An administrative nurse faces a trial and a ten year prison sentence if convicted of reporting a doctor for practicing bad medicine. The official charge is "misuse of official information" a third degree felony in Texas. The prosecution will argue that Anne Mitchell has a history of making inflammatory statements about Dr. Rolando G. Arafiles, Jr. Mrs. Mitchell has stated that as a nurse, she had a professional obligation to report the doctor for improper prescribing and surgical errors-including a failed skin graft that Dr. Arafiles performed without surgical privileges. According to the NY Times article, Arafiles also sutured a rubber tip to a patient's crushed finger which was later flagged as inappropriate by the Texas Department of State Health Services. When informed of the complaint, Arafiles complained to his friend who happened to be the Winkler County Sheriff. The Sheriff obtained a search warrant and seized the nurse's computer. He found the letter and she was arrested. It's not clear from the article how the sheriff determined Mitchell to be a suspect.
The case has received attention from the legal and medical communities in Texas and across the country. Legal experts have argued that Mitchell appears to be protected under Texas whistle blower laws.
While Dr. Arafiles has friends in high places, the law would appear to side with a healthcare professional who reports a doctor for questionable medical practices.
In a 4-2 vote, the Illinois Supreme Court has overturned a five year state law capping damages in medical malpractice lawsuits. The Court found that the law was unconstitutional because it limited the compensation injured victims could receive for pain, suffering, and other non-economic damages. The majority opinion concluded that the law violated the state Constitution's separation of powers clause by imposing decisions that are properly reserved for juries and judges.
The decision was a major victory for consumers and injured victims of medical malpractice. Approximately 30 states have laws that limit non-economic damages. 11 states have overturned such laws.
The Court's ruling came in the case of Abigaile Lebron, who suffered severe mental impairment after a botched Caesarean section four years ago.
The Checklist Manifesto is an important new book authored by surgeon Atul Gawande. In the book, the author discusses the importance of preparation (using a checklist) to ensure that such things as medical errors are avoided. Gawande makes the point that it takes a system of redundancy to avoid common medical errors. While the book is not solely intended for the healthcare profession, doctors and hospitals should read this book and incorporate his ideas on how to improve healthcare and avoid errors in the future.
Some of his suggestions may appear obvious. For instance, he notes that in a surgical setting those in the room should know each others' names. That may be obvious, but what procedures are in place in operating rooms across the country to ensure this happens? Checklists help us recognize what's important and what needs to take place in each and every situation. Completing such checklists helps busy professionals avoid common errors that may be taken for granted in the absence of such a checklist.
The checklist idea is the brainchild of Dr. Peter Pronovost, a critical care specialist at the Johns Hopkins medical center in Baltimore. According to a December 2009 NY Times book review,
"In 2001 Dr. Pronovost borrowed a concept from the aviation industry: a checklist, the kind that pilots use to clear their planes for takeoff. In an experiment Dr. Pronovost used the checklist strategy to attack just one common problem in the I.C.U., infections in patients with central intravenous lines (catheters that deliver medications or fluids directly into a major vein). Central lines can be breeding grounds for pathogens; in the Hopkins I.C.U. at the time, about one line in nine became infected, increasing the likelihood of prolonged illness, further surgery or death.
Dr. Pronovost wrote down the five things that doctors needed to do when inserting central lines to avoid subsequent infection: wash hands with soap; clean the patient’s skin with chlorhexidine antiseptic; cover the patient’s entire body with sterile drapes; wear a mask, hat, sterile gown and gloves; and put a sterile dressing over the insertion site after the line was in."
While these seemed obvious to everyone, they involved the leading causes of infections in the ICU because they weren't being followed. The Times continued,
"But Dr. Pronovost knew that about one-third of the time doctors were skipping at least one of these critical steps. What would happen if they never skipped any? He gave the five-point checklist to the nurses in the I.C.U. and, with the encouragement of hospital administrators, told them to check off each item when a doctor inserted a central line — and to call out any doctor who was cutting corners. As Dr. Gawande relates it, “The new rule made it clear: if doctors didn’t follow every step, the nurses would have backup from the administration to intervene.”
Facing a recall of approximately 8,000,000 vehicles, Toyota is facing Congressional scrutiny over safety issues involving sticking accelerator pedals in a number of Toyota models and brake defects in its popular Prius hybrid. The recall is sending shock waves in political circles as well. This morning, Transportation Secretary Ray LaHood told Toyota owners to stop driving their vehicles and return them to dealerships for repair. This afternoon, Lahood has backed off that statement, saying he didn't mean what he said.
In spite of the political turmoil and potential economic fallout for the best selling automaker in the US, consumers are left to question the safety of their vehicles. At least one Congressman echoed consumer concerns. Henry Waxman (D-CA) commented, "Like many consumers, I am concerned by the seriousness and scope of Toyota's recent recall announcements."
Toyota said it would take months to complete repairs on the recalled vehicles since it would send notices to affected customers in batches of ten thousand to avoid overrunning repair shops. So, it looks like Toyota owners will be dealing with this for quite some time.
