Insurers stop claims

More hospitals to forgo
payment for ‘never events’

By David Baker
Posted January 30, 2008

The state of Washington is the latest state to announce an agreement under which hospitals will no longer be paid for treatment that results from a so-called “never event.”

As I reported here briefly last week from England, a never event is one that is so clearly preventable that there can be no doubt that the hospital was responsible for it. Troy Brennan, chief medical officer for Aetna, one of the insurers that is will soon refuse to pay for such events, was quoted in The Wall Street Journal on January 15 as saying that never events “are ones that are so egregious that there can’t be any argument that they should ever happen.”

Now Aetna is being joined by a growing number of health insurers that are requiring hospitals to agree that they will not bill either the insurance company or the patient for treatment needed as a result of a never event.

One of the those 28 never events describes exactly what happened to Lisa. It reads:

“Death or serious injury arising from hypoglycemia, the onset of which occurs while the patient is in the care of a healthcare facility.”

Lisa had been in Samaritan Hospital for five days when she was found nearly dead and with a blood sugar level near zero.

But despite that, the hospital has spent the past four years denying that it is responsible for Lisa’s injures and death. It is clear now that they knew immediately – almost certainly the same day – that they were responsible for a terrible mistake. But their response was to deny me access to the medical records and refuse to talk to me about what had happened.

Samaritan Hospital billed and was paid about $74,000 for treating Lisa for the injuries it allegedly had caused. Doctor bills added another $20,000. What other profession would get paid by the victim for dealing with the consequences of its own horrific mistakes?

The idea of a never event also fits with a legal doctrine called ‘res ipsa loquitur’, which is Latin and means “the thing itself speaks.” In other words, the defendants had total control of the situation, and the event is not supposed to happen. If it does, the defendants therefore must be presumed to be responsible for it.

As for the lawsuit, back in September, an attorney for the hospital and its nurses told me she was now prepared to make an offer to settle the case. This happened one day after I had deposed one of the doctors, and the doctor, an expert in diabetes, had testified that the most likely cause of a huge plunge in blood sugar – such as the hospital records show had happened to Lisa – was insulin.

This was the doctor who had placed a note in Lisa’s chart that day on what to do if she became hypoglycemic.

Lisa did become hypoglycemic. But those orders, the record shows, were ignored.

So if the defendants did in fact want to settle, the next step would have been to present a specific number to me, and then probably there would be a negotiation between the parties of a final amount.

But that hasn’t happened, because over the past four months the attorney has instead given only excuses for the delay, while the insurance company has evidently spent weeks trying to find an expert, who – for a fee – will presumably say that the hospital had limited or no responsibility for Lisa’s injuries and death.

It’s not exactly dealing with me in good faith. Meanwhile the hospital itself is apparently refusing to consent to a settlement because I have since released the doctor I deposed from the lawsuit.

The next step is a motion for summary judgment based on the doctrine of res ipsa loquitur. This will force the defendants to either try and settle the claim – if I am still willing at that point to talk to them – or to explain in detail why they are not liable.

Meanwhile, more insurers are going to stop paying for treatment resulting from these never events. And it’s a sad indictment of greedy and uncaring healthcare providers like the operators of Samaritan Hospital that in the future they may find ways to fatally injure and maim fewer of their patients.

Not because its wrong to fatally injure and maim patients.

But because they will no longer be paid for treating patients that they fatally injure or maim.

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