Lisa Zenzen Baker, 1961-2003


Monday, September 15, 2008

Double tragedy

Medical-error lawsuits were 
not always hidden from view

By David Baker
Posted Sept. 10, 2008

On February 27, 1985, Lillian Cedeno of Schenectady was in Albany Medical Center Hospital for chemotherapy to treat her cancer.

Three days later she was paralyzed and in a coma after two doctors injected a drug into her spine instead of a vein.

At first Albany Med managers kept quiet about the terrible mistake. But someone connected with the hospital tipped off local newspapers. A week later the story was printed and broadcast across the country.

Lillian Cedeno was 21. She was five and a half months pregnant. The baby, a girl, was delivered by Cesarean section, but she developed breathing difficulties and died three weeks later.

Lillian Cedeno never regained consciousness. She also died, three months after the appalling error.

These details, and most of the information that follows in this article came not from the pages of a lawsuit – as information about more recent cases that have been reported here have done – but from press accounts at the time.

The local papers were first. Then The New York Times. At least one radio network, NBC, aired the initial story and several follow-ups provided by reporters at its local affiliate, WGY.

And today, thanks to the Internet, most of the information made public then is now available, without leaving home.

But that is not the case with more recent medical errors. That’s because starting about 10 years ago, newspapers in the Capital Region stopped reporting the filing of medical malpractice lawsuits, even ones alleging mistakes widely considered indefensible, such as leaving a surgical sponge inside a patient as employees at Albany Memorial Hospital were alleged to have done in a case reported on this page back in May.

So now the only way to find out about these lawsuits is to go to each of the county clerks’ offices, search the records and ask to see the files. In Albany County there is a limit of five files per visit. And if you want a copy of any of the documents, it costs 65 cents a page.

Most people aren’t going to do that. And no one apparently has thought of collecting that information and making it available, permanently and in one place.

Until now.



Sunday, September 14, 2008

It all 'ads' up

Yesterday’s big news 
gets no mention today

By David Baker
Posted September 15, 2008

The appalling, inexplicable mistake by two doctors at Albany Medical Center Hospital that took the life of Lillian Cedeno and her baby in 1985 generated a lot of publicity. But if it happened today, would it get any attention at all?

The answer would seem to be no, given the silence of the Capital Region’s newspapers on alleged medical negligence over the past 10 years.

And it’s not that all the area’s hospitals have not faced – and often eventually settled – many lawsuits accusing them of causing death and serious injury.

But the newspapers haven’t reported even the most serious of these claims. What they have done, though, is run a steady stream of advertising for the hospitals.

These ads might lead people to think that the hospitals are in competition with one another. But a closer examination of the announcements reveals that each hospital usually promotes a different specialty. It also reveals that they take turns in running major campaigns, suggesting that they are coordinating their advertising calendars while maintaining a steady stream of revenue to an uncritical media.

And this absence of bad publicity can affect the amount that the hospitals’ insurers have to pay out when a claim is settled (which is almost always only after several years of litigation and often only after the plaintiff’s attorneys have been forced to prepare for a trial and a verdict that the insurer knows all along it will never risk).

The Cedeno case was settled a year after the deaths for $400,000 (which, adjusted for inflation would be $810,200 today)*. Of that, $360,000 – $729,180 in today’s dollars – was for Lillian Cedeno’s wrongful death and conscious pain and suffering, and $40,000 ($81,200 today) for the wrongful death of her baby, Lillian Kathy Valerio.

But it would have been a lot less if the mistake had not been reported, according to E. Stewart Jones of Troy, an attorney who represented the Cedeno estate. In a story that ran in July 1986 in the Times Union, Jones was quoted as saying: “If it wasn’t for all the publicity that surrounded the case, the mother’s life would have been worth $50,000 to $75,000 maximum and the baby $25,000,” because, he said, “the woman had no work skills and terminal cancer, which reduced her life’s worth in dollar terms.”

The case also prompted a debate on the public’s right to know versus the right to privacy. Among those attending a forum held at the College of St. Rose in April 1986 were Dr. Anthony Tartaglia, then chief of staff at Albany Med, and Harry Rosenfeld, (of Watergate fame) then editor, now retired and editor at large at the Times Union.

Tartaglia defended the hospital’s decision to withhold the identities of the two doctors involved in the Cedeno case for three months, claiming that if their names had been disclosed, reporters “would have swarmed to their homes.”

But Rosenfeld cited a very similar case in Miami. “There, the names of all the doctors were released right away,” he said. “They accepted full responsibility. The straightforward approach of the Miami doctors was the best one to take.”

Albany Med was cited by the state Health Department for three violations in the Cedeno case, but it said a possible fine of $3,000 would not be imposed if within 10 days the hospital came up with a plan to improve its procedures regarding the administration of potentially dangerous drugs. A second investigation concluded that the two doctors should not be charged with medical misconduct. However, they were both transferred to doing what Tartaglia told The New York Times was ‘no patient-care work.”

But even with the lenient action taken by the state for a seemingly inexcusable error, an organization that represents hospitals was not happy. George Allen, president of the New York State Hospital Association, sent a letter to then health commissioner David Axelrod, complaining that press stories emanating from the department about medical errors at Albany Med and several other medical facilities were ‘pillorying hospitals.” Allen suggested that Axelrod hold a press conference “to inform the public that New York’s hospitals are the finest in the world.”

A spokesman for the department didn’t agree. “The Health Department found deficiencies in each case,” Bill Fagel was quoted as saying in a Times Union story in April 1986. “We don’t feel these are negative,” he said, referring to the published reports. “From our point of view, these are constructive in the sense that the hospital is bound to live up to the hospital code and rules and regulations.

“And when they violate it, the public has a right to know.”


*Inflation adjustments from the U.S. Department of Labor, Bureau of Labor Statistics Consumer Price Index, April 1986-July 2008: 102.55 percent.


Enough is enough


For hospitals and their insurance
companies, it’s value for money

Posted Sept. 14, 2008

There is an old adage that says: “Any publicity is good publicity.”

For some people, that may be true.

But it’s different for the operators of a hospital or nursing home, when the publicity is about patients dying or being injured while in their care.

It’s not good for business. Not for the medical facility. And not for its insurance company, which might have to pay out far more in a case that has been all over the news than it would if the alleged harm is kept quiet.

Which would explain why, for the past decade, the operators of medical facilities in the Capital Region have kept virtually every medical malpractice lawsuit filed against them out of the news.

They’ve done it by what in some contexts would look like bribery. They pay the media a lot of money for advertising. And the media ignores legal claims of alleged malpractice that caused death or injury.

Quid pro quo. Something for something. Just like many politicians.

That is a serious accusation. Four years ago a detailed letter was sent to the editor and to the publisher of the Times Union, describing what had been found and asking for comment. It produced not even an acknowledgment of the correspondence, certainty not a denial or explanation.

And here’s an example of selective reporting that really makes the point: When Laura Woolsey, who had a heart condition, died of a heart attack after her complaints of extreme pain were repeatedly ignored by contract medical staff at a jail, the TU ran several stories and an editorial.

But when almost exactly the same thing happened to Joan Clark at Albany Memorial Hospital, the paper didn’t print a word. Not when the lawsuit was filed. And not three years later when it was settled.

The jail's healthcare contractor, of course, doesn’t advertise in the TU.

In the Lillian Cedeno case, the publicity could have cost Albany Medical Center Hospital’s insurance carrier an additional $325,000 – $658,000 in today’s dollars – when it paid out on the claim in 1986.

That’s according to Troy attorney E. Stewart Jones, who represented the Cedeno estate, and who knows something about medical malpractice claims. The case was settled for $400,000. Without the media attention, he said at the time, the insurer would have paid as little as $75,000 for the lives of Lillian Cedeno and her baby.

Who says advertising doesn’t pay?

But it also does nothing to reduce the horrendous toll of death and injury in hospitals. In fact, it could well be having the opposite effect because everyone involved knows mistakes will be kept secret; there will be no public embarrassment.

Add to that the knowledge that a team of lawyers is ready to fight every claim, no matter how strong – which also discourages the filing of many valid claims – and the result is a continuing culture of denial that is causing countless unnecessary deaths and injuries.

All aided and abetted – to their financial benefit – by news organizations that boast about defending the public’s right to know while actively hiding public information that is easily obtainable and which, as former TU editor Harry Rosenfeld and a Health Department spokesman have said, is clearly in the public’s interest to know.

Enough. This alliance against the public good must be dismantled. The only question now is: How much damage will the participants allow to be done to themselves when it happens?

Back to Site Guide

Saturday, September 13, 2008



How many times has your hospital been sued?

The newspapers won't tell you



Friday, September 12, 2008

CMS targets blood sugar errors

Medicare will add Lisa's

'never event' to its no-pay list

By David Baker
Posted Sunday August 3, 2008

Starting in October, Medicare will no longer pay hospitals for treating injuries caused by low blood-glucose levels.

This so-called "never event" is one of 28 conditions identified by the National Quality Forum as errors that should never happen, and that a growing number of insurers are declining to pay for.

The rule change approved this week by the Centers for Medicare and Medicaid Services describes the condition as "patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility."

Lisa died in Samaritan Hospital three weeks after she was found in her hospital bed with - according to the hospital's own records - a blood glucose level of just 2 mg/dL

A normal reading is 80 to 140 mg/dL.

The hospital has denied any responsibility for Lisa's death.

Meanwhile, Samaritan and Albany Memorial Hospital - both of which are owned by Northeast Health Inc. - appear in a survey conducted by the respected Leapfrog Group on a wide range of patient safety issues,

Both hospitals are listed as "declined to respond."


Thursday, September 11, 2008

Misplaced sponge update

Doctor dropped from suit;
hospital may have settled

By David Baker
Posted Wednesday August 13, 2008

A doctor named in a lawsuit which alleged that a surgical sponge was left inside a patient during surgery has been dropped from the case.

Dr. John Malfetano was dismissed out of the lawsuit in May. The case, which also names Albany Memorial Hospital, was filed in 2006 by Melanie and Christopher Kiefer of Ulster County.

The Kiefer's case was cited here as an example of how medical providers will fight even the strongest claims. Leaving an object in a patient is widely considered to be totally indefensible.

It is also a 'never event.' A growing number of insurance companies are refusing to pay hospitals for additional treatment required as a result of a never event, saying the fact that it happened is in itself conclusive evidence of negligence.

Hypoglycemia - low blood sugar - that starts while a person is in a healthcare facility and causes death or injury is also a 'never event.'

According to the Kiefer's lawsuit, Melanie Keiefer needed a second surgery to remove the sponge, and also suffered other serious conditions, including peritonitis.

As was reported here in June, the case against the hospital apparently was settled just before it was to go into court. An entry made on the court system's Web page just after the trial was due to start says the case was 'Disposed."

A partial stipulation of discontinuance signed on May 20 and filed on June 18 at the Albany County Clerk's office says the case against Malfetanto was discontinued by agreement of all the parties. It is signed by E. Stewart Jones, Jr. and a lawyer at Carter, Conboy, Case, Blackmore Maloney & Laird, the Albany law firm representing the defendants.

There is nothing in the file indicating how the case against Memorial Hospital was resolved. The judge's office has apparently not yet sent its papers in the case to the clerk' s office for filing.

Further information will be posted here as it becomes available.

Friday, September 05, 2008

Penalties considered

Probe of attorneys' actions goes on

Posted Friday, Sept. 5, 2008

An investigation of a complaint that attorney Stephen Coffey tried to destroy a lawsuit pending against Samaritan Hospital over the death of Lisa Baker is continuing. A staffer at the Committee on Professional Standards said this week that the complaint, filed in April, is still active and that it should be completed "in a month or two."

The complaint alleges that Coffey, a partner at the Albany law firm of O'Connell & Aronowitz, called and offered to review the case, and later asked for and accepted $1,500 for an expert's evaluation of the medical records but never had the review done. It also alleges that Brendan Tully, another lawyer at the firm, stated in writing that the firm had complied with a judge's instructions to make a formal application for an extension of a stay of the lawsuit, and that they notify the defendant's attorneys that they had done so when he knew that no letters had been sent.

As a result, all three defendants filed motions asking the court to dismiss the case. The motions were denied after an affidavit was filed describing Coffey's actions, a move that Tully, hours before the deadline, allegedly advised against.

The complaint also alleges that O'Connell & Aronowitz, because it represents hospitals and organizations that represent hospitals, has a conflict of interest that meant it could not have taken the case against Samaritan, and that the intention of Coffey and Tully was to get the lawsuit thrown out for failure to proceed.
-David Baker