July 1st, 2008

Kings County Hospital. Women Dies in ER. And It’s On Video

The story doesn’t get much more appalling than this. Esmin Green — a troubled 49 year-old woman who is waiting in the psychiatric emergency room of Kings County Hospital for a bed — collapses onto the floor. After she had been waiting almost 24 hours. And then is ignored for an hour. And then dies.

And it’s caught on video:

There is little doubt in my mind that if this incident were not caught on film that the medical records would not only detail an altogether different story, but that those records would be hard to challenge. According to this story at the Huffington Post regarding the medical records, however, the records can be challenged. And that is because of the video, which shows she collapsed at 5:32 a.m. Notwithstanding that:

One notation said that at 6 a.m., she was “awake, up and about” and had just used the restroom. Another said that at 6:20 a.m., she was sitting quietly in the waiting room, and had a normal blood pressure. During both of those times, Green was either in her death throes or already dead.

The most disturbing part of this is that it is reminiscent of the infamous Kitty Genovese murder. Genovese was a 29 year-old New York woman who was repeatedly stabbed over a prolonged period of time, and while her screams were heard by many, there were no prompt reports to the police. The murder was the inspiration for the 911 emergency telephone system.

But here, we have actual employees inside an emergency room that fail to act. The most disturbing image, to me, is the security guard that rolls up in a chair and then rolls away. He couldn’t even be bothered to stand up to see what was going on.

Before this death, the hospital had already been sued after an investigation at the hospital “showed that Kings County psychiatric facilities are overcrowded and often dangerously unsanitary and that patients — including children and the physically disabled — are routinely ignored and abused” according to ABC News.

The fact that the attorneys here were able to get this videotape is remarkable. The incident happened, according to the story, on June 19th. That means that it was not procured through any new litigation. Because the quickest way to get pre-suit discovery in New York is through a separate action before a lawsuit is started to preserve evidence, brought on by Order to Show Cause. The judge would then order evidence preserved through a Temporary Restraining Order and then order a hearing. That takes time. Especially since there appear to be other patients in the video clip, and that brings on issues of privacy and HIPAA.

So the tape either came from prosecutors or health department investigators, or was possibly turned over as part of the prior litigation. But my guess is that it was probably leaked by a very angry employee of the hospital or security staff.

Kings County Hospital, by the way, is city-owned.

Also at:

The Medical Quack;
Kings County Hospital Lets Woman with Mental Illness Die (PsychCentral)

September 7th, 2007

NYC To Put Hospital Error Data Online

The New York City Health and Hospitals Corporation, which runs 11 city-owned hospitals, will start today to put data online on infection and death rates. The hospitals treat 1.3 million patients a year.

According to an article in the Metro section of today’s New York Times, the effort for greater transparency is driven by Mayor Michael Bloomberg as part of a public health initiative. It also comes due to an effort by the hospitals to improve patient safety. (See also, New York City Reports Lowest Number of Claims In 10 Years.)

This web site will allow the public to see, among other things, the overall death rate, the rate of deaths after heart attacks, preventable bloodstream infections and pneumonia cases.

The medical industry is not exactly known for its transparency when it comes to medical errors and poor outcomes. Which seems to put this initiative near the forefront of identifying, and hopefully treating, systemic problems within the institutions that have led to incalculable misery, death and medical malpractice lawsuits.

This initiative comes on the heels of the federal Centers for Disease Control and Prevention projecting that 1.7 million patients nationwide get infections each year during a hospital stay, and that of those, 99,000 would die. The centers estimate the cost of treating such infections at more than $30 billion a year.

It also comes on the heels of Medicare refusing to pay for the treatment of avoidable infections and other hospital-caused injuries. According to a Jacob Goldstein WSJ Health Blog posting earlier this week, with money on the line, hospitals have already responded by changing policies for the better.

All of which leads one to wonder: Is there a hospital health care revolution taking place?

More info at: The Committee to Reduce Infection Deaths

March 19th, 2007

Misdiagnosis Occurs In 15 To 20 Percent Of All Cases

Misdiagnosis occurs in 15 to 20 percent of all cases, according to a new book out by Dr. Jerome Groopman called “How Doctors Think.”

In an op-ed in today’s Boston Globe (The Mistakes Doctors Make) based on the book, Dr. Groopman writes:

Why do we as physicians miss the correct diagnosis? It turns out that the mistakes are rarely due to technical factors, like the laboratory mixing up the blood specimen of one patient and reporting another’s result. Nor is misdiagnosis usually due to a doctor’s lack of knowledge about what later is found to be the underlying disease.

Rather, most errors in diagnosis arise because of mistakes in thinking.

In the piece, he deconstructs how a tumor was missed for years in a woman who had just given birth.

The book is reviewed at this link to Time. The Time lead is for an overlooked tumor in an 8-year old. According to the review,

[Groopman] learned that about 80% of medical mistakes are the result of predictable mental traps, or cognitive errors, that bedevil all human beings. Only 20% are due to technical mishaps–mixed-up test results or hard-to-decipher handwriting–that typically loom larger in patients’ minds and on television shows.

The result of Groopman’s journey is How Doctors Think (Houghton Mifflin; 307 pages), an engagingly written book that is must reading for every physician who cares for patients and every patient who wishes to get the best care. Groopman says patients can prompt broader, sharper and less prejudiced thinking by asking doctors open-ended questions and learning to identify some of their common thinking mistakes.

While some have a knee-jerk reaction to the attorneys who initiate suit on behalf of patients injured by malpractice, it’s nice to know that some doctors are thinking about the actual problem. Because shooting the messenger, a time-honored way of changing the subject, is a lousy way of fixing a problem.

(Globe op-ed via David Williams at Health Business Blog)

Addendum 3/21/07 — Dr. Groopman on The Colbert Report.

December 15th, 2006

Are Electronic Health Records Coming Soon?

Often, medical malpractice occurs for the simplest of reasons: One health care practitioner did not effectively communicate a problem to another. And often, this is simply because of sloppy record keeping or illegible handwriting.

So it is worthy to note from this AP story last week, that the era of electronic medical records may well be here:

WASHINGTON – Five of the nation’s largest employers plan to soon give their workers an unusual health-care benefit: their very own electronic medical records that they can take when they travel, change jobs, or see a new doctor.

About 2.5 million workers and their dependents would have access to their health records through their computers. The records would be compiled by an independent, nonprofit organization. The information would be stored in a database that only the employee would supposedly be able to access.

The companies providing the electronic health records are Applied Materials Inc., BP America Inc., Intel Corp., Pitney Bowes Inc., and Wal-Mart Stores Inc.

The companies hope that cutting out the paperwork in health care will reduce administrative costs, duplicative care and medical errors.

Of course, this will raise another problem, that of privacy if too many folks can snoop through the records. But if that issue can be addressed, we may solve one of the many problems that bedevil our healthcare system.

Links to this post:

are electronic health records coming soon?
cross-posted from ny personal injury attorney blog. often, medical malpractice occurs for the simplest of reasons: one health care practitioner did not effectively communicate a problem to another. and often, this is simply because of …

posted by Eric Turkewitz @ December 20, 2006 12:32 PM

November 18th, 2006

Hospitals are not healthy

A recent op-ed in the New York Times reminds us again that a hospital is not just a good place to get better, but also a great place to get sick. That’s not being cute, but simply reminding us that about 100,000 people die each year from infections they acquire in the hospital. The author of the column, former lieutenant governor of New York Betsy McCaughey, points out that this is five times as many as die of AIDS in this country.

The killer bacteria are known as MRSA., or methicillin-resistant Staphylococcus aureus. MRSA, which by definition is resistant to antibiotics, increased in the United States by 32 times from 1976 to 2003, according to the Centers for Disease Control. While staph infections comprised only 2% percent of hospital infections in 1976, it is now 60 %.

Infections are carried from patient to patient due to sloppy institutional practices, as germs travel on gowns, gloves, bedrails, stethoscopes, wheelchairs and even blood pressure cuffs. Prevention comes in the form of testing people for the bacteria that causes the problem, and isolating those individuals. The cost of illness and death vastly outpaces the cost of testing.

The sad truth is that so many of these infections and deaths are preventable. Other developed nations, faced with rapid growth of the problem, have nearly eradicated it with testing.

Ms. McCaughey, who is also the founder of the Committee to Reduce Infection Deaths, writes:

Treating hospital infections costs an estimated $30.5 billion a year in the United States. Prevention, on the other hand, is inexpensive and requires no capital outlays. A pilot program at the University of Pittsburgh found that screening tests, gowns and other precautions cost only $35,000 a year, and saved more than $800,000 a year in infection costs. A review of similar cost analyses, published in The Lancet in September, concluded that M.R.S.A. screening increases hospital profits — as it saves lives.

The failure to take proper preventative measures is institutional malpractice, and has caused extraordinary suffering and loss. Must hospitals wait to be hit by juries with large liability awards before they change their conduct?