Medical-Legal News

A family who sued for medical malpractice in which UPMC Presbyterian was accused of covering up some of the events of a death at the hospital in 2009 was settled without a trial for $1.37 million.

According to the Post-Gazette, the deceased was admitted to the hospital with what was diagnosed as an easily treatable amount of bleeding on the brain. The family accused UPMC officials of manipulating the deceased’s electronic health record to cover up the circumstances that led to his death.

Lawyers and advocates commented on the settlement as unfairly protecting the four doctors named in the case.  Three days after the family signed settlement documents on January 17, 2012, UPMC asked, and the family didn't oppose, a request to remove the four doctors as defendants in the case. When the case was finally settled the only named defendant, and the only one that officially paid any money, was UPMC Presbyterian hospital.  A UPMC spokesman said the four doctors were dismissed because "the issue in that case was not due to the actions of any one physician."

The family was not allowed to talk about the case because of a confidentiality clause in the settlement. The patient or the patient's family often do not care who is named in a malpractice action as long as they get fair terms in a settlement.

According to a Pittsburg medical malpractice attorney who represents patients and their families: "If a case is settled under the doctor's name, it has to be reported to the National Practitioner Data Bank."   Dismissing doctors as defendants may be a way for the hospital to protect the physician from discipline, or hiring assessment based on prior malpractice claims.

The American Medical Association (AMA), an organization representing physicians, does not believe filing settlements to the data bank would helpful for evaluating physician competence or quality:  "The relevance of medical liability settlements is questionable, as there is no evidence that an act of negligence occurred," according to president of the AMA.

Since physicians are a hospital’s main revenue generators so they may be willing to let the doctors be dismissed to keep the doctors happy, according to a Pittsburgh attorney who represents patients in medical malpractice cases.

State medical boards delay in communicating doctor troubles across state lines, allowing many physicians to practice while facing serious charges.  An example is Dr. Gerard Dileo.

In 2008, Louisiana Board of Medical Examiners investigators said Dr. Gerard Dileo was prescribing pain pills without fully examining patients. Allegedly, in some instances, he used computer-generated clinic notes and prescriptions that were created two weeks in advance of seeing the patient.  His license was put on hold for 5 years, and he was prohibited from practicing pain management.  However, he continued to work as an obstetrician/gynecologist and University of South Florida assistant professor.

In 2009, medical boards in California and Florida disciplined Dileo for his Louisiana violations.  Yet, he remained at University of South Florida because the university was not notified by medical boards.  Some at the university knew of his troubles in California and Florida, but   University of South Florida does not track whether any of its health faculty have been similarly disciplined.

In September 2010, Dileo was indicted on federal prescription drug (including oxycodone and hydrocodone) and money-laundering charges. However, he stayed at University of South Florida another five months. 

In November 2010, Dileo was convicted, and he lost his Florida medical license.  University of South Florida leaders learned of Dileo’s arrest through the media, and gave him 30 days’ notice.  He had no patient complaints or Florida malpractice suits. 

Dileo could face up to 40 years in prison, plus fines of at least $1 million.  He arrived at University of South Florida as OBGYN in 2006, and became an assistant clinical professor in 2007.   When he arrived  at the university, he had never been disciplined by a professional organization.  He went on to lead the OBGYN’s department's division of chronic pelvic pain.

In May 2012, Robert Wood Johnson Foundation (RWJF), NPR, and Harvard School of Public Health published results of a poll on Americans’ views on costs and quality of medical care.

Americans are concerned about the financial costs of medical care, and struggle to ensure appropriate care, according to a poll. RWJF commissioned the poll to understand Americans’ attitudes on costs and quality of medical care in the US.

Eighty-seven percent of the general public believes the cost is a problem.  Sixty-five percent of believes cost has gotten worst in the past five years.

The poll examined sick Americans’ experiences. “Sick Americans” are those who said they had a serious illness, medical condition, injury, or disability requiring a lot of medical care or who had been hospitalized overnight in the last 12 months.  Many of these sick Americans, especially those who did not have insurance, reported having problems accessing care due to cost.

According to the study, though the cost of healthcare affected people’s finances, the quality was not always satisfactory.  Thirty percent hospitalized Americans say there was poor communication among the doctors, nurses and other health care professionals.  Some of these persons wanted doctors to discuss long term health issues.  About eighteen percent sick Americans thought they did not get the tests they thought they needed.  Fifteen percent of sick Americans were tested or treated for something they thought unnecessary.

The poll was designed by researchers at the Harvard School of Public Health with a representative national sample of 1,508 adults age 18 and over.  

Patients are being readmitted to hospitals because poor planning and revenue pressures drive them home too early, according to logistical studies conducted by researchers at the University of Maryland's Robert H. Smith School of Business.

The studies indicate a correlation between how full a hospital is at time of discharge, and readmission rates.  Surgeons and hospitals are revenue-driven to perform as many surgical procedures as feasible.  The research conclusions suggest patients went home too early:  "Discharge decisions are made with bed-capacity constraints in mind," says a University of Maryland Professor with the Smith School's France-Merrick Chair in Management Science, who conducted the research with a Ph.D. student and other colleagues.

Poor planning sent the patients home before they were healthy enough to leave, and then later they had to be readmitted.  The studies appear in two issues of the peer-reviewed journal Health Care Management Science:

• "The impact of hospital utilization on patient readmission rate"   
• "Examining the discharge practices of surgeons at a large medical center"

In the studies, researchers tracked patient movement, occupancy rates, day of the week, discharge data, staffing levels, and surgical volume.  Researchers discovered patients discharged when a hospital was busiest were 50 percent more likely to return for treatment within three days. Recovery was possibly incomplete when patients were first released.

Maintaining revenue and earning a livelihood may put pressure on surgeons and hospitals when there are not enough beds.

Checklists for discharging patients may be a way to prevent patients from going home too early. 

According to computing.co.uk, doctors abroad are embracing technology to provide patients with remote monitoring.  In 2011, Britain's Department of Health indicated it wanted to install remote patient monitoring such as cameras and online reporting in the homes of 3 million patients.

A study by the Whole System Demonstrator program found that remote monitoring reduced mortality rates by 45 percent.  The study took over three years and covered nearly 6,200 patients in three cities suffering from one of these conditions: diabetes, heart failure or chronic obstructive pulmonary disease (COPD).  Other results on the value of telehealth:

•    Cut emergency visits by 15 percent;
•    Reduced emergency admissions by 20 percent;
•    Decreased elective admissions by 14 percent;
•    Reduced bed days by 14 percent.

A recent Harvard Business Review blog post by a professor of International Business at the Tuck School of Business at Dartmouth College also attempted to persuade the US to get into telemedicine.  The professor cited a study of telemedicine at Lazarus Hospital in India that adopted telemedicine to treat patients with end stage renal disease. For rural patients, the hospital used peritoneal dialysis, performed in patients' homes, rather than hemodialysis, provided at the hospital and which may be more expensive, and requires the patients to travel for treatment.  Using telemedicine tools, the hospital cut the costs of treatment 90 percent, and the rural patients had better survival rates.

The professor at Dartmouth College alleged doctors in the US may not be using telemedicine or embracing technology as much as other professions because they get better reimbursement for non-telehealth care methods.  The cost of healthcare in the US is more than many other countries, due to the reimbursement structure, which may affect the type of care doctors provide patients.

Physicians are embracing technology in their operations according to a survey by ON24 and MedData Group.  Almost 85 percent of 971 doctors surveyed preferred to participate in continuing medical education (CME) online.

Around 96.1 percent of the doctors surveyed by ON24 and MedData Group, from various specialties, saw the benefit of technology, such as the convenience and avoiding travel.  According to the President and CEO of MedData Group:  "The results of the survey point to wider adoption and more meaningful use of online training anytime, anywhere."

With travel costs factored in, some CME have become so expensive that hospitals assist doctors out with their CME costs, according to American Medical News.  A similar study published in 2010 concluded that half of all CME would be online by 2016.

The CME study mirrors other evidence that doctors are starting to turn to technology for many uses, including research, communication, and patient care. A recent survey by Kalorama Information discovered that the market for hand held devices "exploded" as doctors turn to them to input patient data.  Previously, AMFS reported in Kaiser Electronic Medical Record System that use of technology is enabling physicians to provide more convenient support to patients and caregivers.

The Boston Globe reported that health officials at three Massachusetts hospitals were cited in April 2012 for wrongly turning away emergency room patients.  ER crowding did not apparently play a role in the three cases according to the news article.

In one case, the patient died en route to another facility.  With this patient, caregivers at Charlton Memorial Hospital in Fall River failed to give necessary medical treatment before transferring the patient, who was not stable and in respiratory distress, state investigators concluded, according to the news article.

In another case at St. Vincent Hospital in Worcester, MA an on-call surgeon refused to go in late at night to perform an emergency operation on a patient with flesh-eating bacteria, investigators discovered.

In a third case, a patient at Lahey Clinic was escorted off the hospital's property. Without any evaluation or treatment, the patient was banned from the emergency room.

Hospitals that violate federal rules such as the Emergency Medical Treatment & Labor Act, making sure there is public access to emergency services, can face sanctions, or risk losing their right to treat Medicare and Medicaid patients.  Charlton Memorial Hospital in Fall River, MA, St. Vincent Hospital in Worcester, MA, and Lahey Clinic in Burlington, MA have been told they will not lose their Medicare contracts, but they could be fined for turning away emergency room patients.  The Boston Globe obtained copies of the state investigative reports through a Freedom of Information request. In all three cases, the Boston branch chief of the Centers for Medicare & Medicaid Services, wrote letters to the hospitals stating he would not end their Medicare provider agreements because they “implemented corrective action that has been effective over the longer term.’’ He stated he referred the cases to the Office of the Inspector General for possible fines.

A study shows patients prefer to have immediate access to their radiology test reports, even when the findings may be hard to understand, according to Wake Forest Baptist Medical Center.  The study was published in the Journal of the American College of Radiology.

The study covered just 53 respondents, but the findings were consistent.  Eighty percent stated they would prefer to receive the test findings through an online portal, versus a telephone call or in-person consultation from or with a physician or nurse.  Approximately half (53 percent) of the people surveyed desired prompt access and another 23 percent stated they desired access within three days, according to the study.

The Department of Health and Human Services (HHS) proposed a rule proposed in 2011, allowing patients across the United States to obtain their test results directly from laboratories. The access to test results is designed to bypass laws in several states that require patients to get the data from their doctors.

In the Wake Forest study, researchers questioned respondents about three radiologic scenarios. The first scenario was a patient with headaches whose head CT was normal except for minor sinusitis. The second situation was a patient with double vision. This person’s MRI showed multiple brain lesions from an unknown cause. The third scenario was a patient with back pain and right leg weakness whose MRI indicated potential cancer compressing spinal nerves, according to Wake Forest.

Yet not all doctors want to give up their part in conveying test findings to patients. Doctors worry patients won't understand or may misinterpret the complex reports.

Study participants showed they realized they might not understand everything in a report, and planned to look for more information from the Internet, friends, medical resources, and doctors.

The authors of the study noted patients were more willing to use reliable Internet tools suggested by their doctors. Ninety percent of participants accessed the online resources recommended by their physicians, according to CMIO.

Wake Forest conducted the research because its developing a patient portal to provide three-day access to patient results.

Following a patient safety investigation of Saint Catherine Medical Center, owner Saint Catherine's Hospital of Pennsylvania filed for Chapter 11 bankruptcy in April 2012, the Republican Herald reported.

The state health department in March 2012 conducted a visit to the Ashland, PA hospital and discovered patient violations, including a lack of surgical gloves, needles, syringes, and medicated soap.  There was also faulty X-ray equipment. The health department declared St. Catherine Medical Center promptly shut down outpatient services and emergency room.

With tight finances, Saint Catherine Medical Center, Saint Catherine Regional Hospital and Saint Catherine Healthcare in March 2012 were ordered to pay a $168,760 judgment to Lease Associates, HealthLeaders Media reported.  At the same time, PPL Electric Utilities filed a lawsuit.

The American Federation of State, County and Municipal Employees, District Council 89, AFL-CIO are claiming wages and benefits.  The workers noticed problems regarding getting paid on time: "Our pays started to become late, and two weeks later, our pays didn't happen - and still hasn't happened," said one worker.

A government-appointed trustee will reorganize the failing medical facility, the Republican Herald noted.  Chapter 11 allows a business to reorganize corporate facilities so that the corporation continues.

Computerized geographic information systems (GIS) can assist to analyze trends associated with childhood obesity and perhaps become an invaluable tool in prevention efforts, according to studies published in April 2012 in the American Journal of Preventive Medicine.

GIS is a type of mapping technology.  The technology was used in Seattle, WA and San Diego, CA to assist in determining a child's environment and how it contributes to the possibility of obesity based on "playability" and "proximity to health food." The mapping technology measured how many playgrounds and parks were within walking distance in several neighborhoods and the number of grocery stores and fast-food eating places to rate the locations’ nutritional and physical health advantages.

GIS data allowed examination of the effects of physical activity and nutrition measures of an environment, which are thought to represent the most important dimensions of obesogenic environments for young people.

An essay accompanying the studies explained that GIS creates a "visual representation" of connections between people and their environments. GIS breaks down layers of geographic information, and allows for the simultaneous evaluation of multiple variables and their interactions.