Just when I was starting to calm down about the controversy surrounding "never events", the New York Times unloads a masterpiece of naivete and contempt. Reading this, my eyeballs almost popped out of my skull. One would think that the editorial staff of such a renowned, prestigous newspaper would exhibit a little more intellectual rigor when composing such a denunciatory op-ed piece. I almost thought Diane Suchetka had infiltrated the NY Times hierarchy.
And now, from the other side of the political spectrum, comes a piece from the National Review (arch conservative publication)that uses the concept of never events in such a way to elucidate the danger of government managed health care delivery. (Thanks to Alice at Cut on the Dotted Line)
To review: "never events" are a new designation for "avoidable" complications that arise during hospitalization. Certainly, wrong site surgery ought not to happen. But the list of never events includes such things as urinary tract infections, surgical wound infections, falls, pressure sores, c difficile colitis, delirium, deep venous thromboses and other similar such events that often arise in the setting of critical illness. Interestingly, you will not find a publishable work of science that describes how to reduce the risk of these events to zero. Why? Because it's impossible. If you put a rubber catheter into your bladder, I don't care how sterilely it's done, eventually a certain percentage of them will cause a urinary tract infection. It's a foreign body, for godsakes. And DVT's are not entirely preventable. Everything we know about prophylaxis with Lovenox/heparin/compression hose talks about risk reduction. There are no magic formulas or medicines or healing balms that will completely eliminate the risk of blood clots. It's absurd. The entire concept is absurd.
Basically, this an attempt to cut costs and distribute blame under the guise of "patient safety". And the ironic thing is, it won't cut costs at all. If anything, we're going to see doctors ordering more tests to prove that the patient had a pre-existing condition prior to admission to the hospital. The rise of community acquired MRSA and even c diff infections mandates this.
Furthermore, these viewpoints articulated by two prestigious national publications illustrate a shocking lack of understanding of the terminology with never event proposals. It attempts to lump together true medical errors (wrong site surgery, blood transfusion reactions) with undesired outcomes that occur despite preventative measures. A bad outcome should never be assumed to be a consequence of a "mistake". It's like sending Josh Beckett down to the minor leagues just because he gives up a home run to a good hitter. Take for example decubitus ulcers. All it takes is 30 minutes of unrelieved pressure from a mattress against your buttocks to compromise capillary blood flow to skin and subcutaneous tissues. Now imagine a 500 pound post op gastric bypass patient flat on her back on an air mattress. It takes 6 people to rotate her every two hours. She gets a pressure sore anyway. At what point was her care compromised? Please demonstrate the error. Ought we to have zero gravity chambers available for such scenarios?
The other fallacy has to do with this idea of "physicians making money off their own errors". Give me a break. Let's say I note a wound infection after a colon surgery. I open the incision a bit and drain the pus. I don't charge for it. The patient goes home with wound care instructions and gauze. Or let's say I diagnose a DVT after a low anterior resection. I put the patient on anti-coagulation and maintain the INR at 2-2.5 for 6 months. I don't charge for it. It all falls under the post operative global billing period anyway.
So let's dispense with this idea that physicians are just racking in the dough taking care of typical post op complications. The entire argument is fallacious and disingenuous. And as long as respected publications like the NY Times and the National Review continue to promulgate this nonsense, the sooner the general public will accept it as the conventional wisdom. Very frightening indeed.....