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Two Never Events In One Day – as one hospitalists see it

Posted Nov 10 2008 4:16pm

This is a good post from the Happy Hospitalists and touches on some of the same areas discussed here with reference to never-never events as well as areas of responsibility and the finances.  There are some real gray areas with the never-never events and the comments made herein substantiate this.  As relative to the financial side of things, depending upon the stability of the hospital where Happy works, a couple lawsuits could stand to throw some hospitals into bankruptcy too, again maybe not where Happy works , but there are many in the US that would fit this scenario and a real reason for concern. 

This somewhat goes back to another related post relative to primary care MDs as well, when they are evaluated for pay for performance and perhaps the information does not make it to the insurance files if they are filling their prescriptions at one of the $4.00 stores, as that does not get reported back to the insurers, so thus physicians are grilled on why their patients are not taking their meds, relative, yes, how far do you go on responsibility for physicians?  They diagnose, they treat, but they don’t live 24 hours with a patient.  

My series on Desperate Hospitals takes a look at some of the ones on the brink in the US, and some struggling so as not to end up there, as enough money to go around is becoming an issue all over, so again, when looking at financials and the overall responsibility of the physicians, what are we doing here?  As mentioned in his post, he had 2 of these to fall under the never never scenario in one day, so are these going to start accelerating and adding up, and who’s the judge here?   Granted there was a purpose to eradicate errors, but the translation and interpretation here is going to be the ultimate end result, and insurance companies are joining the same group, so we can hope that the never never provisions will be appropriately interpreted and not lead to big loopholes to further deny payment of healthcare claims and put more hospitals on the brink or out of business.  BD 

So I had the wonderful opportunity to be the doctor on record of two Medicare Never Events in one day. According to Medicare, these are events that should never happen. Events that any lawyer or lay person would interpret to mean malpractice. Hey, it should never happen. Right?

One of them fell. Fell trying to get up to use the rest room. Fell while nobody was in the room. Fell out of confusion. A patient who was not previously confused. She got a huge extracranial hematoma. No intracranial concerns. But what would happen if she did? What if she sustained a life threatening subdural hematoma? What if she sustained a hip fracture? What if she sustained a pneumothorax and required a chest tube….None of that would be paid for.

My second patient developed a deep venous thrombosis after a hip surgery, in spite of being on appropriate prophylaxis according to the Chest guidelines. Again, patient gets a bad outcome from a well documented complication of a medical illness and all of the sudden the connotation of a never event places blame directly on the backs of the nurses and the doctors. It is a haven of jackpot lotto lawsuits just waiting to happen.

The Happy Hospitalist: Two Never Events In One Day

Related Reading:

When Pay for Performance and $4.00 Generic Prescriptions Hit the Wall

Slow Medicare reimbursements are hurting doctors in California, Nevada and Hawaii

Algorithms, Formulas and Investigations leads to AARP suspending sales of some health plans

“Beware of Geeks Bearing Formulas”…Warren Buffett
The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers

Desperate Hospitals Series – 11-02-2008 Update

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