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Archive for the ‘Medical Malpractice’ Category

Abusive Hospital Billing and Medicare Fraud

Tuesday, May 14th, 2013

A conversation with a senior citizen can be revealing. Medicare typically covers 80% of hospital costs, not including the first day of the stay. Medicare also carefully reviews hospital charges, and often refuses to pay certain charges it deems to be inappropriate. At that point, the hospital will attempt to collect from the patient.

A client recently reported a conversation she had with her father, who reported an incident of abusive billing by his local hospital. He had a pacemaker implant, which took less than half an hour. The pacemaker implant was done with mild sedation, and when my father received the bill from the hospital, he was billed for the services of two anesthesiologists, for 4 hours each. He called the hospital and explained that he sat in the hallway from 8 until 10:30, a period of time for which the hospital had claimed the two anesthesiologists were present. The implant itself was completed in 30 minutes, during which he discussed Coptic Christianity with the cardiologist. One anesthesiologist was required to be present because of the sedation. It is not clear why the second anesthesiologist showed up. They left at 11.

The client’s father looks at his hospital bills, especially when Medicare disallows a charge which the hospital later attempts to collect from him. He called the billing department and asked them for an explanation of the charge, which was $800 after Medicare and his secondary insurance plan had paid their portion of the bill. The hospital representative explained that he was billed for 4 hours of service by the two anesthesiologists. Medicare had disallowed the bill for one of the anesthesiologists because she had allowed her certification to lapse. Her father told the hospital representative that not only were the two doctors not present for longer than 30 minutes, but two doctors were not necessary and he did not plan to pay the bill unless he was ordered to do so by a court. The hospital quickly removed the charges.

Her mother-in-law was reviewing the many bills and notices she receives from various facilities, doctors, and statements from Medicare, when she noticed that a local equipment company had been billing Medicare on her behalf for a wheelchair, at $140.00 per month, a wheelchair she had never seen or needed. She called the owner of the medical equipment supply company and pointed this out to him, and he became quite agitated with her. No wonder, as he was engaged in Medicare fraud, and probably on a wider scale than this one instance. We have suggested she report this crime to Medicare, but she, like many elderly people, fears getting on the wrong side of what appears to her to be a monolithic healthcare system.

The United States is one of the only countries in the developing world in which people end up in bankruptcy due to medical bills. Sadly, some of those bills are due to cost transferring, and it is difficult to actually pin down hospitals for the cost of a procedure or hospital stay. This is because hospitals are involved in multiple agreements with different third-party payers, and they shuffle costs around to maintain profitability. Even non-profit hospitals are run this way, and although they are technically non-profit, administrators and high-level employees benefit from incredible perks, including board meetings in Hawaiian resorts (St. Dominic’s Hospital in Jackson, Mississippi) or satellite offices in Italy and Ireland (University of Pittsburgh Medical Centers). At the same time, patients are subjected to inadequate care due to inadequate staffing by nurses and aides.

If you receive a suspect hospital bill, or believe you have been used in a Medicare fraud scheme, you should see an attorney for an evaluation of your case. You may be able to challenge unfair charges, or charges for services not received. If you don’t challenge these charges, the hospital will turn your bill over to a collection agency and you will find yourself in a defensive posture. With respect to Medicare fraud, the government rewards whistleblowers, and your attorney can explain the law in this respect.

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Surgical Errors as Actionable Medical Malpractice

Friday, May 3rd, 2013

An interesting article came out today in Medscape, a news service for physicians linked to WebMD. The article discussed what surgeons call “never events.” Basically, these are events that should never happen in surgery, and yet it was reported that over 4,000 of these events happen every year — that equates to over 80 “never events” each week.

What sort of event is a “never event?” Doctors often call them “check-writing events” because they are always considered medical malpractice causing injury to the patient. Every one of these “never events” involve inexcusable error by the physicians or medical providers involved.

Examples of ‘Never Events’

A classic example of a “never event” includes leaving a surgical instrument or sponge in the patient after closing the operative site. One of the first things any medical student learns on their surgical rotation is that every tool and sponge must be counted before surgery and before closing. The scrub nurse or operating room technician is responsible for counting correctly, but ultimately, this count is the physician’s responsibility.

A sponge or instrument left in a body cavity can cause any number of problems, including infection or inflammatory response. This generally involves opening the patient back up during a second surgery to retrieve the instrument.

Because operations are inherently dangerous, medical negligence in surgery is especially egregious. Of all malpractice claims, surgical errors accounted for 24.2% of all claims paid between 1986 and 2010.

In addition to foreign bodies left in the surgical site, a surprising number of surgeries are performed on the wrong side of the body. A May 2009 study found that surgery patients injured during surgery are seven times more likely to die while hospitalized than other patients. They are also more likely to be readmitted to the hospital within 3 months than other patients.

Recent cases in the news have focused upon wrong site surgeries, and despite guidelines for surgeons to mark the body part that will be operated upon, these errors still occur.

Some of the types of iatrogenic injury (injuries caused during surgery or post-surgery) include:

Pneumothorax (collapsed lung);
Infections;
Post-operative hemorrhage;
Post-operative respiratory failure;
Post-operative metabolic problems (electrolytes);
Post-operative “wound dehiscence” – wound opens after surgery;
Accidental puncture or laceration;
Pulmonary embolism or deep vein thrombosis (blood clot in the lungs or in the deep veins of the legs and pelvis);
Sepsis – an inflammatory reaction as a result of an infection, sepsis can cause organ failure and death

It is extremely important to pay close attention to the events surrounding your surgery. If you have a close friend or relative, have them accompany you to the hospital and check closely with your physician after your surgery and during your recovery period. A multitude of things can go wrong in the hospital, and during your recovery you may not have the mental clarity to notice things that are out of the ordinary.

If you or any of your relatives have suffered complications either during surgery or during your recovery period, you should contact a medical malpractice attorney for an evaluation of your case. Iatrogenic injury, those injuries and illnesses that occur as a result of hospitalization for something else, can be the result of medical negligence, and can cause significant injury and even death.

If you have any questions, call the top-rated medical malpractice lawyers of Passen Law Group at 312-527-4500 for a free consultation.

Tags: Medical Malpractice, Surgical Error
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Diagnostic Errors

Wednesday, May 1st, 2013

Over a period of 25 years (1986-2010), approximately 38.8 billion dollars were paid out by physicians and their insurance companies as a result of diagnostic errors. These errors were not only “wrong diagnoses,” but also included failure to diagnose or delay in diagnosis of a medical condition. Surprisingly, diagnostic errors are more common than surgical mishaps.

Diagnostic errors are dangerous because it may take months or even years to get the right diagnosis, once a wrong diagnosis is on the patient’s chart. Other times, a unreasonable delay of hours can mean the difference between a safe result and disaster for the patient.

Medical diagnosis is sometimes a difficult task for physicians, as there are always many different diagnoses (or “differential diagnoses”) to consider when a patient presents with a problem. Sometimes wrong diagnoses happen because the disease has not “presented itself” fully – the patient may see the doctor early in the disease process. However, sometimes the diagnosis is delayed or missed because the physician lacks the knowledge to make the diagnosis — or because the doctor fails to comply with the appropriate standard of care of a reasonably careful physician.

In those instances, when a reasonably careful physician should have made a correct diagnosis; when a physician ignores the safety of a patient; when a physician decides not to order certain tests to confirm a diagnosis; and the patient is injured as a result — that is actionable medical malpractice.

This problem is not infrequent in the emergency department, and the emergency department should be staffed with doctors who are trained to look for the life-threatening disease, when making a diagnosis for a patient who has, after all, been concerned enough about their symptoms to make a trip and usually has a long wait.

Common Examples of Diagnostic Errors

Examples of failure to diagnose in the emergency department include patients who have undergone CT scans to look for evidence of stroke. Ischemic, or non-hemorrhagic (bleeding) stroke is not evident on CT scan in the early stages of the stroke, and some clinicians fail to adequately test the neurologic function of the patient. All studies should be evaluated in concert with the clinical signs and symptoms displayed by a patient. In this case, the patient left the Emergency Department with weakness on the left side, because the doctor looked at the CT scan (which did not show the stroke yet – it was too early) and he failed to look at the patient. The weakness progressed to a left sided paralysis.

An example of diagnostic delay occurred when a radiologist failed to notice a spot on the chest x-ray of a patient, who returned 9 months later to his physician with metastatic lung cancer. The first chest x-ray was taken only because the patient had a cough, and since it didn’t show pneumonia, the radiologist and the patient’s doctor both failed to notice any other findings that were incidental on the chest x-ray. When they went back to look at the x-ray after the patient had been diagnosed with inoperable lung cancer, it was clear that the spot was present all along, and was probably the reason for the patient’s cough.

In both of these instances, failure to diagnose and delay in diagnosis had disastrous consequences. If you or a family member has suffered consequences like these as a result of a failure to diagnose or a delay in diagnosis, then you may have been the victim of medical negligence, and you should contact a Chicago medical malpractice attorney.

Tags: Diagnostic Errors, Medical Malpractice
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Delay in Diagnosis and Repair of Bowel Perforation

Sunday, April 21st, 2013

A continuing problem affecting patients who undergo common surgeries is the delay in diagnosis and treatment of iatrogenic bowel perforation as a result of the surgery. Iatrogenic is the term used to describe injury that occurs during the course of medical treatment. Many types of intra-abdominal surgery may place a patient at risk for bowel perforation. However, failure to diagnose and repair the injury promptly is medical malpractice, and may result in significant permanent injury or death.

Examples of Bowel Perforation

The medical literature is filled with examples of bowel perforation errors caused during surgery. One case reported in the medical literature described a 46-year-old woman who underwent elective surgery to release tissue adhesions. The iatrogenic perforation was not noticed before the surgery was completed. The patient began to complain of pain the second day after surgery.

Some symptoms of perforation after abdominal surgery include increasing pain, vomiting, distension of the abdomen, and inability to pass urine or gas. There are also signs that indicate perforation has allowed peritonitis to set in, and these signs include signs similar to all serious infections – rapid heart rate, fever, dehydration, and low urine output. Signs specific to an intra-abdominal process include an absence of bowel sounds and tenderness to palpation of the abdomen.

The surgeon in this case ordered a series of abdominal x-rays, but drew no conclusion from the studies, and prescribed pain medication as the patient’s condition deteriorated. The definitive response to evidence of bowel perforation and rapid deterioration in the patient’s condition after intra abdominal surgery is an exploratory laparotomy. The perforation must be repaired, and the abdominal cavity must be thoroughly decontaminated.

Unfortunately, sometimes a physician sees their post-surgical patients only once daily. They write orders in the morning on rounds, and typically get the results the next day. In smaller hospitals, where the surgeon may be the only physician caring for the patient, this can present significant risks.

A young girl in Mississippi was scheduled for an elective iliostomy for treatment of Crohn’s disease. After surgery, the surgeon in the local hospital signed out for the day, and when he saw her the next morning, she was having difficulty managing her abdominal pain. Typically post-surgical patients do experience some pain, which is easily controlled with medication. However, the pain of peritonitis is severe, and is characterized by its progression.

Despite changes in her vital signs that indicated she most likely had an infectious process going on, the surgeon failed to consider the most damaging possibilities. Instead, he sent off for chest x-rays and a urinalysis, failing to acknowledge that her signs and symptoms pointed to something much more serious than a catheter acquired urinary tract infection or a pulmonary infection as a result of not fully expanding her lungs post operatively.

This surgeon also allowed the patient’s condition to deteriorate for several days, during which he opted for “conservative management.” Sometimes conservative management means appropriately waiting for a disease process to declare itself, but in the case of a bowel perforation and significant deterioration in the patient’s status, conservative management has no role in the treatment plan. A surgeon should never let the sun set on a suspected bowel perforation. If there is any doubt, the experienced surgeon knows that an exploratory laparotomy may be not only diagnostic, but also life saving.

In both of these cases, the patient’s condition deteriorated to multi-organ failure. The mortality rate of multi-organ failure ranges from 26% to 88%, depending upon the number of critical body systems that fail. Both patients died after many days in the intensive care unit, receiving too little care too late.

These were avoidable deaths. If you or a family member has experienced a failure to diagnose a bowel perforation after surgery or even after a colonoscopy, you may have been the victim of medical malpractice.

Contact Passen Law Group’s top-rated medical malpractice attorneys at 312-527-4500 for a free consultation regarding your case.

Tags: Bariatric Surgery, Bowel Perforation, Surgical Errors
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Intubation Errors Leading to Brain Damage or Cardiac Arrest

Friday, April 19th, 2013

Sometimes a patient will arrive at the Emergency Department in respiratory distress. This is manifested many ways: the patient may be wheezing loudly on expiration, they may have slight shortness of breath, or they may appear to have no air movement at all despite frantic efforts to breathe.

Respiratory Distress or Failure

Respiratory distress is not difficult to recognize. The patient has labored breathing, and may exhibit “air hunger,” known as “dyspnea.” Their respiratory rate may be elevated, and their ability to breath is often hampered by a supine position.

Addressing the underlying cause should determine appropriate treatment for respiratory distress. A patient with a severe asthma attack should be treated with nebulized medications and steroids; the patient in congestive heart failure may have wet lungs full of fluid, which will respond to a diuretic; a patient with a tension pneumothorax must receive a chest tube to release the pressure trapped in the chest; patients with emphysema, or COPD, often require supplemental oxygen — though it’s important to note that with too much supplemental oxygen, the drive to breath is suppressed.

After attempting to treat respiratory distress in the Emergency Department setting, it is important to evaluate the patient’s response to treatment in a timely manner. Although some information is gained from the pulse oximeter the nurse will have placed upon the patient’s fingertip, this simply reads the saturation of oxygen in the blood stream. For various reasons, that oxygenated blood may not be getting to the lungs, or the carbon dioxide released from deoxygenated blood may build up with a failure to provide adequate ventilation.

Acute respiratory failure often occurs among patients with heart failure, pneumonia, or chronic obstructive pulmonary disease. Respiratory failure can also be a result of pulmonary contusions or pneumothorax. Asthma can quite quickly lead to respiratory failure in the severe asthmatic. Choking can obstruct the airway and when the patient becomes unresponsive, it is time to address ways to oxygenate them.

Respiratory failure must be addressed immediately. It is defined by difficulty breathing and certain parameters indicating the partial pressure of oxygen and carbon dioxide in the arterial system. It’s not important to understand the mechanisms of homeostasis of oxygen and carbon dioxide, as they can be complex. The body has many compensatory mechanisms, and it is the job of the physician to obtain an arterial blood sample and analyze the results for signs of respiratory failure.

Ventilation and Intubation

At that point, if a patient is in respiratory failure, they must receive assisted ventilations with supplemental oxygen. Usually, after ventilating with a bag-valve mask device proves inadequate, some advanced airway is required. In most settings, this involves endotracheal intubation. This is the term for inserting a breathing tube into the trachea, and supplying oxygen directly to the lungs. In an emergency situation, the endotracheal tube may be hooked up to a bagging device, which delivers oxygen, while a respiratory therapist is called to set up a ventilator.

Problems with endotracheal intubation can be devastating. The anatomy of the oropharynx, or the inside of the mouth and back of the throat, can be difficult to identify in some patients, particularly those who are obese, or have short necks. Some doctors may not be adequately trained to perform intubations routinely, simply because they stood by during residency and didn’t participate actively in enough intubations under supervision.

The esophagus lies directly behind the trachea. It is a narrow muscular column. When looking in the throat to find the landmarks, which mark the entrance to the trachea, the physician must find the vocal cords, and the tube must pass through those cords, which form a triangular opening, into the trachea. If the tube is not seen to go through the cords, it may well be lodged in the esophagus, and oxygen will be delivered to the stomach.

Intubation Errors

Doctors sometimes commit intubation errors, especially if the anatomical landmarks are in some way distorted. The tissues around the trachea may become swollen and edematous with multiple intubation attempts. Intubation attempts interrupt oxygenation provided by “bagging” the patient, and they should brief, because lack of oxygen quickly leads to cell death.

A study in Anesthesia and Analgesia in 2004 revealed that complications increased significantly with the number of attempts at intubation. Some of these complications have far-reaching consequences. They include aspiration of gastric contents into the lungs, which causes aspiration pneumonia, often associated with a high morbidity and mortality rate. Hypoxemia, or inadequate delivery of oxygen was associated with 70% of the patients who experienced greater than two intubation attempts.

11% of patients in the study who had experienced greater than two attempts at intubation suffered cardiac arrest. Pre-arrest bradycardia, or abnormally slow heart rate, is another complication.

Difficulty with intubation can result in brain damage and death. While some patients may be difficult to intubate, the American Society of Anesthesia recommends limitation of laryngoscopic attempts at intubation to three. There are other alternatives, which must be attempted if the patient has a difficult airway and the physician is unable to intubate quickly.

All physicians in an Emergency Department setting should be trained in some alternative methods of providing emergency airways. These include surgical procedures in the ER, utilizing fiberoptic bronchoscopy, and calling for anesthesia or surgical consultants. Some physicians are reluctant to call for help, and instead will try to futilely place an adjunctive airway in an emergency, losing valuable time and putting the patient at risk of brain injury or cardiac arrest.

If you or a family member has experienced harm from failure of a physician to secure an airway in respiratory failure or cardiac arrest, you may have been the victim of medical negligence. You should contact a medical malpractice attorney for evaluation of your case, as you may have certain recourse to damages under the law. Call us at 312-527-4500 for a free consultation.

Tags: Brain Damage, Cardiac Arrest, ER Malpractice, Intubation Errors
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