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The number of children hospitalized with MRSA-related infections acquired in the community has more than doubled since 2000, according to a new study from UC Davis and published in this month's Academic Pediatrics. 
"Often parents don't recognize that their kid's abscess or other soft-tissue infections might be MRSA because the child hasn't been in nursing homes or hospitals, where you usually think of getting staph infections," said Patrick S. Romano, a professor of medicine and pediatrics at the UC Davis School of Medicine and the study's senior author. "It's usually pretty easy to treat, if you treat it early and know what you're looking for," he added.
The study suggests the cause of the surge may be two-fold, both of which involve a general lack of awareness and prompt treatment of MRSA-related infections. 
"In the early part of the decade, clinicians generally didn't recognize the growing prevalence of community-acquired MRSA," Romano said, differentiating between MRSA cases that occur in hospital settings or nursing homes, and the growing proportion of cases that occur in the community among otherwise healthy people. "Starting around 2005, physicians began treating community-acquired MRSA more effectively."
Proper hand washing techniques is an important preventative step that parents should teach their children in order to prevent infections and the spread of potentially harmful bacteria.

A $29 million verdict against a medical clinic in Erie Pennsylvania has been upheld by a federal appeals court.  The family had originally filed suit against the US government because it funded the clinic and alleged that Christian's cerebral palsy was caused by medical practitioners' failure to diagnose a brain infection.  According to court documents, the medical staff failed to recognize the signs of the brain infection, including the child's inability to see, for 12 hours.  The delay allowed the infection to spread since it was not treated with antibiotics.
According to news sources, "The U.S. government argued that Arroyo’s parents filed the case after the statute of limitations, based on when they reasonably should have known that their son’s brain damage was caused by a medical mistake. However, the U.S. Court of Appeals for the Seventh Circuit rejected that argument last week, upholding the verdict."

A British teenager was permanently paralyzed after an epidural anesthetic was left in her spine for too long.  The hospital, Birmingham Children's Hospital, admitted the medical error after the painkiller was left in her back for two days. 
Sophie Tyler was 14 when she entered the hospital to undergo routine surgery to remove gallstones. "My daughter's life has completely changed as a result of what happened," said Sophie's mother Sue. "From being an outgoing teenager, her life has altered overnight and we have all had to come to terms with what has happened."
Despite warnings that something was awry, hospital officials didn't remove the anesthetic until two days after surgery.  Sophie had complained that numbness had spread to her lower extremities and she was unable to move her feet.  An MRI scan later revealed that the
"anaesthetic had entered her spinal cord and damaged her membrane, permanently paralysing her."

According to Sky News, "Dr Vin Diwakar, chief medical officer at the hospital, said: "We are deeply sorry for the unimaginable distress we have caused Sophie and her family as a result of the care she received at our hospital three years ago. The care we provided fell below our usual high standards and since then we have implemented a whole series of changes to try to ensure that this never happens again."

Today's issue of the New England Journal of Medicine has linked the proper use of electronic health records and better diabetes care and improved outcomes, according to one study.  While the researchers note that such a link has never been shown before, the new study does provide evidence that electronic health records may actually assist in improving diabetes care.
The authors of the study concluded, "These findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types." 
While this is one study in one area of medicine it does lend itself to further discussion of the role of electronic medical records in the management and practice of healthcare.  Prior to this study, we've chronicled medical errors caused by sloppy or incomplete paper health records.  There is a great deal of data that points to the possibility that paper records are not the most efficient nor the most accurate form of charting patient histories or recording treatment plans.  Perhaps this study is a step in the right direction that will provide impetus to expanding the use of electronic records.

The American Journal of Infection Control has published a study performed by Israeli researchers that found 60% of hospital workers' clothing testing positive for pathogens such as those that can cause pneumonia, MRSA, and blood stream infections. 
While the number is high, most experts believe there are more pressing concerns regarding bacterial infections in hospitals.  For example, lack of proper hand washing remains one of the leading causes of infection and the spread of germs and bacteria in a hospital setting. 
“Uniforms could be a source of contamination, but there is more concern about other surfaces around the patients,” said Russell N. Olmsted, president of the Association for Professionals in Infection Control and Epidemiology.
“What we don’t want to do is direct a lot of energy to sterile attire,” he added.  “There are surfaces around the person that have a higher bacterial load. There could be 100 colony-forming units to 1,000 units on a bedrail, for instance,” said Olmsted, an epidemiologist in infection prevention and control services at St. Joseph Mercy Health System in Ann Arbor, Mich.
The study, if nothing else, is a good reminder that hospitals can be very dangerous places for those whose immune systems are already compromised.  Health industry experts have been calling for a serious effort to reduce MRSA and other hospital-acquired infections.  It's so important, your own life may depend on it.

A new study shows that the United States' newborn mortality rate is higher than countries such as Malaysia, Cuba, and Poland.  In fact, there are 40 countries worldwide that have a lower newborn mortality rate than the United States.  The study reveals that the US mortality rate for newborns is on par with Qatar, Croatia, and the United Arab Emirates.
Pediatrician Dr. Joy Lawn who works with Save the Children noted that the three leading causes of infant mortality are preterm delivery, asphyxia, and severe infections.  All three causes are easily preventable with standard medical care. 
Twenty years ago, the United States had the 28th lowest risk of infant mortality.  The situation has deteriorated drastically in a few decades.  This is an obvious and urgent public health concern that should be addressed and corrected immediately.

A Concord NH midwife who had surrendered her license last year settled a birth injury medical malpractice lawsuit for $730,000.  This is the second lawsuit Concord midwife Jeanne Browne has settled in the past two months.  In June, Browne settled a lawsuit filed against her after a woman had to undergo a hysterectomy after an infection developed while she was under Browne's care.
According to the Concord Monitor, "Browne, who founded the Concord Birth and Wellness Center, voluntarily surrendered her license last June following an investigation by the state Midwifery Council into a series of complaints about the care she provided her patients. The complaints, which came from Concord Hospital, Dartmouth-Hitchcock Medical Center and an obstetrician, alleged that Browne hadn't managed cases appropriately, failing to consult with obstetricians about high-risk pregnancies."
 

The hurricane forecast models point to a rough weekend for the Granite State.  Now is the time to make all your preparations for Hurricane Irene which is expected to hit New England over the weekend.  In preparing for the hurricane, make sure to have plenty of bottled water, flashlights, batteries, and non-perishable food items in case electricity is unavailable for any extended period of time.  It's also a good idea to have cash available in case ATM machines aren't working.  Today is also an appropriate time to fill your vehicle's gas tank. 
Make sure to check around the outside of your home and secure patio furniture and other items that can become projectiles in a bad windstorm.  If you're in an evacuation zone, make plans for your pets as well. 
Finally, follow all instructions from law enforcement authorities, fire, and safety officials.  Let's make sure we're all careful this weekend!

When Republican Presidential candidate Rick Perry visited the Granite State on August 17, 2011 he told a gathering at a "Politics and Eggs" gathering in Bedford that his state of Texas has witnessed an increase in the number of doctors practicing in the state.  He cited tort reform legislation as the main reason for the increase.  Here's an excerpt of what the Texas Governor said: 
"I’ll tell you what one of the results was," he said. "This last year, 21,000 more physicians practicing medicine in Texas because they know they can do what they love and not be sued.  Some 30 counties that didn’t have an emergency room doc have one today.  Counties along the Rio Grande, where women were having to travel for miles and miles outside of the county to see an ob-gyn, for prenatal care and now they have that care."
That's wonderful news for the state of Texas if only it was accurate.  Politifact, an online investigative journalism site, did some research into Perry's claims and found them to be false.  Politifact rated his comments as "False" based on the number of actual doctors added to the state's healthcare rolls since tort reform was introduced in the state in 2003 as well as the reasons for the actual slight increase in the number of docs.  In actuality, the number of new doctors is around 5,000. 
Politifact also couldn't find evidence that the increase in doctors practicing in Texas was attributable to tort reform since the numbers had already increased prior to tort reform enactment in 2003.  The data shows the increase may be attributable to the state's population growth and not tort reform.  Here's an excerpt of the Politifact article:
"Jon Opelt, executive director of Texas Alliance for Patient Access, a group that supports tort reform and is funded by health care providers, sent us some analysis he had done that filtered out the population effect. Opelt said the higher rate for doctors -- 24 percent -- translates into an additional 1,608 physicians thanks to tort reform. At least, that’s what he said when we first spoke to him. Later, after we showed him that the growth of doctors increased at a faster rate in the pre-reform years, Opelt sent us new numbers, saying tort reform brought 5,000 more doctors to the state and the ratio of doctors to residents has never been better. (We found those numbers to be a stretch: The upward revision comes from including administrators, teachers and other licensed doctors who don’t actually treat patients.) In any event, from the pro-reform vantage point, the most accurate figure is 5,000 -- a far cry from 21,000. But the case for Perry’s statement gets even shakier when you review numbers prior to the new malpractice rules. It turns out that in the nine years before tort reform, the number of doctors grew twice as fast as the population. So Texas did a pretty good job attracting doctors before the law changed."
Hopefully, those attending the local "Politics and Eggs" realize there was some "spam" served up at the event regarding tort reform and healthcare.  Kudos to Politifact for doing the research and checking the Governor's stats on the state of healthcare in the Lone Star state.

In 2004, NY Court of Appeals changed state law when its ruling allowed mothers to sue for emotional distress when they claimed medical malpractice was to blame for their stillbirth.  Prior to the 2004 decision, mothers had to prove that they were physically injured.  No consideration was given to the emotional turmoil, pain, and suffering caused by a stillbirth.  The 2004 appellate ruling should have changed that. 
However, a mother who suffered a stillbirth in 1997 sued for malpractice.  In 2005, a jury awarded her $1 million for her emotional suffering.  The case was appealed and the verdict was finally upheld this year after six years of appeals by the hospital.  While her case languished in the appeals process, the mother, Lucia Ferreira, was left to languish. 
Because Lucia's case was the first of its kind since the Court of Appeals ruling to reach trial, the appeal was brutal.  Her trial lawyer called the stillbirth malpractice an "epidemic of error" that included a failure to examine Lucia at all on her final visit prior to the tragic stillbirth.  Even the general counsel for the hospital seemed to acknowledge the tragedy of the situation when he stated in an interview that Lucia's case, "perhaps should have been handled differently."
Lucia Ferreira should be commended for her bravery and tenacity.  She didn't allow the pain of loss or the slow wheels of justice to deter her.  She continued to fight.  Good for her.
 

Failure to diagnose hemorrhagic shock in a man who later died resulted in a $2.5 million Maryland jury verdict. 
"According to allegations raised in the complaint, Dr. David Harding failed to notice Dixon was bleeding internally when he examined him. The family alleged that if Dr. Harding had noticed the internal bleeding he could have saved Dixon’s life, but as a result of the failure to diagnose the bleeding, Dixon ultimately died of multiple organ failure."
Since Maryland has a cap on non-economic damages, the ultimate monetary verdict may be lowered.

The latest edition of the Harvard Business Review offers an interesting analyis of how healthcare costs can be controlled and lowered by measuring patient quality outcomes rather than organizational groups or narrow diagnostic treatment groups.
The new healthcare model is presently being tested at the Head and Neck Center at MD Anderson, the Cleft Lip and Palate Program at Brigham and Women's Hospital in Boston. 
Costs, as everyone knows, are a hot-button issue.  Politically, medical malpractice reform has been the easy if not facile solution to the cost issue.  However the authors of this article believe the problem is systemic that requires a new way of facing the problem.
"The proper goal for any health care delivery system is to improve the value delivered to patients. Value in health care is measured in terms of the patient outcomes achieved per dollar expended. It is not the number of different services provided or the volume of services delivered that matters but the value. More care and more expensive care is not necessarily better care.  To properly manage value, both outcomes and cost must be measured at the patient level. Measured outcomes and cost must encompass the entire cycle of care for the patient’s particular medical condition, which often involves a team with multiple specialties performing multiple interventions from diagnosis to treatment to ongoing management. A medical condition is an interrelated set of patient circumstances that are best addressed in a coordinated way and should be broadly defined to include common complications and comorbidities. The cost of treating a patient with diabetes, for example, must include not only the costs associated with endocrinological care but also the costs of managing and treating associated conditions such as vascular disease, retinal disease, and renal disease. For primary and preventive care, the unit of value measurement is a particular patient population—that is, a group with similar primary care needs, such as healthy children or the frail and elderly with multiple chronic conditions."
Any one interested or concerned about the cost of healthcare and the issue of the quality of patient care must read this article.

Pitocin, a synthetic form of oxytocin, is administered in some birth scenarios in order to induce or quicken labor.  While the drug may be beneficial in certain delivery situations, it can be a dangerous drug for both the mother and the child if administered incorrectly.  Too much Pitocin may lead to the following birth-related injuries: uterine rupture, post-birth hemorrhage, neonatal hypoxia, fetal asphyxia, cerebral palsy, brain injury, paralysis, and still birth.
In cases where Pitocin is administered, healthcare professionals must use electronic fetal monitoring since the drug may cause fetal distress.  Because the drug quickens vaginal contractions, it also lessens the blood flow and oxygen to the fetus.
The use of Pitocin requires expert monitoring of the mother and fetus as well as careful administration of the drug.  Pitocin errors may lead to irreversible injuries to both mother and child.

The Associated Press calls it the most comprehensive study in two decades.  The finding were published today by the New England Journal of Medicine.  The findings may surprise some who seek to characterize all medical malpractice claims as frivolous and blame all healthcare woes on medical malpractice lawsuits. 
The study made reference to an earlier study in New York that concluded that most of those injured never file a medical malpractice claim.  Some are dissuaded from doing so because of the high upfront cost in most medical malpractice cases.  The study found that only 1 in 5 malpractice claims conclude with a successful outcome for the injured party. 
According to the Associated Press, the study found:
—About 7.5 percent of doctors have a claim filed against them each year. That finding is a little higher than a recent American Medical Association survey, in which 5 percent of doctors said they had dealt with a malpractice claim in the previous year.
—Fewer than 2 percent of doctors each year were the subject of a successful claim, in which the insurer had to pay a settlement or court judgment.
—Some types of doctors were sued more than others. About 19 percent of neurosurgeons and heart surgeons were sued every year, making them the most targeted specialties. Pediatricians and psychiatrists were sued the least, with only about 3 percent of them facing a claim each year.
—When pediatricians did pay a claim, it was much more than other doctors. The average pediatric claim was more than $520,000, while the average was about $275,000.
Public health advocate Dr. Sydney Wolfe of Public Citizen expressed his disappointment that the study didn't address issues that might improve public health safety.
"The thing that's disappointing about their study is they don't focus on what can be done to prevent people from being injured," said Wolfe, who has pushed for more aggressive policing of doctors by state medical licensing boards.

The numbers are downright scary-in 86% of medical transfers ie. patient transfer from one facility to another, medication errors occur.  According to an industry source, "A study by Boockvar K., et. al. (Arch Intern Med. 2004;164:545-50) showed that at least one medication order was altered and out of that, 65% were caused by discontinuations, 19% were caused by dose changes, and 10% were caused by formulary substitutions.
That study also showed that half of adverse drug events (ADEs) attributed to medication changes were caused by discontinuations. A study from Wong JD, et. al. (Ann Pharmacother 2008;42:1373-9) showed that 30% of patients discharged from the hospital (to any location) have at least one medication discrepancy."
Obviously, these are unacceptably high error rates, especially given this population's already precarious state of health.  This data demonstrates an urgent need to address this issue with iron clad systems and protocols, including communication protocols, that address the root causes of these errors.

The Clinical Advisor published an article this month concerning a 2008 study of electronic prescription error rates that, if still true, should give industry officials some cause for concern.  According to the study, "The analysis focused on 3,850 computer-generated prescriptions received across three states over four weeks in 2008. In total, 452 prescriptions (11.7%) contained 466 errors, 163 (35%) of which were considered potential adverse drug events. None of the errors were life-threatening. Omitted information was the most common mistake, accounting for 60.7% of all errors.
"
While the article is interesting, its efficacy is limited by its date-it's already three years old and technology has made significant advances since that time.  (I would be very interested to see if a more recent study came to the same conclusions.)  Secondly, if the overwhelming majority of errors concern errors of omission, there's a reasonably easy solution-implement prescription writing software that doesn't allow for such omissions ie.  the one entering the data can not proceed until the error of omission is corrected. 
Perhaps the most significant statement in the article is this:  "Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors," cautioned Karen C. Nanji, MD, and coauthors in their report for Journal of the American Medical Informatics Association.  

In January 2004, 83-year old Clara Tucker entered DeKalb Medical Center to undergo aortofemoral bypass surgery.  Initially, the surgery appeared to be successful.  However, Clara continued to complain of severe abdominal pain and a foul body odor.  Four years later, on December 17, 2008, she was re-admitted to DeKalb Medical Center and a CT scan revealed a mass near Tucker's colon.  On December 21, 2008, laparoscopic surgery was performed to remove "an old laparotomy pad with some purulent material around it that smelled like anaerobic pus," according to the order. 
The surgical team had incorrectly counted the number of surgical sponges and left one sponge inside her abdominal cavity.  It took four years and severe pain, nausea, and infection to finally discover the medical error.
Last month, a DeKalb County jury found in favor of Clara Tucker and awarded her $375,000.

According to the Orange County Register, five months ago, Public Citizen's Dr. Sidney Wolfe wrote a letter to the executive director of the Medical Board of California, Linda Whitney.  In the letter, Wolfe wrote that a review of the National Practitioner Data Bank between 1990 and 2009 revealed that 710 physicians who'd had their medical priviledges restricted due to incompence and/or medical malpractice, were never disciplined.  Of the 710 physicians, 102 of them posed an "immediate threat to the health and safety of patients". 
In April, an attorney for the Board responded to Wolfe's letter by stating, "Resources permitting, the board will endeavor to respond to your requests, as it is always interested in improving public protection."  Yet, the Board has not even requested the names of the physicians which are readily available from the database.  So, Wolfe decided to take the matter directly to Governor Brown.  According to the Register, Wolfe wrote,

–the medical board is not protecting California patients from hundreds of doctors with proven poor records
–California's performance in reviewing and disciplining bad doctors has slipped substantially in the last 13 years.  In 1997 it was 18th in the country in disciplining bad doctors but today it ranks among the lower half of U.S. states.

"I hope, because of the threat posed to California patients by such dangerously inadequate medical board activity, you will order an independent investigation of these serious problems," Wolfe wrote.
Here's what Public Citizen found as published by the Orange County Register:

–A physician identified only as number 2111 had three clinical privilege actions taken against him by hospitals in 2007 and 2008, including a permanent loss of privileges.  He also had eight medical malpractice payouts between 1991 and 2008 totaling some $2 million,
–Physician number 3869 also lost his privileges permanently at his hospital because he was considered an "Immediate Threat to Health or Safety."  This docter had six medical malpractices payouts totalling $454,000 between 1992 and 2008.  One of his patients suffered major permanent injury.
–Physician 5039 lost hospital privileges in 1991 and had 15 medical malpractice payouts between 1993 and 2009 totalling $1.9 million. Those include two cases of foreign objects left inside a patioent, two cases of improper performance, and one patient who suffered significant permanent injury.  Like the others, there was no Medical Board of California action taken against this physician as of December 2009.

These are egregious breaches of safety protocols and California patients are the ones who suffer because governmental agencies have failed to respond.  Let's hope Governor Brown decides to act before more innocent lives are affected.

This week, Illinois residents will be able to check their doctor's background.  The law, which takes effect this week, will give Illinois consumers the ability to check a doctor's criminal history, if the doctor has been fired, and if any medical malpractice claims have been filed in the last five years.
The bill has been fought by the physicians lobby for years.  However, a Chicago Tribune investigative report found that state regulators had allowed doctors to continue practicing medicine even after some doctors had committed serious medical errors and been convicted of sex crimes.  As he signed the bill into law yesterday, Governor Pat Quinn called the bill "the #1 consumer bill."  According to the Tribune, ""I think this is our best bill this year when it comes to empowering consumers, health care consumers," Quinn said.
The new law will provide consumers the freedom to make informed decisions about their healthcare providers and should be replicated in other states.

In this Sunday's NY Times Magazine, Darshak Sanghavi, chief of pediatric cardiology at UMass Medical School, penned a fascinating piece about the continuing problem of medical errors.  In the article, Dr. Sanghavi notes that the mandated reduction in interns' hours in a hospital setting treating patients has not provided the swift cure many had imagined when the mandate was first promulgated.  Sanghavi employs other data on medical errors as well as interviews with experts on the subject to conclude that medical errors occur for many reasons that have nothing to do with sleep deprived doctors. 
One of the main culprits Dr. Sanghavi points to is the lack of proper communication between doctors and medical staff during shift changes.  In one instance, Sanghavi asked permission to observe a shift change at Children's Hospital in Boston.  What he witnessed was enlightening.  First, the intern leaving his shift suggested that they review patients in alphabetical order and not in order of the severity of their condition. Secondly, Sanghavi witnessed numerous interruptions that didn't allow thorough or complete discussion of a patient's history or condition. 
Another problem area concerns the persistence of "pen and paper" medical charting.  Prescription drug errors are more likely to occur when electronic charting is not used.  Sanghavi illustrates his point in the following account: "I walked to our outpatient clinic to see what might happen if I prescribed both phenelzine and Demerol to a made-up patient using the clinic’s electronic medical-record system. Immediately, a large box appeared with the message, “This combination of drugs is associated with a potentially fatal adverse reaction.” Then I went over to the inpatient wards, where, as in roughly two-thirds of American hospitals, there is no computerized prescribing system. Nothing would prevent me from writing the orders for Demerol on the paper chart. Were Libby Zion admitted to a typical hospital today, no matter how rested her doctor was, the same error that killed her could happen again."
Medical errors remain a vexing problem for the healthcare industry.  No one fix will solve this problem.  The entire system must be examined and each facet of care including doctor to doctor communication and doctor to patient communication must be improved.  Medical charting and notes should be handled electronically, there's no excuse for this delay.  A doctor's sleep deprivation is only one issue of many that must be addressed in order to improve patient safety.