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Hospital-Acquired Illness: Who Should Pay?

By Rheingold Giuffra Ruffo Plotkin & Hellman LLP

Patients go to the hospital hoping for a diagnosis, a cure, a way to feel better. According to an article in the February 22, 2010 issue of the Archives of Internal Medicine, however, many hospital visits may actually lead to infection and illness. In fact, authors Michael Eber, Ramanan Laxminarayan, Eli Perencevich and Anup Malani report that as many as 1.7 million hospitalizations each year are affected by what researchers call “health care-associated infections.” Sepsis and pneumonia infections acquired in the hospital may kill 48,000 people or more in the United States each year.

What Is a Health Care-Associated Infection?

The Centers for Disease Control and Prevention defines a health care-associated infection as an infection a patient acquires during the course of receiving treatment for other conditions in a healthcare setting. The CDC states that health care-associated infections are one of the top ten leading causes of death in the United States.

Although a patient can acquire any number of infections in a healthcare setting, the Eber study focused on pneumonia and sepsis (a serious and potentially life-threatening medical condition in which the immune system reacts to a severe infection that has spread through the bloodstream).

Who Pays for Health Care-Associated Infections?

Based on hospital discharge records from the Nationwide Inpatient Sample database, sepsis and pneumonia cases were identified among 69 million discharges from hospitals in 40 states between 1998 and 2006. Using criteria adapted from prior studies to exclude community-acquired infections, the study reported for patients with health care-associated infections the following average lengths of stay required, costs of care and mortality rates for patients with health care-associated infections:

  • In sepsis cases not associated with invasive surgery: 1.9 to 6.0 days, $5,800 to $12,700 and 11.7 to 16.0 percent
  • In pneumonia cases not associated with invasive surgery: 3.7 to 9.7 days, $11,100 to $22,300 and 11.7 to 16.0 percent
  • In sepsis cases associated with invasive surgery: 10.9 days, $32,900 and 19.5 percent
  • In pneumonia cases associated with invasive surgery: 14.0 days, $46,400 and 11.4 percent

Medicare and many state Medicaid programs have been amended to reduce or eliminate payments for re-hospitalization due to health care-associated infections. Some private insurers are amending policies to eliminate what has come to be known as “never events” or events that never should have happened, including health care-associated infections. Meanwhile, patients pay via co-pays and deductibles,as well as time away from work and serious illness and infection resulting in surgery, prolonged hospital stays and sometimes even death.

Are Hospitals and Employees Liable for Health Care-Associated Infections?

Determination of hospital liability for patients’ injuries is complicated and requires investigation of the specific circumstances, such as:

  • Patient risk factors: Among these factors are the severity of the injury or illness for which the patient was admitted, the health of the immune system of the patient and the duration of the patient’s stay in the hospital
  • Organizational risk factors: These factors include the cleanliness of the hospital, water and HeatingVentilating and Air Conditioning (HVAC) filtration systems and concentration of patients
  • Iatrogenic risk factors: These are determined by the individual activities of the surgeons and doctors, including frequency of hand-washing, use of antibiotics and level of care used during invasive procedures

In a medical malpractice action against the hospital, it is critical to establish that the doctor, nurse or hospital staff owed a duty to the patient. The extent of any duty to provide an infection-free environment for patients will be an area for courtroom and perhaps legislative debate.

How Can Patients Be Proactive?

According to a December 18, 2009 article by Kelly Pyrek, a recent study shows health care-acquired litigation has been on the rise and predicts that it will continue to increase at a rate of 1 percent per year. Perhaps both in response and anticipation, some hospitals are taking actions to minimize risks of infections, which may include:

  • Implementing effective checklists for reducing risks of infection
  • Adopting and enforcing hand-washing policies
  • Installation of sanitizing hand gel stations
  • Standardized used of antibiotics for invasive procedures

Savvy patients may wish to inquire into hospital policies and statistics related to health care-acquired infections.

Patients who have suffered from these conditions may be wondering whether a health care-acquired infection is the cause. An experienced medical malpractice attorney can provide the knowledge and resources needed to evaluate your situation and whether to pursue a claim against the hospital.

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