Articles Posted in Medical Malpractice

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The announcement last week that the federal government will bar most nursing homes and other care facilities from forcing clients to sign care contracts requiring them to settle disputes in arbitration is an enormous victory for ordinary Americans – one that deserved more attention than it received in both the national and local media.

As the New York Times noted: “With its decision, the Centers for Medicare and Medicaid Services, an agency under (the Department of) Health and Human Services, has restored a fundamental right of millions of elderly Americans across the country: their day in court. It is the most significant overhaul of the agency’s rules governing federal funding of long-term health care facilities in more than two decades.” Because virtually every nursing home and care facility in the country receives funds from either Medicare or Medicaid (and often from both) the rule is, effectively, universal. The rule change was essential to curb the spread of arbitration since a 2015 Supreme Court ruling (DIRECTV v Imburgia) which not only held that arbitration clauses are legal but also threw out state-level bans on the practice.

Obviously a federal law banning forced arbitration clauses can’t be passed in Washington’s present polarized political climate, but with last week’s decision the federal government effectively used the leverage that comes from being the largest single player in our healthcare system to put citizens ahead of corporate profits. The new federal rules effectively overturn the Court ruling in the area of nursing homes and related services.

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According to the Oregon Department of Prisons website our state first experimented with private prisons in the late 1800s. The state penitentiary “was leased to a private company… Since this concept was becoming very popular nationwide, Oregon’s legislature approved the experiment.” It did not last long. “In one day every inmate at the penitentiary escaped. Most walked out the front gate.”

This amusing historical nugget is a reminder that some ideas never quite go away – in this case the idea that private companies are always more efficient and that their need to make a profit will not result in either sloppy work or abuses (the 19th century version of private prisons made their money mainly by hiring the prisoners out as labor). Today, private prisons are illegal in Oregon, and our state is one of 11 that do not use the private system at all, according to a 2012 report by The Sentencing Project. An announcement by the Obama administration last month that the Federal government will phase out its use of private prisons is also likely to put a dent in the industry.

As a recent article in The New Yorker outlines, however, beyond the full-scale privatization of prisons the growth of all prisons over the last generation along with America’s collective assumption that private services are always superior to public services has led to some shocking arrangements in both government and private-run prisons. These often deny basic civil rights to prisoners with the goal of making money for the government. For example, the magazine notes, “short phone calls from prison can cost up to fifteen dollars, largely because the companies operate as monopolies within prison walls. The private companies also offer state and local authorities a percentage of their revenue, which contributes to the cost of the calls and creates other perverse incentives. Some jails, for instance, have removed in-person family-visitation rooms to make way for ‘video visitation’ terminals, provided by private firms, which can charge as much as thirty dollars for forty minutes of screen time.”

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The Oregonian reports that a Beaverton nurse was allowed to continue working with patients while under investigation for sexual misconduct on the job and allegedly committed a similar offense during that time. The incident, if the facts are as reported, raises serious questions about how the nurse’s employer, Kaiser Permanente, deals with abuse allegations among its employees. The result is a case which concerns both hospital malpractice and sexual assault.

According to the newspaper the 37-year-old North Plains man was indicted earlier this month “on one count of first-degree criminal mistreatment, three counts of invasion of personal privacy, two counts of computer crime and four counts of third-degree sex abuse, police said. The charges relate to three alleged victims, but detectives have identified two more and are investigating their claims.”

The claim that the man was allowed to keep working is particularly striking when one considers how quickly the case has moved. Far from being something that has dragged on for many months or years, The Oregonian reports that “police first started investigating (the nurse) on Jan. 28 after a woman reported that he made sexual statements to her and sexually touched her during a visit to the Beaverton clinic two days earlier.” In other words, this case has gone from initial allegations to a wide-ranging indictment in about nine weeks – a case of the criminal justice system moving fairly quickly. Despite that, however, it is hard to imagine another workplace context where an employer would regard it as OK to keep an employee accused of sexual assault in a position to recommit the alleged offenses.

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It is an election year, so between now and November we can expect to hear many politicians at the national, state and local levels complain about trial lawyers and call for “tort reform.” As an article published this week in Slate outlines, however, an often disingenuous campaign designed to ‘protect’ big business frequently has an even more shocking effect – protecting child abusers and other people who injure children.

The article begins with the story of an Ohio pastor who was convicted of raping a 15-year-old girl in 2008. In addition to his criminal trial the man was sued by the girl and her family in civil court. As I have written in this space on many occasions, this right alone is important and worth defending. Access to courts for victims and their families is essential if justice is going to be served. As the article notes, quoting a legal scholar at New York University, often “the civil justice system is the only way for a perpetrator to be held directly accountable to the victim.”

A court awarded the victim $3.6 million in damages, but because of award caps required under Ohio’s tort reform laws she was only able to collect $350,000 – less than one-tenth of what the jury decided was her due. The girl and her family are now suing to have those caps declared unconstitutional on the grounds that they are “arbitrary and unreasonable, and thus a denial of due process.” Specifically, there is a strong argument to be made that damage caps violate the US Constitution’s guarantee of a trial by jury. An inherent part of that right is letting the jury decide what is fair – something that the tort reform movement seeks to stifle.

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A groundbreaking three-part series published last week by the New York Times has drawn much-needed attention to a problem threatening almost everyone in America despite the fact that many people are not even aware that it impacts them directly.

As the paper reports in part one of the series: “Over the past few years it has becomes increasingly difficult to apply for a credit card, use a cellphone, get cable or Internet service, or shop online without agreeing to private arbitration. The same applies to getting a job, renting a car or placing a relative in a nursing home.” As the series goes on to detail, while arbitration may originally have been conceived as a way for businesses to resolve disputes among themselves more quickly and cheaply than by using our courts it has become a more-or-less routine way for corporations to tilt the field in their favor in any dispute with their customers. The newspaper quotes a federal judge in Boston who aptly describes this development as “among the most profound shifts in our legal history… Ominously, business has a good chance of opting out of the legal system altogether and misbehaving without reproach.”

What makes the new realities outlined in the Times so scary is how widespread they have become in the years since 2011 when a Supreme Court ruling opened the way for wider use of arbitration clauses and made filing class action lawsuits more difficult. The system is particularly lopsided because the growing class of professional arbitrators who administer it generally rely on large corporations to bring them repeat business (an arbitrator must be approved by both sides to a dispute, but large companies have far more knowledge of who they are agreeing to, and can make it clear they will not pick a given individual again if he or she rules against the company) – a conflict of interest that the Times examines at length and which strips away even the thin façade of impartiality that surrounds the arbitration process.

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When July began on Tuesday an important new Oregon law also went into effect. As reported by The Oregonian a new “mediation program… (gives) patients and their families an option besides suing when medical errors happen.”

The measure was a priority for Gov. John Kitzhaber and, as the newspaper notes, became law following input from both trial lawyers and the Oregon Medical Association. The new law “is intended to cut down on lawsuits and boost the reporting of medical errors to help improve health care practices.”

Some practical details remain to be worked out, and it will take months if not several years before we can say with certainty how well the program is working in practice, but as a public health matter we should all hope that the Early Discussion and Resolution Program, as it is formally known, performs as expected. As I have written in this space as recently as last month, medical mistakes remain far too common in our state and reducing or eliminating them is made more difficult by a reporting system that remains, to a great extent, voluntary. As a result, doctors and patients alike are often working from inadequate data. A system that improved both the volume and the quality of data on medical mistakes would be a huge boon to everyone.

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A story earlier this week on Oregon Public Broadcasting began with a stark statistic: “Oregon’s health care facilities reported more than 650 adverse events last year, 44 percent of which ended in serious harm or death, according to a new report by the Oregon Patient Safety Reporting Program.” Forty-four percent means that, as the article’s headline put it: “285 medical mistakes ended in serious injury or death in Oregon last year.”

For a state our size this is a shocking, and frankly unacceptable, number. “Adverse events include medication mix-ups, falls, infections, and erroneous surgeries being performed,” according to OPB. The number in the study is the largest reported in Oregon’s history, though the people who compiled the study say that can be attributed, in part, to a higher participation rate (the study was voluntary, since “the state doesn’t require health care facilities to report such mistakes,” OPB notes.)

The important thing to take away from the study, however, is how critical it is for doctors to take extra care when prescribing drugs and ordering treatment. Mistakes are simply less likely to happen when fewer and more carefully considered treatments are ordered, a fact that our current system, in which doctors get paid for each procedure they order, does not always encourage.

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We have all heard stories of medical price-gouging, but an investigation published earlier this week by the Tampa Bay Times shows that in Florida hospitals have taken the practice to a new level.

According to a lengthy investigation by the newspaper, a change in Florida law several years ago allowed hospitals to charge special fees for the use of trauma centers. The centers are specialized facilities within emergency rooms and hospitals have long argued that establishing and maintaining them incurs unique costs which the institutions ought to be able to pass along to patients and insurance companies. For such fees “a fair cost, according to the federal government’s Medicare program, is just under $1000.” According to the newspaper, however, because the fees are not regulated “the average fee today tops $10,000; the most expensive hospital regularly charges $33,000.”

To be clear: these fees are in no way related to actual services rendered. They are, as the newspaper puts it, a “cover charge.” The paper recounts numerous instances in which patients “were charged more in trauma fees than for their actual medical care.” Since the fees are both unregulated and unrelated to the actual medical services a patient receives, the hospitals have an obvious incentive both to raise the fees as much as they can and to admit patients to the trauma center regardless of whether or not they actually need to be there. In one particularly shocking case, “an uninsured woman… was charged $33,000 even though she only needed someone to treat superficial cuts.”

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The small-town pharmacist who knows all of his or her customers is a staple of TV and the movies. That fictional pharmacist has plenty of time to triple check medications and their dosage and to discuss things in detail with patients, most of whom have been his friends for years.

It ought to come as no surprise in 2012 that reality does not measure up to Hollywood’s fantasies. According to The Oregonian, “a recent survey by the Oregon Board of Pharmacy reported that more than 350 chain pharmacists – more than half of those responding – said their working conditions don’t promote safe and effective care.”

Perhaps most shockingly, only one-quarter of the 1300 pharmacists responding to the state’s survey “agreed working conditions promoted safe and effective patient care.” The article goes on to note that “many complained of having more prescriptions to fill each day with fewer staff; of 12-hour shifts with scant breaks; and constant distractions, such as administering immunization shots to augment profits.”

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One might have thought that when considering health policy the safety of hospital patients would be just about everyone’s top priority – medical professionals and legislators (and, of course, patients themselves) alike. After all, there are few areas of our lives in which we base crucial decisions to the judgment of others more than in the realm of health care. Yet as it considers Governor John Kitzhaber’s health care reform bill Oregon’s legislature is not only ignoring simple remedies that could lower costs even as they improve the quality of care in our state, it is also threatening to leave the poor outside the system, with no way to obtain justice when doctors, hospitals and nurses fail to deliver the care patients deserve.

It is distressing to see Oregon’s legislature spending too little time addressing patient safety issues as it considers health reform. As a recent article in The Oregonian notes, the cost savings offered by the proposed legislation lie mostly in the future. Broadly speaking that is good – one of the few things that liberals and conservatives agree on these days is the fact that rising medical costs represent a significant long-term budget problem at both the federal and state levels (how that problem should be addressed is an issue that elicits far less agreement). But as nationwide surveys that have been around for quite some time have shown, there are a number of basic fixes that can be implemented more-or-less immediately which will both reduce costs and improve patient safety.

Even more distressing, however, are aspects of the proposed law that would make it difficult or impossible for patients injured by negligent doctors to defend themselves in court. Under the current version of the legislation, strict limits would be placed on the ability of patients covered under Medicaid or the Oregon Health Plan to seek justice for their injuries at the hands of negligent providers. The result would be to create a two-tiered system of responsibility and accountability, one in which – to use an extreme example – a doctor who amputated the wrong limb of a patient with private insurance would be held accountable for his horrific mistake, but would receive no sanction if the patient in question was too poor to afford private coverage.

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