April 13

Patients in US Hospitals At High Risk of Harm from Professional Negligence

A report in the April issue of Health Affairs indicates that one in three patients who are admitted to a US hospital suffer from  a mistake. [1]

According to the Center for Disease Control (2002) 100,000 patients die from infections contracted in US hospitals. [2]

According to a comprehensive study by HeathGrades (2004) another 195,00 patients die in hospitals from preventable errors [3]

According to the Institute of Medicine (2006) one and a half million patients are harmed from preventable drug-related errors.  Of these, 400,000 are preventable drug-related injuries that occur each year in hospitals; another 800,000 occur in long-term care settings, and roughly 530,000 occur among Medicare recipients in outpatient clinics.  The IOM committee report noted that these are likely underestimates. [4]

The New York Times reports (below) that NY state inspectors have found that "long after a major Brooklyn hospital said it had stopped over-radiating premature babies, inappropriate X-rays were still being administered as recently as January." The inspectors found 27 instances of infants having been subjected multiple times to over-radiation.

The state inspections were prompted by a February investigative report by The Times that revealed that in 2007, doctors at the Brooklyn hospital of the NY State University Downstate Medical Center discovered that premature babies had frequently been subjected to whole body X-rays when only chest exams had been ordered. Although doctors had discovered the over-radiation errors, they were never reported to NY State health officials as required.

Given the appaling number of preventable deaths and injuries due to negligence by physicians, medical support staff, and medical institutions that shield them, why are Americans reluctant to complain–even when they witness practices that undermine patient safety?

Maureen Dowd sheds light on why we are reluctant to take charge and give doctors orders to protect ourselves and our loved ones from negligent doctors who are clearly not guided by the Hippocratic Oath requiring doctors to "do no harm."  

"I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses and orderlies, irrationally hoping that they’d treat my brother better if they liked us."

Doctors and nurses who fail to comply with hand washing rules, doctors who wear ties–even in the knowledge that ties have been shown to spread lethal infectious diseases– may be accused of homicidal negligence.  Such doctors should lose their license and hospitals that fail to enforce safety measures should be publicly identified.


1. Still Crossing The Quality Chasm—Or Suspended Over It? http://content.healthaffairs.org/content/30/4/554.full

2. Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002 http://www.cdc.gov/ncidod/dhqp/pdf/hicpac/infections_deaths.pdf

3 Patient Safety in American Hospitals Study Released by HealthGrades, July 2004  http://www.healthgrades.com/media/english/pdf/hg_patient_safety_study_final.pdf

4. Preventing Medication Errors:Quality Chasm http://www8.nationalacademies.org/onpinews/newsitem.aspx?recordid=11623


Vera Sharav





April 12, 2011

Giving Doctors Orders


When my brother went into the hospital with pneumonia, he quickly contracted four other infections in the intensive care unit.

Anguished, I asked a young doctor why this was happening. Wearing a white lab coat and blue tie, he did a show-and-tell. He leaned over Michael and let his tie brush my sedated brother’s hospital gown.

“It could be anything,” he said. “It could be my tie spreading germs.”

I was dumbfounded. “Then why do you wear a tie?” I asked. He shrugged and left for rounds.

Michael died in that I.C.U. A couple years later, I read reports about how neckties and lab coats worn by doctors and clinical workers were suspected as carriers of deadly germs. Infections kill 100,000 patients in hospitals and other clinics in the U.S. every year.

A 2004 study of New York City doctors and clinicians discovered that their ties were contagious with at least one type of infectious microbe. Four years ago, the British National Health System initiated a “bare below the elbow” dress code barring ties, lab coats, jewelry on the hands and wrists, and long fingernails.

The Centers for Disease Control and Prevention says that health care workers, even doctors and nurses, have a “poor” record of obeying hand-washing rules.

A report in the April issue of Health Affairs indicated that one out of every three people suffer a mistake during a hospital stay.

I saw infractions of the rules in the I.C.U. where Michael died, but I never called out anyone. I was too busy trying to ingratiate myself with the doctors, nurses and orderlies, irrationally hoping that they’d treat my brother better if they liked us.

Commenting on the new report on hospital errors, CNN’s senior medical correspondent, Elizabeth Cohen, instructed viewers to “ask doctors and nurses to wash their hands” if they haven’t.

“They sometimes will actually give you a hard time, believe it or not,” she said, “and they say, ‘My gloves are on. I’m clean.’ ‘Well, I didn’t see you put those gloves on. What if you put those on with dirty hands?’ ”

I called Cohen, the author of “The Empowered Patient,” to ask her the best way to confront those taking care of you or family members. She said that you have to get over the “waiter spitting in your soup scenario,” that the medical professionals will somehow avenge themselves, by giving less attention, if you insult them.

“There are all sorts of reasons we default to being quiet,” she said. “It is general etiquette not to correct another adult, especially when this is their profession. But when the consequences are so grave, you have to summon up your courage.” You could say that you are a germaphobe, she suggested, and ask if they could please just indulge you?

Dr. Peter Pronovost of Johns Hopkins has been able to prove in a national program that you can curb infections and reduce mortality rates in I.C.U.’s by adhering to checklists, creating accountability and fostering a culture where patients, their families and even nurses and residents feel freer to challenge doctors.

“There’s no doubt that it’s really difficult to question physicians,” Dr. Pronovost says. “It’s hard even for me when my wife or my kids are ill. Many clinicians aren’t the most welcoming. They give verbal or nonverbal clues to say, ‘Hey, I have the answer.’ We just need to change the culture. The patient really is the North Star.”




April 12, 2011

Bad X-Rays Found Again at Brooklyn Hospital


Long after a major Brooklyn hospital said it had stopped over-radiating premature babies, state inspectors have found that some inappropriate X-rays were still being administered as recently as January, state records show.

Claudia Hutton, a spokeswoman for the New York State Department of Health, said state regulators suspected that similar cases were occurring at other hospitals. The department is deciding whether to conduct spot checks around the state to determine the extent of the problem.

The inspection at the Brooklyn hospital, the State University of New York Downstate Medical Center, in March, was prompted by an article in The New York Times in February, revealing that in 2007 the hospital had discovered that premature babies — the most vulnerable of all patients — were frequently subjected to whole-body X-rays when only chest exams had been ordered. These errors had never been reported to state health officials.

Downstate officials said they had promptly put an end to the risky X-ray practices. But last month, state inspectors reviewed chest X-rays of premature babies taken late last year and early this year and found 27 instances of infants’ irradiated beyond the chest area without proper shielding. Some premature infants were over-radiated multiple times, inspection records show.

“We were disappointed to find so many X-rays in our sampling that did not have adequate shielding to protect infants from being exposed to excess radiation,” said Dr. Nirav R. Shah, the state health commissioner. “Additional training and monitoring must be put into place to rectify this situation.”

In a brief statement released on Tuesday by Ronald Najman, a Downstate spokesman, the hospital said that in the wake of the inspection, it had addressed the issues raised by regulators “to ensure that we provide quality care to our patients.” The statement did not say why the problems had continued after radiologists at the hospital said they had stopped the original improper scanning practices.

Children are particularly vulnerable to radiation’s effects because their cells divide quickly and because they face an ever-increasing number of radiological procedures over their lifetime as new medical uses are found for radiation. X-rays are invaluable in diagnosing internal complications. But minimizing exposure is important because most scientists believe the effects of radiation are cumulative, meaning the more radiation one receives, the greater the chances of developing cancer later in life.

The state inspection on March 9 found “neonatal imaging was not provided in accordance with physician orders and the facility policies and procedures,” according to a statement of deficiencies sent to the hospital on March 21.

The first case cited in the report involved a baby born prematurely at 26 weeks who received five chest X-rays over a period of two months in which the radiation was not properly limited, or coned, to the chest area. For example, one “showed the patient’s neck, chest, abdomen, the upper arms and a small section of the right thigh.”

A second baby who was to have a chest X-ray had an image taken that included “the entire head, left arm, right arm, chest and abdomen,” the report said.

According to the state, one radiologist explained the wide areas of irradiation by saying that “technologists were sometimes instructed at the bedside by physicians to include additional areas of interest in the chest X-ray.”

Ms. Hutton, the state health department spokeswoman, said that explanation was unacceptable when the official medical record called only for a chest X-ray. “You shouldn’t be taking X-ray views not ordered by the doctor,” she said, “and if the doctor ordered them, they should be in the chart.”

According to the inspection report, the 27 improper X-rays were found among 542 chest images reviewed by state inspectors.

Ms. Hutton said if a fine was imposed, it would probably be a small one. “We just want compliance,” she said. “This is not a revenue stream for us.”

The hospital’s failure to report the problems in 2007 rankled state regulators. “You could have called us and said, ‘We just found something really bad,’ ” Ms. Hutton said. “We had to learn about the issue from The New York Times.”

The Times article quoted extensively from internal e-mails at Downstate, including one from 2007 in which Dr. Salvatore J. A. Sclafani, the radiology chairman, wrote that he was “mortified” to find that the same premature infant had received about 10 whole-body X-rays when only a simple chest X-ray had been ordered. “Full, unabashed, total irradiation of a neonate,” Dr. Sclafani said, adding, “This poor, defenseless baby.”

Dr. Sclafani recently took a leave from his position to do research.

Downstate officials told The Times during the winter that back in 2007, the hospital had instituted procedures intended to minimize exposure to radiation. The steps included reducing the radiation dose administered to pediatric patients undergoing CT scans and eliminating CT scans that were not absolutely necessary.

According to doctors familiar with Downstate procedures, those steps did reduce exposure to radiation from CT scans.

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