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Public hospitals in Illinois paid more than $180 million over the past decade for patient deaths at the taxpayer-supported institutions, a figure that points to numerous medical errors despite efforts to reduce mistakes, a Better Government Association investigation found.
Most of those payouts stemmed from deaths at Cook County hospitals and the University of Illinois Hospital & Health Sciences System on Chicago’s west side. The BGA also reviewed payments related to deaths at the five federal Veterans Affairs medical centers in Illinois as well as seven state-run mental health facilities and 20 locally controlled hospitals outside Chicago.
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In all, the BGA examined payouts for 184 patient deaths. The payments range from multimillion-dollar settlements to amounts totaling tens of thousands, according to records obtained through both federal and Illinois open-records laws.
While system-wide failures at VA hospitals in the U.S. are widely reported this year, patient advocates warn that mistakes at all types of hospitals are contributing to fatalities. Hospital officials, lawyers and patient advocates say the death payouts illustrate just a portion of the problem. Plaintiff lawyers, for instance, say they take only a fraction of the potential malpractice cases brought to them because they want to go forward with only lawsuits they’re confident they can win. While Illinois public hospital officials say they are making headway reducing errors through better tracking and system changes, patient groups say medical centers are making too little progress.
“There’s a lot of smoke and no fire,” said John James, who runs the advocacy organization Patient Safety America and conducted a study published in a peer-reviewed medical research journal last year about lethal hospital mistakes. The errors, he added, are “not being dealt with seriously.”
SETTLEMENTS
Among the findings of the BGA’s Rescuing Illinois review: Cook County paid $93.2 million as a result of 79 wrongful death cases at John H. Stroger Jr. Hospital and three other facilities between January 2004 and April of this year. During that same period, the University of Illinois Board of Trustees agreed to pay 35 estates $64.2 million, most of which was the result of deaths at the U of I’s Chicago hospital (formerly University of Illinois at Chicago Medical Center).
Among the largest sums were payouts that went to the husband and nine children of a 27-year-old pregnant woman who died after severe bleeding and to the family of a 39-year-old Indiana mother of two who died following an elective procedure to test her liver, according to allegations in court filings.
Payouts contribute to higher malpractice insurance premiums — costs that are passed on to taxpayers who fund the public hospitals. Deaths are just one component of malpractice. Patients who survive and live out their lives hurt by serious medical errors may be entitled to even greater sums of money. Unlike neighboring Indiana, where a plaintiff can collect no more than $1.25 million in a medical malpractice lawsuit, caps on legal payouts in Illinois have been struck down three times by the state’s Supreme Court.
Payments made as a result of legal settlements tell only part of the story. Even hospital officials admit only a fraction of error cases are challenged in court, and U.S. Bureau of Justice Statistics estimates less than a third of plaintiffs in medical malpractice suits win their cases.
According to James’ study published last year, the number of preventable deaths at U.S. hospitals may be more than 400,000 a year. That number was four times as high as a previous estimate from a 1999 study of hospital errors nationwide and dwarfs the few thousand wrongful death payouts made each year in the U.S. Both studies highlight a crucially important issue, one the medical community wrestled with for decades.
ILLINOIS IMPACT
In Illinois where government health care providers say they are making changes to reduce errors, survivors often spend years trying to collect money from public hospitals after deaths of children, wives, husbands and parents.
In mid-January, Cook County paid $2.25 million to settle a suit following the death of a 46-year-old woman in 2010. Three days after being admitted to Stroger hospital, Michelle Marshall died from a condition caused by blood clotting in her leg, according to a lawsuit.
Hours before Marshall’s death, a Stroger hospital doctor ordered a blood thinner to treat the woman’s clotting but the therapy wasn’t administered, according to court records. Later that night, Marshall was found on the bathroom floor of her hospital room gasping for air and was declared dead following 30 minutes of attempted resuscitation, according to court documents.
John H. Stroger Jr. Hospital accounted for much of Cook County’s $93 million in wrongful death settlements. / www.cookcountyhhs.org
“The finest doctors can make a mistake,” said Steven Muslin, the lawyer who represented Marshall’s estate. “In our case, it was some sort of systemic breakdown.”
One of the largest payouts for a Stroger hospital death case in the past 10 years was a $9.8 million settlement in 2008 related to the death of a woman pregnant with her ninth child, Cook County data and court records show.
Farrah Dickerson, 27, was 31 weeks pregnant when she was admitted to Stroger for bleeding. She entered on August 4, 2005, and remained at the hospital until she died eight days later from cardiac arrest after she suffered shock caused by severe bleeding, according to a lawsuit filed by the woman’s husband.
Lawyers for the woman’s estate claimed in court documents that doctors didn’t recognize or treat the severity of her bleeding in time to save her life. The woman’s child was born alive, according to a lawyer for her estate and court records.
Without addressing any individual case, Cook County officials said that many of its patients enter the public hospital already in poor health because they don’t have access to insurance and often don’t get medical care until their illnesses are far along.
“As a safety net system we care for a significant number of patients who are uninsured, have not had access to primary care and tend to have a more advanced stage of illness than typical acute care hospital patients,” John Jay Shannon, CEO of the Cook County Health and Hospitals System, said in a statement.
That said, the county hospital system “has prioritized quality and safety,” he added.
Dr. Shannon declined to be interviewed for this story.
Cook County health system analyzes data generated from doctors, nurses and other hospital staff who record accidents and errors through an electronic reporting system. Last year, the hospital appointed its first chief quality officer, Krishna Das. A spokeswoman said mortality rates at Cook are “better than average” for comparable hospitals.
GROWING WORKLOAD
A BGA review of the federal website, Medicare.gov, found both U of I and Cook’s Stroger hospitals are similar to national averages for death rates among key categories, such as heart failure, pneumonia and surgical complications.
Last year, Stroger hospital admitted more than 23,000 patients and logged 134,000 emergency room visits, the Cook spokeswoman said.
The Cook County hospital system also includes Provident Hospital and Cermak Health Services, the hospital for Cook County jail inmates. In 2011, the county shut down Oak Forest Hospital and converted the facility into a health clinic.
At U of I, Michelle Ballog, a mother of two from Valparaiso, Indiana, went to the Chicago hospital for a diagnostic procedure to check whether her liver was functioning correctly, a lawyer for her estate said. After arriving April 17, 2008, the woman died eight days later. The woman’s husband retained a lawyer and entered into settlement talks. In 2009, the U of I’s trustees paid the family $9 million.
In documents filed in Cook County Circuit Court to settle the case, the woman’s estate claimed that U of I doctors “improperly performed” the procedure, “failed to recognize” initial breathing problems and “failed to properly resuscitate” the woman, according to settlement documents.
The woman’s father, Bob Malizzo, said in an interview that hospital officials were forthright admitting errors that led to his daughter’s death. He now sits on a patient safety panel at U of I and travels the country talking about the need for hospitals to make changes that will protect patients. While some hospitals are addressing the problem, there’s more work to be done, he said.
“We’ve seen a lot of change in health care for the better,” he said, “but we’re not where we should be – not even close.”
Internal investigations in death cases are a part of U of I’s plan to cut down errors. Findings from these in-house probes are used to improve the system so that patients are protected even when errors occur, university officials say. Data are collected and analyzed to help determine if safety efforts are working.
“The goal is to put things in place to prevent errors from getting to the patient,” said Timothy McDonald, former chief safety and risk officer for health affairs at U of I.
McDonald, a physician and lawyer, spent 15 years studying quality issues at the U of I to help reduce harm to patients by creating more checks and balances. Each investigation into a patient mishap is aimed at improving the system, according to McDonald.
As a result of these efforts, medical malpractice lawsuits dropped more than 60% at U of I since 2006, McDonald said. That decline helped lower U of I’s annual malpractice insurance payment more than 40% since 2010 to about $25 million last year, he said.
“We’ve made very substantial improvement,” said McDonald, who declined to comment on specific cases.
ROBOTIC SURGERY
Another large lawsuit settled by the U of I in recent years involved a 49-year-old father of one who died following a robot-assisted surgery.
At the advice of U of I doctors, Juan Fernandez underwent a robotic-assisted procedure to remove his spleen in January 2007, court documents state. Lawyers for Fernandez’s wife alleged that four doctors were responsible for piercing part of the man’s small intestine known as the duodenum during the surgery but didn’t recognize the perforation. Days later, after the man’s condition worsened, doctors performed another procedure and still didn’t recognize the pierced intestine, the suit alleged. Two weeks after the initial procedure, Fernandez died after suffering from infection, flesh-eating bacteria, difficulty breathing and brain damage from lack of oxygen, according to court documents.
The lawsuit alleged that the surgeons caused the puncture and failed to properly diagnose and treat the problem. The doctors denied the allegation.
One of the lead doctors wasn’t experienced in using the surgical robot, lawyers for Fernandez claimed.
The two sides settled on a $6 million payment as part of negotiated agreement struck before a jury reached its decision in favor of Fernandez’s estate.
The Fernandez death points to the risk associated with even the most cutting-edge technology designed to help assist doctors perform procedures, the man’s lawyer said.
“Just as any complicated piece of machinery has a learning curve, that’s even more true with a robot used for surgery,” said Fernandez’s lawyer Edward McNabola.
Despite their efforts to improve their processes, U of I officials vigorously defended a number of cases. In the 10-year period reviewed by BGA, U of I spent almost $500,000 on outside lawyers to defend wrongful death suits.
VETERANS AFFAIRS
A myriad of problems leading to deaths of Veterans Affairs hospital patients are one of the highest profile and most tragic national health care stories this year.
Marion VA Medical Center paid $8.5 million for 31 deaths since 2004. / Photo courtesy Marion VA Medical Center
In early 2008, a government report highlighted problems at the Marion VA hospital following a spike in deaths at the downstate institution. After a review of 29 deaths following surgeries in the hospital’s 2007 fiscal year, the VA’s inspector general cited multiple quality problems and said the surgical department was in “disarray.” The downstate hospital paid out $8.5 million for 31 cases since 2004.
The Marion center leads the other Illinois-based VA hospitals but all five have paid out hefty sums of money in patient death cases, a number that totals $19.3 million over the last 10 years, according to data obtained via the federal Freedom of Information Act.
Among the cases, the U.S. government settled the case of a Kentucky man who died after gallbladder surgery in August 2007 at the Marion VA hospital. The man’s widow settled with the government for almost $1 million.
Marion VA medical staff was negligent in caring for Shank’s husband, Robert, and failed to treat his bleeding in a timely manner, the lawsuit alleged.
Among the reforms, the Marion VA center created a more rigorous background check of doctors, a hospital spokeswoman said. Additional staff was hired for surgery, pharmacy and other areas and a “more rigorous quality management review program” was put in place, she added.
The state of Illinois paid $4.11 million since 2004 for eight deaths at mental health hospitals run by the Department of Human Services.
One of the largest payouts stemmed from a patient suicide at Chicago-Read Mental Health Center, court records show. Milan Romic, a 37-year-old Chicago man, was admitted to Read in August of 2006 because he had suicidal thoughts and paranoid delusions, according to a lawsuit against hospital workers.
Romic’s brother filed suit alleging nurses, technicians and a doctor on duty at Read were negligent caring for the man. The lawsuit claimed health care workers failed to do proper checks on Romic even though he posed a danger to himself. After previously threatening to kill himself, the man was found hanged with a bedsheet in the early morning three days after being admitted, according to a lawsuit. The state settled with Romic’s family for $800,000, a review by the BGA found.
DHS officials declined a request for an interview. A spokeswoman said all “unusual incidents” are reviewed to determine cause. “Actions have included staff retraining and revising facility policies and procedures,” the spokeswoman said.
Small county, city and medical district hospitals outside Cook County also made payments in wrongful death cases over the past decade, though those amounts tend to be much less than what’s paid out at the larger urban medical centers. More than $800,000 in payouts were made from seven of these 20 local hospitals in Illinois over the past 10 years.
Rural hospitals face a number of challenges, including staffing their emergency rooms 24 hours a day with doctors.
