You want to think patients are safe in their hospital beds. Think again. Take the gruesome case of Dominic Marion Jr., who a week after undergoing double knee surgery at a Phoenix hospital in 1996 died and had his genitals removed.
It's unclear exactly when the mutilation occurred, other than in the early hours of Halloween morning 1996. Also at issue is whether Marion's death from a heart attack (he'd had several before) was related to the mutilation. What is clear is that Marion, who was 58 and the father of four adult children, had his genitals removed while he was still in his hospital bed at the now shuttered Phoenix Regional Medical Center.
Last month a Phoenix jury found the hospital responsible for the mutilation and ordered the hospital's then-owner, HCA--The Healthcare Co., to pay the family $2 million; the jury cleared the company in Marion's death.
"I believe, and the jury clearly agreed, that the principal problem centered around (the hospital's) faulty security system," says Grant Woods, an attorney for the Marion family who was Arizona's attorney general from 1991 to 1999.
Especially troubling is that Woods says trial testimony revealed that in 1995 the hospital had an independent study done of its security system; the study listed 50 needed improvements, most of which weren't addressed. "The hospital had no alarms and no internal security cameras," Woods says. "There were plenty of opportunities to commit this crime and not get caught."
Hospital security is a pressing issue; recently a troubled woman kidnapped a newborn from the maternity ward at Loyola University Medical Center in Maywood, Ill. The baby was later found dead. Officials blamed faulty security.
"We're hopeful that this jury has sent a message to hospitals that they will be held responsible for a reasonable level of security for their patients and their employees," Woods says.
Dead payments in Ohio. HHS' inspector general's office and the Ohio state auditor's office released a singular report last month detailing how from 1994 to 1999 the Ohio Department of Human Services made 114,780 Medicaid payments totaling almost $82 million to 4,113 different healthcare providers "for services provided to 26,822 apparently deceased recipients."
Alwyn Cassil, spokeswoman for the inspector general's office, says Ohio is the only state she knows of that has done such an audit. The federal government made $20 million in fee-for-service Medicare "overpayments" for deceased recipients last year, Cassil says. "I was kind of surprised. That's a relatively small pool for that amount of money to come out of."
The human services department is trying to recover the overpayments, but $14 million--$8.5 million of which is the federal share--remained uncollected as of Sept. 30, 1999, says spokesman Jon Allen.
Providers don't bill the state; the state makes its monthly Medicaid payments based on data maintained at county human services departments, according to Allen. Ohio officials are working to shorten the length of time between when a Medicaid recipient dies and when that person's record is updated, Allen says.
Ohio officials want to get legislative approval to put into place a system where providers directly bill the state.
"Under direct billing . . . we can get to the root of the issue: `Did you do this knowingly?' " Allen says. "Under direct billing, providers won't be able to say, `Oh, well, the county lost the information.' "
That sounds good. But there's more. While some lag time is unavoidable, according to the audit, in more than 30% of the cases the overpayments went on for more than five months; in more than 10% they continued beyond 11/2 years--some for more than 31/2 years. Even more, the audit details how "a small number of providers accounted for a disproportionate share of the overpayments."
But still, Allen says, Ohio officials are not investigating the possibility of fraud among some providers. What Outliers wants to ask is: Why not?
The write stuff. Paul Hackmeyer, M.D., is worried about one of medicine's most notorious problems: horrible penmanship.
So Hackmeyer, chief of staff at Cedars-Sinai Medical Center in Los Angeles, wrote a prescription of his own: a three-hour handwriting class teaching physicians how to write in italics.
The May 9 class began with a humbling request: "Pretend like you're in first grade." For the next three hours, 60 doctors spent a grueling night confronting one of their own worst enemies.
Illegible handwriting has been taken more seriously since a scathing report by the Institute of Medicine last year concluded that medical errors, including "written miscommunication," could be responsible for as many as 98,000 deaths per year. Last October, a Texas jury blamed a physician's illegible handwriting in the accidental death of a man who had a heart attack after receiving the wrong prescription.
Marshal Fichman, a kidney specialist whose before and after handwriting samples are featured below, said the class was helpful. "I'm not a superstar in that department, but it's definitely improved. The key factor is how much time you take to write," he said.
And when he's in a hurry? "It's not as illegible because the italics slow you down."