Update on Missed MI and Willful and Wanton Negligence in Texas

Last year I wrote about a case where a physician and hospital were found guilty of negligence for missing a Myocardial Infarction (i.e., heart attack) in a patient under the willful and wanton doctrine that was created in Texas as a part of tort reform. That case was appealed by the hospital and subsequently reversed. “We hold that the evidence of deviation from the standard of care by St. Mary’s nursing staff is legally insufficient to support the jury’s finding that the willful and wanton negligence of the hospital was a proximate cause of Stacy’s death.” It looks like Texas continues to hold very stringent requirements for determining medical negligence.

 

More information can be found here: http://setexasrecord.com/news/239006-st-mary-hospital-wins-appeal-of-1-2m-jury-verdict

 

My original blog post:

Monday, September 12, 2011 Missed Myocardial Infarction Held to Constitute Willful and Wanton Negligence in Texas As a part of Tort reform in Texas, in order to find a physician providing emergency medical services　guilty of negligence, the claimant must show that the doctor acted with willful and wanton negligence. Willful and wanton negligence is defined as　gross negligence. Plaintiffs must prove that ER doctors acted with conscious indifference, or gross negligence, rather than simple negligence. This is extremely difficult to prove and is one of the primary reasons for the decrease in medical malpractice cases against emergency medicine physicians in Texas. However, recently a Texas court held a hospital liable for willful and wanton negligence for a missed MI. This is a rare precedent in Texas since the enactment of Tort Reform.　 An elderly woman with history of diabetes and hypertension presented to ER with chief complaint of chest pain, chest discomfort and chest tightness. She was triaged as level 3 (low severity level), given albuterol nebulizer treatments and discharged home with a prescription for captopril. She he died at home the next day, autopsy reported that cause of death was MI (severe atherosclerotic disease was seen).　 It was later determined that during her brief stay in the ER, she had 2 EKGs done (one EKG was reported normal but the other showed a Septal Infarct). 　 The treating physician settled out of court and the hospital was found liable for negligence.　 The court found that prematurely discharging a patient with chest pain, improperly interpreting EKG results, and prescribing medication without first determining the effect it will have on the patient’s cardiovascular system constituted willful and wanton negligence (gross negligence). 　

 

More information on this case can be found here: http://www.beaumontenterprise.com/news/article/St-Mary-s-found-negligent-in-ER-death-737829.php

Health Insurance Marketplace

Open enrollment for the new Health Insurance Marketplace created under the Affordable Care Act is set to debut on October 1st. There is a website that is available to apply for coverage, compare plans and enroll. The website also provides individuals information about whether they qualify for health insurance under the marketplace, qualify for lower cost insurance, what is available in their individual state marketplace, as well as what specific benefits are available for indivudials, families and small businessess. This site can be used by indiviudals that do not have insurance, as well as individuals with insurance looking to change their current insurance. The link to this website is: https://www.healthcare.gov/

The State of Medical Malpractice Payouts

I have written a few articles and blog posts about medical malpractice.  A company recently published a study of medical malpractice claims from 2012.  Some interesting findings are:

 

• New York had the highest dollar amount of total payouts for 2012, $763,088, 250. 
• 48% of all payouts came from only 5 states (New York, New Jersey, California, Florida and Pennsylvania). 
• The vast majority of payouts were from settlements; only 5% of payouts made it to trial and were received from a judgement. 
• Texas and North Dakota had the lowest, per capita payouts.
• The highest percentage of malpractice claims were due to failure to diagnose.
 

A link to that study can be found here:
Diederich Heatlhcare 2013 Medical Malpractice Payout Analysis.
http://www.diederichhealthcare.com/medical-malpractice-insurance/2013-medical-malpractice-payout-analysis/

Links to some of my articles on Medical Malpractice:

Bailey, R.  Resident Liability in Medical Malpractice. Annals of Emergency Medicine (January 2013).

http://www.annemergmed.com/article/S0196-0644(12)00409-X/abstract

 

Bailey, R. Medical Liability Reform: The Good, The Bad and The Ugly. What’s Up in Emergency Medicine (June 2011). https://www.emra.org/content.aspx?id=583

 

Bailey, R. The Litigators Lions Pit: The Top 10 Medical Malpractice Issues Every Resident Should Know. What’s Up in Emergency Medicine (March 2011).

http://www.emra.org/content.aspx?id=597

Patient Sues Hospital, Nurse and EM Doctor for Malpractice for Being Left on a Bedpan Too Long

A patient in Louisiana filed a lawsuit for being left on a bedpan too long.  The patient arrived to the Emergency Room with a chief complaint of severe headache, dizziness, nausea and vomiting. At some point during his ER stay, the patient was given an enema, placed on a bedpan and then given medication that made him fall asleep.  Apparently he stayed on the bedpan for over 4 hours, subsequently developed swelling and pain of both lower extremities and was diagnosed with deep vein thrombosis of both lower extremities.

 

I am interested in finding more details about this case and also interested in following the arguments and ruling.  My biggest question, how would the doctor know that the patient has been stuck on the bedpan if he didn't place it there himself?

 

Barnett K. Man sues hospital that allegedly left him on bedpan for over four hours. The Louisiana Record. February 12, 2013. http://louisianarecord.com/news/249019-man-sues-hospital-who-allegedly-left-him-on-bedpan-for-over-four-hours

A Novel Approach to Medical Liability Reform, No-Fault Liability

I have written multiple articles on Medical Liability and its reform.  Another idea has been proposed, institution of a no-fault liability system. There is currently a proposal in the Florida legislature to create what they have named, a Patients’ Compensation System.  In this system, an injured patient would file a claim with the help of a patient advocate, a medical review department would research and review the claim, a fee schedule would be used to determine and recommend an amount for economic and non-economic damages.₁  If there was a dispute, a judge would determine whether law was appropriately applied. 

The proposed system would hypothetically be faster and also much cheaper than the current system.₂  It is also believed that by removing blame from the equation, physicians will be less likely to practice defensive medicine, which in turn would help lower cost of medical care by billions.  “If an effective no-fault PCS would be enacted, and assuming a slow change in physicians' defensive medicine behavior, first year savings for payors could be $1.5 billion; that number may grow to annual savings exceeding $16 billion when physicians have reduced their defensive medicine practices significantly.” ₃ 

Money that physicians currently pay for malpractice premiums would go towards funding the Patients’ Compensation System.

I think this is a very interesting system to help curb liability and health care costs, and more importantly, compensate injured patients faster.  I will be keeping a close watch on how this develops.

 

References

1.      Guglielmo, WJ. Movement to A No-Fault Liability System.  Medscape. September 13, 2012.  http://www.medscape.com/viewarticle/770384.  Accessed September 18, 2012.

2.      Latner, AW.  Florida Considers patient Compensation System.. The Clinical Advisor. February 21, 2012. http://www.clinicaladvisor.com/florida-considers-patient-compensation-system/article/228551/ Accessed September 18, 2012.

3.      Bioscience Valuation. The economics of defensive medicine and no-fault patients' compensation systems: Florida. July 6, 2012. http://www.patientsforfaircompensation.org/media/21160/bioscience-fl.pdf Accessed September 18, 2012.

Are Health Care Workers Ethically Obligated to Receive Influenza Vaccinations?

I recently wrote a post about a new law in Texas requiring health care facilities to require their employees to obtain vaccinations, including the influenza vaccination. The National Vaccine Advisory Committee also announced that health care facilities should consider requiring their employees to receive influenza vaccinations. 

 

I then came across a very interesting perspective.  An ethicist recently wrote an article about this topic, proposing that health care workers are ethically obligated to get the influenza vaccination.  I agree with his view point.  Influenza is a very communicable, but preventable disease.  Health care providers are susceptible to obtaining the virus from their patients, and passing it on to other patients.  By nature, we are also tempted, even feel obligated to work when ill (and still infectious).  We take an oath to do no harm to our patients, and one of the easiest ways to do so is to obtain vaccinations for communicable diseases.

 

 

A link to the article can be found here:

Why Hospital Workers Should be Forced to Get Flu Shots,

http://www.medscape.com/viewarticle/770383

New Law in Texas Requires Vaccination of Healthcare Providers

It has been well documented that unvaccinated health care workers have been implicated in hospital outbreaks of influenza.  A new law in Texas seeks to help reduce these outbreaks.  Starting September 1, health care facilities (hospitals, nursing homes, dialysis centers, ambulatory surgical centers, birthing centers, freestanding ERs) will be required to implement preventable disease immunization policies.

Health care workers can be exempt from the policy for health reasons, but they will have to take precautions if they have contact with patients (e.g., wear masks).

Hopefully implementation of this new law will aid in preventing the spread of vaccine-preventable diseases and help improve patient health and safety.

More information can be found in the August 2012 issue of Texas Medicine:

Code, C.  Lifesaving Shots.  Texas Medicine.  August 2012.