severed spinal cord | Lane Brown, LLC

Researchers have found that as many as 28% of adult patients in intensive care units die each year with a misdiagnosis,
and up to 8% die with a potentially fatal “major missed diagnosis,” such as pulmonary embolism or myocardial infarction.

These findings come from a meta-analysis of 31 autopsy-based studies (BMJ Qual Saf 2012; doi:10.1136/bmjqs-2012-000803), and might even understate the rate of missed diagnoses, said Bradford Winters, MD, PhD, associate professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine, in Baltimore, who led the research.

“Since we did not include non-autopsy-based studies in our analysis, we did not evaluate misdiagnoses that did not result in death, but that are likely associated with increased morbidity health care costs,” Dr. Winters told General Surgery News.

The 31 studies–which were observational, mostly retrospective studies and largely based in the United States–included information from 5,863 autopsied adults who had died in an intensive care unit (ICU). The papers were published between 1966 and 2011. The analysis excluded publications that examined the rate of disease-specific misdiagnoses and studies
that did not include original data. A median of 43% of ICU deaths that occurred during the study period were autopsied.

The investigators turned to the Goldman Classification, widely used for autopsy findings, to group the misdiagnoses they identified. The criteria define class I errors as “missed major misdiagnoses with potential adverse impact on survival and that would have changed management”; class II errors as missed major diagnoses that would not have affected survival or altered the course of care; and class III and class IV errors as misdiagnoses related to the terminal disease but not related to death or unrelated to both disease and death, respectively.

The rate of misdiagnoses detected during autopsy ranged from 5.5% to 100%, with a 28% overall rate (1,632 of 5,863), the researchers found. Class I and class II errors accounted for 8% and 15% of misdiagnoses, respectively; class III and class IV errors accounted for 15% and 21%, respectively. Dr. Winters noted that some studies reported only the total number
of misdiagnoses and class I or class II errors, leaving the specific misdiagnoses of the remaining 41% unclear.

The most common class I and class II misdiagnoses reported in the studies were vascular events and infections.

The 8% rate of major and potentially lethal ICU misdiagnoses is higher than the 5% rate of lethal misdiagnoses documented in the general hospital population in a previous study (JAMA 2003;289:2849-2856). The difference, Dr. Winters explained, can be attributed to ICU-specific factors such as the inability of patients to communicate their medical history during the workup process and limited staff resources leading to “competition for care.” Factors not specific to the ICU, including an overload of information and cognitive errors that lead to a biased interpretation of patient data, also may play a role.

Richard Dutton, MD, executive director of the Anesthesia Quality Institute, in Park Ridge, Ill., who specializes in trauma, said several limitations may undermine the generalizability of the findings. “Most autopsied patients have some level of diagnostic uncertainty to begin with, which makes the population in this meta-analysis not completely representative of the general ICU population,” said Dr. Dutton, who was not involved in the research.

Some of the studies included in the meta-analysis were conducted before the introduction of more accurate and advanced imaging-based diagnostics, Dr. Dutton noted. And he questioned the effect that missed class I or class II diagnoses would have had on patient outcomes had they been identified. “If a patient is dying of septic shock, secondary events like myocardial infarction and pulmonary embolism, which are common during the immediate premortem period, may not have affected their survival.”

For YEARS, Plaintiffs who have successfully prosecuted their personal injury and medical malpractice cases have been forced to wait unreasonably long periods of time because of the poor response times of Medicare and its administrative agencies. The crime has not been limited to the injury victims, though. Because they have had to wait, our government has also had to wait with them, often causing delays of months and even years in the receipt of settlement and verdict awards to plaintiffs and reimbursement of public funds to government agencies and medical insurance carriers, and payment for services provided by medical providers. At long last, a bi-partisan law has been passed by Congress and signed by President Obama into law. The following is a statement from the American Association for Justice (AAJ) President Mary Alice McLarty in response to the President signing the Strengthening Medicare and Repaying Taxpayers (SMART) Act, which was introduced by Reps. Tim Murphy (R-PA) and Ron Kind (D-WI) in the House and Sens. Ron Wyden (D-OR), Rob Portman (R-OH), Ben Nelson (D-NE) and Richard Burr (R-NC) in the Senate:
“This bipartisan legislation is a practical solution that will streamline the Medicare Secondary Payer system to ensure that seniors and persons with disabilities get timely assistance and taxpayers are repaid millions of dollars every year.”
“This legislation is a big step forward and is the result of senior advocates, the legal community and the business community coming together to work out a common sense solution.”
“There is still work to be done. To ensure this legislation has the most impact, [the Centers for Medicare and Medicaid Services] CMS must eliminate confusion and uncertainty by providing clear, efficient and definitive information to seniors.”
Medicare Secondary Payer (MSP):
• The MSP process ensures Medicare is reimbursed for medical bills that are the responsibility of another party – such as an insurer or negligent party.
• A senior or person with disabilities who has been injured, and later obtains recourse through the legal system, often cannot access their settlement until Medicare is reimbursed for all medical costs.
• The current MSP system is inefficient and slow to return dollars to the Medicare Trust Fund, which is funded by tax payer money.
• It can take years for the Centers for Medicare and Medicaid Services (CMS) to report reimbursement amounts to beneficiaries and CMS can seek multiple reimbursement amounts over time, providing further delay and uncertainty.
The SMART Act will:
• Require CMS to maintain a secure web portal to access claims and reimbursement amounts in a timely fashion.
o CMS must upload care payments they disperse within 15 days with the required information about the payment.
• Streamline the process of obtaining reimbursement amounts.
o Medicare beneficiaries must notify CMS they are anticipating a settlement no more than 120 days beforehand.
o CMS then has 65 days to ensure the web portal is up-to-date, but may request an additional 30 days, if needed.
o Reimbursement amounts are reliable if downloaded from the web portal within three days of settlement.
• Provide a process and timeline for discrepancies and appeals.
o Medicare beneficiaries can provide documentation for discrepancies on the web portal to CMS.
o CMS has 11 days to respond to discrepancies.
o If CMS does not respond in 11 days, the amount calculated by the beneficiary is the correct amount.
o An additional appeal process must be established by CMS for reimbursements it attempts to collect from insurance plans.
• Create a threshold for collecting any payment amounts by CMS that are below the cost it incurs to collect an average claim.
• Readjust the penalty for reporting errors by insurers based on the violation.
• Ensure greater privacy for beneficiaries by no longer requiring use of full social security or health id claim numbers.
• Create a three year limit for CMS to seek any repayments beginning from when they were informed of an anticipated settlement.

We hear a lot about “Judicial hellhole” labels, referring to geographic areas of our country in which tort reformers want to make sweeping changes to defeat the rights of innocent people who have suffered the most serious injuries as a result of someone else’s negligence. These labels are pure propaganda, and are shamelessly published and repeated by media which are careless (to put it kindly) about verifying the accuracy of the outrageous claims made by corporate, medical, hospital and insurance interests. They would like to nothing more than to minimize their own financial exposure and accountability by blaming our jury system, and fair-minded people like you who sit on those juries, for large verdicts and settlements. In fact, our judicial system was created to level the playing field of ordinary people and small businesses who had been at the mercy of corporate irresponsibility. Can you spell ENRON? BP? Do they exude a sense of responsibility? Of a sensitivity to those they’ve harmed? The answer is clear… Instead of standing for corporate and individual responsibility, big business, the insurance and medical industries stand together to crush the rights of individuals who have been harmed by wrongdoers.

The American Tort Reform Association (ATRA) is dedicated to help corporations evade responsibility for wrongdoing by undermining the civil justice system. Each year at this time ATRA issues an update to its inflammatorily titled “Judicial Hellholes” report, employing junk research to stoke public fear and foster misperception about how the legal system works. This report, like so many in the past, contains factual inaccuracies which further undermine the validity of their so-called “rankings”.

Even the Illinois Civil Justice League, which is closely allied with ATRA, disagrees with the placement of Madison County on the judicial hellhole list and has stated that Madison County and its judicial leadership have taken major steps toward improvement of its judicial system and is not deserving of the “hellhole” title.

Oftentimes, citizens can only get a fair shake by taking their grievances to court, particularly when taking on such powerful special interests. No entity, government official or business should be permitted to use its power to infringe upon the right of citizens to have their day in court.

The fact is that corporations don’t fear frivolous lawsuits. If they are truly frivolous, they are lost. They DO fear MERITORIOUS cases… actions brought by citizens against corporations producing unsafe products, polluting air and water, swindling their employees, or otherwise acting irresponsibly. They DO fear actions against doctors and hospitals who have neglected reasonable standards of practice and maimed and killed innocent patients by their neglect. Every measure that tort reformers suggest has been intended to make it harder and harder, and more and more expensive, for people to bring their meritorious cases to court. The most common goal of tort reformers is to put artificial limits on the amount of damages that can be recovered in cases where it has been proven that the damages sought to be recovered by the injured plaintiff WAS caused by the defendant’s neglect! They don’t care what the evidence shows, or what YOU believe is fair for that individual case.

The real “judicial hellhole” is the one that ATRA and its allies wish to create: a court system in which regular citizens have no prospects for fair treatment and justice because their hard-won rights have been stripped away by powerful special interests.