Personal Injury and Social Security Disability Blog

Medical Malpractice Reform Said to Increase US Deficit

Writing for the Huffington Post, Joanne Doroshow of the Center for Justice and Democracy highlighted a March analysis from the Congressional Budget Office determining that savings from malpractice reforms would be minimal. Doroshow argued that reforms imposed by HR 5, which includes a $250,000 noneconomic damage cap will actually increase the US deficit. According to Doroshow, malpractice victims who cannot secure compensation through litigation will turn to avenues like Medicare and Medicaid. The CBO's prediction that reform will reduce health spending by 0.4 percent doesn't account for this. Nor does the CBO consider "that these kinds of extreme 'tort reforms' would weaken the deterrent potential of the tort system, with accompanying increases in cost and physician utilization inherent in caring for newly maimed patients."

From the American Association for Justice news release.

Friday Fun

This naked balloon dance video is 30 years old, but still funny (to some of us anyway). PG-rated.

Iowa Surgical Centers Face Little Oversight

This story is about Iowa, but it should serve as a warning to everyone that when the government does not regulate healthcare providers, there is a chance that patients will suffer. This article ran in theDes Moines Register recently, and is excerpted here:

Iowa is home to dozens of outpatient surgical centers, but none of them is licensed and many are uninspected by the state.

They often deal in volume, each day performing dozens of operations - including spinal surgery, cosmetic surgery, hip replacements, hysterectomies and other complex procedures - that don't require overnight hospitalization.

Federal officials are concerned about rising infection rates in surgical centers, which they say are a major problem attributable to unsafe medical practices and failure to follow basic patient-safety guidelines.

But Iowa is one of only of seven states that don't license the so-called ambulatory surgical centers, which represent one of the fastest growing, but least regulated, segments of the health care system.

The centers are another segment of Iowa's health care system that's almost entirely unregulated by the state, leaving consumers with little or no information on the quality of care that's being delivered.

In addition, hospice providers that care for Iowans in the final stages of terminal illnesses are now being inspected by the state on a schedule of one visit every 20 years. Also, the state exercises no oversight of privately run home health agencies, cannot impose fines on hospital-owned nursing homes and is years behind in the inspection of dialysis treatment centers.

There are now 5,000 outpatient surgical centers nationwide, handling almost half of all same-day surgeries in the United States. They perform 20 million operations annually.

Iowa has 26 Medicare-certified surgical centers that are being inspected once every three years, but there are an unknown number of centers in Iowa that aren't part of the Medicare system. Those surgical centers aren't tracked or monitored by the federal government. And because Iowa doesn't require them to be licensed, the state doesn't track them, either.

"We know they're out there," said David Werning, spokesman for the Iowa Department of Inspections and Appeals. "But they don't have to report to anyone, so we don't know where they are. There's no way to count them, and currently no way to license them."

Kevin Hamers of the Iowa Association of Ambulatory Surgical Centers said his organization would probably oppose legislation that simply required surgical centers to be licensed and subject to state inspection.

Figuring out which surgical centers have problems and which have a good record of meeting minimum standards of patient care isn't easy in Iowa.

The state inspections department's website has no inspection information on 12 of the 26 Medicare-certified surgical centers. As for the 14 others, many of their inspection reports are at least seven years old. One dates back to 1995.

The accrediting agencies don't offer much in the way of information, either. For example, the Accreditation Association for Ambulatory Health Care will confirm a center's accreditation, as well as its name, address and phone number - but that's about it.

Last year, a U.S. Centers for Disease Control and Prevention study of surgical centers in three states found that two-thirds of them had problems with infection control. More than 28 percent of them had failed to follow the standard infection-control procedures for preparing surgical equipment, even though they knew they were being observed by researchers at the time.

That study was conducted in the wake of a public uproar over a health scare in Nevada. State health officials had discovered that three former patients of the Endoscopy Center of Southern Nevada had contracted hepatitis C, a potentially life-threatening disease of the liver.

After learning that doctors at the center had been routinely reusing syringes and vials of anesthetic on different patients, state and federal health officials contacted 50,000 clinic patients to warn them of potential health risks. More than 100 of the patients tested positive for hepatitis.

Public health officials later issued a report that said the outbreak, testing and investigation had cost taxpayers at least $16 million and could have been prevented if the surgical center had adhered to "common-sense" practices.

Medicare Data Reveal Top Safety Issues at Texas Hospitals

The Houston Chronicle reports, "Allowing the public to see information about mishaps and errors that occur during a patient's hospital stay has been a contentious issue for hospital personnel, who believe the public could misread it." Two reports released this month by the Centers for Medicare and Medicaid Services are the "first to look strictly at how many times bedsores, surgical errors and falls and trauma, for example, occur among Medicare patients." The most common hospital-contracted "malady among older patients in Houston is systemic vascular infections, a problem often caused by unsanitary or improper procedures during their hospital stay." Among 46 hospitals "within a 50-mile radius of the city of Houston, half reported vascular infections in Medicare patients through catheters, the tubing used for various procedures."

The Fort Worth (TX) Star-Telegram reports, "At Baylor Surgical Hospital at Fort Worth after surgery in 2008," a 67-year-old woman with gangrene, who was "disoriented and on pain medications, called for help," but nurses failed to respond, according to a lawsuit filed in state district court in Fort Worth. The suit alleges, "Edna Faye Smith fell from bed and broke her leg and ankle. When nurses placed her back on the bed, an audible 'pop' came from the right ankle to the foot," and Smith required more surgery. Notably, the CMS' "information on so-called hospital-acquired" conditions, which "Baylor disputes as flawed," shows the hospital's "rate of falls and trauma was about nine times the national rate per 1,000 patients discharged."

From the American Association for Justice news release.

Concern Grows Over Window Blind Safety

I've written on this topic many times, as it is a real concern to me. Too many infants die needlessly each year because they get strangled by the cords on window shades or blinds. The New York Timesran a lengthy article recently about this danger. Here are the opening paragraphs. You can read more after the break.

On an idyllic August day in 2009, Kathleen Leeson took her children to church, fed them leftover pizza and planned to take them to the park.

But before they left, she decided to put her 2-year-old foster son, Angel, down for a nap. A short time later, her daughter came out of the bedroom and announced that Angel was “sleeping in the window with something around his neck.”

Ms. Leeson, who lives in Montgomery Village, Md., found him lifeless and hanging an inch off the floor, with a window-blind cord wrapped around his neck. “I was screaming his name and shaking him, and the realization hit me, ‘Oh my God. This can’t be happening.’ ”

For the last 25 years or so, manufacturers of window blinds have installed safety features and offered tips to parents to try to minimize the dangers from their products. Even so, children like Angel continue to strangle on the cords with grim regularity, an average of one a month.

Now, prodded by a Missouri mother whose daughter was strangled in a window blind, the Consumer Product Safety Commission has asked manufacturers to devise a way to eliminate the risks from window cords or perhaps face mandatory regulations. Critics of the industry complain that manufacturers have dragged their feet on addressing safety hazards for decades, making minor tweaks or putting the onus on parents to shorten cords or buy tie-down devices. Until recently, regulators have done little to crack down, they say.

In response to the commission’s latest push, the industry, working with a task force of regulators and consumer advocates, says it will come up with a fix by the fall.

But the negotiations have gotten off to a rocky start. Like some other regulatory battles that involve consumer safety, this one comes down to a sobering question: how much should manufacturers, and ultimately consumers, be required to pay to prevent the maiming or death of a child?

Office of National Drug Control Policy Says Congress Should Mandate Painkiller Safety Training

USA Today reports, "To halt prescription drug abuse, the nation's fast-growing drug problem, Congress must require special training for doctors and other health care workers before they are allowed to prescribe powerful drugs such as OxyContin," ONDCP Director Gil Kerlikowske said Tuesday.

The Wall Street Journal reports the Food and Drug Administration said Tuesday that it will require pharmaceutical companies to produce new educational tools about their opioid painkillers in an effort to reduce prescription drug abuse. Department of Health and Human Services Assistant Secretary Howard Koh said at a briefing, "This growing public-health crisis is suffocating our society."

USA Today reports, "American Medical Association President Cecil Wilson said his organization supports the intent of the drug abuse prevention plan but is concerned 'that a key element of this strategy that relies on industry to develop educational materials and initiatives to train prescribers could in the future become a mandatory part of the DEA registration process for prescribing controlled substances.'"

Bloomberg News reported, "Pfizer Inc. (PFE), Johnson & Johnson (JNJ) and Endo Pharmaceuticals Holdings Inc. (ENDP) will have to train doctors before they can give patients extended-release painkillers under a US plan aimed at reducing prescription drug abuse." The Food and Drug Administration said on Tuesday that "sixteen companies that make 25 pain patches and pills must create a program to teach medical professionals when these drugs should be used to combat pain and how to recognize signs that the treatments are being misused."

HealthDay reported, "The new Risk Evaluation and Mitigation Strategy (REMS) is part of a larger multi-agency initiative announced Tuesday by the White House to reduce overall prescription drug abuse in the" US. "'This new REMS will provide tools to doctors and other prescribers for appropriate pain management to reduce risks and at the same time preserve access for patients and appropriate management of pain for those suffering from moderate to severe pain,' said Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research at the" FDA. "For now, the initiative will be limited to extended-release and long-acting products, which, Woodcock said, 'have a much greater risk than immediate-release because they contain more medicine.'"

Modern Healthcare reports, "President Barack Obama's administration also will push for enactment of as-yet-unintroduced legislation to require physician participation in opioid prescribing training. And Gil Kerlikowske, director of National Drug Control Policy, said he is confident that Congress would enact such a measure promptly based on the previous passage of other recent measures focused in part on opioid-abuse control." But, "if Congress does not enact a law requiring mandatory physician participation in such training, the FDA could aim to tighten control on opioid prescribing through restricted formularies."

The Hill "Healthwatch" blog reported, "As a first step, the FDA sent letters to opioid manufacturers on Tuesday requiring that they provide a plan for training prescribers and educating patients about the safe use, storage and disposal of opioids. They have 120 days to respond, setting in place a regulatory process that officials hope to have in place within 12 months. 'We have determined that a Medication Guide and a Communication Plan are not sufficient to mitigate the serious risks,' the letters state. 'Your (strategy) must include tools to manage these risks'"

On its website, CNN reports, "'Unintentional drug overdose is a growing epidemic in the US and is now the leading cause of injury death in 17 states,' said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. 'There are effective and emerging strategies out there to address this problem. Support for this action plan will help us implement those strategies which will go a long way to save lives and reduce the tremendous burden this problem has on our healthcare system and our society.'"

From the American Association for Justice news release.

Friday Fun

Who can resist a funny video about drunk monkeys...?

Study Finds Surgeons' Skills Decline the Day After Drinking Alcohol

The Los Angeles Times reported there "are no rules on the amount of alcohol a surgeon may (or may not) consume on the eve of a day in the operating room." A group of researchers designed an experiment to determine the effect of drinking on a surgeon's drinking the night before they would perform a procedure on a laparoscopic surgery simulator, compared to a baseline. All of the surgeons "were tested on a breathalyzer before the virtual surgeries began, and at least five of the six passed." The researchers "didn't take comfort in the fact that there were few hangovers. Instead, they said they were bothered that surgeons had trouble in their virutal ORs even though they appeared sober."

Reuters reported author Anthony Gallagher, of the Royal College of Surgeons in Ireland, and colleagues say, "It is likely that surgeons are unaware that next-day surgical performance may be compromised as a result of significant alcohol intake."

HealthDay reported the "error rate in the operating room due to a hangover seemed to peak around lunchtime, according to the research, published in the April issue of Archives of Surgery." The message "appears obvious: 'Surgeons and other [medical personnel] should not drink excessively the night before operating,' said the study's first author, Tony Gallagher, a professor of human factors at the School of Medicine at University College Cork in Cork."

MedPage Today reported the conclusion of the study was that "after a night of drinking, surgeons' skills remained subpar well into the next day -- no matter how experienced the surgeon -- suggesting a need for recommendations to address the issue, a multinational group of investigators concluded." The "effects of alcohol on next-day performance were observed in both surgical novices and experienced surgeons, Gallagher and co-authors reported in the April issue of Archives of Surgery.

From the American Association for Justice news release.

Ford Expands Recall of F-150 Trucks Because of Faulty Airbags

The AP reported under regulatory pressure, Ford expanded its recall of the F-150 pickup truck over an "electrical short" than can cause air bags to deploy without a crash. The recall includes 1.2 million trucks largely from model years 2004 and 2005, and some from 2006. Former National Highway Traffic Safety Administration Administrator Joan Claybrook said before the automaker's recalls last year, it was unlikely the NHTSA would've called for the expanded recall, "but the agency has become more aggressive since being criticized over Toyota's problems." Toyota spokesman Wes Sherwood "said the company didn't recall the trucks five years ago because it didn't think there was a safety risk."

The Los Angeles Times reported, "Federal safety regulators said there have been at least 269 incidents - more than a third of which resulted in injuries - making it the most 'ever recorded in any inadvertent airbag deployment investigation or recall' in the history of the National Highway Traffic Safety Administration." The Times adds the size of Ford's initial recall of 144,000 pickups "drew the interest of federal safety regulators who thought that the automaker should have called back far more trucks."

Reuters reported the recall includes 89,000 vehicles in Canada, 46,000 in Mexico, and 10,000 elsewhere around the world.

From the American Association for Justice news release.

SSA Holds Compassionate Allowance Hearing on Autoimmune Diseases

The National Organization of Social Security Claimants Representatives (NOSSCR), recently published an article about compassionate allowances by the Social Security Administration for claimants suffering from autoimmune diseases:

Impairments that are on SSA’s list of Compassionate Allowances are those that provide almost a 100% guarantee that the person will be found disabled. Individuals with these conditions are not expected to improve. If a claimant is diagnosed with one of these conditions, an approval is generally issued within two weeks.

To determine which impairments should be on this list, SSA has held several hearings on various medical conditions. On March 16, 2011, SSA heard from several experts in the field of autoimmune diseases at an outreach hearing in Baltimore, MD. Doctors specializing in each of these individual conditions spoke at the hearing, as did a doctor from Johns Hopkins Center for Autoimmune Disease Research, several advocacy groups and individuals living with some of these conditions. Some of the more common autoimmune diseases are rheumatoid arthritis, lupus and scleroderma. This is a difficult classification as there are over 100 autoimmune diseases that share some common impairments, but that also each have their own differentiating features and may affect one individual differently than another. All are caused by the body’s autoimmune response to one’s own tissue, cells and organs. Many people suffer from more than one autoimmune disease. For example, 95% of people who suffer from lupus also have arthritis, but the two conditions are not the same.

Commissioner Astrue opened the hearing by explaining that the purpose was to learn more about the functional limitations caused by autoimmune diseases and then determine whether the confirmation of a diagnosis alone can meet a compassionate allowance definition of disability. SSA is seeking information on what an adjudicator with no medical training can look for in an autoimmune disorder that would almost guarantee a finding of disability. One problem is that there is not enough research done on many of the autoimmune diseases to have highlighted an objective marker. ODAR Deputy Commissioner Glenn Sklar questioned the accuracy of a diagnosis made by a general practitioner. Many patients do not have access to specialists, but because many autoimmune disorders are rare, a general practitioner may not be familiar with all of the symptoms, and may not make an accurate diagnosis. Because a compassionate allowance will be made on the basis of a diagnosis, it is important that the diagnosis can be reliable. Diagnoses made by specialists are more reliable.

A striking similarity of all of these conditions is the number of organs they affect. A person with a primary diagnosis of lupus may also have pulmonary fibrosis, digestive disorders or cardiac impairments. People with rheumatoid arthritis have an increased chance of heart attack and stroke. In addition, although none are curable, all are more treatable when diagnosed earlier. So an individual whose treatment began soon after symptoms surfaced may be less disabled than one with less access to medical care who may not have begun treatment until the symptoms were much more advanced.

Many of the speakers focused on the combination of impairments. For example, the President of the Lupus Foundation of America explained that there were four organ combinations affected by lupus that she felt were most likely to result in disability: 1) brain and nervous systems, which lead to seizures, psychosis, severe headaches and movement disorders; 2) heart and lungs, which cause pulmonary embolism and hypertension, myocardial infarction and lung diseases; 3) muscles and joints causing limitations in mobility, avascular necrosis and rheumatoid arthritis; and 4) kidney involvement that can lead to the need for dialysis and transplants. Other autoimmune disease combinations can lead to similar problems.

The individuals with these diseases spoke of their struggle to remain in the workforce as their conditions progressed to the point of disability. They explained the extreme fatigue they experience everyday, the difficulty in doing the simple daily activities and the debilitating side effects of medication needed to keep the primary impairments under control.

The speakers’ handouts are available online at www.ssa.gov/compassionateallowances. The material includes useful information about each of these conditions for attorneys who are representing clients with the specific condition. There is information about how several organs can be affected and some very graphic pictures of the debilitating effects of these conditions.

There are currently 88 conditions on the Compassionate Allowances list. This list, as well as information about how SSA processes claims involving these conditions, can be found at www.ssa.gov/compassionateallowances.