Massachusetts Medical Law Report Blog

It isn’t new news that hospital-acquired infections are an ongoing problem.

Here in Boston, Beth Israel Deaconness Medical Center is leading the charge to be clear with patients about its rates of infection.

And today, an official from the Department of Health and Human Services (HHS) will soon reveal a new “national action plan” to prevent hospital-acquired infection. According to Modern Healthcare (requires free log-in) the action plan was discussed at the Joint Commission’s 2008 Annual Infection Prevention and Control Conference in Chicago.

The plan, which is expected to be released in October, will reportedly focus on four types of hospital-acquired infections: catheter-associated urinary-tract infections, surgical-site infections, bloodstream infections and ventilator-associated pneumonia.

HHS is stepping up in the face of a recent GAO report that criticized the agency for a lack of a focused effort to fight the problem.

It is not common for a physician to be criminally prosecuted when his or her patient dies or is injured during a medical procedure the doctor performs.

But last week a former gynecologist in Hyannis, Mass., whose patient died while he was performing an abortion last year, was indicted for involuntary manslaughter. The arraignment will take place this week.

For a doctor, the very thought of being indicted over a medical procedure is chilling. And from all the cases I have seen and researched, I can tell you it is rare.

But when might negligence in a medical situation become arguably a crime?

Simply put, a doctor sued for negligence would be accused of breaching his duty of reasonable care to a patient, thereby causing injury. A civil negligence claim might become a criminal charge for involuntary manslaughter when the doctor’s behavior was allegedly so egregious as to constitute wanton or reckless conduct.

I was interviewed on the subject and quoted in the Cape Cod Times. Read the article here.

As the article mentioned, the doctor in this case is accused of failing to monitor the patient’s pulse or blood pressure while she was sedated and delaying calling 911 for help when he couldn’t resuscitate her. He is also accused of trying cover up evidence of the “botched procedure” to the Massachusetts Board of Registration in Medicine.

It remains to be seen what will happen in the doctor’s criminal trial, which won’t happen until some time next year.

I would be interested to hear what others think about whether a situation like this should be handled as a criminal matter.

In a matter of hours today, President Bush vetoed the bill that was intended to stop the Medicare fee cut, and the House and Senate both overwhelmingly passed the bill again, overriding the veto.

Physicians here and everywhere are breathing a sigh of relief.

“Congress did the right thing again,” said Bruce Auerbach, M.D., president of the Massachusetts Medical Society. “It voted again in favor of senior citizens, military families, physicians, and access to health care.”

Dr. Auerbach said that such a large cut in reimbursements would have needlessly jeopardized access to health care for seniors and endangered the financial viability of physician practices.

 You can read more here.

After Bush vetoed the bill protecting physicians from the planned Medicare fee cut, the House and Senate are getting to work on garnering enough votes to override it.  Sounds like it won’t be too hard to do.

See more here.

The Senate was already expected to hold the override vote this evening.

Alas, President Bush has vetoed the bill that would have protected physicians from the impending Medicare fee cut.

More details soon.

The Medicare fee cut can’t win, even if it took Sen. Edward M. Kennedy, despite battling a brain tumor, to seal the deal.

“I return to the Senate today to keep a promise to our senior citizens and that’s to protect Medicare,” Kennedy said in a statement . “Win, lose or draw, I wanted to be here. I wasn’t going to take the chance that my vote could make the difference.”

And what a difference it made for physicians who were on the edge of their seats, fearing that this year the scheduled 10.6 percent cut in Medicare payments.

Casting the 60th vote — the one needed to secure a veto-proof margin — Kennedy’s dramatic entrance onto the Senate floor today encouraged several other Democrats to cast their votes to halt the cut.

In fact, the vote means a fee increase, adding a 0.5 percent increase for the rest of 2008 and a 1.1 percent increase for 2009.

Dr. Bruce Auerbach, president of the Massachusetts Medical Society, said in a statement: “Common sense prevailed, and a crisis in care has been avoided. The Senate did the right thing for our senior citizens and our physicians. A cut that large in reimbursements would have needlessly jeopardized access to health care for seniors, as well as endanger the viability of physician practices.”

Did you hear about the woman who died in a Brooklyn, N.Y. hospital waiting room? If you don’t believe it, click here to check out the youtube video.

Seeing is believing, but my jaw dropped when I heard that the psychiatric patient had been dead for more than an hour by the time hospital workers found her.

Not surprisingly, several hospital workers were fired as a result of the incident, according to the Associated Press.

Of course, a death that goes unnoticed in the emergency room is the big news that’s been reported. But what really struck me as well is the report that the woman had been waiting in the E.R. for almost 24 hours.

Now, I know that patients sometimes wait a long while in an E.R. But can someone please tell me 24 hours is by no means the norm? That is just plain scary.

After the House blocked the bill that would cut physicians’ payments under Medicare by 10 percent, the Senate today failed just short of voting to consider the bill.

With Congress starting a one-week recess, it looks like the cut will go into effect — at least for now.

Knowing that Congress has blocked similar cuts at the 11th hour for years, The Wall Street Journal Law Blog asks: Will this be the time when time runs out?

The House voted to block a proposed Medicare fee cut that is scheduled to go into effect on July 1. The measure would also increase Medicare payments to doctors by 1.1. percent next year.

Good news for doctors?

Not so fast — President Bush is threatening a veto because the the bill would reduce federal payments to private Medicare Advantage plans, in his view reducing access to care for older Americans.

The Senate is expected to take up the measure shortly.

Read more about the legislation from The New York Times.

Meanwhile, the bill would give financial incentives to encourage electronic prescribing. If you’re still holding on to your prescription pad - or just interested - check out Massachusetts Medical Law Report’s coverage of the pros and cons of e-prescribing here.

Across the state, the primary care shortage in Massachusetts seems to be only getting worse.

We’ve all been reading about the issue for months, even years. But it was only recently that I saw the challenges we face firsthand.

In my column in the Summer 2008 issue of Massachusetts Medical Law Report, I tell the tale of my own search for a primary care doctor … which was even tougher than I ever dreamed it could be for the editor of a medical-legal newspaper for doctors in a place with such a significant number of skilled physicians. (See “One editor’s search for primary care.”)

And then today, I saw an extensive article in the Berkshire Eagle detailing the sad state of primary care affairs in Western Mass.:

“As America is living longer, gaining weight and confronting more complicated health problems like diabetes, primary care doctors are fleeing the field. Practicing doctors are retiring younger, studies show, and medical students are choosing better-paying specialties,” the Eagle reports.

And Dr. Bruce Auerbach, president of the Massachusetts Medical Society, is quoted as saying that Western Mass. is experiencing perhaps the worst crisis in primary care of all the areas in the state.

Why the worsening crisis? In the article, primary care doctors say they are increasingly stretched to see more patients in the same amount of time, with lower reimbursements and more regulations. Fewer med students are interested in primary care because the salaries are lower than those of specialists.

Meanwhile, insurers are trying to think of new ways to solve the rising tide of health care costs, such as “tiering,” which health care professionals generally oppose.
How can we solve this conflict and maintain the health of our Commonwealth if there aren’t enough primary care doctors?

Surely, there is something we can do, isn’t there?

The Eagle article struck me because it suggests one thing my optimistic self has been afraid to consider: Is there a fleeting chance we can’t solve it?