2018 LHA Trust Funds Newsletters

Claims and Conclusions Newsletter

June 2018: Accident at Work? How to Tell the Difference Between a Work-Related Injury and a Pre-Existing Medical Condition
How often do you run into someone who thinks that “if something happens at work, it falls under workers’ comp.” This is an incorrect assumption that can lead one awry when dealing with workers’ compensation issues. Learn how to tell the difference between a work-related injury versus a pre-existing medical condition. Read more here

September 2018: Late To Report- A Claim Study
Prompt reporting of workers’ compensation claims is critical and has a direct impact on the outcome of the claim. Find out how one late report has impacted both employer and employee so far in this issue of Claims & Conclusions. Read more here

December 2018: Questioning Claims- Things Are Not Always As They Seem
Most worker’s compensation claims are fairly straightforward, but occasionally a claim will have extenuating circumstances or issues that may impact the investigation. This newsletter focuses on one such claim, where the initial claim seemed compensable. Yet as the investigation continued, it became clear that things were not what they seemed. Read more here

Claims and Risk Newsletter

February 2018: Short Staffed? A $2.7 Million Price Tag
A 61-year-old female went to the hospital with what she thought was a bad cold, and was admitted with a diagnosis of pneumonia. Following admission, she became increasingly feverish and short of breath, but her family’s calls for help went unanswered. In fact, her daughter was unable to find anyone when she went to the nurses’ station looking for assistance. The patient eventually stopped breathing, and someone finally responded to the family’s desperate and frantic calls. Shirley was successfully resuscitated but sustained brain damage due to oxygen deprivation. Read more here

March 2018: Nurses, Caregivers, Patient Advocates
This claim involves the death of a patient as a result of sepsis that allegedly developed when she was discharged with a fever 11 days after a urinary tract surgery. The daughter of the deceased patient initiated a medical malpractice suit against two physicians and the hospital, spotlighting the responsibility nurses have to advocate for patients…even if it means questioning doctor’s orders. Read more here

April 2018: How a Hospital Chart Saved an Emergency Department
How could a hospital chart save an Emergency Department? In this claim, a couple brought their 11-month-old child into the ER. The infant was diagnosed with a bowel impaction and treated with no apparent issues. But shortly after being discharged, the parents called saying the child had a broken leg and that it was broken at the ER. What did the patient’s chart reveal? Read more here

May 2018: No Record, No Defense. Maintaining Patient Documentation in Your Facility
It is emphasized over and over in this newsletter that maintaining medical documentation is important. This claim perfectly demonstrates why, spotlighting a case with missing medical records. Emergency department staff say the missing records are a result of equipment malfunction. The plaintiff’s attorney claims it’s a cover up. Who does the jury believe? How can you prevent this from happening in YOUR facility? Read more here

July 2018: From Birth to Malpractice: The Question of “Laboring Down”
Most people don’t associate pregnancy and childbirth with malpractice, but that’s exactly what this newsletter’s claim involves. How did the Medical Review Panel rule? Was this claim an exposure of a gap in patient care or birth complication beyond the healthcare provider’s control? Read more here

August 2018: Checks and Balances- Making Sure Patients Receive Proper Follow-Up Care
Medical personnel play a significant role as patient advocates. Processes should be in place to make sure that patients receive agreed-upon follow-up care. But what happens when those processes fail? Who is responsible? Read more here

September 2018: Scripts & Suicide- Assessing Opioid Patients in the ER
Headlines featuring the ongoing opioid crisis is nothing new. Emergency Departments should be prepared to access and treat patients complaining of opioid withdrawal, keeping in mind that patients with drug abuse disorders carry a high risk for suicidal tendencies. Read more here

October 2018: Mental Illness and Elopement- When Are Hospitals Liable?
In this claim, the patient is a 26-year-old male with a past medical history of schizophrenia with audible and visual hallucinations, alcohol abuse, and use of illegal substances. He presented to the Emergency Department via EMS and it was determined that he did not need to be placed under a Physician’s Emergency Certificate (PEC) as there were no indications he was a danger to himself or others. The patient then ran away from the psychiatric holding room, left the hospital and was later found dead. What was the Medical Review Panel’s decision? How do hospitals handle elopements of mentally ill patients? Read more here

November 2018: Credentialing Controversy- Review and Verify
This claim focuses on the issue of negligent credentialing, currently a prime area for liability claims. A post-Medical Review Panel lawsuit was filed despite a ruling in favor of both surgeon and hospital. The allegations centered on the hospital’s responsibility as part of the credentialing process to ensure surgeons know all the requirements. In addition, what are the responsibilities of other departments during credentialing if something is overlooked? Read more here

December 2018: Infusion Confusion- Risks and Preventative Measures
Most patients acquire an IV when they enter the hospital in order to deliver a fluid or medication directly into their vein. However, especially in the very young and old, there are significant risks to this very common procedure. This newsletter discusses recent claims regarding IV sites and processes that can be put into place to ensure there are no unnecessary complications for the patient. Read more here


January 2018: eNSIGHTS
At A Glance: Physicians Face Cyberattacks, Commission Will Note Hand Hygiene, and A Severe Flu Season. Read more here

March 2018: eNSIGHTS
At A Glance: Biopsy Results Differ Among Labs, Predictive Software Gains Foothold, and Hospitals Vulnerable As Insurers Diversify. Read more here

May 2018: eNSIGHTS
At A Glance: Alarm Raised Over Physician Burnout, Increased Penalties for Fraud and Abuse, and Bacteria Found on 75% of “Clean” Scopes. Read more here

July 2018: eNSIGHTS
At A Glance: Medicare Will Pay For Social Services, Amazon Wades Deeper Into Healthcare, and an Algorithm Predicts End of Life. Read more here

September 2018: eNSIGHTS
At A Glance: Rigorous ID for Newborns, Colonoscopies Lead to Infections, and New Life for Single-Payer. Read more here

November 2018: eNSIGHTS
At A Glance: Accredited Hospitals Not Any Better, How To Deliver Bad News, and Fit People Live Longer. Read more here

General Liability Newsletter

July 2018: Who Has The Coverage? What To Do When Liability Seems Unclear
Liability coverage seems pretty simple at first. Often times that is not the case. Liability insurance is rarely that simple. Lawsuits often times contain multiple allegations triggering more than one type of insurance coverage. Read more here

September 2018: Video Recording- Potential and Pitfalls
The evolution of video recording technology has presented health care facilities with new opportunities and significant challenges. While security video recording can help protect facilities by offering indisputable evidence in the case of a liability claim, privately made video or audio recordings made with smartphones can create HIPAA violations in an instant. How do facilities reap the benefits and avoid the pitfalls of video recording? Read more here

November 2018: Hospital Handling- The Disposition of the Deceased
Most claims involve the living. But very occasionally, a claim is filed seeking compensation for damages to the deceased. This type of claim falls outside of the parameters of the Louisiana Medical Malpractice statute and there is no cap on the amount of damages that could potentially be awarded. This newsletter highlights policies and procedures hospitals should have in place to avoid liability. Read more here

Physicians Quarterly Newsletter

May 2018: Routine Procedure? Don’t Fall Into Bad Habits
Every physician clinic sees repeat patients. But no matter how often a procedure is performed, health care professionals must fight the urge to let their guard down and provide less than standard patient care. How can you prevent this from happening in your own practice? Read more here

August 2018: Dealing with Diagnosis- Appropriate Care or Malpractice?
Some complaints, such as broken bones, are easy to diagnose and treat. But what healthcare providers know and the general public does not always appreciate is that “diagnosis” is as much art as it is science. This newsletter discusses two cases in which physicians failed to properly diagnose the patient. Does this fall under appropriate care or is it malpractice? Read more here

December 2018: The Art of Communication- Connecting Physicians and Nurses
Did you know that nearly 60% of medical errors are a direct result of a communication breakdown, according to The Joint Commission? The massive body of work documenting communication in healthcare speaks to the fact that how we deliver information to one another in a clinical setting is of paramount importance to patient safety. This newsletter highlights some key recommendations to help physicians create better communication with nurses in order to prevent mistakes. Read more here

Workers' Compensation Newsletter

February 2018: Save Money with the Louisiana Second Injury Fund
Now is a good time to think about the importance of the Second Injury Fund (SIF) and recognize the value the SIF process brings to employers in the state of Louisiana. There is great payback on a Workers’ Compensation claim if the criteria is met and when the claim is approved for Second Injury Fund reimbursement. Each employer, whether self-insured or a purchaser of an insurance policy, pays an annual assessment into the SIF program. Employers should strive to recoup some of those dollars back when possible. Read more here

July 2018: A Tale of Two Claims- Watching the Second Injury Fund in Action
Now is a good time to think about the importance of the Second Injury Fund (SIF) and recognize the value the SIF process brings to employers in the state of Louisiana. There is great payback on a Workers’ Compensation claim if the criteria is met and when the claim is approved for Second Injury Fund reimbursement. Each employer, whether self-insured or a purchaser of an insurance policy, pays an annual assessment into the SIF program. Employers should strive to recoup some of those dollars back when possible. Read more here

August 2018: Don’t Be A Statistic! Lift Patients Safely
Lifting patients is the most common cause of back injuries in healthcare. These job-related back injuries lead to lost workdays, high medical costs, individual pain and suffering and possibly long-term disability. This newsletter explains how to prevent injuries to both employee and patient while on the job. Read more here

2017 LHA Trust Funds Newsletters

Claims and Risk Newsletter

October 2017: Determining When to Go Up the Chain of Command
A 68-year-old female presented to the emergency room at 11:00 pm with complaints of pain in the lower abdomen. Symptoms had begun approximately six hours earlier; she also had constipation and nausea. Lab results indicated significant hypokalemia. A CT of the abdomen indicated sigmoid bowel perforation with adjacent abscess, possibly secondary to ischemic bowel. She was admitted to the floor at 2:45 am with planned percutaneous drainage of the abscess. Read more here

September 2017: What to Do When You Suspect Patient Neglect or Abuse
This month we will look at the duties of a facility when a patient presents for treatment and the facility suspects neglect or abuse of the patient. We recently had two claims from two different member facilities where a patient came into the ER and there was the possibility of neglect. In one instance the hospital took no action and a PCF complaint was subsequently filed. In the other case, the appropriate authorities were notified and no further action was taken against the facility. The claim in which a PCF complaint was filed is still ongoing. Read more here

August 2017: Improper Communication – A Life-Threatening Result
Our claims study this month is related to the care of a six-year-old male child who presented to his pediatrician with viral symptoms. On his first visit to the pediatrician a urinalysis was run to rule out a urinary tract infection; that test revealed small levels of bilirubin. Read more here

July 2017: Patient Monitoring and Documentation
Patient monitoring and documentation are often an issue in medical malpractice claims. Documentation regarding postoperative care is especially vulnerable. Busy nurses may have difficulty prioritizing and are sometimes stretched to comply with their hospital’s own postoperative monitoring policy and procedures. In addition, documentation is often the last priority. Read more here

June 2017: Timely Reporting of Critical Labs
As we all know, the timely reporting of “critical” lab values is of utmost importance. Unfortunately, there have been instances when the communication process fell through the cracks. This month, we will look at two claims related to this standard of care. Read more here

May 2017: IV’s and the Risk of Extravasation
The patient was an oncology patient being treated as an outpatient for non-Hodgkin’s lymphoma, a cancer of the lymphatic system. On a regular basis (every third Friday), she presented for treatments. Her chemotherapeutic regimen consisted of four different drugs, three of them given intravenously. The IV drugs were Cytotoxan, Oncovin, and Adriamycin. Read more here

April 2017: Maintaining and Addressing Issues with Hospital Equipment
It is important that a hospital has a designated schedule for maintenance and cleaning of their equipment. These schedules should cover in-house testing as well as preventive maintenance. They should be easily accessible and readily available for the staff to see. This will also serve to potentially mitigate any legal claims against the facility if the facility can produce a written maintenance schedule. Read more here

March 2017: Medication Decisions for Chronic Pain Patients
Chronic pain patients can be problematic when trying to help them manage their pain with a course of care that will provide maximum benefit with the least amount of risk. Prescription medications, specifically steroid medications, come with significant risk when used for anything other than short-term treatment. Read more here

February 2017: Venipuncture and IV Liability: Retention of a Surgical Item
Professional liability claims are filed related to both venipuncture and IVs on a fairly regular basis. Allegations vary from phlebitis and site infection to nerve injury. We may look at evidence of technique and monitoring to determine potential liability related to this type of claim. Unfortunately, staff decision making, as well as documentation requirements across various ancillary departments, can sometimes hinder our defense. Read more here

January 2017: What Things are Subject to Surgical “Count”?
We have two cases pending before Medical Review Panels that deal with the alleged failure of the surgical nursing staff to properly count material used during the procedure; therefore resulting in a retained foreign body that necessitated subsequent procedures to remove. Read more here


September 2017: eNSIGHTS
At A Glance: Increased Use of Antidepressants, New Thinking on Antibiotic Use, and Faster Door-to-Balloon Times. Read more here

July 2017: eNSIGHTS
At A Glance: Amazon at Healthcare’s Doorstep, Hospital Fined for Immigrant Disclosure, and Group Dangles Rewards for Whistleblowers. Read more here

May 2017: eNSIGHTS
At A Glance: The GOP Healthcare Bill, Hospital Floors Pose Infection Risk, Payment Upfront, and Insurers Signal Mounting Troubles. Read more here

March 2017: eNSIGHTS
At A Glance: Colorectal Cancer Rise in Young Adults, Hospital Floors Pose Infection Risk, Retail Clinics Draw More Patients, and Designed for Comfort. Read more here

January 2017: eNSIGHTS
At A Glance: Antibiotics: Wider Use of Statins Eyed, Ashtma Widely Misdiagnosed, Hospitals Reduce Readmission Rates, and Doctors Prescribing Stronger Antibiotics. Read more here

Physicians Quarterly

August 2017: Off-Label Use of a Medical Product/Device
A few years ago one of our Trust Fund Members was sued in state district court for failing to notify a patient that a “recall” had been ordered for a product that had been utilized for a surgery she had recently undergone. Investigation and legal discovery determined that the hospital had not followed its own policy for notifying its surgeons and patients about recalls. The case was eventually settled as to the hospital; however, in the course of that litigation, it was also determined that the surgeon who performed the procedure had used the product in question in an “off-label” manner, i.e. the product was not intended for the subject procedure. Although the hospital had settled, the case went to trial against the surgeon. The jury found in favor of the surgeon. As of this date we, are unaware if that case was subject to appellate review and a published opinion. Read more here

February 2017: The Credentialing Process: The Role of the Physician
In the 1970’s sitcom Chico and The Man, one of the standard gag lines was Chico’s response to almost any request with the phrase “Hey, that is not my job, man.” While it is true that liability claims related to allegations of either “negligent credentialing” or negligent implementation/operation/use of electronic health records (EHR) would be directed at the hospital or healthcare facility, it would be foolish to disassociate the role played by the practitioner in both of these areas. It is most definitely the job of the practitioner to cooperate with the hospital in the credentialing process and in the use of the EHR. Damage to a hospital’s finances and/or reputation for injuries resulting from a credentialing or EHR related issue will also impact the medical staff to some degree. Read more here

General Liability Newsletter

July 2017: Injury Claims From Auto Accidents
Injury claims arising from auto accidents are typically handled and resolved by auto liability insurance carriers. However, auto accidents occurring on a hospital campus may present general liability exposure for the hospital. The LHA Trust Fund was recently presented with a claim made on behalf of a pedestrian who was struck by an automobile that was turning into the hospital’s parking garage. One vehicle was at a stop sign waiting to turn left into the parking garage. Another vehicle was in the process of exiting the parking garage. The exiting vehicle stopped to allow a pedestrian to cross. The other vehicle thought the exiting vehicle stopped to allow him to turn into the garage. He began his turn without noticing the pedestrian and struck the pedestrian causing serious injuries. Read more here

March 2017: Non-Medical Equipment Inspections: The Role of the Physician
It is not news to hospital administrators, risk managers, and compliance coordinators that the periodic inspection and maintenance of medical equipment is a high priority issue. In a November 2014 article in Becker’s Hospital Review, it was noted: “New regulations and standards for medical equipment maintenance were recently announced by The Joint Commission (TJC), aligning TJC’s accreditation with updated regulations from the Centers for Medicare and Medicaid Services (CMS) issued on December 20, 2013. The new regulations mandate substantial changes in the ways hospitals manage medical equipment – and these new requirements mean administrators will spend more time, money and staff to maintain their facility’s medical equipment.”Read more here

Workers' Compensation Newsletter

July 2017: Louisiana Supreme Court Decision Settles Choice of Pharmacy Issue
The Louisiana Supreme Court delivered a victory last week to employers in a decision released on June 29, 2017, in Burgess v. Sewerage and Water Board of New Orleans, a choice of pharmacy case. This is an important decision for those of us interested in pharmacy cost containment. The choice of pharmacy is an issue that circuit courts have been split on for some time. The Louisiana Supreme Court found that this choice belongs to the employer. This decision is not harmful to the injured worker. Read more here

May 2017: The Aging Workforce and the Impact on Workers’ Compensation
Older workers make up a larger segment of our workforce than ever before. According to the U.S. Bureau of Labor Statistics, between 1977 and 2007 the segment of workers 65 and over increased 101 percent. This trend has continued to increase. The aging workforce significantly impacts workers’ compensation by driving up both medical and indemnity costs. The aging worker also often presents an increased recovery time subsequent to injury. This is not discriminatory, just the reality that we all eventually come to know. Read more here

April 2017: The Importance of Post-Accident Drug Testing
Intoxication is defined as a state in which a person’s normal capacity to act or reason is inhibited by alcohol or drugs. Drugs can include prescription medication, over the counter medication or illegal narcotics. Similar to “buzzed driving,” there is even a phrase that has been coined “buzzed working.” The statistics surrounding drug use are staggering. 75% of illegal drug users are employed, and drug and alcohol users are 3.5 times more likely to have workplace accidents. Some studies have shown that up to 20% of all occupational injuries involve drugs and/or alcohol. Read more here

March 2017: Considering Medicare Set-Asides in WC Claims
Workers’ Compensation Medicare Set­-Aside Allocations (WCMSA) play a significant role in how workers’ compensation claims are evaluated when considering the settlement of a claim. As per Federal law, Medicare is always a “secondary payer”, meaning if there is any other available insurance, in this case from a workers’ compensation or personal injury settlement, Medicare will not pay bills for injury unless that insurance becomes unavailable. Because the injured worker received settlement money from an insurance company to cover future medical treatments, Medicare wants to make sure that the injured workers spend the portion of the settlement money on the injuries designated in the settlement before taxpayers start paying for injuries through Medicare. Read more here

Workers' Compensation Claims and Conclusions

June 2017: Carefully Worded Judgment Documents
Our injured worker (a 63-year-old Certified Nursing Assistant), strained her lower back while helping a resident to a sitting position in order to make a transfer to a lift. A simple claim, right? Obviously, compensability isn’t an issue, as this injured worker is clearly within the course and scope of employment when the injury occurred. The CNA immediately chose her orthopedist, whom she had generate a work status slip to remove her from the workforce. Interestingly enough, her physician indicates, “… (she) is permanently disabled from work,” (only four (4) days post incident). Read more here

March 2017: Ingenious Strategy
Several newsletters ago, we reviewed the importance of investigation and utilizing social media to thwart bogus claims. Our injured worker thought she had outsmarted the system. The claim began innocently enough with a strain/sprain injury to the lower back. The initial red flag was the choice of physician the injured worker demanded. Efforts to divert her to a physician less liberal were unsuccessful. Knowing the reputation of the medical provider, a Second Medical Opinion (SMO) was secured quickly, then followed by a state Independent Medical Exam (IME). Read more here