Archive for the 'Surgery' Category
February 2nd, 2009 by Trisha Torrey
A new post by my blog guest Anonymous, poses a question, “Informed consent is just a cruel joke, isn’t it?”
This gentleman, who underwent surgery, was given Versed as anesthesia, despite stating that he did not want to be given any drug that would render him unconscious. So, not only did he deny consent, he stated that he did not want to be put to sleep at all.
We don’t know too many of the details, and we have not been given the other side of this story.
But it does call patients rights into question. And our understanding of Informed Consent.
Take a read — see what you think — and if you have ideas for what could have been done differently? Please post your comments, too.
Versed, PTSD and Questions About Informed Consent
January 9th, 2009 by Trisha Torrey
Not sure what it looks like where you live, but it’s cold outside where I live in Upstate NY, and we’ve got plenty of the white stuff on the ground.
Whereas some friends might curl up with a good book, I tend to gravitate to puzzles and thought provokers when I’m indoors and have some time on my hands. So I thought I’d provide you with a few links and summaries. I’m curious about your opinions:
1. Scenario: Your Uncle Henry lives in Rural-alia and needs prostate surgery. His primary care doctor refers him to a general surgeon who provides Henry with a list of all the side effects and describes the surgery and potential, probably outcomes, including incontinence and impotence. Uncle Henry settles on a date for the surgery, but confides in you that he’s really frightened and does not want to live with those side effects.
Questions: Do you suggest to Uncle Henry that he go into the city to find a second opinion? Do you tell him there are newer forms of surgery that may minimize the chances for those outcomes? Is it up to the surgeon to explain to Henry that there are other hospitals and surgeons that can do a better job?
Background: Should patients be told of better care elsewhere?
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2. Scenario: Aunt Genevieve has been hobbling around for years on that bum knee of hers. She finally lets you talk her into visiting an orthopod, and he tells her she really needs to have her knee replaced. She follows through, the surgery and recovery are a bear, and she begins to have real problems almost immediately with the knee not really working right. Then, as you dig into more information for her, you find out her surgeon is actually one of the inventors of the knee which was used in the surgery.
Questions: Do you confront the surgeon about the problems? What do you ask him to do about them? And does it matter that he owns the patent (and therefore makes money) for the artificial knee? Should he have disclosed that fact to Aunt Genevieve?
Background: Don’t be a victim of medical marketing
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Thoughts on either one? Just hit the “add a comment” button below…
September 18th, 2008 by Trisha Torrey
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. )
August 16th, 2008 by Trisha Torrey
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?
