"A Remedy for Troubled Doctors"

Today's Wall Street Journal has a fascinating article about a California program that helps determine if physicians who have been disciplined can start practicing again.  The goal of PACE (Physician Assessment and Clinical Education Program) is "

to evaluate the competence of troubled doctors whose infractions range from serious medical error and negligence to sloppy record keeping and anger management. Using a mix of computer-based simulations, multiple-choice exams, cognitive-function screenings and hands-on observation, PACE faculty and staff tests doctors' knowledge, skills and judgment, providing remedial courses and a weeklong mini-residency supervised by UCSD medical faculty.

The article also states that

Harvard University patient-safety expert Lucian Leape estimates that as many as 10% of the nation's 750,000 physicians will demonstrate "significant deficiencies in knowledge or skills" at some point in their career. Combine that with other problems, including abusive behavior toward colleagues and patients, drug and alcohol dependency, stress-related mental-health issues and age-related cognitive decline, and at least a third of physicians will have a problem that poses a threat to safe patient care at one time or another, Dr. Leape says.

This sounds like an excellent program - one that is in the best interest of physicians and patients.

 

2009 Medical Malpractice Claims Report Released

The Tennessee Department of Commerce and Insurance has released the 2009 Medical Malpractice Claims Report.  Despite its title, the Report reveals data for calendar year 2008.

This is the fifth report issued by the Department and contains more different types of data than released in previous years because of a change in the reporting law.  Today I will report on some of the data and will address the balance in later posts.

In 2008, there were 3154 medical malpractice claims  closed in Tennessee.  (More than one "claim" can arise in a single case; a claim is defined as "a demand for money damages for injury or death caused by medical malpractice; or a voluntary indemnity payment for injury or death caused by medical malpractice.")  Of those claims 43 were resolved through ADR, 459 were resolved through settlement, 425 were resolved through judgment, and 2227 were otherwise resolved.

I do not understand the difference between those cases resolved by ADR and those resolved by settlement, given the difficulty settling any case without going through a mediation.  However,  the numbers appear to  tell us that  almost 70% (2227 out of 3154) of claims are dropped before suit is filed or by voluntary dismissal.  How do we know that?  Because we know the other 30% or so were settled or resulted in a judgment.

As indicated, 425 were resolved by the entry of a judgment.  How many were judgments for the plaintiff?  Five.  Just over one percent.  In other words, there were 420 claims resolved by judgment, and while the exact numbers are unreported it is reasonable to assume that many were resolved by summary judgment and a lesser amount by judgment for the defense after a trial.

The total amount of damages paid for the five cases in which a plaintiff received a judgment was $790,000, or just under $200,000 per claim.  The total damages received in the claims that were resolved by settlement or ADR was about  $118,500,00, or about $230,000 per claim.  

Payments of judgments were down over 90% from a year earlier.  Payments by settlement or ADR were about the same as they were in 2007.  

The largest reported judgment was $1,150,000.  Obviously, that judgment was not paid because it exceeds the total amount of damages paid for all judgments.  (if a case is settled post-judgment the amount is recorded as a settlement.)

There were 5,780 claims pending at the end of 2008.  

I will share more of the data contained in the Report in a later post.

 

HealthGrades Sixth Annual Patient Safety in American Hospitals Study

HeathGrades studies Medicare patient care in our nation's hospitals based on 15 indicators of patient safety.   

Here are some highlights from the 2009 report representing data from 2005 -2007:

· There were 913,215 total patient safety events among 864,765 Medicare beneficiarieswhich represents 2.3 percent of the nearly 38 million Medicare hospitalizations.

· These patient safety events were associated with over $6.9 billion of excess cost.

· The overall incidence rate remained virtually unchanged compared to last year’s study(except the failure to rescue indicator for which there were major methodological changes).

· Eight indicators showed improvement over the course of the study.  Complications of anesthesia, death in low mortality DRGs, failure to rescue, iatrogenic pneumothorax, selected infections due to medical care, post-operative hip fracture, postoperativehemorrhage or hematoma, and transfusion reaction showed improvementranging from 2.3 percent to 52.0 percent.These eight indicators accounted for 14.5 percent of the total patient safety eventsduring the study period.

· Seven indicators worsened over the course of the study. Decubitus ulcer (bed sores), post-operative physiological and metabolic derangements,post-operative respiratory failure, post-operative pulmonary embolism (potentially fatalblood clots forming in the lungs) or deep vein thrombosis (blood clots in the legs), postoperativesepsis, post-operative abdominal wound dehiscence, and accidental punctureor laceration all worsened with changes ranging from a one-percent increase in events to23.4 percent.These seven indicators accounted for 85.5 percent of the total patient safety eventsduring the study period.

Other interesting data:

· There were 97.755 actual inhospital deaths that occurred among patients who experienced one or more of the 15 patient safety events.

· 92,882 of these deaths could be directly attributable to a patient safety event.

· Hospitals that had received a Patient Safety Excellence Award had a 43% lower risk of experiencing patient safety incidents.

· If all hospitals had performed at the same level as the award winners, 22,771 deaths could have potentially been avoided and $2.0 billion would have been saved.

· Award winners in Tennessee are Baptist Riverside, Cenntennial, Memorial (Chattanooga), Northcrest (Springfield), St. Thomas, Vanderbilt and Williamson Medical Center.

Medical Research, Anyone?

Here is a list of medical sites created by  from Exposing Deceptive Defense Doctors by Dorothy Sims as posted here.

 

*www.nlm.nih.gov/

This is the National Library of Medicine/National Institutes of Health, with a great search site.

* www.guidelines.gov/
This is an extremely useful website. It has hundreds of protocols on how to perform procedures, and is very good for use in research if you intend to cross-examine a specialist or get involved in a medical malpractice case.

* www.pubmed.com/
This free website allows you to search extensive medical databases for abstracts of articles by subject or author.

* www.mdconsult.com
This is a pay website, which frequently provides the entire medical journal article (rather than an abstract, as provided by www.pubmed.com).

* www.mdinabox.com/links.php#medical
This is a links page from mdinabox, which gives you good links to medical subspecialties and federal research links, as well.

* www.almexperts.com/ExpertWitness/experts_and_consultants/index.html
This website provides information, including CVs, about experts all over the world. Check out the DME and verify his CV before the deposition.

* www.abms.org/
This site is the American Board of Medical Specialties. Use it to verify the defense witness’s board certification.

Medical Websites by Subspecialty:

American Board of Medical Specialties: www.abms.org

Anesthesiology: www.asahq.org

Cardiology: www.acc.org; www.asecho.org; www.americanheart.org

Chiropractic: www.amerchiro.org; www.accoweb.org; www.nysca.com

Emergency Services: www.aaem.org; www.abem.org; www.acep.org

Endocrinology: www.aace.com; www.diabetes.org; www.endo-society.org

Gastroenterology/Liver: www.acg.gi.org; www.gastro.org; www.asge.org; www.sgna.org; www.liverfoundation.org

General Medicine: www.aafp.com; www.abms.org; www.ama-assn.org; www.aamc.org; www.nysafp.org; www.nycms.org

Hematology: www.hematology.org

Iatrogenic Injuries: www.iatrogenic.org

Immunology: www.ashi-hla.org; www.aaaai.org

Infectious Disease: www.cdc.gov/ncidod/
id_links.htm
; www.amm.co.uk/html/public.htm

Internal Medicine: www.acponline.org; www.abim.org; www.sgim.org

Obstetrics/Gynecology: www.acog.org; www.abog.org; www.accesspub.com/tempobg/soc/socm.htm

Midwifery: www.acnm.org

Neurology: www.stroke.org; www.aan.com; www.neuroguide.com; www.ninds.nih.gov/disorders/stroke/stroke.htm

Oncology: www.asco.org; www.cancernet.nci.nih.gov; www.oncolink.upenn.edu

Opthamology: www.eyenet.org; www.ascrs.org; www.asoprs.org; www.glaucoma-foundation.org

Optometry: www.aaopt.org, www.aoanet.org

Orthopedics: www.aaos.org, www.sportsmed.org

Pediatrics: www.aap.org

Pharmacy: www.aphanet.org

Physical Medicine: www.aapmr.org

Physical Therapy: www.aaptnet.org; www.apta.org; www.nationalrehab.org

Physiology: www.faseb.org

Plastic Surgery: www.plasticsurgery.org

Podiatry: www.apma.org; www.footandankle.com/podmed/

Preventative Medicine: www.acpm.org

Psychiatry: www.abpn.com; www.psych.org

Pulmonology: www.lungusa.org; www.aarc.org; www.chestnet.org; www.thoracic.org

Radiology: www.asrt.org; www.rsna.org; www.acr.org

Rheumatology: www.rheumatology.org; www.arthritis.org

 

Thanks Dorothy.