Archive for March, 2013

Winners and Losers in Healthcare litigation

March 29th, 2013 16 comments

The lawsuit against the Hospital that infected my father was dropped on March 26th, on a technicality.  The technicality was a misunderstanding and had nothing to do with the facts.  The facts are and always will be that Dad’s Hospital had a MRSA outbreak.  He was the 3rd of three patients who became infected in his Hospital in a month’s time and all three died.

Who wins and who loses in  Dad’s medical harm case.

The first thing I’d like to do is thank my attorney for taking Dad’s case.  Dad asked me to do this, when he found out that his Hospital had infected him, and my attorney did this work on a contingency.  He is a saint for doing this because most lawyers would not take an Hospital Infection case. Even though patients die every day because of Hospital Acquired infections, these cases are notoriously difficult to win.  My attorney worked for me for free because he sees and understands that  injustice.  I am eternally grateful to him for taking Dad’s case.

Of course the biggest loser was Dad.  He lost his strength, ability to walk and eat, his independence, and what remained of his health.  He went from being upright, walking with a walker, and back in his own home after 12 days of Hospital rehabilitation, to being a completely bed bound patient. He lost it all overnight.  Then ultimately, he lost his life.  When he died, he was in a stark lonely nursing home isolation room.  That was the last place on earth that he wanted to be.  His death was a release from loneliness,  isolation and suffering.

My family also lost.  My brothers and I lost our father, and all of our kids lost their grandfather.   My mother lost her love of 62 years.  Although Dad was disabled, my parents had lived independently in their own home and they looked after each other.  They were inseparable, except by death.  My mother now lives a very solitary life…alone in the home that Dad built for them.  I live 70 miles from her and my brothers live even further away.  Her life has continued to shrink since Dad left.  When we talk on the phone, or visit, her sadness and loneliness comes through.  Yet, that is her home, that she shared with Dad, and she is not at all interested in leaving it to live closer to me.

Then there is the monetary loss.  Medicare and private insurance paid almost $50,000 for my fathers care at the end.  Around 2/3 of that was for care needed because he became infected in his hospital.  Those were costs that I believe should have been the Hospital’s loss. Even though they failed to protect my father from infection, they got paid a lot, in full.   I guess that means the Hospital was a  winner, of money at least.

When my father went into the nursing home for 9 weeks, my parents paid out of pocket for that.  If he had not been infected in the Hospital, it is likely that he would have continued to gain strength after rehabilitation and been able to continue living at home with my mother.  My parents, again, lost financially, around $17,000 for long term care.  That was an out of pocket expense to my parents, an expense that was again a result of the infection he contracted while rehabilitating from a minor ankle fracture.

So, it appears that the biggest losers were my father, my mother, and my family. But, there were other losers too.

The Hospital that cared for my father also lost.  They lost my family’s respect, admiration and trust. It was in that Hospital that I started my nursing career.    According to the questions and comments of their defense attorney (who represented them and spoke for them),  they seemed to think that my father’s infection was his own fault. That makes me very angry.  They kept the infections in their facility a secret, so my family couldn’t possibly have known the risk my father faced. Had they been more transparent, we could have made a more informed choice for his care.   From my observations they hadn’t changed anything to prevent MRSA infections, even though 2 other beloved seniors from the community had already died with MRSA before my father became infected.  Those other two families suffered great loss too.

The hospital also lost the money that they paid their “super” attorney. I wonder how much the Hospital  lost to this lawyer.  The attorney’s legal tactic seemed to be  1. place blame on Dad for his Hospital Acquired MRSA infection, and 2. belittle/discredit me and my volunteer patient safety work.    Rather than the Hospital admitting fault, apologizing, fixing the problem  and offering my family emotional and financial support, they paid the attorney (probably a ton of money)  to further alienate my family.   I pity any attorney who makes a living by attempting to beat down victims and their families, and for facing a job like that every day…..people like that seem ethically and morally deficient to me.  So, actually, in my opinion, that type of attorney is a loser too!  I also pity the Hospital for not seeing how much more constructive it would have been to work with me and my family to come to resolution and to welcome us to work on the solutions, rather than further alienating us.

My father’s community lost too.  They lost 3 beloved seniors, who had worked, loved and raised families  there.   They were cherished by their families, their churches and their friends and neighbors.

What could everyone have done differently?  The Hospital could have made aggressive  changes immediately after the first of those 3 beloved MRSA victims became infected.  The changes are outlined in the CDC recommendations, which they claimed they followed. If  they had actually done what they said they did, they could have prevented my father’s infection and he could have lived longer and independently.    They could have been transparent about the infections, so my family would have been fully informed before we chose where my father would get rehabilitation for his broken ankle.  My family could have engaged more aggressively and asked more questions about the Hospitals infection rates. We also could have spent more time at his bedside and been watchdogs to be sure that every single person who touched him had washed their hands.   The housekeepers could have cleaned the rooms better. The doctors could have made more effort to give the right antibiotics by doing appropriate cultures and sensitivities of Dad’s sputum.  They could have begun screening patients for MRSA immediately after the first victim became infected in their hospital,   to be sure that anyone carrying the organism was kept separate from those who did not carry it.

My father definitely could have been better protected from infection, and he could have lived longer.

When we get right down to it, the only one who ends up winning from this case is the Hospital’s attorney….his bank account is fatter.  The  rest of us involved have all suffered a great loss.   I feel badly for everyone who lost, but I can’t feel sorry for the’ Hospital’s attorney.  Maybe I will find a way to understand him and feel some compassion for him in the future.  I just hope for his sake that it doesn’t involve him losing a family member because of preventable infection.  I want everyone, including the opposing lawyer’s family, and the Hospital that infected my father,  to benefit from my work to stop Hospital Acquired Infections and Healthcare harm.  I fully intend to move on and make progress with this work.



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Jordan Rau, writes about Hospital and doctor rating sites

March 21st, 2013 No comments

I was interviewd for this article.

Hospital Ratings Are In The Eye Of The Beholder


By Jordan Rau

KHN Staff Writer

Mar 18, 2013

This KHN story was produced in collaboration with

How good a hospital is St. Mary Mercy Livonia Hospital? Depends on whom you ask.

The Leapfrog Group, a respected nonprofit that promotes patient safety, gave an “A” to this Michigan hospital. The company Healthgrades named it one of America’s best 50 hospitals.

But the Joint Commission, a nonprofit organization that accredits hospitals, and U.S. News and World Report omitted St. Mary from their best hospital lists. Consumer Reports gave it an average safety score of 47 points out of 100, citing high numbers of readmissions, poor communication with patients and excessive use of scans. Medicare, which has a new program rewarding hospitals for meeting certain quality measures, is reducing St. Mary’s payments by a fraction this year.

Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as “Best Hospitals Honor Roll,” “America’s Best Hospitals” and “100 Top Hospitals.” Illinois, Florida and other states have created their own report cards. In some places, such as California, there are more than a dozen organizations offering assessments on hospital quality.

But those ratings, each using its own methodology, often come to wildly divergent conclusions, sometimes providing as much confusion as clarity for consumers. Some hospitals rated as outstanding by one group are ignored or panned by another. Ratings results from an individual group can change significantly from year to year.

“We’ve alternatively been labeled the least safe hospital in Maine and the safest hospital in Maine,” said Dr. Douglas Salvador, vice president of quality at Maine Medical Center in Portland.

And the ratings do not always jibe with the views of authorities who oversee hospitals. For instance, UCSF Medical Center has gotten good grades from multiple safety raters even as California public health officials have fined it $425,000 repeatedly for endangering patients.

As ratings multiply, more and more hospitals have something they can boast about. A third of U.S. hospitals—more than 1,600 — last year won at least one distinction from a major rating group or company, according to a Kaiser Health News analysis. In the greater Fort Lauderdale hospital market, 21 of 24 hospitals were singled out as exemplary by at least one rating source. In the Baltimore region, 19 out of 22 hospitals won an award.

“I worry a lot about these ratings,” said Jerod Loeb, executive vice president for health care quality evaluation at the Joint Commission. “They’re all justifiable efforts to provide information, but at the end of the day every single one of them is flawed in some respect. Rather than enlightening, we may be confusing.”

Not A ‘Complete Picture Of The Care’

There are so many report cards on hospitals that the Informed Patient Institute runs a website that grades the raters. Carol Cronin, its executive director, said most report cards are not easy for consumers to use. “A lot of them don’t help users quickly understand which hospital is better than another,” she said.

But many hospitals are eager to trump these distinctions in their marketing. Healthgrades, U.S. News and Leapfrog not only encourage this but also profit from it by charging licensing fees to hospitals that want to advertise their awards. “A hospital cannot buy an award, they must achieve it,” Healthgrades said in a statement.

Dr. Andrew Brotman, chief clinical officer at NYU Langone Medical Center in Manhattan, said the fees can be substantial. “Healthgrades, which is one we did well on, charges $145,000 to use this even on the website as a logo, so we don’t do that,” he said. “U.S. News is in the $50,000 range. Leapfrog is $12,500.”

Healthgrades and Truven Health Analytics, which publishes the 100 Top Hospitals, offer consulting services to hospitals that want to improve their overall performances. Jean Chenoweth, a Truven senior vice president, said the list doesn’t earn Truven any money but it “gives the company a lot of visibility.”

Consumer Reports bars hospitals from using its ratings in marketing, but patients must subscribe to read them online. (Others generally provide free access to ratings on their sites.) The Joint Commission does not charge hospitals that make its top quality list.

A Pew Research Center survey found 14 percent of Internet users consulted online rankings or reviews of hospitals and medical facilities. Florence Harvey, 70, said when she moved to Washington, D.C., last fall, she picked a health plan and doctor affiliated with Washington Hospital Center after reviewing all the local hospitals rankings on U.S. News’ website. “That was the one that had the best across-the-board ratings,” she said.

But Harvey may be an anomaly. Dr. Peter Lindenauer, a professor with Tufts University School of Medicine based in Springfield, Mass., said the limited research on rankings “suggests they have had very little impact on patient behavior.”

That’s not surprising since many admissions, such as those due to a heart attack or car crash, have an immediacy that rules out comparison shopping. Also, researchers note, many patients defer to their physicians’ recommendations or go to the hospital where their chosen surgeon has privileges. Still, rating groups say the ratings help keep the pressure on hospital executives to keep quality up.

“Patient safety has to be a priority 24-7,” said Leah Binder, Leapfrog’s president. “The minute it slips off the priority list, that impacts the rating.”

The calculations that go into these ratings are complex. Most hospital assessments synthesize dozens of  pieces of data Medicare publishes on its Hospital Compare website, including death rates and the results of patient satisfaction surveys. They also examine other sources and use private surveys to create user-friendly lists or grades, which they display on their websites.

The Joint Commission looks at how frequently patients received recommended treatments, such as flu shots for those with pneumonia. Consumer Reports examines the numbers of patients who die or are readmitted, infection rates and Medicare patient surveys of their experiences. Leapfrog looks at data from its surveys of hospitals, the consistency with which hospitals followed safe surgical practices and frequencies of infections and some types of patient harm. Healthgrades analyzes detailed Medicare records to find death and complication rates for 27 procedures and conditions.

Truven considers profitability along with quality in its assessments. U.S. News surveys physicians about which places they think are the best, and those reputation ratings account for a third of most of its assessments. U.S. News ranks hospitals by geography and singles out hospitals that do well in 16 specialties, including cancer, neurology and orthopedics.

“Ratings and ranking programs certainly offer people information they can use to make their hospital selections, but we don’t recommend relying on any one of them completely,” Jennifer Kennedy, a spokeswoman for St. Mary Mercy, said in an e-mail. “None are able to tell the whole story or paint a complete picture of the care that is delivered.”

Patient safety rankings are based on how frequently correct procedures or errors occur, so hospitals can get good grades even if they have made some egregious errors. Leapfrog gave a “B” to UCSF Medical Center in San Francisco even though California regulators have penalized UCSF eight times for infractions since 2008, most recently for leaving a sponge in one patient and a plastic clip in the skull of another. Those errors cost UCSF $200,000 in fines.

Dr. Josh Adler, the chief medical officer at UCSF, said penalties were partly a result of the hospital’s policy to make sure that all errors are reported to authorities. “The key is that we constantly strive to deliver the highest quality, safest, and most satisfying care, and that we are a learning organization,” he said in an e-mail.

The ratings groups believe the public benefits from the multitude of ratings. Dr. John Santa, who directs Consumer Reports’ health ratings, said consumers benefit from different vantages just as they do for cars or electronic devices, and the competition spurs each rating group to get better. “We think that’s consistent with good science,” Santa said.

Avery Comarow, health rankings editor for U.S. News, agrees. “People go to hospitals for different reasons and priorities,” he said. “I’m not sure there could be a single rating system that can do it all.”

Many of the hospital graders are expanding their awards. Last year, the Joint Commission identified 620 hospitals as “top performers,” up from 406 the previous year. Healthgrades now provides awards for emergency rooms, maternity care, pediatric care, bariatric surgery and gynecology surgery. In 2011, U.S. News started identifying the best hospitals in regions of the country, and identifies 748 hospitals as a “best” hospital in at least one specialty.

But because of limitations in data, the ratings cannot always offer patients the kind of specificity they seek. When Kathy Day of Bangor, Maine, needed a hysterectomy in 2011, she wanted to compare hospital infection rates for the procedure. But she said when she called Brigham and Women’s Hospital in Boston, “the response I got from them was, ‘We don’t have to give you that information, we’re not required to report those infections until next year.’ “

“I said, ‘I have cancer this year and I need surgery now, so next year doesn’t help me,’” recalled Day, 63, a registered nurse and consumer advocate. She said the hospital ultimately told her its infection rates were average, but the attitude turned her off so much that she underwent surgery successfully at Maine Medical Center.

Brigham and Women’s website publishes six types of infection rates, but not one for hysterectomies. “We are continually working on making data about more types of infections available,” a hospital spokesman, Tom Langford, said in an e-mail.

Constant Turnover

Much of the quality data is rudimentary, as the science of evaluating hospitals is still in its adolescence. Adding to the confusion is that hospitals can rise and fall from year to year as groups tweak their methods of assessment and as hospital performance shifts, even slightly. A study sponsored by the Commonwealth Fund, a health care philanthropy in New York, found that only 46 percent of hospitals ranked as top performers by Thomson Reuters in 2008 were also winners in 2007. In the Joint Commission’s rankings, 583 hospitals missed being designated a top performer because they fell short on just one of 45 measures.

In some cases, hospitals that have won awards are being penalized financially by Medicare for falling short on the government’s quality assessment. Saint Francis Hospital in Tulsa, Okla., which is losing 0.54 percent of its Medicare payments this year under the government’s quality program, is a Healthgrades Distinguished Hospital for Clinical Excellence and was ranked the second best hospital in Oklahoma by U.S. News.

Paul Levy, the former CEO of Beth Israel Deaconess Medical Center, said he is concerned that as awards multiply they may encourage complacency. “There’s a danger,” he said, “that some hospitals look at their excellent ranking and say ‘See, we’re there, we’re done,’ while process improving has got to be a never-ending philosophy.”

Some of the hospitals that do the best in the rankings have limited respect for them. Advocate Christ Medical Center in Oak Lawn, Ill., last year received praise from Leapfrog, U.S. News, the Joint Commission, Truven and Healthgrades. But Dr. William Adair, vice president for clinical transformation, says the hospital doesn’t license any of the distinctions. “We’re all made a little bit uneasy, to be frank about it,” Adair says. “Some of these organizations are looking for revenue. It blurs the effectiveness of the ratings processes.”

Still, many hospitals are happy to use the praise. Dr. Brotman from NYU said: “Even though there’s not a hospital executive who won’t tell you that they have a great deal of skepticism about a lot of the methodology, there’s not one who will tell you they don’t want to be on the lists.”

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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Predatory Direct to Patient Advertising

March 12th, 2013 No comments

The purpose of the following letter, which I recieved in my snail mail yesterday, is to attract healthcare ‘customers’ and make money.  The medical device company that is sponsoring this event produces surgical mesh.  The doctor who signed this letter is promoting a product for American Medical Systems, INC.  Surgical mesh can cause horrible complications that are difficult and at times impossible to reverse.  Do not be fooled by the term “minimally invasive”.

Read this letter carefully and then look at who is sponsoring this event.   Take your health concerns to your trusted family doctor and see if there are any natural remedies, exercises, physical therapy or other approaches to your problem.  Except in genuine emergencies and certain problems like cancer,  surgery should be the last approach to a problem, not the first choice.  Find out about the possible complications of any surgery, including infections.  Get your surgeons complication rates before consenting to surgery.

Women…beware.  This type of ad may lead many of you to unnecessary and possibly dangerous surgery.







surgicalmesh ad

Flashes and Floaters, oh my

March 11th, 2013 1 comment


March 5, 2013

When getting up from my chair yesterday, I saw a  lighting like crescent shaped streak in the periphery of my right eye.  “Hmm, that’s weird” I thought.  I quickly dismissed it because it was  instantaneous and painless and I could see fine.  Well, it kept up all day long.  Then later in the afternoon, after putting make up on under bright lights, I had a big black worm like floater.  It looked like soot from a candle.  I have had that off and on ever since, along with just rare “lightening like” flashes.  I had an important meeting last night, but before I went, I called my primary care doc.  She responded quickly and recommended that I get my eye examined sooner rather than later.  It was probably dumb, but I went to my meeting about healthcare first, and then to the Eastern Maine Medical Center ER.  I know, my eye should have been my primary concern…we only get two of them.

At approximately 9pm, my husband Mike  went with me to the EMMC ER.  This is may alma mater.  I worked as a triage nurse in this very same ER in the 90s.  It has changed a whole lot since then…and not at all in good ways.

The first thing I had to do was go through a TSA like screening.  “Walk through here, put your purse here, remove pocket contents, walk through the scanner, come over here and get your purse, etc etc.  They did not frisk me however.  The Bangor TSA did frisk me from head to toe last week.  I think it’s time for some profiling.  An old lady like me is 99.99% unlikely to be a threat to anyone.

Next I went to the registration desk.  I stood there for a few minutes while 2 young women had their backs to me about 6 feet away.  They chatted and obviously did not know I was there, so I moved the chair in front of me and made a noise.  No response.  Then just as I quietly said “excuse me”, the security guard came over to alert them to the fact that I was standing there waiting. They finally turned to look at me. I had begun to sit down at one widow, but was quickly told to “come over to this chair”. There was no Please and no Thank You.   I followed my direct order.   The young woman who registered me might as well have been a robot.  She never said “hello”,  and NOT once did she make eye contact.  She was cold and lacked empathy as she mechanically ‘registered’ me.  Her “triage” question was “What’s going on tonight”.  She got the job done, but I could have done just as well at a kiosk with no human  being part of it, similar to printing out a boarding pass at the airport computers.   I was instructed to “sit over there” and wait and the triage nurse will come get you.  There were not many people in the waiting room and I figured (wrongly) that it wouldn’t be long.  The triage nurses are behind closed doors with glass and blinds blocking their view of the waiting room.  A young woman and her mate (husband, boyfriend or partner) sat about 15 feet from me. She was trying to lie on her side in an upright chair.  She was crying and so was her mate.  She was clutching her abdomen and obviously in agony.  My observation was that nobody paid attention, nobody cared, and nobody monitored what was going on in that waiting room.  I was appalled.

When Mike noticed  the sign that said the wait time was  2 to 3 hours to be put in a room, I made a quick decision.  I guess if they put that sign up, we “patients” should be patient and willing to just accept that.  Even if we are in agony, and crying in pain, like that poor young woman I described earlier,  we are expected to wait.  NO, that is not acceptable.  I made a phone call to the competitor, St Joseph Hospital, and I was told that the wait would not be that long.  I told the triage nurse and the cold distant registrar that I would be heading across town  to the competitor.  The nurse looked a tiny bit surprised, but said “oh, ok, that’s fine”.  It seemed that this was not the first time this had happened…and I would guess it happens a lot of the time. As a nurse, I feel guilty that I did not offer to give that poor suffering young woman a ride over to St Joseph Hospital with us.  As a patient, I had absolutely no regrets that we left.   As both, I am very sad that by my observations, the EMMC ER has not improved in customer service and efficiency of care.

St Joseph Hospital reception was a complete turn around from EMMC.  I was warmly greeted, with eye contact and a smile. The triage nurse took me back to the triage room immediately after I took my coat off.  She was about my age and I knew her name, although we had never met.  We connected immediately.  I chatted her up while she efficiently triaged me.  We continued our conversation behind a closed door in the ER exam area.  She is a long time ER nurse and knows so much.  I waited over an hour in that room after she left.  She walked by and asked if anyone had been in to see me.  I said ‘not a soul”.  It was only about 5 minutes later that a Nurse Practitioner came by to examine my weird eye.  He was kind, thorough and efficient.  Aside from a boring hour in the exam room, my visit to St Joes was excellent.

Today I will see an ophthalmologist.  I hope my retina is intact and where it belongs and I have a good feeling that it is.  My ailment is not life threatening at all, and  I do realize that.  But, I fear that even if it had been, my greeting at the EMMC ER would not have been much different, unless I arrived in a speeding ambulance with lights flashing and a warning to the triage nurse. (Update: my eye is detached retina.)

When I worked at the triage desk at EMMC, my desk faced the entrance door, and the waiting room.  There was no barrier.  The registrars sat perpendicular to my desk and they also faced the door and waiting room.  We all watched what was happening there, even while we registered and triaged other patients.  Once a patient had been signed in, we were responsible for observing them and caring for them while they waited.  It seems now that nobody is watching or caring about the patients who are waiting in the waiting room.  Improving privacy for patients and safety for patients and staff has to somehow still allow for observation and care of patients who are waiting for emergency care.  Sometimes those patients need attention because their triage status can change.

If I had the opportunity, I would go to EMMC, sit down with their ER leadership and tell them exactly how I felt about my visit last night.  Maybe I will send a letter and offer to do just that.  If my brief encounter is any indication, my alma mater has not improved over the years, it has gotten worse. I am sad to be saying that.  I know some great nurses who work there, and I suspect that these things I have mentioned are systems problems…like work overload, understaffed, clogging up of the flow because no in patient  beds are available, no beds are available because there is no staff to accept them  and poor coordination of care.  As in most cases, it is a mess that needs to be fixed from the top down.   My letter will go out to the EMMC Chief Nursing Officer tomorrow……