Chicago-Land Personal Injury Lawyer - Medical Malpractice

Bad Medicine: Illinois Insurer Refuses to Pay for ‘Never Events’

Nick Avgerinos — Thu, 07 Aug 2008 14:52:17 GMT

What’s a ‘never event’? That was my first question, too, when I heard about this new development. ‘Never event’ is the term used to describe medical errors that should never happen. Despite the name, however, ‘never events’ sometimes happen. Examples: a sponge left in your chest after surgery, or an amputation of the wrong limb. Obviously, these are not your typical medical mistake, and the exception rather than the rule, but the notion is troubling nevertheless.

We have no clear way of tracking ‘never events’ presently, but with legislation passed in 2005, Illinois is set to begin collecting such data by the middle of next year. But, to put the problem in perspective, a 2003 study in the New England Journal of Medicine found that foreign objects are left behind in 1 out of every 1,000-5,000 abdominal surgeries. That translates to approximately $50,000 per corrective surgery, usually paid for by insurers.

We’re used to the phrase “The customer is always right,” and we expect to be treated that way; if we receive the wrong meal, our server will bring the right one; if we purchase a lemon on the lot, the dealer will replace it; if we were overbooked on the flight, we should get vouchers for the future. There’s a certain give-and-take in our society, and an understanding that we should get our money’s worth.

But not when it comes to healthcare. Most often, you go to the doctor’s office and fork over your co-pay, not bothering to question whether your money was worth it if you don’t come away with any type of diagnosis. Similarly, your hospital sends its bills to your insurance carrier, regardless of the outcome of your surgery…until now. Now, Illinois patients are getting a voice…surprisingly, from their insurance company.

As reported by the Chicago Tribune, Blue Cross and Blue Shield of Illinois has come forward, saying that if a hospital commits a serious error, it will no longer pay the claim. The new payment plan is expected to be in place by the end of the year. And while this might seem like a way to cut costs for the insurance company (and let’s face it, that’s probably part of it), it’s a measure aimed to provide an incentive for quality healthcare. And considering that Illinois Blue Cross shelled out less than a million dollars for ‘never events’ in 2007; that chunk of change just might be enough to inspire change in Illinois hospitals.

We can’t be blind to potential problems, though. For instance, we’re relying largely on the hospitals to report the very errors that will result in non-payment; talk about a conflict of interest. In Minnesota, where hospitals are required to report ‘never events,’ 125 ‘never events’ occurred last year. We have been witnessing respect for the “I’m sorry” movement, so let’s hope that this new change doesn’t signal a decline in openness about hospital errors. We all make mistakes; this change in insurance policy is just forcing hospitals to take ownership of theirs.

Originally posted at InjuryBoard by Nick Avgerinos

It’s Never Too Late To Say You’re Sorry (But Earlier Is Better for Business)

Nick Avgerinos — Thu, 26 Jun 2008 10:36:00 GMT

To apply the law to a given situation, specific facts are needed. Legal battles then center upon a game of “he said, she said,” leading to a messy fight and often less-than-ideal resolution. But what about the truth? You can’t handle the truth. At least that’s what we’ve been told. But what if we laid all the cards on the table right away?

I recently wrote about the financial reward doctors may get for admitting their mistakes in “Slice of Humble Pie: Doctors may get Cash Bonus for an Apology.” In it, I referenced the recent New York Times editorial with data suggesting that a simple “I’m sorry” or upfront offer of fair compensation, depending on the situation, decreases the chances that a claim will be brought, thereby eliminating the need for litigation. Straight-shooting from doctors: we save time, they save money. Everybody wins.

But what about personal injury claims? Someone is hurt and someone is to blame. Everyone wants compensation but no one wants to pay. Sound about right? Well, maybe businesses should consider a new strategy. I just came across an article claiming that they, too, can reap financial rewards for a similar forthrightness.

The study, conducted by University of Virginia Law School Professor Jeffrey O'Connell and Associate Professor of Finance Patricia Born of California State University-Northridge, examined court settlements of businesses facing personal injury cases between 1988 and 2004 in Texas and Florida. What did they find? Promptly paying plaintiffs' out-of-pocket medical expenses and lost wages can save businesses money as well as time. The upfront acknowledgement of fault circumvents lengthy courtroom battles and decreases the prevalence of “pain and suffering” awards.

In a time of complex mergers and acquisitions, something as simple as an “I’m sorry” is too often overlooked. Businesses become entangled in lawsuits for a multitude of reasons, but here is a simple way to get out of personal injury suits as quickly as possible. Just fess up; sometimes it’s okay to settle. Swallow those excuses along with a slice of humble pie and focus your energy on making things right. The reward? The study estimates that companies could save an average total of $114,000 per claim or $670,000 for severe injuries by promptly settling cases instead of fighting them in court. Not bad.

O'Connell and Born propose an early offer system that would give businesses 180 days to offer claimants payments for their medical expenses and lost wages. O’Connell explains this proposal, saying, "Thus a crucial element of the tort system's deterrence mechanism is retained: Injured parties could still win suitably large monetary awards under the early offers model for both economic and non-economic damages in clear cases of aggravated error."

Would such a system suit everyone’s purpose? The victim receives acknowledgment and prompt compensation, and the business can cut its losses, not losing time and money entangled in a lawsuit. Sounds good. Then again, businesses might not be ready to claim responsibility; maybe they’re not actually at fault. And maybe victims would rather hold out for a larger award. Maybe not so good. O’Connell and Born’s study provides interesting data, but the merits of their proposal, and early settlement in general, still have to be weighed on a case-by-case basis.

Originally posted at InjuryBoard by Nick Avgerinos

Slice of Humble Pie: Doctors may get Cash Bonus for an Apology

Nick Avgerinos — Tue, 27 May 2008 14:52:42 GMT

Medical malpractice claims cause doctors far and wide to head for the hills. After all, nothing can put a dent in many years of hard work quite like a hard-wrought fight about who messed up what and why so-and-so is suffering the long-term consequences. Doctors are wary of the money involved with such a suit, as well as the ramifications for their reputations. In today’s technology-savvy society, the threat of a flag next to your professional credentials is a big concern.

On the flip side of the coin, patients have a right to know which doctors have a history of problems with patients. A doctor with multiple flags, for instance, is likely not your first choice for a big surgery. After all, the choice of a healthcare provider can be a matter of life and death. You have a right to know. Or, arguably, you should. But, given the private nature of medical information, it’s often hard to find out.

The fact of the matter is that injuries are hard to trace. The result? The contest can become not a quest for the truth, but a prize for storytelling. Why? Juries are made up of people like you and me, and we like a good story. The emotional pull of the story trumps all when facts are few and far between. That’s why communication is key between doctors and patients. More information leads to more just deserts. (Before I get e-mails informing me as to my misspelling of “just deserts,” rest assured that it is correct. Although pronounced like its delicious homonym, its spelling is like that of its arid counterpart. Some remember that dessert has two S’s like Strawberry Shortcake, so you can remember that the phrase “just deserts” has only one S like “deserve,” from which it derives. But I digress.)

As it stands, much talk of medical mistakes is left for translation by the law. So, there is a lot of settling. Translation: $$$. A recent study by the Department of Justice, however, suggests that the awards from cases that go to trial aren’t quite as big as you might think. In 2001, the last year studied by the DOJ, the median award was $422,000. In fact, analyzing data from the National Practitioner Data Bank, the median medical malpractice award has actually declined 8% since 1991, adjusting for inflation. For those who have to pay these sums, however, that’s still a pretty big chunk of change.

A recent New York Times editorial suggests, however, that there’s a simple solution to keeping your good name in the medical field. Admit your mistakes. That’s right, it’s time to eat a big slice of humble pie and fess up when something didn’t go well. Apparently, a handful of prominent medical centers are doing just that, and reaping substantial economic benefits. A simple “I’m sorry” or upfront offer of fair compensation, depending on the situation, decreases the chances that a claim will be brought, thereby eliminating the need for litigation. The Times offers some pretty staggering data. For instance, at the University of Illinois, of 37 cases where the hospital acknowledged a preventable error and apologized, only 1 patient brought suit.

In a world where many are discouraged against bringing “frivolous” lawsuits, this is a significant step in the right direction. Once you or your family suffers an injury, the cases no longer seem frivolous. Patients deserve accurate information regarding their treatment and the dignity that an upfront apology affords. As attorney Brooks Schuelke recently recognized, it’s important to recognize the gravity of many injuries suffered.

Dennis Quaid addressed Congress regarding this problem quite eloquently: “Like many Americans, I believed that a big problem in our country was frivolous lawsuits. But now I know that the courts are often the only path to justice for families that are harmed by the pharmaceutical industry and medical errors. Yet the law is stacked against ordinary people.” The sweet simplicity of “I’m sorry” offers a hallmark of humanity in the otherwise heavily bureaucratized world of medicine.

Originally posted at InjuryBoard by Nick Avgerinos

R&B Settles Gastric Bypass Medical Malpractice Suit in Chicago

Tony Romanucci — Tue, 06 Nov 2007 10:57:59 GMT

Michael Cabay entered Loyola University Medical Center in March 2001 for a routine gastric bypass surgery.

According to WebMD:

More than 177,000 people in the U.S. had weight loss surgery in 2006.
"Roux-en-Y" gastric bypass surgery -- where most of the stomach is bypassed and a small stomach pouch is made -- is the most commonly performed weight loss surgery today, accounting for about 80% of all weight loss surgery in the U.S.

The surgery was successfully performed. Following the surgery, on March 22, 2001, Michael Cabay, began experiencing severe abdominal pain.

The surgeon was aware of Michael's condition and concerned that he may be developing a post surgical complication. Due to Michael's continued abdominal pain, a CT scan was ordered at 9:00 p.m. on March 22, 2001 on an emergency (stat) basis. The CT scan showed a partial bowel obstruction. However, a report was not completed until the following day. Subsequently, Michael Cabay developed an anastomotic leak as a result of the obstruction, became septic and died. The leak occurred because there was too much gas in the bowel that was not released before the pressure built up enough to cause a rupture of the surgical site. R&B was able to obtain a multi-million settlement as a result of Loyola's negligence. We are very pleased that this result was obtained and that Michael's children will be taken care of for the rest of their lives despite the fact that Michael will not be with them.

For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.

Originally posted at InjuryBoard by Tony Romanucci

Ilinois Supreme Court Approves Malpractice Case Rules

Chrissie Cole — Thu, 27 Sep 2007 22:54:02 GMT

Madison County Court adopted new rules this year for handling medical malpractice cases, approved by the Illinois Supreme Court, according to Chief Judge Ann Callis.

The new rules require anytime a medical malpractice case is filed that the persons filing the case and the doctor meet and talk of settling.

A few years ago, Doctors saw their insurance premiums increase and dozens closed up shop in the area.

Insurance companies faulted the aggressive Metro East Trial Bar. In most cases lawyers contended the courts were not to blame. The issue has spawned battles in the Illinois Legislature in recent years.

It was in Madison County that Gov. Rod Blagojevich in 2005 signed compromise legislation limiting the amount of money for pain and suffering that any doctor or hospital could be forced to pay in a lawsuit while also reforming the physician insurance industry.

For more information please visit our section on Medical Malpractice & Negligent Care Injuries.

Originally posted at InjuryBoard by Chrissie Cole