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Seeking accountability, improving safety.

Patient safety should be of paramount concern to a hospital. If economic considerations or protecting physician or hospital relationships are a higher priority than patient safety, the public should know it. By exposing such derelictions of duty, we can help our clients and bring about change to protect future patients.

One credentialing Credentialing is the administrative process for validating the qualifications of licensed professionals, organizational members or organizations, and assessing their background and legitimacy.  claim stands out in my memory as an example of how the civil justice system can hold a hospital accountable for ignoring clear warning signs about a doctor who represented a threat to patient safety. A local orthopedic orthopedic /or·tho·pe·dic/ (-pe´dik) pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopedics.  surgeon, who had been respected in the community, was near the end of his long career when he suddenly started performing a large number of spinal surgeries with pedicle pedicle /ped·i·cle/ (ped´i-k'l) a footlike, stemlike, or narrow basal part or structure.

1. A constricted portion or stalk.

 screw instrumentation. The expense to patients for these surgeries was many times that of a conventional spinal surgery, as were the hospital-related charges (anesthesia anesthesia (ănĭsthē`zhə) [Gr.,=insensibility], loss of sensation, especially that of pain, induced by drugs, especially as a means of facilitating safe surgical procedures. , operating room operating room
n. Abbr. OR
A room equipped for performing surgical operations.
 expenses, charges for the surgical hardware, and so on).

The risks involved in these procedures were also many times greater than with a laminectomy laminectomy /lam·i·nec·to·my/ (lam?i-nek´tah-me) excision of the posterior arch of a vertebra.

Excision of a vertebral lamina. Also called rachiotomy.
 or spinal fusion spinal fusion
A surgical procedure in which vertebrae are joined. Also called spondylosyndesis.

Spinal fusion 
. Unfortunately, the surgeon's patients were plagued with bad results, serious complications, and the need for repeated surgeries. These injuries and problems increased the hospital charges because of the need to treat the complications that the surgeon had created.

The surgeon, who had been on the staff for many years and was one of the hospital's "good old boys," was allowed to perform these surgeries without anyone questioning his competence and training. In addition, nobody questioned his motivation in starting to treat so many patients with this novel, risky, and expensive surgery. As he performed more surgeries, the trail of horrible results and serious complications grew.


Eventually, some of the patients found their way to our office. As we interviewed more and more of them, we wondered why a respected surgeon would suddenly resort to performing such an extreme procedure on so many patients. We contacted several attorney friends to learn more.

With a few phone calls, we quickly learned that it was well known that this doctor had made some unfortunate personal investment decisions and lost a tremendous amount of money. A quick check of the court records confirmed that he was having serious financial problems.

The motivation to perform procedures that generated huge surgical fees seemed obvious. The hospital allowed the doctor to proceed without restriction, and both realized huge profits at the expense of the patients who were seriously injured in·jure  
tr.v. in·jured, in·jur·ing, in·jures
1. To cause physical harm to; hurt.

2. To cause damage to; impair.


Proving negligent negligent adj., adv. careless in not fulfilling responsibility. (See: negligence)  credentialing is usually a challenge because of the privileged nature of the peer-review and quality-assurance activities in hospitals. We are usually unaware of other patients who become victims because of the peer-review process and patient confidentiality patient confidentiality Medical practice A Pt's right to privacy and freedom from public dissemination of information that the Pt regards as being of a personal nature. See HIPAA, Medical privacy.  obstacles. However, in Florida, evidence considered in peer review can be used when obtained from the original source, even though the details of the hospital's protected peer-review action are not discoverable or admissible (algorithm) admissible - A description of a search algorithm that is guaranteed to find a minimal solution path before any other solution paths, if a solution exists. An example of an admissible search algorithm is A* search. .

In this case, we knew who many of the victims were because they had contacted us with concerns about their care. The outcomes the patients experienced should have prompted hospital investigation and action if the staff had followed quality-assurance requirements. Each patient became a potential witness to demonstrate why the surgeon should have been stopped--or never permitted to do this type of surgery at all.

When asked about obtaining informed consent from his patients, the doctor testified that he was unaware of the risks or the potential for the complications his patients experienced when he began doing the surgery. He said he learned about the risks and complications as he proceeded.

This testimony supported our contention that allowing him to perform this risky surgery was unacceptable. How could any patient provide informed consent for the procedure when the surgeon was learning about the risks as he went along?

The hospital had quality-assurance guidelines guidelines, a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks.
 that should have ensured that the trail of complications and injuries was discovered. Armed with the hospital rules and regulations, the applicable statutory quality-assurance requirements, and a dozen or so victims of the procedure, we established proof that this doctor should have been stopped. We also demonstrated that by failing to take action, the hospital generated enormous profits.

Because of peer-review protection, hospitals' actions regarding staff privileges staff privileges Admitting privileges The rights that a health professional has as a member of a hospital's medical staff, which includes hospitalization of private Pts, participation in committees, and in decisions relevant to the hospital's future.  and quality assurance escape public scrutiny. We will never know what action this hospital took once the dozen or so cases arising from its negligent conduct were settled. However, because the factual information becomes available to the public and the media when lawsuits are filed, it is my hope that the payments generated by settlements and the potential for adverse publicity from such suits would lead the hospital to make the facility safer.

For decades, hospitals have hidden behind independent-contractor and peer-review defenses to avoid responsibility for injuries caused by incompetent incompetent adj. 1) referring to a person who is not able to manage his/her affairs due to mental deficiency (lack of I.Q., deterioration, illness or psychosis) or sometimes physical disability.  doctors. The law in most states has now evolved to prevent this injustice when hospitals allow unsafe physicians to obtain or retain staff privileges. In my view, it is a public service to expose hospitals that bend their rules and protect their physicians, rather than protecting the patients who come to the hospital.

If the business of running a hospital follows common sense and reason, a hospital accepting responsibility for failing to protect patients will do more to protect future patients from similar risk than a thousand new rules to be followed in a confidential peer-review setting. Accountability should promote change.

TOM MASTERSON is a partner at Masterson Law Group in St. Petersburg, Florida St. Petersburg (often shortened to St. Pete) is a city in Pinellas County, Florida, United States. The city is known as a vacation destination for North American and European vacationers, as well as a politically important battleground in U.S. Presidential politics. .
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Author:Masterson, Tom
Date:Sep 1, 2008
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