Since 2009, the FDA has been aware that duodenoscopes manufactured by Japanese companies Olympus, Pentax and Fujifilm have been at the origin of the spread of sometimes fatal spread of pathogens but did nothing to change the situation. Hospitals that faced such outbreaks began sterilizing the devices more rigorously and the transmission of dangerous disease stopped. Therefore, the suspicion was that the superbug outbreak happened because of medical malpractice during which the hospital staff didn’t respect the sterilization procedure. However for the first time on Thursday the FDA said that even hospitals that fully respected the sterilization process could have their devices infected by the superbug. However the FDA didn’t propose to improve the sterilization procedures. They only issued a “safety communication” warning healthcare providers that duodenoscopes’ “complex design” may impede effective sterilization. The problematic part is a movable “elevator” mechanism at the tip of the duodenoscope: Its moving parts have microscopic crevices where bodily fluids can remain after standard cleaning. The FDA and the manufacturers are aware of this deadly manufacturing flaw but the FDA didn’t require the manufacturers to improve their device either. Read more on Reuters
Reports of medical staff suffering personal injury after being attacked by patients or patient’s visitors are on the rise. Recent cases of extreme violence such as one involving a 68 year old patient attacking nurses with a metallic bar that he pulled from a bed (see video) or the death of a prominent cardiologist at a Boston Hospital who was shot by a gunman last month have led hospitals to revisit their security policy.
Shootings in hospitals are not that common but violence against hospital staff is happening daily. Workers are being kicked, scratched, punched beaten and even sexually assaulted by patients. Emergency room and psychiatric nurses and other workers dealing with elderly patients are the most at risk of being assaulted and injured by a patient. According to the US Bureau of Labor Statistics hospital workers are five time more likely to be assaulted on their jobs than workers in other industries. Last year a study entitled “Incidence and Cost of Nurse Workplace Violence Perpetrated by Hospital Patients or Patient Visitors” and published by the Journal of Emergency Nursing indicates that in the last year 76% of nurses experienced violence (verbal abuse by patients, 54.2%; physical abuse by patients, 29.9%; verbal abuse by visitors, 32.9%; and physical abuse by visitors, 3.5%). Perpetrators were primarily white male patients, aged 26 to 35 years, who were confused or influenced by alcohol or drugs.
Hospitals have started to initiate various programs to train their staff on how to recognize and deescalate potentially violent situations but too little is being done to stop the assaults. According to a recent article, Epidemic of Violence against Health Care Workers Plagues Hospitals published in Scientific American, hospital administrators and the judicial system do little to prevent assaults by patients. The cost of violence prevention is small, however, when compared to the amount that hospitals lose in worker-compensation claims every year and in time off due to injury—roughly a third of which is patient-inflicted, according to OSHA statistics.
Medical negligence by doctors or medical staff who do not respect cleaning procedures or fail to discard contaminated implements are often the reason why hospital patients are getting infected by contaminated instruments. Yesterday, UCLA Medical Center announced that 179 patients may have been infected by the super-bug bacteria carbapenem-resistant Enterobacteriaceae (CRE) transmitted by two infected endoscopes during diagnosis and treatment of pancreatic and bile duct problems. The hospital also said that two patients died of complications related to this issue. Outbreaks of CRE and other superbugs are a major issue among hospitals in the USA and all over the world. A recent study found that if the rampant spread of super-bugs wasn’t halted it could kill up to 10 million people a year worldwide and cost $100 trillion. Read more in the New York Daily News
Nonprofit hospitals despicable practices of overcharging patients with no insurance and then using aggressive tactics to collect payments are being discouraged by new rules recently adopted by the Obama Administration. Under the new rules, patients with no insurance who are eligible for financial assistance can not be charged more than “the amounts generally billed” to people who have insurance through a government program or a private carrier. Additionally, hospitals must try to determine whether a patient is eligible for assistance before they start to use aggressive tactics to collect payment.
Read more in the New York Times
Device-related hazards can lead to medical malpractice. In its 2015 top 10 Health Technology hazards, ECRI Institute lists 10 safety topics deemed crucial for hospitals to address. Here is the list of the top 10 technology hazards;
1. Alarm hazard: inadequate alarm configuration policies and practice 2. Data integrity: incorrect or missing data in EHR’s and other Health IT Systems 3. Mix-Up of IV lines leading to misadministration of drugs and and solutions 4. Inadequate reprocessing of endoscopes and surgical instruments 5. Ventilator disconnections not caught because of mis-set or missed alarms 6. Patient-handling device use errors and device failures 7. “Dose Creep”: unnoticed variations in diagnostic radiation exposures 8. Robotic surgery: complications due to insufficient training 9. Cyber security: insufficient protections for medical devices and systems 10. Overwhelmed recall and safety-alert management program
In future blogs we will look at each of these medical technology hazards in detail.
The complete report can also be downloaded here
After a first US patient died from Ebola yesterday in a hospital that handled the case in a very negligent manner (see article in Reuters), New York hospitals and airports are gearing up for the worst. Starting this Saturday all passengers arriving from the West African countries of Guinea, Liberia and Sierra Leone will have their temperature taken. Passengers suspected to have contracted the virus will be sent to Bellevue Hospital Center in Manhattan. Bellevue can treat up to 4 patients in dedicated isolation rooms and 9 additional rooms may be similarly equipped if necessary. The staff has received training related to leave-no-skin-cell uncovered precautions and all necessary protective gear is available.
Read more in the New York Times
After visiting a friend at the Emergency Room of the New York Presbyterian/Columbia Medical Center Hospital in Washington Heights in Manhattan, Senator Adriano Espaillat University said he was outraged by the horrendous conditions patients and staff had to deal with. People are lying on stretchers in the hallways, there is no privacy, the staff is overwhelmed, patients are waiting 85 minutes to see a doctor on average and 717 minutes to get a room.
Senator Espaillat is planning to meet with hospital management this week to discuss the problems.
Read more in the New York Daily News
A diagnosis delayed by a too long wait time in an emergency room can be medical malpractice and can be deadly. In Bedford-Stuyvesant, patients checking in at the ER of the Brooklyn Interfaith Hospital wait an average of 125 minutes before they can be seen by a doctor. The hospital recently added more staff but it has financial struggles. Most of its ER patients are uninsured.
The Brooklyn Hospital has the worst ER waiting time in New York State and 4 times the national average according to an article in the New York Daily News.
Recently more and more hospital patients have been receiving bills with hefty charges from unexpected out of network doctors or other medical service providers such as labs or Radiologists. Services that used to be included in the daily hospital rate now comes as additional costs because they are provided by out of network contractors. Many emergency rooms, for example, are now staffed by out-of-network doctors who bill separately.
Out-of-network doctor charges are not negotiable and can reach phenomenal amounts. For example a patient requiring a skin graft would pay $1,781 to an in-network doctor while an out-of-network doctor would potentially charge $150,500. In a recent article in the New York Times, Elisabeth Rosenthal exposes this practice.
Sharon LaFraniere and Andrew W. Lerhen from the New York Times continue to investigate Medical Malpractice in military hospitals. The two reporters who last June provided an in-depth analysis of the flaws of the military hospital system (see “In Military Care, a Pattern of Errors but Not Scrutiny” ) recently published a new article focusing on the high risk of medical malpractice in small military hospitals. Military hospitals with a turnover of 10 to 30 patients a day are often staffed with inexperienced doctors and nurses who are not busy enough to keep their skills sharp. Most of them are poorly managed and run by untrained and inexperienced physicians with a culture of complacency that threatens patients safety.
Most of these small military hospitals are being considered for closing or transforming into outpatient facilities by the Pentagon as part of its plan to scale back costs but political obstacles are preventing streamlining the system.
Read the complete article here