Malpractice? Would you sue?

[mikeesik]

I lost a Kidney because of a car accident.

What happened was that on the evening of the car crash I was taken to the Hospital and had exploratory surgery and I needed repairs.

After being in the hospital for 13 months the Doctor, idiots; were wondering why my Blood pressure was too high.
I received a Angiogram 14 months after the fact.

What happened was on the night of the crash I received internal injuries. The stupid Doc. opened me up and closed me.
For over 14 months my right Kidney was starving of blood due to main arteries being damaged by the crash.

I tried to sue....no way could I.

I know today that I was burnt and should have been compensated.
In this country anyways, it is difficult to sue for mal-practice.

[Superman]

Originally Posted by dhoward

I disagree. The medical profession should be held to a higher standard than the guy who missed loading a bag of mulch in your truck.
They DO fuk up. They should fuk up less.

It is my hope that medical folks hit the bull's eye all the time. In the real world, they don't.

I was walking through the grocery store about an hour ago, thinking that EVERY SINGLE MOMENT of life, every friggin' breath........is so special. So sacred. Life and health are unimaginably precious. I was conscious of my breathing, and the colors and the experience.......it was indescribable. Medical people hold these treasures in the palm of their hands.

So yeah, when they fuk up, the stakes are really high. My prayers are with them. But you know what? They don't always hit bullseyes. In a sense, that is not human error.

We can sue them for their part in our odyssey but in most cases, they are not causing the danger or the misery.

IMHO.

[bivenator]

Moses, the cyst is complex and wifes age is 40. A CA125 was not done. None of the dr's are suggesting it could be cancerous.

Here is an excerpt from the CT report as it pertains to the appendix. It was this info that spurred the decision to proceed with surgery. Keep in mind that blood work was negative and symptoms did not match appendicitis.

The opacified bowel is unremarkable, Visualized portions of the appendix are normal. However, trace fluid and stranding within the right lower quadrant adjacent to the appendiceal tip is concerning for early appendicitis. Alternatively, other nonspecific etiologies of mesenteric inflammation could be considered. There is no evidence of perforation or abcess.

Within the same report the radiologist states' the ovaries, uterus and bladder appear grossly normal.

Tobra, I guess some of the replies did not fit the usual advice given on the boards when you feel somebody has done somebody wrong. Often the pimp hand is the problem solver of choice. Some responses seemed kinda soft.

I don't expect a lawsuit and don't intend to file but will leave my options open as this winds its way thru the administration. I think a fair outcome and one that I will lobby for is to forgive the CT, CT interpretation and antibiotic treatment given as a preop precaution. I will pay for the US, pain meds and lab work.

[dhoward]

Originally Posted by Superman

Snipped

I was walking through the grocery store about an hour ago, thinking that EVERY SINGLE MOMENT of life, every friggin' breath........is so special. So sacred. Life and health are unimaginably precious. I was conscious of my breathing, and the colors and the experience.......it was indescribable. Medical people hold these treasures in the palm of their hands.

....snipped

IMHO.

Please.
I'm glad you could use my post to describe your last Psilocybin experience.
IMHO.

My point is based on 12 years of lower back pain, surgeries, pain management, gastro-intestinal problems, psychological treatment, hospital stays and billing issues that my wife has endured. The medical profession tends to bring feelings like bivenator expressed on itself. Certainly, unless you've been to medical school, making an absolute diagnosis and developing a treatment plan is outside most people realm of expertise, but it's certainly not out of the question to have alternative input considered. And in general, you are the only oversight there is when it comes to your health. Simply dismissing errors and omissions does not improve the overall system. I have on several occasions considered lawsuits, when their had been misdiagnosis and actual (albeit minor) damage. What seemed to work better was to have the incidents reviewed independently, and results presented to the hospital or professional in question.
When I hear physicians complain about how little they make, and the cost of their education, it irritates me when they take a half-assed, "I know everything" approach.

[Superman]

For the record, my grocery store experience was not unusual, and not brought on by psychedelic drugs. At least, not this time.

[Noah930]

For malpractice, you have to demonstrate gross negligence. While you may have objected to the CT scan and preferred a cheaper ultrasound, the CT scan was not an inappropriate test given what you present of your wife's symptoms. Additionally, different specialists are held to different standards. So an NP working in the ER is not held to the same performance standard as a general surgeon or gynecologist. The NP may have had the wrong working diagnosis (and you can be rightfully mad at that), but that's why the surgeon was called in. And BTW, no surgeon is going to operate based upon what an NP tells him/her to do. No surgeon is going to operate based upon what an ER doc tells him/her to do. No surgeon is going to operate solely based upon what a radiologist tells him/her (which is why the surgeon went to see the CT scan for himself). BTW, fat stranding around the appendix can be an early indicator of appendicitis, and is one of the signs of appendicitis looked for in an ultrasound.

That the CT scan was apparently misread by the radiologist is a separate matter. But that brings us to a different question: who ya gonna sue? Shotgun approach (a.k.a. everybody)? Or is your ire directed specifically at the nurse practitioner? Or the radiologist? Or the CT tech? Doesn't seem like the general surgeon did anything wrong. Arguably, the NP didn't do anything wrong. The NP may have had the wrong working diagnosis, but did not order an inappropriate test given what you've told us. And while the NP may have had the intent to operate, the NP doesn't have the authority/privilege to operate. Heck, the ER NP doesn't even really have the privilege/responsibility to obtain surgical consent from your wife. Which is where the surgical consultation comes in.

I understand you're upset. You're mad at the cost of the test. You're mad that the NP didn't "listen to you." You're mad at the radiation exposure (which is generally held to be negligible from a medicolegal perspective). But that doesn't mean the care you received fell under "gross negligence." The only exception may be the radiologist's reading. Would be interesting to see if there's any "correction" in the final report. Of course, there's probably some legal disclaimer that the reading is "preliminary" and is not final until the dictation transcription is read, reviewed, and signed by the radiologist.

I wasn't there, but: Periumbilical pain can be an early sign of appendicitis. Nausea, vomiting, and bowel habit changes are not commonly associated with appendicitis. Admittedly there's usually some sort of elevated white blood cell count on bloodwork. I don't know what the physical exam was like; that, and the "look" of the patient count for a lot in forming a differential diagnosis. But it's not unrealistic to obtain a CT scan in that setting. In fact, I'd opine that there will be far more CT scans obtained in an ER setting than ultrasounds. Some of that is due to logistical and/or staffing issues. Some of that is honestly medically-related. But, again, the CT scan is more likely going to be considered the standard of care than the ultrasound.

One final random thought: traditionally it is (unofficially) taught general surgeons that there should be a 10% negative appy rate. That means 10% of appendectomies are done ... on normal appendices. If your rate of false appys is lower than that, you're not aggressive enough of a surgeon; you're going to sit on too many patients you should have operated on (at least at an earlier and more favorable time in their disease state). If your rate is higher than that, you're too aggressive. Interestingly, even with the advent of all these fancy-schmancy tests, the false appy rate hasn't changed too much over the years. And even if an appendix looks normal at time of surgery, it gets taken out anyway as SOP.

Best of luck to your wife with her cyst.

[targa911S]

Had the exact thing happen to my wife and they indeed did remove a healthy appendix and admitted to it. She had some kind of stomach flu. We tried to sue but were told by the attorney that,

" An error in diagnosis does not constitute malpractice"

end of story.

[bivenator]

Thanks Noah.

There was an addendum following the conversation between surgeon and radiologist.

I appreciate all the well wishes, we are now off to see the wizard.

[peppy]

I hope things work out.

We went through similar feelings a few years back....I'm glad we did not sue. No amount of money can make it right. We did press and get the answers that we needed to be at peace (this board helped tremendously).

On the other hand I would still like a few minutes alone with a couple of doctors from Duke.

[john70t]

Originally Posted by dhoward

Please.
When I hear physicians complain about how little they make, and the cost of their education, it irritates me when they take a half-assed, "I know everything" approach.

The above is quite true, but related to the system, IMO.
Now there are more patients, more older retiring G.P.s, more anti-efficient bureaucratic steps, more complexity and miscommunication, more siphoning of direct payment for time/labor, and more potential for catastrophic loss of a lifetime career because of a single mistake.

Basically, the modern doctor is under fire at a time when he/she is needed most.
When the big monetary voices speak, the "walls" go up.

Human mistakes happen everywhere. That is nature. Bring the problems into the open and fixing them make a better system.

[bivenator]

Got the bill over the weekend, the CT was billed at an unbelievable 6800 dollars vs. the ultrasound which was an astonding 1100 dollars. Total bill for 8 hours and a bunk diagnosis 13k. No harm though right.

Pretty high, no wait, incredibly high. I haven't even recieved the Dr bill and radiologist bills.

Its gonna be a fight to get this right.

[Baz]

Isn't there someone who audits procedures daily and acts as an independent quality control tech at a hospital?

Isn't this done automatically without a prompt?

Are there eBay ratings for hospital staff?

How do we know we're in good hands?

pretty important (life and death, right?) matters we are dealing with.

Then there's the financial aspect.

How is it looked at --- money over treatment --- or treatment over money...where is the emphasis?

Scary stuff!

[red-beard]

Scott,

Why don't you at least have a catastophic care policy on your wife? Mine kicks in at $5K and goes 100% at $8K out of pocket. The cost for both my wife and myself is $320/mth. This is Blue Cross/Blue Shield, good just about anywhere in the country.

James

[bivenator]

Thats a painful one red. We have had some rocks in the road of our marriage. She didn't want to tell me that she had let her insurance lapse and was using the money I was giving her to buy her prescriptions but not insurance. I was pushing her to get a job outside the home but she resisted tremendously. I did not know (or did not want) of the severity of her insurance bills and she did not want to tell me, as that would lend more credence to my view that she needed to work. Stupid X2

[Erakad]

I agree your best opportunity to is visit the Patient Advocate, relate you poor experience, and maybe they'll adjust the bill. Each healthcare facility has a Quality Office who's sole job is to over see provider credentialing, quality of care, patient/employee satisfaction, etc, etc. You may consider also speaking to the hospital's Administrator.

Patient satisfaction is important to healthcare organizations, tracked by accreditation agencies, and actually reviewed during the accreditation inspections. As a patient, you even have the right to speak to the inspectors at that time.Through encounters like you experienced, the hospital can improve their delivery of care, while avoiding other potential mistakes, i.e., they will learn from your experience, and improve those areas that fell short. If it was just a staff member with poor interpersonal or technical skills, that can be improved, and it will happen.

The bottom line is you need to talk to someone at that facility, and remain calm and professional. Describe the encounter(s); sequence of events, what was ordered, what was discussed, outcomes, and why it didn't meet your expectation. Ask for a written response (from the patient advocate).

Good luck, I think you'll find there will be action taken.

[Tobra]

Hope she is doing okay, ovarian cyst hurts like putting your nuts in a vise, or so I am told. My sister, who is a pretty GD tough chick, said it was orders of magnitude worse than when her about to pop appendix was plucked.

You should be able to get them to come off the price a bit, some is better than none, particularly if you approach the patient advocate/ombudsman the right way. Ask for a letter, maybe even send a letter to them. Less likely to lose your cool and take a poke at somebody if you are not talking to them face to face.

Originally Posted by Baz

How is it looked at --- money over treatment --- or treatment over money...where is the emphasis?

Scary stuff!

Scary indeed, medicolegal tends to trump all, particularly in an emergency room setting

[Zeke]

Originally Posted by bivenator

Got the bill over the weekend, the CT was billed at an unbelievable 6800 dollars vs. the ultrasound which was an astonding 1100 dollars. Total bill for 8 hours and a bunk diagnosis 13k. No harm though right.

Pretty high, no wait, incredibly high. I haven't even recieved the Dr bill and radiologist bills.

Its gonna be a fight to get this right.

I don't think you're approaching this with a very good attitude. You need to sit down with the billing dept head and ask some questions. You should be able to pay what they would accept through negotiated fee schedules with insurance companies.

But, you need to be prepared to write the check right then and there once the bottom line is understood. That's a very good reason they mask the bottom line. They don't know what you can do for them. They might have to put you into collection and take cents on the dollar or wait months and years as you stretch out payments.

All they want is to get paid and will take ready cash in exchange for a much reduced (read: negotiated) fee. This doesn't have to be a battle.

Do get a receipt that says what is being paid and that it is paid in full.

[bivenator]

Went to hospital today to speak with the patient liason. He was attentive and what I percieved to be genuinely concerned with the outcome of our visit.

I am not the person who uses the pimp hand. I am very slow to anger.

He and I discussed the visit and he will have somebody from financial services call me. I requested an itemized bill with CPT codes so that I can compare with real world payments as opposed to hospital billing.

One resource on the web, similar to kelly blue book for medical procedures, listed the abdominal CT w/contrast at 675$.

Hard to fathom how a non-insured patient can be billed at 10x the normal amount reimbursed by medicare or insurance company.

[RWebb]

I am sure they will back off on the cost & likely work out a low or no interest payment plan.

Part of what you are seeing is amortization of the capital costs for a high tech machine -- some one has to invent the things, develop them and test them besides the "mere" operation of them and then the evaluation...

Best wishes.

[cairns]

Your trip needs to be to the hospital's patient advocate. Request adjustment for the bill. Do nothing but smile, be friendly, be cordial. Find discounts for cash payments, ask what can be done to help you out. Never threaten to sue or seek an attorney. Ask what their rates to the insurance companies are and request an adjustment of your billing down to that level. Work the help me out angle.

This is the best advice I've seen on this thread. I'm glad you took it. You were lucky; your wife was lucky and the correct diagnosis was made. Hospitals are full of people and people make mistakes. But the system worked and the doctor corrected the mistake before any harm was done.

Suppose she had a malignant tumor and you refused the scan- and it metastized like crazy. You go back in three months later and there's no hope. Would you be happy you saved money on the scan?

My wife had misdiagnosed ovarian cysts for years. We didn't know it at the time but that's why she wasn't getting pregnant. By the time we knew it was too late- she was in her late forties. We could have sued her gyno big time. But for what? Spend years in a courtroom because we couldn't have kids- collect (maybe) a bunch of money?

Fate happens sometimes. You should get over it. Best of luck.