Articles Posted in Surgical Complications

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 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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The New York Medical Board is slow to punish doctors who lose their license to practice in other states. According to The New York Post, the state licensing board for doctors took between “a few weeks to several months” to stop 14 doctors who had lost their ability to practice medicine in New Jersey over the last six months. Perhaps even more worrisome, the local newspaper found that two of those doctors were still practicing medicine despite being deemed unfit to practice just across the river. New Jersey did not perform much better at ensuring potentially dangerous doctors stayed away from the state’s patients – five doctors with their New York licenses suspended in the last six months were still practicing in the state.

Perhaps overstating the obvious, Patient-safety advocate Betsy McCaughey told The Post that licensing board’s slow movement on incompetent doctors “could lead to unnecessary additional harm to patients.” The founder of the Committee to Reduce Infection Deaths then harped on the unnecessary risk to patients by stating “all you have to do is send an email.” McCaughey correctly notes that the New Jersey Board of Medical Examiners receives a daily alert for doctors whose license has been suspended or permanently revoked. With this information delivered each day, it is not unreasonable to expect a prompt investigation.

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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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