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Medical Mistakes: Who Pays When Problems Arise?

November 1, 2016

There has been a medical mistake.

This sentence is one of the most frightening things a patient, or their family, can hear after any operation. Most certainly, initial fears are focused on health complications and patient wellbeing. However, lingering concerns often reside as well: who is at fault? How will this be financially rectified?

Health Issues

The Journal of Patient Safety conducted a study of patient care and medical mistakes in 2013. Their initial data found that in 1984 98,000 patients died due to complications with care or medical mistakes. In their 2013 study they found that the number of instances had risen to 400,000. These figures do not include numerous patients that live through mistakes with varying states of complications.

Procedures as simple as placing a central line in a vein for medication to major surgery can be the cause of medical mistakes. The complications that can arise leave many patients unable to work, and they may have to pay large sums to cover medical costs or hire an attorney to pursue a medical malpractice case. Many news outlets have covered the problem of medical mistakes resulting from colonoscopies, central lines, and hernia operations. Though these are common procedures, they can carry grave health and financial consequences.

Costs

Many of the issues for patients, insurance agencies, and hospitals arose in 2007 when the Centers for Medicare and Medicaid Services (C.M.S.) decided to deny payment for medical mistakes. After this, many insurers followed suit by deciding not to cover costs of these complications. In theory, this was to place further pressure on care providers to perform better and have hospitals cover the costs for their mistakes.

However, in the years that followed, much of the cost has fallen to patients unless they can prove medical malpractice. Even provisions regarding quality care in the 2010 Affordable Care Act have left many risks for patients entering hospitals. The C.M.S. has established a list of mistakes that should never occur, but this list has been saturated in recent years with many new entries.

The original entries to the list included mistakes such as operating on the wrong side of the body, the wrong procedure being performed, or death during an operation. A study done by the Archives of Surgery concluded that complications from preexisting conditions (including diabetes or lung inflammation from smoking) did not make doctors or hospitals liable for certain mistakes. Thus, complications from high-risk patients have increasingly been seen as less preventable for medical professionals and hospitals.

The most recent study in terms of cost was in 2008, which stated that medical errors added $19.5 billion dollars in extra care and medication. These expenses were put upon insurers and patients themselves. Average costs that have been covered by Medicare and other insurers range from $40,000 to $65,000 depending on the medical issue; beyond that, the patient is often responsible to pay.

However, patients should not pay for issues out of their control – especially if those issues are caused by someone else, like a doctor or nurse who makes a mistake.

Addressing Issues 

When facing the possibility of a medical error, it is important to have an idea of what to do beforehand. First and foremost, strive to live a healthy lifestyle as this reduces high-risk situations for patients and doctors alike. Second, you or a family member should request to be notified if an error does occur during a procedure since most hospitals and medical networks have differing rules. Third, contact your insurance provider and request information about their coverage in cases of medical error. This can be a difficult question to answer, but having some knowledge beforehand is helpful.

If you do suffer adverse effects or lose a loved one due to the negligence of your medical care provider, you should consult with an experienced personal injury attorney right away. They can review the unique circumstances surrounding your experience and help you determine your best course of action. At the Law Office of William D. Cook, we offer free consultations so we can better understand your situation and provide you with candid advice about whether or not you should pursue a personal injury claim. Call our offices today at (800) 757-7757 or fill out our convenient online form to request a free consultation.

References:

Chen, P. W. (2010, May 26). Who pays for medical complications? Retrieved from http://www.nytimes.com/2010/05/27/health/views/27chen.html

Data on medical errors will now be withheld from the public. (2014, August 20). Mercola. Retrieved from http://articles.mercola.com/sites/articles/archive/2014/08/20/medical-errors-public-disclosure.aspx

Frances, A. (2014, November 20). Why are medical mistakes our third leading cause of death? Retrieved from http://www.huffingtonpost.com/allen-frances/why-are-medical-mistakes-_b_5888408.html

James, J. T. (2013, September). A New, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128. Retrieved from http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx

Luthra, S. (2015, November 9). A medical mistake happens. Who pays the bill? The Washington Post. Retrieved from https://www.washingtonpost.com/national/health-science/a-medical-mistake-happens-who-pays-the-bill/2015/11/09/9d4f6ee6-78d1-11e5-b9c1-f03c48c96ac2_story.html

When hospitals err, who pays for their medical mistakes? (2016, January 22). HealthNetwork. Retrieved from https://healthnetwork.com/blog/when-hospitals-err-who-pays-for-their-medical-mistakes/

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