QUALITY: Matt Quinn on why we “need” malpractice litigation

From the THCB Sacramento bureau, Matt Quinn chimes in on the “value” of malpractice litigation. Matt has been annoying the doctors over at DB’s Medical Rants (in these long, varied and interesting comments) by defending trial lawyers–which is a little akin to a Satanist wondering into a Catholic mass. Over here in the more rarefied air of THCB, I’ve been trying to suggest that there’s a middle path in the malpractice debate. But like Matt I don’t think that the AMA policy of just putting a $250,000 limit on pain and suffering awards does anything to solve the problem. Matt picks up on a tragic case in Sacramento, where apparently one hospital follows a stricter guideline than another, and it really made a big difference. Matt comments:

    In summary, a woman’s doctor recommends that she go to UC Davis Medical Center for a days-long diagnostic procedure to try to determine the source of the aberrant electrical activity in her brain. She would be taken off all medications, and a video camera trained on her during her stay would record any seizures and collect corresponding brain activity. The data might later enable a brain surgeon to remove the tissue causing the seizures. During the “monitoring” the woman has a seizure and dies. Her family finds her about an hour after she died. Experts say there are no standards – only guidelines from the National Association of Epilepsy Centers – for running video-EEG monitoring units.

    “There is no national standard requiring that a human being be observing every patient on video monitoring 24 hours a day,” said Dr. Robert Gumnit, a Minneapolis neurologist who pioneered the technology more than 30 years ago. “The reason is that the information is being gathered to learn about the electrical activity of the brain and the behavior of the patient during a seizure – and that is always analyzed the next day or some other time. It’s not being used to ensure patient safety.”

    Nevertheless, some centers do more than others in that regard. At Sutter General Hospital in Sacramento, for example, a specially trained technologist sits in front of a bank of large monitors – one for each of four beds – 24 hours a day. Each monitor shows the patient in the bed and displays the patient’s brain waves, blood oxygen levels and respiration rates.

    Such monitoring would have probably saved this woman (or at least alerted a nurse to respond). I wonder if this has ever happened before (why does Sutter have more stringent guidelines?). Why wouldn’t the National Assoc. of Epilepsy Centers commit to standards? It would certainly make assessing liability (to mention nothing of ensuring that no harm is done) much easier.

I’m not sure that we need malpractice litigation in this case (especially as a California taxpayer I’m picking up the defense’s tab), but something should be done to make sure that UC Davis Medical Center does much better in the future, and that guidelines/processes aren’t implemented so differently in the same town. And if it takes a lawsuit to do that? Well, surely we can do better.

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