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physician discipline mapsAccording to a new study published in BMJ Quality and Safety, the percentage of doctors who get disciplined or who pay a medical malpractice claim, is four times less in some states than others. And New York came up short.

The researchers out of the University of Michigan Medical School examined state medical board physician disciplinary action rates using the US National Practitioner Data Bank and the American Medical Association estimates of physician demographics across all 50 states and the District of Columbia from 2010 to 2014. Results were adjusted using a multilevel logistic model controlling for year of disciplinary action, physicians per capita in each state, and the rate of malpractice claims per physician in each state.

For the US as a whole there are 3.75 actions – including 1.15 that are “serious” – annually, for every 1,000 practicing physicians. The variation among states, however, remains large. Delaware scored the highest, with 7.93 actions per 1,000 physicians, 2.71 of which were major infractions. Dissimilarly, Massachusetts had the lowest of all actions, at 2.13; and New York had the lowest rate of major infractions, at 0.64. Connecticut and Pennsylvania also scored low.

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According to a recent study out of the New England Journal of Medicine, “Prevalence and Characteristics of Physicians Prone to Malpractice Claims,” “a small number of physicians with distinctive characteristics account[] for a disproportionately large number of paid malpractice claims.”

The authors of the study conducted an extensive review of the National Practitioner Data Bank, analyzing 66,426 claims paid against 54,099 physicians from 2005 through 2014. According to the results, approximately 1% of all the physicians accounted for 32% of paid claims and, the more often a doctor is sued, the more likely he or she will be sued again. For example, as compared with physicians who had one previous paid claim, physicians who had three paid claims had three times the risk of incurring another, and a doctor who had six or more paid claims was 12 times as likely.

Risks also varied by specialty. For instance, the risk of recurrence was approximately double among neurosurgeons and orthopedic surgeons as compared to internists. The lowest risks of recurrence were seen among psychiatrists and pediatricians. Male physicians also had a higher risk of recurrence than female physicians.

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Originally created by Dr. Lawrence Weed in the 1960s as a part of his recommendation for a problem-oriented medical record, a problem list, distilled to its basic form, is a document that states the most important health problems facing a patient, such as illnesses or diseases, injuries suffered, and anything else that has previously affected, or is currently affecting the patient. According to the Journal of American Health Information Management Association (AHIMA), among other things, the problem list was designed to help practitioners identify the most important health factors for each patient, allowing for customized care. However, a recent article entitled, “Problem Lists Can Threaten Safety, Pose Liability Risks,” published by Healthcare Risk Management, illustrates the ongoing problems with problem lists.

A team of researchers led by Adam Wright, PhD, a scientist at Brigham and Women’s Hospital in Boston, studied 10 healthcare organizations that use different electronic health records in the United States, United Kingdom, and Argentina. The study, which was published in the October 2015 issue of the International Journal of Medical Informatics, was designed to see how complete problem lists were at each facility. The investigation revealed staggering levels of completeness varying from 60% to 99%, with an average of 78%.

Larkin v. Johnston, a recent malpractice case out of Massachusetts, illustrates what can happen when a problem list is incomplete. Andrea Larkin, a 28-year-old woman, former school teacher, who ran the Boston Marathon in 2004, suffered a stroke that left her partially paralyzed after childbirth and now requires 24-hour care. The case began with Larkin’s visit to a clinic after running the Boston Marathon and experiencing dizzy spells. Dr. Jehane Johnston ordered an MRI and CT scan which revealed brain abnormalities. Dedham Medical Associates had a specific policy requiring doctors to make note of such abnormal findings in a “problem list,” on the inside cover of Larkin’s medical record. This policy was intended to improve patient safety by bringing the conditions to the attention of any clinician’s review of the chart in the future. Unfortunately, Larkin’s abnormal brain findings were never entered in the problem list, so, when Larkin became pregnant nearly four years later, Larkin’s obstetrician was not aware of her brain issues.  Larkin, who would have been given a C-section had her OB-GYN been aware of her brain abnormalities, was allowed to have a vaginal birth which resulted in a massive stroke just hours after giving birth to her daughter.  Larkin was awarded $35.4 million – over $41 million with interest.

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initialsA woman suing a doctor, a physician’s assistant (“PA”), and a surgical center for malpractice, as a result of receiving an operation on the wrong knee, is entitled to partial summary judgment on the issue of liability, according to a Bronx judge.

Following an automobile accident, the plaintiff sought treatment from Dr. Hostin, an orthopedic surgeon, for a torn meniscus and a partial ACL tear in her right knee. Prior to the surgery, the doctor initialed the plaintiff’s right knee and then left to care for another patient who’s surgery was scheduled just prior to the plaintiff’s. When the plaintiff awoke from anesthesia, she realized that the surgery had been performed on her left knee, instead of the intended right one.

According to court papers, Dr. Hostin, after finishing the other patient’s surgery, entered the operating area and saw that surgery had already been started by his PA. A camera had been previously inserted under the plaintiff’s kneecap and the doctor saw a torn meniscus in the live video, so he decided to direct the PA on how to complete the procedure. Dr. Hostin did not realize the mistake until after completion of the wrong-site surgery.

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A recent case out of Illinois alleges that a husband’s disabling injury was caused by a neck injection. According to the complaint, on March 20, 2015, Bill Blechinger came under the care of a doctor for an undisclosed ailment. A day later, the plaintiff entered the emergency department at St. Joseph’s Hospital – again for an undisclosed ailment – during which time an injection was administered to his neck.

According to court documents, the injection was negligently and carelessly administered in the absence of a sterile environment, causing an infection. Among other claims, the plaintiff asserts that he has become been crippled, permanently disabled, and suffers great pain, mental anguish and disfigurement. Plaintiff further asserts that he has been permanently prevented from attending his usual duties, and has lost wages, income, and has incurred large amounts of medical expenses.

The trial lawyers at Bottar Leone, PLLC, have decades of experience investigating, prosecuting and trying to verdict all types of medical malpractice cases. Victims of medical complications due to the negligence error of the administering physician could be entitled to monetary compensation. Do not hesitate to contact us to speak with someone about a potential malpractice claim.

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stethoscope-hand-moneyAccording to a recent article out of the New York Times, shorter hospital stays are not because hospitalized patients are becoming younger and healthier.  In fact, by and large, today’s patients are actually older and sicker. Rather, shorter hospital stays may be attributed to hospital financing.

According to the New York Times, in 1980 the average hospital stay in the United States was 7.3 days, while today it is closer to 4.5 days. One reason attributed to this change came in the early 1980s when Medicare stopped paying hospitals for their claimed costs and phased in a payment system. This “prospective payment system” pays a predetermined rate tied to each patient’s diagnosis and shifts the financial burden of a patient’s hospitalization from Medicare to the hospitals. As a result, hospitals are economizing and one way to do this is to get patients out of their hospitals, sooner.

Almost as soon as this “prospective payment system” started, experts raised concerns that it would lead to a higher rate of readmission. Meaning, patients discharged too quickly may be prone to complications, necessitating their return to the hospital. According to the New York Times, evidence backs this logic.  And, with recent programs created by the federal government aimed to penalize hospitals for readmission rates, e.g., Medicare’s Hospital Readmissions Reduction Program, where hospitals lose up to 3 percent of their total Medicare payments for patients readmitted within 30 days of discharge, questions remain as to whether patients are getting the care they need.

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The highest court in New York recently reinstated a medical malpractice suit against a Long Island hospital and the doctor and physician’s assistant who gave painkillers to a woman who subsequently crashed her car.

Specifically, the lawsuit arises from a motor vehicle accident that occurred after a non-party, Lorraine A. Walsh, was treated at defendant South Nassau Communities Hospital. As part of the treatment, Walsh was intravenously administered an opioid narcotic painkiller and a benzodiazepine drug, but was not warned that such medication either impaired, or could impair, her ability to safely operate an automobile. Shortly thereafter Walsh drove home from the Hospital, and while allegedly impaired by the above-mentioned medication,  crossed a double yellow line and struck a bus driven by Edwin Davis (plaintiff).

The question before the Court of Appeals was whether third party liability can attach when a hospital administered drugs to a patient and then released her, in an impaired state, without any warning that the medication impaired or could have impaired her ability to safely operate a motor vehicle. In a 4-2 decision, the Court answered in the affirmative. In so doing, the Court noted that its conclusion with respect to the duty owed is accompanied by “three observations:” (1) the duty imposed is a small one – where a medical provider administers medication that impairs or could impair the patient’s ability to safely operate an automobile, the medical provider satisfies its duty by warning of those dangers; (2) the duty is met by simply advising/warning, and not “preventing” one from leaving; and (3) courts should proceed cautiously and carefully in recognizing a duty of care.

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Medscape recently surveyed almost 4,000 primary care physicians and selected specialists to find out if, and why, they were sued. According to the results, 59% were named in at least one malpractice suit – nearly half (47%) were among others named in the suit and 12% were the only parties sued.

When asked about the nature of their lawsuits, respondents could check as many options as were relevant. The top three reasons and their corresponding percentages are as follows:

  1. Failure to diagnose – 31%
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Crouse Hospital and St. Joseph’s Hospital Health Center are being penalized by the federal government for having high rates of avoidable patient complications. They are among 758 U.S. hospitals – 46 in New York – having their payments from Medicare reduced by 1 percent over the course of the federal fiscal year, which runs through September 2016.

The fines are based on the government’s assessment of the hospital-acquired condition (HAC) score. HACs are conditions such as infections, sepsis, broken hips, and other problems patients did not have upon arrival at the hospital, but developed during their stay. Each hospital was given a score of 1 to 10, 1 being the best and 10 being the worst. The following are the HAC scores for Central New York hospitals:

  • Crouse: 9
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DrAccording to a paper published in the new issue of the Journal of the American Medical Association, more than one in four doctors in the early stages of their careers have signs of depression, and their patients – now and in the future – may suffer because of it.

The findings come from an investigation of 50 years’ worth of studies, published between January 1963 and September 2015, that looked for depression symptoms in more than 17,500 medical residents. Their analysis revealed that the percentage of residents with possible depression ranged from 20 to 43 percent, resulting in an average of 29% physicians-in-training with depression or depressive symptoms.  By way of comparison, in 2013 the National Institute of Mental Health reported that about 6.7% of all U.S. adults had at least one major depressive episode during the previous year.

According to Srijan Sen, M.D., Ph.D., senior author of the study and a member of the University of Michigan’s Depression Center, depression obviously negatively impacts the doctors-in-training themselves, but it also affects patient care, as mental health issues are linked to medical errors. Indeed, it could interfere with attention and focus, the development of the doctor-patient relationship, and result in a resident physician less engaged or interested in a patient’s care – inevitably resulting in errors. The prevalence of depressive symptomatology and disease in physicians-in-training is a significant and important indication of a system in need of change.

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