Articles Posted in Hospital Mistakes

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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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According 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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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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According 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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According to the Centers for Disease Control and Prevention, the number of women dying because of pregnancy and childbirth is going up. More than 25 years ago (1987), there were 7.2 deaths of mothers per 100,000 live births; in 2011, that number more than doubled to 17.8 deaths per 100,000 births.

According to experts reporting on this subject, there is not any one factor to explain the increase, but a number of issues, including obesity related complications, record-keeping changes, age and delayed childbearing, health disparities, and an increase in the number of cesarean section births. One of the causes not mentioned, however, is medical malpractice.

Recently, a family of a 32-year-old woman who died from complications during pregnancy while being treated at the Cooley Dickinson Hospital, filed a lawsuit against the hospital for negligence. According to the complaint, the hospital staff missed signs of pre-eclampsia – a potentially fatal complication of pregnancy – and then failed to timely treat it. The complaint further alleges that after the woman was unresponsive for over 10 hours and had given birth by cesarean section, staff realized she had suffered a massive cerebral hemorrhage and would not recover.

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According to a recent study, medication errors or adverse drug events occurred in about half of all surgeries done at one of the nation’s most preeminent hospitals.  Specifically, over the course of an eight-month period in 2013-2014, researchers observed randomly selected operations at Boston’s Massachusetts General Hospital (“MGH”), and documented every drug given immediately before, during, and after the surgery.

“We knew that medication errors were common,” said Syracuse medical malpractice attorney Michael A. Bottar, “but the results of the study were startling.” During 124 of the 277 observed operations (i.e., 45%), researchers noted at least one medication error or drug-related incident that harmed a patient.  More than one-third of the observed errors injured patients, including three life-threatening mistakes.  Two of the life-threatening mistakes were caught by the operating room staff and one was intercepted by researchers.

The most frequently observed errors were:

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According to the Centers for Medicare and Medicaid Services (“CMS”), between October of 2008 and June of 2010, more than 11,000 Medicare-eligible patients received care and treatment at Crouse Hospital in Syracuse, New York.

During that time period, at least two patients experienced a 100% preventable surgical complication known as a gossypiboma or textiloma, which is when an object like a sponge, pad, or gauze are accidentally left inside a patient after the incision is closed. For this adverse incident category, Crouse’s rate per discharge of 0.609 was more than six times the national rate per discharge of 0.09.

“CMS’ report is significant because it lifts the veil of secrecy surrounding medical mistakes at area hospitals,” said Syracuse medical malpractice lawyer Michael A. Bottar, of Bottar Law, LLC. “These statistics do not include errors affecting non-Medicare-eligible patients.”

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According to, a study published by The Project on Government Oversight suggests that Syracuse’s Veterans Administration Medical Center, also known as the Syracuse VA, has very few medical malpractice claims filed against it.

There may be a number of reasons for the low volume and size of claims against the Syracuse VA for medical malpractice. One explanation is that many veterans are not inclined to file a lawsuit against an entity that is providing ‘free’ medical care to them. Second, many veterans do not know that they have been injured by malpractice because they are advanced in age and/or are suffering from a constellation of disabilities stemming from their military service. Finally, claims against the Syracuse VA for medical malpractice are complicated because they are governed by the Federal Tort Claims Act (FTCA). Many personal injury lawyers do not prosecute FTCA cases because they are not familiar with the administrative claims process or the technical requirements of a lawsuit in federal district court.

“We like the complexity of FTCA cases,” said Michael A. Bottar, a Syracuse-based attorney handling a number of VA medical malpractice lawsuits, as well as claims against the the Department of Health and Human Services. “In addition, many agencies, including the VA, do a pretty good job of resolving claims during the administrative review process. Sometimes a lawsuit is unnecessary.” This, of course, assumes that the attorney handling the FTCA claim knows what information must be submitted to the agency, how to submit it, where it should go, and when. “The FTCA can be a mine field for the uninitiated, as there are short deadlines,” Bottar added.

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According to the American Heart Association, patients with stroke symptoms who are admitted to a hospital over a weekend have a higher risk of death than those admitted on a weekday. The risk is more than 17% higher. “This known as the weekend effect,” said Syracuse medical malpractice lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC, a law firm prosecuting New York stroke misdiagnosis lawsuits.

“Generally, there is decreased staffing at hospitals over weekends and, in turn, the quality of care can decrease.” However, the “weekend effect” appears not to occur at comprehensive stroke centers where brain imaging and acute stroke teams are available around-the-clock.

Designated stroke centers in central New York include Crouse Hospital and Upstate University Hospital. A list of the 116 other designated New York stroke centers can be found here.

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“Hospital errors result in the death of nearly 200,000 Americans every year,” said New York wrongful death lawyer Michael A. Bottar, Esq. In an effort to improve patient care, and to attract more doctors, upgrade its information/technology systems and stabilize its finances, Community Memorial Hospital, located at 150 Broad Street in Hamilton, New York, just minutes from Colgate University, will soon link to Syracuse’s Crouse Hospital.

CMH is a 40-bed hospital where approximately 5,000 procedures were performed in 2009 and 2010. Most of those procedures (more than 4,000) were diagnostic or therapeutic in nature. Since 2005, CMH has been investigated twelves times by the New York State Department of Health. According to the NYSDOH website, eight investigations resulted in no citations. However, four investigations resulted in a total of 33 citations including statement(s) of deficiency for, e.g., infection control, anesthesia services, pharmaceutical services, quality of care, supervision of nursing care, nursing services, medical staff and incident reporting.

Hospital officials noted that the Crouse-CMH affiliation is not a merger or asset acquisition like the recent transaction between Syracuse’s Community General Hospital and Upstate Medical University. According to, Dr. Paul Kronenberg, Crouse’s president and CEO, noted that “the affiliation with Community Memorial is part of Crouse’s strategy to develop an integrated delivery network and expand its geographic reach.”

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