Philadelphia Medical Malpractice Attorney Blog

More Visits, Less Availability

A new study released in JAMA shows that the number of annual emergency department visits between 1997 and 2007 increased from 94.9 million to 116.8 million -- nearly twice as much as would be expected for population growth.

Also published recently was the Department of Health and Human Services' 2007 Emergency Department Summary (.pdf file here). Lots of interesting statistics.

Most of the increase in ED visits were due to Medicaid patients. One quarter of the 117 million visits to the emergency department in 2007 were made by patients with Medicaid or SCHIP. Seventeen percent of visits were covered by Medicare. In other words, 42% of hospital ED visits (50 million or so) are paid for by the state or federal government.

The graph to the right from the San Francisco Chronicle shows how emergency department use by Medicaid patients is now more than five times the rate of emergency department use by patients with private insurance - and since they are from 2007, these numbers don't include the impact from the recession.

Further breakdowns in demographics from the DHHS report include high ED utilization rates for children less than 1 year old (88 visits per 100 US infants), patients older than 75 (62 visits per 100 US persons), homeless persons (72 visits per 100 population), blacks (74.6 visits per 100 black persons), and nursing home residents.

In addition, the number of "safety net" hospitals - defined as those who treat patients regardless of the ability to pay - increased by more than 40% from 2000 to 2007.

Before you start blaming Medicaid patients for health care crisis, think about why there is a disproportionate use of emergency departments by Medicaid patients. If you or your child has a medical problem and few private physicians will accept your insurance, what are you supposed to do? You go to a place where they will accept your insurance and you get relatively timely care (as opposed to an appointment 4 months in the future). Although there are undoubtedly people that abuse the Medicaid system, in general, it isn't the patient's fault for having Medicaid. It is the fault of the government for failing to adequately fund and monitor the Medicaid program.

With the increase in visits, there are longer waits and less availability of medical care.

An inferior vena cava filter or an IVC filter is meant to save a person's life but a current investigation by The Food and Drug Administration has revealed that patients with an IVC filter living in Philadelphia and across the United States can be killed by the device.

An IVC filter is a cage like device that is inserted in a major vein to prevent clots from reaching the heart or lungs. The filters are meant to be temporary but for many patients they become permanent. If an IVC filter is left in the patient for an extended period of time, the filter can grow into the vein making it impossible to remove. A permanent filter can fracture or splinter sending a piece of it to the heart or lungs, instantly killing the patient.

The FDA is putting the filters under further review but has received hundreds of reports of patients living permanently with temporary IVC filters. Some of the complaints have ended in death. IVC filters are implanted into patients with a high risk of clotting. Patients who are immobile due to a spinal cord or traumatic brain injury may also have an IVC inserted into a vein.

Related Sources:
FDA warning about clot filters sparks concern

Researchers have predicted that the new health care bill will mean longer waiting times at emergency rooms across the United States.

The new health care bill will insure 32 million Americans and add 16 million patients to Medicaid. Medicaid patients are by far the largest consumers of emergency room and such a large addition may place a strain on the already under staffed and over worked emergency room. The study also found that there is a shortage of family care physicians in the neighborhoods where the majority of the newly insured live.

Longer wait time at the emergency can be a matter of life of death. Also the more patients using the emergency room for situations that are not an emergency can cripple the staff and send many away without proper care.

Related Sources:
Claim: Health Reform Will Mean Longer ER Wait Time

Maternal mortality is rare but has nearly doubled in the last decade. A death is considered a maternal mortality if it can be attributed to a delivery complication up to 42 days after delivery. The most common causes of maternal mortality are hemorrhaging, uncontrolled blood pressure and a fatal blood clot. The healthy community along with the federal government is alarmed at this spike in deaths especially after a more concentrated effort has been established to prevent such occurrences.

Pregnancies are changing in the United States and so far delivery procedures have been behind the curve. Almost one third of all deliveries are now cesarean which is a major surgery and can lead to more hemorrhaging than a vaginal delivery. Also women who have c-sections are more likely to have future babies also delivered by c-section which can be riskier than a second vaginal delivery. Women are also more likely to be obese than in the past leading to higher blood pressure and diabetes that can cause complications after delivery.

Perhaps the most startling cause of death is a deep vein thrombosis or DVT which is a blood clot in the leg that can be fatal if moves to the lung. Most pregnant women are not aware that a DVT can occur during pregnancy and after delivery but pregnancy naturally causes the body's blood to clot which can lead to problems. Women who have a c-section are more likely to suffer from DVT and hemorrhaging. Doctors and hospital must be vigilant in their attention to the patient to guard against these complications.

Currently there is not enough information available to determine why black women are three times more likely to suffer maternity mortality than white women.

Experts believe that close to half the deaths reported could have been prevented if delivery protocol would change to accommodate the changes in pregnancies.

Related Sources:
Hoped-for drop in childbirth deaths not happening

Consumer Reports conducted a nationwide study on the amount of central-blood line infections at hospitals and most hospitals in the Philadelphia area were graded above average. Pennsylvania is one of only 23 states that have a policy for all hospitals in the state to mandatory report infections.

Hundreds of thousands people die each year in hospitals due to infection with the most common being a central line infection. Central lines are catheters that are placed in a major vein to quickly deliver medication or fluids to a patient. One third of patients who die in hospitals from infections are from central line infections that occur in intensive care units.

In the Philadelphia area, St. Christopher's and Hahnemann University Hospital scored better than average along with A-I DuPont in Delaware. Surprisingly Children's Hospital of Philadelphia was graded well below average and officials from the hospital have acknowledged the problem and have implemented a system that is already producing better results.

Research has shown that central line infections are relatively easy to avoid with some very simple steps and good hygiene practices. Two thirds of infections can be prevented if hospital staff wash their hands before and after touching a patient or a catheter, disinfect the patient's skin before applying the catheter and wearing protective gear such as gloves, masks, caps, and gowns when caring for a central line patient.

Related Sources:
Consumer Reports exclusive on hospital infections

What should have been a 90 minute operation turned into a seven hour ordeal for a patient who elected to have liposuction and scar correction surgery. The surgeon reportedly fell asleep during the procedure because he had been up late the last night writing his book. When the doctor took his first case at 8 a.m., the operating room nurse noticed that he look tired and was so concerned that she asked him to postpone the next operation. The doctor refused and briefly dozed off during that appointment. Again the operating nurse asked the surgeon to take a break and called the plastic surgery department twice but they only told her to keep an eye on him. Finally at 1:30 p.m. the doctor abruptly left during an operation when another surgeon was called in to assist the doctor with the operation because a resident doctor noticed that the doctor did not have his "A game."

Unfortunately for the patient the surgeon and hospital's negligence will force him to have another surgery to correct the mistakes made by the dozing doctor. Even though the doctor had a history of drug and alcohol abuse not once did someone step in and remove the surgeon from the operating room. Patient safety specialists believe this case reveals how the culture of operating rooms makes it difficult for nurses, technicians, residents, and fellows to challenge an operating doctor. Further negligence occurred when no doctor visit was given to the patient upon discharge and he was not notified for ten days on why the doctor left the operating room. The hospital fired the doctor, re-examined its policies and educated employees on recognizing and reporting impaired physicians. For his ordeal the patient settled out of court for an undisclosed amount.