More than 12,500 patients of a New York Hospital had their financial records compromised after an assistant clerk sold them for $3 a piece to a ringleader who made purchases at various high end retailers in Manhattan. Between January and June 2013 32 year old Monique Walker who worked in the financial department of the Montefiore Medical Center in the Bronx sold information such as names of patients, social security numbers, credit card numbers and birth dates to 28 year old Fernando Salazar who was sending his “buyers” Patricia Charles, 43, Lawrence Davenport-Brown, 23 and Charde Lawrence, 28, of Staten Island, Ashly Garrett, 25, of Queens, Sasha Rivera, 31, of Brooklyn, and Crystal White, 32 to shop at various high end venues in Manhattan. They all face charges including grand larceny, possession of a forged instrument, identity theft, unlawful possession of personal identification information and related counts. Read more in the NY Daily News
Hospital negligence can sometimes also happen outside of the hospital when a healthcare facility doesn’t proprely mitigate the risk of vehicular theft in front of its entrance. In a recent blog post, the Joint Commission is warning about reports of patients and other individuals who have been stealing ambulances, delivery vans, police cruisers snow plows and private cars that were left unoccupied and running in front of hospital entrances. According to the Joint Commission the risk is especially high for hospitals and healthcare facilities with a very active emergency department. Thieves are often patients who either are at the hospital under the supervision of a law enforcement agency, have substance abuse problems or mental health issues. Individuals with no links to the hospital or the patients have also been reported stealing unattended vehicles at hospital entrances. These types of incidents are extremely dangerous not only for the medical staff which can be injured when trying to stop the suspect or can be unwittingly kidnapped during the vehicle theft but also for pedestrians and road users who could be struck by a suspect attempting to flee.
The Joint Commission recommends that hospitals work with ambulance services, authorities as well as vendors and suppliers to make sure their vehicles are secured when left unattended in front of hospitals. Valet parking staff should receive specific training and security personnel should monitor locations where vehicles stop near entrances and exits. Signage reminding drivers to remove their keys from the ignition when their vehicles are unattended can also help mitigating the risk of vehicular theft.
After two patients died and many other suffered personal injury from a recent “superbug”outbreak involving duodenoscopes, the safety of these medical devices (see previous blog) and the method used by hospitals to reprocess them are being questioned. In a recent Hazard Report, the ECRI Institute is recommending culturing Duodenoscopes as a key step to reducing carbapenem-resistant Enterobacteriaceae (CRE). The Institute believes that duodenoscope procedures are vital when treating and diagnosing conditions of the gall bladder and pancreas with Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures and the risk of infection can be mitigated if hospitals upgrade their reprocessing methods by also scope culturing.The Institute recommemds that hospitals not only check with the duodenoscope manufacturer as to whether they are using the appropriate reprocessing method but also add a baseline culture of all duodenoscpoes. Read the complete ECRI High Priority Hazard Report
Picture Duodenoscopy image of two pigment stones extracted from common bile duct courtesy of Wikipedia
Sharing diabetes pens among patients is a gross medical malpractice that can lead to transmission of infections and viruses such as HIV and hepatitis viruses. According to the FDA, since 2008 thousands of patients may have been exposed to blood-borne pathogens from the sharing of multi-dose pen devices for insulin and other injectable diabetes medicines. In 2009 the FDA was informed that 2,114 patients from a U.S. army facility had been injected with pens that had been used on other patients. Then in 2011, 2,345 patients from the Dean Clinic in Wisconsin were notified that pen and needles had been shared among patients. More recently in 2013, 716 patients from the Veteran Health Administration were notified of potential exposure to infections through the sharing of diabetes pen. Last March in New York, the South Nassau Community Hospital in Long Island contacted 4000 patients to be screened for HIV and Hepatitis after a nurse said she was using the same insulin pen for multiple patients (see previous blog).
Insulin pens and pens for other injectable diabetes medicines should never be shared among patients, even if the needle is changed. To promote safe use, the FDA is requiring that pens and packaging containing multiple doses of insulin and other injectable diabetes medicines display a warning label stating “For single patient use only.” Read the safety announcement from the FDA
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