Globe: New approach to medical errors takes hold

Doctors generally don’t admit to or apologize for even the most obvious medical mistakes. For the most part, they’ve never been allowed to. Blame it on those nasty malpractice lawyers who will use it against the doc in court. Or blame it on the hospital lawyers, who need to protect the institution, even if it means not sharing the facts with patients.

So, the Globe reports on an idea that’s been kicking around for a while called DAO – Disclose, Apologize and Offer. Championed at the University of Michigan, the system encourages doctors to admit to and apologize for medical errors and offer settlements as a way to keep the cases out of court.

In most states, anything that sounds like an apology can be used against a doctor in potential malpractice lawsuit. A survey by Harvard researchers identified one barrier to the new approach as “physician discomfort with disclosure and apology.” Still  risk management lawyers at Harvard hospitals issued a consensus statement endorsing the concept six years ago. The Mass Medical Society has been  looking for ways to promote the approach beyond Harvard. A local non-profit that runs support groups for doctors and patients – Medically Induced Trauma Support Services  – is also involved in the effort. And, Gov. Deval Patrick’s pending costs containment bill includes a provision that would make apologies inadmissible in malpractice cases.

Hints that the idea is taking hold emerged in a Globe story last year story on a lawsuit over a fatal overdose of blood thinner contains this statement from Mass General.

A spokeswoman for Massachusetts General Hospital said in a statement yesterday that the hospital regrets the error, and “our hearts go out to Mrs. Oswald’s family.’’

“As soon as we understood what had happened, we apologized and explained the situation to Mrs. Oswald’s family,’’ said (spokeswoman Peggy) Slasman. “We undertook a thorough and extensive internal review of the case, and we communicated with family members throughout this process. As a result of this event, we have made some specific changes to our practices to reduce the chance of such an event from occurring again.’’

In the Globe story Linda Kenney of the  Medically Induced Trauma Support Services welcomes the change, but advises patients to have a lawyer on hand  “to make sure the patient is getting what they are entitled to.’’

“The medical malpractice insurers have tons of attorneys on retainer,’’ said Kenney, whose group belongs to the new Massachusetts coalition.

And malpractice lawyer Andrew Meyer has this to say.  “For the most part, malpractice insurers are looking for a discount from fair compensation’’ by making an early offer, Meyer said. But “if a patient’s rights are not limited in any way, I have no issue with an attempt at early resolution. Cases just drag on for years.’’

More here.

Hold the fried chicken: RedSox workout tips from the Globe

Some of the BoSox players were lifting chicken legs instead of weights last spring, but not Ellsbury and Pedroia.  Jacoby returned from an injury for a great year and Dustin was solid all season.

The Globe’s Daily Dose offers some advice from their off-season trainers, who counsel them “on the importance of sleep, self-massage to relieve soreness, and what they need to eat to help build muscle.”

Also, please note this week’s publication of the Health Wonk Review, the biweekly digest of the best of health policy blog. This edition includes links to posts about the upcoming Supreme Court decision on insurance mandates, HIT and primary care and the new Independent Payment Advisory Board. Also note the previous edition, brought to you by Center for Objective Health Policy, a site that encourages “individuals to apply free-market ideas to healthcare.”

Coakley take note: State requires coverage for outdated breast cancer treatment

BHN did a double take this morning on the Globe story about the Senate candidates’ debate about mandated insurance coverage. Apparently, the state still requires insurers to cover the cost of bone marrow transplants for breast cancer, even though researchers concluded TEN years ago that the procedure doesn’t work. (WBUR had the story as well.)

In Mass and some other states, insurers are required to cover treatments for conditions like infertility and alcoholism. Repub Scott Brow has proposed a bill that would kill all the mandates since they drive up insurance costs. According to the Globe story:

Coakley’s campaign attacked the bill, saying it would allow insurance companies to get out of covering things such as mammograms, bone marrow transplants for breast cancer patients, and hospice care for seniors.

BHN thought it mighty be a Globe error. But, indeed, Coakley repeats her support for the coverage in a press release on her web site:

Today Scott Brown offered his own health care reform “solution” for rising health care costs in Massachusetts that would allow the removal of coverage for critical health services for women, children, and seniors. His plan would allow the removal of previously mandated insurance coverage for such basic care as mammograms, minimum maternity stays for new mothers, hospice care for seniors, and bone marrow transplants for breast cancers patients.

Here’s a 2000 New York Times story entitled “Cancer Study Shuns Bone Marrow Therapy.“

Bone marrow transplants are ineffective when breast cancer has spread to other organs in the body, a nationwide study released today by The New England Journal of Medicine has found.

The reason Mass added bone marrow transplants for BC to the list is that — even though women were demanding it –the procedure was unproven and considered experimental. Now the results are in and have been for a while– BMT doesn’t help. But the mandated coverage remains on the books. It’s far from the only outdated statute in Mass, but Coakley might want to reconsider her continuing support for it.

Mini-monopolies for biodrugmakers = high costs for patients?

But, does it also support innovation?

Generic drugs are one of the great, if imperfect, compromises of health care.  Limits on patents allow companies get a return on their investment — or more– and then others to make cheap but effective copies. Now Congress is considering a plan to give similar treatment to biotech drugs know as “biologics.”  And, industry has put up a fight, with the stock argument that limits wil hurt innovation.

( FYI, the late Ted Kennedy was on their side — the folks in Kendall Square are his contituents. ) 

Jerry Avorn of the Brigham – a voice of reason on the development, promotion and use of pharmaceuticals — offered a compromise last month in the NEJM. His would ”balance the need for financial incentives with the need for competition, promoting access and motivating important subsequent innovation.”

Here’s background and an 11/28 update from the reliable Alicia Mundy at the WSJ.

Makers of the complex drugs known as biologics are near a victory in Congress that would slow the development of generic-drug competitors, but supporters of generics are gearing up for a last-ditch fight.

Without support from the White House, which has promoted the creation of generic biologic medicines, the efforts by a few senators and House members on behalf of generics are likely to fail, politicians and analysts say.

Health-care overhaul legislation in both the Senate and House would, for the first time, set up an approval process that allows generic-drug firms to develop copycat versions of biologics. But the legislation would prohibit generic-drug companies from competing with sales of brand-name biotechnology medicines for at least 12 years.

The drugs treat conditions like …such as cancer, multiple sclerosis and rheumatoid arthritis. Drugs that treat anemia brought on by chemotherapy and kidney dialysis cost Medicare about $3 billion last year, even though a generic version of one of them is available in Europe

Home health and healthy homes

For the latest on the Senate health reform bill, see Kaiser Health News or The Washington Post.  

This on home health from David Abel in today’s Globe.

A $332 million state program that oversees home health care services for about 18,000 elderly and disabled residents is vulnerable to fraud and has employed personal care attendants who have committed felonies, including manslaughter, assault, and threatening to commit murder, according to a report released yesterday by the Office of the State Auditor.

Click here for the actual audit report. People are constantly trying to rip off the home health system, something that is so needed and so expensive. They are not just stealing from frail elderly, but from the rest of us. Fraud leads to more paperwork and auditing, making it doubly evil. 

Also, it might be fair to say you’re only as healthy as your hometown. I just discovered the CDC’s Healthy Places program.  

CDC recognizes several significant health issues that are related to land use, including–

       Accessibility

       Children’s Health & the Built Environment

       Healthy Aging & the Built Environment

       Gentrification

       Healthy Community Design

       Healthy Homes

       Health Impact Assessment

       Injury

       Mental Health

       Physical Activity

       Respiratory Health & Air Pollution

       Social Capital

       Water Quality

 

The EPA has a similar program.

 EPA helps communities grow in ways that expand economic opportunity, protect public health and the environment, and create and enhance the places that people love. Through research, tools, partnerships, case studies, grants, and technical assistance, EPA is helping America’s communities turn their visions of the future into reality.

 I found a link on their website to a new Institute of Medicine reporting on “Local Government Actions to Prevent Childhood Obesity” that cites a health promotion program in Somerville called Shape Up Somerville.

Shape Up Somerville is a city wide campaign to increase daily physical activity and healthy eating through programming, physical infrastructure improvements, and policy work.  The campaign targets all segments of our community, including schools, city government, civic organizations, community groups, businesses, and other people who live, work, and play in Somerville. 

This effort began as a community based research study at Tufts University targeting 1^st through 3^rd graders in the Somerville Public Schools.  Today there is Coordinator working on active and healthy living programs supported by the Health Department and a Taskforce that is a collaboration of over 11 initiatives and 25 stakeholders involved in working on various interventions across the city, such as:

• School Food Service
• Teachers teaching an-School Curriculum
• After School programs using a new curriculum
• Parent, City Employee and Community Outreach
• Restaurants
• Walkability and Safe Routes to School
• Extension of the Community Path
• School Nurses and Pediatricians
• Policy Initiatives
• Farmers markets and community/school gardens

Patient group joins breast cancer gene patent suit

Many Boston orgs have reps working with this not-into-pink,  Bay-area group, including Silent Spring Institute, Our Bodies, Ourselves and local breast cancer activist groups.

 Here from Breast Cancer Action’s press release:

 Breast Cancer Action (BCA) is challenging the legality of patenting human “breast cancer genes.” BCA is joining the American Civil Liberties Union in suing Myriad Genetics (a private biotechnology company based in Utah), that currently holds the patent on the two human genes known as BRCA1 and BRCA2.

The BRCA1 and BRCA2 genes are present in every human. However, people with certain genetic mutations on these genes are at an increased risk of developing breast and ovarian cancer. Myriad holds exclusive rights to these genes and their mutations and to the research performed on them. Testing for the BRCA1 and BRCA2 mutations can only be performed at Myriad labs and currently costs over $3,000.

Since 1998, when BRCA1 & 2 were first patented, BCA has maintained that the patenting of human genes interferes with patients’ access to genetic testing and medical care.

“The time has finally arrived for the courts to decide who owns our genes,” said Barbara Brenner, executive director of Breast Cancer Action.

Here’s a story on the topic from MIT’s Tech Review.

Last stop. Please take your belongings and your patients’ medical records

That headline was too hard to resist.  From today’s Globe

Paperwork containing the personal medical information of at least 66 patients at Massachusetts General Hospital was lost this month when an employee apparently left it on an MBTA train.

The hospital sent out letters last week to patients whose identities were included in the lost paperwork, telling them the information listed their names and dates of birth, and private medical information, including their diagnoses and the name of the provider with whom they met. The material constituted billing records for patients who attended the hospital’s Infectious Disease Associates outpatient practice on Fruit Street on March 4.

Deborah A. Adair, the hospital’s privacy officer and director of health information services, said in a statement released yesterday that while the incident was regrettable, the hospital followed privacy laws by immediately alerting affected patients and authorities, including the state attorney general’s office and the Department of Consumer Affairs and Business Regulation.

 In case you were wondering, it was the Red Line.

For more on medical privacy see the HHS HIPAA site

Hanging with the Health Wonks

Today I defer to the New England links on The Health Wonk Review, a biweekly collection of the best in health policy blogs. Every two weeks, a different blogger hosts this blawg digest — I mean, blog… no,  I mean the current host, Health Blawg. Newton lawyer David Harlow hosts this health policy and law site and he’s on wonk review duty.  

 He links to the Health Beat Blog, which offers comments and links to the written version of Congressional testimony delivered last week by Harvard doc and New Yorker writer Atul A. Gawande.

 As a clinician, public health researcher, and medical-watcher, this is what I see: our health system is failing-on cost, coverage, safety, and value-because the complexity of health care itself has exceeded our abilities as individual clinicians.

 He also links to his own piece on medical tourism, my piece on HIT and a Mass Hospital Association bit on unions. Other items cover primary care in Mass. and a piece from Health Care Renewal on how Harvard pays its docs. Finds links to all of the above here.

Vermont link to Supreme Court ruling on FDA liability

Big Supreme Court ruling. This from The Washington Post site:

The Supreme Court today ruled in favor of a woman who had her arm amputated after an improper injection of an antinausea drug and said drugmakers could not rely on federal regulation to protect them from lawsuits brought under state consumer protection laws.

The court ruled 6-3 that Congress did not mean to shelter drugmakers such as Wyeth Pharmaceuticals from the kind of lawsuits brought by Diana Levine of Vermont, who developed gangrene after a physician’s assistant injected the drug Phenergan into an artery.

For more on musician Diana Levine, see the bio on the web site for her company, ReBop Records

This from her bio:

 Diana has been a performing musician for over 25 years, first as Diana and Liz Winn, then as a singing bass player for The Re-Bops and various other rock and roll, R&B, and blues bands. While her ability to play music was compromised by the loss of her right hand in 2000, she continues to find new ways to follow her callings, both as a songwriter and as a producer of recordings that let families relate, create, communicate, play, solve problems, and exercise imaginations.

 More on this from me later.