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Week in Review

by Kroger Burrus on April 24th, 2013

Kroger | Burrus Week in Review

CASES

Tawa v. Gentry
A patient experiencing heart palpitations filed suit against his admitting physician, the physician’s practice group, and a nurse practitioner alleging he experienced a stroke due to the improper discontinuation of antithrombotic therapy. The admitting physician argued that the patient’s expert was unqualified to evaluate an administrative decision not to prevent implementation of another physician’s order. The Houston appellate court concluded that the expert adequately asserted that the defendant physician was responsible for the patient’s overall care and had breached the standard of care by allowing the discontinuation of antithrombotic therapy. The trial court abused its discretion by refusing to dismiss the complaint against the nurse practitioner because the patient’s expert did not demonstrate familiarity with the standard of care for nurse practitioners.

Lo v. Gonzalez
A patient who had undergone spinal surgery filed suit against a radiologist she alleged did not diagnose a failed fusion, resulting in delayed surgical intervention and a period of resultant prolonged pain. The defendant radiologist’s motion to dismiss was denied by the trial court. The Houston appellate court held the report was inadequate because it did not provide any factual basis to conclude that the patient’s pain had increased beyond what she had already been experiencing.

Yagnik v. Hernandez
A physician found liable for the death of a patient challenged the jury’s finding of damages on the basis that jurors committed jury misconduct by averaging their individual findings regarding damages. The Fort Worth appellate court affirmed the trial court’s denial of a new trial on the basis that evidence of jury deliberations submitted by a juror may not be considered. The court also overruled the physician’s assertion that the patient’s expert established as a matter of law that the patient’s nurses were liable for his death. Although the expert opined that the nurses should have contacted the physician about his patient’s condition, this testimony did not establish that the nurses were solely responsible for the patient’s death.

CHRISTUS Health Gulf Coast v. Aetna
Several Houston-area hospitals sought to recover prompt-pay penalties from a Health Maintenance Organization for nonpayment of medical services provided by the HMO’s delegated network. The Texas Supreme Court held that the Prompt Pay Statute, which imposes penalties on HMO’s that do not timely pay for undisputed medical bills submitted by providers, requires privity of contract between providers and HMO’s. The hospitals in this case contracted with a third-party administrator of the HMO’s health plan and did not have a direct contractual relationship with the defendant HMO.

NEWS

Proposal Would Give Physicians Access to Confidential Complaint
Proposed legislation would allow physicians to obtain a copy of confidential complaints made against them. The bill would also require the Texas Medical Board to supply reports it compiles while investigating cases, including the credentials of experts.

Episcopal Diocese Approves Sale of St. Luke’s to Catholic Health Initiatives
The Episcopal Diocese of Texas has approved an agreement to transfer the St. Luke’s Episcopal Health System to Catholic Health Initiatives. As part of the transfer CHI will contribute more than $1 billion to a new Episcopal Health Foundation that will focus on meeting the needs of the area’s underserved population. CHI will also contribute $1 billion toward future investments in the health system. The transfer includes the Texas Medical Center campus, as well as hospitals located in The Woodlands, Sugar Land, Pasadena and The Vintage. CHI has committed to maintaining all current physician models and retaining all employees.

Studies Question Shorter Shifts for Doctors in Training
Efforts to relieve fatigue among medical interns and residents by capping shift hours have been questioned by a series of studies that suggest these efforts have resulted in heavier workloads as interns and residents strive to accomplish more in less time. These studies found that many interns have not been getting significantly more sleep, are not happier, and are not studying more as a result of the shift hour limits.

Quality Improvement Programs Reduce Early Elective Deliveries
A multi-state quality improvement program intended to reduce the number of elective deliveries has led to a significant reduction in early deliveries. A group of 25 hospitals in Texas and four other states that implemented a toolkit called “Elimination of Non-medically Indicated Deliveries Before 39 Weeks Gestational Age” reported that the rate of elective early term deliveries decreased from 27.8% to 4.8% over a one-year period.

Study Finds Complications Can Increase Profits
A study of 12 hospitals in South Texas found that hospitals earn more when surgical mistakes are made. The study found that when surgery goes wrong patients typically remain hospitalized for 14 days rather than three, resulting in almost $40,000 in additional profits when the patient has private insurance. The study’s authors emphasized that they did not find any suggestion of intentional wrongdoing, but noted that hospitals that succeed in decreasing postsurgical complications could experience adverse financial consequences.

ER Visits Underreported When Calculating Readmission Rates
A study conducted at a Boston hospital found that almost one-quarter of patients may return to the emergency department within 30 days from discharge. Patients who are not re-admitted will not be included in readmission rates, which under the federal health law can affect hospital penalties and reimbursement rates.

‘Big Data’ Could Lead to Big Savings in Healthcare
Data analytics used to predict healthcare needs could save between $300 billion to $450 billion in healthcare costs. Improvements in data analysis and data sharing can help reduce the number of repeated tests, predict the onset of expensive diseases to allow earlier and more effective treatment, and help optimize triage and discharge decisions.

Routine HIPAA Audits Expected to Commence Soon
Investigations into HIPAA compliance will no longer be initiated only by complaints and self-reported breaches. A pilot audit program for HIPAA compliance is already underway and routine audits are expected to commence not long after the pilot concludes in September of 2013. The audit process will involve requests for documents related to privacy policies and workplace training followed by site visits and interviews of key personnel. The Office of Civil Rights will use auditor’s reports to determine what types of technical assistance should be developed and whether to conduct compliance reviews.

Lawyer Who Rejected $8 Million Settlement Wins $130 Million Verdict
A New York attorney who declined an $8 million settlement on behalf of his clients won a $130 million verdict after a third trial of the case. The plaintiffs in the medical malpractice case lost the first trial in 2009 but obtained an order for a new trial that resulted in a hung jury last year. The suit involved allegations that errors during delivery caused the child to develop cerebral palsy.

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