Physicians

PHYSICIANS: A “black box” for docs by John Irvine

OB-GYN Dr. Gil Mileikowsky was forced from his position at Encino Medical Center in Los Angeles after he testified in a 2003 case involving a medical mistake at the hospital. A day after confirming in court that doctors in his department mistakenly removed both of a woman’s fallopian tubes in error, he found himself being escorted from the building by security on the orders of administrators. Tenet Health Systems, the company that operates the hospital, likely rues that day.

Enraged by his treatment,  Dr. Mileikowsky went to war, becoming an outspoken advocate of changes to the federal whistle blower laws
protecting doctors, arguing that administrators use dirty tricks to destroy
the reputations of doctors who speak out when mistakes are made — labeling them as "disruptive" and organizing "sham peer review" proceedings.  His passionate arguments won the support of the Association of American Physicians and Surgeons. He would be represented in court  by star attorney Alan Derschowitz. A California court threw out Mileikowsky’s subsequent case against Tenet.  Earlier this month, however, that decision was reversed, in a ruling that likely foreshadows serious problems ahead for hospital operators who want to avoid scrutiny of safety conditions at their facilities.  Last week, Dr. Mileikowsky testified to a hearing held by the Small Business Administration on the need for added protections in the system. His solution: a metaphorical "black box" at hospitals and an "FAA" to monitor safety conditions in the healthcare system. In this YouTube segment he talks about the issues involved and the current state of safety reporting. — John Irvine

UPDATE: You can learn more about Dr. Mileikowsky’s campaign against medical errors at the web site of the organization he founded, the Alliance for Patient Safety.

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EMR Software GuyBart LeemattVijay Goel, M.D. Recent comment authors
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EMR Software Guy
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It is unfortunate that we largely view medical mistakes as an opportunity to blame instead of an opportunity to learn. Unless we embrace a more systems-oriented mindset (wherein physicians and their patients recognize errors are at least in part the product of a system breakdown), doctors will continue to be fearful of admitting mistakes when they occur, or owning up to near-misses that could help prevent future errors.
EMR Software Guy
http://www.electronic-medical-record.blogspot.com/

Bart Lee
Guest

John Irvine’s note is most welcome. We represented Dr. Mileikowsky; Charly Kagay of this office handled the appeal. See http://www.allianceforpatientsafety.org/westhills/wh-06-08-2007.pdf. Dr. Mileikowsky’s Black Box idea is a system of anonymous and objective review. See http://www.allianceforpatientsafety.org/blackbox.pdf Presently “Peer Review” as discipline is all too often biased. These biases go largely uncorrected because of the immunity provisions of the Health Care Quality Improvement Act, which has not improved the quality of health care. There is a sword available, by a simple amendment, to untie this Gordian Knot: My suggestion, which follows, as to the best and quickest way to fix HCQIA’s immunity… Read more »

matt
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matt

This is the same Tenet that operated Redding Medical Center, where Dr’s Moon, Realyvasquez, and others were doing invasive procedures and open heart surgery on patients who didn’t need them…in order to drive revenue. There was little or no peer review or oversight, even though RMC was performing angioplasty and surgery at rates many times the national average.
And the same Tenet that was found to be involuntarily admitting psych patients a decade earlier…in order to drive revenue.
The whole affair is detailed in Stephen Klaidman’s book “Coronary: A True Story of Medicine Gone Awry”: http://www.amazon.com/Coronary-True-Story-Medicine-Gone/dp/0743267540

Vijay Goel, M.D.
Guest

It is really disappointing how the medical establishment acts as if doctors are superhuman– 36 hour shifts, inability to make mistakes, using licensing as a shield to competition….
In this case, as any process improvement guru (incl. Brent James) would believe, every mistake is a treasure. Analyzing and fixing the system for every significant failure makes the system more robust. Denying that it happened makes it more likely it will happen again.
These types of decisions reflect organizations who forget that their role is service, not omniscience.