I don’t usually write about local or state news because my work is really more broad than that — however — an article in my local newspaper about a local hospital and wrong-site surgery just begged for some additional information!

Wrong site surgery — a “never event” that takes place an estimated 100 - 200 times per year in the United States. In this case, the patient was supposed to have his fractured right hip replaced with a new one. However — the patient woke up in the recovery room with — surprise! — a new LEFT hip. Yes, the surgeon had replaced the wrong hip. And of course, the right hip was still in the same fractured state it began with.

I can only imagine that this mistake took place like most of the wrong-site surgical mistakes do. In a hurry (because, never forget - time equals cost), shortcuts were taken. And who pays the price? The patient, of course. Oh yes, the hospital will now pay a $ 6,000 fine, too — more about that in a moment.

According to the article and the New York State Health Department, this is what took place:

• Instead of marking the skin on the correct hip with a skin marker, the surgeon used a ball-point pen.
• + The surgical nurse didn’t know whether or not the skin had been marked, so he or she prepped the wrong hip.
• + The nurse who transported the patient to the operating room never verified the correct side either.
• + The “time out” process, which is required by the Joint Commission (the group that accredits hospitals) was not followed. (Of course not — time OUT is expensive!) There are actually three required Time Outs: 1 - before anesthesia, 2 - before any cuts are made, and 3 - post surgery, they are expected to account for all the tools and materials used that should not be left behind in the patient.
• + The MRI films were not displayed in the OR for review prior to the surgery.

= one patient who is far worse off than when he or she was admitted to the hospital for surgery.

There’s no mention of what happens to the medical personnel who made the errors. One can only hope they are being dealt with. (And I won’t even go into the hospital policies that caused them to take short cuts to begin with. Were they running behind? Were they pressured to make up time? No excuses — but I do recognize that the pressures on these folks are outrageous, and then, as usual, we patients pay the price….) But I digress…

The hospital was fined $6000. I wondered — who gets that fine money? Where does it go? Hospitals all over New York State (and every other state, too) get fined on a regular basis. Does the money simply enhance the general budget? (Are we going to try to make up for Wall Street’s woes by fining healthcare facilities?)

So I called the New York State Health Department. After several minutes of being passed around from one department to another — I actually found someone who was very helpful! Peter Farr, from the Bureau of Hospitals, explained that until recently all that money simply got deposited into the general fund. BUT! Recent new legislation has established the Patient Safety Center, and now most of the fine money will be funding that program. The Patient Safety Center will be tasked with transparency issues — reporting all that data that we patients have not had access to, but will begin seeing (and hopefully using) in the near future.

You know, though, we patients can all learn from this wrong site surgery story:

• If you will have surgery, mark the area of your body that is to be operated on. Use a marker that won’t wash or rub off right away (like a sharpie), and mark “THIS HIP” or “CUT HERE!” or whatever works for the surgery you’re about to have.
• Then mark the area that could be mistakenly opened. “WRONG HIP” or “NO! NOT HERE!” on parts that could be cut accidentally.
• Before they give you that pre-sleep drug, and anytime you see or encounter anyone who might be in the OR, remind them to take their “Time Outs.” Don’t worry about whether someone will be in the OR or not — assume they all will, and remind them all. Ask your loved one or advocate who is with you before your surgery to do the same.

I have to think that the surgical personnel at this hospital are just as appalled as anyone else about this mistake. They will be second-guessing themselves for a very long time, and I’m sure they will be correcting themselves and being far more careful in the future.

So my advice is simply for the rest of us to learn from their errors — and perhaps to think some good thoughts for that poor patient who had two hips replaced in one day, and will hopefully recover 100 percent.

(PS — If you are the patient, why not get in touch? We’ll keep your identity anonymous, but we’d love to hear your impressions…. email blog (at) epadvocate.com. )

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Beginning October 1, 2008, Medicare, and many health insurance companies, will no longer pay hospitals for the additional services needed for patients who suffer from “never events.”

Never Events, as defined by the National Quality Forum, are those events which should never happen to a patient.  There are 28 errors on the list ranging from wrong site surgeries to drug errors to crimes committed by medical professionals.

Not included on the list from the NQF are HAIs (hospital-acquired infections).  There may be many reasons for this, but there are many groups and organizations that believe HAIs like MRSA, C.Diff and VRE SHOULD be included on the list.  Many of them, although not all of them, are preventable.

Regardless of what the left hand is doing (NQF), the right hand of payers (Medicare and many insurers) have decided that these infections will no longer be covered.  That means that any hospitalized patient who contracts, or at least presents with, an infection during a hospital stay may not be charged for the extra cost of treating the infection, nor will the hospital be paid by Medicare or many of the health insurance companies.

I don’t have the expertise to say whether this is right or wrong.  On the one hand, I believe it’s absolutely necessary to force hospitals to figure out ways to decrease the numbers of patients who contract these infections, estimated to be upwards of 5 million patients per year.

On the other hand, I know that sometimes patients arrive with pre-existing infections that may be apparent when they are admitted.  Can they be tested upon arrival?  Of course they can — although some hospital personnel point out how expensive that is, and that insurance won’t cover that either.  I have no doubt that there will be some problem for patients that crops up from this new ruling.  Hospitals will refuse to admit patients at risk, or they will discharge them too early so they can — at least in the paperwork — ignore an infection just as it begins.  Hospitals will do whatever they need to to protect their *sses — and it will be at the expense of patients.  Unintended consequences, all based on money.  What else is new?

During the past few days, a dialogue has taken place… wait… make that a diatribe…. on the blog of a certain “buckeye surgeon” where complaints and barbs have been thrown at a newspaper reporter who wrote about this October 1 date for reimbursement stoppage.  On just about the same day, the Wall Street Journal printed an article by Dr. Betsy McCaughey, founder of RID (Reduce Hospital Deaths) that gave some statistics about hospitals that have addressed infection problems — and have successfully reduced their numbers, one (claims) to 0 patients over a span of years.

So –I pulled some quotes from Dr. McCaughey’s WSJ article and posted them to the blog — and you would have thought I was the devil-incarnate…. whoa!  A regular lightening rod!  All those doctors so quickly turned their ire on me.  And I thought angry patients got worked up!  They can’t hold a candle to posters like “white coat” and “anonymous” who — God forbid — don’t even use their real names.

No — they attacked me one after the next.  In fact, it began when I suggested that SOME hospitals were actually trying to help patients!  SOME hospitals are actually asking their doctors and personnel to adhere to a checklist that — (you won’t believe this) — actually prevents infection!

Oh — one even attacked me for not being grateful that I was misdiagnosed with cancer.  She told me I should not have been upset at the misdiagnosis — I should have been relieved that I didn’t have it.  (My standard reply, which I didn’t bother with is — “gee — you didn’t get hit by a car today.  Are you relieved and grateful?”)  Of course — what on EARTH does this have to do with infections?  I’m not sure.

What’s the bottom line?  What can we learn from this?  Honestly — I do NOT believe that including HAIs on the list of never events Medicare and some insurances will no longer pay for was the right approach.  While some infections could have been listed and it would have been helpful, instead I think Medicare has only thrown down the gauntlet for hospitals to go underground.  Patients will pay the price in even worse health problems.  We must be more vigilant and be prepared to stand up for ourselves and our loved ones, and once October 1 rolls around, that will be even more difficult.

What the Trisha-bashing on the Buckeye Surgeon’s blog has shown me is that when we patients begin to stand up for our NEED for decent healthcare, we become the enemy.  The point I tried to make on a couple of the blog posts was that I think patients and providers need to remember that we have the same goal — improved patient care.  But those folks didn’t want to go there.  They just wanted to bash me.

I pray none of them is ever hurt by a medical error.  I hope none of them ever suffers at the hands of a medical practitioner who is probably just in a big hurry because he doesn’t get reimbursed well enough for his work.  I hope they don’t lose a loved one, like I did, after she acquires MRSA.

But mostly I hope they will stop taking their frustration out on the messenger.  Afterall — excuse me — I THOUGHT we all had the same goal?

Don’t we?

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Last January I posted three stories I had been told, all within a few days of each other, about patients who had acquired MRSA in the hospital and had been revictimized by the system that would not treat them, listen to them, or help them get well. Over the next several days, I was condemned, chastised and even told my allegations were off base…

Today another comment was left on that post, and it compelled me to follow up.  Because as disgusted as I was with the reaction to that original post, I am truly even more upset and disgusted by what this poor young woman wrote to me today….

Here’s the synopsis:

The original post was called “MRSA:  Patients Ignored, Left to Die.”  It told three stories.  The first one was about a young woman who had (to that point) been in the hospital for almost a year because her MRSA could not be controlled, and because the hospital was not taking the steps needed to help her.  Update:  The woman, Tameka, has since died, 11 months after acquiring the infection. To those of you who suggested the story was untrue — I suggest you explain that to the woman’s family.

The second story was about Maxine who had been struggling to find anyone to help her or her family get someone — anyone — to treat them for the MRSA they had all acquired.  A number of commenters told me that could not possibly be true…. yet since then I have received at least a dozen additional emails reporting exactly the same thing — plus the comment that was left today tells the same tale.

Further, a good friend, someone I work with frequently and who works in healthcare, is dealing with this exact scenario with her father.  After knee replacement surgery, and despite a spiking fever and a swollen red surgical site, her father’s surgeon kept telling her and her dad, “Looking good!”

Update on Maxine:  I have not heard from her in many months.  I don’t know if she has found treatment, and I don’t know if she has gotten past the infection.

The third story was about a young man, Jeff, who had been treated by an ungloved doctor in an emergency room who, when Jeff asked him to wash his hands and put on gloves, told Jeff that the “MRSA thing had been blown out all of proportion.”  I know that most of you reading this will be incredulous — but I can almost guarantee there are some of you who think that doctor is right.

Why the follow up today?  Because today I heard from Sarah who tells a very frightening and sad tale about the MRSA her mother acquired after surgery a few weeks ago.  I’m going to reprint her comment in its entirety below — or you can read the original here.

In effect, Sarah’s mother’s experience is a compilation of the three originals.  The very sad part is that this story is repeated MILLIONS OF TIMES A YEAR.  The CDC’s numbers are 1.7 million infections per year, but Dr. Betsy McCaughey, director of RID (Reduce Hospital Deaths) proves in this piece that that number is way too low.

So here we are, almost 8 months later, and infection rates and experiences have gone from bad to worse.  What will it take to pull those denial heads out of the infection sand?  How difficult can it possibly be for a provider to wash his hands before he touches a patient?  Why can’t hospitals test patients for MRSA before they are admitted, then care for them appropriately if they already have the infection?

Patients — my advice to you is two fold:

First:  take a can of lysol with you to the hospital.  Spray anything you will touch, or that will touch you.  TV remotes, telephones, bed rails, bed linens — any type of surface can harbor infections.

Second:  Don’t let anyone in a hospital or doctor’s office touch you without washing and sanitizing his/her hands first.  Do NOT go to any hospital that does not allow 24 hour visitation — then make sure there is someone with you 24 hours per day to be sure that anyone who touches you washs and sanitizes his/her hands first.  Plus, make sure any equipment has been sterilized — stethoscopes, IVs — even the IV ‘tree’ that holds those bags of liquid — spray it !

Of course, there are a dozen other steps you can take — but these are a start.

Yes — I know I get wound up — I can’t help it.  There are so many, many safety problems patients have to contend with when they access healthcare.  Not all of them are so easily preventable, but most of MRSA is.  It costs almost nothing for a healthcare provider to wash hands.  It costs next to nothing to test a patient as s/he enters the hospital, then to manage the care in a place removed from other patients who are not infected.

………………………………

Here is Sarah’s post.  You can find the original here.

My mom who lives in Fresno California was recently diagnosed with MRSA. She got it after a surgery. She started to have pain and was throwing up. Her doctor that performed the surgery was in denial that she had MRSA.  Before my mom had the surgery she was scared that she was going to get MRSA. She has Lupus so her immune system is not good.  She did have the surgery and 4 days later she got violently sick. The doctor would not run a test to see if she had it.

The hospital doctor had to step in and order the test and four days later sure enough the test were positive.  After that her doctor finally came by to see her ( which he had not been back to see her since she first got ill and she had requested to be tested for MRSA ) he called her some unkindly names and refused to treat her. Everything happened in front of the hospital staff. He is the one who did the surgery and now he is REFUSING TO TREAT HER!  And the scary thing is that he had orders for her to have a catheter put in her.

The hospital doctor of course did not put a catheter in her.  The hospital doctor had to treat her and the doctor for disease control is also treating her.  They discharged her after 3 weeks in the hospital. So don’t tell me that MRSA is no big deal and don’t tell me that doctors and staff will not refuse to treat someone.  I know that by law they have to but that does not mean that they will.  They will come up with some kind of reason of why they can’t.

Not everyone can be treated by text book. In my moms case she already had a bad immune system you would think that after knowing my moms medical history that it would make sense to test for MRSA before having the surgery. Now after being out of the hospital for 1 week she started to throw up and was having pains again.  Since she can not find a doctor that will treat her she had no choice but to go to the ER. The staff there was rude! She informed them that she has MRSA and that she currently has an open wound and she also has a vacuum that is sucking out the drainage in her belly.

she was also throwing up and they laughed when she asked them to wear gloves before touching her. Her arms were wet and moist and the triage person did not care to wear gloves even if it was to turn her arm a certain way. She then asked if they have a separate waiting room to put her in and they again laughed and said you have to wait in the main waiting room like all of the others.

Why wouldn’t they have a room for contagious people that have MRSA that is currently vomiting? Or what happens to people who have chicken pox and they sit next to someone like me who is 30 years old that has never had chicken pox. What happens to the people who have a weaken immune system and they sit out there with the healthy sick people.

My mom waited out in the waiting room for 4 hours and she ended up leaving. The next day her home health nurse made her go back to the ER because she has lost 20lbs and was still actively throwing up. She went in thru triage and immediately was sent back to a room. She is still in the hospital and they did find 3 other pockets that is filled with fluid and they need to be drained.

I understand the MRSA is different for people who are healthy. They usually can bounce back. But what about the ones who have a weak immune system.  And by the way my mom is a clean freak. So what happens when the bloggers like the ones who are on attack and are in denial of how serious MRSA really is start to blame the patient on poor hygiene when it is the hospital staff and the hospital itself that laughs when they are requested to wear gloves. And if you have ever seen some of the staff that cleans the hospital do you think they really take that much pride in cleaning. I know people who use to work sterilizing the equipment. What a big joke of workers they were. Needless to say they no longer work there. They were given the job because their mom was a head nurse and no one had the balls to say that person did not perform her job well because you do not want to have any conflict with her mom who was one of the head nurses.

This all is bad.  My mom is only 54 years old she looks terrible and who knows how much longer she will last. I wonder if those other bloggers work in the medical field.

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In January, I told you about three heinous infection situations — three people who contracted MRSA from negligence and bad medical protocol. At the time, I took some major hits from providers — in effect, chastising ME for the plight of these people, and taking offense to the fact that I blamed the professionals who should have been preventing these infections to begin with.

Word came this morning from my friend and colleague, Ilene Corina, patient safety expert and president of PULSE of NY (www.pulseofny.org ) about the death of Tameka, the young woman who over a year ago contracted MRSA after surgery in a Long Island, NY hospital. Ilene herself had been called in to see if there was anything she could do to help. She observed those same professionals providing care, changing dressings, with no gloves, not taking additional precautions.

Ilene has blogged about the experience of attending the young woman’s wake, and the follow up letter she received from the NY Dept of Health in which Tameka’s name was not even spelled correctly.

My heart breaks for Tameka’s family. This sort of horror only makes me dig in my heels even further to make sure YOU, my readers, understand how to protect yourself from the same demise.

Learn about how these deadly infections spread. Understand that they can too easily be contracted — by you or by your loved ones. And please, please, please take the simple steps required to prevent them!

It begins by insisting on handwashing.

And clearly, when that isn’t done, it ends in heartbreak.

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