The Doctors Company, a major insurance company that provides medical malpractice coverage to physicians, announced the results of its study into eight years of claims against hospitalists. The company’s thorough study provides insight to the many problems with hospitalist-managed health care.
What are hospitalists?
Hospitalists are physicians who provide patient care in hospital settings. They also see patients in nursing homes and rehabilitation facilities, but typically do not have offices outside hospitals where they see patients.
The concept of hospitalists is still pretty new. The goal of having such physicians is to have an on-site physician to manage the care provided by many different types of doctors and healthcare providers while the patient is admitted to a hospital or facility.
For post-surgical patients, for example, the hospitalist is supposed to act as the quarterback, making sure that the patient is receiving proper nursing and therapy care and that medical specialists, like the surgeon, physical medicine and rehabilitation doctor, wound care physician, are getting the information that they need for proper patient care and orders.
From my experience as a Houston, Texas medical malpractice lawyer, the lofty goals for hospitalists still leaves much work undone. In many lawsuits that I have handled for seriously injured patients and their families, I believe that having a hospitalist involved in the health care at issue was a net negative. In other words, the patients would have been better off without a hospitalist involved at all.
Quality of care concerns with hospitalist care
While I think the idea behind the creation of the hospitalist field is a good one, in reality many hospitalists are not truly engaged in providing quality patient care. Jam-packed schedules have them managing staggering numbers of patients at different hospitals, nursing homes, and rehabilitation facilities.
In one lawsuit involving a Sugar Land, Texas area hospitalist, I noticed that his curriculum vitae, or resume, stated that he had seen 20+ patients a day, seven days a week, for over 12 years. I asked him about it at his deposition and, at first, he was proud of the statistic and agreed with it. Only later did it dawn on him that routinely seeing that many patients a day did not present a good picture of the patient-centered care that he wanted the jury to believe that he provided.
In my view, hospitalist involvement often provides other medical specialists, like surgeons and cardiologists, with a false sense of security that someone else—the hospitalist—is doing the heavy-lifting when it comes to patient management. This can blur the lines of responsibility, meaning that when everyone is responsible, no one is actually providing the necessary care.
Moreover, when something goes wrong, hospitalist defendants invariably point the finger at other providers and emphasize that the hospitalist’s role is narrow and, frankly, almost irrelevant.
As I mentioned at the beginning of this article, data from The Doctors Company sheds some light on the types of problems that arise in hospitalist care. The eight-year study of 464 claims found that 78% of all claims or lawsuits against hospitalists fell within the following three categories.
36% of all claims were diagnosis-related. This means that the claim alleged that the hospitalist failed to diagnose the patient, unreasonably delayed the diagnosis, or made the wrong diagnosis.
36% of the claims alleged improper management or treatment of the patient. This deals with the hospitalist’s decision making for care after a diagnosis was made.
11% of the claims were related to medication errors. These medication mistakes led to serious conditions like sepsis (a system-wide blood infection) or loss of infected limbs from a lack of antibiotics, respiratory failure from excessive doses of narcotics, and toxicity resulting from the failure to monitor medications.
In addition, the insurance company study identified hospitalist-related issues that were present in many claims.
First, patient assessment issues. Hospitalists often fail to establish a differential diagnosis and fail or delay in ordering diagnostic tests. The differential diagnosis process is fundamental to all types of medical practice. It involves assessing the patient and making a list of every reasonable condition, disease, or illness that could explain the patient’s signs and symptoms. Then the doctor uses diagnostic tests and assessments to rule in or rule out each potential diagnosis, starting with the most dangerous one.
Second is communication among healthcare providers. In the reviewed claims, there was a trend in allegations that hospitalists did not share important information with other healthcare providers.
Third, selection and management of therapy. Hospitalists were frequently accused of mismanaged pneumonia, asthma, infections, sepsis, cardiac arrhythmias, heart attack, and traumatic injuries.
Fourth is communication between patients/family members and hospitalists. Many claims alleged that hospitalists had poor rapport with patients, language barriers, and inadequate medication instructions.
Lastly, failure to obtain a consult or referral. Based on the claims reviewed, many hospitalists were alleged of failing to recognize the need for bringing in a medical specialist to help with the patient. In other words, hospitalists felt that they could manage patients on their own without assistance.
In my experience as a Houston, Texas medical negligence lawyer, the study conclusions are accurate. I have filed medical malpractice lawsuits against Texas hospitalists with practically every one of the common quality of care issues addressed in the study.
We are here to help
If you or a loved one has been seriously injured by a medical malpractice, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
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Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, doctors, surgeons, pharmacists, and other healthcare providers. In 2017, H Texas magazine recognized him as one of Houston’s top lawyers. That same year, the Better Business Bureau recognized Painter Law Firm with its Award of Distinction.
