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Sterigenics and Cancer

You may have heard or read the front-page news about Sterigenics recently. There is evidence that this Chicago-area business has for decades been releasing toxic, cancer-causing fumes into the Willowbrook community. There is further evidence that some government entities knew about the great public risk this entailed, but did not alert the public.   As the evidence against Sterigenics continues to rise, so too do the number of personal injury and wrongful death lawsuits against the company.

Sterigenics

Sterigenics is a plant in Willowbrook, located in DuPage County, west of Chicago. As part of its operations, Sterigenics routinely emits the gas ethylene oxide. Ethylene oxide is used to sterilize medical equipment, such as surgical trays.  Sterigenics operates over 40 facilities in 13 countries.

Cancer Clusters

According to the CDC (Centers for Disease Control), when a greater-than-expected number of cancer cases within a group of people in a certain area over a certain amount of time appears, it may be a cancer cluster. Could there be a cancer cluster in Willowbrook?

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For over a decade, proponents of tort reform have argued medical malpractice reform is needed to reduce spiraling healthcare costs. If these reforms were implemented, tort reformers promised reduced healthcare costs. Opponents of tort reform argued medical malpractice reforms would have no significant impact on healthcare costs, as medical malpractice lawsuits account for less than 1% healthcare costs. So, who was correct?

According to recent figures, the total number of medical malpractice payouts on behalf of doctor fell to its lowest level in a decade–down 28% since 2003. In addition, the total value of medical malpractice payouts is also significantly down. However, the nation’s healthcare expenses did not followed suit. Instead, healthcare costs have risen a startling 58% in the last decade. This confirms that medical malpractice costs have no appreciable impact on healthcare costs. Indeed, if medical malpractice costs were a major driver behind soaring healthcare costs, the substantial reduction in medical malpractice payouts over the last decade should have significantly lower healthcare costs.

In 2012, the total number of medical malpractice payouts was 9,379 compared to 16,565 in 2001. In 2012, the total value of medical malpractice payouts was $3.14 billion versus $4.41 billion in 2003. Despite these significant reductions in medical malpractice payouts, healthcare costs over doubled in the last decade.

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As a patient, you rely on your doctor to recommend the best medication and treatment for you based on their extensive knowledge and experience. Most doctors do keep their patients’ best interests in mind while making medical decisions. However, some doctors may be swayed by payments–sometimes substantial–from drug and device companies. If a doctor recommends the wrong drug or medical device because of financial interest and that decision harms the patient, the doctor is guilty of medical malpractice.

The practice of medical device and drug companies providing gifts and payments to physicians is nothing new. A recent study published by the New England Journal of Medicine found that over two-and-a-half years, physicians licensed in Massachusetts received over $76 million from those companies. This figure does not gifts of less than $50. Doctors received these payments for attending lectures, dinners, or conferences sponsored by companies hoping to promote their products, raising the question of conflict of interest. For example, if a patient sees two different doctors for a medical issue and one recommends surgery while the other opts for a wait-and-see approach, the patient might wonder if one doctor has some kind of relationship with the device and drug industries.

Currently a few states have laws requiring corporations to disclose payments to health providers. The Physician Payment Sunshine Act goes into effect in 2014, making corporate payment information available nationwide. Having this sort of transparency about financial influences on physicians will mean better options for patients. They will be able to seek out information when picking a doctor or making a decision about a medical procedure. Patients may also consider checking payment information when a doctor switches a long-time prescription medication from a generic to a name brand.

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When a medical malpractice lawsuit results in a “catastrophic” payout, or an award of over a million dollars, the case often makes headlines in the media and in legal circles. In some of the media coverage, researchers even claim these lawsuits are frivolous and create a heavy financial burden on the healthcare industry. But a new study once again shows that these assertions are not only exaggerated, they are completely incorrect.

A group of researchers from the Johns Hopkins School of Medicine examined the catastrophic payouts by U.S. doctors (through their insurance companies) between 2004 and 2010 listed in a government database of medical malpractice payments. These awards most commonly involved injury to or death of an infant, quadriplegia or brain damage resulting from a procedure, or an anesthesia problem. Their findings showed that though the high-profile cases attracted attention, the actual impact on the nation’s healthcare spending was negligible–the cases paid an average of $1.4 billion yearly, which works out to a mere five-hundredths of a percent (.05) of money spent on healthcare in the U.S.

According to the research team, the true financial drain on the healthcare system is the cost of unnecessary services, which can reach up to $60 billion a year. Study leader Marty Makary, an associate professor of surgery and health policy, says, “the real problem is that far too many tests and procedures are being performed in the name of defensive medicine, as physicians fear they could be sued if they don’t order them.” Makary believes this finding illustrates why efforts to create malpractice caps are misguided and will have little impact on overall healthcare spending. “It’s not the payouts that are bankrupting the system–it’s the fear of them,” Makary says.

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A recent study published in the Morbidity and Mortality Weekly Report found that as many as 3 in 4 patients infected with hepatitis C virus (HCV) are unaware of the infection. These patients would have initially tested positive for HCV antibodies, but never received a follow-up RNA test to determine if they still harbored the virus in their system. These carriers are at a much higher risk of developing liver cancer, but because they aren’t tested further, don’t receive the medication that could save their lives. Physicians suspecting HCV should order timely test and treat the disease. Failing to do so may cause serious harm and lead to a medical malpractice lawsuit.

Baby Boomers, those born between 1945 and 1965, make up nearly a quarter of the U.S. population and are particularly at risk. In 2012, the Centers for Disease Control and Prevention (CDC) recommended that all Baby Boomers be tested for HCV. In studies of HCV infections reported from 8 sites nationwide, the CDC found that 67% were from this age group. Additionally worrying is the fact that nearly three-quarters of deaths involving HCV infection occurred in this demographic group. In the past, HCV testing was reserved for those with known risk factors, like use of injection drugs, blood transfusions, or organ transplants, so it’s likely that many Boomers have never been tested.

Left untreated, a hepatitis C viral infection can be life-threatening, leading to serious liver damage. Liver cancer is the most rapidly increasing cause of cancer-related deaths in the U.S., and the number of deaths caused by HCV has risen to 15,000 per year, which is double the number from a decade ago. A physician fails timely diagnose and treat hepatitis C may be guilty of medical malpractice.

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Going through a surgical procedure can be a nerve-wracking event. As a patient, you put your trust in your surgeon’s experience and skill to provide you with excellent care. But even in the best situations, complications can occur–either during the operation or following the procedure, sometimes leading to medical malpractice lawsuits. While doctors and patients alike hope to avoid any kind of surgical errors, hospitals have been shown to gain financially from post-surgical complications.

A new study of a group of southern hospitals reveals that the “contribution margin,” or profit per patient, is higher when patients have one or more complications following surgery. The study’s senior author, Dr. Atul Gawande from Brigham and Women’s Hospital and the Harvard School of Public Health, emphasizes that this information is not to suggest that hospitals are counting on surgical complications to bring in more money. The real problem lies in the way hospitals are paid for patients covered by Medicare or private insurance versus those who pay out-of-pocket or are covered by Medicaid.

Researchers evaluated the hospital group’s financial information over the course of caring for over 34,000 patients in 2010. Close to 2000 of those patients experienced one or more complications following surgery. Privately insured patients who experienced no complications netted the hospitals an average of $17,000 of profit; for those with one or more complications the profit jumped to an average of $56,000. Comparatively, hospitals lost money in all surgeries involving Medicare patients and patients paying out-of-pocket, regardless of complications.

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Doctors who work in high-risk specialties, like surgeons, are practically guaranteed to face a medical malpractice claim during their careers, according to a 2011 study by the New England Journal of Medicine. The study, which analyzed malpractice claims from a large liability insurer over a period of 14 years ending in 2005, found that 99% of doctors in high-risk specialties, like neurosurgeons, thoracic-cardiovascular surgeons, and general surgeons, were likely to face a claim by age 65. In contrast, only 75% of physicians in low-risk specialties could expect a claim during their career.

Annually, only 7.4 % of doctors across all specialties faced a malpractice claim, according to the study, but within that percentage there was a significant variation between specialties. Neurosurgeons were most likely to face a claim at 19.1%, with thoracic-cardiovascular surgeons and general surgeons close behind, at 18.9% and 15.3%, respectively. Less likely to face a claim were lower-risk specialties like family medicine (5.2%), pediatrics (3.1%) and psychiatry (2.6%). Additionally the study found that within the percentage of doctors facing claims annually, only 1.6% of the claims were compensated.

In regards to payment of claims, the study discovered that there was no correlation between the specialties with the highest number of claims and the highest average payment. For example, although neurosurgeons faced the highest number of claims in a year, their average payment was calculated at $344,811, as opposed to the average payment for a claim against a pediatrician, calculated at $520,924. Additionally, payments exceeding $1 million, defined in the study as outliers and accounting for less than 1% of all payments, were mostly attributed to lower-risk specialties including obstetrics/gynecology, pathology, and pediatrics.

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When a patient goes to a doctor or hospital, he or she puts their health and well-being in someone else’s hands and expects the best care possible. While this is the case in most situations, unfortunately doctors and healthcare providers can and do make mistakes–this is known as medical malpractice. When these mistakes have devastating or even tragic consequences, patients and family members may feel the need to hold health professionals responsible for their negligence and file a medical malpractice lawsuit. While patients need to have some form of recourse for conduct that falls below the standard of care, the amount of time health professionals spend dealing with medical malpractice lawsuits can affect patients and doctors across the entire industry.

A recent study of the malpractice claims records of more than 40,000 doctors, published in Health Affairs, found that most claims took nearly two full years from the beginning of the lawsuit and nearly four years from the actual event to come to resolution. If a case resulted in payment to a plaintiff or involved more serious patient injuries, the suit often took even longer to resolve. The study also examined how much of a doctor’s career is spent on open claims. The findings showed that an average open claim takes four years of a doctor’s time as he or she works through the lawsuit, with certain specialists, like neurosurgeons, devoting even more of their professional lives to legal issues.

Drawn-out legal battles can have adverse effects on patients as well. A medical malpractice case that successfully creates change in a doctor’s actions, a facility’s philosophy or even throughout the industry can benefit many patients. But if the lawsuit is tied up in court, these improvements are delayed as well. Studies also show that patients would prefer that physicians acknowledge medical errors and apologize for the mistake early in the legal process rather than deal with a lengthy claim that could delay compensation.

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Welcoming a child into the world is a happy time for a family but, even with the best possible care, problems can arise. When a birth injury occurs due to a medical malpractice, the consequences can be devastating to the child and the family. A recent study conducted by the federal Centers for Disease Control and Prevention found that in the years 1999-2009, birth injury and complications including kidney failure, respiratory distress, and cardiac arrest related to childbirth increased by 75%. Even the days immediately following childbirth proved less safe, with severe complications more than doubling during the same time period.

Demographic changes can account for some of the increase in complications. Many women are delaying parenthood until their late 30s and early 40s and experiencing issues that go along with advanced maternal age. The steady rise in obesity in the U.S. means that more expectant mothers are overweight, so their health may be compromised even before their pregnancies. Chronic conditions, such as diabetes or liver disease, can also put women at higher risk for complications throughout pregnancy. However, the most common cause of death after childbirth, severe bleeding, or hemorrhage, can affect even healthy women with no history of problems during pregnancy.

Danielle Dargatz, a 25-year-old Milwaukee woman, had experienced a healthy pregnancy and wasn’t considered high-risk for complications when she delivered her daughter in 2012. Unfortunately, following the birth she began hemorrhaging and her doctor was unable to stop the bleeding with medication and other traditional measures. A surgical team was called in to perform an emergency hysterectomy. Ms. Dargatz’s story has a happy ending, but some women and their children aren’t as lucky.

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Very few of us have jobs in which there are no distractions. When distractions occur, they often impact our ability to perform our job effectively. According to a recent study, doctors are also not immune to the adverse impacts that distractions have on job performance. Specifically, the study found that distractions during surgery significantly increased the rate of surgical errors by residents.

As reported in the Archives of Surgery, participants of the study consisted of 18 general surgery residents from Oregon Health & Science University of Portland. Each of the 18 general surgery residents was required to perform a simulated laparoscopic cholecystectomy, which involves removing the gallbladder, with and without distractions. The commonly cited distractions used during surgery were expected movements seen by the observer, a ringing cell phone answered by the observer, conversations between the observer and a third party unrelated to surgery, noise from a dropped metal tray, and a question about a topic unrelated to the surgery.

Out of 18 surgeries, distracted residents made eight medical mistakes. Residents who were not distracted made only one surgical error out of 18 operations. The authors of the study concluded that realistic operating room distractions and interruptions greatly increased the likelihood of surgical mistakes–at least for novice surgeons. This study is important because it shows unnecessary distractions and interruptions significantly increase the rate of adverse patient outcomes and, by extension, the rate of avoidable medical malpractice lawsuits.

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