Friday, May 7, 2010

Resident/Interns Making Life and Death Decisions while Exhausted and Sleep Deprived

The November 1999 report of the Institute of Medicine (IOM), entitled To Err Is Human: Building A Safer Health System, focused a great deal of attention on as many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors. Medical Errors are the eighth leading cause of death. More people die each year due to medical error than die due to work related injuries and even more than die in automobile accidents. These medical errors can occur outside the hospital in other medical settings and even at home as there are medical errors in the writing and filling of prescriptions. The Massachusetts State Board of Registration in Pharmacy estimated that 2.4 million prescriptions are filled improperly each year in the State. See the IOM reporton Medical Errors was issued in February 2000 http://www.ahrq.gov/qual/errorsix.htm.

What are medical errors? Well it can be a botched surgery, amputation of the wrong limb, an wrong medication dose given, ordering the wrong diagnostic test or forgetting to order a diagnostic test, poor infection control leading to nosocomial or post-surgical wound infections, giving the wrong blood unit to a patient, improperly adjusting IV fluid flow, misinterpretation of a test and failure to act on abnormal results.

So how do you feel about the idea that a resident/intern in charge of decisions that affect you or your loved one has been sleep deprived and is exhausted? It is clear all rational decision makers that a doctor who is unable to get adequate rest will probably start making mistakes. In the hospital environment this can lead to medical error and even patient death. Rather than hiding the truth of medical errors we need to address this problem head on and need to address the abusive system of on call duty and lack of sleep time for resident/interns.

There is a new study out call Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, http://www.iom.edu/residenthoursthe most comprehensive study of resident work hours conducted to date. According to this recent Institute of Medicine study there are many abuses of scheduling of the more than 100,000 resident physicians in teaching hospitals across the country. Often in the U.S.A. these interns and residents are routinely scheduled to work shifts of 24-30 consecutive hours, with little or no sleep. They work in operating rooms and ER’s on the wards and in clinics. According to the study, the residents/interns when they are done their 12 hour or longer shifts, they potentially face back to back “on-call shifts” that can be 30 hours long. This brutal schedule leaves them sleep deprived and deeply fatigued interns and residents make mistakes thus impacting quality of medical care and safety. The rising level of medical errors in the USA is a testament to this real problem of quality of patient care and safety. Marathon work hours are linked to significant increase in failures of attention, performance deficits and medical errors. Driving back to their homes after an exhausting day at work leads to increased car accidents. The study reviews the robust evidence base linking fatigue with decreased performance in both research laboratory and clinical settings and makes a number of important recommendations for changes in the current system of training physicians. These include new limits on resident physician work hours and work load, increased supervision, training in structured hand-overs and quality improvement systems, more rigorous oversight and the identification of expanded funding sources necessary to successfully implement the recommended reforms.

There is a human cost to medical error in injury, increased sick time, days off work, and even death due to medical errors. This is a huge problem for our health care system, one which costs about $37.6 billion each year; about $17 billion of those costs are associated with preventable errors. Imagine how much more efficient and economical our medical system would be if we could prevent the expenses related to medical error which account for direct health care costs.

Medical error is often not attributable to individual negligence or misconduct. The key to reducing medical errors is to focus on improving the systems of delivering care and not to blame individuals. Health care professionals are simply human and, like everyone else, they make mistakes.

For more information on medical errors, select http://www.ahrq.gov/qual/errorsix.htm

See also the landmark research conducted by Lucian Leape, M.D., and David Bates, M.D., and supported by the Agency for Health Care Policy and Research, now the Agency for Healthcare Research and Quality (AHRQ).


Medical Errors: The Scope of the Problem. Fact sheet, Publication No. AHRQ 00-P037. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/errback.htm The prestigious Institute of Medicine (IOM) in December 2008 released its landmark report, Additional information on Resident Duty Hours: Enhancing Sleep, Supervision, and Safety can be found at http://www.iom.edu/residenthours. Copies of the report are available from the National Academies Press; tel. 202-334-3312 or 1-800-624-6242 or on the Internet at http://www.nap.edu. In addition, a podcast of the public briefing held to release this report is available at http://national-academies.org/podcast.

Lingering Questions Revolving around the Murder of a Doctor in Connecticut

Dr. Lishan Wang is charged with homicide of another doctor, Vajinder Toor. Lishan Wang is now facing charges of homicide in Superior Court New Haven, CT in the U.S.A. Dr. Lishan Wang filed a law suit alleging that he was retaliated against for being a whistleblower and then lost his job. He feared that he would not regain employment and then would no longer be able to support his family. Like many doctors in the USA he faced an unresponsive peer review system that was not transparent nor equitable. It is a terrible tragedy that it appears that he has chosen to take the life of another. In the hours after police say he shot and killed Dr. Toor, Lishan Wang is said to have expressed regret for what he'd done as he spoke with the Branford police.


See these news reports:

http://www.etaiwannews.com/etn/news_content.php?id=1243083&lang=eng_news&cate_img=316.jpg&cate_rss=news_Health

http://www.nytimes.com/2010/04/27/nyregion/27haven.html




http://hosted2.ap.org/txdam/f1a8086a13814cd2a20ca4ab28b1288e/Article_2010-04-27-US-Yale-Doctor-Killed/id-4b6761986ae549af92b143c7131bc121


I do not want to diminish the gravity of the offense of which Dr. Lishan Wang is charged and to which he apparently confessed to police. If he is guilty he should certainly bear the weight of the justice system for his crime. Homicide is never justified and this was a terrible loss for the Toor family. Toor leaves behind his wife, who was 14 weeks pregnant with the couple's second child and a toddler son. We extend great sympathy and condolences for this grieving family.


I believe we learn to prevent further tragedies by recognizing the truth behind these events. This is one reason why Medical Whistleblower provided information to the Office of the High Commissioner for Human Rights in Geneva information about the lack of protections for those who are defenders of human rights. In this UPR report Medical Whistleblower outlined the many ways in which justice is not served in the medical quality review and peer review system and why medical professionals in particular are threatened frequently with bad faith peer review. Bad Faith Peer Review is the lack of due process, transparency and justice in the administrative system controlling doctor's licensing. It is important the public recognize the inherent problems in the system that lead up to this tragic death so that the Toor family and others can understand what may have driven this man to such a desperate act.


TIMELINE OF EVENTS



July 2006 - May 2008: Wang is a resident at Kingsbrook Jewish Medical Center.

Nov. 2006: Toor joins the staff at Kingsbrook.

May 25, 2008: Heated argument between Wang and Toor where Toor accuses him of using "hostile body language."

July 6, 2008: Wang files EEOC complaint against hospital.

July 25, 2008: Wang terminated by Kingsbrook.

Nov. 2008: Wang resigns from a job at AE & LY Medical Associates of Flushing, N.Y., and moves back to Texas.

Feb 2009 – Feb 2010 Dr. Wang does postdoctoral work at Morehouse School of Medicine in Atlanta

May 8, 2009: EEOC gives Wang permission to sue hospital.

July 28, 2009: Wang files federal discrimination lawsuit against Hospital. In the federal discrimination lawsuit filed by Wang in 2009, Toor is referenced at least four times, and is accused of racial discrimination. In one incident documented in the suit, Wang said Toor humiliated him in front of other medical residents during a morning conference.

August 2009: Toor moves his family to Meadows condominium complex in Branford in preparation for a fellowship at Yale School of Medicine.

March 10, 2010: Federal judge orders Wang to comply with subpoena from hospital attorney's seeking his IRS returns, medication history and employment records.

April 13, 2010: Federal judge postpones conference call on status of federal discrimination case until May 6, 2010.



April 26, 2010 Police said Dr. Vajinder Pal Toor, 34, was walking to his car outside his Branford condo on Blueberry Lane just after 8 a.m. Monday when he was shot at least three times. Police said Toor's pregnant wife heard the commotion and confronted the gunman, later identified as 44-year-old Lishan Wang, of Georgia. Police said Wang turned and fired at her, but missed. Toor was pronounced dead at the scene. Police said Wang then fled in a red minivan. The names of two additional people directly involved with Wang's termination from the residency program were also located inside the van, according to court documents. These additional people were apparently unhurt. Using a description of the vehicle provided by witnesses, police were able to locate the Wang and take him into police custody. Police said two large-caliber handguns were found in a tote bag in the minivan's back seat. Branford police released a report from an officer who interviewed Wang. In the report, Wang told officers that he was sorry for what happened.

Support the US Prosecutors - AUSA's of this country and their ability to prosecute criminal activity in the medical community

US Federal Prosecutors are the front line of defense for the American public. Without adequate numbers and experienced prosecutors in the US Attorney Offices we will not have successful prosecution of criminal activity in the USA. Crimes are either not investigated or given too few investigatory resources, prosecutions are not pursued because evidence is not followed through on and quality of investigatory and prosecution efforts is decreased when there are not sufficient funds available.

Support Senate Bill S-596

Federal AUSA Attorneys are on the front lines of stopping financial fraud, the criminal division investigates fraud, internet criminal activity, identity fraud and also RICO (Raketeering, Influenced Corrupt Organizations). Mindful of the ease with which criminals establish “front organizations” to assist in money laundering, terrorist financing, tax evasion and other misconduct, it is shocking and unacceptable that many state laws permit the creation of corporations without asking for the identity of the corporation’s beneficial owners. The Senate bill S. 596 will guard against that, and no longer permit criminals to exploit the lack of transparency in the registration of corporations. It also will create a critical information gathering tool by giving law enforcement authorities access to the true identity of the owners behind certain corporations suspected of criminal acts, without unduly intruding upon individual privacy.

Also Support Senate Bill S-331


S. 331 A bill to increase the number of Federal law enforcement officials investigating and prosecuting financial fraud. by Senator Charles Schumer
January 27, 2009

SECTION 1. SHORT TITLE. This Act may be cited as the `Supplemental Anti-Fraud Enforcement for our Market Act' or the `SAFE Markets Act'. SEC. 2. FINDINGS. Congress finds the following: (1) A critical part of solving our current financial crisis, and preventing future debacles, is to bring to justice those who caused it through fraudulent acts. (2) However, law enforcement resources directed to financial fraud have been severely diminished in the last several years. Recent reports indicate that the FBI's staffing for white collar crimes such as mortgage fraud has decreased by 36 percent from 2001 levels, with a loss of 625 agents. The number of Assistant United States Attorneys has increased between .5 and 1 percent per year in recent years, but virtually all new prosecutors have been dedicated to fighting gang, internet, and immigration crimes, and some offices have been subjected to hiring freezes. In addition, the budget of the Securities and Exchange Commission has remained static for 3 years until Congress increased its appropriations by 4 percent for 2009. (3) In the wake of the Savings and Loan crisis of the 1980s, a series of strike forces based in 27 cities was staffed with 1000 FBI agents and forensic experts and dozens of federal prosecutors. That effort yielded more than 600 convictions and $130,000,000 in ordered restitution. (4) This authorization will bring FBI and prosecutorial staffing up to the levels that are necessary to investigate and prosecute complex financial crimes. Only through effective law enforcement can we restore worldwide faith in American markets. SEC. 3. ADDITIONAL LAW ENFORCEMENT. (a) Additional Employees for the Federal Bureau of Investigation- The Director of the Federal Bureau of Investigation is authorized to hire an additional 500 agents who shall be dedicated to investigating violations of the law relating to the United States financial markets. (b) Additional Employees for the Department of Justice- The Attorney General is authorized to hire an additional 50 Assistant United States Attorneys who shall be dedicated to prosecuting violations of the law relating to the United States financial markets. (c) Additional Employees for the Securities and Exchange Commission, Division of Enforcement- The Securities and Exchange Commission is authorized to hire 100 additional enforcement staff members who shall be dedicated to prosecuting violations of the law relating to the United States financial markets. SEC. 4. AUTHORIZATION. There are authorized to be appropriated to carry out this Act $110,000,000 for fiscal year 2009.