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never events

Falls are considered “never events” under Medicare guidelines and of course are the subject of litigation against hospitals and other providers. The costs of overreaction to fear of being charged with error are not so readily measured, but are only too real:

If hospitals are scrutinized for the occurrence of falls, the natural tendency will be to focus on such events even at the expense of competing (and perhaps more important) outcomes. Unintended consequences are likely to include a decrease in mobility and a resurgence in the use of physical restraints in a misguided effort to prevent fall-related injuries.

[New England Journal of Medicine via KevinMD]

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Wachter’s World (via KevinMD) reports on what can happen when promising innovations are too rapidly accorded the status of obligatory standards of care.

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That’s what the federal government, if not common sense, says. But what if the fall is from the roof?

We’ve already aired much dissent from the medical profession about whether or not top-notch hospital care can in fact prevent all instances of patient falls, decubitus pressure ulcers (bedsores), hypoglycemia, deep vein thrombosis, delirium, suicide attempts, c. difficile infection, or iatrogenic pneumothorax. Nonetheless, Medicare has adopted its proposal to deny hospitals reimbursement for the cost of treating such events and complications, with likely consequences both for hospital behavior (refusal to admit some patients at high risk of never events), for private insurer behavior and for the climate of medical malpractice litigation. (Kevin Sack, “Medicare Won’t Pay for Medical Errors”, New York Times, Sept. 30). White Coat Rants, who has blogged extensively on the issue in past months, has some predictions (Oct. 1) of things we can now expect to see more of: more patient transfers between hospitals (since Medicare will not punish the second hospital for the first’s “never event”; underdiagnosis of certain conditions and overdiagnosis of others; and, more remotely but no less alarmingly, pressure on some families to serve as ultimate bearers of risk for supposed never events affecting the frailest and most elderly:

Say hello to the Advance Beneficiary Notices. Medicare won’t cover preventative care, so you are going to have to pay for it out of your pocket. If you’re prone to falls or bedsores, you’ll have to pay for a personal nurse to wait on you hand and foot so you don’t develop these never events. If you don’t pay for a personal nurse 24 hours around the clock to keep a never event from happening, you’re personally responsible for paying the costs of treatment if the “never events” occur. You had the opportunity to prevent the events but you were just too cheap to pay for it. I think that ABNs are less likely to catch on, but eventually I think they will become commonplace.

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Thanks to a new city ordinance, they get to provide some of the world’s most expensive free hotel service to patients who are well enough to leave but refuse. (WSJ health blog, Aug. 4).

More: Numerous interesting comments from readers including this from Throckmorton:

This is not just in L.A. but happens all around the country as well. Our area saw this increase with the rise in nursing home suits. Nursing homes are now very reluctant to accept patients who are at risk for decubitus ulcers, etc. This combined with the declining revenue has led to the situation where there are no places that will accept transfers from the hospital. As more and more patients fill the wards awaiting placement, the hospital has no choice but to divert those that need urgent care.

You may not be able to get a nursing home patient out of the hospital, but at least you will not have a problem finding them an attorney.

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Blood should never clot, microorganisms should never happen, and one doc-blogger is on a tear (Aug. 14, more, Aug. 17) over the sometimes absurd hype being given to the concept:

“Never events” are and always have been “all about the Benjamins.” Look at this news release. The “background” section states that the “never events” were “required” pursuant to Section 5001(c) of the Deficit Reduction Act. Medicare wants to stop paying for things not because they “should never happen” but because it’s trying to save money. The whole “never event” moniker is just a spin they put on the cuts to make it look like someone else’s fault. Do “never events” never occur at government run hospitals? We’ll never know because CMS doesn’t even include government run hospitals on the “hospital compare” list.

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June 9 roundup

by Walter Olson on June 9, 2008

  • Florida trial lawyers have funneled millions to Gov. Charlie Crist and GOP state legislators; now guess why Orlando isn’t going to get commuter rail [Bousquet/St. Petersburg Times; Sentinel]
  • What his ex-law firm told the world was “extremely inappropriate personal conduct” was in reality no more than a “brief, consensual kiss” with co-worker, charges attorney in $90 million defamation suit; Kasowitz Benson says it was following zero tolerance policy [American Lawyer]
  • SCOTUS, 9-0, Thomas writing, narrows scope for money-laundering charges over hiding unexplained cash — but will that curb forfeiture abuse? [Grits for Breakfast, Greenfield]
  • After West Virginia high court refuses to review $405 million royalty dispute jury verdict against Chesapeake Energy and another defendant, company scraps plans to build $30 million headquarters in the state [PoL]
  • Even after discounting anti-corporate rhetoric, there does seem to be a story here about aggressive seed patent litigation tactics used by agri-giant Monsanto, a firm known to our readers [Barlett & Steele, Vanity Fair; earlier]
  • Medical liability consequences of much-promoted concept of hospital “never events” [Buckeye Surgeon]
  • Cellphone rage update: Judge Robert Restaino ousted for jailing 46 people after one of the annoying devices rang out in his Niagara Falls, N.Y. courtroom [Buffalo News, earlier]

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May 12 roundup

by Walter Olson on May 12, 2008

  • Canada free speech: Islamic group files complaint against Halifax newspaper over cartoon of burka-wearing terror fan; two more libel suits aimed at online conservative voices; growing furor over complaint against Steyn/Macleans [National Post]
  • More than 5,000 students committed crimes last year in Philadelphia schools, but none were expelled — consent decrees tying system’s hands are one reason [Inquirer]
  • U.K.: Man threatened with legal action for flying pirate flag as part of daughter’s birthday party [Guardian]
  • Bankruptcy judge doesn’t plan to accept at face value Countrywide’s claim that it generated false escrow documents by mistake in foreclosure [WSJ, WSJ law blog]
  • Amid bipartisan calls to step down, Ohio AG Marc Dann [Apr. 19, May 6] hires an opposition researcher [Adler @ Volokh] on top of Washington lobbyist [Legal NewsLine], after being rebuked by judge for political suit [Dispatch]. And where’s that ethics form on the Chesley flight? [Dayton Daily News]
  • Missouri med-mal claims fall sharply after legislated damages curb [Springfield News-Leader]
  • More on Dartmouth prof Priya Venkatesan, the one who wants to sue her students — as suspected, she’s a devotee of deconstructionist Science Studies [Allen/MtC; earlier]
  • Covert plan to sabotage Chinese economy? [Wilson Center event]
  • What, never? Well, hardly ever: Docs continue to assail notion that various complications such as patient delirium, clostridium difficile infection, iatrogenic pneumothorax, etc. — not to mention falls — are “never events” [KevinMD various posts; earlier]
  • Mich. high court agrees anti-gay-marriage amendment bars municipal health benefits for domestic partners, just what key proponents had claimed it wouldn’t do [Rauch @ IGF, Carpenter @ Volokh, earlier]
  • Private service rates the safety of charter air providers — but can it afford the cost of being sued after giving a bad rating? [Three years ago on Overlawyered]

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…or the universal adoption of round-the-clock patient guards or restraint devices, it’s hard to go along with the notion that hospital falls should be so-called “never events”. (Happy Hospitalist, Jan. 15, Feb. 20). Nor is the concept much more useful when it comes to patient suicide attempts or hypoglycemia, among other misadventures (White Coat Rants, Feb. 5)(via KevinMD). Related: letters section, 2004 (pressure wounds/bedsores).

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August 27 roundup

by Walter Olson on August 27, 2007