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The cost of malpractice cases at Chicago's two public hospitals: $160 million—and counting

Wednesday, December 21, 2016
Crain's Chicago Business

In early 2012, Linda Myers, a 60-year-old cancer patient, was vomiting and choking just before receiving a CAT scan at Cook County's Stroger Hospital. What happened next was the focus of a lawsuit her daughter, Michele Mallicott, brought against the public hospital. During the scan, Myers vomited again, causing her to choke and stop breathing long enough that she suffered brain damage, according to the Cook County lawsuit. Myers, a south suburban housekeeper, remained on life support until she died eight months later, according to court records. Late last year, Mallicott settled her lawsuit against the hospital for $1.5 million. The Myers case is one of 41 that the Cook County Health and Hospitals System, which operates Stroger, settled with patients and relatives from 2012 through last September, according to data obtained through open records requests. The settlements total more than $80.5 million for medical negligence cases. Chicago's other major public hospital system, the University of Illinois Hospital and Health Sciences System, agreed to pay $83.7 million in 33 medical malpractice cases during the same period, records show. Since 2012, the total dollar amounts for settlements at each of these hospital systems swing wildly year to year, showing an inconsistent trend. But multimillion-dollar payments continue to mount despite efforts to cut down on medical mistakes. The BGA's review of court settlements also finds the two taxpayer-funded hospital systems poured enormous amounts of money and resources over many years to fight lawsuits that ultimately ended in multimillion-dollar payouts. U of I, for instance, paid nearly $4 million to at least seven private law firms since 2012. The Cook County state's attorney's office usually represented Stroger in malpractice cases. This report was produced by the Better Government Association. This report was produced by the Better Government Association. The two publicly owned Chicago medical centers aren't unique in paying such big sums. Hospitals across the country are sued for malpractice, paying 10-figure settlements and struggling to cut down on errors. They include university hospitals as well as church-affiliated nonprofits and big for-profit institutions. “There is a huge problem here,” says Martin Hatlie, chief executive at Chicago-based Project Patient Care, a nonprofit group that researches and advocates for safer medical treatment and advises the federal government. Speaking broadly, he calls hospital legal settlements only “the tip of the iceberg” because a great number of harmful or deadly incidents don't end up in court. THE BIGGER PICTURE In 2014, the Better Government Association examined wrongful death lawsuits at public hospitals across Illinois, including local medical centers, Veterans Affairs hospitals and mental health treatment centers. The BGA found that over 10 years those hospitals agreed to pay victims' families more than $180 million. The vast majority of those settlements were paid out by the Cook County and U of I health systems. In this investigation, the BGA focused in on just those two, but expanded the scope to include injuries that became the focus of medical malpractice lawsuits as well as wrongful deaths. The BGA analysis puts a spotlight on a problem at all hospitals: Human error and inadequate procedures lead to avoidable fatal mistakes or disabling injuries. The mistakes also contribute to the rising overall costs to the health care system. Officials from both hospitals say trying to compare how well they rate on medical malpractice issues in Illinois and across the nation is extremely difficult. Indeed, public information measuring how much hospitals pay out in medical malpractice lawsuits is sparse and every hospital differs in size, patient population and specialized procedures. Citing the high cost of fighting the hospitals, plaintiffs' lawyers say they turn away most prospective clients unless they view the cases as guaranteed wins in court. For the past two decades, academic and other private researchers have produced multiple studies on how many people die in the U.S. every year from avoidable medical errors. One study earlier this year estimated that number to be 250,000. Federal officials are pushing hospitals across the country to reduce avoidable hospital deaths, including those caused by medical errors. As part of that effort, officials in charge of the federal health plans Medicare and Medicaid are reducing payments to hospitals with a high number of deaths, injuries and infections deemed to be preventable. U.S. officials say their efforts are beginning to reduce fatal and harmful errors. “I do think we have systemic efforts ... and we're seeing it make a difference, but we have a long ways to go,” Hatlie says. “There's still a lot of harm that happens.” Barbara Malizzo's daughter died after a procedure at University of Illinois Hospital in 2008. - Madison Hopkins/BGA Photo by Madison Hopkins/BGA Barbara Malizzo's daughter died after a procedure at University of Illinois Hospital in 2008. TOO MANY MISTAKES Locally, while officials with both Chicago hospitals say they are trying to reduce errors as well as become more transparent about medical mistakes, critics say the efforts fall short. Mallicott says it was difficult to find details from hospital officials about what happened to her mother during the CAT scan. “I said to myself, 'I need to get a damn lawyer because somebody knows what happened,'” she says. As part of the agreement in the Myers case, neither Cook County nor Stroger, admit blame or malpractice. Advocates say too many mistakes still occur. “We've made great strides but we're still not there,” says Bob Malizzo, a patient advocate from Indiana whose adult daughter died after a procedure at University of Illinois Hospital in 2008. “A lot of these doctors need to slow down—slow everybody down so we pay more attention to safety in health care.” Since their daughter's death, Malizzo and his wife, Barbara, travel the country pushing for stronger hospital policies and procedures to protect patients from medical errors. The Malizzos also sit on an internal committee at the U of I hospital where they provide their input on safety issues. The BGA examined thousands of pages of court documents from dozens of legal settlements involving alleged wrongful deaths or personal injury cases at Cook County and U of I over the past five years. The settlements involved cases ranging from brain damage in children to death. Among the largest payouts involved cases in which babies were left permanently disabled following birthing or other procedures. At the U of I, there are around 200 patient safety “events” reported every week, ranging from minor issues to more serious incidents, says Jodi Joyce, U of I hospital's chief quality and patient safety official. “We treat all seriously.” Eliminating mistakes in total is unrealistic, she adds. “Errors are a non-preventable part of health care,” Joyce says. “We focus on how to contain and detect errors before they reach a patient.” Officials with Cook and U of I hospitals say they have taken a number of steps to improve patient safety after they more thoroughly researched incidents in which patients are harmed. Linda Myers did eight months after undergoing a CAT scan at Cook County's Stroger Hospital. - Photo provided by her family. Photo by Photo provided by her family. Linda Myers did eight months after undergoing a CAT scan at Cook County's Stroger Hospital. WHO REALLY KNOWS? Asked to compare their malpractice records with peers in the private sector, officials with the two public hospitals say there is no reliable standard to measure. With the exception of very large settlements announced by plaintiffs' law firms, malpractice payouts aren't often made public. Even using publicly available data, comparing hospital settlements outside of Illinois can be difficult for a variety of reasons—including differences in hospital size, demographics and various state tort laws. “It is very challenging for health care organizations to compare themselves to their peers when it comes to malpractice claims because hospitals typically keep that information very close to the vest,” says Krishna Das, chief quality officer for Cook hospitals. Representatives from Rush University Medical Center, University of Chicago Medical Center and Northwestern Memorial Hospital declined to comment. But last month, Northwestern's Central DuPage Hospital in Winfield paid $20 million to settle a negligence claim brought by a former Chicago lawyer whose family claimed he was misdiagnosed and suffered severe brain damage as a result. The Leapfrog Group—a hospital research and rating organization founded by Boeing, General Electric and other major U.S. employers—advocates for cutting costs in the health care system. It grades hospitals for safety twice a year, though it doesn't factor in medical malpractice. For its most recent ratings, released in October, Leapfrog gave U of I and Stroger middling to low marks for overall patient safety. Stroger received a “C” and U of I a “D” in its most recent Hospital Safety Grade report, which rated more than 2,600 hospitals. The twice-yearly grades represent declines—as recently as the spring of 2013, both hospitals received safety grades of “B.” University of Chicago and Rush recently received “A” grades from Leapfrog and Northwestern was given a “B.” U of I was one of only 157 hospitals to earn a “D” in the recent Leapfrog survey. In late 2014, the federal agency that runs Medicare and Medicaid, the largest health insurer in the U.S., cut government payments to U of I, Stroger and more than 700 other hospitals nationally because of high rates of events that harmed patients. The pay cuts were part of an effort to force hospitals to reduce the frequency of mistakes, infections and other things that can hurt patients. Other Illinois hospitals were targeted by Medicare, including Northwestern Memorial Hospital in Chicago, which saw Medicare payments cut in both 2014 and 2015. THESE THINGS TAKE TIME In addition to steps taken to catch errors, hospitals are being encouraged by the U.S. government and patient groups to own up to mistakes immediately after they are made. It's one of the practices patient advocates such as the Malizzos espouse. Quick resolutions of serious or fatal errors can spare families from additional grief, and helps establish trust. Juan Avila and his wife, Rosa, filed a lawsuit in 2010 against multiple doctors, including some from University of Illinois. For four years, doctors had examined a lump on Juan Avila's thigh, court documents show. When a specialist at U of I tested a sample of the growth and determined it wasn't cancerous, Avila's wife and two children were relieved, according to the family's lawyer. A subsequent test a little more than a year later determined Avila did, indeed, have cancer and that the earlier diagnosis may have prevented him from receiving timely and effective treatment, according to documents in Avila's lawsuit. When the case finally went to trial last May, Avila was too sick to attend, his lawyer Bryan Hofeld says. His cancer is no longer treatable, Hofeld says. A Cook County jury awarded Avila and his wife $10 million, Hofeld says. Cook officials agreed not to appeal and settled after the trial for $9.3 million. Dr. Andre Kajdacsy-Balla, the U of I specialist named in the settlement, says in an interview that he made no mistakes testing the tissue sample because there was no cancer present. The tissue, which was extracted by someone else, must have been removed outside the tumor, said Kajdacsy-Balla, who is a pathologist. “There was no misdiagnosis,” he says referring to his part of the biopsy process. Kajdacsy-Balla notes a number of doctors examined Avila over a period of years. If a mistake was made, it was the fault of another doctor, he says. Under the settlement neither U of I nor the doctor admit blame. “I could've said before everything started, 'I made a big mistake here—let's settle this,'” the doctor says. “But I didn't make a big mistake.” In some cases, the patients don't live to see the outcome of their cases. In 2008, cancer patient Wendy Cash of Rockford sued Stroger, alleging doctors were negligent during treatment of an infection, a condition that led to the amputation of her left leg. After five years of fighting the suit, Cook County settled the case for $2.4 million. By then, Cash had been dead for more than three years. Brett Chase is a senior investigator and Madison Hopkins is an investigator with the Better Government Association. Better Government Assn. Central DuPage Hospital More +


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