Contra Costa Times, Knight Ridder Newspapers September 14, 1999 Font Page

Mum is Often the Word When Caregivers Stubmle

Part 3 of a four-part series

By Andrea Gerlin

Doctors at the Medical College of Pennsylvania Hospital made a mistake three years ago when they performed a procedure on the right side of Morton Tarason's chest: The problem they were attempting to fix was on the left side of Tarason's chest.

The incident was properly reported to MCP administrators, who earmarked $7,500 in estimated damages in case the episode came to light and the 79-year-old Tarason or his family filed a claim or lawsuit.

The administrators need not have worried about that. No one from the hospital ever informed the patient or the family that the hospital had made the mistake.

"I was not told that it was done on the wrong lung and that he had to go back for a second procedure," said Tarason's daughter, Lynne Jaffe, who lived with her father in Bensalem. She learned about the mistake when The Inquirer asked about her father's medical treatment at MCP and provided her with the information in the hospital's internal incident report.

Jaffe said that neither she, her father nor her brother, Rick Tarason, was told about the botched procedure. Jaffe said she was at the hospital with her father virtually round-the-clock during his illness.

"That would have been something I should have been told," she said.

Her father died three months later. It is unclear whether the unnecessary invasive procedure worsened his health. Tarason's family has not filed a lawsuit.

The hospital's current and former owners declined to discuss the treatment of specific patients, including Tarason.

The Inquirer has reported over the last two days that hundreds of patients suffer medical errors at hospitals across the country every day. One reason the problems persist is that medical professionals routinely do not tell patients or their families about the errors. As a result, the public is effectively shielded from knowing about them.

In a study published in 1991 in the Journal of the American Medical Association, researchers at the University of California at San Francisco found that only 54 percent of medical residents discussed their mistakes with their attending doctors, who are legally and ethically responsible for them. Only 24 percent told the patients or families of the mistakes. The study confidentially surveyed 254 residents - doctors-in-training who have completed medical school - in three large internal medicine training programs that it did not identify.

Lenny Rosenfeld, vice president of quality management at Tenet Healthcare Corp., MCP's current owner, said: "We do not withhold information on these things. We deal with them appropriately." The hospital's former owner, the Allegheny health system, declined to comment.

In some cases, MCP patients or their families learned of errors only through an inadvertent disclosure by a hospital worker or after suspicions led them to contact lawyers who obtained medical records documenting the mistakes. In other cases, including the Tarasons', the family learned about mistakes when The Inquirer provided them with information in the hospital's own internal incident report obtained from Bankruptcy Court documents.

Professional medical associations are unequivocal about a doctor's responsibility to disclose errors to patients or relatives acting on their behalf. The American Medical Association's Council on Ethical and Judicial Affairs states in its ethics code:

"Situations occasionally occur in which a patient suffers significant medical complications that may have resulted from the physician's mistake or judgment. In these situations, the physician is ethically required to inform the patient of all facts necessary to ensure understanding of what has occurred. Concern regarding legal liability which might result following truthful disclosure should not affect the physician's honesty with a patient."

Many doctors say that guideline is routinely not followed.

"Welcome to the real world," said Frank Davidoff, a physician and editor of the Annals of Internal Medicine, the journal of the Philadelphia-based American College of Physicians. "There's a pull in a doctor's mind. Part of you feels obligated to tell the patient, part of you feels your own professional competence is at stake."

Sometimes doctors are untruthful with the lawyers and malpractice insurers defending them, said John Reed, director of the Pennsylvania Medical Professional Liability Catastrophe Loss Fund. "We've had cases where we made doctors pay [the settlement] out of their own pocket because they lied to us," he said.

Doctors commonly contact hospital risk managers - lawyers and administrators who seek to limit error and accompanying liability - after mistakes occur to seek advice on what to tell patients or relatives.

William N. Kelley, chief executive officer of the University of Pennsylvania Health System, said the system's risk-management team gets involved when mistakes are made. He said the Penn system expects its staff to be honest. "I can't guarantee it happens 100 percent of the time, but that's the intent," Kelley said.

Howard Grant, a pediatrician and lawyer who is chief medical officer of the Temple University Health System, said Temple encourages its staff to be truthful with patients. He added, "You always discuss situations with risk management."

Stanley Trooskin, chief of surgery and medical director at MCP Hospital, said MCP has a 24-hour risk-management hotline for employees to report errors.

He said that whether doctors tell patients about errors "is going to depend on the individual." He added, "I think that you have to be honest. It's not good for the lawsuit, but you have to be as honest as possible. Lawyers wouldn't want you to be honest."

A chest scan overlooked

until after a patient's death

After 78-year-old Emilio Devico underwent a triple bypass at MCP Hospital in September 1997, he developed complications, including an adverse drug reaction, a bowel hernia, and a wound infection. After making progress, Devico was weaned a week later from a ventilator that was helping him breathe. His breathing difficulties returned, and he died that day.

A week before he died, Devico had undergone a chest scan. According to internal hospital records, no one looked at the results of the scan until after Devico died. The scan offered at least one clue explaining why Devico might have been struggling: He had a blood clot in his inferior vena cava, a large vein that brings blood from the lower body back into the heart.

That no one had read the scan while Devico was alive came as news to Devico's son Anthony, who had power of attorney for his father, and said he was told that everything possible had been done to save his father.

"They never told me that he had a clot," Anthony Devico said. "This is the first time I'm hearing about it."

Emilio Devico had so many ups and downs following his surgery that his son said he became suspicious and returned to MCP Hospital the day after his father died to get a copy of his father's medical records. A clerk told Anthony Devico that the records were not available, he said. He said he returned two days later, threatened to bring a lawyer, and the hospital provided him with the records. They charged him $900 for the copies. The hospital currently charges 25 cents a page for copy requests exceeding 60 pages, a Tenet spokesman said.

Devico has not filed a lawsuit.

Equipment with a defect

causes a delay in treatment

Pauline Langhuber, 62, went into cardiac arrest at MCP Hospital's dialysis center in March 1997. According to the hospital's internal report, a paddle on the center's defibrillator, which is used to jump-start the heart's electrical activity, would not come off its base.

A staff member had to get another machine from the emergency room, and Langhuber was revived after an estimated 10 to 15 minutes. She underwent an emergency cardiac catheterization, after which she remained unresponsive, having suffered severe brain damage. It is unclear whether the delay caused the brain damage.

An attendant in the dialysis center, who witnessed the resuscitation, told Pauline Langhuber's husband about the defective machine, said her brother, Edward Brosz. Her husband, Carl, approached hospital officials, who agreed that something had gone wrong but refused to acknowledge that the defibrillator was defective.

"They were not forthcoming," Carl Langhuber said.

The hospital's internal report is entirely consistent with the account that the dialysis attendant gave Carl Langhuber. It says that the defibrillator paddle could not be removed from its base and that a second machine had to be obtained from the ER.

Langhuber has not filed a lawsuit.

A patient cannot be connected

to resuscitation equipment

MCP internal records note that Howard Ferguson could not be connected to resuscitation equipment when he developed breathing problems in the cardiac-care unit in April 1997.

The polio that Ferguson, 74, contracted in the 1950s required him to have a tracheostomy, an opening directly into the windpipe that enabled him to breathe. His widow, Elaine, said the "trache" attachment was metal, which permitted him to talk.

The metal attachment was in place after Ferguson underwent a coronary artery bypass and valve replacement at MCP Hospital two years ago. Afterward, he developed shortness of breath and a slowed heartbeat. According to the hospital's insurance report, nurses in the cardiac-care unit could not assist his breathing because a manual-ventilation "ambubag" cannot be connected to a metal attachment.

Ferguson went into cardiac arrest and died.

Elaine Ferguson said no one at MCP ever told her what happened before her husband died.

"That was not explained to me," she said after she was told about the information in the hospital's internal incident report.

Ferguson, a registered nurse, said she was aware of the metal attachment's limitations but was never told that a problem had developed in connecting the ambubag. She said she had assumed that nurses had switched her husband in an instant to an alternative plastic trache attachment known as a "Shiley." She now suspects that the CCU crash cart lacked the plastic attachment, which is commonly used in hospitals and could have been rapidly connected to the ambubag had it been available.

"They should have had a Shiley on the cart," she said. "Nursing personnel could put it in, if they had one, in five seconds."

Ferguson has not filed a lawsuit.

Numbness develops when a bar

impinges on a patient's nerve roots

Nancy Rowbottom was taken to MCP Hospital after she broke her pelvis in a car accident in 1996. An orthopedic surgeon there put two bars in the region where her lower spine joined her pelvis. After the surgery, she developed numbness in the area. The 32-year-old Rowbottom said it remains a "horrible" impediment, and she expects it will continue for the rest of her life.

She asked the surgeon whether the bars caused the problem. She said his account was "sketchy" and that he had said that he had checked a scan and did not see the bars putting pressure on nerves. "He blamed it more on the accident," Rowbottom said. "I didn't really believe him at the time."

Rowbottom did not learn that her skepticism had been justified until she was told about the information in the hospital's insurance report. The entry indicated that she had developed the numbness "as a result of sacral bar impinging on nerve roots."

The statute of limitations

sometimes is extended

Under Pennsylvania law, plaintiffs in malpractice cases have two years to file suit or they forfeit the right to sue. In some circumstances, hospitals or doctors who withhold information can be legally vulnerable beyond the two-year statute of limitations.

Clifford Rieders is a lawyer from Williamsport, Pa., who has researched the statute of limitations in medical malpractice cases. "Where a person in the exercise of reasonable diligence did not know or could not know that they were harmed, the statute of limitations is extended so it's two years from when they found out they were harmed," Rieders said.

The law is clearer in cases where information has been fraudulently concealed from patients, Rieders said.

However, it is usually difficult for patients to prove what they were not told. Most state laws - including Pennsylvania's - consider the information contained in internal hospital reviews of physicians' competency as "privileged" and unavailable to patients or the public.

Internal records of medical errors at MCP were made public last year when Tenet Healthcare Corp., which purchased the hospital from the Allegheny health system, included them in documents filed in U.S. Bankruptcy Court in Pittsburgh.

It is unclear how many MCP Hospital patients or their families were not told the truth about their treatment. Of the 598 entries recorded in the hospital's 10-year insurance report, 154 were "closed" as of June 30, 1998, the date of the report. Of the closed incidents, 140 were resolved - according to the report - because the statute of limitations had expired.

Frank Donahue, Inquirer news researcher, and Sally Downey, Inquirer editorial assistant, contributed to this article.