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A February 16th article in Crain’s Chicago Business covered the increase in opioid-related overdoses and their impact upon hospitals in Illinois. The number of overdoses is rising, but so are the costs associated with treating these patients. Between January-September 2016, the number of opioid-related emergency room visits was 77% higher than that same time period just a year before. Nationwide, the average cost of an intensive care unit stay for an overdose was $58,517 in 2009. In 2015, the average cost per ICU stay jumped to $92,408.

A representative for Cook County Health and Hospital System told Crain’s that they estimate they spent $25 million last year treating between 4-5,000 patients with opioid-related illnesses. As a point of comparison, they treated 1,000 of these patients in 2006.

Loretto Hospital says that 1 out of every 3 patients in the emergency room is there to be treated for an opioid-related issue. They also estimate that nearly 40% of the patients admitted for treatment are later readmitted, something that costs them more than just writing off a single visit. Readmission rates have been a major quality indicator for hospitals and under the Center for Medicare and Medicaid Services “Readmissions Reduction Program,” hospitals who have high readmittance rates will see reduced payments from Medicare and Medicaid. For many hospitals, Medicaid reimbursements make up a large chunk of their revenue.

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A February 10th article in Medical Economics tackles the issue of legal responsibility for physicians treating one of the estimated two million patients with a BRCA mutation or Lynch Syndrome. 1 in 400 Americans are carriers of the BRCA gene mutation, said to be associated with a 50-70% higher risk of developing breast cancer and a 15-64% higher risk of ovarian cancer. Lynch Syndrome, a condition linked to a 70% higher risk of colorectal cancer, is found in 1 in every 350 Americans. The condition is also associated with elevated risk of endometrial, gastrointestinal, and genitourinary cancers. The problem with these conditions is that experts believe nearly half of those who carry the BRCA gene or Lynch Syndrome will find out they have cancer without knowing previously that they are carriers, leaving medical economists to speculate that a potential legal crisis will occur when patients realize that a simple screening recommended by their physician could have ultimately prevented their cancer or saved their lives. Giving clarity to the magnitude of the potential situation, Medical Economics says that the average medical practice has 2400 patients, 6 of whom will be carriers of the BRCA mutation and 7 of whom will be found to have Lynch Syndrome.

Giving Detailed Family History Could Save Your Life

Under the Affordable Care Act, most insureds who meet a specific set of criteria are eligible for cancer and genetic screening and according to Medical Economics, millions of them have not been referred by their doctor for testing. The journal recommends physicians obtain a complete family history as it relates to cancer, using whatever method of collection will gather the most thorough information without adding to an already robust workload. In the case of obtaining a proper cancer history for each patient, experts agree that the time spent to gather the information is a worthy cause. Even allowing a patient to self-report information through an electronic questionnaire that can be imported into their electronic medical record (EMR) is beneficial.

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In a New York Times OpEd from late January, the first victim of Dr. Larry Nassar’s to come forward shared how speaking out against the physician cost her several friendships and proved to be the difficult choice when compared to staying silent. After sentencing Nassar to up to 175 years in jail, judge Rosemarie Aquilina told victim Rachel Denhollander: “You made all of this happen. You made all of these voices matter. Your sister survivors and I thank you. You are the bravest person I have ever had in my courtroom.”

Legal Background Prepared Her To File Complaint, but Not for Emotional Toll

One of more than 200 victims, Rachel Denhollander, now an attorney in Louisville, Kentucky, was the first to go to authorities with allegations of abuse at the hands of the former Michigan State University sports medicine physician and USA Gymnastics team doctor. Denhollander was just 15 years old when Dr. Nassar abused her under the guise of providing pelvic floor therapy. Several years later, in 2004, she was working as a gymnastics coach and decided to tell another coach about Nassar with the hope that her fellow coach would not allow her team to see him for care. That same year, she also told a nurse practitioner about the abuse. In 2016, the Indianapolis Star published a piece about sexual abuse within USA Gymnastics and after learning of the story, Denhollander contacted them to share what had happened to her. She realized that it might be time to officially file a complaint against Nassar with the police. But before she did so, her legal education and experience as an attorney taught her that she had come prepared with hard evidence in order to have her voice heard. She told the New York Times that the average pedophile is reported 7 times before an allegation is actually investigated, so she knew she had to have as much documentation as she could in order for her story to be taken seriously.

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It happens so often that there’s a well-known term for it in the legal community: Deny and defend. It refers to a situation in which a guilty party denies any wrongdoing and allows an attorney to vigorously defend them in court. This term is often used in medical malpractice cases. But what about the morality and ethics behind applying such tactics? There are real people on the other side of these denials, people who have lost children, loved ones, their own ability to walk, talk, or enjoy life as they did before an accident, error, abuse or neglect.

About 15% of hospitals and health organizations have implemented an accountability model for medical error commonly referred to as a “communication and resolution” program. The focus of programs such as these is to acknowledge to victims and their families that a mistake occurred, provide possible explanations as to why it happened, take responsibility and ownership of that error, offer condolences, and potentially provide some form of compensation. All of this happens outside of a courtroom.

Several Illinois Hospital Groups Using Communication and Resolution Programs

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Super Lawyers, a rating service of lawyers whom are considered among the most accomplished and well-regarded in the profession, has released their 2018 Top Lists. According to Super Lawyers, placement on their lists is determined through a system that includes “12 indicators of peer recognition and professional achievement.  The patented multiphase selection process is rigorous and methodical.”

Levin & Perconti is pleased to share that 12 of our attorneys have been placed in top lists compiled by Super Lawyers.

3 of our Partners ranked in the Top 100 attorneys in the state of Illinois. Partner Susan Novosad placed not only in the state’s Top 100, but also in the Top 50 Women category. We are also thrilled to announce that 2 Partners and 7 Associate Attorneys were named in the Rising Stars category.

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Patient safety has become a major focus for hospitals in recent years. Risk management and patient safety officials are tasked with implementing initiatives that reduce physician and staff errors, including everything from proper labeling of specimens to medication safety and counting of supplies following surgical procedures. Great strides have been made as a result of these efforts, but a startling 80% of all medical errors involve  miscommunication between providers. The average patient in a hospital will see between 3-4 physicians during their stay, allowing ample opportunity for vital information to simply slip through the cracks. In an Medscape article published last year, the author refers to a 2015 review conducted by the company that insures Harvard-affiliated hospitals.  After looking at nearly 24,000 medical malpractice claims against Harvard-affiliated facilities, they found that 30% of the cases involved a communication gap between providers. Those 24,000 claims paid out $1.7 billion to victims, 1700 of which involved a death.

According to an assistant vice president for the insurance firm, CRICO,  “Errors often occur because information is unrecorded, misdirected, never received, never retrieved, or ignored. Every mode and system by which patients and caregivers share health-related information is vulnerable to failure.” According to the review’s results, more often the not, the communication breakdown occurs between providers, not between the provider and the patient.

Who’s Responsible When Information Goes Missing?

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The results from this year’s Centers for Medicare & Medicaid Services’ (CMS) Overall Hospital Quality Star Ratings report have been released and the results are mixed for Chicago. For many hospitals, Medicare and Medicaid are the single largest payers for health care, leaving facilities heavily reliant on receiving reimbursement from the programs in order to stay afloat financially. 57 different factors are analyzed in order to assign a rating to a hospital, including readmission rates within 30 days of a discharge, a number CMS has been pressuring hospitals to drastically reduce in order to avoid financial penalties.

The Best and Worst of Chicago

There are 82 hospitals within a 50 mile radius of Chicago, but only 74 hospitals were included in CMS’ ratings. Pediatric hospitals are not included in CMS’ star ratings. Freestanding pediatric hospitals such as Ann & Robert H. Lurie Children’s Hospital of Chicago and University of Chicago Comer Children’s Hospital do not participate in the Inpatient and Outpatient Quality Reporting programs run by CMS and therefore are unable to be rated.

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With the number of sexual assault and harassment claims increasing by the day, the public is beginning to see just how many crimes have been buried with the help of confidentiality agreements. It seems as if no industry has been immune to engaging in cover ups of rape, assault, harassment, and abuse. In light of all the stories recently brought forth in the news, maybe it shouldn’t be a surprise that hospitals are also involved in the business of paying for silence.

Trusting in your physician and placing your health in their hands is one of the most important relationships you will ever have in your life. A feeling of mutual respect is key, as is faith in their ability to provide the best possible care for you, personally. So what happens when this delicate relationship is damaged? What happens when a doctor takes advantage of a patient and instead of being backed by the hospital system, the patient is dismissed or quieted?

Colorectal Surgeon Anally Raped Two Patients, Allowed to Continue Working 

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Just before Christmas, Congress voted to temporarily keep funding the Children’s Health Insurance Program (CHIP), the federally and state funded insurance program for 8.9 million children in the United States. Children enrolled in CHIP have families that earn too much to be eligible for Medicaid, but do not have the ability to obtain private insurance. Insurance under CHIP is either free or available at a reduced cost.

States are responsible for the administration of CHIP, using state funds in conjunction with federal dollars and are able to operate the program either separate from or as an extension of Medicaid. Without adequate federal funding, however, CHIP would not be able to support all children in need.

With the December 21st vote by Congress to allocate $2.85 billion to CHIP, the program should be safe until March of this new year. When states were notified of the extension of the program, they breathed a sigh of relief knowing they wouldn’t have to send out letters over Christmas notifying needy families that their health insurance would be cut. Even with the extension, it doesn’t guarantee that every state will have enough to keep everyone enrolled until March. As part of the agreement, Congress also authorized the Centers for Medicare and Medicaid Services (CMS) to grant more funds to the neediest states.

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A yearlong investigation by ProPublica and NPR has revealed that in addition to the U.S. having the highest rate of maternal death of any industrialized country, black women are 243% more likely than whites or hispanics to die during pregnancy, childbirth or the postpartum period.

Why are Mothers Dying During Pregnancy and Childbirth?

For women of all ethnic backgrounds, data from the CDC shows that the rate of severe complications related to childbirth more than doubled between 1993-2014. The ProPublica/NPR investigation points to a variety of factors contributing to the increase in the maternal death rate; chief among them are increases in the average age and weight of pregnant women. Factors such as age and weight mean a greater likelihood of diabetes and high blood pressure (hypertension). The report also cites a 2008-2012 study of women in New York hospitals that found that women with “severe pre-existing conditions were three times as likely as other new mothers to experience life-threatening impacts of childbirth.” If anything, the knowledge of the increasing rate of maternal deaths due to age and weight should urge healthcare providers to practice precaution over a more laid back approach to addressing complaints and even borderline abnormal symptoms in pregnant and postpartum women.