CT Center for Patient Safety
CT Center for Patient Safety Newsletter
October 2013
In This Issue
How Many Die from Medical Mistakes
Help with Obamacare
Road Map to Eliminate HAI
FDA calls for device IDs
How Many Die from Medical Mistakes in U.S. Hospitals?

The number keeps growing.  John James, in the Journal of Patient Safety, estimates that the numbers are between 210,000 and 440,000 patients each year who go to the hospital for care and suffer some type of preventable harm that contributes to their death.
That makes medical errors the third-leading cause of death in America.  John James, a toxicologist at NASA, turned patient activist when his 19 year old son died from negligent care.
James based the estimate on four recent studies that identify preventable harm. In the four studies researchers who examined records of over 4,200 patients found serious adverse events occurred in as many as 21 percent of the cases reviewed and rates of lethal adverse events in as many as 1.4 percent of the cases.
Click here for the full story at MedCityNews
John was recently on Medtalk discussion his findings, and you can listen to the conversation on YouTube.
John, thank you for the work you do.

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As of October 1st the Healthcare Insurance Marketplace opens its doors. Obamacare can be confusing, but a few points to keep in mind are:

  • Everyone must have insurance or pay a penalty
  • There are new benefits and protections
  • Young adults can stay on parents plan until age 26
  • There are no longer lifetime limits
  • Your insurance company may not spend more than 20% of your premium on overhead or you will get a refund.
  • Premiums can't be higher due to current or previous illness or due to your gender.
  • Summaries will be in plain language with "apples to apples" comparisons available.
  • If you are on traditional Medicare, you don't have to do anything!
  • If you have a private pay insurance plan, you may want to call your insurer. Some plans will remain and some will be discontinued. You will have the choice to buy through the marketplace or outside of it.

Connecticut's Healthcare Insurance Marketplace:  Access Health CT
To apply and/or compare plans (in and outside of the exchange): www.healthcare.gov
White House White Board: What ObamaCare Means For You

Dear Members,    


Before you go for a medical procedure, please ask for all of the costs you will incur.  There is a lot of change happening.  Hospital systems are growing larger and many medical practices are now associated with those hospitals.  Don't be surprised by a new charge that you, and not your insurer, will have to pay. It is called a "facility fee."


The practice has drawn scrutiny from the state healthcare advocate, Attorney General George Jepsen who announced that he would take aim at these unanticipated fees.  He plans to seek legislation requiring medical offices to clearly disclose if they'll charge patients a facility fee.


Facility fees are charges patients can receive if they have in-office procedures performed at medical offices owned by a hospital or that use hospital-owned equipment. The fees are in addition to the bill for the doctor's services, and in some cases, have cost unsuspecting patients thousands of dollars. The article in the CT Mirror used as an example Michael Lipkin, a Stamford resident who got a $5,000 bill for an electrocardiogram and sonogram his teenage daughter received at a medical office in a residential neighborhood. That medical office was not associated with a hospital, but because the hospital owned the equipment used in the testing, he received one bill from the practice and he was billed $5,000 by the hospital - for the testing.


As the consumer spends an increasing share of his hard earned dollars on healthcare, we have the right to know before we incur the costs.  Just because there was no facility fee when you had your colonoscopy several two years ago, it does not mean you will not be charged one when you have it this time.




Road Map to Eliminate HAI:

2013 Action Plan Conference



Lisa McGiffert, Consumers Union


In 2005, we introduced legislation requiring public reporting of Hospital Acquired Infection.  At the time, providers talked about the expected rate of infection. Of course we said that no patient going into a hospital expected to get an infection.


I recently returned from this two day summit at the US Institute of Peace in Washington, DC.  This is our fifth conference.  Advocates from across the country demanded that action be taken and the Centers for Disease Control, CMS and HHS, to name just a few of the federal giants that either oversee or pay for treatment, paid attention. 


What can I report?

  • There is public reporting of some infections by hospitals
  • There is improvement in infection rates in hospitals
  • Much more work needs to be done in ambulatory care settings
  • Nursing home workers need far better infection control training and support
  • Home healthcare - a growing segment - is the "wild west of infection control."

The conference began with a patient story and ended with Lisa McGiffert from Consumers Union asking for urgency.  We are seeing an increase in antibiotic resistance, an increase in C-Difficile cases and continued concern that we simply do not know how to effectively combat this plague of healthcare acquired infections.


So often during these two days, I heard repeatedly how hard it is to get doctors and providers to wash their hands.  So often, the solution to what seems to be an intractable problem is simple and it is, in this case, simply good and consistent hand washing techniques.

FDA calls for device IDs in 2020

but Voluntary is Ridiculous


A new rule requiring medical devices to be marked with identification information is expected to improve patient safety and make hospital supply operations more efficient. But the Food and Drug Administration will take another seven years to roll out the system, and much of its success depends on the voluntary participation of healthcare providers.


The FDA released the long-awaited regulation Friday. Dr. Jeffrey Shuren, Director of the agency's Center for Devices and Radiological Health, called the unique device identification system "a landmark step in improving patient safety, modernizing our post-market surveillance system for medical devices and facilitating medical device innovation."

As part of the new system, manufacturers will be required to assign some medical devices with a "unique device identifier," which will include a product lot number, expiration date and manufacturing date. The FDA will operate a publicly searchable database that will house UDI data. In addition, UDI data could be used in electronic health records, registries and insurance claims.

The FDA says the system will reduce medical errors, lead to more accurate reporting of adverse events, and provide better understand underlying problems in devices.

While manufacturers are required to comply with the system, the participation of healthcare providers is voluntary.   Without participation from hospitals, some experts say that hospitals and patients won't achieve all of the possible benefits the system could provide.


We need to put patients' needs before special interests' demands. 

Now is the time to show your support our efforts.     

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