walked over to Starbucks this morning for my “free” coffee, the staff must have read my blog about them because they had my tall “red-eye” (bold coffee with a shot of expresso) on the counter by the time I got to the register (darn)!

I doubt any of us, as CLNC^® consultants, ever forget our first case. Mine is most memorable for several different reasons. I learned so much, some of it the hard way. I had earned my CLNC^® Certification a few months earlier and used Vickie’s advice regarding marketing myself by mailing out my resume with my qualifications and a cover letter, then followed up with a phone call. One attorney had a case on his desk, which had been referred to him by another attorney. The case involved a potential client who lived out of state. The attorney drove approximately six hours one way to interview the potential client and his wife. He felt there was probable merit to the case but he needed someone to review the records. He had filed the proper notices to all the possible defendants of a medical malpractice lawsuit.

I was so excited the day the records arrived at my home. There was a large amount of records as the potential plaintiff had a five-week hospital stay with numerous complications. So I began the screening process.

The potential plaintiff, Mr. Smith, had recently been diagnosed with Hodgkin’s disease and had a mediport placed for chemotherapy treatments. However, the symptoms of a pre-existing esophageal diverticulum had become so pronounced that he decided to have an elective excision of the diverticulum with a myotomy before starting chemo treatments. Mr. Smith had an extensive medical history including a previous heart attack with placement of a stent, hypertension, hyperlipidemia, three back surgeries and diabetes.

Mr. Smith experienced several complications after the first surgery, one of which made it necessary for placement of a chest tube, which was done at the bedside by the surgeon. Mrs. Smith alleged she had not been called at home for permission so proper consent was not given for the procedure and it caused Mr. Smith excruciating pain, which resulted in a second heart attack and a transfer to ICU.

The dots just weren’t connecting. Something wasn’t right. Mr. Smith had a second heart attack which was confirmed by the medical records, but how could I prove what happened to him? How could pain from the chest tube insertion, etc., cause the second heart attack? He already had a stent resulting from the first MI, combined with the high cholesterol and diabetes.

So here I go, back to my Core Curriculum for Legal Nurse Consulting^® textbook. It almost jumped out at me, as if a light bulb had suddenly come on in my head! In Module 3, “Theories of Liability and Defenses Used in Medical-Related Cases,” it discusses the four legal elements, which must be satisfied to prove negligence: duty, breach of duty, damages and causation. The definition for causation pretty much says it all: “A reasonable connection between the acts of negligence and the alleged damages.” I felt the other three elements of duty, breach of duty, and damages were satisfied, but not the element of causation. So I read further. Under, “Factors to consider when evaluating causation,” it lists as one of the factors, “Past medical history and pre-existing conditions.” And I continued to read and in Module 5, “How to Screen Medical-Related Cases Effectively and Efficiently,” Vickie discusses defensible cases which plaintiff attorneys frequently reject because of pre-existing conditions.

So here I am feeling pretty good about myself. I am ready to type my letter to the attorney advising him that in my opinion, his case does not have merit. I used one of the samples provided in the Core Curriculum to ensure my opinion sounded professional. I relayed to the attorney that I felt Mrs. Smith had some legitimate complaints regarding Mr. Smith’s hospital stay and that while it was sad he had experienced numerous complications, it was my opinion that the element of causation could not adequately be satisfied due to Mr. Smith’s past medical history and pre-existing conditions and then I went on to list all the pre-existing conditions.

The attorney very politely informed me that he wanted me to list the deviations from the standards of care and then he would make the decision whether the case had merit.

In a much later phone conversation, the attorney stated, “Ms. Holmes you were right in the first place.” Well, needless to say, this made me feel pretty good.

There are many things I learned from my first case. One of the most important things is to communicate thoroughly upfront with your attorney-client. Don’t assume anything. If in doubt, ask questions. I think there are many attorneys, especially attorneys in small firms who have not worked with a CLNC^® consultant before and really do not know how much help we can be to them.

I have twenty-two years of nursing experience and am confident regarding my nursing skills and judgment, but I am still building confidence as a Certified Legal Nurse Consultant. Owning a legal nurse consulting business is entirely different from what I have been accustomed to doing for a paycheck. This case did boost my confidence. My first conclusion was correct and the attorney finally agreed. If we are not honest with our attorney-clients about our findings, we both will come out losers in the end.

I believe everything we need to be a successful CLNC^® consultant is included in the Core Curriculum for Legal Nurse Consulting^® textbook and the lectures that go along with it. Vickie’s CLNC^® Mentoring Program is invaluable. Each time I have used the mentoring program, my questions were answered in a very timely manner, sometimes within a couple of hours. I live in a small town and I feel isolated at times. With the mentoring program, no matter what the question is, support is readily available.

We have to make the decision to take the plunge. For me, I thought about it for approximately four years. And you know what, it’s scary. But I believe with Vickie’s help and persistence it’s possible to be a successful CLNC^® consultant.

P.S. Please comment and share your most memorable CLNC^® case.

Guest Blogger Profile

Peggy Holmes RN, ONC, CLNC owns and operates Holmes Legal Nurse Consulting in Arkansas. She has 22 years of nursing experience and currently works part time in The Women’s Center at the local hospital. She consults on medical related cases and specializes in orthopedics, pediatric and med-surg cases.

How do you start your day? Does your breakfast contain a line of pills (and I don’t mean vitamins) longer than your middle finger? If you open your medicine cabinet too quickly is there an “orange avalanche” of pill bottles? Have you succumbed to the slick marketing of pharmaceutical companies like many of my baby boomer friends who daily whip out an array of drugs for restless leg syndrome, elevated cholesterol, reduced bone density and sleep deprivation?

If you read any magazine and look at the ads, you’ll see that the pharmaceutical companies have medicalized just about every illness, condition and quirk. Not only are drugs shamelessly marketed directly to potential “patients” but to the physicians who would and do prescribe them. My 27 years of experience consulting on products liability and medical malpractice cases as a legal nurse consultant have caused me to be very suspicious of pharmaceutical companies and the diseases they create, and of course, very agitating to my personal doctors.

My Italian grandmother lived a long life and never took a single prescription drug. In Italy, food is the drug, and she proved to me first hand that what I shove into my mouth directly impacts my energy level and the state of my health. Relax, this isn’t a blog on diet. I don’t advocate any particular diet but I try and stick to a Mediterranean diet (mainly for the spaghetti), it’s what keeps me a healthy size 4 (I wish).

I’m a small woman at 5′ 2½”. When I was diagnosed with osteopenia my physician immediately recommended Fosamax^®. Considering all the side effects of Fosamax, which I’m intimately familiar with because of products liability litigation, I rejected it outright, but I know others who haven’t and others who won’t when their time comes (good luck chewing your steak).

Instead I increased my vitamin D, calcium and vitamin K intake; hit the weights in the gym a lot harder and added a little jump roping; all without the help of estrogen (natural, artificial or otherwise). It took some serious discipline but in one year I had gained significant bone mass – at a time and at an age at which the vast majority of women lose bone mass.

My physician couldn’t believe it and in fact, seemed almost upset that I did it without her help (or her meds). Surely I was an anomaly. No matter the evidence, there was no way she was a believer. She continues to practice medicine like the typical pill-pushing physician who’s been brainwashed by the pharmaceutical companies. Thank God I’m a nurse and can think for myself.

But most consumers can’t, so that’s why the book Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Petersen is one of my favorites on the pharmaceutical industry. Not a day goes by that I don’t read about a new drug’s serious side effects and the products liability cases generating from them. This book focuses on the institutional deception of pharmaceutical companies and is a must read for all Certified Legal Nurse Consultants who consult on pharmaceutical products liability cases, and even medical malpractice cases. The author discusses physicians’ less-than-appropriate relationships with the pharmaceutical industry and how it’s marketing, not science that drives these companies.

You won’t need this book to tell you what you probably already know, but it will help you think differently about your legal nurse consulting business and the CLNC^® services you provide to your attorney-clients in this drug-dependent age.

Add this book to your “must reads.” And be careful what you put in your mouth – remember doctors used to endorse cigarettes once upon a time.

Success Is Inside!

P.S. If you want a truly eye-opening book on food and diet, try this one: Good Calories, Bad Calories by Gary Taubes – it’s not a diet book and not a light read but will change your thinking (it got Tom off beer).

Really, I mean that. Tom says that being around so many nurses has taught him one thing (well, two if you count never turn your back on a proctologist). Hospitals are great places to visit loved ones when you’re well, but they’re a horrible place to be when you’re sick. Studies have shown the longer you’re in a hospital recovering, the more likely you are to develop an infection, iatrogenic injury or even die.

Tom usually blogs about technology, but this one was too good for me to pass up. ECRI has come up with a list of the Top 10 Health Technology Hazards! That just sounded like fun. For your legal nurse consulting business, this is an eye-opening list of just what can (and will probably) go wrong with healthcare technology. ECRI even ran the list in order of importance. Here we go:

1. Alarm Hazards. You know you ignore them or worse – turn them off.
2. Needlesticks and other Sharps Injuries. This is really low-tech. We’ve been maliciously sticking unsuspecting patients with needles for years.
3. Air Embolism from Contrast Media Injectors. This I read AFTER my MRI?
4. Retained Devices and Unretrieved Fragments. Suddenly patients find themselves setting off the metal detectors at the airport or they are billed for a missing forceps.
5. Surgical Fires. Another reason why CRNAs shouldn’t smoke at work.
6. Anesthesia Hazards Due to Inadequate Pre-Use Inspection. More likely due to pre-use use by the CRNA and/or the anesthesiologist.
7. Misleading Displays. Especially the one showing brain activity.
8. CT Radiation Dose. Everyone else leaves the room during the x-ray, why shouldn’t the patient?
9. MR Imaging Burns. You stick a damaged headset and goggles on the patient, then ram him into the magnetic bore and wonder why he comes out with his hair on fire?
10. Fiber-Optic Light-Source Burns. Another way to set a patient on fire is by resting a hot “cold light source” on him during surgery.

The ECRI report also lists five of last year’s hazards that didn’t cause enough harm to make this year’s Top 10. They are still described as “significant” concerns. ECRI has taken the time to identify problems that any Certified Legal Nurse Consultant realizes are avoidable. I’d get a copy of this list and keep it handy when screening your medical malpractice cases. For a limited time, you can use the link above to visit ECRI and download a free copy of the report.

It’s like Tom always tells me “Technology is fun – in the right hands.”

Success Is Inside!

P.S. Have you seen any med-mal or products liability cases in your legal nurse consulting business related to these topics? What, in your opinion, is the biggest health technology hazard? Comment here.

As a young baby boomer, I have to face the fact that one day I’ll be old. Not tomorrow and not the next day, but sooner than I want to admit. One good thing is – I’ll have lots of company. The bad thing is – all those Generation Waste kids that will be taking care of us (you know the ones with piercings, tattoos and bad work ethics).

What brought this up? The Center for Medicare and Medicaid Services (CMS) has released a rating system for nursing homes. What a genius idea! Now we can pick our nursing homes the way we pick our vacation hotels (no, they’re not on Priceline yet). The system goes from one to five stars based on factors including inspection records, number of patients developing pressure ulcers, complaint inspections and more (including staffing).

It seems the non-profit facilities had a higher number of five-star nursing homes (I never, ever thought I’d say “five-star” and “nursing home” in the same sentence) that was double the number of five-star for-profit facilities. Interestingly, the number of one-star for-profit nursing homes was double the number of one-star non-profit nursing homes. In other words, these owners put profit before people.

You can read more about this at Medicare’s website and while you’re there, download a handy “Nursing Home Checklist” to take with you when you start looking for your own nursing home. It’s got a fun nursing home locator with a variety of search options so you can see what’s available in your area.

On a serious note, as a Certified Legal Nurse Consultant working on cases involving nursing home residents, I’d be very interested in the rating for the defendant facility and any quality data you can drill down into about that facility. CMS has given the plaintiff’s bar another effective weapon in the fight against evil. The defense bar can use this too – if their facility is highly rated.

Check it out now – before you have to.

Vickie

P.S. If you want to spend your breaks reading an excellent, and moving, novel about nursing homes pick up “Old Friends” by Tracy Kidder. It will make you laugh and cry – sometimes at the same time.