Jennifer Liu Dr. Lefebvre
Cluster 7 Biomedical Sciences 28 July 2014
“Pseudos:” Common Medical Errors and Malpractice Law
Medical errors and malpractice frustrate, harm, and even kill thousands of people. The most common forms of malpractice include misdiagnosis, negligence, and hospital-acquired, or nosocomial, infections. Many of these medical errors are avoidable, but due to the carelessness of the doctor or hospital staff and the faults of the current healthcare system in the United States, the patient suffers. Although medical malpractice law offers victims of malpractice the opportunity to seek compensation, the complicated legal process often does not favor the patient.
Every year, more than 200,000 Americans die as a result of medical errors. The current medical malpractice laws have both benefits and drawbacks. While the legal responsibilities that physicians must uphold should encourage better medical care, the sheer number of patients that doctors see on a day to day basis make room for possibly disastrous mistakes. Common medical errors include misdiagnosis, negligence, and nosocomial and iatrogenic complications.
Misdiagnosis occurs when a doctor incorrectly assesses a patient’s symptoms, which can lead to improper treatment or even death for the patient. Physicians may be accused of negligence if it can be proven that they did not provide adequate medical care that other reputable medical practitioners would have given. Patients may contract nosocomial, or hospital-acquired, infections and iatrogenic, or physician-induced, complications because of careless medical practitioners and staff. Medical mistakes can dramatically increase a patient’s mortality rate, medical costs, and hospitalization time in addition to severely damaging the reputation of both the physician and hospital. However, patients are not left defenseless in the face of medical malpractice, as victims can sue doctors and hospitals although the convoluted process and
plethora of legal restrictions surrounding this type of lawsuit do not necessarily work in favor of the plaintiff.
Cases of misdiagnosis have increased dramatically in recent years, with doctors often neglecting to consider all the possibilities or dismissing the patient’s physical pain as psychotic or neurological. Misdiagnosis occurs more often than major surgical mistakes such as operating on the wrong patient or body part, and can often result in improper treatment (“Physicians Misdiagnose at an Alarming Rate”). Occasionally, a patient’s condition may be difficult to diagnose due to the lack of conclusive symptoms. However, in cases such as that of Lessya Kotelevskaya, misdiagnosis could have easily been avoided. Kotelevskaya was diagnosed with a condition she never had – cancer in her jaw. As a result of the unnecessary radiation exposure, her originally healthy jaw died, leaving her face badly disfigured. Although doctors who first examined her jaw claimed she had acquired a tumor, a second opinion from a different surgeon revealed that cancer had never been present, and that what had been seen may have simply been a benign cyst. The entire process had an adverse effect on her health and quality of life (Weller). An examination done by researchers at Johns Hopkins Hospital in Baltimore revealed that in the tissue samples of 6,000 cancer patients across the nation, one out of every seventy-one cases was misdiagnosed, and up to twenty percent of cancer cases were misclassified. Because of its heavy reliance on tissue biopsies, cancer diagnosis may be inaccurate depending on the level of
expertise of the examining pathologist (Mckenzie). Consequently, it is advised that patients suspecting cancer seek out a second opinion prior to considering treatment as misdiagnosis can lead to costly, pointless procedures. The journal BMJ Quality and Safety published a meta-analysis in 2012 providing evidence that fatal diagnostic errors in American ICUs seem to equal the 40,500 annual breast cancer deaths (Boodman). With increasingly advanced technology,
there is hope that the issue of misdiagnosis will be alleviated in the future. However, improved patient-physician communication and implementation of alternate tests would significantly increase the accuracy of diagnoses as well.
At least 25,000 to 120,000 deaths occur as a result of medical negligence, which is defined by the McGraw-Hill Concise Dictionary of Modern Medicine as “the failure or alleged failure on the part of a physician or other health care provider to exercise ordinary, reasonable, usual, or expected care, prudence, or skill – that would usually and customarily be exercised by other reputable physicians treating similar patients” (“Saks”; “Negligence”). The delay in beneficial treatment caused by this now common occurrence may severely harm the patient physically, emotionally, and financially. However, the death of Rory Staunton could have been averted with improved communication between hospital staff, physicians, and the patient. Staunton was a teenager who ultimately died from septic shock after sustaining a cut on his arm that allowed pathogenic bacteria to enter. Some of his symptoms, such as vomiting and high fever, suggested a stomach virus to his pediatrician, but other signs, including mottled skin, rapid pulse, an enormous number of white blood cells, and alarmingly low number of platelets
indicated that Staunton’s body was fighting a serious infection (Dwyer). However, the failure of several physicians to note his mottled skin and closely examine his blood tests before sending him home caused them to overlook the possibility of sepsis, which occurs when bacteria enter the bloodstream and trigger inflammation throughout the entire body. If sepsis progresses to septic shock, the organs fail and blood pressure drops to a life-threatening level (“Sepsis”). Caught early, sepsis can be effectively treated with antibiotics and chances of survival
significantly heighten. Poor patient-physician communication and carelessness on the part of the hospital and responsible physicians at NYU Langone and Staunton’s pediatrician contributed to
the patient’s death. Rory Staunton’s case has prompted medical reforms across the nation to prevent a similar event from recurring.
Nosocomial and iatrogenic complications pose a large threat to hospitalized patients. Hospital-associated infections have been estimated to account for 2 million cases and 20,000 deaths annually. In crowded healthcare settings such as hospitals, a patient with a compromised immune system is significantly more susceptible to nosocomial infections because of the possibility of bacterial or viral transmission from other infected patients. In addition,
unsterilized, invasive surgical tools and failure to maintain proper hygiene among patients and staff increase the risk for both nosocomial and iatrogenic complications. These infections not only prolong the pain and raise the mortality rate of the patient, they also cost United States healthcare system almost $10 billion per year (Goodman). The most common nosocomial infection is of the urinary tract, typically induced by the insertion of a catheter. Thus, catheters should be avoided if possible, and kept hygienic if necessary. Surgery also increases risk for infection transmission between patients, especially if surgeons and nurses neglect to properly sterilize all equipment between operations (“Prevention of Hospital-Acquired Infections”). For example, in South Carolina’s Greenville Memorial Hospital this year, fourteen patients tested positive for exposure to Mycobacterium abcessus and contaminated surgical tools have been identified as the cause. Although the hospital-acquired infection has not been the sole cause for the death of any patients, it contributed to the death of one of the fourteen patients (Osby). Maintaining proper hygiene and sterilization is key to reducing the incidence of hospital-acquired and iatrogenic complications. Even simple actions by medical practitioners such as washing hands frequently can make a significant impact on patient care.
Medical malpractice laws have been enforced in order to protect patients from
irresponsible hospitals and physicians. Victims of malpractice can sue doctors or hospitals for a variety of faults, including misdiagnosis, negligence, and healthcare-associated complications. However, the plaintiff faces many challenges in order to win a malpractice suit as each state in the United States have differing regulations regarding the issue. For example, medical
malpractice claims must be brought within a certain time frame, known as the statute of limitation, of the injury, expert testimony must be provided, and the case must pass a review panel before a trial can occur. In addition, states may place limits on the amount of money that injured patients can receive (Boeschen). According to studies done by the Archives of Internal Medicine, doctors win 80% of malpractice suits, “only 4.5% of malpractice claims undergo a jury verdict,” and less than two percent of those who sue receive money for their suffering (Keller; “Doctors Win 80% of Medical Malpractice Cases at Trial”). Most medical malpractice suits involve misdiagnosis or negligence, and the plaintiff must prove that the physician’s actions harmed him or her, a patient-physician relationship existed, and that the doctor provided
substandard patient care (Boeschen). For hospital-acquired infection suits, the prosecution must prove that the infection was preventable and that the hospital did not meet the appropriate medical standard of care and is liable for the situation (Goguen). However, medical malpractice does not solely harm the patient, physicians are negatively affected as well. Fearing malpractice suits, many doctors practice “defensive medicine” and may be inclined to call in specialists or order expensive diagnostic tests when it is unnecessary. The currently popular method of lowering healthcare costs, cutting physician salaries, promotes defensive medicine and medical malpractice. Doctors, especially general practitioners, feel rushed to see as many patients as possible in order to maintain their income, and as a result do not have the time to carefully
examine each patient. This situation greatly increases the margin for error and fails to decrease healthcare costs because of the needlessly high number of doctors called in per patient and the excessive number of tests ordered (Jauhar 22). Medical malpractice continues to be a prevalent issue within America’s healthcare system, and the current legal system put in place to protect both doctors and patients appears to have more drawbacks than benefits.
Misdiagnosis, negligence, and hospital-acquired complications remain ongoing problems as the most commonly occurring forms of medical malpractice because of the current healthcare system within the United States and human carelessness. While some mistakes may be
unavoidable, a substantial amount of suffering can be averted with improved communication and sanitation within healthcare settings. Reforms should be made to protect the patient from medical malpractice and its consequences in a way that brings justice to both doctor and patient.
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