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On May 9, 2014 we wrote about the House’s investigation into secret waiting lists that may have lead to the deaths of forty or more veterans. Now the Chicago Tribune reports that federal auditors have visited the Edward Hines Jr. Veterans Affairs Hospital due to allegations that similar secret waiting lists were also used there. The Hines facility is in Maywood, a suburb of Chicago.

The Tribune reports that a social worker has alleged that veterans seeking care at Hines were placed on secret waiting lists, rather than the official waiting lists. This was allegedly done so executives could collect bonuses that are supposed to be reserved for executives who provide speedy care despite an ever increasing demand on veteran’s hospitals.

The president of the American Federation of Government Employees VA Local 781, Germaine Clarno, told Tribune reporters that he has actually seen the waiting lists and that multiple hospital employees have told him about them. Meanwhile, the director of the facility claims she has “received no evidence or specific facts about data manipulation.”

NBC News reports that multiple whistleblowers claim administrators at a VA hospital in Phoenix ordered thousands of appointment requests from veterans be diverted to a “secret unofficial list” that was not to be reported. The theory was, if those veterans died, their names would disappear, and the hospital’s performance record would improve. Then the hospital would not be held accountable for possibly killing the patient with a delayed diagnosis.

One whistleblower explained to NBC that there was a huge demand on the hospital, and that they had limited resources. Rather than finding a solution to the supply and demand problem, the hospital covered up the problem. Veterans, both young and old, tried to get the medical care they were promised upon entering the military, but were turned away without treatment or diagnosis.

Failures to Diagnose Caused Veteran Deaths

The Center for Investigative Journalism reports that in the decade following 9/11 the Department of Veterans Affairs paid $200 million to nearly 1,000 families in wrongful death cases. The median payment for each family was $150,000. Thirty-nine of the veterans died due to malpractice at the clinics in Danville, Marion, and Hines, Illinois alone.

Delayed diagnosis, delay in treatment, and improper performance repeatedly appear as the type of malpractice in these cases. The report includes a Shreveport, Louisiana veteran who overdosed on morphine in a locked psychiatric unit and a delusional Portland, Oregon veteran who jumped off the roof of a VA hospital. It also includes Iraq War heroes who committed suicide after being turned away for mental health treatment and Vietnam veterans who died from known cancerous tumors that were allowed to grow. The Seattle Times reports that the 1,000 families includes the family of a veteran who bled to death after knee replacement surgery and the family of another who died after being sent home with fractured ribs and a fractured spine.

Nursing Home Fall

In today’s world of gizmos and gadgets, we tend to trust our technology to make our lives easier and more error-free. However, a new study on computer software that is widely used to locate cancerous regions in mammograms shows that the technology may be doing more harm than good. The study shows that the software has not only failed to make breast cancer detection more accurate, but that it has also increased the risk that a patient will be erroneously told that her mammogram shows cancer cells.

The study, which may be found online in the “Journal of the National Cancer Institute,” bases its conclusions on the analysis of about 1.6 million mammograms taken at radiology facilities in several states between 1998 and 2006. The same researchers who have published this study were also the authors of a similar one conducted in 2007, when they first became skeptical of the efficacy of this mammogram technology, known as computer-aided detection (CAD).

The problem comes from the fact that mammograms themselves are not always as trustworthy as we would rather them be. According to the National Cancer Institute, the average mammogram may overlook up to 20 percent of breast cancers. However, studies show that having multiple radiologists examine a mammogram may improve the accuracy of its result. This is where CAD has been most often deployed – as a second set of eyes to look at a mammogram. Thus, CAD is being used as if it is as good as a radiologist’s eye, and it simply may not be the case that it is.

Beyond aiding in the recovery for those affected by medical errors, malpractice lawsuits also play the critical role of ensuring hospital safety stays on the public radar. Without focused attention on the need to identify problems and improve, there is the risk of facilities getting caught in a rut–doing the same thing over and over, regardless of the errors that result.

The focus on malpractice does not exist only in newspapers. Medical researchers and academics are also drawn to the topic to study exactly what types of errors are most common and how they can be prevented.

For example, earlier this month international researchers published the results of a detailed study of a medical malpractice claims to understand what forms are most frequent. The findings were shared in full in the online version of the British Medical Journal (BMJ Open). The abstract and full text of the report can be found here.

Last week we touched on a somewhat nuanced legal issue that has been discussed repeatedly across the blogosphere over the last few days. The issue is known as the Lost chance” or “loss of chance” doctrine. It most often applies to cases of missed diagnosis or delayed diagnosis. Considering that diagnostic errors are the most common mistakes leading to medical malpractice judgments and settlements, it it worthwhile to re-emphasize more of the general principles underlying the debate around this issues.

Lost Chance of Survival in Illinois

Illinois is among a number of states that have adopted the “lost chance” doctrine. Simply put, lost chance is the harm resulting to a patient when negligent medical treatment has allegedly decreased the patient’s chance of survival or recovery. In 1997 the Illinois Supreme Court heard Holton v. Memorial Hospital and ultimately recognized the right of patients in certain cases to seek recovery, even if the patient’s risk of survival or recovery was less than 50%. With this ruling, Illinois joined a majority of states in recognizing the lost chance doctrine. Undoubtedly, patients in Illinois prospered with this ruling, both from a fairness and financial standpoint. After all, a delayed diagnosis can be lethal in some circumstances.

One of the most contentious legal issues facing courts in medical malpractice cases over the years has to do with “loss chance.”

Here’s the situation: To file a lawsuit and recover on a claim, a patient must show that the negligence on the part of the defendant actually caused harm. Negligence alone is not enough. In other words, a doctor’s failure to wash their hands before a procedure may be negligent, but if it cannot be shown that the dirty hands caused actual problems for the patient, then there can be no recovery.

But what happens when the “harm” is simply a lowered chance of a positive outcome down the road? This is especially common with mistakes like delayed diagnosis. If a patient has cancer, a doctor may misread test result and fail to notice the problem. The patient may eventually have the cancer identified later–perhaps even by the same doctor–but the delay in identifying it meant that treatment was delayed. If treatment had been started earlier, the patient may have had a better chance of beating it. The doctor’ delay did not “cause” the cancer–it was there already–but it did lower the patient’s chance of survival.

Patients assume that doctors know what they are doing at all times. There is a tendency to trust doctor decisions without question, simply doing as one is told and expecting the outcome that the doctor says is likely.

But, as the hundreds of thousands of patient who suffer at the hands of medical errors know–doctors are not perfect. In the heat of a workday they may misread a test, fail to wash their hands, prescribe the wrong dosage of a medication, or otherwise take steps that will cause patients more harm. Understanding the prevalence of preventable errors, many advocates encourage patients be proactive in their healthcare. There are things that patients can do on a consistent basis which may allow an error to be caught before it causes harm.

For example, well-known TV doctors Oz and Roizen recently shared information on way to help your doctor avoid a misdiagnosis. The tips provided in the story are worth reading, as misdiagnosis remains one of the most common forms of medical malpractice. The article reminds that “39 percent of U.S. malpractice payments are for nondiagnosis or an incorrect or delayed one.” Even more, “of all medical mistakes, diagnostic errors appear to be the most common, most costly, and most dangerous.”

With all of the discussion of “rampant” lawsuits and doctor’s fear of malpractice laws, one might get the impression that winning a case for negligence is easy. The opposite is true. In all civil lawsuits, the benefit of the doubt goes to the defendants, as the plaintiff (injured patient/family) is required to prove each element of the claim.

Even in cases where negligence occurred, securing enough proof for the mistakes can be hard. For one thing, the defendant usually has access to all of the necessary material to show what happened. That material takes many forms, from patient medical records to the recollections of those who provided the care. The defendants are required to provide access to the necessary information as part of the “discovery” process of litigation. But on many occasions those parties are less than forthcoming, using every available tool to delay providing the information to trying to withhold important details altogether.

In the worst cases, the very medical records which are critical to the case are altered, painting a false picture of the care that was provided to the patient in the case. Considering that the documents are in the possession of the defendant and can be decisive in a case, the unlawful “doctoring” of those records is far more common than one might expect. Unfortunately, it has become critical for medical malpractice lawyers to familiarize themselves with the signs that these records were altered.

Medical malpractice occurs any time that a medical professional breaches a duty of care equal to that of other reasonable professionals in the area. When that breach causes real injury to a patient, then the injured party (or their family) can pursue accountability and redress via the civil law.

As most community member knows, there are seemingly an endless array of ways that harmful mistakes can be made by doctors. Everything from botching a surgery to accidentally providing too much medication. Estimates from many different organizations over the years have discovered that the overall scope of medical errors are staggering, with the most aggressive arguing that as many as one in three patients may fall victim to some lapse in case. Most of those are minor, however .

There are some types of malpractice, of course, that are not minor–resulting in very real harm or even death. It is those types of accidents that are mostly likely to spur medical malpractice lawsuits and accountability via a judgment or settlement.

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