Reporting, Investigation, Disclosure, and Remedying of Medical Errors Leads to Similar or Lower Than Average Malpractice Claims Costs

June 29th, 2010

A Veterans Affairs Medical Center developed a comprehensive process designed to proactively identify and remedy medical errors. Key elements of the process include widely publicizing the disclosure policy and process throughout the hospital, prompt reporting and investigation of potential errors, full disclosure of investigation results to the patient and/or family, and apology and fair remedy when an error has occurred, including appropriate compensation. The program led to liability claims costs that were the same or lower than those of a comparison group of similar Veterans Affairs hospitals that did not practice full disclosure.

According to recent government surveys:

Between 44,000 and 98,000 people die each year in hospitals because of medical errors [1] while an estimated 40,000 individuals suffer medical harm in the health care system each day…

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Veterans get hooked, not healed, at VA hospital

June 22nd, 2010

Two doctors who worked at the Hampton VA Medical Center say powerful narcotics are being over prescribed to veterans there, leaving them addicted while their underlying medical conditions go untreated.

The doctors have warned that the high volume of narcotics may be feeding a pipeline of dangerous drugs that are illegally resold in the community, with potentially fatal results.

Federal authorities are looking into the allegations.

One of the doctors was fired after airing her concerns.

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Legal battle continues over training death

June 1st, 2010
By David Porter – The Associated Press
Posted : Sunday May 30, 2010 16:27:56 EDT

GARFIELD, N.J.  – A federal judge found the Navy 80 percent negligent in the training death of Seaman Freddie Porter Jr. when it awarded $1.25 million to his mother, Cassita Massiah, last December.

As it stands, it won’t be the Navy paying Massiah. Instead, a company found to be 20 percent negligent – the owner of the tugboat that overran Porter’s small Navy vessel more than two years ago – has been ordered to pay the total damages.

The decision by U.S. District Judge Henry Coke Morgan Jr. has spawned a legal battle that could alter how the government defends itself in similar lawsuits.

The seeming inequity stems from long-held legal precedent of sovereign immunity that protects the government from lawsuits – in this case, by military personnel injured or killed in the course of service. The government can be sued by a third party  – a product manufacturer, for example – to contribute to a damage award, but those suits rarely succeed, according to Daniel Rose, an attorney representing Massiah.

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Man sues Hampton VA doctor over missed stroke symptoms

May 24th, 2010

By Bill Sizemore
The Virginian-Pilot
© May 18, 2010

HAMPTON

After the Hampton VA Medical Center denied responsibility, a Chesapeake veteran has sued the emergency-room doctor there who failed to diagnose a stroke that left him permanently disabled.

John Morgan, a Marine veteran, went to the Hampton center Nov. 23, 2008, complaining of slurred speech, unsteady gait and weakness on his left side – what government investigators later described as “classic stroke symptoms.” He was discharged by the physician on duty, Dr. Razaak Eniola.

The next day, he went to Sentara Norfolk General Hospital, where he was found to have suffered a stroke and was hospitalized for six days.

A subsequent investigation by the inspector general’s office at the U.S. Department of Veterans Affairs found the Hampton center at fault in the case. But when Morgan filed an administrative claim for compensation, the VA denied liability on the grounds that Eniola was a contract doctor, not a VA employee.

Full story…

U.S. to pay $350,000 after suicide of Marine

May 18th, 2010
By William H. McMichael – Staff writer
Posted : Saturday Jan 17, 2009 6:57:58 EST

The government has agreed to pay $350,000 to the family of a Marine combat veteran who committed suicide after what his family alleged was negligent mental-health care at Department of Veterans Affairs facilities in Massachusetts.

Former Marine Reserve Cpl. Jeffrey Lucey hanged himself in the cellar of his family home cellar on June 22, 2004, two weeks after being turned away from the Northampton Veterans Affairs Medical Center, where he had gone for treatment after a combat tour in Iraq.

A spokeswoman for Michael Sullivan, U.S. Attorney for Massachusetts, verified Jan. 15 that both parties have reached a negotiated settlement but noted that the agreement must still be accepted by the court.

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Staff error caused hepatitis outbreak

May 12th, 2010

By MARY SHEDDEN

TAMPA – The area’s first known group outbreak of hepatitis C was isolated to mistakes made by an employee at a Brandon holistic medical clinic, public health officials say.

Up to eight patients at Wellness Works, 1209 Lakeside Drive, have tested positive for the blood-borne illness, which is most often transmitted by the improper sharing of needles or intravenous medical equipment. Since the Hillsborough County Health Department launched an investigation in July, nearly 130 patients have been tested.

No more patients tested positive since The Tampa Tribune first reported the outbreak in February.

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US inquiry finds problems at Prescott VA hospital

May 8th, 2010

PHOENIX – A federal agency that investigates whistle-blower complaints has closed its probe of the VA Medical Center in Prescott after concluding that medical errors had occurred and the facility had suffered from understaffing of nurses and housekeepers.

The Office of Special Counsel investigated problems in the hospital’s long-term care and hospice wards reported by a nurse who alleged that she was fired in 2008 because she complained that patients were suffering. The report found no evidence to support an illegal firing.

A full investigation by the Veterans Affairs Office of Medical Inspector – completed in September and released Thursday – concluded that some workers made medication errors, including overusing laxatives and misusing narcotics. More serious allegations of patient abuse could not be substantiated.

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VA Limits Surgeries At Some Hospitals After Deaths

May 7th, 2010

by David Schaper : May 6, 2010

The Department of Veterans Affairs is implementing a new rating system for its hospitals that at some facilities will limit the types of surgeries doctors can perform.

The changes come after several patients died because of surgical mistakes at one Illinois VA hospital.

VA officials acknowledge that at least nine patients died directly because of surgical mistakes by doctors at the Marion VA Medical Center in southern Illinois in 2006 and 2007. A VA investigation found that poor care at Marion contributed to the deaths of at least 10 other patients, and to the illness and injury of several more.

The investigation found doctors performing surgeries they were not qualified or trained to perform. It found the Marion VA hired one doctor in particular, thought to be responsible for many of the deaths, not knowing he was under investigation for malpractice in Massachusetts.

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Office of Inspector General Report on Quality of Care Issues at the Louis A. Johnson VA Medical Center, Report No. 09-02950-58

January 29th, 2010

Department of Veterans Affairs Office of Inspector General (214.4 KB)

Service members have little recourse against malpractice

January 29th, 2010

Just before midnight on Feb. 20, 2007, she gave birth by cesarean section to a healthy boy.

But Wilson never got to hold her baby. According to her medical records, a uterine artery was cut during the delivery, causing massive internal bleeding. The estimated blood loss was equivalent to the total blood volume of an average adult.

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