FIRST DO NO HARM 8 Ja nua ry 2008 A Pa tie nt I nve stig a tio n - - PDF document

11/6/2014 1 WHAT HAPPE NE D T O ME ? 8 Ja nua ry 2008

A Pa tie nt’ I nve stig a tio n into Ne g a tive Surg ic a l Outc o me s

DAVI D ANT OON

T his pr e se ntation is the e xpr e ss opinion of David Antoon

FIRST DO NO HARM

VICT IM HAR M

 Pe rma ne nt Physic a l Disa b ling Ha rm  Disa b ling De pre ssio n/ PT SD  L

• ss o f

Re la tio nships/ I ntima c y  L

• ss o f E

mplo yme nt  L

• ss o f Me dic a l Be ne fits

 Divo rc e  Suic ide  L e g a l Atte mpts Vic tim c re dib ility is a tta c ke d “E xpe c te d Outc o me ” T

• rt Re fo rm

L e g a l E xpe nse s  No Disc lo sure - “Wha t Ha ppe ne d to Me ? ”  No Clo sure

Me dic ine vs Aviation

 Ne g a tive Outc o me (Me dic a l o r Avia tio n)

• Ba d L

uc k? de sc rib e d b y Do c to r

• Or Ca usa l F

a c to rs?

Me dic ine vs Aviation

 Airc ra ft Ac c ide nts - Ne xus o f F a ilure s

• Huma n F

a c to rs

• F

a tig ue

• F

a ilure to tra ining

• F

a ilure to e va lua te

• Stre ss
• Alc o ho l/ Drug s/ Me dic a tio n
• Ma na g e me nt/ Ove rsig ht
• We a the r
• E

q uipme nt (Airc ra ft o r g ro und)

11/6/2014 2

Me dic ine vs Aviation

 Airc ra ft Ac c ide nt I nve stig a tio n

• I

nde pe nde nt I nve stig a tio n

• Multidisc iplina ry Bo a rd Me mb e rs
• De te rmine Ac tua l a nd Pro b a b le Ca use s
• Pub lic Re le a se o f All I

nfo rma tio n

• No Co nfide ntia lity
• No Co nc e a lme nt
• T
• ta l T

ra nspa re nc y

Me dic ine vs Aviation

 Me dic a l Ne g a tive Outc o me I nve stig a tio n

• Pe e r Re vie w (Unlike ly)
• No t I

nde pe nde nt

• Co nfide ntia l
• No T

ra nspa re nc y

Ove r vie w

 Pa tie nt Pre pa ra tio n/ Re se rva tio n Afte r Dia g no sis  Ne g a tive Surg ic a l Outc o me / Ob se rva tio ns  I nve stig a tio n (Airc ra ft Ac c ide nt Me tho do lo g y) Me dic a l Re c o rds Se a rc h Cre de ntia ls E xa mina tio n Othe r Vic tims Co nflic t o f I nte re st

Ove r vie w

 Ag e nc ie s Co nta c te d  Omb udsma n (Co nfide ntial)  Ho spital CE

O re q ue sting Pe e r Re vie w (No Re spo nse )  Me dic a l Bo a rds (Ohio , Uta h, I ndia na , I

• wa ) (Co nfide ntia l)

 Blue Cro ss (E mplo ye r) a nd He a lth Ne t F e de ra l Se rvic e s (Go vt) (No Re spo nse )  CAQH (T

• p Se c re t !)

 Ohio De pa rtme nt o f I nsura nc e (Co nfide ntial)  Ohio De pa rtme nt o f He a lth  CMS (Ce nte rs o f Me dic a re / Me dic aid Se rvic e s)  Jo int Co mmissio n (COI , Co nfide ntial)  HHS/ OI G, CMS/ OI G (L a c k o f Re so urc e s)  HHS/ Offic e o f Civil Rig hts (HI PAA)  F DA (Co nfide ntia l – Wa rning L e tte r)  Ohio I nspe c to r Ge ne ra l (Ove rsig ht o f Me dic a l Bo a rds)  Ohio Atto rne y Ge ne ra l (Only I nve stig ate s Me dic a l F ra ud)  Ne ws Me dia (Co nflic ts o f I nte re st, Ce nso ring o f Co mme nts)

PAT IE NT DE CISIONPR E PAR AT ION

 R

e ad Patr ic k Walsh’s Book - SUR VIVING PR OST AT E CANCE R

 Vo lume Ce nte r  Re c o rd o f Po sitive Surg ic a l Outc o me s  Surg e o n with Hig h Vo lume E xpe rie nc e  Surg e o n who is Bo ard Ce rtifie d  Surg e o n with Po sitive Surg ic a l Outc o me s  Assure that o nly this surg e o n will pe rfo rm the pro c e dure

11/6/2014 3

R e pr e se nte d by Sur ge ons On Hospital We bsite

R e pr e se nte d by Doc tor R e pr e se nte d by Doc tor

11/6/2014 4

 “Ne a rly fo ur ye a rs a g o , g o ve rnme nt inspe c to rs inve stig a ting a c o mpla int b y re tire d Air F

• rc e Co l. Da vid

Anto o n thre a te ne d to c ut o ff Cle ve land Clinic fro m re c e iving Me dic a re pa yme nts a fte r b e ing sto ne wa lle d b y ho spita l o ffic ia ls. T he Vie tna m c o mb a t ve te ra n ha d a c c use d the ho spita l o f fa iling to fully inve stig a te his c ha rg e tha t so me o ne o the r tha n his a utho rize d surg e o n ha d pe rfo rme d pro sta te c a nc e r surg e ry a nd le ft him g ra ve ly injure d..”  “All o f the vio la tio ns we re re po rte d to the ho spita l's b o a rd o f g o ve rno rs a nd to Co sg ro ve , who in a t le a st

• ne c a se wa s pe rso na lly c ite d fo r syste mic

ma na g e me nt fa ilure . T he y c ite d him fo r fa iling to e nfo rc e a n a de q ua te info rme d-c o nse nt syste m a fte r he a dmitte d so me pa tie nts we re no t to ld a ro b o t wo uld b e use d in the ir pro c e dure ..”  “A thre e -mo nth Mo de rn He a lthc a re a na lysis o f hundre ds

• f pa g e s o f fe de ra l inspe c tio n re po rts re ve a ls the 1,268-

b e d ho spita l spe nt 19 mo nths o n “te rmina tio n tra c k” with Me dic a re b e twe e n 2010 a nd 2013 a s a re sult o f mo re tha n a do ze n inspe c tio ns a nd fo llo w-up visits trig g e re d b y pa tie nt c o mpla ints..”

11/6/2014 5

 “… Ohio ho spita l inspe c to rs a g a in thre a te ne d to suspe nd Cle ve la nd Clinic 's pa rtic ipa tio n in Me dic a re a fte r ho spita l o ffic ia ls to ld a pa tie nt the y ha d no e vide nc e tha t a surg e o n ne g le c te d to re mo ve a suture ne e dle a fte r surg e ry. I t wa s o nly unde r q ue stio ning b y a g o ve rnme nt inspe c to r tha t a ho spita l o mb udsma n la te r a dmitte d ha ving a n X-ra y o n file sho wing the le ft-in ne e dle , a c c o rding to inspe c tio n re po rts o n file with the CMS..”  “T he b usine ss-b a c ke d L e a pfro g Gro up, fo r insta nc e , g a ve the Cle ve la nd Clinic a D whe n it e xpa nde d its sa fe ty g ra de s in 2012 to inc lude fa iling g ra de s. T he g ra de impro ve d to C la st ye a r.”

A R

• botic Sur

ge r y Disaste r