Articles Posted in Surgical Complications

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The federal government opened a probe into a hospital run by the Department of Veteran Affairs. According to the New York Daily News, the federal probe is a response to a veteran’s allegations of neglect, medical malpractice, and elder abuse. The local newspaper describes the experience of Gary Zambito, who served in the armed forces during the Vietnam War. During his military service, Zambito suffered an injury which led to health complications for the next fifty years. While he trusted the VA to look after his care, Zambito describes a nightmare of incompetence and fraud. Zambito says the care provided by the VA was so insufficient that it “nearly killed” him. After suing the government for $4 million, the federal government opened a probe into the nursing home and hospitals for criminal malfeasance.

According to the veteran, he sought help from his local VA hospital on Long Island back in 2015 when he started experiencing “dizzy spells” that would commonly end in blackouts. Zambito says he told doctors that being knocked unconscious in the Vietnam War led to heart problems – specifically, an irregular and rapid heart rate. Despite this knowledge, doctors did not seem interested in drawing the connection between Zambito’s fainting spells and his heart condition. After being told that there was nothing the doctors could do to help him, Zambito spent the next three years simply enduring the dizzy spells and fainting. According to his attorney, the veteran fell and injured himself 18 times over the next 14 months. Finally, he went to a private doctor who prescribed the drug Flecainide Acetate, which eliminated the fainting problem immediately.

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In a major victory for New York nurses, several major hospitals agreed to establish minimum staffing levels for nurses at hospitals. The unions representing the nurses in negotiations had threatened to a 10,000-strong strike at the hospitals if the hospitals did not satisfy their demands. Marc Kramer, the lead negotiator for the hospitals, told The New York Times, “This significant investment in our nursing teams will ultimately benefit patients in the long term, while preserving hospital’s flexibility to deliver the individual, tailored health care that our institutions are known for around the world.” The hospitals agreeing to minimum staffing levels for nurses include Mount Sinai, New York-Presbyterian, and Montefiore hospital systems.

Nurses have fought for established minimum nursing ratios for years. Frustrated by the Albany’s reluctance to take action, the nurses finally threatened to walk off the job this year. While the exact ratios have not been decided yet, California’s mandatory minimum ratios differ depending on the circumstances – more nurses are required in the ICU than an urgent care clinic. For example, California requires one nurse for every eight healthy babies in a nursery ward. The New York Times says that New York-Presbyterian nurses describe a workload that is at least double what would be legal in California.

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A Tennessee woman is suing her doctor at Vanderbilt University Medical Center for allegedly operating on the wrong kidney. The woman, Carla Miller, went to the Nashville hospital in November 2017 running a fever and complaining of pain in her side. The medical professionals at the hospital decided Miller would need a stent put in her right kidney. A stent is a small mesh tube and was intended to connect Miller’s right kidney to her bladder. Unfortunately, the doctors botched the surgery and put the stent on her left kidney, which was functioning normally at the time.

Now, Miller is suing the hospital for medical malpractice. She says that the failed surgery caused permanent damage and she will now be on dialysis for the rest of her life. Further, Miller will need to undergo two more surgeries – one surgery to remove the misplaced stent and one surgery to place the stent in the correct location. According to the lawsuit filed by Miller, she is seeking $25 million in damages from the hospital. Describing the ordeal to CBS New York, Miller said, “This type of error is shocking and inexcusable in modern medicine, and it is mind-boggling that it could occur at an institution like Vanderbilt.”

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America has one of the highest maternity mortality rates in the developed world and, sadly, that rate is only increasing each year. According to hospitals, these ever-increasing number of childbirth complications are primarily caused by demographic and financial considerations out of their control – poor access to healthcare compounded by pre-existing health problems which commonly afflict low-income mothers. A recent analysis by USA Today, however, shows a different cause and puts the primary blame on the hospitals, not the mothers.

According to the newspaper, many of the hospitals with a high rate of childbirth complications are “training hospitals” for medical students. The newspaper delves into several stories of women receiving poor care while delivering their child at the hands of these physicians-in-training. In one instance, Felicia West slipped in the bathroom and fell on her six-month pregnant belly. After being admitted to Touro hospital in New Orleans she suffered a seizure and went into respiratory arrested. The doctors performed a C-section on West’s child and, while the baby was fine, the mother’s health continued to deteriorate. The doctors misdiagnosed her with a rare blood disorder and in the following days, her blood pressure continued to increase. According to the American College of Obstetricians, a blood pressure reading over 160 is the “most important factor” of a coming stroke in pregnant women and new moms. Strokes that are not “treated expeditiously can result in maternal death.”

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With Americans living even longer, hospitals have begun evaluating the best methods to ensure elderly surgeons are safe and competent in the operating room. Unlike other industries, such as aviation where commercial pilots are required to retire at 65, doctors and surgeons are not obligated to put down the scalpel and leave the operating room upon reaching a certain age. Given the precision and high stakes of performing an operation, health care experts worry whether this is a good idea – especially when studies show that doctors are not accurate judges of their own abilities.

Research has unambiguously shown that cognitive and physical abilities decline with age and surgeons must possess exceptional skills in both these areas to remain effective. The consequences of a delayed reaction or a minor slip of the forceps can be the difference between a patient living or dying. Studies on the mortality rate of patients with elderly surgeons have been mixed, however, with some studies showing a higher rate of patient deaths for surgeons over the age of 60 and other studies showing a lower rate. Speaking to The New York Times, Dr. E. Patchen Dellinger, an expert on aging physicians, said that the older surgeons bring to the operating room may outweigh his or her decline in abilities. In his opinion, there “are sharp, wonderful doctors, and those who need to stop” which he estimated to be approximately 5 to 10 percent of doctors over the age of 75.

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After a decade of rapid consolidation in the healthcare industry, researchers are now analyzing the effect of hospital mergers and the results show lower-quality care and higher prices for patients. According to an analysis by The New York Times, hospitals see an increase in both patient mortality rates and “patients with major health setbacks” after merging with another hospital. With one less competitor in the geographic area competing for patients, the higher price for medical care after a merger should not be surprising. However, hospitals and healthcare systems have often rallied public support for their mergers by touting improved patient care as one of the tangible benefits. Given the increased breadth of healthcare offered by larger hospitals and a supposedly synergistic benefit from having a single healthcare provider, hospitals reasoned that larger and more capable hospital systems would lead to better outcomes for their patients.

While touting better care for patients may be an effective tool for helping hospitals receive approval for their merger, the evidence on the subject points in a different direction. Several Medicare studies show hospital competition “results in lower rates of mortality from heart attacks and pneumonia.” A national study on cardiologists measured whether market concentration, or the number of cardiologists competing against each other for patients, effected patient care. The results showed that patients in areas with a “highly concentrated market,” where the majority of cardiologists worked for the same hospital or employer, are more likely to “have heart attacks, visit the emergency department, be readmitted to the hospital or die.” The author notes these increases “are large” – a cardiology practice that increased its market share from 40 percent to 60 percent would see heart attack rates increase by 5 to 7 percent.

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America is one of only two countries in the world where the rate of deaths during pregnancy increased between 1990 and 2018. In an exhaustive expose in National Geographic, the news magazine details the causes of the country’s high rate of death for pregnant women, the widening racial disparity, and the progress meant to help alleviate the unnecessary and tragic problem. Given the increased attention to the issue in recent years, public health advocates are hopeful the trend will begin reversing itself in the next few years.

Overall, 700 women die each year giving birth in the United States – a rate of approximately 14 deaths per 100,000 births. However, this data does not show the wide racial disparities in the maternal death rate. For black Americans, the likelihood of dying during birth is more than three times higher than the average at 47 maternal deaths per 100,000 births. Native Americans also have a higher maternal death rate at almost 39 per 100,000. Comparatively, Hispanic and Asian American women have a lower-than-average rate of maternal deaths at 12.2 and 11.6, respectively. Researchers and public health advocates say the high maternal death rates are directly linked to a woman’s ability to access adequate prenatal healthcare – with almost 9 percent of black Americans receiving no prenatal care before giving birth. The research found a full 60 percent of the maternal deaths last year were fully preventable. Continue reading

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The new documentary “Bleed Out” provides an infuriating first-hand account of a routine surgery that went horribly wrong and changed a woman’s life. The documentary, which was released on HBO this month, dives into the third most common killer of Americans – preventable medical errors. According to a study released by Johns Hopkins University, medical errors kill 250,000 Americans each year.

The harrowing documentary follows Judie Burrows, who went in for a routine hip replacement surgery almost a decade ago and is now unable to speak, broke, and suicidal. According to her son, Steve Burrows, comedian and documentarian, his mother fell down in November 2009 and broke her hip. After spending eight days in a Wisconsin hospital without any plan of care, the hospital finally performed X-rays and rushed the woman into heart surgery. Unfortunately, the doctors in charge of caring for Judie did not consider her daily blood-thinner medication and the patient ended up losing half of her blood during the surgery.

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Doctors accused of medical malpractice or other unprofessional conduct in another state may still be able to practice in New York State. In a report analyzing 250 doctors accused of professional misconduct, USA Today found that doctors accused of running pill mills, were found liable for medical malpractice, and engaging in inappropriate relationships with their patients, are still practicing medicine – just in a different state. In most states, including New York, a doctor who voluntarily surrenders his license in a different state is not automatically disqualified from practicing medicine.

Unlike most states, however, New York even allows some doctors with felony convictions to practice medicine. Under New York’s licensing scheme for doctors, a medical board is allowed to approve or deny a doctor’s license to practice medicine in the state based on their own criteria. In circumstances where a doctor voluntarily relinquishes his or her license in another state, there is rarely a “paper trail” describing any misconduct. According to LoHud.com, some states do not track allegations of misconduct against doctors and other states do not make the information available to licensing boards in other states. This haphazard system undoubtedly endangers these doctor’s patients.

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Continuing the state’s decade-long decline, New York ranked a dismal 48th in overall patient safety. The rankings, which are released twice each year by the non-profit organization Leapfrog Group, compile data from hospitals across the country and measure the rate of medical errors, infections and injuries, and patient satisfaction, to determine each hospital’s ranking. Since Leapfrog Group began ranking patient safety in 2012, New York has fallen from 40th worst state in the country to 48th.  In the tri-state area, Connecticut also ranks low for patient safety while New Jersey ranks among the best states in the country.

According to Leapfrog, the worst hospitals in the state are located in New York City and upstate. In fact, five of the 20 hospitals across the country that received an “F” from Leapfrog are located in the five boroughs. In the Hudson Valley, the hospital results were mixed. Here are Leapfrog’s patient safety ratings for the local-area hospitals:

A

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