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What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
Anesthesiologist Guilty on 2 Counts of Manslaughter

Anesthesiologist Guilty on 2 Counts of Manslaughter

A Manhattan jury found Stan Xuhui Li, MD, guilty of manslaughter for overprescribing painkillers to two patients, Joseph Haeg, 37, and Nicholas Rappold, 21, who later suffered fatal overdoses. The 60-year-old anesthesiologist from New Jersey, was found guilty of two counts of second-degree manslaughter, six counts of recklessly endangering the lives of six other patients, and 180 counts of selling prescriptions for controlled substances (view all charges here). Dr. Li ran a pain-management clinic out of a basement office in Queens 1 day each weekend, seeing up to 100 patients a day. Posting a price list on his wall for drugs, Dr. Li accepted payment primarily in cash and pocketed nearly $500,000 over 2.5 years. He prescribed opioids such as oxycodone and anti-anxiety drugs such as alprazolam to high-risk patients—ignoring evidence of drug abuse and addiction, drug diversion, prior overdoses, and degenerating health. Manslaughter In both manslaughter counts, Dr. Li was charged with failing to perform adequate examinations to verify Haeg and Rappold’s reports of chronic pain and ignored repeated warning signs of addiction. According to prosecutors, Haeg received 15 prescriptions for controlled substances from Dr. Li, including oxycodone, within 3 months leading up to his death. In the final month, Haeg received more than 500 pills in two visits, the last visit only 3 days before he died of acute oxycodone intoxication. Rappold also died 3 days after his last appointment with Dr. Li. He was found with a bottle of Xanax with only 35 pills remaining of 90 from a prescription prescribed only 3 days before. Cause of death was acute intoxication by the combined effects of Xanax...
Safe Harbor for Docs  Who Follow Guidelines

Safe Harbor for Docs Who Follow Guidelines

Physician leaders are supporting a new proposed federal law that aims to reduce litigation against physicians, lower healthcare costs, and establish more fairness in the analyzing of malpractice claims. The new House bill, Saving Lives, Saving Costs Act, introduced by Congressmen Andy Barr (R-KY) and Ami Bera, MD, (D-CA) would create “safe harbor” – protection from liability – for physicians who follow best practice guidelines from malpractice suits. More than 75% of physicians face a malpractice claim over the course of their career—a liability climate that can drive patient care and encourage overutilization, adding billions of dollars in health costs each year. And patient outcomes don’t appear to improve as a result. If the physician being sued argues that he or she adhered to relevant, best practice guidelines, the case will be put in front of an independent medical review panel for investigation. If the panel determines that the clinician did comply to the guidelines or that the injury was not caused by failure to comply, the case will be dismissed. Personal injury lawyers are pushing back, one in particular claiming: “There is no evidence, however, that this safe harbor would actually promote patient safety. In fact, in Texas, where emergency room physicians have had immunity since 2003, patient safety has steadily decreased.” The Center for Justice and Democracy argues that clinical practice guidelines should not be used as a legal basis for determining negligence. The organization claims that there is already a general recognition that conflict of interest and specialty bias are ongoing problems in the development of clinical practice guidelines. Other concerns include the numerous, and sometimes contradictory, guidelines...

Patient Falls Off OR Table: System Error?

An anesthetized patient fell to the floor headfirst from an operating room (OR) table during a laparoscopic appendectomy in Scotland. The table had been tilted into an extreme head-down position to facilitate the operation. Fortunately, no injury occurred. The Edinburgh Evening News account says that there were 10 staff members in the room at the time the case started, but no one had placed a safety restraint on the patient. The hospital has experienced 11 other major surgical errors in the last year, including two instances of wrong-site surgery and a case in which five swabs were left inside a single patient. An investigation by the hospital noted that the level of situational awareness of staff in the operating theatre was inadequate, and teamwork and communication were poor. In addition, the safety culture within the OR was described as not highly attuned to patient safety. The staff was also distracted by mobile phone use and idle chatter. Instead of addressing the obvious human errors such as failure to place the safety strap, which in US hospitals is clearly the duty of the circulating nurse, the hospital’s plan of correction focused on the following typical system-type corrections: Compulsory training of 1200 staff. Although there were 10 staff for a laparoscopic appendectomy (in the US there would be 4: nurse, scrub tech, surgeon, anesthesiologist), I doubt that there are 1200 people working in the OR of this 570-bed hospital. What will those not working in the OR have to gain from compulsory training? I wonder if anyone considered that 10 staff for an appendectomy is far too many, and that’s why there...
A Focus on Diagnostic Errors in Malpractice Claims

A Focus on Diagnostic Errors in Malpractice Claims

Studies have shown that about 5% of autopsies in hospitals in the United States reveal lethal diagnostic errors, accounting for 40,000 to 80,000 deaths annually that could have been averted with a correct diagnosis and prompt and appropriate treatment. Despite the significant impact of diagnostic errors, the problem has received relatively little attention in clinical research. Analyzing Long-Term Malpractice Data In BMJ Quality and Safety, my colleagues and I published a study that sought to characterize the consequences of diagnostic errors by analyzing closed, paid malpractice claims. We reviewed data from the National Practitioner Data Bank (NPDB), an electronic repository of payments made on behalf of physicians with medical liability settlements or judgments. The NPDB also includes adverse peer review actions against licenses, clinical privileges, and professional society memberships. Diagnostic errors were defined as missed, wrong, or delayed as disclosed by subsequent tests or findings. After analyzing more than 350,000 medical malpractice payments over 25 years, the most common and costly involved diagnostic errors. About 29% of these medical malpractice payments resulted from diagnostic errors, which also accounted for the largest fraction of total payments. Another 27% were from treatment errors, and 24% were from surgery-related errors. Diagnostic errors cost $38 billion in malpractice claims payouts over the past 25 years, with an average per-claim payout of more than $380,000. About 93% of payments were made on behalf of allopathic and osteopathic physicians, as opposed to nurse practitioners or other healthcare providers. Death was the most frequent outcome resulting from diagnostic errors, followed by significant permanent injury, major permanent injury, and minor permanent injury. Our study also showed that...
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