According to Coverys, a national provider of professional medical liability insurance, between 2013 and 2017, diagnosis-related errors were the leading cause of claims for medical malpractice. These types of mistakes often lead to adverse effects on patient health and potentially contribute to fatalities. The family of 88-year-old Mary Ludlow brought a malpractice claim against Pleasant Valley Manor, Lehigh Valley Hospital, and the Pocono Health System following her death caused by drowning in excessive fluid. The suit alleges that the medical staff demonstrated a failure to diagnose her conditions and improperly discharged her from the hospital.
Series of Mishaps
Ludlow first arrived at Pocono Medical Center unresponsive due to a lack of oxygen, and she also showed signs of a fever. She was initially diagnosed with an infection in her urinary tract. She also showed signs of heart failure, pulmonary failure, and Parkinson's disease. She had difficulty eating and was accumulating fluid in the lungs. After several days, she was discharged to Pleasant Valley Manor, a 174-bed nursing facility in Stroudsburg, Pennsylvania. The facility's medical staff quickly determined that she should return to the hospital. After being readmitted, doctors made a proper diagnosis and the claim contends they recognized that her prior discharge was an “egregious error.” By this time, her conditions had worsened and she died several days later.
Dr. Rose Gulibe, the director of palliative care at Pocono Medical Center at the time, supposedly told Ludlow's daughter, Loni Kotowski, that the death was preventable. She told Loni the staff failed to assess Ludlow's levels of fluids, electrolytes, and aspiration. The claim asserts the hospital medical staff discharged Ludlow knowing her condition was unstable. The plaintiffs acknowledged that Ludlow first entered the hospital in extremely poor condition, yet she would have survived if her conditions had been properly identified and treated.
Pressure to Discharge
In the 1980s, Medicare began reimbursing at fixed levels according to the condition that the patient was diagnosed with having. Hospitals now faced potential financial risks associated with being reimbursed from Medicare. A trend developed where the average patient hospital stay decreased, yet rates of patient readmission rose. The government next created penalties for facilities found to have high rates of readmission. Thousands of hospitals are estimated to now lose over $400 million in reimbursements annually for failing to satisfy these revised Medicare standards.
Medicare Readmission Criteria
Medicare makes assessments of hospital performance largely based on their rates of patient readmission. There are five central conditions that are considered, which potentially incentivize hospitals to discharge patients quickly, including the following.
- Heart attack
- Heart failure
- Chronic respiratory conditions
- Replacements of hips and knees
Questions Prior to Discharge
There are several questions that are critical in evaluating whether a patient is appropriate for hospital discharge as follows.
- Has the patient's condition stabilized?
- Did the patient receive all necessary care?
- Is the patient demonstrating mental awareness?
- Has the patient been properly instructed regarding their care after being discharged?
- Does the patient have a place to recover safely?
- Has an appointment for follow-up been established?