GOVT SORRY FOR ERROR

A COURT clerk's mistake is why Dickson Tan Yong Wen ended up getting the extra strokes.

This was revealed in a joint statement by the Law and Home Affairs ministries yesterday.

'Unfortunately, when the warrant of commitment was prepared by the Court Officer (that is, court clerk who assisted the judge with the administrative aspects of the case), the Court Officer erroneously reflected on the warrant of commitment an additional three strokes to one of the charges,' the statement said.

Tan was found guilty of abetting an illegal moneylender. He was convicted and sentenced on 28Feb.

The statement said that prison officers followed proper procedures when administering the caning on 29Mar this year.

This included verifying with the prisoner that the number of strokes of caning as specified in the warrant of commitment was correct.

Tan also did not raise any objection to number of strokes when he was interviewed during his admission process to prison on 1 Mar.

On the day of the caning, statement said, Tan acknowledged on the Inmate's Events Sheet that eight strokes was correct. And just before he was caned, Tan confirmed once again to the prison officers and the Medical Officer that the number of strokes were correct.

The Subordinate Courts has since taken various steps to tighten the processes. These efforts include checklists for Court Officers in preparing warrants of commitment and layers of additional checks for warrants of commitment, the statement said.

It also added that the Government regrets the error.

'The Government has also offered to refer the case to mediation. In negotiations so far, Tan's settlement sum has escalated from an initial amount of $150,000 to $3m (out of which he said he would donate $2.7m to charity), made on a without prejudice basis. This could not be accepted by the Government.'

The statement also said the court officer had resigned over the incident.
By Tay Shi'an
newpaper.asia1.com.sg

A $962,120 medical bill error

The patient didn't have to pay, but it's still a useful lesson for others, an economist says.
Helen Dorroh White thought she was doing the right thing when she called a health insurance company to question a nearly $1-million medical bill. Instead, she said, no one seemed to care.

White, a Glendale lawyer, was closing the financial affairs for a deceased client when she came across the insurance statement. It showed a $962,120 bill for her client, Dusanka Mlinarevich, who spent four days at Glendale Adventist Medical Center after suffering minor injuries in a fall at her Burbank home last year.

That struck White as odd, she said, because the hospital had told her the bill was $48,106.

Concerned about the discrepancy, White called the health insurance company, Long Beach-based SCAN Health Plan.

"My first question was, 'Is this some kind of typo or some mistake?' " said White, 73. A customer service representative paid little heed, White said, and insisted that the amount was correct.

"She didn't even bat an eye," White said.

Fearing fraud, White wrote a letter to the U.S. attorney's office and contacted The Times.

After inquiries from a reporter, SCAN's vice president of marketing, Sherry Stanislaw, said the company found a computer glitch that was producing erroneous claim reports for customers.

Actual billings and payments were not affected, Stanislaw said. She confirmed that Glendale Adventist's bill was for $48,106 and said that SCAN paid a negotiated rate of $4,350 and that Mlinarevich, who died in August at age 78, was assessed a $150 co-payment.

Because patients are responsible only for co-payments and deductibles, few consumers ever take a close look at their medical bills, said Devon Herrick, a healthcare economist and senior fellow at the National Center for Policy Analysis.

To help keep rising healthcare costs in check, more consumers should do what White did, Herrick said. "Most insurance companies will agree that they'd want their enrollees to scrutinize their bills."

SCAN said the computer glitch was being investigated. Stanislaw conceded that her customer representative should have heeded White's concerns and contacted a supervisor. The company is sending White a new claim statement, she said.

White wasn't completely pleased.

"It is easy to blame the computer. Well, who programs the computers?" she asked. "The last I checked, computers didn't program themselves."
By Daniel Yi, Times Staff Writer

Why King-Harbor must die

We must admit that the patient can't be saved -- and move on.
FOR FOUR YEARS, Los Angeles County officials have been dithering and bickering over what to do about Martin Luther King Jr.-Harbor Hospital.

Those who believe it must be closed argue that patients are dying because of substandard care and that there is little indication that anything — including downsizing by 80%, firing hundreds of staff members and changing the hospital's ownership and leadership — has worked to overcome its staggering problems. Opponents counter that King-Harbor served 47,000 emergency room patients in South Los Angeles last year and that, even with all its flaws, a bad hospital is better than no hospital at all.

So how are we to know whether the benefits of closure outweigh the risks of keeping the hospital open? As the state Department of Health Services, the federal government and the Los Angeles County Board of Supervisors all contemplate the possible demise of King-Harbor, how are we to determine whether the time has indeed come?

This much we know: There are no perfect hospitals. A seminal study by the Institute of Medicine conducted in 1999 found that 44,000 to 98,000 patients die from medical mistakes in the United States each year — the equivalent of a commercial jet crash every day. The average hospitalized patient suffers one medication error daily, according to another report from the institute, and patients in intensive care units experience nearly two mistakes in their care each day.

Until recently, we approached problems of poor quality and safety by admonishing doctors, nurses and hospitals to try harder, underscoring these exhortations with threats of malpractice lawsuits. But eventually it became clear that that was not enough. As Albert Einstein observed, we cannot solve our problems with the same thinking we used when we created them.

What we've learned in recent years is that most errors are not committed by incompetent doctors or slacker nurses but by well-trained, committed caregivers working in environments that are simply too complex for any human to get it right every time. This epiphany has led us to embrace what is known as "systems thinking" — in which we aim to create systems and structures that anticipate errors on the part of fallible workers and catch those errors before they cause harm.

By implementing relatively simple system fixes — such as double-checking before administering dangerous medications, marking surgical sites on patients' skin with indelible ink to ensure that we don't operate on the wrong body part, implementing computerized prescribing systems and limiting resident work hours (to less than 80 a week) and the number of patients assigned to each nurse (to no more than five) — we have begun to move the safety needle in the right direction.

Evidence is emerging that medical errors are decreasing and that hospital death rates in the last five years have fallen. Certain problems once felt to be inevitable, such as hospital-acquired infections, can be all but eliminated by widespread implementation of a series of safe practices, including religious attention to hand-washing and the use of other sterile techniques.

But even as we chalk up some safety victories, there remain problems so stubborn that they can't be solved by changing procedures and implementing new systems. The question is — because even the best hospitals will commit terrible, even lethal, errors every year — how do we know when a hospital is so bad that it should be deemed unfit for patients?

This question has been brought into sharp focus by the extraordinary saga of King-Harbor. What is so shocking about the story is not that the initial reports in 2003 showed scores of safety problems, although the breadth and depth of the problems far exceeded the usual litany. Nor is it the tale of a resource-poor hospital serving indigent patients struggling to make ends meet; those problems exist everywhere. Nor is it that the organizational chart of King-Harbor needed reshuffling — reorganizations of failing enterprises, guided by consultants, are a dime a dozen (not counting the price of the consultants, of course).

No, King-Harbor's problems are distinguished by their intractability. Other hospitals have had highly public errors or sustained withering press coverage but used these traumas to create a platform for improvement. Boston's Dana-Farber Cancer Institute, for instance, was transformed after a chemotherapy overdose there killed a Boston Globe healthcare columnist. Johns Hopkins Hospital in Baltimore, often rated as the nation's finest, was nearly brought to its knees by the error-related death of a young girl, but it used the tragedy as a springboard to develop a world-class safety program.

And other resource-poor county hospitals — such as San Francisco General and Harbor-UCLA — manage to provide high-quality care even in the face of budget woes and enormous caseloads.

But at King-Harbor, highly public disasters involving quality and safety have not managed to upend the status quo. Regulators have issued stern threats to yank funding or certification — but have then lowered the bar again and again. Leaders have been fired, organizational charts have been reshuffled and consultants have come and gone, and yet the shocking revelations — including numerous deaths from medication errors and lapses in monitoring — keep on coming.

When a patient can literally lie dying on the ER waiting room floor — a janitor mopping up around her — at a hospital whose every move is being scrutinized by the media and legislators, we know that the problems cannot be fixed by a better computer system, a few new bylaws or more intensive personnel training. The troubles run far deeper than that.

We physicians are socialized to believe in the possibility of redemption and healing — that the tumor can be excised, the obese patient will finally stick with that diet, the baby will emerge from the womb hale and hearty. This is mostly a good thing, but it can take us down dark alleys. For example, our "never say die" attitude sometimes leads us to over-treat patients with terminal illnesses, flogging them with another course of chemotherapy long after realistic hope is gone.

We now teach young doctors to recognize when cure is impossible and, at those times, to help guide patients and families toward what we have come to call a "good death." When offering this "palliative care," we focus on keeping the patient comfortable while encouraging loved ones to honor the past, come to terms with the present and make appropriate plans for the future.

With that in mind, we can never forget what King-Harbor represented at its christening: a shining light emerging from the dark shadows of the '60s riots. We must recognize the service of those committed, competent caregivers (and there were and are some) who struggled to provide high-quality care in a dysfunctional environment. We have to empathize with the patients who may be inconvenienced, or even harmed, when their local hospital — bad as it was — is no longer down the street.

But how can we stay silent in the face of overwhelming evidence that this hospital cannot ensure a decent level of safety, knowing that no patient with a choice would dare cross its threshold? How can we continue to focus on cure when hope has long since vanished? Surely, the resources being poured into that one last change in the organization chart, one more consultant engagement or one more staffing surge could better be used to ramp up the capacity of other hospitals' ERs and clinics to absorb King-Harbor patients.

King-Harbor is on life-support, and has been for years. The disease is a cancerous culture, and one more course of chemo won't help. It is time to orchestrate a "good death" — to focus on healing the community and making plans to care for the patients of South L.A. once this hospital is gone.
By Robert M. Wachter, ROBERT M. WACHTER is a professor of medicine at UC San Francisco and the author of "Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes" and the forthcoming "Understanding Patient Safety."

Error gave woman HIV, but Navy turns its back on her

WINTER SPRINGS - Richelle Starnes' cell phone alarm beeps to interrupt her three times a day. It's her reminder: Take the medication.

Richelle is 26, a forward on the semipro Orlando Falcons soccer team, and the ring is a reminder she has HIV.

Now, however, she has enough pills to last into mid August. After that? That's a question she's wrestling with the Navy over.

It's the Navy that has been treating Richelle since she was 10. That's when she learned she was infected with HIV, an infection she and her family blame on the Navy. But as Richelle has become an adult, the Navy says it no longer will pay for her pills.

* * *

Richelle's parents and older sister were living near San Francisco in 1979 when her mother Kathy became pregnant. Her father was a radioman on a submarine. But soon after Kathy became pregnant, a painful lump on her side and bleeding sent her to a Navy doctor. He sent her home, missing signs she had an ectopic pregnancy, that a fertilized egg had implanted not in her uterus but in a fallopian tube.

A few days later, the tube burst. Kathy was rushed to the nearest hospital, not a Navy facility. She needed immediate surgery and a blood transfusion. The couple was told the Navy doctor would be reprimanded.

A year later, Richelle was born. It would be a decade before the family knew anything was wrong, that in an era before blood was tested for HIV, the blood Kathy had received was tainted.

* * *

Brown spots appeared on her mother's thighs in 1990. By then, the family was in Maryland, and her mother was sent to the National Naval Medical Center in Bethesda. Doctors saw the blood transfusion on her mother's medical charts and ordered an HIV test.

Richelle's parents told her and her older sister over ice cream. Richelle remembers crying, that her mother's pill case beeped when it was time to take medication, and being told she and her sister would have to be tested.

Dr. Richard Moriarty, then a Navy doctor, remembers thinking she didn't look like a child with HIV. A day after her 10th birthday, he told her family. Richelle was positive.

* * *

Some people didn't understand. In a home economics class, one classmate refused to cook in her kitchen. Another time, kids said they didn't want her swimming in a lake. When she went to college, her school and soccer coach knew, but she didn't initially tell friends.

She waited a semester, then told her soccer team. There were never any questions. But when she told her roommate, their relationship soured. By the end of the semester, Richelle was sleeping on friends' floors.

* * *

In graduate school, Richelle knew she wanted to study HIV policy and said so in introductions. Someone asked why, just making conversation.

"Because I'm HIV positive, " she said.

Her frankness impressed a classmate, Jeff Starnes.

They didn't know each other well, but in 2003 Richelle's mom died of complications from AIDS. Jeff sent Richelle a card.

They started dating, but Jeff was hesitant to kiss her. He went with Richelle to her doctors in Bethesda and asked a lot of questions.

They also went parasailing and hot air ballooning and to New York, where they saw the musical Rent. Her mom had wanted to do some of the same things, but never got the chance. Later, Jeff had another question. Would she marry him? She said yes.

But trouble started soon after. For years, Richelle had flown to Maryland to see her doctor and get medication. She'd participated in research studies and talked to medical students about her disease. With regular medication, her viral load - the amount of HIV in her blood - is undetectable.

* * *

In 2005, the Navy told Richelle she'd need to get treatment elsewhere. Her case did not satisfy the "compelling criteria" for a special designation that would extend her care, the Navy wrote.

Working through two congressmen, she's managed to get her care extended - one year at a time.

She and Jeff moved to Florida, where he works in law enforcement. Through artificial insemination and months of planning, they had a baby, Braden, last July. As a precaution, doctors had them feed the newborn tiny syringes of antiviral medication for weeks. Tests show he is HIV-free.

On June 22, she got her decision on care for this year. The Navy will let her see their doctors but will no longer pay for hospitalization or for her medication, which costs thousands of dollars a year.

"They can't make what they caused right, " Richelle said. "They can't bring my mother back. They couldn't promise me a future. What they could do was take care of the medical side of it."

The doctor and nurse who treated her as a child agree, and wrote the Navy. That promise was one reason the family never thought of suing and doesn't have a lawyer now.

The Navy reviewed the decision again at the request of Richelle's U.S. representative, Tom Feeney. Assistant Navy Secretary William A. Navas Jr. said he was sympathetic to the situation, but the program under which she got treatment was "not intended to provide lifelong care."

Without help from the Navy, Feeney, a Central Florida Republican, said he will look at writing a personal bill for Richelle, one Congress could pass to grant her care.
By ASSOCIATED PRESS

Amite mayor held liable in malpractice suit

Also doctor, town’s chief sued for not treating patient
AMITE — A Tangipahoa Parish jury found that an Amite family physician’s failure to treat a diabetic patient’s rising blood sugar levels led to the ailing man’s dementia and institutionalization for the last three years of his life.

That same jury handed down an $814,079 award on June 22 for damages against Dr. Reggie Goldsby, who also is mayor of the town, for the pain and suffering of the late Marion Hendry and his only daughter, Tanya Hendry Sparks, court records show.

In 2000, Sparks, acting on her father’s behalf, filed a medical malpractice complaint in the 21st Judicial District Court against Goldsby and Hood Memorial Hospital in Amite. After that, she filed a lawsuit seeking damages in 2003 against Goldsby, his liability insurance company and the hospital.

The hospital was dropped from the suit before trial, Sparks’ attorneys said.

According to court records, Marion Hendry entered Hood Memorial Hospital in Amite for treatment of a swollen hand on March 13, 2000.

Eleven days later, he suffered from dementia and dehydration and his health had declined so severely that he was unresponsive. As a result, Hendry’s daughter had him transferred to another hospital, North Oaks Medical Center in Hammond, court records show.

Hendry, a retired high school teacher and former assistant superintendent for the Tangipahoa Parish School System, never recovered from his dementia and died three years later in an assisted living facility, said Hendry’s attorneys, Charles Moore and Patrick Boryles.

A medical examination board, a panel of doctors who determine whether medical personnel are at fault in malpractice complaints, found that Goldsby failed to treat Hendry, a known non-insulin dependent diabetic, for his rising blood sugar levels while under his care at Hood. That failure likely led to his failing health and dementia while at Hood, the board decided in April 2003, court records show.

The board found that Goldsby failed to follow “standard practices of care” in treating Hendry, according to court records.

However, the medical examination board did not link Goldsby’s mistake to Hendry’s permanent disability and dementia. Instead, a trial jury was charged in 2003 with determining whether Goldsby caused Hendry’s injuries, Moore said.

After a four-day jury trial and two hours of deliberations on June 22, the jurors found that Goldsby’s breach in care led to Hendry’s declining physical and mental health and eventual death on Nov. 28, 2003.

Goldsby did not return telephone messages seeking comment. His attorney, James Strain, also did not return calls, but his staff said Strain was in Shreveport Tuesday and Wednesday working on another case.
By DEBRA LEMOINE
Advocate Florida parishes bureau

Are doctors' malpractice premiums unfair?

Insurance companies have said for years that they're paying more and more in medical malpractice claims as they push for caps on lawsuits, like the cap approved in Idaho. But a new study shows claims have been decreasing for seven years while the insurance premiums continued to rise. Report author Jay Angoff with the American Association of Justice says it looks like the insurance companies are overcharging doctors.

"The amount they project that they're going to be paying out in the future has decreased by 48 percent over the last four years, yet rates have been going way up," Angoff told SVO. "This makes no sense."

The insurance industry has criticized the report, saying it doesn't take into account all insurance company liabilities, and that profits are low in the malpractice sector compared to other insurance categories. Angoff based his report on company filings with state governments.

Angoff says doctors don't have time to do their own investigations of insurance company claims and don't seem to suspect anything is amiss.


"They believe what the insurance companies tell them about malpractice claims going up, when in fact, they're going down, and therefore they accept these rate increases."
By Gary Stivers

Pa. physicians fearing boost in malpractice insurance fees

Pennsylvania's doctors, especially high-risk surgeons and physicians from the east who pay higher medical malpractice rates, worry that a state-mandated change in insurance could result in an overnight 25 percent increase in their premiums.

Any doctor who does the majority of his work in Pennsylvania is required by state law to carry at least $1 million in liability insurance. The first $500,000 is covered by the doctors through the private insurance market. The next $500,000 in coverage is purchased through the state's MCARE program, which charges doctors an assessment, then pays claims out of that group fund.But the state Department of Insurance is mulling a change that would require doctors to purchase the first $750,000 on the open market -- either through a private insurer, or through doctor-run organizations known as risk-retention groups and insurance exchanges.

The hope is that the state has recovered from what physicians groups billed a medical-malpractice crisis three years ago, and that there are enough insurers underwriting enough products to drive down costs organically.

Doctors say that's not the case yet.

"I believe that it could destabilize the medical malpractice marketplace," said Dr. Lewis Sharps, a spinal surgeon from Chester County, "and reactivate the crisis we faced from 2002 to 2004."

Dr. Sharps has a unique vantage point: In addition to being a high-risk surgeon, he's also the CEO of a medical insurer called the Positive Physicians Insurance Exchange.

His company paid for an actuarial analysis of what might happen if the shift takes place -- an orthopedic surgeon whose med-mal insurance was $60,000 annually would see the payment jump to $75,000.

"It's a very significant concern," Dr. Sharps said. "Many physicians don't even know this is going on."

What's going on is this: The Insurance Department is analyzing the state's marketplace to determine whether there's enough underwriting capacity to shift med-mal liability away from the state and into the private market. The shift, as a side effect, could save Pennsylvania about $70 million of the roughly $120 million that is now spent on MCARE abatements, which are financed by cigarette tax money.

High-risk specialists get full abatements in their MCARE assessments, meaning the extra $500,000 in coverage costs them nothing, wiping out what otherwise would be a bill of tens of thousands of dollars. Lower-risk doctors get a lesser abatement.

The insurance commissioner is supposed to issue a decision by this week regarding the shift, and changes, if they are authorized, would go into effect in January, without legislative authorization.

By law, the insurance commissioner reviews the marketplace capacity every two years -- the last time this happened, in 2005, then-Commissioner Diane Koken announced that there would be no change in the 50-50 split.

Doctors fear that this year could be different, because two years of relative calm on the med-mal front have led to more stable rates and new carriers. In the last three years, for example, about 30 new carriers have begun offering services in the state -- though that's not necessarily reflective of a fully healthy market, since most of those carriers do only a sliver of business here.

State Rep. Todd Eachus, D-Luzerne County, viewed as an ally of the medical community, said it's too early for the Insurance Department to declare the marketplace healed. That's because the full effects of the raft of med-mal reforms enacted in 2004 won't be known for another year or two.

"I really don't want anyone meddling with the Legislature's work at this point," the representative said. "It was a difficult debate. There was a lot of finger-pointing" among legislators, lobbyists, the medical community and attorneys. Mr. Eachus has sent a letter to the governor, asking him to delay the shift.

Doctors also hope to prod the state Legislature and the governor to reauthorize the state's MCARE abatement program, which expires annually. Much of the would-be cost of the state's insurance assessment is defrayed by the abatement fund.

Historically, renewal hasn't been a major political issue, in large part because of the persistence of the state's many doctors and surgeons' lobbying groups. In recent years, they've sought reductions in their medical malpractice premiums, a medical school loan repayment program, caps on "pain and suffering" jury awards and a change in litigation rules forbidding "jury shopping" -- the practice of moving a case from county to county in search of a jury more sympathetic to a given malpractice plaintiff.

Some legislators have complained of "doctor fatigue," while many doctors say the state hasn't gone far enough to make Pennsylvania an attractive place in which to practice, thanks to high med-mal rates and lower-than-average service reimbursements from insurance companies.
By Bill Toland, Pittsburgh Post-Gazette