Ask doctors what concerns them most, and chances are they’ll say, “medical malpractice.” A recent New England Journal of Medicine study found that 75% of doctors who practice psychiatry, pediatrics or family medicine will be sued during their career. Neurosurgeons, orthopedic surgeons and obstetricians have it worse, as virtually all of them will be sued before they finish practicing medicine.

The medical malpractice debate often pits physicians — who say the threat of lawsuits pushes them to order expensive, unnecessary tests — against lawyers who believe that lawsuits are needed to hold doctors accountable.

How can physicians avoid the courtroom? If an error was made, many insurers advise physicians not to talk to patients. That’s wrong. Physicians should disclose their mistake, apologize and, when appropriate and through mutual agreement, compensate injured patients.

For more than a decade, the University of Michigan Health System has used such a program, and its incidence of malpractice claims has since dropped 36%.

This approach should be spread nationwide. Actually, in 2005, then-Sens. Hillary Clinton and Barack Obama co-sponsored the National MEDiC Act, which among other things would have implemented apology laws throughout the U.S. Although the measure never became law, at least 36 states have passed legislation protecting apologies from being used against doctors in court.

Doctors also must create and maintain open lines of communication with patients, which is critical to preventing lawsuits in the first place. Doctors have to better explain, and patients better understand, that not all adverse outcomes are due to physician errors. Although the Institute of Medicine’s 1999 seminal report, “To Err is Human,” concluded that medical errors caused up to 100,000 patient deaths a year, 90% of those deaths were attributed to systemwide procedural failures at medical institutions.

There’s no panacea for eliminating mistakes, but a starting point is clearly communication. Better doctor-patient exchanges improve medicine, and when patients and their families are kept in the loop, they also are less likely to pursue a lawsuit. And, then, if errors are made, doctors should apologize and work with the patient and, when necessary, their lawyer, to find a compromise.

Transparency is the key to an open, trusting and healthy doctor-patient relationship.

From the American Association for Justice press release.

The details of this story were published by the New York Times. Here are the opening paragraphs:

To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.

]]> http://www.pissd.com/2012/01/u-s-to-force-drug-firms-to-report-money-paid-to-doctors/feed/ 0 http://www.pissd.com/2012/01/hhs-report-finds-most-hospital-errors-unreported-by-hospital-employees/ http://www.pissd.com/2012/01/hhs-report-finds-most-hospital-errors-unreported-by-hospital-employees/#comments Thu, 19 Jan 2012 10:05:01 +0000 Bob Kraft http://www.pissd.com/?p=8610 In continuing coverage, ABC News reports on its website, “A new report released Friday by the inspector general of the US Department of Health and Human Services found that more than 80 percent of hospital errors go unreported by hospital employees.” The new “report, which looked at data from hospitalized Medicare patients, also found that most hospitals where errors were reported rarely changed their policies and practices to prevent repeat errors, saying the event did not reveal any ’systemic quality problems.’”

The National Journal reported, “In correspondence published alongside the report, former Centers for Medicare and Medicaid Services head Dr. Donald Berwick said Medicare officials plan to develop a list of reportable events to help make it clear what hospital employees need to look out for.”

From the American Association for Justice news release.

From the American Association for Justice news release.

Presidio County is bigger than Delaware and has just one practicing physician who doesn’t deliver babies or treat emergencies. It’s the kind of underserved region that Gov. Rick Perry suggested would benefit when he proposed a crackdown on medical malpractice lawsuits in 2003.

Now running for president, Perry says his tort reform plan proved the wisdom of his business-friendly policies by expanding health care across the state.

Yet none of the 23,000 doctors Perry says Texas has newly licensed have come this way.

“Some patients, when they find out they’re pregnant, bam — they’re out of here,” said Dr. Darrell Parsons, whose practice in Presidio is just across the Rio Grande from Ojinaga, Mexico.

An analysis of Perry’s tort reform initiative in Texas reveals a more complicated bottom line than his campaign rhetoric on the issue would suggest. State medical data show that the number of physicians practicing in Texas has increased since the initiative passed in 2003, though by considerably less than the total Perry cites. And the bulk of that influx has come in larger cities where health care was already abundant, leaving large rural swaths of Texas still without doctors.

Discussing his malpractice reforms in a speech in Georgia in September, Perry said, “Pregnant women have better access to OB-GYNs. People in need of trauma care have better access to neurosurgeons and other specialists. That’s what tort reform is really all about. About how to give better access to the people of my home state. We need to spread lawsuit reform across all economic sectors of this country.”

However, medical records in Texas show that of the state’s 254 counties, only 106 have an obstetrician/gynecologist — just six more than in 2003. In Presidio County, which has 8,000 residents and is growing, some of Parsons’ patients move 240 miles away to live with relatives in Odessa or Midland when they become pregnant.

Overall, the increase in physicians in Texas roughly tracked the state’s population growth. Medical rolls increased by 24 percent since 2003, while Texas’ population was soaring by 20 percent during the decade. Texas also saw rapid growth of physicians per capita before tort reform, according to the Texas Department of State Health Services.

The statistic Perry most often cites — 23,000 newly licensed doctors after tort reform — includes about 10,000 who sought licenses in Texas but took jobs elsewhere and physicians practicing telemedicine in other states.

Perry made access to health care a major argument for tort reform in the initiative’s advertising campaign in 2003, saying the state was hemorrhaging doctors because of lawsuits and malpractice insurance costs. The ballot issue, Proposition 12, became the most expensive campaign ever waged to amend the Texas Constitution. More than $15 million was spent in the showdown between trial lawyers and health care interests.

In a speech to the conservative Heritage Foundation that year, Perry told a New York audience how three out of five Texas counties lacked an obstetrician.

“That’s a hardship for many pregnant women in certain areas of our state, but especially women with high-risk pregnancies,” Perry said.

Eight years later, that ratio is the same.

Copper sheathing on bed rails may curb hospital bugs. MedPage Today reports, “Copper sheathing on bed rails and intensive daily cleaning of hospital patients’ rooms were effective in reducing bacterial contamination on ‘high-touch’ surfaces, according to studies presented” at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Investigators “at the Medical University of South Carolina in Charleston…found that bacterial loads were substantially lower on bed rails sheathed in a copper alloy, relative to conventional plastic rails, and rebounded more slowly after disinfectant treatment.”

From the American Association for Justice news release.

With little oversight and apparent carte blanche, a relative handful of Texas physicians wrote $47 million worth of Medicaid prescriptions for powerful antipsychotic and anti-anxiety drugs over the past two years, according to a Star-Telegram analysis.

The top five doctors alone wrote $18 million worth.

Most of the drugs have gone to children and adolescents, although prescribing the drugs to children, such as a toddler, is considered “off-label” — uses not approved by the federal Food and Drug Administration.

Now the state’s Medicaid program is among others under scrutiny, after Sen. Charles Grassley, R-Iowa, began investigating the use of mental-health drugs this year. Grassley, the ranking member of the Senate Finance Committee, told federal health officials to keep a better watch on top prescribers. His conclusion: Either some physicians have specialized expertise or the number of prescriptions suggests “overutilization or even health care fraud,” according to an October letter sent to the Health and Human Services Department.

Some advocates are concerned that the drugs are unsafe for children, who make up nearly 75 percent of Texas Medicaid’s 3.2 million recipients. In a 16-state study, Texas had the maximum rate of prescribing multiple mental-health drugs to youths in foster care. Although the number of prescriptions had dropped 19 percent by 2007, Texas was still tops, according to the June study.

And some doctors churn out prescriptions for children and others at an alarming rate. Antipsychotic drugs prescribed to children under 6 grew by 20 percent from 2007 to 2009, according to a November report by the Texas Health and Human Services Commission.

About 1.7 percent of children on Medicaid received antipsychotic drugs in fiscal 2009, state officials said.

Some children are overmedicated: One area doctor routinely prescribes five potent mental-health drugs simultaneously, said one of the state’s top prescribers. He said he tries to scale back the number of drugs the children are on.

Some experts believe that medication has pushed aside talk therapy, which might be effective and reduce medication needs.

The child, 31/2, suffers from shaken baby syndrome. When stressed, he pulls at his ventilator hoses and tracheotomy tube so much that his hands must be tied to the bed. He is prescribed antipsychotics because other sedatives could suppress the breathing centers of the brain.

Grassley asked Texas and other states for the top 10 prescribers who billed Medicaid for certain drugs. The Star-Telegram used prescriber numbers to identify the doctors, then sorted and tallied the drugs they were prescribing. Also reviewed was information on other mental-health drugs that have cost taxpayers about $1.3 billion during the past five years.

The analysis and research found:

In the past two years, 72 Medicaid providers wrote 186,992 prescriptions, an average of 2,597 each.

The state’s top prescriber, child psychiatrist G.K. Ravichandran of Houston’s Shamrock Psychiatric clinic wrote 27,000 scripts for the anti-anxiety drug Xanax in the past two years. The next-closest physician wrote 6,300.

Under his license, 44,138 prescriptions for antipsychotic drugs were written, at a cost to Medicaid of $6.4 million.

Dr. Fernando Siles, a child psychiatrist in Greenville, is the second most prolific Medicaid prescriber. He sees children from across North Texas, including Tarrant County.

In the past two years, Siles’ medical license was used to write 13,601 antipsychotic prescriptions at a cost of $4.6 million.

Siles, who treats solely Medicaid recipients, some as young as 3, has three nurse practitioners who also write prescriptions under his license, he said.

Many children referred to him are already on multiple antipsychotic drugs, and he tries to cut back, he said. “Fifty percent of the medications I prescribe, I did not start them on the medicine,” he said. “They came from other doctors.”

There may be other physicians who are also prescribing high volumes of antipsychotic drugs but aren’t as easily detected, state officials say.

Some physicians use a clinic to hide the volume of their prescribing, said Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, which oversees Medicaid.

“To be quite honest, we feel like single doctors have started to bill under clinics to maybe hide that, to make it look like it’s not a single doctor prescribing all these,” she said.

The 13-year-old girl suffered depression and post traumatic stress disorder. She cut her arms and stomach. Her stepfather molested her, and then beat her when she refused to have sex. She cannot sleep at night for the nightmares of being locked in a closet. Prescribed an antipsychotic off label, she begins to have fewer flashbacks and nightmares.

Another top prescriber, Dr. Adolphus Lewis of Fort Worth, is a family physician who also treats the elderly. In one year ending in 1994, he wrote 61 prescriptions for one male patient, including enough Vicodin and Valium to pop seven pills a day.

The state medical board accused Lewis of prescribing “medically excessive” numbers of pills to a woman who later died, court documents show. Her death, which was due to respiratory failure, implicated three drugs, including two that Lewis previously prescribed, according to the documents.

About 40 percent of the 72 top Medicaid prescribers among certain antipsychotic drugs have been disciplined by the state medical board. By comparison, last year the state disciplined less than 1 percent of the state’s 62,521 doctors.

In 2002, the Texas Medical Board restricted Ravichandran’s license for five years for “unprofessional or dishonorable conduct that is likely to deceive or defraud the public or injury the public.” The restriction, which was not related to prescriptions, was lifted within three years.

Siles’ license is spotless.

Lewis was restricted in 1998 for failure to practice medicine in an acceptable manner because of his prescribing. From 2008 to 2009, he wrote 3,696 prescriptions for antipsychotics — roughly 10 each day — that cost taxpayers $1,395,595. Lewis’ license is connected with 10,000 prescriptions of mental-health drugs to 1,864 clients from 2005 to 2009, fifth most in the state among Medicaid providers.

The state has automated checks, called edits, to catch overuse, incorrect dosage and misuse, Goodman said.

Identifying even one inappropriate prescription is difficult, Goodman said.

“To really prove up a case, you have to prove some of those prescriptions were inappropriate. And it’s not just the volume alone that does that,” she said. “It’s really going in and looking at the patient’s records and getting another doctor to say, ‘That prescription was not appropriate in that case.’”

From the American Association for Justice news release.

The Boston Globe reported, “Total payments to doctors for promoting pharmaceutical companies’ products to their colleagues appear to be falling in Massachusetts, suggesting that new restrictions designed to distance doctors from industry are leading some to abandon the lucrative speaking circuit.” The story reports on payments by Eli Lilly and Co., down 46 percent since 2009; GlaxoSmithKline down 29 percent. The story was based on data from ProPublica.

The Star-Ledger (NJ) reported, “In 2010, 11 drug makers, including New Jersey-based Merck and Johnson & Johnson, paid out more than $446 million to doctors across the country, according to the news organization ProPublica.” But “the current ProPublica database does not include a number of drug makers, including Roche and Bristol Myers Squibb.”

The Oregonian reported, “A database released today by the nonprofit ProPublica provides new details about the depth and breadth of the pharmaceutical industry payments, including in Oregon. The list includes 12 companies which cover more than 40 percent of US drug sales.”

The Orlando Sentinel reported, “Doctors in Florida have received more than $56 million from a dozen pharmaceutical companies since 2009, according to data released Wednesday by ProPublica.”

The Cleveland (OH) Plain Dealer reported, “Doctors in Northeast Ohio have been paid $5.8 million by drug companies since 2009 for talks about the companies’ medications.” The St. Louis Post-Dispatch reports that payments are declining in “a nationwide trend.”

From the American Association for Justice news release.