Articles Posted in Surgical Complications

An estimated 161,000 Americans die each year because of preventable medical errors, according to a new study by Johns Hopkins University. The study, which was published by Leapfrog Group, a nonprofit which ranks hospital safety, shows that fatalities by preventable medical errors are trending downward. Three years ago, the number of preventable deaths stood at 206,000.

“We are cautiously optimistic we are going to see real change and that is good news from this report,” Leah Binder, President and CEO of the Leapfrog Group, told Modern Healthcare. “But 161,000 is still a lot of people it’s a terrible problem. We have a long way to go.” Binder continued to explain that the number of preventable deaths is likely an underestimate since the study only looked at 16 safety categories and the “subset of each safety issue” in each category. According to Leapfrog Group, 15 of the 16 measures used to judge patient safety are the same used by the Centers for Medicaid and Medicare Services (CMS) to judge nursing home quality.

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A new study suggests that doctors are more likely to skip screenings and otherwise make mistakes with patients later in the day. According to a JAMA Network Open study, doctors ordered fewer breast and colon cancer screenings for patients with an afternoon appointment – despite the fact that all patients were due for a screening. According to the study, the doctor was most likely to order a medical screening for his patient with an 8 AM appointment. By 4 PM, the likelihood that the doctor would order screens for their patient had dropped by 10 to 15 percent.

Other studies have confirmed that poorer outcomes for patients are more likely in the afternoon. A 2014 study, cited by The New York Times, found that doctors were more likely to dole out unnecessary antibiotic prescriptions in the afternoon. In fact, the likelihood of an unnecessary antibiotic is 26 times higher for a 4 PM appointment compared to an 8 AM appointment.  Other studies located by the New York Times found that patients were less likely to receive the flu vaccine and more likely to receive prescription opioids for back pain. Even the amount of hand washing by doctors fell during the afternoon hours.

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With more doctors putting in long hours, the profession now carries one of the highest risks of burnout. According to the AMA, physicians suffer from “burnout” roughly twice the rate for the general population. The blame, according to doctors, lies in the corporatization of healthcare which has rapidly accelerated over the last decade. Doctors say that corporate healthcare chains squeeze as many patients as possible onto each doctor attempting to maximize their revenue. This leaves doctors without adequate time to diagnose a patient, record their medical information, and deal with their health insurance companies. In a New York Times article, the author states that doctors work nights and weekends to adequately care for all their patients at “a high personal cost.”

Regulations also eat up an unnecessary amount of time, according to doctors. The E.M.R. or Electronic Medical Record appears especially burdensome. Data shows that primary care physicians are now spending two hours typing into the E.M.R. for each hour spent with their patients. The time spent on the E.M.R. does not even include the compliance workshops and continued medical education required of all doctors.

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A disgraced doctor pleaded guilty to three charges of manslaughter last week in Queens, according to The New York Daily News, Indicted on felony charges last year, Dr. Lawrence Choy ran a ‘pill mill’ out of his Queens office from 2012 to 2016. The former doctor routinely prescribed the so-called ‘Holy Trinity’ of drugs to his patients – an opioid, a benzodiazepine, and a muscle relaxer. All three medications are both extremely addictive and extremely dangerous because of their ability to suppress breathing and cause an overdose. Tragically, Dr. Choy’s reckless prescribing habits caused three of his patients to fatally overdose.

After the deaths of his patients, Dr. Choy closed his medical practice and fled to Wyoming. The long-distance move did not matter to federal authorities who charged Dr. Choy with 231 crimes last year in a complaint detailing the doctor’s recklessness and indifference to his patient’s suffering. According to prosecutors, Choy’s pill mill in Queens was popular across the entire northeast – patients from New Jersey and Pennsylvania routinely made the trip just to visit Choy. According to federal prosecutors, Choy began doling out oxycodone prescriptions beginning in 2012 when Choy received a tax bill for more than $1 million. Once word got out that Choy would exchange prescriptions for cash, addicts would travel to the Queens doctor to get their fix and drug dealers would travel to get their supply. A single oxycodone pill prescribed by Choy could be sold for $30 on the street, less than the cost of a month’s prescription without insurance.

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An ophthalmologist is facing a lawsuit and revocation of his medical license after operating on the wrong eye. The Chicago woman, Sutton Dryfhout, says she came in for a routine cyst removal surgery and experienced a living nightmare. According to Dryfhout, Dr. Benjamin Ticho realized his mistake after the surgery when Dryfhout was already in post-operative care. Amazingly, the doctor chose to attempt surgery on the correct eye – with Dryfhout no longer under anesthesia. The lawsuit filed by Dryfhout says Dr. Ticho came into the recovery room and told a nurse that he “forgot something” and then asked them to hold down the patient while he attempted to operate on her left eye. The nurse allegedly complied.

Speaking to New York Daily News, Dryfhout said she screamed and yelled for Dr. Ticho to stop and that she could “[feel] surgical instruments including a needle and scissors going into her eye and could feel burning from a cautery pen being used on her eye.” Dryfhout also alleges the ophthalmologist did not follow proper hygiene protocols by using unsterile equipment and performing the entire operation without gloves. After the impromptu surgery on the correct eye ended because of Dryfhout’s screams for help, Dr. Ticho allegedly went to the patient’s medical records and consent forms and changed all references to performing surgery on her “left eye” to her “right eye.”

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New York may join the rush of states requiring explicit informed consent for patients undergoing medical exams. The new law aims to prevent medical students and residents from performing pelvic, rectal or prostate exams on patients while they are under anesthesia. Amazingly, these medical exams are routinely performed on men and women while they are under anesthesia. Given the sensitive and personal nature of these exams, medical students and residents have long learned the procedure by using unconscious and anesthetized patients.

“There’s a surprising disconnect between the culture of medicine, where intimate exams without explicit consent of the patient are considered a defensible, standard practice, and the rest of us, who are horrified that a trainee could be allowed to perform a pelvic or rectal exam without asking,” said Amy Paulin, New York Democrat who sponsored the bill. Teaching universities across the country oppose the stricter consent laws, saying that practicing on unconscious patients is necessary to teach medical students. The Association of American Medical Colleges has denounced pelvic exams without explicit consent as “unethical and unacceptable.” According to the newspaper, most – but not all – of the country’s medical schools agree with the association and have already implemented policies requiring explicit consent at their hospitals.

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New York hospitals continue to rank poorly compared to the rest of the country, according to the nonprofit LeapFrog’s rankings released last month. According to Washington D.C. organization, which ranks hospitals on 12 factors related to patient safety and then assigns a letter grade between A and F to each hospital, New York is the 47th worst state for patient safety at hospitals. Just 7.5 percent of New York hospitals received an “A” – a pathetically low percentage compared to states like Maine, Utah and Virginia, which received “A” at 50 to 60 percent of their hospitals. 

The Empire State has almost three times as many hospitals with a “D” rating (30) than an “A” rating (11), according to LoHud.com. Unlike the federal government which takes medical outcomes and other indicators of quality into account when assigning its maligned star-rating system, Leapfrog Group focuses on preventable safety issues. Examples include mistakes like leaving sponges or medical equipment in bodies or preventable infections caused by unsanitary conditions. The nonprofit told Lohud.Com that its ranking system provided more helpful information to patients “because it focuses on the most serious life-or-death measures.” 

Here are the patient safety rankings for hospitals in the Hudson Valley, published for Fall 2019: 

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Every year, hospitals across the United States are graded on their record for patient safety by the federal government and a nonprofit organization, Leapfrog Group. The federal government uses a “star-based” rating system where hospitals receive a grade between one and five stars, with a one-star rating representing a hospital with serious and widespread safety problems. According to LoHud.com, New York had 48 one-star facilities in the state. Six of these unsafe hospitals were in the Hudson Valley.
Leapfrog Group focuses on more “preventable safety issues”, according to the local newspaper. The metrics used in Leapfrog’s calculations focus on the rate of “infections and medical mistakes, like sponges or tools left in bodies” or “complications such as collapsed lungs.” The nonprofit group assigns a letter grade to each major hospital in the country, which range from an “A” to an “F.” The researchers at Leapfrog point to a study by Johns Hopkins University that found 160,000 deaths each year are caused by “hospital-acquired” conditions – such as infections. Of the 30 hospitals receiving a “D” or “F” grade in New York, two are located in the Hudson Valley. According to Leapfrog, only 12 percent of hospitals nationwide receive a letter grade below “C”.

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According to The New York Times, long-term care hospitals continue to provide poor care to elderly Americans. Long-term care hospitals, also called long term acute care hospitals, provide care typically after a person is being discharged from intensive care and is too sick to return to their nursing home. Close to 400 long-term care hospitals exist in the United States, a number that has dipped in the last decade after skyrocketing in the 90s from just 38.

The proliferation of long-term care hospitals during the period is now largely regarded as unnecessary and many elder care advocates say they harmed individuals while enriching their owners. Because patients at these hospitals are so sick, the hospital receives hefty sums performing multiple procedures and diagnostics on their patients. In 2017 alone, Medicare – which pays for two-thirds of all long-term care stays – paid out an eye-wateringly high 4.5 billion to these several hundred hospitals.

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A recent study by The Doctors Company found that misdiagnosis is the top allegation in medical malpractice lawsuits filed across the country that involve children. The researchers conducting the study said “misdiagnosis” included missed, failed or the wrong diagnosis and were largely the result of inadequate medical examinations, according to Fierce Healthcare. The study conducted by a non-profit doctors group involved reviewing over 1,200 medical malpractice lawsuits filed across the country through 2008 and 2017.

The report also illuminated several prominent trends in medical malpractice lawsuits. For example, poor communication was cited as a factor causing the child’s injury in 15 and 22 percent of the lawsuits. Systemic failures were also a common factor. Systemic failures typically meant not notifying patients of important test results, according to the online news agency.

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