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Just an anecdote: Our friend in New Orleans had his wife's second baby delivery. They went to the same hospital and doctor as the first normal delivery. She wa

• pen2l 10y ago
  A lot of errors do seem to be this type: wrong medicine being given. The error can originate from any step of the way (doctor ordering the wrong medicine, pharmacist failing to confirm medicine being given is good or not, the nurse mistaking it, the drug-dispensing machinery involved failing, etc.). Do any HN users have thoughts on what sort of system could be put in place to minimize mistakes like this in the field?
  • progressive_dad 10y ago
    There was a definitive study done that showed you can reduce malpractice mistakes by some insanely HUGE amount by changing 1 variable: Leave nurses alone while they're administering medicine. In the study they gave nurses "Do Not Distrub" vests where doctors (no matter how important or urgent) may not disturb the nurses while they are wearing them. Can't find the original study but here is a related piece on hospitals initiating the practice with related resources: https://www.amsn.org/practice-resources/care-term-reference/care-issues/question-do-not-disturb-vest-while-administering https://www.amsn.org/practice-resources/care-term-reference/...
  • deleted 10y ago
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  • flarg 10y ago
    I am a former pharmacist who has moved into technology consulting. I'm in the UK so forgive the UK focus of my response. It is in fact the role of a pharmacist to reduce medication errors - and this is achieved through a series of checks - largely focussed on asking 'is this the right medicine and dosage for this patient and the condition to be treated?' and 'has the correct medicine, dosage and dosage form been dispensed?' Errors tended to occur outside of pharmacy's area of control; in theatres to where pharmacists often have little access, in ward settings where medicines are administered in sometimes noisy and chaotic environments, in clinical teams where pharmacists are not allowed to have a presence, and indeed in the modern NHS where pharmacy staffing levels are severely reduced. A technological solution is possible - based on the concept of checklistbundles, patient medical and medication record systems and image scanning technology - but it is usually hard to sell clinicians on the idea of a check-list never mind anything else. Until there is a true incentive to change practices around medication administration (i.e. unlimited fines) this will always be a hard thing to change.
    • noir_lord 10y ago
      The tragedy here is that checklists where invented for dealing with complex common situations under stress (iirc they where popularised not sure if invented in the modern form as a way to allow pilots to fly a much more complex aircraft than preceeding models[1]). http://www.atchistory.org/History/checklst.htm http://www.atchistory.org/History/checklst.htm
      • flarg 10y ago
        Indeed - the corresponding research into checklistbundles indicated that they would be quite effective; but I think the lack of anything like 100% uptake is due to the lack of appropriate technology to easily create, maintain and utilise checklistbundles.
        • SapphireSun 10y ago
          I really doubt that... I'm pretty sure the reason for lack of uptake is organizational and social in nature. A checklist is the simplest thing in the world. I can make a checklist right now! - Write comment (Check!) - Check grammar and spelling (Check!) - Scrub abusive language (Check!) - Click "reply"
  • Zigurd 10y ago
    Checklists. It's been thoroughly studied. It works in other disciplines. I'm amazed the malpractice insurers don't write this into their policies: Checklists done or you're uninsurable.
  • estreeper 10y ago
    To reduce this class of errors, perhaps RFID tags could be used? If the medication is prepared in a low-distraction area and tagged there, then the person administering the medicine would scan the tag to make sure it's correct before going through with it. The person tagging the medication could still make a mistake, but it would be harder for everyone else, and perhaps during the tagging process some kind of automatic flagging could be employed if the medication doesn't seem to match the patient's problems.
    • leonth 10y ago
      This is already being done in a small number of hospitals in the USA and other parts of the world. The problem is mainly the resources (money and time) needed to repackage all the drugs to their own unit doses fast enough. Most of the time a barcode / QR code / equivalent 2D printed codes suffices and is much cheaper (and more flexible) than RFID tags. However, you won't believe the kind of things that go wrong with this approach either. It's basically operating a manufacturing plant inside a pharmacy / hospital, but without presence of anyone titled "engineer". In an ideal world, the drug authority (FDA) would require all manufacturers to print proper barcodes in all unit doses at the time of manufacture.
  • cmiles74 10y ago
    Computerized order entry of medications. Poor penmanship and unreasonably unpleasant (or unreachable) physicians is still the root cause of many erroneous orders. Even today, with the push for electronic systems, many physicians push the entry duty off on someone else thus keeping this kind of error alive.
  • jules 10y ago
    Not taking medicine like epidural anaesthesia that isn't absolutely necessary would reduce the risk. I find the idea of spinal anaesthesia scary in general. It's poison with such a dose that it shuts essential parts of your nervous system down, but just under the dose that kills you. It's also in one of the most vulnerable places of your body, so that any mistake will likely have great consequences.
• deleted 10y ago
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• NotHereNotThere 10y ago
  I'm sorry for your friend, this is a terrible situation to be in. And it's exactly why many people think pregnancies and births are over medicalized, especially in the US. Women have given birth for a long time without medical intervention, using competent mid-wives, and now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine, etc. It's pretty insane.. The movie "Business of being born" (http://www.imdb.com/title/tt0995061/ http://www.imdb.com/title/tt0995061/) goes into detail of how the mindset of handling pregnancies shifted over the last decade, and how pregnancies are almost a "disease" to be treated. Edit: Since I'm getting downvoted for this, I simply wanted to correlate that more interventions = more risk. No other intent, and definitely not trying to "victim blame" given I have no knowledge of the specific situation above.
  • rayiner 10y ago
    > Women have given birth for a long time without medical intervention And they were dying in droves: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm (Figure 2); http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm (Figure 1). Maternal mortality decreased from 700-800 deaths per 100k live births at the turn of the century to less than 30 in 1967, and 5-10 by 1996. Hospitalized births is one of the, if not the most astonishing triumph of modern medicine. It's bigger than the advances in cancer treatment and HIV put together.
    • Florin_Andrei 10y ago
      Plenty of medical care, and therefore quite a few medical errors: live until 85. No medical care, and therefore zero medical errors: live until 62, die of something trivial.
      • cloverich 10y ago
        A more correct interpretation would be "Much higher chance of dying of something trivial at any time before 85."
• maxxxxx 10y ago
  The US needs a system where victims of malpractice get compensated but the doctors or hospitals are not necessarily held liable (unless it's gross negligence). US doctors spend a lot of time, energy and legal maneuvering denying and covering up mistakes instead of being able to admit them and improve procedures if necessary. In my view there should be a nationwide malpractice insurance pool and the medical associations should push for better quality standards within their ranks.
  • wskinner 10y ago
    That seems like it would raise a serious issue of moral hazard.
    • toomuchtodo 10y ago
      Not if you pull the license of repeat offenders. F* up once? It happens, medicine is hard (EDIT: Document what went wrong, put a process in place so it doesn't happen again, issue a notice to all other medical facilities offering related procedures). F* up again? You're out of a job. No different then how the FAA and the NTSB operate. EDIT: Medicine can be made safer through the same processes used to ensure air travel is the safest transport method in the world. It can't be as safe, but we can do better.
      • rplst8 10y ago
        I disagree entirely. People are known to be fallible. Processes prevent things from accidentally happening. In areas where the life of someone or a large organizational failure hangs in the balance of an action, that action should be wrapped in process to ensure it's correct execution, with fail-safe mechanisms put in place. Further, these systems should be audited on a regular basis to ensure compliance. Only in the case of purposeful or willful action or absolute gross negligence or being found unfit for duty (mentally or physically) should someone have their life ruined by removing their status/job/career path.
        • deleted 10y ago
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• cmdrfred 10y ago
  I wish I could just set an arbitrary cap on my liability. I'm sorry I totaled your car, here's 50 bucks.
  • dllthomas 10y ago
    Talk to your state senator...
  • forgetsusername 10y ago
    Provided nobody was hurt, your liability would be limited to the value of the car.
• refurb 10y ago
  That's how it works in Canada. You keep the malpractice insurance rates low by limiting payouts.[1] [1]In 1978, the Canadian Supreme Court limited damages for pain and suffering. Adjusted for inflation, the cap now is just over $300,000. The United States has no federal cap on damages, though a few states, including Florida, have imposed them.
  • LoSboccacc 10y ago
    So you get five year worth of money for lifetime impairment? Sounds fair.
    • refurb 10y ago
      I guess that's what disability insurance is for? You also get a pretty good safety net in Canada in terms of health insurance coverage and disability payments.
      • iends 10y ago
        Long term disability insurance is crazy expensive in the USA. My wife got multiple quotes around $15,000 a year for a perfectly healthy 28 year old woman. It excluded back issues because she went to a chiropractor a few times. This was for like 60% income replacement too.
        • twoodfin 10y ago
          I would guess that there's a serious adverse selection problem in personal disability insurance.
        • nommm-nommm 10y ago
          The strange thing is long term disability insurance for a group plan is really cheap. My work provides it as an option and I only pay $300/year or so for the premiums, work doesn't pay any percent of the premiums.
          • 10y ago
• tn13 10y ago
  I am unable to why the state must pay compensation here. It should be the Hospital. It looks to me that State and Hospitals have colluded to create this $900M fund while reducing risk for Hospitals and not giving anything to the patients. Can I have the link for SC affirmation ?
• melling 10y ago
  Shouldn't we be discussing ways to eliminate problems rather than increasing malpractice? What we want is for there to be a system where one person making a mistake is caught by enough redundancy. Maybe it's a cultural issue too? Remember the problem with pilots? http://blogs.wsj.com/middleseat/2008/12/04/malcolm-gladwell-on-culture-cockpit-communication-and-plane-crashes/#:xNCkaXp4D4D8FA http://blogs.wsj.com/middleseat/2008/12/04/malcolm-gladwell-...
• usaar333 10y ago
  When my wife received an epidural, I noticed a warning label on the connector that said "Epidural, do not connect IV". The only thing stopping such a horrible error is this label. IV and Epidural connectors are fully compatible even though they should never be used interchangeably. I can only imagine how many other simple medical failsafes are missing.
  • pak 10y ago
    This is a very interesting little point, that consumer electronics (especially ports) have little physical safeguards to prevent errors—e.g., you can plug USB2 into USB3 for backward compatibility, but not vice versa, for the B plug; ungrounded extension cords try to prevent you from plugging in grounded plugs. Medical equipment generally doesn't do this. I think the problem is that there is a tradeoff between safeguards and allowing improvisation in a time of shortage or emergency; for example, I've seen blood draw lines repurposed as external irrigators (not as catheters) and that's totally safe as long as you dispose of the needle in a sharps bin.
    • eru 10y ago
      That's a good point. I guess one problem is that the failures of the `can't improvise' case are really easy to see and imagine. Whereas the other failure of mixing up connectors could always be blamed on human error. Someone should figure out which scenario causes more damage. With enough stocking, we should be able to avoid the need for improvisation? As a technical solution, medical connectors could come with bits that prevent mistakes (and clearly different colours and perhaps even outside textures to use sense of touch, too); but with the safety bits simple to break off on both sides, so that you can still plug them together. So you can still plug together arbitrary things, but you get a short moment where you have to consciously use some force.
  • mortenjorck 10y ago
    Indeed, while the anesthesiologist was ultimately at fault, this story made me wonder about the design parameters around the mistake. Are the vials the same color? Do they have the same size and shape? Was this anesthesiologist near the end of a 16-hour shift and had to differentiate two very similar objects? Your comment about the physically compatible, deadly-if-switched connectors was an eye opener: It's almost like if the USB standards group settled on a two-prong design that was physically compatible with a North American 110V AC outlet, and every USB cable shipped with a label saying "DO NOT PLUG INTO WALL OUTLETS".
• knz 10y ago
  At least they were able to recover some cost. My wife was nearly killed due to the negligence of an ER doctor during the pregnancy of my first child. Every doctor and nurse we dealt with could not understand how it happened and several told us that it was clear negligence but we were told by several lawyers that because there was no immediate and obvious long term harm we were unable to recover any of the additional costs associated with a six week stay in the ICU and hospital. We filed a complaint with the hospital in the hope that the doctor would at least be held professionally accountable but I'm skeptical that it amounted to anything. Pregnancy comes with some inherent risks but it's ridiculous that it's so hard to recover costs associated with gross negligence by an ER doctor (longer hospital stay, counselling for the trauma, related procedures because the doctor messed up so badly etc).
• knz 10y ago
  At least they were able to recover some cost. My wife was nearly killed due to the negligence of an ER doctor during the pregnancy of my first child. Every doctor and nurse we dealt with could not understand how it happened and several told us that it was clear negligence but we were told by several lawyers that because there was no immediate and obvious long term harm we were unable to recover any of the additional costs associated with a six week stay in the ICU and hospital. We filed a complaint with the hospital in the hope that the doctor would at least be held professionally accountable but I'm skeptical that it amounted to anything. Pregnancy comes with some inherent risks but it's ridiculous that it's so hard to recover costs associated with gross negligence by an ER doctor (longer hospital stay, counselling for the trauma, related procedures because the doctor messed up so badly etc).
• sjg007 10y ago
  Since the care transferred across state lines can he make a federal case?
  • bduerst 10y ago
    AFAIK, it's based on where the malpractice happened. Plus, that would set a terrible precedence if one hospital couldn't airlift someone out to another hospital that could provide adequate care, because they were afraid of a federal case.
• rms_returns 10y ago
  Can you please state the name of the hospital and the doctor? The least we can do is blacklist that hospital in our friend circles and defame it on FB, twitter, etc.
• Dr_tldr 10y ago
  Anytime someone talks about the need for tort reform and capping non-economic medical malpractice damages, this is what they're advocating for. The idea that a "cap on damages" number could be found to cover lifetime expenses incurred for all malpractice cases would be difficult to swallow even if the number was backed up by a fairly large data-set. It's totally absurd when you consider that these numbers are usually arbitrarily set by uninformed politicians and highly biased lobbyists.
• goodJobWalrus 10y ago
  Wow, I am about to have a baby any day now, this is scary. I really hope they are better in Canada with these things.
• nugget 10y ago
  Do you know whether an anesthesiologist or CRNA provided the epidural? There's a huge push to replace MDs with nurses for anesthesia (to keep costs down) and I've heard of cases like this as a result. Like Nabisco shrinking a package of oreos from 6 cookies to 4 (for the same price) it's part of the slow dilution of service that we aren't supposed to notice.
  • Scoundreller 10y ago
    Is there evidence to suggest that CRNAs provide poorer care? Someone that is paid less or has less education does not automatically result in poorer outcomes.
    • nugget 10y ago
      Pay has nothing to do with it but I don't think it's a stretch to believe that the average MD with 4 years of med school + 4-5 years of 60 hr/week residency would outperform the average CRNA (nursing + 18 months of 40 hr/week residency). The studies done are usually political submarines motivated by one side or the other in the fight against mid level independent practice rights.
• ams6110 10y ago
  As my brother the surgeon says, the last place you want to be when you're sick is in hospital.
• peterwwillis 10y ago
  I am very sorry for your friend's wife. That's.... it really really sucks. It occurs to me that if all the medical malpractice deaths (250,000) were paid out at that cap ($500k), that would cost 125 billion dollars. We don't have a lot of extra room in our budget right now, so that's going to be tough to pay out, even though it's not even enough. But clearly the even bigger problem is the 250,000 unnecessary dead people. If we took a part of that money and used it to fund an agency that just works to fine-tune and eliminate medical malpractice deaths, that would save almost double the amount of people that die from guns and automobiles each year. But that wouldn't help your friend's wife, who didn't die. What would have helped her would have been avoiding medicine that was not necessary, like the epidural. Of course it would have been an excruciating delivery that nobody should have to endure - but I think a risk assessment would conclude that the risk (death) is not worth the benefit (lack of pain). At the same time, having better drugs would also help, but we don't necessarily have that as an option today. So perhaps a campaign to avoid unnecessary medical procedures, and literature to help educate and give agency to those who would be going through those procedures, would be helpful.
• peter303 10y ago
  Colorados limit is $250K. Lawyers wont take a case unless it is slam dunk.
• fencepost 10y ago
  Replying since you don't have contact info... If they had life insurance it may be worth looking at that policy as well - depending on the policy it may also cover disability or loss of (use of) limbs. Sounds like every little bit may help.
• xahrepap 10y ago
  Another anecdote: a close loved one lost their leg due to malpractice. Staff infection. He went in and told the doctor he thought he had an infection. The doctor said it was fine even after running other tests. He's has multiple doctors and nurses look at the test since and say that it's pretty obvious that he had an infection. The greatest part? Their lawyer could not get any doctor to testify as an expert witness, which is required under Utah state law for malpractice (which makes sense, I suppose). Even if they could've, the lawsuit would've only covered $400k since it's capped. Which might've covered the doctor bills, but not the damages to his life... He was between jobs, then ended up in and out of the hospital for a couple years due to the infection getting out of control (lost his leg, had his shoulder replaced, physical therapy, ended up falling and having pretty sever damage and having to start over again). By the time he was on his feet again, he was worn out and past retirement age. Whose going to hire a "gimped old man"? It was a mess. Still is... But things worked them selves out as best as possible. But it's incredible to me that that doctor is still practicing and possibly destroying other people's lives because no other doctor was willing to "out" a "colleague". Frustrating.
• StanislavPetrov 10y ago
  >The amazing thing is that the state of Louisiana has a $500k limit on malpractice! This is what politicians are referring to when they talk about "tort reform" (rather then the egregious legal nonsense they decry when trying to get it passed).
• wolframarnold 10y ago
  It's heart-wrenching stories like these that prompted my wife and me to have our daughter at home. It was a beautiful birth. Birth is not a medical emergency, but hospital economic incentives are such that they're always trying to make it one.
  • et2o 10y ago
    The only reason it is no longer a medical emergency is because of modern medicine and hospitals. Women and children used to die frequently during childbirth.
    • wolframarnold 10y ago
      The entire mammalian animal kingdom is fully capable of giving birth, autonomously and unassisted (if necessary). Human females, too, can tap into that part of their brains, if you let them, and don't distract or scare them with bright lights, beeping machines, cramped rooms, force them to make complex decisions that require cognitive function. Birth is operating from the mammalian part of the brain, not the pre-frontal cortex. If this wasn't true, mammals wouldn't exist. Think about it. As a male, however, you'd have to have seen it to believe it. I'm a male, and I saw it. It blew my mind.
      • et2o 10y ago
        I have seen many more than one birth. Your statement is a little ridiculous and I hardly know where to begin. I don't especially care where in the brain things originate (and I think you don't know much about the brain). If I get heart block, I want a pacemaker, even if it's not a part of the "mammalian brain". By the way, a mouse has a prefrontal cortex. Continue your appeal to nature while I remind you that no one weeps when most mammals lose an infant. For a lot of biological reasons, it's hard to compare human reproduction to mammalian reproduction at large, and there are even more differences during childbirth. I'm really glad that your decision worked out for you, but it's dangerous to encourage others to engage in dangerous behavior. If something goes wrong during childbirth without medical attention, people can and do die needlessly. You seem like someone who might not, but please consider vaccinations for your child. http://www.hrsa.gov/healthit/images/mchb_infantmortality_pub.pdf http://www.hrsa.gov/healthit/images/mchb_infantmortality_pub...
• WalterBright 10y ago
  One way to deal with the wrong drug problem is to use different colors and shapes of bottles to represent different categories and dangerousness of drugs. Coloring can be added to the drug itself, such as using a red for more toxic medications, and green for more benign ones. A deeper shade of the color can represent an increased concentration. Just like different shapes and colors of wine bottles are used for different wine categories. I saw a show once which traced a medicine overdose to the bottles for the different strengths of the same drug being identical. The doctor just picked up the wrong one.
• jgrowl 10y ago
  Another anecdote... My step sister went in to have a growth removed from her arm. Was just supposed to be a simple outpatient procedure. They put a cuff on her arm and injected lidocaine. Their first mistake was loosening up the cuff which shot lidocaine into her heart and stopped it. The second mistake was that no one noticed for 5 minutes. She was literally sitting there dead for 5 minutes. They somehow revived her but the had brain damage. She acts like a completely different person now. She got diagnosed as bipolar afterwards and the hospital claimed that she just always was like that. They offered a small amount that they ended up having to take it after a whole horrible legal process. It was like maybe 50k for completely disabling her. She has 4 kids, one disabled, and is too incompetent to take care of them. She lost them all. She now is off and on homeless after she started breaking all the windows in the house and lost her fiance because he couldn't take it anymore. She hordes trash and thinks she's going to be a famous singer. If I remember right, the anesthesiologist got in trouble for previously watching porn on his phone during procedures.
• Fuxy 10y ago
  This mechanism is completely broken considering medical care in the US is ridiculously expensive. The hospital should be held responsible financially for the patient until she dies or their mistake gets fixed. No lawsuit just a simple if you break it you own it philosophy so the hospital is responsible for the medical bill and any loss in financial earnings incurred because of their mistake payed monthly to the patient or its immediate family.
• speby 10y ago
  That is terrible, truly terrible. If given a blank slate to work with and dealt with all over again, what would be a better way of dealing with the liability? More monetary compensation? Or something else?