Who should I contact about this matter?

[amiledeep]

I live in NJ. Yesterday I went in for a CT abdominal scan with and without contrast. Before I got the scan without contrast, the tech put in the IV to be used for the contrast. He had difficulty finding the vein, and had to wiggle the needle around in my arm in order to find it. The first CT scan went ok. I had my eyes closed so I wouldn't be alarmed at seeing the machine move. All of a sudden I felt a very sharp pain in my arm where the IV was. I let the nurse know, and she told me she was administering the contrast. They had already explained that I should feel a flush or burning sensation when it was being administering, so I was expecting that. This was a very sharp pain, and it became worse. Finally, when I stopped yelling that it was hurting and just started yelling, they realized that almost the entire portion of contrast went into my arm instead my vein. My arm immediatly swelled, and they had to enact a major infiltration protocol. The radiology team estimated that over 50cc of contrast had infiltrated my arm. Because it was such a large infiltration, I had to have a plastic surgery consult. They sent me to the ER to wait for the surgeon. When I got to the ER, a nurse came in and asked for my medical history (which she wrote in a small notebook), not my chart, and left. After that, nobody came in to monitor my condition, or see how I was doing. A doctor did come in eventually to tell me that the plastic surgeon had been called and would come down when he was finished in the OR. Again, nothing. No monitoring. At this point it was about 1, and I had been in the hospital since 9:30, and in the ER since 10:30. When I felt a change in my status I had to get out of my stretcher, go into the hall, and find someone (twice) before someone finally came in. I was not offered any water. The plastic surgeon finally came down, told me everything looked fine, and he was going to discharge me and send me home with a sling for my arm. I again had to go out into the hall to find someone to start the discharge paperwork. When 'my' nurse came in (the only time I saw her was when I was first admitted and to give me the discharge papers. The discharge papers did not have any instructions on them, so while I was given oral instructions on how to care for myself when I got home, I was given no written directions. The nurse told me I could leave, and I asked when I was supposed to get my sling. She had no idea I was supposed to get one, and told me she would find someone to give me one. Someone came in and handed me a box, and I told him I didn't know how to put it on and I needed someone to show me. He didn't know, so he had to go out and find someone.

I have two issues: number one, the lack of care I recieved in the ER. I have never been in an ER before where I was not monitored, and where I had to physically get out of bed in order to find help. I don't know who to contact about this. I also want to make sure I am not billed for any of the procedures that had to be done because of the infiltration. I believe that the fact that the tech had a difficult time putting the IV in the first place, and the fact that my infiltration was so large because they ignored my cries of pain too long, makes me not liable for anything related to the infilitration. I am not looking for the hospital to admit liability or give me money. I simply want to not to recieve a bill, but I'm not sure how to go about it. Should I consult a lawyer first? Is there someone at the hospital I should contact about this?What is the name of your state (only U.S. law)?What is the name of your state (only U.S. law)?

[You Are Guilty]

First, before doing ANYTHING else, get a copy of your entire medical records from the hospital as well as the CT/radiology section (odds are the people who did the CT are not hospital employees).

Once you have a full copy of the records in your hands, you can google "risk manager [insert name of hospital]" and give that person a call to explain your concerns. If that call goes well, follow up in writing. If it goes poorly, it might be time to seek out the assistance of a lawyer.

Good luck.



PS: To be clear, I am not taking the position that you have a valid med mal claim here. It's possible, but it's impossible to tell based solely on the facts you've posted thus far.

[lya]

Is there negligence? Yes; failure to ascertain a patent IV access before administering any fluid or medication is negligent.

Is there damage as a direct result of the negligence? Yes.

Is there permanent damage as a direct result of the negligence? No.

What costs are associated with this? There should be no ER charge and no charge for the sling and no charge for an evaluation by a plastic surgeon. If there are such charges, the hospital should reverse the charges and the patient should not have to pay for any of these services.

Is it painful? Yes; it is.

Will it go away? Yes; if the patient wears the sling and elevates the arm, it will go away (resolve) without complications.

This event is not worthy of a medmal lawsuit. It is worthy of the patient's not having expenses due to the ER, the sling, and the plastic surgeon.

As for the ER events, I believe the ER was used as a holding area and for ease of examination by the plastic surgeon. I do not believe it was for an actual ER admission that required follow-up, a glass of water, assistance with ADLs, etc.

IV infiltrations are reported internally and such occurrences are thoroughly evaluated for root cause. Corrective action is taken when indicated.

I do not see any viable claim of medical malpractice; but, to learn about the statute of limitations and the merits of any potential claim, the OP should consult with a medmal attorney.

[You Are Guilty]

Originally Posted by lya

Is there negligence? Yes; failure to ascertain a patent IV access before administering any fluid or medication is negligent.

I'm showing my rust here, but my admittedly vague recollection is that an extravasation could be caused subsequent to the cannula placement. The (at least, initial) discomfort reported by the patient could be attributed to the contrast. If the IV wasn't secured properly and there was some movement due to the discomfort, could that not have caused the problem?

(OP - you can ignore this reply, it doesn't change anything for you whether the IV was placed wrong initially or secured wrong and allowed to move. I'm just curious as I had a similar case a long time ago and have forgotten the medicine behind the IV placement procedure.)

[petomane]

Nowadays rates of contrast injection for CT can be up to 4cc/sec and even the best IV site can blow. So contrast extravasation is fairly frequent. Maybe once a week at my last job. Getting the plastic surgery consult is being very cautious, so good for the patient. OP should make sure the scan was adequate. If only a portion of the bolus was administered, this could limit the sensitivity of the exam.

[You Are Guilty]

You know, that's a good point I completely overlooked. OP (or OP's insurance) should not be charged for having to repeat the CT with contrast.

[lya]

Standards of Care for IVA and IV administration are in place to reduce the risks associated with IV Access and IV administration route. Failure to ascertain the patency of an IVA is negligent. After the administration of the fluid begins, extravasion due to the vein's "blowing" or leaking is not negligent. Failing to heed the patient's complaints of severe discomfort and check the IV site via inspection and palpation is negligent. Stopping the infusion after 50ml infiltrated rather than before, earlier when the patient continued to complain, may have been negligent.

Negligence does not equal viable medical malpractice lawsuit.

I do not believe the subsequent CT with contrast should be free of charge. I believe the initial CT with contrast should not be charged.

[amiledeep]

I'm not looking to sue the hospital for malpractice. I'm just inquiring on what my next step is to make sure I'm not billed for the infiltration. I was admitted to the ER specifically because the plastic surgeon did not accept insurance, and this was a way around that. So I am expecting a bill for this. I went in for a CT, and I plan on paying for that. But the treatment they had to give me was because the infiltration was so lage, and I feel that that my infilitration was so large because of the staff's negligance, and I should not be financially responsible for that. That's all. I just dont know what to do. Should I wait until I get a bill? Should I contact a hospital manager?

[ecmst12]

You should talk to the hospital risk manager. Like you were advised before.

[lya]

Originally Posted by amiledeep

I'm not looking to sue the hospital for malpractice. I'm just inquiring on what my next step is to make sure I'm not billed for the infiltration. I was admitted to the ER specifically because the plastic surgeon did not accept insurance, and this was a way around that. So I am expecting a bill for this. I went in for a CT, and I plan on paying for that. But the treatment they had to give me was because the infiltration was so lage, and I feel that that my infilitration was so large because of the staff's negligance, and I should not be financially responsible for that. That's all. I just dont know what to do. Should I wait until I get a bill? Should I contact a hospital manager?

Risk management is really an internal operation and not always available or appropriate for contact from outside the hospital's staff. I advise sending a letter to the hospital administrator, asking for your hospital bill to be reviewed so that you are not billed for the ER, the plastic surgery consult, or the initial CT with contrast.

One thing that is on your side is this: Effective October 1, 2008, Medicare and Medicaid plus several major insurance companies will no longer pay for 11hospital acquired conditions. Your event happened so close to 10-01-08, the administrator will be very, very familiar with events such as yours and will, perhaps, be very willing to absorb these expenses.

[lya]

To correct my previous post and to update anyone who is interested, here are the 11 (not 9) conditions that will no longer be paid for if acquired after admission by Medicare, Medicaid, other federal programs, Humana, Aetna, Cigna, Wellpoint, UnitedHealth Group, and BlueCross/BlueShield Association:

Pressure Ulcers

Catheter-Associated Urinary Tract Infections

Retained Foreign Objects

Mediastinitis after CABG Surgery

Air Embolism

Blood Incompatibility

Vascular Catheter Associated Infections (not infiltration)

Falls

Manifestations of poor Glycemic control, i.e., Diabetic Ketoacidosis, Nonketotic Hyperosmolar coma, secondary Diabetes with Ketoacidosis, Secondary Diabetes with Ketoacidosis, Hypoglycemic coma

Surgical site infections following certain elective procedures
a. orthopedic procedures, that involve the repair, replacement or fusion of various joints including the shoulder, elbow and spine
b. bariatric surgery for obesity

Deep Vein Thrombosis/Pulmonary Embolism following total hip or knee replacement

[las365]

Originally Posted by lya

To correct my previous post and to update anyone who is interested, here are the 11 (not 9) conditions that will no longer be paid for if acquired after admission by Medicare, Medicaid, other federal programs, Humana, Aetna, Cigna, Wellpoint, UnitedHealth Group, and BlueCross/BlueShield Association:

Pressure Ulcers

Catheter-Associated Urinary Tract Infections

Retained Foreign Objects

Mediastinitis after CABG Surgery

Air Embolism

Blood Incompatibility

Vascular Catheter Associated Infections (not infiltration)

Falls

Manifestations of poor Glycemic control, i.e., Diabetic Ketoacidosis, Nonketotic Hyperosmolar coma, secondary Diabetes with Ketoacidosis, Secondary Diabetes with Ketoacidosis, Hypoglycemic coma

Surgical site infections following certain elective procedures
a. orthopedic procedures, that involve the repair, replacement or fusion of various joints including the shoulder, elbow and spine
b. bariatric surgery for obesity

Deep Vein Thrombosis/Pulmonary Embolism following total hip or knee replacement

This is very interesting, and scary. I had not heard about it. Is this legislated somewhere, or is it a "policy" that these insurers have unilaterally decided to implement? It seems unbelievable to me that a health insurer could legally prevail in suddenly refusing to cover treatment for complications from covered illnesses or procedures. It appears that these insurers are trying to make a factual declaration that all of these conditions are caused by malpractice alone. I understand that they are trying to push liability onto the treatment providers or facilities, but what happens to the insured?

[You Are Guilty]

Ok, it was bothering me that I didn't remember the medicine here so did some research. Unfortunately, it didn't exactly clarify what the follow up treatment should be (although the extravasation rates were reported as betwee 1/106 and 1/1000). Anyway, OP, based on the link below, it would appear the hospital took proper follow up care of you, although the events immediately after the extravasation are still suspect.
http://www.acr.org/SecondaryMainMenuCategories/quality_safety/contrast_manual.aspx

Either way, be sure to follow up with everyone you can at the hospital to resolve the billing issue.

[lya]

Originally Posted by las365

This is very interesting, and scary. I had not heard about it. Is this legislated somewhere, or is it a "policy" that these insurers have unilaterally decided to implement? It seems unbelievable to me that a health insurer could legally prevail in suddenly refusing to cover treatment for complications from covered illnesses or procedures. It appears that these insurers are trying to make a factual declaration that all of these conditions are caused by malpractice alone. I understand that they are trying to push liability onto the treatment providers or facilities, but what happens to the insured?

Scary, indeed! It is the Federal Government who enacted this latest nail in the coffin of affordable healthcare because, as you may have guessed, the cost of treating these conditions is now divided among all other healthcare costs.

My terminology of the Federal Government includes the insurance companies listed as these companies run healthcare in the US and, apparently, "run" quite a few Congressional seats and committees.

Remember this issue when you cast your votes next month. If the candidate or his/her party wants more government involvement in healthcare and you vote for "it", you just voted for these insurance companies to continue to dictate healthcare in the US and for the costs of all these, and more to come, denials of payment, which means higher overall costs in healthcare.