Kelly on Malpractice

In the past, I have devoted entire issues on the subject of Staph and MRSA infections, which are among the most dreaded types of the 1.7 million infections that occur annually in U.S. hospitals. These are bloodstream infections introduced through the large intravenous catheters that deliver medication, nutrition, and fluids to patients in intensive care. These central-line infections account for about 15 percent of all hospital infections but are responsible for at least 30 percent of the 99,000 annual hospital-infection-related deaths, according to the best estimates available. I am handling an increasing number of malpractice cases involving the failure to diagnose and treat central-line infections in the hospital’s intensive care unit. Most of my cases are death caused by sepsis. However, you should know that even for those clients who survive, a central-line infection meant weeks or months of debilitating treatments and side effects that caused or contributed to a permanent injury. You will probably see one of these claims in the near future. I’ll explain why and what to look for when screening the claim.

In the past, doctors considered central-line infections an unavoidable risk of intensive care. But contemporary medical studies show that hospitals can cut their infection rate to near zero by following a low-tech program that includes a simple checklist of sanitation and common sense use of central lines. Central lines are long, flexible catheters that thread through a large vein that leads to the heart. Unlike regular IVs, which usually stay in for only a few days, central lines can stay in for weeks or months. It is not unusual for a patient to have something put into a central line like food or medicine many times a day. The problem is that every time a doctor, nurse, or medical technician touches that line or the skin surrounding it, or the catheter’s dressing is dislodged, there is a risk of introducing bacterial contamination unless the strictest sterile conditions are observed. If that happens, the central line’s biggest virtue—the ability to spread its cargo throughout the body quickly—becomes its biggest vice. Bacteria, including the antibiotic-resistant superbugs like Staph or MRSA, can quickly multiply, thereby causing sepsis. Sepsis is an infection of the entire bloodstream. Sepsis produces high fevers and rigors or violent shaking chills. The high fever could induce delirium. Many patients report the fever and delirium feels like the worst flu imagined “multiplied by 10.” Worse yet, sepsis is deadly. Sepsis kills nearly 50 percent of its victims.

If you choose to take one of these cases, then fight to discover the hospital’s annual infection rate. Tennessee law requires the hospitals’ infection control departments to report contagious infections to the Tennessee Department of Health each time such an infection is detected. This proof will demonstrate that the defendant hospital is aware of its infection problem but failing to respond to it reasonably. The Leapfrog Group, which collects information submitted voluntarily by hospitals, reported an infection rate for cardiac ICUs nationwide at 50% more than average since 2000. For surgical ICUs, the infection rate was 100% more since 2000. These are sobering facts that justify more malpractice lawsuits for failing to prevent, diagnose, or treat bloodstream infections until hospitals do a better job protecting their patients.

There are certain things I look for in every potential malpractice claim involving hospital-acquired infection. I review the client’s medical chart to look for words like nosocomial infection, sepsis, or iatrogenic infection. These are “buzz” words that indicate a potentially viable claim. My clients have been patients who are usually already in a poor state of health, thereby impairing their defense against bacteria. My clients have been patients of advanced age or premature birth along with immunodeficiency (due to drugs, illness, or irradiation). My clients have had diseases that present specific risks like chronic obstructive pulmonary disease, which can increase chances of respiratory tract infection. My clients have been patients who needed invasive devices like intubation tubes, central lines, catheters, surgical drains, and tracheostomy tubes, which all bypass the body’s natural lines of defense against pathogens and provide an easy route for infection.

Here are some other things you need to know when investigating a claim. Nosocomial infections are infections that are a result of treatment in a hospital. Infections are considered nosocomial if they first appear 48 hours or more after hospital admission or within 30 days after discharge. The term “nosocomial” comes from the Greek word nosokomeio meaning hospital (nosos = disease, komeo = to take care of). The CDC estimates that roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined, cause or contribute to 99,000 deaths each year. Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Many types of infection are difficult to attack with antibiotics. Moreover, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital. Nosocomial infections are commonly transmitted when hospital officials become complacent, and personnel do not practice correct hygiene regularly. Increased use of outpatient surgery means that people who are hospitalized are more ill and have more weakened immune systems. Some medical procedures bypass the body’s natural protective barriers. Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as “vectors” for infection.

Among the categories of bacteria most known to infect patients are MRSA, Gram-positive bacteria, and Helicobacter, which is Gram-negative. While there are antibiotic drugs that can treat diseases caused by Gram-positive MRSA, there are currently few effective drugs for Acinetobacter. However, Acinetobacter germs are evolving and becoming immune to existing antibiotics. In many respects, Acinetobacter is far worse than MRSA. Another growing disease especially prevalent in New York City hospitals is the drug-resistant Gram-negative germ called Klebsiella pneumoniae. More than 20% of the Klebsiella infections are now resistant to virtually all modern antibiotics. Those superbugs are spreading worldwide. The bacteria, classified as Gram-negative because of their reaction to the Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream, and other parts of the body. Their cell structures make them more difficult to attack with antibiotics than Gram-positive organisms like MRSA. In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital.

The CDC reports that one-third of nosocomial infections are preventable. The CDC also estimates that 2 million people in the United States are infected annually by hospital-acquired infections, thereby resulting in 20,000 deaths. The most common nosocomial infections are in the urinary tract, surgical site, and various pneumonias. The drug-resistant Gram-negative germs can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters, and ventilators. These are key things you need to know when investigating a potential hospital-acquired infection case.