The Indiana Physician Orders for Scope of Treatment (POST) form was created in 2013. It is much broader than a Living Will, which is limited to end-of-life decisions regarding artificially administered food and water. The POST Form allows a patient to state their preferences for life sustaining treatments including resuscitation, medical interventions (e.g., comfort care, hospitalization, intubation, mechanical ventilation), and antibiotics. The form must be signed by a physician to become activated. While it is intended for seriously ill persons, I have begun introducing it to many of my estate planning clients, regardless or age or health, and suggesting that they may want to consider discussing the form with their family doctor. More information about Indiana's POST program may be found at www.indianapost.org/
How do east-central Indiana and west-central Ohio hospitals rank as far as patient safety? One such measure is http://www.hospitalsafetyscore.org which has assigned grades of A, B, C, D, or F to more than 2,600 U.S. hospitals based on 26 safety measures and standards, including errors and accidents such patient falls, retained surgical objects, central line blood infections, as well as policies and procedures hospitals have in place to protect patients from such incidents.
Current Grades for Area Hospitals
Henry County Hospital, New Castle: A
Ball Memorial Hospital, Muncie: A
Reid Hospital & Health Care Services, Richmond: B
Fayette Regional Health System, Connersville: B
Good Samaritan Hospital & Health Center, Dayton, OH: B
KNH-Grandview Medical Center, Dayton, OH: B
Wayne Hospital, Greenville, OH: C
Miami Valley Hospital, Dayton, OH: C
McCullough-Hyde Memorial Hospital, Oxford, OH: D
St. Vincent-Randolph in Winchester is apparently not yet ranked.
I was glad to see that the Indiana hospitals in and around Wayne County rank well. However, I am concerned about the lower scores for some of the Ohio hospitals, as I have had numerous clients and acquaintances who have received treatment at each of them.
Of course, these grades are only as good as the data which they are based upon. If you take a look at the full score for a hospital, you can see that this site largely relies upon information reported to CMS (Centers for Medicare and Medicaid Services), especially regarding reported incidents.
It appears that McCullough-Hyde's grade of D is largely due to a high number of falls or traumas (about 3 times the rate of average performing hospitals) and a higher than average number of postoperative pulmonary embolisms and deep vein thromboses. The high rate of falls is 1.74 out of every 1,000 patients discharged and the worst performing hospital in the country had a rate of 2.1.
Thinking deeper, all of this data is based on self-reporting that the hospitals are required to do and you have to wonder about how accurate it truly reflects the number of actual incidents. Certainly not all patient falls, for example, get charted and I suspect the ones that actually end up included in the CMS data are mostly the ones resulting in injury. (Although, when you think about it, all falls potentially could result in injury and thus should be reported). One would suspect that different hospitals have different cultures and policies regarding the charting and reporting of incidents such as falls. A hospital that is willing to provide fuller and more accurate disclosure may end up being penalized when compared to a hospital that doesn't self-report as fully. I am interested in learning more about how accurate this data truly is. However, there is no doubt that patients are entitled to this sort of information and are well-advised to seek it out and consider it when making decisions about where to receive care.
That is the conclusion of an April 2011 article in the medical journal Health Affairs. When compared with standard methods of reporting adverse events in hospitals--a hospital's own voluntary reporting system and screening using the Agency for Healthcare Research, and Quality's Patient Safety Indicators--the "Global Trigger Tool" found that approximately 90% of such errors were under-reported.
The Global Trigger Tool uses specific methods
for reviewing medical charts. Closed patient
charts are reviewed by two or three employees--
usually nurses and pharmacists, who are trained
to review the charts in a systematic manner by
looking at discharge codes, discharge summaries,
medications, lab results, operation records,
nursing notes, physician progress notes, and
other notes or comments to determine whether
there is a “trigger” in the chart. A trigger could be
a notation indicating, for example, a medication
stop order, an abnormal lab result, or use of an
antidote medication. Any notation of a trigger
leads to further investigation into whether an
adverse event occurred and how severe the event
was. A physician ultimately has to examine and
sign off on this chart review.In this study's review of 795 patient records from three hospitals, overall adverse events occurred in 33.2% of hospital admissions. This compares with inpatient adverse event rates of approximately 3% in other studies. Given the attention that has been focused on patient safety in the last 10-15 years, especially since the Institute of Medicine's 1999 report To-Err-is-Human: Building a Better Healthcare System, it's disturbing to think that this level of errors still seems to exist. Moreover, as this study's authors note, the true rates of adverse events are likely to be higher still, given the consistent finding that direct observational studies reveal higher rates of such events than retrospective studies because not all adverse events are documented in the patient record.
This recent article (from a medical journal and co-authored by a doctor) debunks 5 widespread misconceptions about medical malpractice claims:
1. Malpractice crises are caused by spikes in medical
malpractice litigation (ie, sudden rises in
payouts and claim frequency).
2. The tort system delivers “jackpot justice.”
3. Physicians are one malpractice verdict away from
4. Physicians move to states that adopt damages caps.
5. Tort reform will lower health-care spending
dramatically.The authors offer 4 truths about the med mal system:
1) It is very slow;
2) It is extremely expensive;
3) It is perceived by everyone involved as unpleasant and often unjust or unfair;
4) Caps on damages do little to improve the system.
All of which I also find to be true about Indiana's regime. However, it's what we've got to work with and in.
This recent article in The New Yorker helps explain why instances of salmonella poisoning are much more common than E. coli. There are virtually non-existent regulatory pressures on chicken processing companies. Bill Marler, the Seattle-based plaintiff's lawyer who has changed the landscape in this area in the last 20+ years, is featured in the article. He's likely the only lawyer with blogs devoted to individual bacteria: botulism, hepatitis, listeria, salmonella, E. coli, and others. His main blog is quite excellent.
In an auto insurance policy, medical payments (med pay) coverage is available to pay for bills incurred by an occupant of the vehicle injured in a collision. This is not money to pay for bills sustained by the driver or passengers of the other vehicle, but for yourself or your passengers. I have found med pay coverage to be useful to clients for a number of reasons.
First, med pay can supplement normal health insurance coverage in paying accident-related bills. Amounts that are not covered because of deductibles or co-pays can be submitted for payment to your own auto carrier under your med pay coverage.
Second, Indiana law permits more favorable repayment terms of subrogation liens for medical bills to an auto insurance company as opposed to a employment-based health insurance carrier. The insurance company that pays for your medical bills which they believe resulted from an injury caused by another party is likely to insist upon being reimbursed from any settlement monies you receive (under their right of subrogation). When your auto insurance company has paid medical bills under your med pay coverage, you and your lawyer are entitled to a 1/3 reduction of the insurance company's lien to reflect the attorney fees that you will incur, as well as a pro-rata share of any costs in bringing your claim. Because of federal law, your health insurance carrier is under no such obligation to reduce its lien.
Let me illustrate this point from a recent case. My client sustained very serious injuries in a collision. He had only recently applied for health insurance and did not even have a card. Fortunately, he had med pay coverage under his own auto policy of $100,000 (an unusually large amount). His bills ended up totaling just over $100,000, so med pay covered virtually all of the bills The other driver's insurance coverage limits were also $100,000. In the course of settling the claim for these limits, I was able to persuade the client's auto carrier to reduce its lien by 2/3. This greatly helped to increase the net amount my client received.
I would definitely recommend speaking with your insurance company or agent about increasing your medical payments coverage. I believe it is available in amounts up to the bodily injury limits of one's coverage (the amount available to pay for injuries to the occupants of another vehicle, when the collision is your fault).
Med pay coverage can also be useful in other scenarios, including if non-family member is a passenger in your vehicle and is injured. It also is available under homeowner's insurance and would be available to pay for medical bills sustained by a guest or other person injured on your property, even if the injury is no fault of yours.
Among the most frequent injuries sustained in motor vehicle collisions are so-called "whiplash" injuries--flexion/extension injuries to the soft tissues around the neck. A frequent area of dispute with the insurance company for a driver who has caused such injuries to my client is the length of time and treatment reasonably required for someone to recover. Insurance companies, their lawyers, and the expert witnesses they hire often contend that most people fully recover from such injuries within a relatively short period of time following a collision--perhaps 2-3 months. In reality, these nature and extent of these injuries and the duration of the symptoms are complex and vary widely. Relevant factors may include the injured person's age, height, seat position at impact, head position at impact, force of the impact (including accounting for the speed and size of the vehicles involved), and preexisting injuries or conditions.
With this in mind, I found quite interesting article entitled "Course and Prognostic Factors for Neck Pain in Whiplash Associated Disorders," in the Journal of Manipulative and Physiological Therapeutics, v. 32, Issue 2, Supplement, pgs S97-107, February 2009. This article was one of many which came out of decade-long research conducted by a task froce on neck pain and its associated disorders. A review of 47 studies led the authors to conclude that approximately 50% of whose with whiplash associated disorders will report neck pain symptoms one year after their injuries.
Based on my own experience in representing injured persons, this finding was not surprising. Whiplash injuries have been caricatured in movies and TV shows and they are consistently ridiculed or downplayed by insurance companies and their representatives. This occurs largely because the injuries to soft tissues cannot typically be seen on film studies --x-rays, MRIs and CT-Scans. Therefore, the diagnosis and treatment is largely based on "subjective" reports of pain from the patient or findings by the physician on physical examination, such as muscle spasm, tenderness or limitations on movement. Nonetheless, there can be no doubt--especially to someone who has experienced such an injury--of just how real and painful and debilitating a whiplash injury can be.