A jury awarded over $2.5 million to James Klotz in a medical malpractice lawsuit against a heart surgeon, his group practice and St. Anthony’s Medical Center in St. Louis, Mo. Mr. Klotz had been rushed to the hospital with a heart attack and a pacemaker was surgically implanted. He then developed a drug-resistant staph infection that resulted in 15 additional operations, 84 days in the hospital and the loss of his right leg, part of his left foot, a kidney and most of his hearing.
Bill Lawton, a retired policeman, went into a New York hospital for orthopedic surgery. He contracted several bacterial infections that landed him in a wheelchair for life.
Maureen Daly took her 64-year-old mother to the hospital for a minor shoulder repair. Her mother became ravaged with multiple infections, left the hospital as a quadriplegic on a feeding tube and died shortly thereafter.
These are dramatic examples of what can go wrong when a person is hospitalized. But, the sad truth is patients are potentially compromised in hospitals every day. Hospitals are now so widely perceived as dangerous places by the public that a whole movement for family advocates to protect hospitalized patients has sprung up across the country. Ensuring the safety of their loved ones by overseeing the proper administration of medications, awareness of allergies, and avoidance of infection are just a few of the justifiable concerns.
Hospital-acquired (nosocomial) infections (HAIs) result in at least 20,000 deaths in the United States every year according to the World Health Organization (WHO). Other estimates indicate the number of deaths may be as high as 100,000 a year, up to 90% of them preventable. Ten percent of all American hospital patients, or 2 million people per year, acquire a clinically significant nosocomial infection. The Center for Disease Control and Prevention (CDC) has only recently acknowledged that hospital-acquired infections, defined as infections identified at least 48-72 hours following admission, are a major public health issue.
Hospitals, by their very nature, harbor a threatening number of viral, bacterial and fungal pathogens. They also house vulnerable patients who act as compromised hosts with broken skin and impaired immune systems. In addition to the high risk of patient-to-patient transmission of infection in this environment, there is danger in many of the invasive measures used to support patients. Common invasive patient care measures such as intubation, the placement of intravascular lines and insertion of urinary catheters pose significant risks. The most common sites for nosocomial infections, in declining order of incidence, are the urinary tract, surgical wounds, the respiratory tract, the skin, the vascular system, the gastrointestinal tract and the central nervous system. Even a relatively minor nosocomial infection can prolong a patient’s hospital stay by 3 to 24 days.
The most common means of spreading nosocomial infections in hospitals is through direct person-to-person transmission or through exposure to contaminated equipment (blood pressure cuffs, stethoscopes, EKG wires, etc.), supplies and environmental conditions. The chain of transmission tends to be subtle, the result of accidental or deliberate disregard for established protocols of infection control. Preventing infections comes down to the basics: hand washing, wearing gowns and gloves when appropriate, proper sterilization of equipment, and thorough environmental cleaning.
Although hand washing has been proven to be the single most effective method to reduce nosocomial infections, studies reveal compliance with recommended hand hygiene practices is unacceptably low in hospitals. The importance of this simple protocol is routinely underestimated by busy healthcare workers. Sloppy sterile technique, rushing through procedures due to a lack of resources to adequately clean rooms between patients, failure to change and properly maintain invasive tubing, and inadequate oversight of environmental sanitation standards are but a few of the daily transgressions in hospitals. Lab coats and scrub clothes carry germs that can live up to 56 days, but many hospitals now require the staff to do the laundering of this essential apparel in their own homes.
The job of infection control in hospitals has become increasingly difficult in recent years because the microorganisms develop resistance to antibiotics, becoming “superbugs” that are bolder and tougher to fight. The fastest growing bugs in the system include MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant Enterococcus), C. diff (Clostridium difficile) and newly discovered “Steno” (Stenotrophomonas maltophilia).
For years, hospital infections were considered inevitable and an unavoidable risk. According to Marci Drees, M.D., from the Center for Outcomes Research at Christiana Care Health System in Newark, Delaware, “I think for too long we’ve had the attitude that these infections ‘just happen’ and are bad luck, but we now know that many are preventable.” And that realization places physicians and hospitals in an entirely new legal position.
The belief that infections are unavoidable shielded hospitals and doctors from liability for decades. Betsey McCaughey, former lieutenant governor of New York and chairman of the Committee to Reduce Infection Deaths (RID), a non-profit patient safety organization she founded in 2004, suggests that the overwhelming evidence that these hospital infections are preventable will cause the next wave of class-action lawsuits:
Most victims who sue will not be able to prove precisely how the bacteria entered their body while they were hospitalized. Soon, it may not matter. Jurors will be told that the defendant physicians and hospital failed to implement guidelines provided by the federal Centers for Disease Control and Prevention (CDC) or such groups as the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Institute for Healthcare Improvement (IHI). Consequently, the argument will go, these defendants should be deemed negligent and held liable for patients’ infections.
Community standards of care and best practice defenses won’t overrule plaintiff attorneys’ insistence that a patient’s infection alone is evidence enough that caregivers breached their duty. In 2004, Tenet Healthcare Corporation agreed to pay $31 million to settle 106 lawsuits by patients who contracted infections after heart surgery at Palm Beach Gardens Medical Center in Florida. Since then, numerous lawsuits have been filed against hospitals in Florida, Massachusetts, Utah and Kentucky by infected patients. Hospitals being sued are saying their infection rates are within national norms as tracked by The National Nosocomial Infections Surveillance (NNIS) system developed by CDC, although as of December 2008, 16 states and Washington D.C. had no laws on public reporting of hospital infections.
Medicare has determined the acceptable rate of hospital-acquired infections is zero. Effective October 1, 2008, the federal program has stopped reimbursing hospitals for treatment of several types of preventable infections. These infections are so obviously preventable that Medicare authorities call them “Never Events”, meaning they should never happen. HAIs are costly, adding an estimated $30.5 billion to the nation’s hospital expenditures each year. Patients, insurers and taxpayers have been assuming much of the cost. Hospitals are now barred from billing patients for what Medicare doesn’t pay, thereby having to absorb even more of the expense. Preventing infections is fast becoming a matter of “life or death” for a hospital’s financial future as it faces potential loss of reimbursement and an onslaught of lawsuits.
Stephanie Johannsen, RN, BSN, MSHA, CLNC, has over 20 years of experience in the health care industry. Her expertise includes the areas of hospital administration, managed care at HMO’s and insurance companies, drug and device clinical trials, and FDA drug and device recalls. Infection Control has been an area of interest since working as a manager in the Operating Room and in hospital Supply Processing and Distribution. For more information and/or comprehensive expert service with your next medical-related case, contact: Johannsen Legal Nurse Consultants, 619-876-2371, firstname.lastname@example.org.>