New Jersey Accident and Injury Law Blog : New Jersey Injury Lawyer & Attorney : Law Offices of Scott D. Grossman : Serving Monmouth County, Bergen County

The Senate earlier this month approved a bill that will require medical errors made at hospitals to be disclosed to the public. The bill is expected to be signed by Governor Jon Corzine. When that happens, patients will be able to check the safety of hospitals through a breakdown of medical errors, giving them the opportunity to make an informed decision about the hospital they are considering.

Currently, data on medical errors is collected and released every year, but patients have no way of knowing the kind or frequency of medical errors that have taken place at a particular hospital. The medical error data provided tends to be general in nature, and is pretty useless to a patient looking for a facility to undergo a procedure.

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A report in Bloomberg effectively illustrates the point that medical malpractice lawyers have supported all along - that controlling malpractice premiums could be done more successfully by cracking down on errant doctors, making it harder for them to practice their brand of medicine.

The report gives the example of a Los Angeles surgeon who has lost two medical malpractice claims, and has had his privileges at the Western Medical Center of Santa Ana suspended, but continues to perform surgeries at another facility. The Medical Board of California has not found it necessary to suspend his license even though it is aware of the two malpractice cases amounting to $528,552 that he lost, as well as the little issue at Western Medical Center.

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It's one of a patient's worst medical malpractice nightmares - a New Jersey doctor, whose clinic was allegedly the source of a hepatitis B epidemic which has already had five of his patients testing positive for the disease. Now, state regulators have indefinitely suspended the medical license of Doctor Parvez Dara.

Health inspectors have described the conditions at Dr. Dara's Toms River office, including blood stains on the floor of the room where the doctor conducted chemotherapy treatments. Inspectors found medication vials left open, and blood inside a bin used to store blood veils. They also found saline and gauze that had not been sterilized. Earlier, health officials had advised approximately 3,000 of Dara's patents to be tested for hepatitis B, after five cancer patients who were undergoing treatment under him, contracted the diseases. Two of his patients were confirmed to have hepatitis B in February, and three others tested positive later.  None of the five patients had any other risk factors for hepatitis B.

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As a Bergen and Monmouth County medical malpractice lawyer, I am aware of  per se negligence or what is referred to in the legal community as res ipsa loquitur type of negligence by doctors or other staff in hospitals. So, it comes as a relief to know that many of these types of obvious errors are not only preventable, but also easily preventable.

According to this news report that relies on a study on the effects of using checklists to go though pre and post surgery routines, post surgery death rates in hospitals can be dramatically reduced if surgeons and other staff in the surgical theater actually use a simple checklist as a guideline of sorts. The checklist, that's been designed by the World Health Organization includes 19 points, including such sweet and simple gems like

• Mark the area or body part to be operated with a pen.
• Make sure that you have the right patient on the table. Ask his name.
• After the surgery, make sure that you haven’t left needles, sponges or other calling cards behind in the patient's body.

Hardly rocket scientist stuff, but according to the study that was conducted across a total of eight international cities, the effects of using a checklist like this reduces post surgery hospital deaths by close to 50 per cent. Post surgery complications dropped by nearly one third.

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New Jersey hospitals may soon be required to reveal not only the serious mistakes at their facility that have contributed to patient injuries or death, but also the identity of the facility. Until now, the state was not required to reveal the facilities responsible for making mistakes including such preventable ones as operating on the wrong part, leaving behind medical instruments or devices in the patients' body or allowing situations to develop that could lead to infections.

When the Patient Safety Act was passed 4 years ago, it required New Jersey's hospitals to report medical and surgical errors that occurred at the facility to the Department of Health and Senior Services. It was believed that Information about medical mistakes would foster a culture of accountability and openness.  Since the Act was passed, more numbers of errors are beginning to be reported, helping the DHSS to add to its database of errors that are likely to happen in a New Jersey hospital, and the best ways to help prevent these in future. At the time the Act was passed, legislators believed that hospitals would be more open about mistakes and disclosing information about these, if their names were not revealed. The bill was passed against the protests of patient safety groups who believed that such secrecy protected hospitals unfairly.

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Madison, New Jersey based Quest Diagnostics, the largest medical diagnostic facility in the country has admitted that it sent out a large number of erroneous Vitamin D test results to doctors and patients in 2008. The company launched an investigation into the matter in June when doctors from around the country began questioning the validity of some of the test results that they had received.   The announcement comes after a probe confirmed that errors had indeed been made with an unspecified number of Vitamin D blood tests that the company had conducted last year.

The company hasn't confirmed how many patients may have been affected by the inaccurate test results nor has it admitted the number of laboratories that were involved in these messed up results. According to industry watchers however, the number is possibly in the thousands. The company has faced problems with Vitamin D analysis testing of the blood before, and had changed its test design from an earlier FDA approved one to a new design. However, the new test design has problems of its own, especially when used to test large volumes.

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The New York Times carried this story that points to how, for so many patients in New York and across the country, medical malpractice laws may be the only thing standing between them and healthcare anarchy. The story focuses on the City's hospitals, in particular University Hospital in Syracuse, but the implications are just as relevant for any hospital in New Jersey.

The report uses the case of a 56-year-old woman, Sharon Yacketta who has had to undergo 19 surgeries in the past 4 years – one to correct her original problem of urinary incontinence, and the remaining 18 to correct the horrific errors that resulted from that first surgery.   Since that first botched operation when surgeons at University Hospital managed to rupture her right ureter, Yacketta has battled infections, and watched helplessly as her urinary incontinence ballooned into a vastly more complicated condition.  

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A new state report released last week says that preventable hospital errors in New Jersey have increased since last year, a trend that has been noticed every year since the error data tracking system kicked off in 2005.

In 2007, according to the third Patient Safety report by the state Department of Health and Senior Services, a total of 72 people died as a result of preventable hospital errors. The report takes into account all types of preventable mistakes in a hospital environment, from surgical and medical mistakes, to bed sores and falls that occur as a result of negligence. The 72 deaths were an increase by 30 from the previous year. There were a total of 456 hospital errors reported for 2007, which was also higher than in 2006. In fact, the rate of errors has grown every year since the Patient Safety Act regulations involving the reporting of hospital errors, came into force. The Patient Safety Act requires all preventable hospital errors committed by hospital staff, including nurses, doctors, surgeons, and others to be reported  to the Department of Health and Senior Services.

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Hospitals in New Jersey are required under the Patient Safety Act of 2004 to report any mistakes to the state Department of Health and Senior Services, but a nationwide survey suggests that most hospitals in the country, which do collect such information, do not use it to reduce the incidences of medical malpractice in their facilities.

The survey, contained in a report by the US Agency for Healthcare Research and Quality, says that an overwhelming majority of hospitals nationwide have begun the practice of collecting information of serious medical mistakes that occur in their facilities. However, the statistics of the number of hospitals where this information is actually shared by key personnel, including managers, is a dismal one in five hospitals. What this means is that most of this useful information, which could actually reduce the incidence of medical errors, and decrease the number of medical malpractice lawsuits, goes to waste, since very little of it is acted upon.

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 The New York Times has an interesting report on a little-known phenomenon in our hospitals that could point in a small way to the reason New Jersey medical malpractice lawyers are as busy as they are. It's about the way obnoxious, brusque or just plain abusive physicians may be contributing to some frightening medical and surgical mistakes.

According to the report, all too often, nurses who play such an important part in the doctor-patient relationship are humiliated, berated and even abused by physicians, so much so that it creates problems in communication. The Times uses some real life incidents to signify how sometimes, fear of approaching a doctor who's known to have a short fuse, can actually deter the nurse from approaching him when a patient's condition is worsening, or when there is an important life-and-death decision to be made about a patient. This lack of communication resulting out of fear of the doctor has led in too many instances, to serious complications, the need for additional surgery to repair the damage, and in some cases, even death. 

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It's everyone's biggest nightmare – popping a couple of pills for an ordinary ailment, and discovering later in your hospital emergency room, that the problem could be traced to pharmacy error at your local store. Now, a troubling report by WCNC points to an incentive scheme at North Carolina's biggest chain pharmacy as the cause of a growing number of errors at the franchise.

The company in question is CVS, which has the highest number of stores – 285 of them - in the state out of all the nationwide chains. According to the report, the distinction with other chains doesn't quite end there. CVS also has the highest number of citations from  the North Carolina Pharmacy Board for prescription errors. In fact, the Board has repeatedly cited the chain for creating a work environment in which employees are likely to make mistakes.

 

Regular customers who get their prescriptions filled at CVS are noticing the difference in service, the report says. Staff members often seem to be in a hurry to rush through prescriptions. It's not simply a desire to squeeze more out of their workday that's behind this high speed work environment. As the report points out, the company has incentive systems in place that reward employees based on the volume of prescriptions they fill. In fact, CVS pharmacists routinely receive updates on the amount of extra cash they stand to make depending on how quickly they can fill bottles with pills.

 

The extent to which CVS has been able to continue this practice unchecked, is shocking. Consider these statistics – the Board of Pharmacy stipulates 150 as the number of prescriptions that can safely be filled by a pharmacist in a single day. At CVS, some former employees have gone on record to claim that on a busy day, it's not unusual for pharmacists to fill as many as 500 prescriptions.  

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As a pharmacy error attorney, I have witnessed first hand many cases where children and adults are given the wrong medication due to medications have similar names and sizes so they are easily confused by pharmacy staff. In addition, children taken to adult hospitals suffer injuries or fatalities because these hospitals carry mostly adult size doses of medication so when a child is treated, their medication is often confused with the appropriate adult size.

According to an article from the American Medical News, a shocking 11% of child patients have adverse drug events during hospital stays. Most of the results came from children staying in adult hospitals and given adult sized doses instead of the pediatric size. Dr. Sharek, chief clinical patient safety officer at Lucile Packard Children's Hospital in Palo Alto, Calif. said “We are so used to writing pediatric, weight-based doses and when children are being cared for at adult hospitals staffed by adult-based nurses and adult-based pharmacists, that's a type of error that could theoretically occur a lot more frequently." The American Medical News goes on to say “The Joint Commission, which accredits and certifies more than 15,000 U.S. health care organizations and programs, said in its sentinel event alert that children are at greater risk for adverse drug events. That's because most medications are formulated and packaged for adults, and most hospitals and emergency departments are geared toward caring for adults.” The Joint Commission is further investigating these problems and suggests that hospitals identify and administer pediatric medications. Frank Federico, RPh, said "Medication should be delivered to the nursing unit or available in ready-to-administer fashion. That way, there is less that nurses have to do and less chance for error.”

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"American Bandstand" or your local dentist's office? FoxNews.com reported a lawsuit filed last month by a Syracuse, New York woman against her dentist who allegedly punctured her sinus cavity during a tooth extraction. The lawsuit claims the Dentist, Dr. George Trusty, was dancing to the 70's hit "Car Wash" while using a drill on the woman's molar.

Ms. Brandy Fanning, 31, of Syracuse, New York, said that as a result of the injuries she sustained by the dentist's actions, she had to undergo emergency surgery. According to court papers, Ms. Fanning is seeking $600,000 for her medical expenses, pain and suffering in the lawsuit she filed against Dr. Trusty in U.S. District Court in Syracuse last month.

 

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When I read this story, I was horrified by what happened to a newly pregnant St. Louis woman who went to Walgreens to fill a prescription for prenatal vitamins and was instead given a potent chemotherapy drug that killed her unborn child. The woman and her husband filed a lawsuit seeking some form of justice against the powerful pharmacy chain, alleging that Walgreens failed to properly supervise pharmacy personnel who dispensed the medicine, failed to verify the prescription with her physician, and failed to follow appropriate protocol.

The couple alleges in their complaint that she began to feel ill and began vomiting about a month into her pregnancy and assumed it was morning sickness, all the while taking what she thought were the prenatal vitamins.  About a month later, she miscarried her baby. It is alleged that her unborn child was killed due to the ingesting of the potent chemotherapy drug.  After her miscarriage, she continued to take the chemotherapy drugs (still thinking they were prenatal vitamins) because she believed that the vitamins would prepare her for a subsequent pregnancy. It wasn't until she telephoned Walgreens for a refill that the pharmacist realized the mistake.  Please read the full article.  I implore you to write in about your own personal stories pertaining to pharmacy mistakes and errors and your opinions about what has happened to this couple.

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Late last week, a friend of mine called the office to tell me about a co-worker who fell victim to the ever-increasing incidence of pharmacy error. The co-worker, let’s call her “Janet,” hadn’t been feeling well and visited her physician, who diagnosed a common infection and prescribed a course of antibiotics. Janet filled the prescription at her local chain pharmacy located in Western Monmouth County. Within a day or two after starting the medication, Janet was feeling increasingly sicker, and at one point, thought she was having a stroke, as one side of her body lost all sensation. Janet’s husband rushed her to the emergency room; at first, the ER doctors thought she was suffering from a rare allergic reaction to the antibiotic, but soon learned that the pharmacy filled the prescription with the incorrect dosage, double the dosage originally prescribed by the doctor! Continue Reading...

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Citizens of New Jersey, would it shock you to learn that in response to concerns about a dangerous increase in pharmacy-related prescription errors, your state legislature has introduced a bill, which if enacted into law, would preclude all forms of recourse should your pharmacist’s mistake cause you or your loved ones to suffer serious physical injuries. Well it’s hard to believe, but amazingly true: pharmacists would receive total immunity from civil liability for any errors committed resulting in serious harm as long as the error was reported to the New Jersey Board of Pharmacy. Even more astonishing is the likely effect the legislation will have on the large national and regional pharmacy chains- complete insulation from liability for the negligent acts of their pharmacist employees. Continue Reading...

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Tonight's 20/20 program (see "Tragic Mistakes") sheds light on what can only be called a silent epidemic of the occurrence of pharmacy errors across the nation. The segment featured the tragic story of a young mother who gave her four-month old daughter who was born prematurely what she thought was an anti-seizure medication. What she actually gave the infant was an adult dose of a diabetes medication, which left her daughter permanently disabled, unable to talk, walk or feed herself. Walgreen's, the national pharmacy chain, was responsible for the dispensing error, this act of negligence that caused irreparable harm.

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Doctors, nurses and other health care providers spend a great deal of time learning how to treat a great variety of illnesses and physical maladies. As a group they are professionals dedicated to helping alleviate the ailments that can plague mankind. Unfortunately, health care providers can also make mistakes. When mistakes are made the effects can be devastating. In fact, according to the National Academy of Sciences, approximately 98,000 Americans die from "medical mistakes" each year.

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