Patient Safety

After doctors in Florida failed to remove his deep-seated brain tumor, Marc Kotolnick traveled to Los Angeles to see Dr. Hrayr Shahinian, a surgeon at Cedars-Sinai Medical Center and a star in the emerging field of minimally invasive brain surgery. Shahinian cut through Kotolnick's eyebrow, drilled a hole into his skull and laced an endoscope into his brain. But when a delicate pair of forceps failed, the surgeon aborted the operation. There was no functioning spare set on hand. The May 2005 incident resulted in a lawsuit, which Cedars-Sinai resolved in a confidential settlement.

Consumer Reports has criticized the safety testing that went into the Lap-Band weight-loss device, raising concerns about poor regulatory oversight of medical equipment implanted in U.S. patients. In a report issued Wednesday the consumer magazine also expressed concerns about risks related to surgical mesh, metal hips and certain cardiac devices. It highlighted how the federal government allows some products to be sold with little or no advance safety testing. Consumer Reports questioned the effectiveness of Allergan Inc.'s Lap-Band product and said government approval was based on a clinical study of only 299 patients.

Recent Senate hearings into state (licensing) requirements for free-standing clinics remind us that, though medical professionals and medical products are strictly regulated, the places in which they are provided often are not. Anesthesia-related deaths in free-standing clinics stand in sharp contrast to the fall in such deaths following the adoption of professional practice and patient monitoring standards in 1986. Such standards have been universally adopted by U.S. hospitals.

While Jesse Bravo was being treated for schizophrenia at White Memorial Medical Center last year, his wife, Laura, called the hospital daily and visited him several times. But when hospital officials decided to discharge him, Laura Bravo said, they didn't notify her and instead left him outside a rehabilitation center in South Los Angeles. She said her husband, who is not homeless, never went inside and spent days on the streets before being found. "Not knowing where he was was very scary," she said.

Los Angeles County supervisors on Tuesday ordered improvements intended to shore up patient safety at the county's hospitals and clinics after reviewing a study commissioned to look at malpractice payouts. The risk management study, conducted by the Abaris Group, a Walnut Creek-based independent consulting firm, found that payouts for malpractice cases settled between 2005 and 2007 increased from more than $8 million to more than $12 million. At the same time, a review of records found that the number of incidents that either resulted in or were expected to result in malpractice lawsuits dropped from 354 in 2002 to 107 last year.

Days after state officials announced that Southwest Healthcare System in Murrieta had received California's first $100,000 fine for putting patients at risk of death or serious injury, federal regulators announced they plan to cut the hospital's Medicare funding June 1. State public health officials also said they had warned Southwest on Thursday that the hospital's "license is in jeopardy due to ongoing systemic problems and a pattern of life-threatening...

Federal regulators have shut down all government-funded human medical experiments at the University of Oklahoma Health Sciences Center in Tulsa amid evidence that researchers there broke multiple rules designed to protect patients, then tried to cover up their lapses by withholding information from university overseers and patients.

Thirteen years have passed since Bob Fauber went to an emergency room with chest pain and was almost mistaken for another patient scheduled to watch a video on sex after a heart attack. Fauber was being stabilized in a Hartford-area hospital room when a nurse arrived with a wheelchair to take him to the film. "I said, 'You have the wrong patient,'" Fauber's wife, Gloria, told the nurse. The nurse apologized and left the room.

In a fight that could have wide-ranging implications, Los Angeles County supervisors are pushing to see confidential medical records used by county doctors to evaluate their peers to determine whether they have met accepted standards of care, saying they need the information to ensure patient safety and justify settling malpractice claims against the county. Access to such information emerged as an issue earlier this year after concerns were raised about peer review at Olive View-UCLA Medical Center . An anonymous letter to state regulators alleged that among other problems at the county hospital's neonatal intensive care unit, doctors and staff were not meeting to discuss medical mistakes and that peer review was "missing.

In an unusual alliance, the Schwarzenegger administration and some Democratic legislators are moving to abolish the state board that regulates acupuncturists, saying the board has been more concerned with promoting the profession than with protecting patient safety. In its six-year existence, the California Acupuncture Board has pressed to expand educational requirements for new practitioners to include physiology and physics as well as Eastern and Western diagnostic techniques.

The Food and Drug Administration has accused the 1-800-GET-THIN marketing company of using misleading advertising in its promotion of Lap-Band weight-loss surgery, saying the billboard, radio and television ads underplay serious risks to patients. The billboards, plastered across Southern California freeways, display the smiling faces of thin people and catchy phrases about the benefits of Lap-Band surgery. There are warnings about the risks, but the typeface is so small it's not legible, the FDA said.

State public health officials have fined 12 California hospitals for medical errors that hurt or killed patients, according to a report released Wednesday. Three of the hospitals — L.A. County/USC Medical Center, Torrance Memorial Medical Center and Brotman Medical Center — are in Los Angeles County. The penalties were issued for errors such as leaving foreign objects in patients' bodies during surgery and administrating the wrong medication. They occurred in 2009 and 2010.

Forty years ago this month, a study published in the New England Journal of Medicine revealed that sleep-deprived resident physicians reading electrocardiograms made twice as many errors as their rested counterparts. Back then, in 1971, there were no limits on the hours that medical residents could be scheduled to work. Thirty-six-hour on-call shifts were the norm. Under new rules that take effect Friday, newly minted medical school graduates will start their internships with shifts limited to no longer than 16 hours.

Three months ago, I finished my last 30-hour shift as a medical student. Although I'll be starting my residency soon, it's unlikely I'll ever again work such a marathon shift. FOR THE RECORD: Physicians: In a Jan. 24 Op-Ed about residency funding, the Accreditation Council for Graduate Medical Education and the Assn. of American Medical Colleges were incorrectly called the American Council for Graduate Medical Education and the American Assn. of Medical Colleges, respectively.

Ever since college student Libby Zion died while under the care of overworked, overtired, undersupervised medical residents at New York Hospital, there has been a push to limit the duty hours of these doctors-in-training. In the 26 years since that fateful night, the Accreditation Council for Graduate Medical Education (better known by the acronym ACGME) has put restrictions on the number of hours residents may work per week (the current maximum is 80) and the length of any single shift (the current maximum is 30, and it will drop to 16 next year)

In a series of mistakes described as a "Swiss cheese" event by hospital officials, a patient recently admitted to Olive View- UCLA Medical Center was not assigned a doctor for two days. The patient was admitted to the Los Angeles County teaching hospital in Sylmar by an emergency room medical student, who filled out the admitting paperwork incorrectly despite help from an attending physician in the emergency room. Although a doctor's name was placed on the paperwork, the doctor was never called about the assignment, according to a memo by Dr. Mark Richman, who said he was the attending physician who helped the student with the paperwork.

In a series of mistakes described as a "Swiss cheese" event by hospital officials, a patient recently admitted to Olive View- UCLA Medical Center was not assigned a doctor for two days. The patient was admitted to the Los Angeles County teaching hospital in Sylmar by an emergency room medical student, who filled out the admitting paperwork incorrectly despite help from an attending physician in the emergency room. Although a doctor's name was placed on the paperwork, the doctor was never called about the assignment, according to a memo by Dr. Mark Richman, who said he was the attending physician who helped the student with the paperwork.

Labor unions representing California nurses are attacking key parts of a bill that would overhaul the state's system for investigating and disciplining health workers accused of misconduct. The objections by the politically powerful California Nurses Assn., Service Employees International Union and groups for other health professions come days before a state Senate panel is set to vote on moving the bill forward. The Senate Committee on Business, Professions and Economic Development must advance the bill Monday or it is dead for this session.

In the 18th century, physicians-in-training literally lived in the hospitals where they worked. Although today's "residents" are no longer supposed to be sleeping on the job, so to speak, their 30-hour work shifts mean that it's not uncommon to find them battling shut-eye in the emergency room. Heroic working hours have long been a badge of honor for senior physicians ? the late cardiovascular surgeon Michael DeBakey often bragged that he slept for only five or six hours per night tops.

In a fight that could have wide-ranging implications, Los Angeles County supervisors are pushing to see confidential medical records used by county doctors to evaluate their peers to determine whether they have met accepted standards of care, saying they need the information to ensure patient safety and justify settling malpractice claims against the county. Access to such information emerged as an issue earlier this year after concerns were raised about peer review at Olive View-UCLA Medical Center . An anonymous letter to state regulators alleged that among other problems at the county hospital's neonatal intensive care unit, doctors and staff were not meeting to discuss medical mistakes and that peer review was "missing.