Tomorrow (2/15), the Washington State House Committee on Judiciary is scheduled for a public hearing on a bill that would allow an individual whistleblower to file a suit against a Medicaid-contracting provider for fraudulent billing of our state’s Medicaid program.  The Senate passed its version of the bill last week.

This new law would give the “relator” (a.k.a whistleblower) with inside information the power to bring a civil suit through his or her own attorney; the Office of the Attorney General could then review the suit (which would be filed under seal) and choose whether to intervene in the suit on the state’s behalf.  What is most remarkable about this bill is that a relator can receive between 15% to 30% of the recovery, if any.  This gives whistleblowers big financial incentive to call out billing fraud perpetrated by their employers.

I blogged last week about the high percentage of medical errors that go unreported.  When you know something went wrong, do not assume that the error triggers action on by the hospital, clinic, or practice group. All too often, errors are unreported and there is no investigation whatsoever.

But what if you aren’t sure? Doesn’t the doctor or hospital have a duty to tell you if something goes wrong with your care?  It turns out that about 1/3 of doctors do not think it is important to disclose serious medical errors to their patients.

In the wake of the recent Health Affairs survey that gave us this insight, Dr. Otis Brawley wrote a nice piece for CNN (Dishonest Doctors, Why Physicians Lie).  “Some doctors do not admit error out of fear of litigation,” Dr. Brawley says. “But my experience is that the discomfort of addressing one’s own failings or weakness is more commonly the reason for not coming forward.”

In my experience in litigation, I also see providers looking out for each other and not disclosing errors because it may implicate coworkers.  While this may be well-intentioned, it leaves patients in the dark about their own care and safety.  In the worst cases, providers actually lie to to patients and their families, rather than admit what has happened.  Once the lie is told, it is even harder to come clean and inform the patient of errors.

Dealing with suspicion in your own care can be tricky.  Patients worry about their ongoing relationship with a provider if they ask too many questions.  Plus, no one wants to place blame where none is due.  If you don’t feel like your doctor is being honest with you, you are not alone.   This is why it is good to call an attorney you can trust to discuss your situation confidentially.

I spend a lot of time talking with potential clients about how a lawsuit works.  Many people have the misconception that when something goes wrong, there is mandatory reporting and an internal investigation, even before they call me.  I always say that just because there should have been an investigation, that does not mean there was one. In the wake of a recent federal report, we know that only a very small percentage of patient harm events are reported:

Hospital incident reporting systems captured only an estimated 14 percent of the patient harm events experienced by Medicare beneficiaries. Hospitals investigated those reported events that they considered most likely to lead to quality and safety improvements and made few policy or practice changes as a result of reported events. Hospital administrators classified the remaining events (86 percent) as either events that staff did not perceive as reportable (61 percent) or as events that staff commonly report but did not report in this case (25 percent). 

-OIG Report, Hospital Incident Reporting Systems Do Not Capture Most Patient Harm

ABC News reported on the OIG conclusions, and also cited a study published in 2011 by Health Affairs, showing that approximately one in three hospitalizations result in hospital-related injuries, and nearly half of those are preventable.

If you are concerned about negligent care you have seen or experienced, don’t assume that something is already being done to address the problem.

Like so many recent articles on opioid pain medication, this article in the Huffington Post pits people in pain against the oversight of prescribers. Unfortunately, it isn’t that simple.  Regular people with legitimate pain can find themselves in a downward spiral when doctors negligently prescribe long-term narcotic drugs.  In the worst cases, these drugs can cause patients to suffer respiratory arrest when their cumulative effects cause the body to stop breathing on its own.  In other words, people die in their sleep.  This is not just happening to people buying drugs off the street; it is happening to regular people taking medications prescribed by their doctor.  Hopefully, the recent attention to this topic, including the recent Seattle Times series, will focus on quality pain treatment beyond just throwing pills at patients in pain.  If you have questions about the negligent prescription of pain medications, call us.