South Florida Sun Sentinel reporters Sally Kestin and Bob LaMendola report that, despite the myriad initiatives and protocols launched in the dozen years since a landmark report thrust medical errors into the headlines, little progress has been made in actually reducing the toll taken by medical errors.
“I don’t really see any improvement in patient safety,” said Dr. Arthur Palamara, a Hollywood vascular surgeon and advocate for safer practices. “Unfortunately, despite all the protocols that were put in place, the adverse incidents, the wrong-site surgeries still keep happening at the same rate.”
A long list of technological advances and a national emphasis on preventing mistakes “hasn’t made a difference,” said Douglas Dotan, chief executive of CRG Medical, a Houston firm that sets up error-prevention systems…
They found that, while some progress has been made, even the most aggressive hospitals have found it difficult to crack the exceeding complex web of human and mechanical interactions that make errors possible.
These findings, which have become a depressingly predictable event, are built in part on research published in the April, 2011 issue of Health Affairs, a publication to which AHCJ members are granted free access.
AHCJ resources on patient safety
Bob LaMendola and Sally Kestin, of the South Florida Sun-Sentinel, report that regulations put in place a decade ago have not reduced the number of deaths related to cosmetic surgery in Florida.
They report that at least 32 people have died in the past 10 years soon after having cosmetic surgery – including “four South Florida mothers in their 30s who went under the knife in the past two years,” according to state incident reports and police records. The causes of death among the 32 people included poor medical care, reactions to anesthesia and heart and breathing problems.
A Sun-Sentinel series in 1998 by Fred Schulte and Jenni Bergal revealed 34 deaths in the preceding 12 years, some of which were “blamed on lengthy surgeries involving multiple procedures at doctors’ offices that were not then being regulated.” (Full disclosure: I was responsible for the online presentation of that series.)
Following the series, the Florida medical board put in place rules that limited lengthy operations, liposuction procedures and overnight stays and included regular inspections.
LaMendola and Kestin point out that the atmosphere around cosmetic surgery has changed in the intervening years:
One reason for the continued deaths may be a huge growth in cosmetic surgeries, but some surgeons, malpractice attorneys and industry experts say problems persist, and the state needs to do more.
Writing in the The Florida Times-Union, reporter Jeremy Cox used public records requests to find that a kidney transplant program at a local safety net hospital had been at risk of closure by federal regulators prior to its abrupt closure in January. It had “failed to meet six of 12 federal standards.”
Furthermore, Cox writes, the records revealed “that hospital officials intentionally misled local media outlets about the full extent of the program’s breakdown. In a memo to Shands spokesman Dan Leveton about how to address the media, Steven Blumberg, vice president of planning and business development, said, ‘If asked, we will say that a program with low volumes is not economical to operate and that quality can be ensured with higher volumes.'” That statement, of course, makes no mention of looming federal intervention or a failure to meet basic quality standards.
Cox’s writeup should serve local reporters well as a sort of “anatomy of a failed transplant program,” as he delves into the regulatory process and exactly where the hospital went wrong.
For those of you who were, like myself, unfamiliar with the institution, Cox writes that “Shands is run by a private not-for-profit company, but it is widely seen as Northeast Florida’s safety-net hospital. The city of Jacksonville gives the facility about $23 million a year to care for the city’s poor, and it gets millions more from the state.”
In looking into the state Department of Juvenile Justice’s use of powerful prescription antipsychotics, The Palm Beach Post‘s Michael LaForgia “analyzed department drug purchasing information and state Medicaid billing data and reviewed thousands of pages of DJJ inspection reports, drug company disclosure records and court documents.” It shows, as he surfaces with some powerful numbers and equally alarming anecdotes (Part 1, Part 2, Infographic).
…in state-run jails and residential programs, antipsychotics were among the top drugs bought for kids – and they routinely were doled out for reasons that never were approved by federal regulators, a Palm Beach Post investigation has found.
A key concern is that the prescriptions may be driven by their improper use as chemical restraints, or by the hefty speaker (and related) fees being paid from pharmaceutical companies to the most prolific prescription writers. Unfortunately, specifics are hard to come by as most homes are run by private contractors and the state doesn’t have the resources for close monitoring. For this story, the reporters were only able to obtain two years worth of data for 25 jails and three programs – a fraction of the statewide total. Those data still paint what LaForgia calls a “startling story.”
A look at the sheer numbers of drugs purchased … suggests a startling story is unfolding in state homes for wayward kids.
In 2007, for example, DJJ bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children.
That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.
Writing for Health News Florida, Brittany Davis shows the importance of following up on a disciplined caregivers story. In February, the DEA released the names of 32 Florida doctors whose prescriptions, they say, were fueling the state’s notorious pill mills. The DEA suspended the narcotics licenses of those doctors at the time.
In her follow-up, Davis finds that at least four of the physicians are still practicing, five have been arrested, at least 12 have shuttered or moved their practices, and a full two dozen still have clear Florida medical licenses despite the federal action. The disconnect between state and federal agencies, she found, may come down to simple communication problems.
[DEA spokesman David Melenkevitz] said the DEA focuses on enforcement, not outreach, and may not necessarily pass on its findings to the [state Department of Health].
“We’re a federal agency and they’re a state agency,” he said. “We work together but operate separately.”
Pat Castillo, of the United Way Broward County Commission on Drug Abuse, said she is “concerned about the disconnect” between the DEA and the DOH.
She’d like to find a way to fill in the gap and help patients get the most updated information on whether their doctors have been in trouble, she said.
“If their DEA licenses are taken away, certainly that’s a red flag,” Castillo said. “Having that kind of information is critical.”
A spokesperson for the state’s Department of Health said that the agency may not “know about the DEA suspensions, or the agency may be conducting its own investigation.”
The Miami Herald‘s yearlong “Neglected to Death” series on abuse and violations in assisted living facilities is expansive, but I recommend starting with this explanation of how the story came together. In short, the crux of project, reported by Rob Barry, Carol Marbin Miller and Michael Sallah, is a huge database, which never had been made public, the paper obtained from state regulators. An accompanying editorial from Aminda Marques Gonzalez details its somewhat unique provenance.
At the heart of the reporting is a rich database of hundreds of thousands of records that includes all inspections and complaint investigations by the Florida Agency for Health Care Administration, the sole regulatory agency for ALFs [assisted living facilities]. Layered in: a decade of complaints filed with the State Department of Elder Affairs and public records including police reports, death certificates and autopsy reports.
The paper has made the database searchable and open to the public.
The Herald reports on a facility where violence is so commonplace that incidents have prompted more than 1,200 calls to 911 in the past five years. It’s important to note that, while we usually think of assisted living for the elderly, there are such facilities for those who have mental illness and other disabilities.
Other stories tell of residents suffering from sores that went untreated, homes and caretakers that failed to keep medical records, facilities that did not protect vulnerable residents from those with a criminal background, a failure to track patients with dementia and more.
A timeline helps explain how and why the assisted-living facilities became a part of the Florida system and their growth.