Medicare and mistakes: more fallout

Implicit in the new CMS rules for hospital reimbursement is the idea that every patient fall, every catheter related infection and every decubitus ulcer is the result of a medical error. The idea is ridiculous. No one who understands hospital care believes it, but the media are lapping it up. Another example of this media credulity comes from the Boston Globe (via Medpundit), in which bed sores and patient falls are equated with errors:

Hospitals also need to make public the rate of other medical errors listed by the Medicare regulators, and lay out their strategies to prevent them. These include the number of times patients fall and the number of pressure ulcers, commonly called bedsores, caused by prolonged bed stays.

One of my commenters, a patient activist with her own blog, supports the CMS policy but believes it goes beyond mistakes to criminal neglect:

…but prior to Oct '08, the times those hospitals will have been reimbursed when they should not have been rewarded for errors and neglect, will have already allowed them to get away with these crimes on patients for too many years.

Medical crimes and negligence can be penalized when due process is followed. What’s unfair is the uniform presumption of guilt just because an adverse event occurred. I asked my commenter point blank if she believed in the presumption of guilt and, if not, how crime and neglect in the hospital setting can be fairly adjudicated.

Meanwhile a commenter to a New York Times article on the same subject was quoted by Medpundit:

So, I admit Mrs. Jones, an elderly patient of mine, to the hospital because she has pneumonia. Because of the stress of the infection, she becomes delirious, which puts her at high risk of falling.In the interest of safety, I restrain and sedate her, which necessitates an indwelling urinary catheter.One week later, despite meticulous nursing care, Mrs. Jones develops a urinary tract infection and a minor pressure sore on her back because of her debilitated, immobilized state.My hospital administrator then suggests that I remove the restraints and the catheter and reduce the doses of her sedatives so that the conditions don’t get worse and our hospital doesn’t lose money.Two days later, Mrs. Jones falls out of bed and breaks her hip.How, exactly, has the new Medicare policy improved Mrs. Jones’s safety?

‘Nuf said.