The contrast between these two screw-ups couldn’t be more striking. In one hospital, a patient dies in an emergency room and the staff tries to cover up the depth of their negligence by doctoring her medical records. And in the other, wrong site surgery results in an apology to the patient, an email to the entire staff and a blog posting to the world.

I covered the first case last week, when a woman was videotaped in the emergency room of Kings County Hospital collapsing and dying while being ignored for an hour. Half an hour after she collapsed, and while the security camera recorded her on the ground, some genius wrote in her medical chart that she was “awake, up and about” and had just used the restroom.

And now we have the polar opposite, courtesy of Paul Levy, the President and CEO of Beth Israel Deaconess Medical Center in Boston at his blog Running A Hospital. Mr. Levy lays out the circumstances of what happened. While he leaves out the details that might identify the patient, he spares nothing in the analysis of how the hospital reacted.

The hospital sent out a detailed memo to the staff last Thursday about the incident, which was subsequently picked up by White Coat Notes, the Boston Globe’s medical blog. The memo details how the surgeon was “distracted by thoughts of how best to approach the case” on a hectic day and operated on the wrong side of the body.

The original memo was blunt:

This week at BIDMC, a patient was harmed when something happened that never should happen: A procedure was performed on the wrong body part. With the support of all our Chiefs of service, we are sharing this information with the whole organization because there are lessons here for all of us.

As we all know, the cover-up is almost always worse than the initial incident. Any student of political scandals knows that. But the same holds true in the field of medical malpractice. The notes in the chart that cover-up the malpractice tend to infuriate juries. A forthcoming acknowledgement of a mistake and an apology would not be treated the same way.

So what does Mr. Levy want to do now? Check this out:

While we explore lots of ideas, one already in my mind and that of this Board member would be to make a video with the actual people — doctors, nurses, surgical techs — who were in the OR at the time to explain what they saw and felt and what they learned from the experience. While they might be in too much distress to do this right now, they might agree over time, and their doing so would create a powerful message at every orientation, at nurses and departmental meetings, and conferences. Of course, if the patient would agree to participate, that would lend even more power to the story.

This type of conduct is simply unheard of from my view in the medical malpractice world. I’ve taken testimony from hundreds of doctors. Exactly one has acknowledged that he made a mistake. Mr. Levy seems hell bent here to destroy the White Coat of Silence that exists widely through the medical community. (See also: How Medical Malpractice Gets Covered Up)

If more hospitals and doctors acknowledged mistakes and sought to learn from them — as Beth Israel Deaconess is doing — it would probably go a long way to putting medical malpractice attorneys out of business. And the reason is really quite simple, and human. Worse than being injured by negligence is adding insult to the injury by covering it up. It is anger that most often causes potential litigants to call medical malpractice attorneys. And that is why many medical practitioners are being encouraged to say they are sorry when such mistakes occur. (Addendum, see also, Why Patients Call Lawyers)

There are some folks that will never learn and will continue to cover up. But there are some folks, like Paul Levy, that seemed determined to make that type of conduct a thing of the past.

See also:

• Surgeon operates on patient’s wrong side (Medical Quack)
• Beth Israel medical teams to take more time outs (Universal Hub)

Updated with more links (and a ton of comments at the original source):

• The Right Lessons From Wrong-Site Surgery (A Healthy Blog)
• A Lesson From Tom (Follow-up to the original post at Running a Hospital)

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)