Philadelphia Medical Malpractice Lawyer Blog

Delaware has become the third state in the nation that will not bill patients or their insurance companies for certain medical errors. Delaware hospitals identified 9 serious mistakes for which they will no longer bill:

(1) performing surgery on the wrong body part;
(2) performing surgery on the wrong patient;
(3) performing the wrong surgery on a patient;
(4) sending a newborn infant home with the wrong family;
(5) unintentionally leaving a foreign object in the body;
(6) medication error that results in serious injury or death;
(7) using wrong artificial donor for insemination;
(8) causing injury by giving patient the wrong blood type; and
(9) air-embolism injury.

Interestingly, the "no pay" rule adopted by the Delaware Healthcare Association applies only to hospitals, which means that patients may still see a bill from their doctor for these types of errors. It is unclear how many errors occur in Delaware's hospitals because Delaware (unlike many states, including Pennsylvania) does not require hospitals to report medical errors to the public. However, one study, performed by the Institute for Medicine in 1999, reported that nationwide, between 44,000 and 98,000 patients die in hospitals each year because of preventable medical errors.

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A new study published in The Journal of the American Medical Association reveals that the likelihood of patient survival after cardiac arrest (when the heart stops) in a hospital is significantly impacted by the time of day the attack occurs. This study follows earlier studies that demonstrated that patients fare worse during weekend care than they do during care received during the workweek for the same health problems.

In the recently-published study, almost 87,000 patients who suffered from cardiac arrest were studied at 507 hospitals during 7 years. Typically, when a patient's heart stops, a team of medical professionals is called urgently to the patient's bedside to begin rendering care from a "crash cart" that contains equipment such as a defibrillator and various drugs. As a practical matter, patients who suffer from a cardiac arrest are usually very sick and even at the best of times the rate of survival is fairly low (among the studied patients, approximately 20% of those who suffered a cardiac arrest during the day shift survived to the point of hospital discharge), but something about the night shift seems to make the chances of survival even worse. In the study, only 15% of those patients who suffered a cardiac arrest during the 11 p.m. - 7 a.m. shift survived long enough to be discharged from the hospital.

This study would suggest that the level of patient care received a night is subpar - either because the night shift workers are too tired to react as efficiently as the day shift workers or because there is less staff during the night hours such that they can't check patients as often and react to problems as quickly or because the experience and skill level of night shift workers is lower than that of day shift workers. Whatever the explanation, it is reasonable to conclude that differences in care are not limited to cardiac arrest situations.

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Evidence showed that poor nursing care at Pennsylvania Hospital of the University of Pennsylvania Health System, including failure to contact a physician as ordered when the patient's blood pressure dropped below 100 and the absence of documented nursing care for a 16.5 hour period after surgery, resulted in the death of a 55 year old woman following a routine hernia operation. At trial, medical records presented to the jury showed that after surgery, a resident examined the patient and noted in her chart that nurses should call a physician if the patient's blood pressure dropped below 100. The same records showed that later the same day, at 5:15 p.m., a nurse recorded a blood pressure of 90/60, but did not call a doctor. This was the last nursing note written in the chart for the patient until 9:45 the next morning, reflecting a gap in documented care of 16 and 1/2 hours. The 9:45 a.m. chart noted that the patient was "extremely sedated, requiring painful stimuli for arousal and with a blood pressure of 90/58."

Following the 9:45 a.m. note, the patient's morphine pump was stopped and she was transferred to the intensive care unit, where she died two and a half days later. Attorneys for the woman's family argued that the nurses violated the standard of care by not calling for a doctor when the patient's blood pressure dropped below 100. Although attorneys for the hospital disputed that the nurses' care was negligent, a nursing supervisor employed by the hospital testified that a doctor should have been called when the patient's blood pressure dropped below 100.

In addition to the allegations that the nurses were negligent for failing to call for a doctor, the plaintiff's attorneys argued that the patient was over-medicated with morphine. Evidence presented at trial showed that people with compromised livers, which this patient had because of a chronic alcoholism condition, process morphine 50% slower than patients with a healthy liver. Attorneys for the hospital essentially argued that the patient was caused by her alcoholism and related medical problems such as liver disease and high blood pressure.

A jury voted 10-2 to award the patient's family $1.2 million dollars, which was $900,000 more than the highest offer the hospital had made to settle the case prior to trial. The hospital has stated it will appeal the verdict.

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The Estate of 77 year old man was awarded $1.7 million by a Philadelphia jury after he slowly suffocated on Ventilator with a mucus plug that went untreated. Simple proper suctioning by his nurses would have prevented his death. Temple University Hospital was found negligent through the failure of its nurses to properly care for the elderly man on a ventilator in the Intensive Care Unit, who was suffering from angioedema (a type of allergic reaction). The patient, who was conscious and communicated with his family and staff by writing notes, had twice given notes to his daughter telling her that he was having difficulty breathing. This information was passsed onto the nurses, who failed to provide breathing medication of Albuterol, which was ordered, and failed to provide needed suctioning of the patient. The verdict, which was unanimous, also found that the physicians caring for the patient were not negligent and attributed full responsibility to the Temple University Hospital.

Testimony included details of the two notes written to the patient's daughter and how the information and concern about breathing was communicated to the hospital nursing staff. Later that evening, the patient was sedated and restrained, making him unable to communicate further with the nursing staff. There were admissions by the physicians that the failure to have given the breathing medication Albuterol would have been below the standard of care. The mucuc plug that formed in the breathing tube was determined to be the cause of death. Apparently, the jury interpreted all the failures as nursing staff responsibilities that were not properly fulfilled. Testimony was also presented describing how the elderly man slowly suffocated over a period of several hours, until he finally arrested and died.

Despite this verdict, defendants are planning to appeal the decision and it will likely be some time until the family sees any money. This case represents an unusual situation when an elderly individual is fully compensated for his pain and suffering resulting in his death. It is also an unusual case in that the doctors were all found not negligent, but the nursing staff and hospital were found responsible. One reason why the verdict was so high was the quality of the plaintiff, who was described as a World War II hero and three time cancer survivor, who cared for his sick wife, who was on dialysis, and did the housework and cared for his grandchildren. There were no offers to settle the case before trial.

Posted by Leon Aussprung | Permalink | Email This Post

Posted In: Hospital Care

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