Wound Care in Crisis – If Lies Require Commitment, What Does the Truth Need?

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By Michael Miller DO, FACOS, FAPWCA, WCC

One of the problems with writing a blog is not the lack of material on which to vent, vex or vociferate. Rather, I deal with the much desired situation in which there are simply so many aberrancies that appear before my now trifocaled vista, that I have to decide which of many potential entities to offend.

I must confess that second place in this months potential ramblings has come close to publication on one other occasion but like all small children when faced with a newer and more shiny toy, I turn towards the hot, new objet d’art with abandon and so, onward and upwards we proceed.

I recently saw the movie Forrest Gump and recognized startling similarities and overlap between the wound care I see in my area and the profound life lessons that envelop the protagonist as his Midas Touch propels him from imminent banality to Grand Supreme status worthy of Honey Boo Boo.

One of my favorite statements that all too frequently comes out of my mouth is "You have a firm grasp of the obvious." It can be said in complementary fashion to provide assurance that ones observational skills are as keen and sharp as an obsidian blade. Of course, more often than not, it identifies the object of the phrase as someone who would have trouble finding their own posterior with both hands (phrase softened for the easily offended) and it is in that context I more often than not unleash it.

In that vein, I complement my own State of Indiana for its efforts to do better care. A little over five years ago, our health department launched an initiative to focus on the problem of facility based medical errors, including development of bedsores. I believed there were and are approximately 300 acute care facilities in Indiana. Ask the average health care worker with any hospital, long-term or home health care experience and they would give a rough estimate of 20-30 bedsores developing in a given health care facility per month. Let me add that I have provided educational programs to numerous audiences throughout the state and when they are asked that question, estimates of occurrence from health care professionals in these venues actually run much, much higher. Even with that number, it comes to about (300 x 20 x 12 months =) 72,000 bedsores/year. For the merciful among you, let’s arbitrarily cut that in half. We now have 36,000 or an average of 120 per facility using very conservative estimates from a variety of congruent sources.

Lest the myth of compassion and honesty be credited only to the IRS, The Department of Homeland Security and Insurance Companies (see my blog on primitive species for more on that topic), the director of the Indiana Patient Safety Center with the Indiana Hospital Association was recently quoted as saying “There’s been a move towards transparency in the past several years. We understand the public’s interest in knowing some of these things and at the same time, the list...is meant to be a list of things that are relatively rare, so when they occur, hospitals take each case seriously and take a hard look at it.”

An article on medical errors in the Indianapolis Star on Monday, November 19th reminded we readers that in 2009, there were ONLY 22 hospital acquired bedsores reported by the offending hospitals. Strangely, while the banner headline boldly reported a decrease in medical errors in 2011, it surreptitiously hid in the following text that an increase to 41 reported bedsores had been identified in 2011. Forgive me for being daft but the algebra I learned in Pennsylvania tells me that going from 22 to 41 is an increase of 186 percent. Let's chalk that up to simple literary discretion. I mean, why stir a flushing toilet.

Recognizing that (1) CMS has mandated financially punitive actions for hospitals where bedsores develop, (2) the knowledge of these occurrences is easily available on numerous web sites from which patients will choose their health care providers and of course, (3) the subsequent lawsuits from angry dissatisfied patients and families…what possible reasons could a facility have for not being honest?

Of course, what long-term care facility would report a bedsore patient received from any acute care facility and risk precluding them from any further transfers? Does anybody really believe they develop in the ambulance ride between the hospital and the receiving facility?

Estimate of 36,000…report of 41 (or even 22). I can only respond with something that embodies the ultimate in sagacious, obeisant revelations, namely “Liar, liar, pants on fire!”

I can only assume that if they report their confabulations again and again, they expect the rest of us to rejoice in pseudo-victory and ignore the horrific implications. The only readers who laughed out loud at this and similar articles like it are the many plaintiff lawyers for whom I work.. This scenario is best exemplified by the famous quote “There are three types of lies - lies, damn lies, and statistics” (attributed to either Benjamin Disreali, Mark Twain or Lord Beaconsfield depending on when you read Wikipedia).

But inane cognition need not be limited only to the acute care side of hell. One long-term care facility corporation (having had horrifically bad outcomes with their wounds and a subsequent state survey due to the actions {or lack thereof} of another wound care group) contacted me and graciously offered to admit as many wound patients as I could for their care. The new administrator gleefully welcomed me and watched with gay abandon as their current stagnant wounds as well as my own additions healed in not-unexpected expert fashion. Of course, no good deed goes unpunished and so, subsequently, their corporate oversight mandated that not only must I assume primary care management of my patients (delighting the facility medical management company to no end) but that I could not receive any new consults until the pending survey (which would of course be based on numerous patients cared for before my arrival) was completed. I can tell you unabashedly that of the 12 wounds I had the opportunity to provide care for prior to this edict, 10 were completely healed with the other two markedly improved. Of course, in their anencephalic, corporate omniscience, there was more risk to having me see their wounds than have their uneducated, untrained “wound nurse” do so. More, it made sense only to them that I manage the primary care when my expertise was clearly in another specialty. When a new morbidly obese patient with a large posterior truncal decubitus, a heavily draining fistula and on parenteral nutrition arrived there, the many panic stricken cries to me for help from the nursing staff could only be answered with my request that they call the corporate wound care oversight to manage it as I had not received the consult. The administrator chose corporate paranoia, banality and job security (though how this meant security is beyond me) over patient care.

The most famous line in the movie Forrest Gump is unquestionably “Stupid is as stupid does.” If you are in the business of patient care, then should not your efforts be directed at caring for patients? I understand that a prior bad experience might make a corporation paranoid. However, when the proof is in the pudding, why would you willingly opt for spoiled custard? There is no CPT code that compensates the health care professional for dealing with inherent corporate, governmental or insurance company bureaucrats, though with the mandate of Obamacare, we may well wind up paying for the privilege.

In keeping with the time-honored practice of biting the hand that feeds me, I unabashedly suggest that we all vigorously and energetically help those who purport to help us. Is there not someone who can create a portal for patients, facilities and others to identify — in HIPAA compliant fashion — the occurrence, date and most importantly, facility in which patients develop a bedsore or have a medical error visited upon their person? If indeed the numbers are as the hospitals report, then verification can only provide strong support of the efficacy of their efforts. If, however, the numbers are as I have suggested, then letting them know that they are not fooling anyone and that their veracity as well as their care must be called into question would be a much-needed kick in the keister. As far as the long-term care corporation is concerned, I can only imagine the outcome of that pending survey in which problematic patient care is again identified and they have to explain why they chose to not only avoid using an on-site expert for their care but demanded potentially problematic care.

The mandate for self-aggrandizing should be left to politicians, elite athletes, and teen pop stars. Hospitals, health care corporations and governmental automatons that do so either willingly or inadvertently take the risk that their next victim is either an angry patient with a hungry attorney or a self-righteous wound care blogger.

Until we ramble next time.

Rudavsky S. Bedsores, incorrect surgeries top list of Indiana medical errors. Indianapolis Star. http://www.indystar.com/article/20121119/NEWS/211190337/Bed-sores-surger.... Published November 19, 2012. Accessed November 22, 2012.

About The Author
Michael Miller DO, FACOS, FAPWCA, WCC is the Founder and Medical Director of The Wound Healing Centers of Indiana and IndyLymphedema, as well as a clinical consultant, teacher, inventor, and published author.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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