posted
This needs attention. This is a situation that should never have existed, and I can't imagine that there's not some grisly truths hidden behind this legal wall
I can't give the hospital the benefit of the doubt in this case. I can't make sense of this in any practical way that doesn't involve terrible negligence or incompetence.
Posts: 15421 | Registered: Aug 2005
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That poor woman! Aaagh, I can't even express what I'm feeling right now. Sputter, stutter, etc. Anger isn't sufficient of a word. Outrage is closer but still not quite right. I hope this gets national media coverage and that hospital gets reamed.
Posts: 180 | Registered: Jun 2005
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I'm not sure we have enough facts. What needs attention, and why should someone get reamed? I don't know.
It sounds to me like she wants to know how she got the infections, so she wants to know if other patients had it, and they can't tell her that. There may not BE any answers she can accept. Or maybe they are covering up something huge, I guess. I just don't know enough. I do know that I don't like that article as writeen at all.
Posts: 1014 | Registered: Jul 2005
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posted
If she did have a severe, systemic, antibiotic-resistant infection, then they might have been right to amputate. I suppose if there were complications from the pregnancy, she might have been at risk for such a thing.
But not telling her exactly what happened? That's really bizarre. There has got to be more to this story.
Posts: 3546 | Registered: Jul 2002
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I find it bizarre that they don't know what happened. I mean, she didn't have the surgery until 12 days after her son was born. The article makes it sound like she was healthy, got put to sleep, and all her limbs were just taken. And yet she was sick enough to get transferred to another hospital for the infection. So if she was too sick to follow what was happening, her husband at the very least should have understood that she was very ill, getting transferred, having surgery. I find it hard to believe it is all that mysterious.
I bet she really wants to know how she got ill, and how it got to the point of affecting all four limbs. I'm not sure her questions can be answered to her satisfaction, even in court.
Mostly, I bet she just wants her limbs back. What other answer could possibly satisfy her?
posted
I think we're missing the point. We could spend a lot of time trying to guess what the missing information is--we obviously don't have all the facts. But this is what we do know: (1) Mejia wants her medical records; (2) there's a Florida statute, "The Patients Right To Know About Adverse Medical Incidents Act;" and (3) the hospital says that under this statute it is not obligated to release the records to her unless she takes it to court.
So the real issue, as far as I see it, is whether people have a right to their own medical information.
But I do recognize that we need to know much more about the particulars. As it is, the story really doesn't make much sense. Right now, WFTV seems to be the only news agency carrying the story. I'm trying out Google alerts, and I'll post new links as soon as I get them. (Assuming I'm not, you know, sleeping or in class.) But Hatrackers seem very on top of things, and someone will probably beat me to it. Posts: 866 | Registered: Aug 2005
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quote:It sounds to me like she wants to know how she got the infections, so she wants to know if other patients had it, and they can't tell her that.
There are two probable reasons for the silence:
1.) There's potential liability here, in a big way. You get this woman in front of a jury, and you're either the worst lawyer ever or you're getting a big award (depending on Florida's medical malpractice laws). When there's liability, lawyers tend to shut everyone up.
2.) If the hospital releases the information, they could be in violation of HIPAA. HIPAA provides exceptions for court orders, so they may not even contest the court order. They just want to see it because to cover themselves from suits by other patients.
2 is a valid reason, and it gives them cover to continue doing 1, at least for a while. This kind of stuff is likely to come out in discovery, and the hospital knows that. But waiting for the court order - which they likely do really need - provides some cover time for them to do their own investigation. A more cynical interpretation is that it gives them more time to get their story straight.
Either way, they really do need that court order, for a variety of reasons. It's possible the patient isn't entitled to it - the amendment might not allow release of patient identifiable information, and something that time-specific might not be able to be made not identifiable.
quote:Mostly, I bet she just wants her limbs back. What other answer could possibly satisfy her?
Of course. I expect a settlement eventually.
Posts: 26071 | Registered: Oct 2003
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posted
My aunt had that same infection in her ankle after surgery. The doctors spent a long time (more like months, not days) and a lot of effort to save her leg. They spoke of amputation and she was aware of the risk if the infection didn't clear up. What I want to know is, how sick was she that some doctor could not tell her, "Hey, lady, you are really sick with a life threatening illness. If you don't get better in a big hurry, you will lose some limbs." At least she would have known what was happening. Waking up and finding your half you body gone is just outrageous!
Incidently, they beat the infection in my aunt and she kept her leg but it was a two year ordeal from the time she broke her ankle to the time they finally pronouced her healed.
Posts: 1319 | Registered: Jul 2005
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posted
Mandy, a lot of people with a severe infection are so ill they are pretty out of it for days and days. That includes flesh eating bacteria infections. I've read about people who had weeks of time lost. I'm not at all surprised she was stunned afterwards to find limbs gone. I AM suprised her husband didn't seem more informed.
I also find it hard to believe your aunt could have flesh eating bacteria for a year and not lose the affected area. She must have had a less extreme type of infection, with a different bacteria at fault.
Tante's husband wouldn't be able to stand up in court either due to disablility, so I find that joke amusing, sort of. Kind of like an "in" joke.
Posts: 1014 | Registered: Jul 2005
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quote:Originally posted by Theaca: Tante's husband wouldn't be able to stand up in court either due to disablility, so I find that joke amusing, sort of. Kind of like an "in" joke.
You got that right. He's the kind of guy that goes into a restaurant and completely ignores the sign that says "Please wait to be seated".
Posts: 10397 | Registered: Jun 2005
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posted
I'm kind of ignorent when it comes to medical matters like this. How does a bacterial infection spread to the point where all four limbs need to go while leaving the rest of the body intact?
Posts: 2437 | Registered: Apr 2005
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This is so awful I dont' want to think about it. If the ones who did this go to prison, it won't be enough to make up for what they did.
Posts: 1877 | Registered: Apr 2005
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posted
The HIPPA act is a federal law, and superscedes the FL statute.
If all she wants to know is how it happened, but not any names, then the hospital has no legal right to withhold that, IMO.
Posts: 15082 | Registered: Jul 2001
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posted
She didn't have the infection for a year. It ate her bone away and it took over a year for the bone to completely grow back. It was touch and go for awhile trying to figure out if the bone would grow back and that was when they had the discussion about amputation.
Even if she was uncoherent enough to be informed, they should have told her husband. Isn't there some kind of consent required? (although I understand in a life saving situation, they probably waive consent)
Posts: 1319 | Registered: Jul 2005
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posted
I can understand the patient not knowing what was going on if she was that ill. Like everybody else, I find it hard to comprehend an infection that affects all four limbs and not any part of the torso.
Like the rest of you, I'm confused why there isn't a mention of a consent form. I thought the hospital had to give full disclosure as to what would be performed and what types of complications to expect. I know I got an earful before I went to surgery.
Of course, we're so limited in information, the article seems to imply that she was perfectly healthy before sugery which I find hard to imagine, like Theca said she was sick enough to have to be transferred to another hospital. And if the hospital is witholding information because she is asking for info about other patients, they may be in the right, under HIPAA. Like Dag said, I suspect they just want the court order to cover themselves from being sued by another patient due to breach of privacy.
Posts: 14428 | Registered: Aug 2001
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posted
Yeah, that's what I wondered, too, Belle. Before docs can do anything, you have to give informed consent (or if you're delirious, then whoever can FOR you). So...yeah. Husband should know more, like theaca said.
Posts: 14745 | Registered: Dec 1999
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posted
I'm not a physician, and I really don't know HOW it happens, but as an epidemiologist, I have investigated several cases of Necrotizing fasciitis (the dreaded "flesh eating bacteria") and for whatever reason, it is common for it to jump from limb to limb without affecting the torso. I've seen more than one case that had one limb after another amputated (of course, they usually die too).
An interesting thing about NF, it can be caused by several different organisms, but it's most commonly caused by Strep or Staph. When it's Strep, it's always susceptible to antibiotics. It's no different than the Strep that causes Strep throat. Most people are auto-infected, meaning their wounds and/or blood are infected by Strep from their own nose and throat.
Just in some people, for reasons that are not well understood, it starts attacking deep tissues and it moves so fast that the only way to save the patient is through surgical removal of the tissue - either debridement, or amputation. Even though antibiotics are effective against the organism, it kills the surrounding tissues so quickly that there's no way for the antibiotic to get in and kill the organism.
From my perspective, as horrible as this case is, this lady is lucky to be alive.
Posts: 2069 | Registered: May 2001
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quote:The HIPPA act is a federal law, and superscedes the FL statute.
HIPAA specifically allows release of information in response to certain state court orders. So even though federal law supercedes state law, it allows state law to trigger exemptions.
If I were a HIPAA information holder, I wouldn't release anything without a waiver or a court order.
Posts: 26071 | Registered: Oct 2003
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posted
I agree that this article is poorly written and leaves much to the imagination.
I can understand the hospital not giving her information concerning other patients but it doesn't make any sense to me that they wouldn't give her copies of her own medical records. Heck, I've gotten copies of mine from doctors and hospitals before without any problems.
Posts: 5879 | Registered: Apr 2001
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posted
Poorly worded? Could win a Pulitzer for it.
I'm still astonished that the tar and feathers come up so quickly with so little information. The article states:
quote:Her 7-year-old son, Jorge, asks his mother over and over what happened to her. Neither she nor her husband has the answer.
"I love her, so I'll always stick with her and take it a day at a time myself," said her husband, Tim Edwards.
The couple wants to know how she caught streptococcus, during labor or after. She doesn't know. She knows she didn't leave the hospital the same.
That doesn't necessarily mean he didn't give consent for surgery. It says that neither of them have "the answer" to her son's question of "what happened?" And if the part of the answer that they want but don't have yet has to do with the details of confidential information in other people's charts, then -- sure -- they should need a court order.
Her own information should be available to her. Out of her chart, which is information that belongs to her. Information out of other people's charts belong to them, and its confidentiality is protected by law. That confidentiality can be superceded, but only for good reasons that have been vetted through the proper channels.
Look: offers that sound too good to be true usually are. One's bemoaned bodily parts are not likely to be doubled in size by a miracle cream ("for the low low price of $9.95! Order in the next ten minutes and get a second tube for free!")
Similarly, stories that sound too outrageous to be true usually are. Not always, but usually. I don't think a tone of condemnation is as warranted in this case as is one of intense curiosity about the facts and clarification that weren't included in the rather sensationally written article.
Posts: 14017 | Registered: May 2000
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posted
It seems extremely unlikely that she's been denied her own medical records, and after a quick re-read of the article, it doesn't seem like that is the case.
quote:The woman filed a complaint against Orlando Regional Healthcare Systems, she said, because they won't tell her exactly what happened. The hospital maintains the woman wants to know information that would violate other patients' rights.
quote:The hospital, in a letter, wrote that if she wanted to find out exactly what happened, she would have to sue them.
Twice, the phrase "exactly what happened" is used in the article. Apparently, her medical record (which almost certainly was released to her, as there's no reason for it not to be) didn't satisfy her as to "exactly what happened", so she wants more information that she doesn't seem to be entitled to.
I can't fault the hospital for this. There is a specific section of HIPAA that allows public health departments to release information for epidemiological investigations, and I frequently have to send requests in writing, citing the statute that allows them to release patient information to me before I can get the information I need to conduct my investigations. They would be in *serious* trouble if they released anything to someone like this without going through the proper channels.
It sounds to me like this lady, who had a horrific experience, has found a sympathetic reporter to try to drum up support for her and against the hospital. Unfortunately, cr*p like this happens, and it's not always anyone's fault.
Posts: 2069 | Registered: May 2001
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posted
Yeah, I agree with your analysis of the article maui babe. It almost seems as if she's not trying to find out why they amputated her limbs but rather why she caught the bacterial infection. Her wanting to know if other patients on the floor seems to be an indicator that she wants to blame the hospital for cross-contamination or something.
Posts: 14428 | Registered: Aug 2001
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posted
And goodness knows, she may well be right. It may indeed be that there was gross negligence leading to cross-contamination, and that would need to be dealt with appropriately.
Posts: 14017 | Registered: May 2000
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posted
*nod* Certainly. But she is not entitled to the private records of other patients in order to prove that point, not without the appropriate court orders.
An extremely poorly written article, to say the least. Makes the hospital sound like a bunch of folks saying "We cut off your limbs for kicks and won't tell you anything about it, Nyah, nyah, nyah!" When in reality, the hospital may well be doing exactly what it's supposed to be doing - protecting the private medical information of other patients.
Posts: 14428 | Registered: Aug 2001
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posted
Of course, it is worth reiterating that this is a horrible thing to have happened to anyone, much less a new mother. Can't even imagine. Posts: 14017 | Registered: May 2000
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"The Orlando hospital says Claudia and her attorneys are requesting information on other patients, to see if someone on the floor had the bacteria. The hospital says they will not release information on other patients."
quote:Originally posted by ClaudiaTherese: (And did anyone else misread the link as "WTF'TV.com"? *grin)
Yes, that site gets linked by collegehumor.com all the time, and for a long time I used to read it that way.
Posts: 2437 | Registered: Apr 2005
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quote:"The Orlando hospital says Claudia and her attorneys are requesting information on other patients, to see if someone on the floor had the bacteria. The hospital says they will not release information on other patients."
Are they legally barred from saying "Yes" or "No" to whether another patient had the disease? They wouldn't have to name names - thereby protecting the identity and condition of their patients - and still answer the question.
Even if the article was poorly written, this still reeks of hospital cover-up.
Posts: 4313 | Registered: Sep 2004
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posted
WFTV gets linked by collegehumor.com all the time?
Huh . . . that's interesting. All these years I've been wondering why local news stations seem to get linked so much on Hatrack, even when the link-er does not live in Central Florida.
-o-
As for the woman in this story . . . How horrible for her. I was saddened to the verge of tears for her.
Posts: 13680 | Registered: Mar 2002
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quote:Originally posted by erosomniac: Are they legally barred from saying "Yes" or "No" to whether another patient had the disease? They wouldn't have to name names - thereby protecting the identity and condition of their patients - and still answer the question.
Yes.
Yes, they are. IRBs have generally held that a data set must not give information that can be traced to a subgroup of less than 20 people.***
quote:Even if the article was poorly written, this still reeks of hospital cover-up.
I understand that this is the way some people will still react. I also understand the (completely understandable) lack of familiarity the lay public has with the intricacies of medicolegal liability issues. I have a similar lack of understanding about most specialized areas of life. It's normal.
Again, I'll reiterate: If it sounds too good to be true, it probably is. If it sounds too outrageous to be true, it probably is.
I think it's generally useful to apply the same level of skepticism at both extremes.
--------------------------
Edited to add: *** This sort of thing is why you might have seen so many healthcare professionals and health researchers griping about HIPAA constraints. On the one hand, respect for personal medical confidentiality is of obvious importance, and it needed to be addressed through legislation precisely because it wasn't being respected suficiently across the board.
On the other hand, many in the know feel HIPAA has decimated the amount of research that will be done. For example, every single person who has access to a dataset of medical information must have been vetted through an elaborate process or only work with data that has been de-identified -- and de-identified does not just mean removing name and Social Security Number. Juxtaposition of otherwise non-identifying details can become identifying in toto.
So, for example, "a person with cystic fibrosis who was hospitalized in Maryland in 1982" may be sufficient information to be construed as identifiable. This is why we try to work with data (sometimes in awkward and counterproductive ways, actually) to make discrete chunks of it non-identifiable to subgroups less than n=20 or so. This is why in assessing the usefulness of a screen for alcohol abuse among adolescents, I might have to specifiy that I will accumulate data not based on specific ages of my study sample, but, say, by groupings of three years.
So in order to get IRB approval, I might have to say that on the data collection forms (which, by the way, might not have any "typical" identifying characteristics, such as name or SSN), I will only mark the adolescent as being "less than 12," "from12-15 yrs old," "from 16-18 yrs old," or "more than 18 yrs old." I might not even be allowed to ask the exact age, only a range.
That seems like a small thing, but it can have big effects in data analysis.
HIPAA is important. I'm glad it is law. However, there is no doubt that it has a lot of fallout. This unfortunate woman having to file a lawsuit in order to get access to the further details she wants is a part of that fallout. Before HIPAA, the hospital might have been able to say "yes" or "no" to your question, erosomniac. Now they can't. It most likely would be illegal to give that answer.
This is just one example of why a policy that looks right in theory also needs to be evaluated in context of how it plays out in the real world. I happen to think HIPAA is still justified, but I also have to admit that it makes things very very complicated in sometimes unexpected ways.
quote:Originally posted by ricree101: I'm kind of ignorent when it comes to medical matters like this. How does a bacterial infection spread to the point where all four limbs need to go while leaving the rest of the body intact?
quote:Originally posted by KarlEd: That's a great question. I was wondering that myself.
It is a great question.
There are all sorts of reasons why the infection may be clinically apparent in the limbs rather than throughout. Most likely, the bacteria itself was transported through the entire blood stream, but there was sufficient blood supply and immune system access to the core areas of the body to fight it off, unlike in the extremities. That is, the infection was probably transported throughout the entire bloodstream, but it could be fought off easier at the central areas.
As you know, one's hands and feet are the first parts to go numb when out in the cold for a long while. Because they are terminal sites, there is less collateral blood supply. In contrast, at the more mid-area of the body, like the trunk, there are vessels and interconnecting corollaries coming from all directions. And with that blood comes the infection-fighting and surveillance system. Less blood supply therefore equals an area where it's harder to fight infection.
Necrotizing fasciitis is a rip-roaring fast-moving infection. Not having as rich a blood supply could be the tipping point between an infection taking hold in a given place and it being fought off in another place.
This is why, for example, we can use epinephrine (aka adrenaline, a potent vasoconstrictor) to decrease the bleediness of a wound we stitch up on some parts of the body. You can use it along with the numbing lidocaine if the vasoconstriction at the part you're trying to staunch bleeding doesn't cut off blood supply elsewhere.
The old adage: no epinephrine at "fingers, toes, penis, nose." (Or "ears," for that matter -- that part doesn't rhyme well, though. ) Those are terminal sites with limited blood supply, and if you cut off any blood supply, it's unlike that the body will have sufficient corollary pathways to reroute the blood and get around the obstructive areas.
Other reasons could come into play, too -- there could be something about the temperature differential that makes the area more amenable to certain bacteria (and again, hands and feet tend to be colder than other parts, and that's why we trust temperatures taken in the butt or mouth to be more accurate than, say, under the arm). Or there could be a particular fungus that infects the nails (toes or fingers) as its primary entry points.
However, I think it's most likely that the patient had bacteria in her blood stream that found it easiest to lodge and take hold in terminal blood supply sites. Given the lightning-fast nature of necrotizing fasciitis progression, I can see where having more limited access could relatively paralyze the immune system from being as effective there.
------------------
Edited to add: you may also have heard that people with diabetes have to be very careful about checking their feet for wounds. Although people with diabetes are more prone to infection everywhere (in general) than those without diabetes, it is particularly common for this to first become apparent in the feet. In the hands, too, but we are more aware of our hands because we're sort of looking at them all the time.
Similar reasons. A lot of bacteria just find the extremities to be the Hilton as opposed to the Red Roof Inn of, er, less hospitable areas. Posts: 14017 | Registered: May 2000
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Blayne Bradley
unregistered
posted
Good thing if its hospitol imcompentance at least they can be sued for an absurb amount of money.
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posted
Why is that a good thing? I mean, no matter what happened, suing someone is not going to bring back this woman's limbs. And the hospital paying out, as you say, an absurd amount of money, only causes the rest of us to pay higher prices because the cost of medical malpractice insurance is insane already.
Not to say the woman shoudn't have the right to sue and have the wrong done to her (if there is one) addressed, but I can't see how it's a good thing. The whole thing is tragic and sad and making the hospital pay doesn't erase that tragedy.
Posts: 14428 | Registered: Aug 2001
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Blayne Bradley
unregistered
posted
Of course it won't but it may let her feel a little bit better.
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posted
My understanding of what I've been told by medicolegal experts is that the primary concern to address for victims of malpractice is that steps be put into place which make sure it never happens to anyone else. (Whether or not malpractice was the case here is still unknown, in my opinion.)
That is, at least for many people, it is most important that nobody else had to suffer as they did. Other things matter as well, but alleviating this particular concern goes a long way towards easing the burden of grief of many victims. I find this comforting, as this usually can be addressed, even if (sadly, regretfully) often the mistakes already made cannot be undone.
For that concern to be addressed would require a full and thorough investigation. I fervently hope that is what occurs int his case. I also hope that this woman and her family receive whatever justice requires, of course, and all the grace and help they can take on top of that.
Posts: 14017 | Registered: May 2000
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posted
The sad fact is that even if there was no incompetence on the part of the hospital, this woman will likely get a large settlement out of them any way. With a competent lawyer, the jury would see a horrifically deformed young mother (who can't even HOLD HER BABY!!!) and an unsympathetic hospital who won't even tell her "exactly what happened". The horrors. It won't even go to court, the hospital will settle first.
Which isn't to say that they were at fault, or that the woman doesn't need money for her future care, and to help pay for household help, etc. But as Belle mentioned above, WE are the ones who will be paying the price - either in higher medical bills, or with the lack of good doctors as they leave medical practice in droves because of cases like this.
Again, I don't know for sure whether the hospital was at fault or not. It's certainly possible. But it's just as likely that this woman was just a victim of bad luck and got her infection from herself...
As this thread has shown, it doesn't really matter. This community, as well as her own community, I'm sure, were all set to lynch the hospital administrator, the medical director, the entire nursing staff etc, all because of one (very poorly written) newspaper article.
quote:I understand that this is the way some people will still react. I also understand the (completely understandable) lack of familiarity the lay public has with the intricacies of medicolegal liability issues. I have a similar lack of understanding about most specialized areas of life. It's normal.
Yes, I've seen the same thing in two different specialties I've worked in.
quote:This is just one example of why a policy that looks right in theory also needs to be evaluated in context of how it plays out in the real world. I happen to think HIPAA is still justified, but I also have to admit that it makes things very very complicated in sometimes unexpected ways.
I was creating databases for cancer clinical trials when HIPAA went into effect. Most of the researchers hated it in their roles as researchers. Of course, the researchers are all oncologists, and several commented that as doctors they think it was long overdue.
Hopefully it can be fine-tuned if needed - which will require calm examination of situations like this.
quote:The sad fact is that even if there was no incompetence on the part of the hospital, this woman will likely get a large settlement out of them any way. With a competent lawyer, the jury would see a horrifically deformed young mother (who can't even HOLD HER BABY!!!) and an unsympathetic hospital who won't even tell her "exactly what happened". The horrors. It won't even go to court, the hospital will settle first.
They will almost certainly need some expert to establish that the standard of care was breached (and remember, it might have been negligence - we have no way of knowing). If they can get to a jury, which means they have enough evidence about the standard of care to survive summary judgment, then I would bet a lot that the plaintiff would win.
Manufacturers are in general strictly liable for product defects that cause harm, even if there was no negligence. Perhaps there needs to be a general insurance pool for all patients to provide similar coverage for mishaps like this that aren't due to negligence - spread the cost over all patients.
Posts: 26071 | Registered: Oct 2003
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posted
(Once again JenniK posting without changing Kwea's screen name)
When I worked as pharmacy tech in Massachusetts, I had an interesting thing comeup with the HIPPA law. One of the men who came to the store all the time told us how he had a fit and was thinking of contacting a lawyer. He had dropped his wife off at the emergency room (earlier int he day) because she was in labor and went to park the car . When he went in to find his wife he was told that they couldn't give him any information on where she was, nor confirm or deny that she was actually in the hospital -due to the HIPPA Laws (This was when they were brand spanking new and people were still having to go through HIPPA training.)She was his wife, and it was his child being born, but even the supervisor told them that "they would have to get permission from her in order to give him any information and if he knew where she was he could ask her for her consent and then they could give him the information on whether she was in the hospital and if so, where she was located"! The guy almost flipped! He was an interesting shade of purple just telling us about the experience. He said it all worked out when the people at the desk had a call from the nurse that was with his wife. They were looking for him as it had been some time since he had dropped his wife off. The people at the reception desk paged him over the intercom asking him to come to the reception desk at the main entrance. He said that he had wanted to jump the desk and strangle them before he told them that that was him they had paged! Then of course, they asked him for photo ID!!! Thank goodness it's gotten a little bit better since then!
Posts: 15082 | Registered: Jul 2001
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