Massachusetts Injury Lawyer Blog

A recent study published by The Journal of the American Medical Association highlights the need for more physicians to report colleagues who endanger patient safety.

The study, conducted by doctors at Massachusetts General Hospital, surveyed 3,000 doctors nationwide about reporting colleagues who are incompetent or who engage in substance abuse or other improper behavior. More than one-third responded that they do not fully support the idea that these doctors should be reported, according to a Boston Globe editorial on the study. Just over one-third of doctors with direct knowledge of a colleague's impairment kept quiet.

While many states mandate reporting, the study found many physicians did not act because they thought someone else was already handling the problem. Other reasons included fear of retribution and cultural differences. The study found minorities and doctors with degrees from overseas were less likely to report peers.

Beyond reporting mandates, the right to practice medicine is a privilege. Because patients' lives are at stake, there must be zero tolerance for physicians not reporting any medical professional engaging in suspect behavior.

Medicine is a profession, not a club where doctors should be allowed to protect each other above and beyond patients. Hospitals and senior physicians need to embrace the idea of reporting so other doctors understand their obligation.

The Boston medical malpractice lawyers at Breakstone, White & Gluck have extensive experience handling complex medical malpractice claims, including medication errors, failure to diagnose cancer and surgical malpractice. We have seen first-hand how doctors who ignore a colleague's improper actions endanger patient safety. These doctors need to remember there are consequences and in their profession, those consequences can come at a moment's notice.

To read an abstract of the study, visit The Journal of the American Medical Association.

To read an editorial about the study, visit The Boston Globe.

Continue reading "Doctors Must Protect Patients and Report Unsafe Colleagues" »

Massachusetts and several other states have been awarded $25 million in patient safety grants from the Department of Health and Human Services. The funds will be used to implement medical care reform and establish plans for reducing future errors.

The funding is part of a patient safety and medical liability initiative announced by President Barack Obama in September 2009.

The Massachusetts Department of Public Health received funding to involve clinicians, patients, medical malpractice insurers and state officials in a discussion about medical errors and malpractice. The goal is to improve efficiency in all aspects of medical care and reduce medical errors resulting in severe personal injury and death.

The grants were awarded in two categories. Three-year awards of up to $3 million will allow states and health systems to implement and evaluate patient safety and medical liability demonstrations. One-year grants of up to $300,000 are for states and health systems to establish a plan for reviewing patient safety in the future.

Health and Human Services Secretary Kathleen Sebelius said: "This new research is the largest government investment connecting medical liability to quality and aims to improve the overall quality of health care."

The Boston medical malpractice lawyers at Breakstone, White & Gluck view this grant as a critical move in improving medical care. Each year, 195,000 people die as a result of preventable medical errors and even more sustain life-altering personal injuries.

Continue reading "Massachusetts Patient Safety Grants Target Medical Liability" »

The recent news that more than 200 EMTs in Massachusetts fraudulently obtained re-certification revealed serious safety lapses in the system. We applaud the state's swift move to suspend the EMT licenses and call on the Department of Public Health (DPH) to closely monitor future re-certifications.

An anonymous caller tipped off DPH officials to the EMT scandal when she reported an EMT-paramedic for a private ambulance company had received re-certification without attending the required classes. When state officials investigated, they learned the fraud ran much deeper, touching more than 200 EMTs throughout the state.

The impacted fire departments include Haverhill, Boston, Lexington and Belmont among others. Haverhill had 30 EMT licenses suspended while Boston had 21.

The abuse was most rampant among private ambulance companies. Armstrong Ambulance of Arlington had 41 EMTs working with fraudulent certification while Trinity EMS had 35 EMTs and Cataldo Ambulance of Melrose had 46 EMTs, according to media reports. For Cataldo, the majority of the involved EMTs came from the company's Atlantic Ambulance Service division on the North Shore.

The state suspended most of the EMT licenses for 90 days to nine months. Lexington firefighter Mark Culleton and former Trinity Ambulance paramedic Leo Nault, the instructors involved in the fraud, have been permanently banned from practicing in Massachusetts.

Emergency medical technicians in Massachusetts are required to undergo between 24 and 36 hours of retraining every two years. The training serves as a refresher course and updates EMTs on new medications, techniques and equipment.

"This ongoing training is critical for EMTs because they are called upon to make life and death medical decisions in the field," said Boston medical malpractice lawyer Marc Breakstone. "The Department of Public Health must maintain a zero tolerance policy towards any fraud or misrepresentation regarding the training and qualifications of the front-line medical providers."

In 2001, Breakstone negotiated a $10.2 million settlement for a Massachusetts family whose toddler was left severely brain-damaged by paramedic negligence. There were significant delays in the care. The ambulance crew got lost on the way to the home, forgot the keys to their medical cabinet and later falsified records in an attempt to hide the medical negligence. As a result of that case, the Massachusetts Department of Public Health established guidelines that made reporting of serious medical errors by EMTs mandatory.

For more information, see these articles from The Boston Globe: "Phone Tip Led to EMT Card Scam" and "State Officials Examining EMT Retraining System"

Continue reading "Massachusetts' Zero Tolerance Policy in EMT Scandal Critical for Safety" »

It's important to know who's providing your medical treatment and their safety record, but many Massachusetts health care consumers fail to ask the question.

The good news is the information is just a few keystrokes away. The Massachusetts Board of Registration in Medicine offers Massachusetts consumers the Physician's Profile database right online.

Click here to learn more about what you'll find on the Massachusetts physician database and for a link to the site.

Continue reading "Know Your Doctor's Safety Record" »

A new federal study found many same-day surgery centers have serious problems with infection control procedures.

The Centers for Disease Control and Prevention visited 68 centers in Maryland, North Carolina and Oklahoma and found 67 percent of the centers had at least one lapse in infection control. Some 57 percent were cited for deficiencies. The patient safety lapses included failure to wash hands, wear gloves and clean blood glucose meters. Clinics also reused medical devices meant for one person. The study did not examine if the lapses led to patient infections.

The study, reported in the Journal of the American Medical Association this week, comes as the nation's 5,000-plus outpatient centers perform more than 6 million procedures and collect $3 billion from Medicare each year.

"This study should be a wake up call to physicians performing relatively minor surgical procedures at walk-in clinics," according to Boston attorney Marc L. Breakstone. "All surgeons must have zero tolerance for lax infection control procedures, which can expose patients to life-threatening infections." According to Breakstone, the risks of serious injury to patients from staph and hepatitis infections are as great in the small center as in the large hospital setting.

The study was prompted by a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two clinics. The clinics have been closed.

For more information, read this Boston Globe article about infection control problems at US same-day surgery centers.

Continue reading "Patient Safety Falls Short at Same-Day Surgery Centers, Study Finds" »

We commend The Boston Globe for highlighting one of the state's most pressing problems in health care: too many Massachusetts hospitals and physicians are still using paper medical records.

In a May 7th editorial, the Globe rightly pointed out that electronic medical records, "will prevent errors, improve diagnostic work, avoid duplication of tests and procedures, and simplify clinical studies." The newspaper called on the 63 Massachusetts hospitals not using any computerized systems to make the change now.

"Electronic medical records would be the best medicine for taking care of medical errors," Massachusetts medical malpractice lawyer Marc Breakstone said in response to the editorial.

A 2008 study by the Massachusetts Technology Collaborative and the New England Healthcare Institute found just 10 of the state's 73 hospitals used a computerized system for doctors' orders. More alarming was the study found 1 in every 10 patients at six community hospitals in the state suffered from serious medication mistakes.

According to the Institute of Medicine, 50,000 to 100,000 patients nationwide die annually of preventable medical errors.

In addition to offering stimulus-bill help, the federal government is threatening to reduce Medicare payments for doctors who fail to implement electronic medical records by 2015. A 2009 national survey by the New England Journal of Medicine showed that only 1.5 percent of hospitals and 4 percent of doctors' practices have adopted comprehensive electronic systems.

At Breakstone, White & Gluck, we know firsthand electronic medical records will save lives. Massachusetts hospitals are doing the public they should be serving a great injustice every day they continue to make excuses for not going electronic.

For more information, read The Boston Globe's editorial.

Continue reading "Massachusetts Hospitals and Doctors Must Implement Electronic Medical Records Now for Safety" »

David White, a principal at the Boston personal injury law firm of Breakstone, White & Gluck, recently appeared on Money Matters Radio for their mid-day show. Here is the audio from the presentation.

Money Matters Radio Broadcast

David talks about what car insurance you should have to protect yourself, and others, in the event of a car accident; about medical malpractice; and about insurance bad faith in Massachusetts.

To download the broadcast, click here.

Many thanks to our good friends at Money Matters Radio and host Chris Findlen.

Preventable hospital infections are claiming some 100,000 lives a year nationwide and threatening patient safety, despite a renewed focus on cleaning up hospitals, the US Department of Health and Human Services' Agency for Healthcare Research and Quality has found.

A recent report found in-hospital infections warrant "urgent attention," with rates of post-operative bloodstream infections and catheter-associated urinary tract infections increasing by 8 and 4 percent respectively. Yet there is good news: the Agency found overall health care quality is slowly improving.

The Agency found hospitals have adopted basic standards for hand hygiene, disinfecting patients, sterile handling of equipment and antibiotic use. 

The Secretary of Health and Human Services, Kathleen Sebelius, anticipates a new law will improve the rates for hospital-acquired infections and prevent fatalities.  Starting in the 2015 fiscal year, hospitals with high rate of infections will face penalties.

Hospital-acquired infections are pervasive and fatal but also extremely preventable.  The Committee to Reduce Infection Death (RID) points to several areas where hospitals can improve: First, over half the time, doctors do not disinfect their hands immediately before touching a patient.  Also, many hospitals do not screen incoming patients for MRSA, one of the most pervasive in-hospital infections.  Finally, surgery patients may not be advised to shower with chlorhexidine soap daily before the operation, although the practice reduces the risk of infection.  RID hypothesizes as evidence of the preventable nature of in-hospital infections grows, so will hospital liability.

For more information on the Agency's Annual Quality and Disparities Report, see this press release or the reports themselves.

For information about different types of hospital-acquired infections and methods to reduce infections, see this guide from the World Health Organization.

Continue reading "New Report Finds that Preventable Infections Still Plague Hospitals-- New Law to Crack Down on Unclean Hospitals" »

According to two new studies, there may be certain times when being admitted to a hospital is more dangerous for patients. A study in the journal Medical Care found that each hospital has a unique set of factors, a "fingerprint", which in combination compromise patient safety. Researchers at the University of Michigan in Ann Arbor found that four factors can affect a patient's risk of dying in the hospital- high hospital occupancy, weekend admissions, nursing staffing level, and seasonal flu. These factors not only increase mortality for individual patients but also interact with each other creating a unique level for each hospital where patient safety suffers overall as a result of medical negligence.

However, according to a column in the New York Times, hospitals that identify their set of factors can make the improvements necessary to protect patients from personal injuries.  Hospitals can schedule their elective surgeries during less busy times and have their staff get vaccinated during flu season to protect patients from exposure.  Additionally, hospitals in an area can work together to develop strategies for diverting patients.     

According to a follow up column in the New York Times, patients who are aware of these factors and in the position to elect when they admit themselves can also protect their safety.  Although both studies' authors emphasize the variable and individual risk level of each hospital, they did suggest factors for patients to consider.  For transplants, Dr. Darrell A. Campbell Jr., author of the University of Michigan study and chief of clinical affairs at the University of Michigan Health System, suggests that patient volume is positive to a degree.  However, if the overall hospital admission level is too high, consider another hospital.  Dr. Matthew Davis, an associate professor of pediatrics, internal medicine and public policy at the University of Michigan and senior author of the study, suggests that patients speak to their doctors about the timing of a treatment or procedure in relation to the hospital's workflow and get their flu shot. 

Continue reading "Is There a Bad Time to go to the Hospital? " »

The very people who take an oath to do no harm may be undermining patient safety systems, despite hospitals' focus on reducing medical errors. In the last decade, hospitals have ramped up patient safety systems by promoting protocols, checklists, and procedures to prevent medical errors. Hospitals have also pushed to increase transparency and disclosure of medical errors. However, studies are showing that doctors are not reporting incidents of medical negligence as often as they should. Some experts point to doctors' fear that an incident report with their name on it could damage their career permanently.

The Joint Commission Journal on Quality and Patient Safety reported last month that most medical residents have never filed an incident report. This is despite the fact that many residents are in fact reponsible for personal injuries or wrongful death of patients during their training. Additionally, young doctors are entering practice without being educated in patient safety, according to a report issued by experts working with the Lucian Leape Institute at the National Patient Safety Foundation. Dr. Lucian Leape, chairman of the report's committee, blames the culture of medical education for the lack of attention to patient safety. Dr. Leape believes the hierarchy, humiliation, and stress of medical education does not allow doctors' the time, sense of community, or support to disclose errors.

After historically ignoring patient safety, some medical schools and clinical training programs have introduced the subject into their curriculum. Not all institutions have succeeded, having difficulty securing financial support or experienced physician-teachers with training in patient safety. However, those institutions that have successfully implemented training programs have benefitted. The University of Illinois at Chicago College of Medicine instituted an extensive patient safety education program six years ago. Graduates of the school have gone on to be leaders in the field of patient safety. More recently, patient safety training was integrated into the residency program. Residents now submit over 100 incident reports- up from zero.

For more information on patient safety, see the National Patient Safety Foundation report. Also, see the New York Times article Learning to Keep Patients Safe in a Culture of Fear.

Continue reading "Patient Safety and Doctors' Fear--Improving Systems to Reduce Medical Error" »

The Massachusetts Supreme Judicial Court has ruled that non-patient claims for personal injury resulting from medical malpractice must first be presented to the Massachusetts medical malpractice tribunal.  The tribunal's job is to review medical malpractice personal injury claims and decide whether there was actual medical malpractice involved or if the injury was merely an unfortunate medical result.

The decision concerned a hospital worker who was killed when a heavily medicated woman lost control of her car and drove it into an entrance to the Brockton Hospital where the victim worked.  The victim's wife sued the doctors for her husband's wrongful death, alleging they had failed to warn the woman that it was dangerous to drive while on her medications.

Ordinarily, medical negligence cases may only be brought by a patient against his or her medical provider. However, third parties may bring claims against a provider if the provider failed to warn the patient of the effects of medication, and the patient then injured the third party. The exception is a narrow one.

The case clarifies pre-trial procedures in such third party cases, as it was unclear whether or not an injured non-patient was required to bring their medical malpractice claim before the tribunal.  However, with today's Massachusetts Supreme Judicial Court ruling, it is now clear that any person looking to bring a claim for personal injury resulting from medical malpractice must first present their claim to the medical malpractice tribunal, whether or not they were the patient.

The case was Vasa v. Compass Medical, P.C., SJC-10457, March 2, 2010.

Continue reading "Massachusetts Court Requires Medical Malpractice Tribunal in Third Party Claims" »

Radiation technology is on the rise, delivering both higher and more precise doses of radiation treatment and better detecting diseases, including cancer. However, as technology improves, patient safeguards and hospital systems are lagging behind, resulting in medical errors that go unnoticed. While there are no recent reports of error, given the large number of cancer treatments as specialized centers, patients in Massachusetts are certainly at risk for excess radiation exposure.

At a New Jersey hospital, 36 cancer patients were overradiated by a medical team that was inexperienced in operating new radiation technology.  The mistakes continued for months because the hospital did not have a system for catching the errors.  A man in Louisiana received 38 doses of overradiation because the machine used to treat him was so new that the hospital made a miscalculation, even with training instructors still on the grounds.

Although radiation mistakes resulting in personal injuries are rare and accident reports show that some mistakes could have been detected through standard protocol checking, some oncologists are warning that safety procedures need updating.  Adding to the safety concerns, hospitals may not have sufficient funding to operate the cutting edge technology correctly and manufacturers sometimes sell machines before computer errors have been resolved.  Mistakes in the application of radiation technology also raise questions about the training and supervision of medical physicists and radiation therapists.  Licensing and registration requirements vary greatly from state to state, and 16 states do not require licensing or registration at all. 

The radiation technology regulation regime creates the potential for injuries as well.  Laws protecting radiation patients are patchwork and poorly enforced, meaning hospitals that cause injury and fail to report mistakes go unpunished.  Additionally, the marketplace for radiation technology is largely unregulated.  New products receive only a cursory review by government regulators.  In a market where new technology is the key to attracting business, both manufacturers and hospitals are eager for new products quickly, even if that means technology with existing errors and operational uncertainties.

Over radiation can cause skin reactions, like rashes, fatigue, diarrhea, nausea and vomiting, trouble swallowing, weakness, headache, and hair loss.  Radiation can also increase the chance of getting certain cancers. 

For more information on radiation technology and its risks, see the New York Times article The Radiation Boom.  For more information on the risks and side effects of radiation treatment, see the Mayo Clinic website. 

Continue reading "As Radiation Technology Improves, Patient Safety is Left Behind" »

Anne Mitchell, a nurse from west Texas, was acquitted today for filing a complaint with the Texas Medical Board (TMB) alleging that a doctor she worked with was endangering his patients. Mitchell had filed an anonymous complaint that an emergency room physician, Dr. Rolando G. Arafiles Jr., at the Winkler County Memorial Hospital, had been improperly prescribing medications and doing surgical procedures when he had no surgical privileges.

Rather than being recognized as a whiste-blower concerned about the health and welfare of the patients, she was actually arrested and charged with the crime of "misuse of official information," which is a felony in Texas.

The trial took four days, but the jury needed less than an hour to acquit Nurse Mitchell.

Though this was a victory for a conscientious nurse, she has lost her job and her reputation has been damaged. The prosecution will tend to chill the efforts of others who are witnesses to medical mistakes.

Could this happen in Massachusetts? The Texas case appears to be unique, but there are other pressures brought on medical staff to look the other way when medical mistakes are made, and strict laws on so called "peer review" cloak investigations with nearly absolute privacy.

Boston medical malpractice attorney Marc Breakstone called the acquittal a victory for consumers everywhere. Breakstone pointed out, "Each year over 200,000 Americans are killed by medical malpractice and hospital infections. We need honest medical staff to bring these issues to light."

He added, "We have seen a number of medical malpractice cases in which doctors and other medical providers have attempted to hide the facts by altering medical records, and are aware of other cases where records have been 'lost.' Sometimes the truth never comes out, other times the medical mistakes are revealed."

Back in Texas Nurse Mitchell and another nurse who were fired are looking for justice. They want to clear their good names, and want compensation for this prosecution.

More Information

Whistle-Blowing Nurse Is Acquitted in Texas, NY Times, Feb 11, 2010

The state Attorney General is in the preliminary stage of a systematic review of the Massachusetts healthcare system and has already made some startling discoveries about healthcare costs. Martha Coakley's office found significant cost variations among hospitals and physicians based on factors other than quality of care.  Although the investigation is still ongoing, Attorney General Coakley has expressed concern about affordable and accessible healthcare if the identified systematic failures are not addressed and has urged policymakers to implement cost containtment measures.

As part of the investigation, the Attorney General's office reviewed documents from insurance companies and healthcare providers representing the bulk of the healthcare market in the state to examine healthcare costs and costs drivers. Specifically, the Attorney General examined insurance contract prices between insurance providers and hospitals between 2004 and 2008. The concern is that although Massachusetts has improved access to the healthcare market--97 percent of the population has healthcare coverage--this improvement could be compromised by cost increases.  Attorney General Coakley warned if left unchecked, price disparities in the market could create a  provider marketplace dominated by expensive "haves" as lower priced "have-nots" are forced to close down or consolidate with higher priced providers. 

The initial findings of the investigation showed that:

• In the same geographic area and across similar levels of service, prices paid by insurance carriers to hospitals and physician groups varied, at the extreme in excess of 200%.
• Price variations are not correlated with quality of care, complexity of the illness or population being served, extent of patients on Medicare or Medicaid, or whether the provider is an academic or research facility.
• Price variations are correlated with the relative market position of the hospital or physician group as compared to hospitals within a geographic region or within a group of academic medical centers.
• Price variations on a per-member, per-month basis are not correlated with the method of payment (e.g. globally or fee-for-service).
• Price increases cause most of the healthcare cost increases in the state.
• Contracting practices distort the commercial healthcare market and reinforce disparities in pricing.
• The report noted that health care costs are increasing much faster than wages.

The investigation is expected to be completed by March 16th and the findings will be presented to the Massachusetts Office of Health and Human Services, Division of Healthcare Finance and Policy.   

For more information on Massachusetts' unique approach to healthcare access, see the following website on the state mandate and statute.  If you need to obtain health insurance coverage, see the following guide to choosing a health plan.

If you have questions about medical negligence or medical malpractice, please feel free to contact our firm for a free consultation at 800-379-1244 

In a recent article in the medical journal Radiology, a study of several hundred radiologists reveals that mammographers may be reluctant to reveal medical mistakes, even if the mistakes relate to potential risk of breast cancer.

In the study the radiologists were given a hypothetical question. They were asked to assume that films were read out of order; that the calcifications in the films were actually increasing and not decreasing, and that they discovered the mistake after initially reading and reporting the results to their patients. Calcifications may be associated with the growth of breast tumors.

Only 14% of the physicians said they would definitely disclose the error. Twenty-six percent said they would probably report the error. The rest would either disclosed the error only if asked by the patient, or not at all.

In the hypothetical conversations with the patients after the mistake was revealed, only 15% of the doctors polled would admit that they made a mistake during the reading of the films.

Failure to diagnose breast cancer due to mammography errors is a common cause of medical malpractice claims, and almost half of the doctors in the study had been party to a suit alleging negligence.

The authors concluded that even though there is a trend towards more physician openness regarding mistakes, disclosure is "the exception, not the rule."

More Information 

Radiology: Radiologists reluctant to disclose mammo errors to patients. www.healthimaging.com. October 30, 2009.

 

Continue reading "Radiologists May be Reluctant to Admit Medical Errors to Patients" »