A 10-year-old who had to have a kidney transplant after mistakes by doctors at a private hospital left him in renal failure, has today been awarded £4.8 million in compensation.
Lucas Tuppeny was born in January 2004 with a bowel defect, and required a colostomy, Judge Richard Parkes heard at London's High Court.
A series of errors by medical staff at the Bupa Cromwell Hospital in Kensington, London, resulted in Lucas suffering renal failure.
It left the youngster needing dialysis from the age of six months.
In October 2005 he received a kidney from his father, Brock, who works in the oil industry.
Lucas, who lived in Ruislip, Middlesex, at the time but is now settled with his mother, Therese, in Seattle, in the U.S., has had 28 procedures with a total of 149 days in hospital.
And he will need another transplant in the future, the court heard.
In spite of his problems, Lucas is an 'enthusiastic, optimistic, energetic and very sociable little boy', Christopher Johnston QC said.
Asked how he was feeling by the judge, Lucas stood and said 'Good, your Lordship', adding he would be having a holiday in the Bahamas before going back to school.
The judge, who approved the settlement against the hospital, which admitted liability, said: 'I am delighted to hear it.
'It is lovely to see you and I would just like to wish you all the best for the future.
'You are very lucky in your mum and your dad.'
Both the judge and the hospital's counsel, Jeremy Hyam, paid tribute to the outstanding care shown by Lucas's mother.
The judge, who had seen a video about Lucas, told Mrs Tuppeny: 'What extraordinary devotion you have lavished on your son throughout these difficult years.
'I don't think anyone on the outside would know what is involved.
'One can only watch with huge respect what you and indeed your former husband have done.
'Having seen the video makes one realise what a splendid young man Lucas is and what potential he has, thanks to you.'
Alison Eddy, a partner with lawyers Irwin Mitchell, said outside court: 'It is a huge relief for his family that the hospital and medical staff who cared for him have now agreed an adequate and fair settlement to cover his care needs both now and in the future.
'This young boy has suffered a catalogue of medical issues throughout his childhood and will face numerous problems in his future as his condition deteriorates.
'We are pleased that we secured this settlement for him and his family, who now have the financial security and reassurance that costs for his future treatment will be met.
'We hope that lessons are learnt by the hospital and their staff so that patient safety in this situation can be improved and each and every patient receives the best quality of care at all times.'
The damages will cover Lucas's medical and care costs and anticipated future loss of earnings.
A spokesman for the Bupa Cromwell Hospital told MailOnline: 'We did not own the hospital in 2004.
'However, we are very sorry that Lucas suffered these problems and would again like to apologise to him and his family.
'We hope that this settlement will give Lucas and his parents the security of knowing that his future care and support needs can be met.
'We wish Lucas and his family well for the future.'
This article is courtesy of the Daily Mail.
Regularly updated blog featuring news, articles and information relating to clinical/medical negligence.
Showing posts with label Private Hospital Negligence. Show all posts
Showing posts with label Private Hospital Negligence. Show all posts
Wednesday, 10 May 2017
Monday, 22 September 2014
Facelift scarred me for life: Pensioner tells of botched operation ordeal
A pensioner has told how she was left scarred for life following a botched facelift.
Pearl Richman was awarded more than £43,000 in compensation after her life was ‘almost ruined’ by a procedure carried out in 2010.
After the operation, the 69-year-old developed necrosis – a form of cell injury which results in the premature death of skin cells – and was left with open flesh wounds.
But despite a court finding in favour of Mrs Richman and awarding compensation, she says she still hasn’t received a penny and the surgeon, from Italy, is still believed to be operating in the UK.
Mrs Richman, from Kenilworth, took her civil case to a county court hearing in April, where a judge awarded costs against the doctor for negligence.
Now Mrs Richman is calling for the government to take action over ‘seagull surgeons’ – foreign doctors who fly into the UK and undertake failed procedures before returning home.
“This might sound dramatic to people, but this has almost ruined my life,” said Mrs Richman.
“I always took pride in my appearance and over the years I went from having lots of photos of myself around the house, to having none.
“I had talked about having a facelift but they are expensive and we didn’t have the money. My kids had always talked about buying one for me and one year my daughter Jo, who has her own business, was able to do just that.”
The company which organised the £8,000 facelift has now gone into administration. The centre introduced Mrs Richman to an Italian surgeon before she underwent the procedure at a hospital in London.
She added: “He never talked about necrosis at all. It wasn’t mentioned. He talked about the normal risks but at no point at all did he mention necrosis. I just remember him saying that he would make me happy.
“When they took the drains out of my face it hurt so much, I screamed and it started to go purple. It went from a large purple bruise to a huge black scab that had the feel and look of leather.”
The company contacted the surgeon in Italy and he arranged an emergency appointment with Mrs Richman.
She said: “When he saw me he took me straight into a treatment room and said it had to be treated like first degree burns. He told me he was so sorry and that it did not happen very often.
“He offered laser treatment which I had and he said he would do everything he could to make it better and put it right. That is the last we have ever heard from him.”
Medical negligence solicitor Jeanette Whyman, of law firm Wright Hassall, is now pursuing the case.
She said: “I am aware of ‘seagull surgeons’ but have not come across the issue to such a horrific degree. He does have insurers but because he has not notified them of the incident, they will not cover him.
“His residency outside of the UK shouldn’t, in theory, make a difference. What it means is we can get a judgment here but it has to be enforced abroad which can be expensive. If there are no assets in the UK, you cannot enforce here and it has to be pursued abroad.”
Mrs Richman is now urging anyone contemplating surgery to undertake extensive checks.
She added: “Surgeons should not be limited to their country but the government should make sure there is a level of accountability through qualifications and insurances.
“Clinics should also be responsible for the actions of the surgeons they use. would not want (this) to happen to another single person.”
This article is courtesy of Wright Hassall.
Pearl Richman was awarded more than £43,000 in compensation after her life was ‘almost ruined’ by a procedure carried out in 2010.
After the operation, the 69-year-old developed necrosis – a form of cell injury which results in the premature death of skin cells – and was left with open flesh wounds.
But despite a court finding in favour of Mrs Richman and awarding compensation, she says she still hasn’t received a penny and the surgeon, from Italy, is still believed to be operating in the UK.
Mrs Richman, from Kenilworth, took her civil case to a county court hearing in April, where a judge awarded costs against the doctor for negligence.
Now Mrs Richman is calling for the government to take action over ‘seagull surgeons’ – foreign doctors who fly into the UK and undertake failed procedures before returning home.
“This might sound dramatic to people, but this has almost ruined my life,” said Mrs Richman.
“I always took pride in my appearance and over the years I went from having lots of photos of myself around the house, to having none.
“I had talked about having a facelift but they are expensive and we didn’t have the money. My kids had always talked about buying one for me and one year my daughter Jo, who has her own business, was able to do just that.”
The company which organised the £8,000 facelift has now gone into administration. The centre introduced Mrs Richman to an Italian surgeon before she underwent the procedure at a hospital in London.
She added: “He never talked about necrosis at all. It wasn’t mentioned. He talked about the normal risks but at no point at all did he mention necrosis. I just remember him saying that he would make me happy.
“When they took the drains out of my face it hurt so much, I screamed and it started to go purple. It went from a large purple bruise to a huge black scab that had the feel and look of leather.”
The company contacted the surgeon in Italy and he arranged an emergency appointment with Mrs Richman.
She said: “When he saw me he took me straight into a treatment room and said it had to be treated like first degree burns. He told me he was so sorry and that it did not happen very often.
“He offered laser treatment which I had and he said he would do everything he could to make it better and put it right. That is the last we have ever heard from him.”
Medical negligence solicitor Jeanette Whyman, of law firm Wright Hassall, is now pursuing the case.
She said: “I am aware of ‘seagull surgeons’ but have not come across the issue to such a horrific degree. He does have insurers but because he has not notified them of the incident, they will not cover him.
“His residency outside of the UK shouldn’t, in theory, make a difference. What it means is we can get a judgment here but it has to be enforced abroad which can be expensive. If there are no assets in the UK, you cannot enforce here and it has to be pursued abroad.”
Mrs Richman is now urging anyone contemplating surgery to undertake extensive checks.
She added: “Surgeons should not be limited to their country but the government should make sure there is a level of accountability through qualifications and insurances.
“Clinics should also be responsible for the actions of the surgeons they use. would not want (this) to happen to another single person.”
This article is courtesy of Wright Hassall.
Friday, 5 September 2014
Safety of private hospitals questioned as report reveals hundreds die unexpectedly
Patients in Britain's private hospitals may be put at unnecessary risk and the NHS is left to pick up the pieces, a report has warned, as 800 people died unexpectedly and a further 921 suffered serious injury following private medical treatment.
Private hospitals rarely have intensive care beds, dedicated resuscitation teams and the surgeons and anaesthetists often work in isolation, the report by a think tank said.
When things go wrong in private hospitals, patients are often transferred to the NHS to pick up the pieces, it was warned, with 2,600 patients transferred as emergencies and 6,000 patients moved in total in 2012/13.
It is not known how much this costs the taxpayer, the report said.
The Centre for Health and the Public Interest cited examples where an anaesthetist covered two operating theatre lists simultaneously, risking the lives of both sets of patients and a surgeon operated in an unsuitable setting because the main operating theatre was not available, putting a patient at serious risk.
In addition surgeon, Ian Paterson undertook dangerous breast surgery and colonoscopies he was not qualified to perform at spire Wellesley and little Aston hospitals in Solihull.
Mr Paterson was suspended by the GMC and the police called in after he was found to be carrying out 'cleavage sparing' mastectomies which breached guidelines because the technique risked the cancer returning.
The report said that a lack of data available from private hospitals makes it difficult for patients to judge the safety of their care.
This is despite many private hospitals treating NHS patients, funded by the taxpayer.
The CHPI obtained from the regulator, the Care Quality Commission, under the Freedom of Information Act figures on patient safety relating to private hospitals.
It was found that 802 people died unexpectedly and a further 921 suffered serious injuries in England in the last four years. It was not possible to determine if these cases could have been avoided, the report said, but private hospitals tended to carry out relatively low risk procedures in which complications should be rare.
The report said: "This could mean that the mortality rates of private hospitals are actually higher than reported here and the mortality rates for NHS hospitals include deaths which were the result of procedures carried out in private hospitals."
There are around 1.61 admissions to private hospitals in England per year for surgery, one quarter of which are funded by the taxpayer.
Report co-author Professor Colin Leys, emeritus professor at Queen’s University, Canada, and an honorary professor at Goldsmiths, University of London, said: “The public and regulators have access to more information than ever before about how NHS services are performing but this report shows that the same cannot be said for private hospitals.
"The Government has recognised the crucial role of transparency in making hospitals safer but reporting requirements should apply wherever patients are treated. With the taxpayer now providing over a billion pounds a year to private hospitals, this is too important to be left to the industry to address.”
Report co-author Professor Brian Toft, visiting professor of Patient Safety at Brighton and Sussex Medical School and member of the World Health Organisation’s European Regional Advisory Council on patient safety and healthcare, said: “The report highlights some sobering examples of what can happen to patients without the right staffing, equipment and facilities.
"When patients choose to have an operation in a private hospital they may be unaware of the difference in terms of risk between a big NHS hospital with surgical teams and intensive care beds and a private hospital with neither. Consent forms should make clear to patients the inherent potential risks in the way these facilities are run.”
Peter Walsh, chief executive of the charity Action Against Medical Accidents, said: “In our experience, there is plenty that can and does go wrong in private healthcare and it is usually the NHS that ends up picking up the pieces.
"This report confirms it is time for the same level of scrutiny, regulation and protection of patients’ safety and rights to be afforded to private patients as is now being done for NHS patients. A comparable complaints procedure and access to independent advice on complaints would be a good starting point.
"Over the years AvMA has seen private patients let down time and time again. For all its problems, the NHS has far more developed systems for patient safety and investigating incidents and complaints.
"It is time for private hospitals to be scrutinised much more closely and patients to have consistent rights wherever they are treated."
The report recommends that private providers should be subject to the same requirements as the NHS to report patient safety incidents, and to report on their performance.
Private hospitals should warn patients, before treatment, of the risks that may be posed by their facilities, equipment or staffing such as the lack of resuscitation team when taking consent prior to an operation.
The hospitals should have on-site registrar-level surgeon or doctor for every specialty for which NHS patients are treated, for an anaesthetist to be on call, and for medical records to be kept on the ward, the report said.
In addition the Department of Health should carry out a review of the nature and cost of admissions to the NHS from private hospitals, and the NHS should have the power to recoup costs resulting from a failure by a private hospital.
A spokesman for the Care Quality Commission said: "We will soon start inspecting Independent Hospitals using the new style inspections that are being carried out in the NHS. CQC will expect from Independent Health equivalent information about performance that it receives from NHS hospitals."
David Hare, chief executive of NHS Partners Network, which represents private hospitals treating NHS patients said: “Patient safety is the number one priority for all independent sector providers of NHS clinical services. Under the robust regulatory regime overseen by the Care Quality Commission independent sector providers are treated in the same way as publicly-owned providers. The Care Quality Commission will assess a provider’s incident reporting processes and crucially examine how patient safety incidents are addressed.
“In the latest available Care Quality Commission State of Care report major and moderate safety and safeguarding breaches in independent sector hospitals are lower than the NHS average and compliance rates better than average. The overwhelming majority of NHS care delivered by independent sector hospitals is safe, efficient and of excellent quality.”
This article is courtesy of the Telegraph.
Private hospitals rarely have intensive care beds, dedicated resuscitation teams and the surgeons and anaesthetists often work in isolation, the report by a think tank said.
When things go wrong in private hospitals, patients are often transferred to the NHS to pick up the pieces, it was warned, with 2,600 patients transferred as emergencies and 6,000 patients moved in total in 2012/13.
It is not known how much this costs the taxpayer, the report said.
The Centre for Health and the Public Interest cited examples where an anaesthetist covered two operating theatre lists simultaneously, risking the lives of both sets of patients and a surgeon operated in an unsuitable setting because the main operating theatre was not available, putting a patient at serious risk.
In addition surgeon, Ian Paterson undertook dangerous breast surgery and colonoscopies he was not qualified to perform at spire Wellesley and little Aston hospitals in Solihull.
Mr Paterson was suspended by the GMC and the police called in after he was found to be carrying out 'cleavage sparing' mastectomies which breached guidelines because the technique risked the cancer returning.
The report said that a lack of data available from private hospitals makes it difficult for patients to judge the safety of their care.
This is despite many private hospitals treating NHS patients, funded by the taxpayer.
The CHPI obtained from the regulator, the Care Quality Commission, under the Freedom of Information Act figures on patient safety relating to private hospitals.
It was found that 802 people died unexpectedly and a further 921 suffered serious injuries in England in the last four years. It was not possible to determine if these cases could have been avoided, the report said, but private hospitals tended to carry out relatively low risk procedures in which complications should be rare.
The report said: "This could mean that the mortality rates of private hospitals are actually higher than reported here and the mortality rates for NHS hospitals include deaths which were the result of procedures carried out in private hospitals."
There are around 1.61 admissions to private hospitals in England per year for surgery, one quarter of which are funded by the taxpayer.
Report co-author Professor Colin Leys, emeritus professor at Queen’s University, Canada, and an honorary professor at Goldsmiths, University of London, said: “The public and regulators have access to more information than ever before about how NHS services are performing but this report shows that the same cannot be said for private hospitals.
"The Government has recognised the crucial role of transparency in making hospitals safer but reporting requirements should apply wherever patients are treated. With the taxpayer now providing over a billion pounds a year to private hospitals, this is too important to be left to the industry to address.”
Report co-author Professor Brian Toft, visiting professor of Patient Safety at Brighton and Sussex Medical School and member of the World Health Organisation’s European Regional Advisory Council on patient safety and healthcare, said: “The report highlights some sobering examples of what can happen to patients without the right staffing, equipment and facilities.
"When patients choose to have an operation in a private hospital they may be unaware of the difference in terms of risk between a big NHS hospital with surgical teams and intensive care beds and a private hospital with neither. Consent forms should make clear to patients the inherent potential risks in the way these facilities are run.”
Peter Walsh, chief executive of the charity Action Against Medical Accidents, said: “In our experience, there is plenty that can and does go wrong in private healthcare and it is usually the NHS that ends up picking up the pieces.
"This report confirms it is time for the same level of scrutiny, regulation and protection of patients’ safety and rights to be afforded to private patients as is now being done for NHS patients. A comparable complaints procedure and access to independent advice on complaints would be a good starting point.
"Over the years AvMA has seen private patients let down time and time again. For all its problems, the NHS has far more developed systems for patient safety and investigating incidents and complaints.
"It is time for private hospitals to be scrutinised much more closely and patients to have consistent rights wherever they are treated."
The report recommends that private providers should be subject to the same requirements as the NHS to report patient safety incidents, and to report on their performance.
Private hospitals should warn patients, before treatment, of the risks that may be posed by their facilities, equipment or staffing such as the lack of resuscitation team when taking consent prior to an operation.
The hospitals should have on-site registrar-level surgeon or doctor for every specialty for which NHS patients are treated, for an anaesthetist to be on call, and for medical records to be kept on the ward, the report said.
In addition the Department of Health should carry out a review of the nature and cost of admissions to the NHS from private hospitals, and the NHS should have the power to recoup costs resulting from a failure by a private hospital.
A spokesman for the Care Quality Commission said: "We will soon start inspecting Independent Hospitals using the new style inspections that are being carried out in the NHS. CQC will expect from Independent Health equivalent information about performance that it receives from NHS hospitals."
David Hare, chief executive of NHS Partners Network, which represents private hospitals treating NHS patients said: “Patient safety is the number one priority for all independent sector providers of NHS clinical services. Under the robust regulatory regime overseen by the Care Quality Commission independent sector providers are treated in the same way as publicly-owned providers. The Care Quality Commission will assess a provider’s incident reporting processes and crucially examine how patient safety incidents are addressed.
“In the latest available Care Quality Commission State of Care report major and moderate safety and safeguarding breaches in independent sector hospitals are lower than the NHS average and compliance rates better than average. The overwhelming majority of NHS care delivered by independent sector hospitals is safe, efficient and of excellent quality.”
This article is courtesy of the Telegraph.
Wednesday, 9 July 2014
USA Military Care, a pattern of errors but not scrutiny
Jessica Zeppa, five months pregnant, the wife of a soldier, showed up four times at Reynolds Army Community Hospital here in pain, weak, barely able to swallow and fighting a fever. The last time, she declared that she was not leaving until she could get warm.
Without reviewing her file, nurses sent her home anyway, with an appointment to see an oral surgeon to extract her wisdom teeth.
Mrs. Zeppa returned the next day, in an ambulance. She was airlifted to a civilian hospital, where despite relentless efforts to save her and her baby, she suffered a miscarriage and died on Oct. 22, 2010, of complications from severe sepsis, a bodywide infection. Medical experts hired by her family said later that because she was young and otherwise healthy, she most likely would have survived had the medical staff at Reynolds properly diagnosed and treated her.
“She was 21 years old,” her mother, Shelley Amonett, said. “They let this happen. This is what I want to know: Why did they let it slip? Why?”
The hospital doesn’t know, either.
Since 2001, the Defense Department has required military hospitals to conduct safety investigations when patients unexpectedly die or suffer severe injury. The object is to expose and fix systemic errors, often in the most routine procedures, that can have disastrous consequences for the quality of care. Yet there is no evidence of such an inquiry into Mrs. Zeppa’s death.
The Zeppa case is emblematic of persistent lapses in protecting patients that emerged from an examination by The New York Times of the nation’s military hospitals, the hub of a sprawling medical network — entirely separate from the scandal-plagued veterans system — that cares for the 1.6 million active-duty service members and their families.
Internal documents obtained by The Times depict a system in which scrutiny is sporadic and avoidable errors are chronic.
As in the Zeppa case, records indicate that the mandated safety investigations often go undone: From 2011 to 2013, medical workers reported 239 unexpected deaths, but only 100 inquiries were forwarded to the Pentagon’s patient-safety center, where analysts recommend how to improve care. Cases involving permanent harm often remained unexamined as well.
At the same time, by several measures considered crucial barometers of patient safety, the military system has consistently had higher than expected rates of harm and complications in two central parts of its business — maternity care and surgery.
More than 50,000 babies are born at military hospitals each year, and they are twice as likely to be injured during delivery as newborns nationwide, the most recent statistics show. And their mothers were more likely to hemorrhage after childbirth than mothers at civilian hospitals, according to a 2012 analysis conducted for the Pentagon.
In surgery, half of the system’s 16 largest hospitals had higher than expected rates of complications over a recent 12-month period, the American College of Surgeons found last year. Four of the busiest hospitals have performed poorly on that metric year after year.
Surgical Complications
Half of the military’s largest hospitals performed worse than established benchmarks in categories such as infections or improperly done procedures, according to a review from the American College of Surgeons. The college compared each hospital with an expected rate of complications based on the procedures it performed and what kinds of patients it served from July 2012 to June 2013.
Little known beyond the confines of the military community, the Pentagon’s medical system has recently been pushed into the spotlight. In late May, Defense Secretary Chuck Hagel ordered a review of all military hospitals, saying he wanted to determine if they had the same problems that have shaken the veterans system.
Mr. Hagel said the review would study not just access to treatment, the focus of investigations at the veterans hospitals, but also quality of care and patient safety — issues that The Times has been looking at, and asking the Pentagon about, for months.
Defense Department health officials say their hospitals deliver treatment that is as good as or better than civilian care, while giving military doctors and nurses the experience they may one day need on the battlefield. In interviews, they described their patient-safety system as evolving but robust, even if regulations are not always followed to the letter.
“We strive to be a perfect system, but we are not a perfect system, and we know it,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs. He added, “We must learn from our mistakes and take corrective actions to prevent them from reoccurring.”
The Times’s examination, based on Pentagon studies, court records, analyses of thousands of pages of data, and interviews with current and former military health officials and workers, indicates that the military lags behind many civilian hospital systems in protecting patients from harm. The reasons, military doctors and nurses said, are rooted in a compartmentalized system of leadership, a culture of interservice secrecy and an overall failure to make patient safety a top priority.
The investigations of unforeseen deaths or permanent harm, called root-cause analyses, are widely regarded as a centerpiece of efforts to make care safer. Asked about the military’s missing inquiries, Dr. James P. Bagian, director of the University of Michigan’s Center for Healthcare Engineering and Patient Safety, said, “If in fact unexpected deaths were reported and ignored, there would appear to be no good answer for that except that someone is sleeping at the switch.”
Avoidable errors can and do occur at the best of hospitals. But the military’s reports show a steady stream of the sort of mistakes that patient-safety programs are designed to prevent.
The most common errors are strikingly prosaic — the unread file, the unheeded distress call, the doctor on one floor not talking to the doctor on another. But there are also these, sprinkled through the Pentagon’s 2011 and 2012 patient-safety reports:
A viable fetus died after a surgeon operated on the wrong part of the mother’s body.
A 41-year-old woman’s healthy thyroid gland was removed because someone else’s biopsy result had been recorded on her chart.
A 54-year-old retired officer suffered acute kidney failure and permanent hearing loss after an incorrect dose of chemotherapy.
Such treatment failures are known as “never events,” because they are potentially so grave — and so preventable. They do not happen frequently. But a persistent rate of such mistakes can indicate broader patterns of slipshod care.
Malpractice suits can also be a rough indicator of risk. From 2006 to 2010, the government paid an annual average of more than $100 million in military malpractice claims from surgical, maternity and neonatal care, records show. It would be paying far more if not for one salient reality of military health care: Active-duty service members are required to use military hospitals and clinics, but unlike the other patients, they may not sue. If they could, the Congressional Budget Office estimated in 2010, the military’s paid claims would triple.
Experience in civilian hospitals, and in the veterans system, has shown that stricter procedures and more sophisticated surveillance can limit errors, sometimes markedly. Among some in the military network, concerns about patient safety are longstanding, if rarely acknowledged in public. But calls for change have consistently foundered in the convoluted bureaucracy.
The military health system is split into three major branches, with the Army, Navy and Air Force each controlling its own hospitals and clinics. The Pentagon’s Defense Health Agency also runs the Walter Reed National Military Medical Center and Fort Belvoir Community Hospital, both outside Washington. Any systemwide change involves a carefully calibrated consensus of three equally ranked surgeons general, as well as the Defense Health Agency. Dr. Woodson, who oversees the system, cannot order the surgeons general to act. He can only recommend.
Progress can be glacial: In 2007, for example, the military started rewriting regulations for handling events that harmed or endangered patients. It finished only last October. Several former Pentagon officials said embarrassing statistics were often filtered out, glossed over or buried amid larger data sets before they reached senior health leaders. Two measures used in major civilian hospitals to monitor quality of care — rates of death and readmission, adjusted for seriousness of illness — are simply not tracked.
“The patient-safety system is broken,” Dr. Mary Lopez, a former staff officer for health policy and services under the Army surgeon general, said in an interview.
“It has no teeth,” she added. “Reports are submitted, but patient-safety offices have no authority. People rarely talk to each other. It’s ‘I have my territory, and nobody is going to encroach on my territory.’ ”
In an internal report in 2011, the Pentagon’s patient-safety analysts offered this succinct conclusion about military health care: “Harm rate — unknown.”
Lethal Medical Errors
Katie Guill checked into the hospital at Fort Leonard Wood, Mo., on Christmas morning 2008, expecting to give birth to a healthy baby boy. She left with an infant so severely brain-damaged that at age 5, he cannot crawl, speak or swallow. He must be fed through a pump.
In the three hours before a doctor finally delivered their son, Justen, by cesarean section, the Guills said in a lawsuit, a monitor sounded 32 alerts that the baby’s heart rate had slowed. The suit also said the nurse had warned the doctor on duty four times that the baby was in distress before he arrived at Mrs. Guill’s bedside. The family’s lawyer, Laurie Higginbotham, said she believed the outcome might have been different had the nurse alerted the doctor’s superiors.
The government settled the case for $10 million, but Pentagon records give no indication that a safety investigation was conducted. Nor is there a record of any action taken against the doctors and nurses involved. A spokeswoman said the Defense Department was legally prohibited from discussing how any specific case had been handled.
“We don’t know what went wrong because no one has ever told us,” said Justen’s father, Jon Guill, a former Army mechanic who served 18 months in Iraq.
The Pentagon had promised to look harder at such mistakes.
In 1999, the Institute of Medicine estimated that medical errors killed between 44,000 and 98,000 patients at hospitals nationwide every year. Those numbers — which most experts now consider an undercount — stunned the medical community and kick-started an aggressive effort to protect patients from accidental harm.
Simply penalizing doctors and nurses for malpractice had failed, the institute concluded, because most mistakes arose from weak procedures, not reckless individuals. It called for new strategies, including mandating that medical workers report mistakes and hospitals investigate and correct the lapses that allowed them to occur.
The Pentagon embraced the report, requiring that military treatment facilities produce a written root-cause analysis within 45 days in all cases of unexpected serious injury or death. “Such events are called ‘sentinel’ because they signal the need for immediate investigation and response,” the regulations state. Military hospitals must also report sentinel events to the Joint Commission, an independent accreditation group. Specialists at the Pentagon’s patient-safety center, created in 2001, were told to review the analyses and recommend changes.
Certainly it is difficult to assess such a divided and diverse medical system, with 56 hospitals, domestic and overseas, ranging from the flagship, Walter Reed, to a hospital in the middle of the Mojave Desert with an average of three inpatients a day. They serve not only young, typically healthy active-duty families but also the longest-serving military retirees and their families. Even so, experts say safety reviews can reveal trouble spots as well as patterns of error across an entire system.
But annual patient-safety reports and other internal documents obtained by The Times show that, for years, the center’s analysts have often found themselves staring into darkness.
As early as 2003, a Pentagon audit noted that medical workers had reported 80 cases of severe harm or death in the preceding 12 months, but that only 32 root-cause analyses had been forwarded to the center. Five years later, another audit concluded, “Unfortunately, R.C.A.s are used relatively infrequently.”
The most recent safety reports paint a similar — and more detailed — picture.
In 2011, 50 unexpected deaths were identified but only 25 analyses submitted.
The next year, the center was informed of 110 deaths but received only 44 root-cause analyses.
And in 2013, the report documented 79 deaths and 31 root-cause analyses.
The safety audits also make clear that of the root-cause analyses that are done, the cases of clearest-cut blame — the “never events” — make up the largest group. Even so, the reports show, those mistakes have not subsided.
In 2010, the safety center had sounded a hopeful note. For the first time in nine years, it said, “all surgeries and procedures were performed on the right person.” But the next year, the center said surgeons were still performing the wrong procedure or operating on the wrong patient or part of the body at an “alarming” rate. It called for intensive hospital audits to lower it.
Last year, medical workers reported virtually the same number of errors. They also reported more cases in which medical devices were inadvertently left inside patients than they had four years earlier.
In a written response to questions from The Times, the Pentagon acknowledged that it had taken a decade before the reporting system was “operational and collecting data in a uniform manner.” Not until last October, for instance, were the Army, Navy and Air Force required to identify the facilities where patients were severely harmed or died.
Senior defense health officials say the missing investigations are not a true measure of attention paid to serious harm. “There are many mechanisms for reviewing significant adverse events,” the Pentagon said in a statement.
In an interview, Dr. Woodson said a different kind of inquiry that hospitals conduct — a risk-management investigation — might have gotten to the bottom of what went wrong. Those investigations focus on whether individual doctors or nurses provided substandard care for which the government could be liable.
“I feel confident that we capture and investigate the overwhelming majority of these adverse events,” Dr. Woodson said. “The key is having a robust system and that you pick all of them up and make the changes that are appropriate.”
But military regulations specifically require both types of inquiries, and for good reason, patient-safety experts say: Otherwise, even catastrophic errors — mistakes for which no one is specifically to blame, but that instead result from systemic lapses — can be easily swept under the rug.
Busy but Troubled Hospital
Womack Army Medical Center in Fort Bragg, N.C., is one of the system’s largest, busiest hospitals. Lately it has also been one of its more troubled.
For three years, it has had a higher-than-average rate of surgical complications, and in March it suspended all elective surgery for two days after inspectors found problems with surgical infection controls. Then last month, the Army ousted the hospital’s leadership after the unexpected deaths of two patients in their 20s: a mother of three who had undergone a low-risk surgical procedure and a soldier who had been sent home from the emergency room.
That same day, Defense Secretary Hagel ordered the systemwide review.
At Womack and elsewhere, some doctors and nurses complain that no one listens to their safety warnings. One staff member interviewed by The Times recalled filing roughly 50 reports of safety problems since 2007, each time providing contact information. Only once, the worker said, did a supervisor respond, and then only to express irritation at the fusillade of filings.
“It is an exercise in futility,” said the staff member, speaking on condition of anonymity for fear of job repercussions. “We can jump up and down and shake our fists, but nothing changes.”
Dr. Lopez, the former Army staff officer, said some hospital officials had told her that they felt pressure from superiors to focus on budget cutting and efficiency, while patient safety got a cursory nod.
Across the system, Pentagon officials cite some signs of progress. In 2008, for instance, the composite rate of 11 types of harm — like pressure ulcers and postoperative hemorrhages — was more than twice that of civilian hospitals with a similar patient mix. Last year, it was better than the civilian average, although the Pentagon’s own analysts warned results might be skewed by reporting problems.
Even so, the most recent patient-safety report complained of a general lack of headway in building a safer system. While the number of reports of harm has varied over the last decade, and “there are certainly pockets of excellence,” it noted, “The leading trends remain consistent.” What was needed was “enterprisewide change.”
The operating room has been one focus of concern.
The study by the American College of Surgeons found that in addition to Womack, three other major hospitals — Madigan Army Medical Center in Tacoma, Wash.; San Antonio Military Medical Center in Texas; and Portsmouth Naval Hospital in Virginia — have had high rates of surgical complications for two or three years in a row. Five of the eight cited last year had also been flagged repeatedly for high rates of infection related to surgery.
Dr. Brian Lein, the Army’s deputy surgeon general, said hospitals that fell below the benchmark “have dug deep into the data to find the actual issues and are addressing those issues.” The Navy echoed that response.
With so many young military families, the system’s maternity wards are among its busiest. Pentagon officials say maternity care is top notch, and on some leading measures of safe childbirth, the military hospitals indeed compare well with their civilian counterparts.
For example, their rate of infant mortality was equal to or lower than that of civilian hospitals in the most recent data analyzed by the National Perinatal Information Center, a private group with a Pentagon contract. In routine vaginal births, the rate of injury to the mother has consistently been below the national average.
On other measures, though, the military system lags.
In 40 percent of the military hospitals, mothers were significantly more likely to suffer hemorrhages after birth than at the civilian hospitals tracked by the perinatal center. The hemorrhages can lead to hysterectomies or even death. About 2,500 cases were recorded in military hospitals in 2012, roughly 760 more than if the military had met the civilian benchmark.
If doctors used instruments such as forceps to assist the delivery, mothers in military hospitals were about 15 percent more likely to be injured than mothers nationally, the most recent data shows.
One of the broadest measures of safe childbirth is the rate of injuries to babies, ranging from cerebral hemorrhages to small cuts on babies’ scalps. From 2009 to 2011, according to a Times analysis, the rate at military hospitals was twice the national average.
In 2011, nearly five in every 1,000 babies born at military hospitals suffered some kind of birth trauma. Had the military met the national average, 107 newborns would have been injured instead of 239.
Dr. Woodson said the military is looking “closely at areas where we are falling short” on maternity care and measuring its hospitals against civilian ones in order to improve.
Ordeal Giving Birth
When Stephanie King felt labor pains on Easter in 2004, she drove to Reynolds Army Community Hospital. She was 34, a kindergarten teacher and mother of two. Her husband, an Army artillery officer, was serving six months in Iraq, so her 12-year-old son accompanied her to the hospital.
Her contractions were coming every three to five minutes, court records show, but a resident on the maternity ward refused to admit her, saying her cervix was not sufficiently dilated. The attending physician agreed.
Mrs. King spent the next two hours in the hospital’s first-floor lobby, waiting room, cafeteria and bathroom. She wanted to seek care at the civilian hospital 15 minutes away, but her military insurance would not cover it. In the midst of her ordeal, her husband called from Baghdad to say he was being airlifted to Germany after an emergency appendectomy.
Finally, fearful that she would deliver on the bathroom floor, she took the elevator back to maternity. A nurse greeted her with what seemed to be a joke: " ‘Oh, Mrs. King, you are back,’ ” she recalled the nurse saying. " ‘You don’t look as good as you did when you first came in.’ ”
Any amusement vanished, however, when staff members realized not only that Mrs. King was about to give birth — but that her file showed she carried a common but symptomless strain of group B streptococcus bacteria. Women in labor must be given antibiotics at least an hour before delivering to avoid transmitting the infection to their newborns, hospital workers later testified.
Dawson King was born just 42 minutes after his mother was admitted. Doctors soon determined that he had contracted an infection, and warned Mrs. King that the only effective medication could cause deafness. Four months later, when Dawson did not turn his head when his parents walked into the room, it became clear that he was profoundly deaf.
Only three years later, after Mrs. King filed a malpractice claim, was the case discussed at Reynolds, court records indicate. The attending physician said a risk-management meeting was held to ensure that the standard of care was met. No report was written, and the doctors and the nurse emerged with spotless licenses.
That result that would appear to point to a lapse in hospital procedures. But both the resident and the nurse testified that they had never attended a meeting at Reynolds to discuss what had gone wrong.
“That’s the disturbing part,” Mrs. King said, while Dawson draped himself over the arm of his father’s chair, looking at photos of himself as a 1-year-old, his head swathed in bandages from surgery for cochlear implants. “Doesn’t the hospital want to know what happened?”
Mrs. King believes that she knows: Her file documented her history of strep B infection and the fact that her second child had been born after a 90-minute labor. And the resident testified that he could not recall if he had read her record before declining to admit her. “It boils down to they did not even read my records,” Mrs. King said.
The government settled the Kings’ case in 2009 for $300,000. Mrs. King describes her son, now an engaging, soccer-playing 10-year-old, as “a success story.” Still, she said, “it was devastating how easily it could have been prevented.”
The Kings’ malpractice payout was relatively modest. An examination of court records and Pentagon data from Reynolds and seven other hospitals turned up dozens of settlements, ranging from $30,000 to $10 million, but no record of a root-cause analysis.
Flying Blind on Safety
On Dec. 7, 2011, Dr. Woodson summoned senior health officials to a Pentagon conference room to discuss the safety of military hospitals and clinics. The deputy surgeons general of the Army, Navy and Air Force were present. So was Dr. Ronald Wyatt, then the director of the Pentagon’s patient-safety center.
According to accounts from several people familiar with the session, Dr. Wyatt suggested that the center was flying blind. Without knowing the facilities’ death and harm rates, as well as the rates of paid malpractice claims, he argued, his staff was unable to identify safety lapses — much less correct them.
And serious lapses did exist, he said, for “this system, like many systems throughout the country, hurts and kills people every day.” Angered, Dr. Richard A. Stone, then the Army’s deputy surgeon general, shot back: “I demand that you retract those statements.”
Dr. Warren Lockette, the deputy assistant secretary for clinical policy, stood by Dr. Wyatt. “What I am hearing is you are all satisfied with the status quo,” he said. Dr. Woodson tried to defuse the tension with a compromise: He would recommend that the services turn over the data.
Asked about the meeting, Dr. Stone said that data should be shared but that Dr. Wyatt’s statement was “inflammatory.”
The standoff was typical, former Defense Department officials say, of a continual tug-of-war between health care officials in the Pentagon and in the individual armed services that has crippled efforts to improve patient safety. In such a politicized system, data can be a weapon.
“Why should the Army safety system want to play with D.O.D., because then I have less control over my data, less control over my kingdom, and potentially D.O.D. is going to tell me what to do?” said Dr. Lopez, the former Army health policy officer.
To keep Pentagon overseers at bay, surgeons general have often relied on a provision in a 1986 law, known as 1102, that prohibits disclosure of medical quality assurance records. Originally adopted to ensure that medical personnel could be honestly evaluated without fear of publicity, former department officials say, it became a tool to withhold a broad range of data from the Pentagon itself.
And from the public. In response to Freedom of Information Act requests, the Pentagon provided The Times with thousands of pages of data. But much information was redacted and some reports were withheld as confidential, including all reports by the Navy’s inspector general on patient safety or quality of care. By contrast, the veterans system posts the reports on a public website.
While infighting held the military’s patient-safety programs in check, some civilian hospital systems cut death and harm rates. At Ascension Health and Kaiser Permanente, two of the nation’s biggest nonprofit systems, investigating workers’ reports was just a first step. The companies also analyze a vast array of data, including readmission and mortality rates.
The death rate is a broad measure that cannot pinpoint where care falls short. Nonetheless, “mortality is the mother of all outcomes,” said Ascension’s chief medical officer, Dr. Ziad Haydar. Measured over time, a death rate, adjusted for seriousness of illness, can show if a medical system is getting more or less safe.
Officials at Ascension and Kaiser say their hospitals have gotten safer. Ascension estimates that its safety measures have saved 1,500 lives in the last six years. Doug Bonacum, Kaiser’s vice president for quality, safety and resource management, said the mortality rate at Kaiser’s 38 hospitals had fallen more than 30 percent in the last four years.
The Pentagon does not routinely track the total number of deaths, and has no method yet to calculate adjusted rates. “Frankly it is not yet a helpful measure for assessing quality,” Dr. Woodson said.
As a result, why some military hospitals report many more deaths than others with similar numbers of patients is a mystery. The Army, Navy and Air Force each said that hospitals with above-average death rates treated older, sicker patients, but did not produce statistical evidence to verify that.
When it comes to gauging the frequency of errors, systems like the military’s that rely on workers to report harm have been shown invariably to undercount. Kaiser has long used another technique, called the Global Trigger Tool, that winnows out indicators of poor care from randomly selected patient files.
Using that technique, researchers concluded in 2010 that one-third of patients at three major civilian hospitals had suffered some kind of harm. A similar pilot study by the Pentagon last year found that nearly half the patients whose files were reviewed at a major military hospital had been harmed at least once. The study suggested 99 percent of harm at that hospital was not reported by medical workers.
Communiation Breakdowns
When patients die unexpectedly, medical workers often cite a breakdown in communications.
That appears to be the overriding explanation for the delay three and a half years ago in treating Jessica Zeppa, a case that ended with a $1.25 million malpractice settlement. But that is only conjecture. Her death was apparently never subjected to a patient-safety examination.
Mrs. Zeppa had been married and living at Fort Sill for only nine months when her husband, James, an air defense tactician, was deployed to the United Arab Emirates. She had their two dogs and a cat for company. And to her delight, she was pregnant. “She was just out of this world about it,” said her mother, Mrs. Amonett.
But five months into the pregnancy, Mrs. Zeppa became so weak that she struggled to climb stairs. She complained that it hurt to drink or swallow.
At Reynolds Army Community Hospital, she was initially treated in the obstetrics and gynecology unit, where an ear infection was diagnosed and she was prescribed antibiotics and ear drops, court records show. Three days later, she arrived at the emergency room at 4:51 a.m.; she was prescribed a painkiller for erupting wisdom teeth.
She returned that same evening and was found to have a fever, a fast pulse and an elevated white blood cell count — possible symptoms of serious infection. The emergency room physician, Dr. Raul Young-Rodriguez, treated her intravenously with fluids and a powerful antibiotic and sent her upstairs to the obstetrics and gynecology unit for possible admission.
No one called the obstetrician on duty to inform her of the patient’s condition, the Zeppas’ lawyers, Heather Mitchell and Steven Clark, said in court papers. Nor did the obstetrician, Dr. Debra A. Carson, call Dr. Young-Rodriguez.
As far as she knew, Dr. Carson later testified, Mrs. Zeppa was there for “obstetrical clearance.” She examined her and sent her home within 20 minutes. Mrs. Amonett said she protested but was told her daughter could not be admitted if the fetus was not in distress.
Dr. Carson testified that she had not checked the military’s electronic record system for Mrs. Zeppa’s history, because all too often she had found patient records missing. In Mrs. Zeppa’s case, lab results were posted less than an hour after she left. Had she seen them, Dr. Carson testified, “I would more than likely have admitted her.”
Two days later, Mrs. Zeppa returned to the obstetrics and gynecology unit, insisting that she would not leave until she got warm. A nurse midwife, Kelly West, treated her with intravenous fluids and again released her. Ms. West testified that she did not review Mrs. Zeppa’s records either.
The next afternoon, with Mrs. Zeppa struggling to breathe, her mother summoned an ambulance. Mrs. Zeppa was airlifted the following morning to a civilian hospital in Oklahoma City, where she miscarried 10 days later and died the next month.
Five months after that, facing a malpractice claim, Reynolds officials conducted a risk-management investigation. In an interview, Ms. West, the nurse, said she had been cleared of violating the standard of care. Nor is there any public indication that the two doctors were penalized. They did not respond to requests for comment.
Medical experts hired by the family’s lawyers said that had the Fort Sill doctors recognized that Mrs. Zeppa was suffering from septic shock and immediately hospitalized and aggressively treated her, she and the baby probably would have survived. The government’s experts disagreed, noting that civilian doctors had been unable to save Mrs. Zeppa in five weeks of treatment.
Justice Department lawyers called Mrs. Zeppa’s death a “unique and tragic case, but not a case of bad and actionable medicine.” Beyond the risk-management assessment, they said, they knew of no other inquiry. Ms. West also said she knew of none in the roughly eight months before she left Fort Sill.
That left any missteps that contributed to Mrs. Zeppa’s death unexplained.
“She was really pretty, and she had a really big heart,” James Zeppa, Mrs. Zeppa’s husband, said. Now, he said, he no longer trusts military medicine.
Mrs. Zeppa’s father, Mike Amonett, had one thing to say about the Fort Sill hospital: “I just want that place shut down.”
This article is courtesy of The New York Times.
Without reviewing her file, nurses sent her home anyway, with an appointment to see an oral surgeon to extract her wisdom teeth.
Mrs. Zeppa returned the next day, in an ambulance. She was airlifted to a civilian hospital, where despite relentless efforts to save her and her baby, she suffered a miscarriage and died on Oct. 22, 2010, of complications from severe sepsis, a bodywide infection. Medical experts hired by her family said later that because she was young and otherwise healthy, she most likely would have survived had the medical staff at Reynolds properly diagnosed and treated her.
“She was 21 years old,” her mother, Shelley Amonett, said. “They let this happen. This is what I want to know: Why did they let it slip? Why?”
The hospital doesn’t know, either.
Since 2001, the Defense Department has required military hospitals to conduct safety investigations when patients unexpectedly die or suffer severe injury. The object is to expose and fix systemic errors, often in the most routine procedures, that can have disastrous consequences for the quality of care. Yet there is no evidence of such an inquiry into Mrs. Zeppa’s death.
The Zeppa case is emblematic of persistent lapses in protecting patients that emerged from an examination by The New York Times of the nation’s military hospitals, the hub of a sprawling medical network — entirely separate from the scandal-plagued veterans system — that cares for the 1.6 million active-duty service members and their families.
Internal documents obtained by The Times depict a system in which scrutiny is sporadic and avoidable errors are chronic.
As in the Zeppa case, records indicate that the mandated safety investigations often go undone: From 2011 to 2013, medical workers reported 239 unexpected deaths, but only 100 inquiries were forwarded to the Pentagon’s patient-safety center, where analysts recommend how to improve care. Cases involving permanent harm often remained unexamined as well.
At the same time, by several measures considered crucial barometers of patient safety, the military system has consistently had higher than expected rates of harm and complications in two central parts of its business — maternity care and surgery.
More than 50,000 babies are born at military hospitals each year, and they are twice as likely to be injured during delivery as newborns nationwide, the most recent statistics show. And their mothers were more likely to hemorrhage after childbirth than mothers at civilian hospitals, according to a 2012 analysis conducted for the Pentagon.
In surgery, half of the system’s 16 largest hospitals had higher than expected rates of complications over a recent 12-month period, the American College of Surgeons found last year. Four of the busiest hospitals have performed poorly on that metric year after year.
Surgical Complications
Half of the military’s largest hospitals performed worse than established benchmarks in categories such as infections or improperly done procedures, according to a review from the American College of Surgeons. The college compared each hospital with an expected rate of complications based on the procedures it performed and what kinds of patients it served from July 2012 to June 2013.
Little known beyond the confines of the military community, the Pentagon’s medical system has recently been pushed into the spotlight. In late May, Defense Secretary Chuck Hagel ordered a review of all military hospitals, saying he wanted to determine if they had the same problems that have shaken the veterans system.
Mr. Hagel said the review would study not just access to treatment, the focus of investigations at the veterans hospitals, but also quality of care and patient safety — issues that The Times has been looking at, and asking the Pentagon about, for months.
Defense Department health officials say their hospitals deliver treatment that is as good as or better than civilian care, while giving military doctors and nurses the experience they may one day need on the battlefield. In interviews, they described their patient-safety system as evolving but robust, even if regulations are not always followed to the letter.
“We strive to be a perfect system, but we are not a perfect system, and we know it,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs. He added, “We must learn from our mistakes and take corrective actions to prevent them from reoccurring.”
The Times’s examination, based on Pentagon studies, court records, analyses of thousands of pages of data, and interviews with current and former military health officials and workers, indicates that the military lags behind many civilian hospital systems in protecting patients from harm. The reasons, military doctors and nurses said, are rooted in a compartmentalized system of leadership, a culture of interservice secrecy and an overall failure to make patient safety a top priority.
The investigations of unforeseen deaths or permanent harm, called root-cause analyses, are widely regarded as a centerpiece of efforts to make care safer. Asked about the military’s missing inquiries, Dr. James P. Bagian, director of the University of Michigan’s Center for Healthcare Engineering and Patient Safety, said, “If in fact unexpected deaths were reported and ignored, there would appear to be no good answer for that except that someone is sleeping at the switch.”
Avoidable errors can and do occur at the best of hospitals. But the military’s reports show a steady stream of the sort of mistakes that patient-safety programs are designed to prevent.
The most common errors are strikingly prosaic — the unread file, the unheeded distress call, the doctor on one floor not talking to the doctor on another. But there are also these, sprinkled through the Pentagon’s 2011 and 2012 patient-safety reports:
A viable fetus died after a surgeon operated on the wrong part of the mother’s body.
A 41-year-old woman’s healthy thyroid gland was removed because someone else’s biopsy result had been recorded on her chart.
A 54-year-old retired officer suffered acute kidney failure and permanent hearing loss after an incorrect dose of chemotherapy.
Such treatment failures are known as “never events,” because they are potentially so grave — and so preventable. They do not happen frequently. But a persistent rate of such mistakes can indicate broader patterns of slipshod care.
Malpractice suits can also be a rough indicator of risk. From 2006 to 2010, the government paid an annual average of more than $100 million in military malpractice claims from surgical, maternity and neonatal care, records show. It would be paying far more if not for one salient reality of military health care: Active-duty service members are required to use military hospitals and clinics, but unlike the other patients, they may not sue. If they could, the Congressional Budget Office estimated in 2010, the military’s paid claims would triple.
Experience in civilian hospitals, and in the veterans system, has shown that stricter procedures and more sophisticated surveillance can limit errors, sometimes markedly. Among some in the military network, concerns about patient safety are longstanding, if rarely acknowledged in public. But calls for change have consistently foundered in the convoluted bureaucracy.
The military health system is split into three major branches, with the Army, Navy and Air Force each controlling its own hospitals and clinics. The Pentagon’s Defense Health Agency also runs the Walter Reed National Military Medical Center and Fort Belvoir Community Hospital, both outside Washington. Any systemwide change involves a carefully calibrated consensus of three equally ranked surgeons general, as well as the Defense Health Agency. Dr. Woodson, who oversees the system, cannot order the surgeons general to act. He can only recommend.
Progress can be glacial: In 2007, for example, the military started rewriting regulations for handling events that harmed or endangered patients. It finished only last October. Several former Pentagon officials said embarrassing statistics were often filtered out, glossed over or buried amid larger data sets before they reached senior health leaders. Two measures used in major civilian hospitals to monitor quality of care — rates of death and readmission, adjusted for seriousness of illness — are simply not tracked.
“The patient-safety system is broken,” Dr. Mary Lopez, a former staff officer for health policy and services under the Army surgeon general, said in an interview.
“It has no teeth,” she added. “Reports are submitted, but patient-safety offices have no authority. People rarely talk to each other. It’s ‘I have my territory, and nobody is going to encroach on my territory.’ ”
In an internal report in 2011, the Pentagon’s patient-safety analysts offered this succinct conclusion about military health care: “Harm rate — unknown.”
Lethal Medical Errors
Katie Guill checked into the hospital at Fort Leonard Wood, Mo., on Christmas morning 2008, expecting to give birth to a healthy baby boy. She left with an infant so severely brain-damaged that at age 5, he cannot crawl, speak or swallow. He must be fed through a pump.
In the three hours before a doctor finally delivered their son, Justen, by cesarean section, the Guills said in a lawsuit, a monitor sounded 32 alerts that the baby’s heart rate had slowed. The suit also said the nurse had warned the doctor on duty four times that the baby was in distress before he arrived at Mrs. Guill’s bedside. The family’s lawyer, Laurie Higginbotham, said she believed the outcome might have been different had the nurse alerted the doctor’s superiors.
The government settled the case for $10 million, but Pentagon records give no indication that a safety investigation was conducted. Nor is there a record of any action taken against the doctors and nurses involved. A spokeswoman said the Defense Department was legally prohibited from discussing how any specific case had been handled.
“We don’t know what went wrong because no one has ever told us,” said Justen’s father, Jon Guill, a former Army mechanic who served 18 months in Iraq.
The Pentagon had promised to look harder at such mistakes.
In 1999, the Institute of Medicine estimated that medical errors killed between 44,000 and 98,000 patients at hospitals nationwide every year. Those numbers — which most experts now consider an undercount — stunned the medical community and kick-started an aggressive effort to protect patients from accidental harm.
Simply penalizing doctors and nurses for malpractice had failed, the institute concluded, because most mistakes arose from weak procedures, not reckless individuals. It called for new strategies, including mandating that medical workers report mistakes and hospitals investigate and correct the lapses that allowed them to occur.
The Pentagon embraced the report, requiring that military treatment facilities produce a written root-cause analysis within 45 days in all cases of unexpected serious injury or death. “Such events are called ‘sentinel’ because they signal the need for immediate investigation and response,” the regulations state. Military hospitals must also report sentinel events to the Joint Commission, an independent accreditation group. Specialists at the Pentagon’s patient-safety center, created in 2001, were told to review the analyses and recommend changes.
Certainly it is difficult to assess such a divided and diverse medical system, with 56 hospitals, domestic and overseas, ranging from the flagship, Walter Reed, to a hospital in the middle of the Mojave Desert with an average of three inpatients a day. They serve not only young, typically healthy active-duty families but also the longest-serving military retirees and their families. Even so, experts say safety reviews can reveal trouble spots as well as patterns of error across an entire system.
But annual patient-safety reports and other internal documents obtained by The Times show that, for years, the center’s analysts have often found themselves staring into darkness.
As early as 2003, a Pentagon audit noted that medical workers had reported 80 cases of severe harm or death in the preceding 12 months, but that only 32 root-cause analyses had been forwarded to the center. Five years later, another audit concluded, “Unfortunately, R.C.A.s are used relatively infrequently.”
The most recent safety reports paint a similar — and more detailed — picture.
In 2011, 50 unexpected deaths were identified but only 25 analyses submitted.
The next year, the center was informed of 110 deaths but received only 44 root-cause analyses.
And in 2013, the report documented 79 deaths and 31 root-cause analyses.
The safety audits also make clear that of the root-cause analyses that are done, the cases of clearest-cut blame — the “never events” — make up the largest group. Even so, the reports show, those mistakes have not subsided.
In 2010, the safety center had sounded a hopeful note. For the first time in nine years, it said, “all surgeries and procedures were performed on the right person.” But the next year, the center said surgeons were still performing the wrong procedure or operating on the wrong patient or part of the body at an “alarming” rate. It called for intensive hospital audits to lower it.
Last year, medical workers reported virtually the same number of errors. They also reported more cases in which medical devices were inadvertently left inside patients than they had four years earlier.
In a written response to questions from The Times, the Pentagon acknowledged that it had taken a decade before the reporting system was “operational and collecting data in a uniform manner.” Not until last October, for instance, were the Army, Navy and Air Force required to identify the facilities where patients were severely harmed or died.
Senior defense health officials say the missing investigations are not a true measure of attention paid to serious harm. “There are many mechanisms for reviewing significant adverse events,” the Pentagon said in a statement.
In an interview, Dr. Woodson said a different kind of inquiry that hospitals conduct — a risk-management investigation — might have gotten to the bottom of what went wrong. Those investigations focus on whether individual doctors or nurses provided substandard care for which the government could be liable.
“I feel confident that we capture and investigate the overwhelming majority of these adverse events,” Dr. Woodson said. “The key is having a robust system and that you pick all of them up and make the changes that are appropriate.”
But military regulations specifically require both types of inquiries, and for good reason, patient-safety experts say: Otherwise, even catastrophic errors — mistakes for which no one is specifically to blame, but that instead result from systemic lapses — can be easily swept under the rug.
Busy but Troubled Hospital
Womack Army Medical Center in Fort Bragg, N.C., is one of the system’s largest, busiest hospitals. Lately it has also been one of its more troubled.
For three years, it has had a higher-than-average rate of surgical complications, and in March it suspended all elective surgery for two days after inspectors found problems with surgical infection controls. Then last month, the Army ousted the hospital’s leadership after the unexpected deaths of two patients in their 20s: a mother of three who had undergone a low-risk surgical procedure and a soldier who had been sent home from the emergency room.
That same day, Defense Secretary Hagel ordered the systemwide review.
At Womack and elsewhere, some doctors and nurses complain that no one listens to their safety warnings. One staff member interviewed by The Times recalled filing roughly 50 reports of safety problems since 2007, each time providing contact information. Only once, the worker said, did a supervisor respond, and then only to express irritation at the fusillade of filings.
“It is an exercise in futility,” said the staff member, speaking on condition of anonymity for fear of job repercussions. “We can jump up and down and shake our fists, but nothing changes.”
Dr. Lopez, the former Army staff officer, said some hospital officials had told her that they felt pressure from superiors to focus on budget cutting and efficiency, while patient safety got a cursory nod.
Across the system, Pentagon officials cite some signs of progress. In 2008, for instance, the composite rate of 11 types of harm — like pressure ulcers and postoperative hemorrhages — was more than twice that of civilian hospitals with a similar patient mix. Last year, it was better than the civilian average, although the Pentagon’s own analysts warned results might be skewed by reporting problems.
Even so, the most recent patient-safety report complained of a general lack of headway in building a safer system. While the number of reports of harm has varied over the last decade, and “there are certainly pockets of excellence,” it noted, “The leading trends remain consistent.” What was needed was “enterprisewide change.”
The operating room has been one focus of concern.
The study by the American College of Surgeons found that in addition to Womack, three other major hospitals — Madigan Army Medical Center in Tacoma, Wash.; San Antonio Military Medical Center in Texas; and Portsmouth Naval Hospital in Virginia — have had high rates of surgical complications for two or three years in a row. Five of the eight cited last year had also been flagged repeatedly for high rates of infection related to surgery.
Dr. Brian Lein, the Army’s deputy surgeon general, said hospitals that fell below the benchmark “have dug deep into the data to find the actual issues and are addressing those issues.” The Navy echoed that response.
With so many young military families, the system’s maternity wards are among its busiest. Pentagon officials say maternity care is top notch, and on some leading measures of safe childbirth, the military hospitals indeed compare well with their civilian counterparts.
For example, their rate of infant mortality was equal to or lower than that of civilian hospitals in the most recent data analyzed by the National Perinatal Information Center, a private group with a Pentagon contract. In routine vaginal births, the rate of injury to the mother has consistently been below the national average.
On other measures, though, the military system lags.
In 40 percent of the military hospitals, mothers were significantly more likely to suffer hemorrhages after birth than at the civilian hospitals tracked by the perinatal center. The hemorrhages can lead to hysterectomies or even death. About 2,500 cases were recorded in military hospitals in 2012, roughly 760 more than if the military had met the civilian benchmark.
If doctors used instruments such as forceps to assist the delivery, mothers in military hospitals were about 15 percent more likely to be injured than mothers nationally, the most recent data shows.
One of the broadest measures of safe childbirth is the rate of injuries to babies, ranging from cerebral hemorrhages to small cuts on babies’ scalps. From 2009 to 2011, according to a Times analysis, the rate at military hospitals was twice the national average.
In 2011, nearly five in every 1,000 babies born at military hospitals suffered some kind of birth trauma. Had the military met the national average, 107 newborns would have been injured instead of 239.
Dr. Woodson said the military is looking “closely at areas where we are falling short” on maternity care and measuring its hospitals against civilian ones in order to improve.
Ordeal Giving Birth
When Stephanie King felt labor pains on Easter in 2004, she drove to Reynolds Army Community Hospital. She was 34, a kindergarten teacher and mother of two. Her husband, an Army artillery officer, was serving six months in Iraq, so her 12-year-old son accompanied her to the hospital.
Her contractions were coming every three to five minutes, court records show, but a resident on the maternity ward refused to admit her, saying her cervix was not sufficiently dilated. The attending physician agreed.
Mrs. King spent the next two hours in the hospital’s first-floor lobby, waiting room, cafeteria and bathroom. She wanted to seek care at the civilian hospital 15 minutes away, but her military insurance would not cover it. In the midst of her ordeal, her husband called from Baghdad to say he was being airlifted to Germany after an emergency appendectomy.
Finally, fearful that she would deliver on the bathroom floor, she took the elevator back to maternity. A nurse greeted her with what seemed to be a joke: " ‘Oh, Mrs. King, you are back,’ ” she recalled the nurse saying. " ‘You don’t look as good as you did when you first came in.’ ”
Any amusement vanished, however, when staff members realized not only that Mrs. King was about to give birth — but that her file showed she carried a common but symptomless strain of group B streptococcus bacteria. Women in labor must be given antibiotics at least an hour before delivering to avoid transmitting the infection to their newborns, hospital workers later testified.
Dawson King was born just 42 minutes after his mother was admitted. Doctors soon determined that he had contracted an infection, and warned Mrs. King that the only effective medication could cause deafness. Four months later, when Dawson did not turn his head when his parents walked into the room, it became clear that he was profoundly deaf.
Only three years later, after Mrs. King filed a malpractice claim, was the case discussed at Reynolds, court records indicate. The attending physician said a risk-management meeting was held to ensure that the standard of care was met. No report was written, and the doctors and the nurse emerged with spotless licenses.
That result that would appear to point to a lapse in hospital procedures. But both the resident and the nurse testified that they had never attended a meeting at Reynolds to discuss what had gone wrong.
“That’s the disturbing part,” Mrs. King said, while Dawson draped himself over the arm of his father’s chair, looking at photos of himself as a 1-year-old, his head swathed in bandages from surgery for cochlear implants. “Doesn’t the hospital want to know what happened?”
Mrs. King believes that she knows: Her file documented her history of strep B infection and the fact that her second child had been born after a 90-minute labor. And the resident testified that he could not recall if he had read her record before declining to admit her. “It boils down to they did not even read my records,” Mrs. King said.
The government settled the Kings’ case in 2009 for $300,000. Mrs. King describes her son, now an engaging, soccer-playing 10-year-old, as “a success story.” Still, she said, “it was devastating how easily it could have been prevented.”
The Kings’ malpractice payout was relatively modest. An examination of court records and Pentagon data from Reynolds and seven other hospitals turned up dozens of settlements, ranging from $30,000 to $10 million, but no record of a root-cause analysis.
Flying Blind on Safety
On Dec. 7, 2011, Dr. Woodson summoned senior health officials to a Pentagon conference room to discuss the safety of military hospitals and clinics. The deputy surgeons general of the Army, Navy and Air Force were present. So was Dr. Ronald Wyatt, then the director of the Pentagon’s patient-safety center.
According to accounts from several people familiar with the session, Dr. Wyatt suggested that the center was flying blind. Without knowing the facilities’ death and harm rates, as well as the rates of paid malpractice claims, he argued, his staff was unable to identify safety lapses — much less correct them.
And serious lapses did exist, he said, for “this system, like many systems throughout the country, hurts and kills people every day.” Angered, Dr. Richard A. Stone, then the Army’s deputy surgeon general, shot back: “I demand that you retract those statements.”
Dr. Warren Lockette, the deputy assistant secretary for clinical policy, stood by Dr. Wyatt. “What I am hearing is you are all satisfied with the status quo,” he said. Dr. Woodson tried to defuse the tension with a compromise: He would recommend that the services turn over the data.
Asked about the meeting, Dr. Stone said that data should be shared but that Dr. Wyatt’s statement was “inflammatory.”
The standoff was typical, former Defense Department officials say, of a continual tug-of-war between health care officials in the Pentagon and in the individual armed services that has crippled efforts to improve patient safety. In such a politicized system, data can be a weapon.
“Why should the Army safety system want to play with D.O.D., because then I have less control over my data, less control over my kingdom, and potentially D.O.D. is going to tell me what to do?” said Dr. Lopez, the former Army health policy officer.
To keep Pentagon overseers at bay, surgeons general have often relied on a provision in a 1986 law, known as 1102, that prohibits disclosure of medical quality assurance records. Originally adopted to ensure that medical personnel could be honestly evaluated without fear of publicity, former department officials say, it became a tool to withhold a broad range of data from the Pentagon itself.
And from the public. In response to Freedom of Information Act requests, the Pentagon provided The Times with thousands of pages of data. But much information was redacted and some reports were withheld as confidential, including all reports by the Navy’s inspector general on patient safety or quality of care. By contrast, the veterans system posts the reports on a public website.
While infighting held the military’s patient-safety programs in check, some civilian hospital systems cut death and harm rates. At Ascension Health and Kaiser Permanente, two of the nation’s biggest nonprofit systems, investigating workers’ reports was just a first step. The companies also analyze a vast array of data, including readmission and mortality rates.
The death rate is a broad measure that cannot pinpoint where care falls short. Nonetheless, “mortality is the mother of all outcomes,” said Ascension’s chief medical officer, Dr. Ziad Haydar. Measured over time, a death rate, adjusted for seriousness of illness, can show if a medical system is getting more or less safe.
Officials at Ascension and Kaiser say their hospitals have gotten safer. Ascension estimates that its safety measures have saved 1,500 lives in the last six years. Doug Bonacum, Kaiser’s vice president for quality, safety and resource management, said the mortality rate at Kaiser’s 38 hospitals had fallen more than 30 percent in the last four years.
The Pentagon does not routinely track the total number of deaths, and has no method yet to calculate adjusted rates. “Frankly it is not yet a helpful measure for assessing quality,” Dr. Woodson said.
As a result, why some military hospitals report many more deaths than others with similar numbers of patients is a mystery. The Army, Navy and Air Force each said that hospitals with above-average death rates treated older, sicker patients, but did not produce statistical evidence to verify that.
When it comes to gauging the frequency of errors, systems like the military’s that rely on workers to report harm have been shown invariably to undercount. Kaiser has long used another technique, called the Global Trigger Tool, that winnows out indicators of poor care from randomly selected patient files.
Using that technique, researchers concluded in 2010 that one-third of patients at three major civilian hospitals had suffered some kind of harm. A similar pilot study by the Pentagon last year found that nearly half the patients whose files were reviewed at a major military hospital had been harmed at least once. The study suggested 99 percent of harm at that hospital was not reported by medical workers.
Communiation Breakdowns
When patients die unexpectedly, medical workers often cite a breakdown in communications.
That appears to be the overriding explanation for the delay three and a half years ago in treating Jessica Zeppa, a case that ended with a $1.25 million malpractice settlement. But that is only conjecture. Her death was apparently never subjected to a patient-safety examination.
Mrs. Zeppa had been married and living at Fort Sill for only nine months when her husband, James, an air defense tactician, was deployed to the United Arab Emirates. She had their two dogs and a cat for company. And to her delight, she was pregnant. “She was just out of this world about it,” said her mother, Mrs. Amonett.
But five months into the pregnancy, Mrs. Zeppa became so weak that she struggled to climb stairs. She complained that it hurt to drink or swallow.
At Reynolds Army Community Hospital, she was initially treated in the obstetrics and gynecology unit, where an ear infection was diagnosed and she was prescribed antibiotics and ear drops, court records show. Three days later, she arrived at the emergency room at 4:51 a.m.; she was prescribed a painkiller for erupting wisdom teeth.
She returned that same evening and was found to have a fever, a fast pulse and an elevated white blood cell count — possible symptoms of serious infection. The emergency room physician, Dr. Raul Young-Rodriguez, treated her intravenously with fluids and a powerful antibiotic and sent her upstairs to the obstetrics and gynecology unit for possible admission.
No one called the obstetrician on duty to inform her of the patient’s condition, the Zeppas’ lawyers, Heather Mitchell and Steven Clark, said in court papers. Nor did the obstetrician, Dr. Debra A. Carson, call Dr. Young-Rodriguez.
As far as she knew, Dr. Carson later testified, Mrs. Zeppa was there for “obstetrical clearance.” She examined her and sent her home within 20 minutes. Mrs. Amonett said she protested but was told her daughter could not be admitted if the fetus was not in distress.
Dr. Carson testified that she had not checked the military’s electronic record system for Mrs. Zeppa’s history, because all too often she had found patient records missing. In Mrs. Zeppa’s case, lab results were posted less than an hour after she left. Had she seen them, Dr. Carson testified, “I would more than likely have admitted her.”
Two days later, Mrs. Zeppa returned to the obstetrics and gynecology unit, insisting that she would not leave until she got warm. A nurse midwife, Kelly West, treated her with intravenous fluids and again released her. Ms. West testified that she did not review Mrs. Zeppa’s records either.
The next afternoon, with Mrs. Zeppa struggling to breathe, her mother summoned an ambulance. Mrs. Zeppa was airlifted the following morning to a civilian hospital in Oklahoma City, where she miscarried 10 days later and died the next month.
Five months after that, facing a malpractice claim, Reynolds officials conducted a risk-management investigation. In an interview, Ms. West, the nurse, said she had been cleared of violating the standard of care. Nor is there any public indication that the two doctors were penalized. They did not respond to requests for comment.
Medical experts hired by the family’s lawyers said that had the Fort Sill doctors recognized that Mrs. Zeppa was suffering from septic shock and immediately hospitalized and aggressively treated her, she and the baby probably would have survived. The government’s experts disagreed, noting that civilian doctors had been unable to save Mrs. Zeppa in five weeks of treatment.
Justice Department lawyers called Mrs. Zeppa’s death a “unique and tragic case, but not a case of bad and actionable medicine.” Beyond the risk-management assessment, they said, they knew of no other inquiry. Ms. West also said she knew of none in the roughly eight months before she left Fort Sill.
That left any missteps that contributed to Mrs. Zeppa’s death unexplained.
“She was really pretty, and she had a really big heart,” James Zeppa, Mrs. Zeppa’s husband, said. Now, he said, he no longer trusts military medicine.
Mrs. Zeppa’s father, Mike Amonett, had one thing to say about the Fort Sill hospital: “I just want that place shut down.”
This article is courtesy of The New York Times.
Thursday, 27 February 2014
Monday, 21 October 2013
Sydney doctors fined for underpaying disabled employee
A western Sydney medical practice and two doctors have been fined $123,690 for discriminating against a disabled former patient that they employed as a receptionist.
The Fair Work Ombudsman has taken legal action against Medical Centre 2000 in Liverpool and its directors, alleging they underpaid the vision-impaired woman more than $20,000 between 2009 and 2012.
It says the woman was initially a patient at the practice before she was offered work there when she was aged 18-21.
The woman was made to work for a month of unpaid training before being paid a flat rate of $7 to $8 per hour.
That was despite the company receiving a disability apprentice subsidy which required her to be paid award rates of $10 - $17 per hour.
The Federal Court in Sydney has found the company and directors breached disability discrimination provisions of the Fair Work Act.
The company which operates the practice has been fined of $88,870 while its two directors, brothers Dr Ahmed Mohamed and Dr Ismail Mohamed, have been fined $17,410 each.
Fair Work Ombudsman spokesman Kevin Donnellan says it sends a strong message that workplace discrimination will not be tolerated.
"It's the biggest penalty that's been imposed in a case that involves discrimination in the workplace on an action taken by the Fair Work Ombudsman," he said.
"So it's a very strong message to all employers."
The Fair work Ombudsman says the woman's underpayment was rectified after legal proceedings began and she was awarded an extra $5000 for non-economic loss.
This article is courtesy from ABC.
The Fair Work Ombudsman has taken legal action against Medical Centre 2000 in Liverpool and its directors, alleging they underpaid the vision-impaired woman more than $20,000 between 2009 and 2012.
It says the woman was initially a patient at the practice before she was offered work there when she was aged 18-21.
The woman was made to work for a month of unpaid training before being paid a flat rate of $7 to $8 per hour.
That was despite the company receiving a disability apprentice subsidy which required her to be paid award rates of $10 - $17 per hour.
The Federal Court in Sydney has found the company and directors breached disability discrimination provisions of the Fair Work Act.
The company which operates the practice has been fined of $88,870 while its two directors, brothers Dr Ahmed Mohamed and Dr Ismail Mohamed, have been fined $17,410 each.
Fair Work Ombudsman spokesman Kevin Donnellan says it sends a strong message that workplace discrimination will not be tolerated.
"It's the biggest penalty that's been imposed in a case that involves discrimination in the workplace on an action taken by the Fair Work Ombudsman," he said.
"So it's a very strong message to all employers."
The Fair work Ombudsman says the woman's underpayment was rectified after legal proceedings began and she was awarded an extra $5000 for non-economic loss.
This article is courtesy from ABC.
Sunday, 4 August 2013
Hospital, surgeon facing hundreds of lawsuits over phantom surgeries
An upstate New York surgeon and his hospital are being accused of greed and negligence in a series of malpractice lawsuits.
Dr. Spyros Panos, formerly a surgeon at Saint Francis Hospital in Poughkeepsie, N.Y., are facing hundreds of malpractice lawsuits over accusations he sliced people open and sewed them back up without actually performing any procedures, or that he performed the wrong surgery.
Scheduling as many as 22 surgeries a day, an almost unheard of workload, Panos was billing for work never completed and his out of control greed resulted in the death of a 76-year-old woman, one of the lawsuits alleges.
Panos reportedly would schedule up to 22 surgeries a day, most surgeons only schedule 32 procedures a month, according to industry statistics quoted by ABC News.
Debra Nenni McNamee alleges that in 2009 Panos was to have performed surgery on her 76-year-old mother Constance Nenni’s left knee to repair damage caused by arthritis, according to ABC. Panos is said to have described the procedure as ‘a simple in and out.’
The procedure involved a small camera being inserted into Nenni’s knee to help clean out any dead or damaged tissue found, a fairly routine procedure. McNamee claims that less than 24 hours after the surgery, Nenni died of a pulmonary embolism said to have been caused by a blood clot that broke free and blocked the lung’s main artery, according to reports.
Though not a common occurrence from knee surgery, older adults are more prone to such complications from any type of surgery. The Dutchess County (NY) medical examiner’s report, purportedly, is what did Panos in.
Panos allegedly had fudged all the post-surgery notes related to the six procedures he had performed on the family patriarch. The medical examiner's autopsy showed no evidence that he had ever removed torn cartilage, smoothed areas of excess wear or removed soft tissue from within the knee joint – he simply opened and closed her knee without so much as a single bit of repair, the Poughkeepsie Journal originally reported.
‘He put her under anesthesia, placed the scope in her knee and then closed her up without performing any surgery,’ Brian Brown, McNamee’s lawyer told ABC. ‘The reports showed no hardware in place and, certainly, no evidence of a total knee reconstruction.’
McNamee’s case wasn’t a one-off, according to several reports. Former patients have brought a total of 250 malpractice suits against Mid-Hudson Medical Group, parent of Saint Francis and Vassar Hospitals, and Panos, according to reports. Both hospitals, located in Poughkeepsie, have declined on multiple occasions to comment, as has Panos. A message seeking comment left with Brent Fleming, Panos' attorney, was not returned.
In another instance, Panos is accused of having performed the wrong surgery.
Barbara Murphy was to have a broken collarbone fixed by Panos in 2010, instead he operated on her rotator cuff as if it was broken, despite there being no evidence to suggest that procedure was necessary, she told the Journal.
Making matters even worse, the Mid-Hudson Medical Group is in the midst of a deal that some believe is an effort to evade liability over Panos, who has since been fired and is also under a federal investigation.
Rival Mount Kisco Medical Group and Mid-Hudson are trying combine assets in a transaction that will transfer ownership of current Mid-Hudson asset to Mount Kisco, leaving Mid-Hudson as nothing more than a shell company that would eventually dissolve, according to the Journal.
Though both sides are adamant the merger is about providing the best care to patients in the region, not everyone is convinced.
‘They are taking what’s valuable and will leave a defunct shell,’ said JT Wisell, an attorney representing 152 plaintiffs suing Panos.
Explaining that Mount Kisco would take Mid-Hudson’s doctors, and its revenue, financial expert Stephen Schulman told the paper that ‘you can’t sue someone with no money.’
This article is courtesy of the Daily Mail.
Dr. Spyros Panos, formerly a surgeon at Saint Francis Hospital in Poughkeepsie, N.Y., are facing hundreds of malpractice lawsuits over accusations he sliced people open and sewed them back up without actually performing any procedures, or that he performed the wrong surgery.
Scheduling as many as 22 surgeries a day, an almost unheard of workload, Panos was billing for work never completed and his out of control greed resulted in the death of a 76-year-old woman, one of the lawsuits alleges.
Panos reportedly would schedule up to 22 surgeries a day, most surgeons only schedule 32 procedures a month, according to industry statistics quoted by ABC News.
Debra Nenni McNamee alleges that in 2009 Panos was to have performed surgery on her 76-year-old mother Constance Nenni’s left knee to repair damage caused by arthritis, according to ABC. Panos is said to have described the procedure as ‘a simple in and out.’
The procedure involved a small camera being inserted into Nenni’s knee to help clean out any dead or damaged tissue found, a fairly routine procedure. McNamee claims that less than 24 hours after the surgery, Nenni died of a pulmonary embolism said to have been caused by a blood clot that broke free and blocked the lung’s main artery, according to reports.
Though not a common occurrence from knee surgery, older adults are more prone to such complications from any type of surgery. The Dutchess County (NY) medical examiner’s report, purportedly, is what did Panos in.
Panos allegedly had fudged all the post-surgery notes related to the six procedures he had performed on the family patriarch. The medical examiner's autopsy showed no evidence that he had ever removed torn cartilage, smoothed areas of excess wear or removed soft tissue from within the knee joint – he simply opened and closed her knee without so much as a single bit of repair, the Poughkeepsie Journal originally reported.
‘He put her under anesthesia, placed the scope in her knee and then closed her up without performing any surgery,’ Brian Brown, McNamee’s lawyer told ABC. ‘The reports showed no hardware in place and, certainly, no evidence of a total knee reconstruction.’
McNamee’s case wasn’t a one-off, according to several reports. Former patients have brought a total of 250 malpractice suits against Mid-Hudson Medical Group, parent of Saint Francis and Vassar Hospitals, and Panos, according to reports. Both hospitals, located in Poughkeepsie, have declined on multiple occasions to comment, as has Panos. A message seeking comment left with Brent Fleming, Panos' attorney, was not returned.
In another instance, Panos is accused of having performed the wrong surgery.
Barbara Murphy was to have a broken collarbone fixed by Panos in 2010, instead he operated on her rotator cuff as if it was broken, despite there being no evidence to suggest that procedure was necessary, she told the Journal.
Making matters even worse, the Mid-Hudson Medical Group is in the midst of a deal that some believe is an effort to evade liability over Panos, who has since been fired and is also under a federal investigation.
Rival Mount Kisco Medical Group and Mid-Hudson are trying combine assets in a transaction that will transfer ownership of current Mid-Hudson asset to Mount Kisco, leaving Mid-Hudson as nothing more than a shell company that would eventually dissolve, according to the Journal.
Though both sides are adamant the merger is about providing the best care to patients in the region, not everyone is convinced.
‘They are taking what’s valuable and will leave a defunct shell,’ said JT Wisell, an attorney representing 152 plaintiffs suing Panos.
Explaining that Mount Kisco would take Mid-Hudson’s doctors, and its revenue, financial expert Stephen Schulman told the paper that ‘you can’t sue someone with no money.’
This article is courtesy of the Daily Mail.
Friday, 21 June 2013
‘Bladder infection’ actually labour
Suffering from abdominal pains, a 17-year-old girl was taken to the Cape Town Melomed Hospital and diagnosed with a bladder infection, only to give birth to a baby boy a few hours later.
Now Micaela October’s father believes the private hospital group was negligent in not picking up that his daughter was in labour.
Eddie October said if he had not asked for a second opinion shortly after Micaela was seen at Melomed Hospital on May 10, she would probably have given birth at home.
But Melomed Hospital has denied that Micaela was misdiagnosed. It said she had a bladder infection, and at the time she was seen by doctors at the hospital she was not in labour and her membranes had not ruptured.
The family were aware that Micaela was pregnant, but did not know when she was due. An ultrasound had been booked for May 10.
During the night of May 9, Micaela complained about pain, and at about 1am her family took her to Melomed Hospital.
October said: “The doctor said she had a bladder infection and gave her only a few Panado tablets. We were given a script to buy antibiotics. We went home, but Micaela still complained of the sharp abdominal pains.”
Later that same day, she went to a private doctor for an ultrasound, and was told she was 32 weeks pregnant.
He recommended that she make a booking for antenatal care with the Mitchells Plain Maternity Obstetrics Unit.
After she was examined at the unit, she was told she was already in labour. She was then transferred to the Mowbray Maternity Hospital where she gave birth to a boy weighing 1.9kg. He has been named Mason.
Melomed spokesman Randal Pedro confirmed that the teenager had been treated at the hospital’s emergency unit for “urinary tract infection in accordance with history given and the findings of the symptoms, tests and examination conducted”.
Pedro said at the time of the examination there were no signs that Micaela was in labour. But October is unconvinced.
“Should she not have gone to the Maternity Obstetrics Unit, I don’t know what would have happened to her – she probably would have given birth at home, something which would have put her and the baby’s life in danger as none of us at home are trained to deliver babies.”
Pedro said that after investigation of the complaint, the hospital found Micaela’s GP had also not found any signs of active labour.
“And in keeping with the advice of the doctor at Melomed Mitchells Plain he urged the patient to book at the MOU for antenatal care as soon as possible.”
This article is courtesy of IOL News.
Now Micaela October’s father believes the private hospital group was negligent in not picking up that his daughter was in labour.
Eddie October said if he had not asked for a second opinion shortly after Micaela was seen at Melomed Hospital on May 10, she would probably have given birth at home.
But Melomed Hospital has denied that Micaela was misdiagnosed. It said she had a bladder infection, and at the time she was seen by doctors at the hospital she was not in labour and her membranes had not ruptured.
The family were aware that Micaela was pregnant, but did not know when she was due. An ultrasound had been booked for May 10.
During the night of May 9, Micaela complained about pain, and at about 1am her family took her to Melomed Hospital.
October said: “The doctor said she had a bladder infection and gave her only a few Panado tablets. We were given a script to buy antibiotics. We went home, but Micaela still complained of the sharp abdominal pains.”
Later that same day, she went to a private doctor for an ultrasound, and was told she was 32 weeks pregnant.
He recommended that she make a booking for antenatal care with the Mitchells Plain Maternity Obstetrics Unit.
After she was examined at the unit, she was told she was already in labour. She was then transferred to the Mowbray Maternity Hospital where she gave birth to a boy weighing 1.9kg. He has been named Mason.
Melomed spokesman Randal Pedro confirmed that the teenager had been treated at the hospital’s emergency unit for “urinary tract infection in accordance with history given and the findings of the symptoms, tests and examination conducted”.
Pedro said at the time of the examination there were no signs that Micaela was in labour. But October is unconvinced.
“Should she not have gone to the Maternity Obstetrics Unit, I don’t know what would have happened to her – she probably would have given birth at home, something which would have put her and the baby’s life in danger as none of us at home are trained to deliver babies.”
Pedro said that after investigation of the complaint, the hospital found Micaela’s GP had also not found any signs of active labour.
“And in keeping with the advice of the doctor at Melomed Mitchells Plain he urged the patient to book at the MOU for antenatal care as soon as possible.”
This article is courtesy of IOL News.
Thursday, 28 February 2013
Doctor criticised after baby dies while in care of privatised GP service
The performance of a doctor treating a seven-week-old baby boy who died while in the care of the privatised out-of-hours GP service in north London was "wholly inadequate", a coroner said on Thursday.
Dr Muttu Shantikumar assessed the newborn baby, Axel Peanberg King, in a telephone call lasting just one minute a few hours before he collapsed in his mother's arms, and later made "wholly inadequate entries on the records that were clearly at odds with the evidence", according to Dr Shirley Radcliffe, the St Pancras coroner.
Axel, previously fit and well, died last November, having contracted a routine cold which developed into a lung infection that went untreated, despite repeated calls and visits by his parents, Linda Peanberg King and Alistair King, over the course of five days to the service and their own GP. Out-of-hours GP cover is run under contract to the NHS in the north central London region by private provider Harmoni.
On the day the baby died, Shantikumar failed to ask the family the essential questions to determine how serious the case was. He downgraded Axel's priority, which had been classified as urgent by a Harmoni call handler, to routine, following his very brief telephone assessment so that the baby was only given an appointment to see a doctor face-to-face three and a half hours later.
When Peanberg King attended the Harmoni clinic, which is located alongside the NHS A&E department in north London's Whittington hospital, she was made to wait with her baby in a queue with six patients ahead of her.
An off-duty NHS paediatric nurse who happened to be sitting near them in the queue realised the gravity of his case and immediately rushed them into the NHS A&E department next door, where frantic efforts were made to resuscitate him in vain. He was declared dead when his father, who had been at home looking after the couple's older child, arrived at the hospital.
The Guardian revealed last December that staff at the Harmoni service feared delays in treating the baby may have contributed to the tragedy. It is very rare, although not unprecedented, for babies in the UK to die of pneumonia.
Recording a narrative verdict which did not apportion blame to individuals, the coroner said it was not possible to say whether intervention at an earlier stage that day would have changed the outcome. Babies that age can deteriorate very rapidly and sadly a few do die, the court heard.
The coroner also found that the consultations and assessments made by staff for the out-of-hours service over the previous few days were appropriate. Two days before he died, the baby had been seen by Dr Kuljeet Takhar, supplied to Harmoni by an agency. The parents had previously reported that Axel was having difficulty breathing, but when Takhar carried out a full examination, he found the baby's lungs were clear and the coroner accepted that at that point the diagnosis of an upper respiratory tract infection was appropriate. Takhar gave a deferred prescription for antibiotics. It was not best practice to do so in babies so young, the coroner said, but Radcliffe also noted that Takhar had told Peanberg King not to be too reassured because very young babies can change very rapidly.
The family said they were not satisfied that they had got to the truth. "We believe there are still many questions to answer about the safety of the service provided by Harmoni. We do not believe that anyone hearing all the evidence in this case could have full confidence in its services. We are now considering all our options to prevent any other children from falling through the net."
Ellen Parry, from the clinical negligence team at law firm Leigh Day, who is representing Axel's parents, said:
"Both Linda and Alistair want to know how their otherwise healthy baby, after repeated visits and calls to this privately run clinic, died from a treatable illness, a death that we believe was entirely preventable."Dr David Lee, medical director for Harmoni, said: "We would like to express our deepest and heartfelt sympathy to the Peanberg King family.
"We believe we have the right underlying systems, policies and procedures to ensure a safe and robust-out-of hours service. We will now be taking full regard of the coroner's findings.
"We know that the review of very difficult incidents such as this always identifies learning points. Our overriding priority is to ensure that this learning is acted on."
The court heard that over the period that the family were in contact with the service there were three gaps in the rota for staff to assess and see patients but Lee said that staffing levels had been safe at all times since slack was built in to allow for people being off ill or for shifts to be unfilled.
This article is courtesy of theguardian.
Dr Muttu Shantikumar assessed the newborn baby, Axel Peanberg King, in a telephone call lasting just one minute a few hours before he collapsed in his mother's arms, and later made "wholly inadequate entries on the records that were clearly at odds with the evidence", according to Dr Shirley Radcliffe, the St Pancras coroner.
Axel, previously fit and well, died last November, having contracted a routine cold which developed into a lung infection that went untreated, despite repeated calls and visits by his parents, Linda Peanberg King and Alistair King, over the course of five days to the service and their own GP. Out-of-hours GP cover is run under contract to the NHS in the north central London region by private provider Harmoni.
On the day the baby died, Shantikumar failed to ask the family the essential questions to determine how serious the case was. He downgraded Axel's priority, which had been classified as urgent by a Harmoni call handler, to routine, following his very brief telephone assessment so that the baby was only given an appointment to see a doctor face-to-face three and a half hours later.
When Peanberg King attended the Harmoni clinic, which is located alongside the NHS A&E department in north London's Whittington hospital, she was made to wait with her baby in a queue with six patients ahead of her.
An off-duty NHS paediatric nurse who happened to be sitting near them in the queue realised the gravity of his case and immediately rushed them into the NHS A&E department next door, where frantic efforts were made to resuscitate him in vain. He was declared dead when his father, who had been at home looking after the couple's older child, arrived at the hospital.
The Guardian revealed last December that staff at the Harmoni service feared delays in treating the baby may have contributed to the tragedy. It is very rare, although not unprecedented, for babies in the UK to die of pneumonia.
Recording a narrative verdict which did not apportion blame to individuals, the coroner said it was not possible to say whether intervention at an earlier stage that day would have changed the outcome. Babies that age can deteriorate very rapidly and sadly a few do die, the court heard.
The coroner also found that the consultations and assessments made by staff for the out-of-hours service over the previous few days were appropriate. Two days before he died, the baby had been seen by Dr Kuljeet Takhar, supplied to Harmoni by an agency. The parents had previously reported that Axel was having difficulty breathing, but when Takhar carried out a full examination, he found the baby's lungs were clear and the coroner accepted that at that point the diagnosis of an upper respiratory tract infection was appropriate. Takhar gave a deferred prescription for antibiotics. It was not best practice to do so in babies so young, the coroner said, but Radcliffe also noted that Takhar had told Peanberg King not to be too reassured because very young babies can change very rapidly.
The family said they were not satisfied that they had got to the truth. "We believe there are still many questions to answer about the safety of the service provided by Harmoni. We do not believe that anyone hearing all the evidence in this case could have full confidence in its services. We are now considering all our options to prevent any other children from falling through the net."
Ellen Parry, from the clinical negligence team at law firm Leigh Day, who is representing Axel's parents, said:
"Both Linda and Alistair want to know how their otherwise healthy baby, after repeated visits and calls to this privately run clinic, died from a treatable illness, a death that we believe was entirely preventable."Dr David Lee, medical director for Harmoni, said: "We would like to express our deepest and heartfelt sympathy to the Peanberg King family.
"We believe we have the right underlying systems, policies and procedures to ensure a safe and robust-out-of hours service. We will now be taking full regard of the coroner's findings.
"We know that the review of very difficult incidents such as this always identifies learning points. Our overriding priority is to ensure that this learning is acted on."
The court heard that over the period that the family were in contact with the service there were three gaps in the rota for staff to assess and see patients but Lee said that staffing levels had been safe at all times since slack was built in to allow for people being off ill or for shifts to be unfilled.
This article is courtesy of theguardian.
Monday, 17 December 2012
Family sues out-of-hours GP provider and nurse over death liability
The family of a young woman is suing the country's biggest out-of-hours GP provider and one of its nurses, whose failures meant her fatal condition was not diagnosed, because neither will accept liability in a test case over legal responsibility in a privatised NHS.
Clare Secker, 19, died of bronchopneumonia in December 2008 after a nurse working for the privately-run telephone service told her parents to give her paracetamol and fluids.
Earlier this year the nurse admitted through her lawyers that she had been "in breach of her duty by failing to arrange for [Secker] to be seen by a doctor". If the young mother, who died when her son Tyler was less than a year old, had been prescribed antibiotics she would have recovered fully.
Despite this neither the firm, which was part of the Harmoni out-of-hours service until it was bought by Care UK in November 2012, nor the nurse has offered compensation to the family.
The nurse claims she does not need to pay out as her employment contract specifically states that the company had insurance in place "to indemnify … for any claim arising from any wrongful act committed by … any employee while carrying out their contractual obligations". But Harmoni says its insurance excludes responsibility for negligence by nurses.
With the Health and Social Care Act 2012 leading to more NHS contracts going to private providers, lawyers are concerned that the fragmented system will lead to a loss of accountability.
The legal wrangle became so protracted that for three years the family could not afford the £1,200 to inter their daughter's ashes. Michael Secker said he wanted this to be "sorted for my daughter Clare and my grandson Tyler".
He added: "We are forced to go to court and keep reliving what happened. We can't believe no one will take responsibility, even though they were at fault and it shouldn't have happened and Clare should be with us now."
The family, who live in Great Yarmouth, Norfolk, is claiming damages of £250,000, saying the sum will help secure Tyler's future. "It's so hard, especially at this time of year. It's nearly four years now and we know we can't ever have our Clare back and Tyler won't have his mum, but we just want it all to be sorted so we can just get on with bringing Tyler up and not having to relive this nightmare over and over again," Michael Secker added.
The family's lawyer, Sandra Patton, head of medical injury at Ashton KCJ solicitors, said: "This has been a horrendous ordeal for the family, and for those responsible to now argue in front of them about who is legally accountable is unacceptable and cruel."
Patton pointed out that if a patient is hurt or dies as a result of NHS care then the health service assumes responsibility, making payouts from a state-backed insurer called the NHS Litigation Authority. She added: "As NHS services are increasingly provided by private companies, this is going to happen more and more, unless something is done to establish a clear line of accountability.
"It cannot be right that patients no longer know who is actually providing their care, or for those who are harmed to have the additional stress of providers trying to dodge responsibility by pointing to a clause in a contract or insurance policy. Until something disastrous happens we, the public, think we are still within the safety net of the NHS and increasingly that's just not the case. There is little transparency or protection, it seems to me."
The local NHS that contracted out the service, NHS Norfolk and Waveney, says it expects the private firm to be insured. A spokesperson said: "We have every sympathy with the family involved in this case. Although the PCT funds the healthcare received by its local population, in the rare and unfortunate event that things go wrong, it is the provider of that care that will be responsible for paying any damages in the event that liability to do so is established."
The company had been owned by Take Care Now in 2008, before being sold to Harmoni. It is now part of Care UK.
A spokesperson for Care UK, which now owns the firm, said: "The company is very keen to see resolution of what is clearly a complex case, which has caused great distress to the Secker family. We urgently want to work with the other parties involved, including all the relevant insurers, to get the right solution for everyone as quickly as possible."
This article is courtesy of theguardian.
Clare Secker, 19, died of bronchopneumonia in December 2008 after a nurse working for the privately-run telephone service told her parents to give her paracetamol and fluids.
Earlier this year the nurse admitted through her lawyers that she had been "in breach of her duty by failing to arrange for [Secker] to be seen by a doctor". If the young mother, who died when her son Tyler was less than a year old, had been prescribed antibiotics she would have recovered fully.
Despite this neither the firm, which was part of the Harmoni out-of-hours service until it was bought by Care UK in November 2012, nor the nurse has offered compensation to the family.
The nurse claims she does not need to pay out as her employment contract specifically states that the company had insurance in place "to indemnify … for any claim arising from any wrongful act committed by … any employee while carrying out their contractual obligations". But Harmoni says its insurance excludes responsibility for negligence by nurses.
With the Health and Social Care Act 2012 leading to more NHS contracts going to private providers, lawyers are concerned that the fragmented system will lead to a loss of accountability.
The legal wrangle became so protracted that for three years the family could not afford the £1,200 to inter their daughter's ashes. Michael Secker said he wanted this to be "sorted for my daughter Clare and my grandson Tyler".
He added: "We are forced to go to court and keep reliving what happened. We can't believe no one will take responsibility, even though they were at fault and it shouldn't have happened and Clare should be with us now."
The family, who live in Great Yarmouth, Norfolk, is claiming damages of £250,000, saying the sum will help secure Tyler's future. "It's so hard, especially at this time of year. It's nearly four years now and we know we can't ever have our Clare back and Tyler won't have his mum, but we just want it all to be sorted so we can just get on with bringing Tyler up and not having to relive this nightmare over and over again," Michael Secker added.
The family's lawyer, Sandra Patton, head of medical injury at Ashton KCJ solicitors, said: "This has been a horrendous ordeal for the family, and for those responsible to now argue in front of them about who is legally accountable is unacceptable and cruel."
Patton pointed out that if a patient is hurt or dies as a result of NHS care then the health service assumes responsibility, making payouts from a state-backed insurer called the NHS Litigation Authority. She added: "As NHS services are increasingly provided by private companies, this is going to happen more and more, unless something is done to establish a clear line of accountability.
"It cannot be right that patients no longer know who is actually providing their care, or for those who are harmed to have the additional stress of providers trying to dodge responsibility by pointing to a clause in a contract or insurance policy. Until something disastrous happens we, the public, think we are still within the safety net of the NHS and increasingly that's just not the case. There is little transparency or protection, it seems to me."
The local NHS that contracted out the service, NHS Norfolk and Waveney, says it expects the private firm to be insured. A spokesperson said: "We have every sympathy with the family involved in this case. Although the PCT funds the healthcare received by its local population, in the rare and unfortunate event that things go wrong, it is the provider of that care that will be responsible for paying any damages in the event that liability to do so is established."
The company had been owned by Take Care Now in 2008, before being sold to Harmoni. It is now part of Care UK.
A spokesperson for Care UK, which now owns the firm, said: "The company is very keen to see resolution of what is clearly a complex case, which has caused great distress to the Secker family. We urgently want to work with the other parties involved, including all the relevant insurers, to get the right solution for everyone as quickly as possible."
This article is courtesy of theguardian.
Subscribe to:
Posts (Atom)