Whistleblower Lawsuit Claims Misdiagnosis, Cover-Up At KU Hospital | KCUR

HM Epstein hmepstein at GMAIL.COM
Fri Jul 8 04:03:54 UTC 2016


Thank you, David. It's interesting because once something is in writing, it
takes on a power that is hard to dispel. Think of all of the news articles
that misstate studies, or overstate them and then the public believes them
for years. A record that states that you discussed a case with Drs. X, Y &
Z is admissible in court and probably more powerful than those doctors'
memories that they did or didn't discuss it with you. While I'm certain
you've never abused this kind of note-taking, do you think others have?
Best,
Helene

hmepstein.com
@hmepstein <https://twitter.com/hmepstein>
Mobile: 914-522-2116

On Wed, Jul 6, 2016 at 10:54 AM, David Katz <d.katz at mail.utoronto.ca> wrote:

> Helene,
>
>
>
> While there is strong security to avoid people surreptitiously logging in
> as someone else, in the systems that I use there is nothing stopping you
> from dictating a note that says “I have reviewed the case with Dr X, Y, and
> Z and they agree with my assessment.” In fact I do this truthfully all the
> time. Those doctors are not notified in any way that their name is used and
> only if they happen to read my note would they know that I used their names.
>
>
>
> David
>
>
>
> *From: *HM Epstein <hmepstein at GMAIL.COM>
> *Reply-To: *Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, HM Epstein <hmepstein at GMAIL.COM>
> *Date: *Wednesday, July 6, 2016 at 10:27 AM
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>
> *Subject: *Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
> Thank you all who addressed my questions about security in EMR's as
> related to the article I shared. Given the level of security and passwords
> that most of you have mentioned are in place at your institutions, I wonder
> how this pathologist at KU Hospital was able to add to the record that two
> doctors concurred with her diagnosis when they hadn't. And how they were
> cited in the record without knowing. If it's as difficult as most of you
> say, then I wonder whether or not the whistle blower is wrong about these
> two doctors and if perhaps they just changed their story when they realized
> the original diagnosis was incorrect.
>
>
>
> As to the question regarding whether this case was an outlier or a more
> common occurrence, my question was about the hospital's active role in
> denying any misdiagnosis and supporting the pathologist who covered her
> tracks. Retaliation is a big juicy topic but is just one more example of
> how a hospital or medical center can cover their tracks.
>
>
>
> Peter Dayton's reference to the CRP and the subsequent change in captain
> and copilot culture brings up an excellent point. That happened because
> there were too many instances of danger to passengers because of pilot
> error or misbehavior.
>
>
>
> Does medicine needs a similar change in culture when it comes to openly
> admitting mistakes, changing the processes by which staff can report these
> mistakes and the administration investigate and improve procedures? Or, for
> the most part, is the culture already changing and KU Hospital is an
> outlier?
>
>
>
> Best,
>
> Helene
>
>
>
>
>
> *--  *
>
> *hmepstein.com <http://hmepstein.com> *
>
> *@hmepstein*
>
> *Mobile: 914-522-2116 <914-522-2116>*
>
>
>
> *Sent from my iPhone*
>
>
>
>
>
>
> On Jul 4, 2016, at 5:12 PM, Peter Dayton MD <pdayton at COMCAST.NET
> <pdayton at comcast.net>> wrote:
>
> Ed you are right ! Ego and the old code of silence is part of our culture.
> Hope we can change that like they did in the airline industry. After the
> disaster in Tenerife the industry got serious about cockpit resource
> management or CRP. That changed the Captain- Co Pilot role interaction
>  which helped in great part to make airlines a high reliability
> institution.
>
>
>
> Peter M. Dayton MD
>
> Medical Director of Patient Safety and Quality
>
> Martin Health Systems
>
> 1815 Kanner Highway
>
> Stuart FL 34994
>
> 772-285-4020 cell
>
> 772-288-2999 fax
>
> 1 Peter 3:15
>
>
>
> *From:* Edward Winslow [mailto:edbjwinslow at gmail.com
> <edbjwinslow at gmail.com>]
> *Sent:* Monday, July 4, 2016 3:04 PM
> *To:* Society to Improve Diagnosis in Medicine <
> IMPROVEDX at list.improvediagnosis.org>; Peter Dayton MD <pdayton at comcast.net
> >
> *Subject:* Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
> As Peter noted, if passwords are kept private (A Cultural norm?), adding a
> signature is impossible in most EMRs. In the "big" EMRs, I think that every
> time a chart is accessed the accessor and time of access are stamped.
>
> While I would hope that systems and physicians are above retaliation I
> have seen several instances where people who place an institution in an
> unfavorable light are retaliated against. Even in systems that are supposed
> to be well-intentioned and patient centric, instances come about. One
> physician who presented a paper on a single institution errors in
> echocardiographic diagnoses was let go. The institutional reps said that
> there were multiple reasons why she was let go, but the ball dropped very
> shortly after the ASE presentation. (
> http://www.medpagetoday.com/cardiology/atherosclerosis/24337).
>
> I would estimate that, unfortunately, retaliation is not as uncommon as we
> would hope it would be. Certainly the lay public doesn't know if, or how
> often it occurs.
>
>
>
> On Mon, Jul 4, 2016 at 9:08 AM, Peter Dayton MD <pdayton at comcast.net>
> wrote:
>
> This whole line of discussion seems to be at odds with a Just Culture. Sad
> to see administrators and colleagues behaving in such a way.  The EMR
> secures physicians signatures and if there are appropriate security measure
> where passwords are not know by anyone but the licensee it should not be
> possible to sign someone else’s signature on a report. Again that is more a
> function of password security and security policy than the EMR. Our IT
> people force a reset every 90 days for access to our EMR which drives me
> nuts but it is a necessary evil.
>
>
>
> I am very aware of Dr. Rand’s case and the issues of expert testimony in
> med mal cases. I have been doing expert work for many years and the
> disciplinary process the respective professional societies are imposing is
> designed to stop egregious statements made in front of lay juries by expert
> witnesses.  The position of the societies is that their reputation is on
> trial as well as the experts always are certified by their respective
> boards and present their opinions to lay juries as a member of the
> respective societies. After practicing OB for 27 years and looking at
> dozens of cases some experts give a fair and honest opinion and some say
> outrageous statements inconsistent with medical evidence. I was once
> accused of missing the diagnosis of IUGR on a 16 week ultrasound,
> understanding that fetal growth is very uniform in the first half of
> pregnancy so a supposed missed diagnosis is in fact an appropriate
> assignment of gestational age in a patient with irregular menses. There are
> several notorious “experts” well known to both the plaintiff and defense
> bar. Tort lawyers have a short list of go to experts on various cases. That
> is why my work has evolved into 10% plaintiff and 90% defense work. I call
> it as I see it. Defense counsel like me to look at cases so they know it
> their client has exposure and should settle because in my experience a lot
> of cases have real standing unfortunately. The American Congress of OB/GYN
> has a “Witness Affirmation Statement “ and has a code of ethics :
>
>
>
> *Expert Witness Conduct and Responsibilities*
>
> Fellows who serve as expert witnesses for either the plaintiff or
> defendant are expected to adhere to the professional principles outlines in
> ACOG's *Expert Witness Affirmation*, available on the ACOG website.  In
> brief, ACOG expects Fellows testifying as expert witnesses to:
>
> ·        Tell the truth.
>
> ·        Evaluate all facts and medical care thoroughly, fairly, and
> impartially.
>
> ·        Include all relevant information.
>
> ·        Limit evidence and testimony to subjects about which they have
> knowledge and relevant experience.
>
> ·        Refrain from criticizing or condemning care that meets generally
> accepted standards in use at the time of the incident.
>
> ·        Refuse to endorse practice that does not meet generally accepted
> standards.
>
> ·        Ensure that testimony is complete, objective, and scientifically
> based.
>
> ·        Strive to provide evidence that will help the court achieve a
> fair outcome.
>
> ·        Distinguish between an adverse outcome and substandard care.
>
> ·        Make an effort to determine whether alleged substandard care
> caused the adverse outcome.
>
> ·        Submit testimony for peer review if asked.
>
> ·        Refuse to accept compensation that depends on the outcome of the
> case.
>
> If you are currently involved in litigation or if you are sued in the
> future, be sure your attorney knows about ACOG's *Expert Witness
> Affirmation*.  If an expert witness testifies on your behalf, he or she
> should sign the affirmation.  Your attorney can use the affirmation to
> bolster the expert's qualifications and credibility.  If the plaintiff's
> expert witness has not signed the *Expert Witness Affirmation*, your
> attorney can raise this in cross-examination.  If the plaintiff's expert
> witness has signed the affirmation, your attorney can, nevertheless,
> cross-examine on the expert's failure to adhere to the affirmation's
> requirements.
>
> Other societies have similar processes. This does break down when a formal
> complaint is made by members to the college about an expert’s testimony. A
> formal sanction or reprimand for egregious statements will hold physicians
> accountable and in effect take them out of the “hired gun loop” . I files
> such a claim many years ago and it went nowhere.
>
>
>
>
>
> Peter M. Dayton MD
>
> Medical Director of Patient Safety and Quality
>
> Martin Health Systems
>
> 1815 Kanner Highway
>
> Stuart FL 34994
>
> 772-285-4020 cell
>
> 772-288-2999 fax
>
> 1 Peter 3:15
>
>
>
> *From:* Lee Tilson [mailto:lee.tilson at GMAIL.COM]
> *Sent:* Sunday, July 3, 2016 6:37 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Whistleblower Lawsuit Claims Misdiagnosis,
> Cover-Up At KU Hospital | KCUR
>
>
>
> No, not that I know of.
>
> Have you heard of how the American Assoc of Neurosurgeons retaliated
> against Dr. Robert Rand? Or other neurosurgeons? Or how a chair that tried
> to get rid of a fraudulent doctor was punished? Retaliation occurs all the
> time. Details and circumstances are different. The goal and effect is the
> same: silencing whistleblowers.
>
> Feel free to call.
>
> Lee Tilson.
> 313 550 7500
>
>
>
> On Sun, Jul 3, 2016, 6:24 PM HM Epstein <hmepstein at gmail.com> wrote:
>
> Thanks, Lee. Beyond the retaliation angle, how easy is it for one doctor
> to insert the names of other doctors into an EHR indicating they "concur"
> with a Dx without the other doctors knowing or agreeing? Has anyone heard
> of this happening before?
>
>
> hmepstein.com
>
> @hmepstein <https://twitter.com/hmepstein>
>
> Mobile: 914-522-2116
>
>
>
> On Sun, Jul 3, 2016 at 5:25 PM, Lee Tilson <lee.tilson at gmail.com> wrote:
>
> I am familiar with a few instances of retaliation against people  who
> attempted to expose misdiagnosis or mistreatment.
>
>
>
> The circumstances were somewhat different. The underlying story is the
> same.
>
>
>
> Feel free to contact me if you think this would be helpful.
>
>
>
> Lee Tilson
>
>
>
> On Sat, Jul 2, 2016 at 2:34 AM, HM Epstein <hmepstein at gmail.com> wrote:
>
> Please read the following summary and I'd appreciate the group's feedback.
>
>
>
> The former chair of pathology at KU Hospital filed a whistleblower lawsuit
> against his current hospital claiming the current head of pathology
> misdiagnosed a patient with a lethal form of cancer, surgeons removed an
> unidentified organ, the lab discovered that the removed organ was
> essentially cancer-free, and then that the pre-surgery sample was also free
> of cancer, covered it up and never told the patient who still thinks they
> have to be on guard against a lethal form of cancer.
>
>
>
> The paragraph I would like your opinion on is deep in the article:
>
>
>
> "In September, Tilzer informed KU Hospital’s chief medical officer and
> risk management officer that the hospital needed to conduct a “root cause
> analysis” of the mistake to make sure it wouldn’t happen again. The chief
> medical officer responded that the original diagnosis was correct because
> two other pathologists signed the report. But Tilzer says the two other
> pathologists did not agree with the original diagnosis, “and the chair
> simply wrote their names in the electronic medical record.”"
>
>
>
> First, is it easy for one doctor to fake the signatures of other doctors
> in the EMR without being discovered? And while the accused pathologist
> finally admitted her error, it appears the hospital hasn't done so nor had
> the patient been notified. Therefore no root cause analysis has been done.
>
>
>
> So, is this a crazy outlier situation or is it a common occurrence?
>
>
>
> Thank you.
>
>
>
> Best,
>
> Helene
>
>
>
>
> http://kcur.org/post/whistleblower-lawsuit-claims-misdiagnosis-cover-ku-hospital#stream/0
>
>
>
> *-- *
>
> *hmepstein.com <http://hmepstein.com> *
>
> *@hmepstein*
>
> *Mobile: 914-522-2116 <914-522-2116>*
>
>
>
> *Sent from my iPhone*
>
>
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>
>
>
> ------------------------------
>
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


HTML Version:
URL: <../attachments/20160708/bcd037ff/attachment.html>


More information about the Test mailing list