Medical Practices a Place for Patient Concern, Not Complacency

While a lot of my thoughts for this posting come from my own experience, many are generated by my colleagues. Recently one of our company executives, Steve Lempp, sent a companywide e-mail about a disturbing and eye-opening book he had read.

I thought I’d share Steve’s thoughts for this blog as I find them enlightening, thought-provoking, and important.

My son is an epidemiologist. He shared a book with me that is troubling on many levels. The book, "A Never Event," by Evelyn V. McKnight* and Travis Bennington, walks readers through the establishment of an oncology clinic in Freemont, Neb., and how a series of events in the early 2000s ultimately led to one of the largest Hepatitis C virus (HCV)outbreaks in the United States.

HCV is again at the forefront of the news with a Nevada jury awarding $24 million in compensatory damages and a staggering $500 million in punitive damages to two health plan members treated by a gastroenterologist for unsafe injection practices. The awards went against two local health insurance companies that referred patients to the in-network gastroenterologist alleging the companies should have known about the unsafe practices.

While the health plan believes it has strong grounds for appeal, the case clearly highlights an issue of importance to all. The lesson to me in all the recent high-profile cases we’ve been hearing about is that when it comes to patient safety, everyone needs to become more vigilant, more aware and more active.

Why? Because, unfortunately these are not isolated cases; there are now equally troubling cases coming to the forefront. An oral surgeon in Oklahoma could face criminal charges for "egregious" disregard for common patient safety techniques that have led to at least one confirmed case of HIV, 57 confirmed for HCV and testing for more than 7,000 patients.

Where to begin on the issues to address as an industry? Here are just a few thoughts:

1. We will have to change our perception of HCV patients - a population often categorized as drug addicts who share needles or sexually active individuals. It could now be anyone.

2. We will have to work harder to educate healthcare providers on the importance of extreme caution when dealing with any medical procedure involving the potential for transmission of pathogens. An ideal place to start is prevention guidelines from the CDC to be found here.

3. We need to empower healthcare workers - including nurses and physician colleagues - to speak up when they see something wrong or troubling. It’s hard to believe that someone at these medical facilities didn’t have some level of concern (in the Nebraska case, they did). Perhaps they felt threatened or that their voice would not be heard. Physicians need to be very clear that if they turn a blind eye - or worse yet, threaten or intimidate staff who raise issues - they are at serious risk not only legally, but also in terms of insurance coverage.

4. We will need to inform and educate patients - any patient - from a cancer patient receiving a transfusion to a diabetic to someone getting a vitamin shot to be keenly aware of the safety steps taken in their medical providers’ office and to speak up if something doesn’t seem right. This may be overkill, but I personally won’t take an injection unless I see the healthcare provider open a sterile product and take all necessary safety procedures. Perhaps even a patient checklist in the exam room is warranted. The CDC has a "Know More"Campaign and educational materials on its website as a start.

Last, I would hope that cases such as these cause everyone in the healthcare industry - from providers to health plans to risk managers, and even those of us in the medical insurance community - to pledge to become more active, involved and committed.

As I said, I thought Steve’s comments were so important they should be shared. These cases didn’t happen in a vacuum. Someone, somewhere didn’t do their job. And someone, somewhere could have and should have done more.

A $500 million judgment is huge; it's a wakeup call to the industry. But the bigger issue should be our own realization that thousands of people are now dealing with a potentially debilitating and deadly disease they should never have acquired. We can do better as an industry and I think that cases like these will help us all to step up and take the necessary actions to ensure we never see incidents like this again.

*Ms. McKnight, one of the authors, was a cancer patient infected due to improper procedures employed by the practice.