Protect Yourself in the Hospital
Author: Thomas A. Sharon, R.N., M.P.H., Hollywood, Florida
Avoiding hospital mishaps: Introduction
It is my intent to educate and not to frighten people. Hospitals are a necessary part of our lives. What choice do we have if, heaven forbid, we are bleeding or suffering from a heart attack or a stroke or a fracture? Those of us who have to rush to a hospital are arriving there in a frightened, vulnerable state. Although we might complain bitterly if health-care workers ignore us, we just do not have the presence of mind to scrutinize the services they provide. Consequently, we put too much trust in doctors, nurses, and corporate management. All too often, we keep quiet even when things do not look right, for fear of antagonizing the people on whom we depend for survival.
According to a well-known Harvard University study of 1999, hospitals kill nearly 100,000 people each year because of human errors, faulty techniques, malfunctioning equipment, wanton carelessness, oversights, or criminal assaults. Many more leave the hospital worse off than when they went in. These counts are greater than the number of casualties that occur from automobile accidents on our roads and highways. Thus after reading this book, you will know how to recognize many hospital situations that are likely to cause serious injury or death.
Although not all bad outcomes are foreseeable, there are repetitive preventable calamities that occur in hospitals across the country. I have been reviewing hospital charts for malpractice attorneys all over the United States for the past eighteen years, and I have seen the same things happening repeatedly with tragic consequences to people of all ages-bedsores, fractures, nerve damage, choking, brain damage, hemorrhage, and death.over the United States for the past eighteen years, and I have seen the same things happening repeatedly with tragic consequences to people of all ages-bedsores, fractures, nerve damage, choking, brain damage, hemorrhage, and death.
Such avoidable catastrophic mishaps occur for a variety of reasons, some of which are negligence, environmental hazards, poor judgment, personality disorders, burnout, and criminal behavior. This seems overwhelming, given that the mission statement of every hospital denotes caring and compassionate community service. We need to keep in mind, however, that we are dealing with a system of services provided by the best and the worst of human beings who are sometimes at their best and sometimes at their worst.
More specifically, there are two basic categories of avoidable disaster: acts of omission and acts of commission. The former refers to the failure to treat or correct a clinical or environmental condition that results in traumatic injury, permanent loss of organ function, or death. The latter refers to a variety of blunders that cause catastrophic or fatal injury such as dropping patients on the floor, surgical slipups, medication errors, and improper technique in performing invasive bedside procedures or physical abuse. The result is always the same-pain, anguish, grief, and terrible financial losses.
You will have the opportunity to examine the preconditions that trigger common accidents, oversights, blunders, or abuse. First, there are those injuries that are associated with being in a particular area of the hospital, such as the emergency room or operating suite. For example, a forensic expert can identify a lower leg paralysis as having resulted from a part of the operating table pressing behind the knee (peroneal nerve plexus).
Second, certain types of patients are prone to certain hospital induced complications such as bedsores, traumatic injuries, and infections. You will come to understand the general standards of care and be able to monitor the services that hospitals provide. You will also recognize whether or not the health professionals provided prior services appropriately. Virtually all of the thousands of plaintiffs' depositions that I have reviewed revealed that patients and family members did not know that the nurses deprived the patient of necessary services such as turning and repositioning every two hours to prevent bedsores.
Third, the financial incentives of many hospitals result in executive decisions that deprive patients of access to additional technology. For example, there are new devices available to promote healing of leg ulcers in people with diabetes. Yet thousands of those individuals undergo avoidable amputation because some health-care executives refuse to purchase or rent such equipment. The information that there is a machine available offering a reasonable chance to save the leg without risk never reaches the patients.
Fourth, there is still an ongoing problem called hospital-induced anemia. This is a bizarre situation, because hospital executives and doctors have known about this problem for thirty years, it is easy to eliminate, and it perpetuates to this day. Critically ill patients are especially vulnerable. Nurses, doctors, and phlebotomists are simply drawing too much blood for laboratory tests. The victim usually suffers multiple complications leading to heart damage, brain damage, kidney failure, and death.
Fifth, current hospital staffing levels make it impossible for nurses to maintain a minimum standard of goal-oriented nursing care. Staffing levels on all shifts are so dangerously low in some places that family members need to remain at the bedside twenty-four hours per day and learn something about the patient's needs. Too many unfortunate souls are being found stone-cold dead in the hospital room, and no one has a clue as to when the victims took their last breath. Moreover, nursing supervisors spend most of their time finding nurses to fill vacant spots throughout the hospital for the next shift and have little time to monitor the quality of care.
Sixth, there are a variety of typical medication errors with a recent proliferation of narcotic overdose causing respiratory depression and death. The narcotic-related deaths and damaged brains appear to be a direct result of the development of a zero tolerance for pain program as a standard of care. This program includes the provision of a machine that allows the patient to self-administer measured doses of morphine and other narcotics intravenously or directly into the spine.
Seventh, there are certain behaviors that we can recognize as indicators that a particular patient is going to be a victim of delayed responses to calls for assistance. This happens most often to patients who are frequent complainers. They are more emotionally needy with a lower tolerance for pain and discomfort. Nurses and doctors develop disdain and contempt for such patients, labeling them as having the "cry wolf" or the "FOS" (full of shit) syndrome.
Finally, the scourge of managed care has resulted in a variety of problems including early discharge with a planned deprivation of necessary diagnostic tests and procedures. This has given rise to the patient-dumping syndrome. Many different types of injuries and complications occur in the home as a direct result of the lack of proper discharge planning. For example, hospitals often send patients home with indwelling chest catheters connecting directly to the inferior vena cava (major vein near the heart) without adequate nursing coverage. The result is sepsis (bacterial infection in the blood), accidental hemorrhage, or both.
In summary, despite the myriad of regulatory surveys at the local, state, and federal levels with visits from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) every three years, the causes of hospital-induced injury and death remain unresolved. In fact, they occur with such regularity that given any of the circumstances mentioned herein, one could virtually predict a catastrophe that is waiting to happen. Thus the malpractice continues with a staggering number of lawsuits in the judicial system. The root cause of this dilemma is the public being unaware of the fact that hospital managers enjoy an unearned public trust. Therefore, I hope that the information offered in this book will provide some insight and prompt people to question what they do not understand and insist on quality performance by experienced hands. So, the next time you see someone who looks like a teenager coming toward you with a long wide needle and quivering fingers wanting to insert it into your spine, you would do well to ask, "How many times have you done this before?"