According to a recently published study, over the past decade, there has been a dearth of funding aimed at improving the care patients receive during outpatient visits.  This is especially important, because ambulatory care patient visits outnumber hospital admissions by 300 to 1.  Despite these numbers, over 50% of all medical malpractice settlements are for adverse events that occurred in outpatient (office) settings.  What’s more, over 65% of those cases involved “major” injuries or death.

According to the American Medical Association’s Center for Patient Safety, the most common errors committed in outpatient or office settings include incorrect prescribing of medications, misdiagnoses, failing to report test results, and poor communication.  (For example, according to a 2009 study published in the Archives of Internal Medicine, office-based physicians failed to follow up on clinically meaningful test results almost 8% of the time.)  The AMA’s website quoted Matthew K. Wynia, M.D., M.P.H. as saying that missed test results “should never happen.”  Dr. Wynia further stated, “You ordered the test.  Why did you order the test if you weren’t going to do something with the result?  It’s almost like a never event.  If you’re going to order the test, then what you’re going to do with the result needs to be clear.”

In the Journal of the American Medical Association‘s December 14, 2011 issue, a commentary co-authored by Dr. Wynia concluded that more research must be performed to determine why so many errors are committed in outpatient-based settings, and the total number of mistakes that have occurred.  To date, no definitive studies have been performed to determine the number of preventable mistakes committed in outpatient settings.  However, according to a 1999 study, as many as 98,000 Americans die every year in hospital settings due to malpractice.  One can only assume that based upon the disparity between the number of office visits and hospital admissions, the number of Americans who die annually from medical mistakes committed in outpatient settings may be as high as 250,000.  The AMA website also quoted David C. Classen, M.D., who co-authored the aforementioned commentary with Dr. Wynie, as saying, “Nailing down the incidence [of outpatient care errors] is the only way you can measure whether all these interventions are really leading to any improvements.  There are a lot of evangelical beliefs in patient safety – that if we just do this, it will get better.  But it won’t get better if we don’t have any reliable way to measure.”

The AMA should be congratulated on recognizing that more must be done to improve the care patients receive in outpatient settings.  However, before any meaningful steps can be made, there must be adequate funding to study why so errors are being committed, and what healthcare providers can do to prevent making those errors again and again.

Read more about the issue of ambulatory care errors on the AMA website: http://www.ama-assn.org/amednews/2012/01/09/prl10109.htm

The full text of Drs. Wynie and Classen’s recent commentary can be found here:  http://jama.ama-assn.org/content/306/22/2504.extract

A few weeks ago, I wrote about how the federal government temporarily took the National Practitioners Data Bank (“NPDB”) offline in September 2011, and then subsequently placed new rules on how the public can use the information contained on the database after it was relaunched.  The NPDB is a federally-maintained database that compiles medical malpractice payouts, hospital discipline and regulatory sanctions against physicians and other healthcare providers.  However, the NPDB does not mention offenders by name.  Instead, it simply assigns a number to each malpractice payout, or adverse disciplinary action, listed.  The new rules that recently took effect now prohibit members of the public from using any information contained in the NPDB to identify any physician by name.

In mid-October, Illinois’ Department of Financial and Professional Regulation recently launched a website, which lists those  active Illinois physicians who have paid a medical malpractice judgment or settlement within the previous five year.  However, unlike the NPDB, the Illinois website, www.idfpr.com, identifies doctors by name!  The Illinois site also lists whether physicians have been fired, had disciplinary actions against them, or been convicted of a felony or class A misdemeanor.  Since launching less than two months ago, the Illinois site has had almost 750,000 hits.  This fact demonstrates that Illinois residents want to learn as much as possible about their treating physicians, including whether they have a history of medical malpractice payouts.

Please note that the Illinois site is still working out some kinks.  For example, approximately 15% of active Illinois physicians have not signed off on their public profiles listed on the www.idfpr.com site.  Additionally, Illinois officials have encountered problems obtaining criminal histories for some healthcare providers.  A recent Chicago Tribune article described how one Illinois chiropractor failed to include his conviction for patient battery, and, as a result, that critical information was not initially included on the www.idfpr.com site.

The aforementioned Chicago Tribune article quoted Sue Hofer, spokeswoman for the Illinois Department of Financial and Professional Regulation, as saying that officials are “really pleased with all the interest” the new website has garnered.  However, some Illinois politicians rightly point out that the site should contain even more information.  For example, State Rep. Mary Flowers (D – Chicago), one of the Patients’ Right to Know Act’s sponsors, would like the public profiles to include medical malpractice payments, firings, and criminal convictions going back ten years.  In fact, she is going to introduce legislation early next year to change the applicable regulations, and allow information for the previous ten years to be posted on the site.

Although the Illinois physician background information website is imperfect, it is nonetheless a fantastic starting point.  If politicians in states other than Illinois are really concerned with improving patient care, they would remove the shackles, and allow the public unfettered access to all healthcare providers’ background information.  The federal government, and all state legislatures, should follow Illinois’ lead by establishing similar websites to inform the public about dangerous doctors.

Read my original post about the NPDB here:

http://commonwealthinjury.com/blog/2011/11/11/louisville-kentucky-medical-malpractice-attorney-the-national-practitioner-databank-should-be-open-to-everyone-no-strings-attached/

Also, more information about the NPDB can be found here: http://www.healthjournalism.org/blog/2011/11/agency-re-posts-national-practitioner-data-bank-file-but-restrictions-draw-fire/

Read the Chicago Tribune article here: http://www.chicagotribune.com/health/ct-met-doctor-profiles-20111127,0,5169338.story

In a November 23, 2011 Huffington Post editorial, Shirley Svorny, a Professor of Economics at California State University – Northridge, provided another reason why the federal government should not impose damages caps in medical malpractice cases.  Professor Svorny concluded that capping medical malpractice victims’ ability to recover monetary damages from negligent providers “would reduce medical professional liability insurers’ financial incentives to reduce practice risk.”  Professor Svorny’s editorial is important, because she is an adjunct professor at the Cato Institute, a libertarian think tank that typically supports Reublican causes.  As most readers know, congressional Republicans are the most vocal supporters of limiting victims’ access to the judicial system, and capping damage awards.

According to Professor Svorny, “Much of the protection consumers have against irresponsible and negligent behavior on the part of health care providers hinges on oversight and incentives created by the medical professional liability insurance industry. A nationwide shift to caps could result in more cases of negligence and substandard care.”  She explains that instituting damages caps would actually reward negligent physicians, because they would end up paying the same malpractice premiums as those physicians who have never been sued.  As it stands now, physicians who have paid at least one jury verdict or settlement usually pay much higher malpractice insurance premiums.  In fact, some doctors and other healthcare providers who have paid multiple malpractice claims are unable to get practice privileges at certain institutions.  That, in itself, keeps dangerous doctors from harming other patients.

Additionally, Professor Svorny argues that capping medical malpractice damage awards would result in malpractice insurers discontinuing incentives that encourage safe practice habits.  For example, some medical liability insurance companies will only provide coverage for doctors with spotless records.  Furthermore, almost all insurance companies reduce premiums for those physicians who regularly attend seminars, or take courses, aimed at enhancing patient safety.

Professor Svorny’s editorial is one of the best arguments I have read about the contentious issue of limiting medical malpractice victims’ rights.  She clearly explains that our current system is not completely broken, as many people would like you to believe.  Moreover, we often hear that the government should not be meddling in our everyday lives by implementing regulations, and that the “markets should works themselves out.”  The current system does just that.  However, if the current Republican congress were to enact the draconian damages caps like those already in effect in states such as Texas, it would be doing exactly what it is making everyone afraid of – having the government, and not the markets, make the “best” decision for you.

Read Professor Svorny’s entire editorial here: http://www.huffingtonpost.com/shirley-svorny/medical-malpractice-caps_b_1110097.html

If you believe that you or a loved one may be a medical malpractice victim, contact Kentucky medical malpractice attorney, Seth Gladstein. You may call Seth and Gladstein Law Firm at 502-855-4177, or toll free 800-991-0474. You may also email him at Seth@CommonwealthInjury.com.