Posts Tagged ‘medication error’

Do You See What I See? by Pat Iyer

Monday, June 14th, 2010

From behind, the group of people walking in front of me through Newark Airport last week looked like a family. There was an older woman, a young couple, and a baby being pushed in the stroller. I filled in: grandmother, husband and wife and child. Then I took a closer look. The first detail I noticed was the older woman. She was in her early 50s. Her hair was cut in a punk style. The top half was dyed a deep purple. The next layer has dyed peacock blue. The bottom layer was a natural brown. She wore a black and white horizontal striped jacket over a white billowy dress. She had on black and white flower pattern leggings. Around her upper right arm was a wide tattoo.

The “husband” was Caucasian. The woman pushing the baby was Asian. The child looked to be full blooded Asian. After studying this unusual group, I realized how quickly I made assumptions. I assumed without thinking that they were a family. (And maybe they were – but maybe they weren’t.) Then I filled in other ideas, and speculated about their relationship, but all I was left with was questions.

How quickly do we jump to conclusions? In the medical legal arena, how often do we reach unfounded conclusions about the defendant? The plaintiff? The public may believe people who sue for medical malpractice are primarily interested in money. Read Sorrel King’s book, Josie’s Story, about the medical error that cost her 18-year-old daughter her life. In the book, Sorrel wrote that her attorney brought legal documents from Johns Hopkins, where the error occurred. “There it was: the settlement offer. It was a concept that was difficult to comprehend – money for the death of our daughter. The concept of us accepting it was almost as appalling as them offering it. We didn’t want their money and felt that by accepting it we would be letting them off the hook. We didn’t want it to be so easy for them.”

When their attorney asked them what they did want, Sorrel said, “I wanted them to remember Josie, to learn something from her and to never let this happen again. I want every hospital in the country to know her name and why she died. I want them all to learn something”’, I said angrily. Her attorney replied, “‘Then do that. Do that with the settlement money. If you leave this money, it will just get sucked up in a black hole. Take the money and do something good. Do something for Josie. You can make this more than a sad story for the media to cover. You can create something much more.” The King family took their settlement check and funded patient safety efforts in the hospital in which their daughter died, and has been instrumental in improving safety in other hospitals throughout the world.

Look at your conclusions. Are they founded on information or insufficient data? How often do we go through a situation assuming we understand it, only to realize a fact that changes all of our conclusions? I recently worked on a large case involving a girl who was in a motor vehicle accident. Her attending physician documented she was intoxicated at the time she came into the emergency department. I got three quarters of the way through 10 three binders before I saw a letter from her attending physician admitting he was given misinformation and the girl had a zero blood alcohol level.

Question your assumptions. Get more data. Ask questions.

[Post to Twitter]  [Post to Yahoo Buzz]  [Post to Delicious]  [Post to Digg]  [Post to Reddit]  [Post to StumbleUpon]  What are these?

Tags: , , , , ,
Posted in Damages, Medical malpractice, Nursing malpractice, Personal observations, medical errors | No Comments »

The Fifth Element of a Medical Malpractice Case by Pat Iyer

Monday, October 19th, 2009
A near fatal overdose of Insulin

A near fatal overdose of Insulin

Linda (name changed) was admitted to an inner city hospital due to leg pain. She wandered through the hospital, searching for something. When she came upon an unlocked medication cart sitting in the hallway, she found it. She took a syringe, a bottle of Insulin, and a bottle of Lasix (reduces swelling) and injected herself with the contents of both bottles. Linda was a substance abuser, but it remains a mystery to this day why she injected herself with these medications. Within hours her blood sugar plummeted and she had a seizure.

After Linda’s acute care was over, it was clear that she suffered brain damage as a result of the drop in blood sugar. Her attorney filed suit against the hospital; his expert (me) opined that it was a deviation from the standard of care to not provide closer monitoring of this young woman. It was a deviation from the standard of care and against hospital policy to leave a medication cart unlocked.

Selecting a jury was tough. The jurors were asked this question: “Do you believe that a person with substance abuse is entitled to the same quality of care as someone who is not abusing drugs?” It took two days to find eight people who could say “yes”. I spent an entire day on the witness stand as each of the defendant’s attorneys cross examined me.  I was told by my client that I did well.  During one of the breaks, I met Linda in the ladies room. She was having trouble getting her clothes adjusted and tried to put her underpants on over her skirt. As a result of her brain damage, her mother had to care for Linda and her daughter; Linda had become easier to control and was on a Methadone program.

The jury came back with a verdict on behalf of the defendants. The plaintiff’s attorney concluded that the jury could not bring themselves to place money in the hands of a substance abuser. They may have also blamed her for what occurred. (Jurors are not allowed to be interviewed after trial in this state so it remains unclear why they came to that decision.)

I’ve recently learned this was the first and last medical malpractice case this attorney tried. Would a more experienced attorney have taken the case?

In order to successfully win a medical malpractice case, a plaintiff has to prove four elements.  (The plaintiff may be in the patient if he or she is alive and capable of filing suit, if not, the plaintiff might be a family member or other entity.)

1. The healthcare provider had a duty to give care to the patient (Duty)
2. The provider did not deliver care according to what the reasonably prudent person would have done in the same situation. (Breach)
3. There were damages or injuries to the patient. (Damages)
4. The failure to deliver care according to the standards of care was the direct cause of the damages (Causation)

The quality of the patient is the unofficial fifth element in a medical malpractice case. I have heard attorneys describe the ideal plaintiff as a person you would enjoy sitting next to in an airplane on a cross country flight. “She’s a church organist”, I’ve been told by an attorney who described a wonderful person. “He and his wife are really nice people”, another attorney said. Conversely, attorneys are hesitant to take a case involving someone who is in prison*, has an intravenous substance abuse history, or in some significant way radically deviates from the norm. The harder it will be for the jury to empathize with the plaintiff, the harder it will be for them to award money. Savvy plaintiff’s attorneys carefully evaluate the background, demeanor, personality and habits of potential plaintiffs. It is better to put the plaintiff on trial before the jury does.

* An exception may be made for people jailed for minor offenses who are the victims of neglect in jail
.
For more on this topic, see Cultural Competence and Attorneys and How is the Economy Affecting Jurors.

[Post to Twitter]  [Post to Yahoo Buzz]  [Post to Delicious]  [Post to Digg]  [Post to Reddit]  [Post to StumbleUpon]  What are these?

Tags: , , , ,
Posted in Damages, Expert witness, Medical malpractice, Trial lawyer skills, medical errors | No Comments »

How a medical malpractice suit can make a difference by Pat Iyer

Thursday, September 10th, 2009
The story of Josie King

The story of Josie King

Why do people file medical malpractice suits? One reason is to get answers about what happened to result in the injury. Another is to prevent the same thing from happening to another person. Although risk managers, practitioners, and administrators may make changes after a bad outcome has occurred, it is not often that the plaintiff gets the satisfaction of knowing that. It is even rarer the terms of a settlement to solidify a plan to share the details of a medical tragedy.

A recent Oregon case shows the power of sharing a lesson that will protect other patients. The plaintiff was an 8-month-old infant who entered a hospital for removal of a cyst that extended through his nose to his brain. The surgery was without complications. After surgery, the infant had fevers, pneumonia, and showed signs of a possible cerebral spinal fluid leak. The discharging physician was a first year resident; the attending neurosurgeon did not see the infant on the day he was discharged. Eight hours after discharge, the infant was taken to the emergency department of another hospital because he was vomiting and lethargic. The emergency department physician called the defendant hospital and was advised that the infant was probably having a medication reaction. The parents returned eleven hours later, when their child was profoundly ill. There was no clear evidence of a systemic infection and possible brain damage.

The infant was emergently transported back to the defendant hospital. He was diagnosed with meningitis, brain damage, and organ failure and suffered a stroke. He requires a ventilator twelve to twenty hours a day, is tube fed, and without effective use of his legs or left arm. He is profoundly developmentally delayed and does not talk. A $12.2 million settlement was reached. The hospital also committed to use the case as a teaching example for its residents for the next ten years and to provide certification of this to the plaintiff’s parents each year from the president of the university.

Source: Lewis Laska, “Infant discharged following brain surgery without being seen by anyone other than junior resident”, Medical Malpractice Verdicts, Settlements, and Experts, February 2009, page 19

The power of sharing the lessons learned from a tragedy of this nature is huge. Unfortunately, it is rare for plaintiffs to achieve this kind of gain. I can think of another case – one we handled at Med League-in which this occurred. I was involved in a Philadelphia case of a young man who developed leg pain and shortness of breath on the day of discharge. The nurse did not inform the physicians, and the man was discharged via telephone order. He collapsed at home and died from a pulmonary embolism. As part of the settlement, the hospital made a policy that a patient had to be seen in person on the day of discharge. They also agreed to use this case in teaching each group of interns and residents.

Anyone not familiar with the story of Josie King, an 18-month-old child who died as a result of medication error, should visit the Josie King Foundation . I heard Sorrel King, Josie’s mother, talk three years ago. Her story lingers. Sorrel took the settlement money provided by Johns Hopkins, the hospital where the incident occurred, and put it back into patient safety efforts. Her work has saved lives of people all over the world. A new book pictured above, has just been released, which describes her crusade.

The key to educate, change, and inspire healthcare professionals with lessons learned so that deaths and injuries make a difference in daily practice.

[Post to Twitter]  [Post to Yahoo Buzz]  [Post to Delicious]  [Post to Digg]  [Post to Reddit]  [Post to StumbleUpon]  What are these?

Tags: , , ,
Posted in Damages, Healthcare Risk Management, Medical malpractice, Medication errors, Nursing malpractice, Patient safety | No Comments »

What Nurses Think: Patient Safety by Pat Iyer

Monday, June 1st, 2009

2008-09-15

What change in healthcare would lead to the greatest improvement in patient safety? A survey of nurses found these answers:

Mandated staffing ratios: 48.2%
Better communication between nurses and doctors: 29.3%
Electronic medical records: 14.2%
Automated medication administration: 8.3%
Source of study: Advance for Nurses, December 22, 2008

Implications for the attorney/legal nurse consultant: When investigating a nursing malpractice case, ask about mandated staffing ratios. Were there any? How many patients were assigned to the nurse at the time of the incident? Was there a persistent pattern of understaffing? Ask for the staffing sheets and have your expert review them to see if they conformed to industry standards.

According to the Joint Commission’s study of sentinel events/medical errors, communication is the number one factor that results in sentinel events. Miscommunication may occur due to fatigue,  distraction, misunderstandings, accents, failure to communicate, hierarchical issues, not having English as a primary language, bullying, and a host of other factors. These factors should be explored to see if and how they contributed to an untoward outcome.

Electronic medical records are coming- but slowly. They improve efficiency and access to information, which may increase patient safety. But there are privacy, security and confidentiality issues that raise concerns among patients and providers. Computerized medical records carry significant cost and operational issues that are major challenges within health care. At a recent meeting of the American Society of Healthcare Risk Management, many of the risk managers told me they were concerned about the quality of information provided by computerized medical records. Critical information about an incident was not always captured by the records, making it difficult to reconstruct what had occurred. Computerized medical records are an improvement over handwritten records, but many agree they are not a panacea. We’ll never eliminate the need for a thoughtful healthcare provider at the other end of the monitor.

The survey results that identify “automated medication administration” as a patient safety feature may refer to one of two patient safety innovations:

  1. The use of an automatic drug dispensing cart, which contains medications in a series of cubicles.
  2. The use of bar codes to identify the correct patient to make sure there is a match with the right drug, dose, time and route of administration.

Although neither of these innovations is fool-proof (or immune from attempts to “work-around” these safety features), both of these innovations have been associated with improved safety in medication administration.

What do you think? What can nurses do to make patient care safer?

[Post to Twitter]  [Post to Yahoo Buzz]  [Post to Delicious]  [Post to Digg]  [Post to Reddit]  [Post to StumbleUpon]  What are these?

Tags: , , ,
Posted in Communication skills, Joint Commission, Legal nurse consulting | 2 Comments »