Medical Malpractice

Report: Medical Malpractice is Not

A 'Frivolous' Matter

Accusations of Lawsuit Abuse Fall Flat

By Steve Rensberry
RP News

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    EDWARDSVILLE, Ill. - (RP NEWS) - 7/21/2021 - Nearly 10 percent of patients with symptoms caused by major vascular events, infections or cancers will be misdiagnosed in the United States, with more than half of those suffering death or permanent disability as a result. That's the conclusion of a 2020 study by John Hopkins University School of Medicine Director Professor David E. Newman-Toker, along with others involved with the analysis. (1)

    It's a sobering statistic, as are a long list of others involving medical malpractice cited in the latest report by the national consumer organization, Center for Justice and Democracy (CJ&D). See: Medical Malpractice Briefing Book.

    "Among the 15 diseases analyzed, spinal abscesses was the disease most often missed (62.1%). More than one-on-four aortic aneurysms and dissections have a critical delay in diagnosis (27.9%) and more than one in five (22.5%) lung cancer diagnoses are also meaningfully delayed," the John Hopkins study notes.

    Research by the Emergency Care Research Institute (ECRI) in 2020 points to similar results, concluding that "missed and delayed diagnosis" were a top patient safety concern. Diagnostic errors contributing to death were found in about 10 percent of autopsies, they said, leading to 40,000-80,000 deaths annually. Based on outpatient studies, approximately 1 in 20 adults experience a diagnostic error. (2)

More insights from the CJ&D's briefing book:

• Despite the Emergency Medical Treatment and Labor Act (EMTALA), which requires emergency departments to treat emergency patients regardless of ability to pay, hundreds of violations of the Act are seen each year. An analysis of 10 years of EMTALA violations (2008-2018), showed more than 4,300 violations involving 1,682 hospitals, roughly 1/3 of the nation's hospitals. (3)
  

• Approximately 1 in 12 errors involved women who were pregnant or in labor, while 1 in 7 involved people who were having a mental health crisis, including thoughts of suicide. "Yet experts say the raw numbers belie both the scope and severity of the problem they see. That's because enforcement of the law depends on someone filing a complaint. Although anyone can file a complaint, it's most often a doctor, nurse, or hospital administrator," the report notes.

•  A study by Professor Ziad Obermeyer of Harvard Medical School, et al, of early death after discharges from emergency departments, using U.S. insurance claims data, shows a significant number of deaths from people on Medicare soon after discharge. "In this national analysis, we found over 10,000 Medicare beneficiaries each year died within seven days after being discharged from emergency departments, despite mean age of 69 and no obvious life limiting illnesses," the report stated. (4)

•  A 2019 study by University of Michigan School of Public Health candidate Jun Li et al, looked at the amount of data available made available by the U.S. Centers for Medicare and Medicaid Services on 1 million U.S. doctors. Its conclusions: Three quarters of clinicians had no information about their quality of care, 99 percent had no data tied to individual job performance, and lax reporting requirements do not require that every outcome be considered, meaning clinicians may be selective in which cases to submit information on. (5)

• Diagnostic errors are the most common and costly errors, according to an 2020 analysis by Coverys Inc. of data from 2010-2019, with death and high-severity injury making up approximately 52 percent of events and 74 percent of indemnity paid; emergency department-related events accounts for 66 percent of indemnity paid.

    The bottom line, as stated in Part I of the CJ&D's briefing book, is that medical malpractice litigation, and the cases that are filed on account of it, are not fundamentally "frivolous," despite the allegations.

    As stated in the book: "According to averages calculated from the most recent data release by the National Center for State Courts (2019): 1) Medical malpractice cases represented only 0.15 percent of state civil caseloads in 2019. This rate is consistent with NCSC data from the previous seven years. 2) Medical malpractice cases represented only 3.9 percent of state tort caseloads in 2019. This rate is consistent with NCSC data from the previous seven years."

    A 2014 study, "Medical Harm: Patient Perceptions and Follow-up Action," by Johns Hopkins University School of Medicine Professor of Surgery Martin A. Makary and others, showed lawsuits being filed following patient harms in just 1 out of every 5 cases, or 19.9 percent. "This is similar to the Harvard Medical Practice Study, which reported an estimated ratio of adverse event to malpractice claim of 7.6 to 1. Other studies have estimated that as few as 2% - 3 % of patients pursue litigation. These findings all suggest that the vast majority of patient harms never result in a lawsuit." (6)

    The argument that patient lawsuit increase medical and insurance costs also is weak, given the data.

    According to the group Americans for Insurance Reform, claims per physician were at their lowest level in four decades in 2016, when adjusted for medical care inflation. When adjusted according to the Consumer Price Index, claims are at their lowest since 1982. (7)

    “Even aside from COVID-19, the briefing book includes a number of new studies that undercut the medical industry’s principal argument for so-called ‘tort reform’ laws: cost savings. It is clear that health care and insurance costs fail to decrease when ‘tort reforms’ are enacted, meaning there is no reason for patients to lose their legal rights.” CJ&D Executive Director Joanne Doroshow stated in a March 2021 press release.

Citations

1) Medical Liability Monitor (Feb. 2021) "Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the 'Big Three.'" ECRI Executive Brief, "Top 10 Patient Safety Concerns 2020 (March 2020).

2) ECRI, "Diagnostic Errors: Why Do They Matter, and What Can You Do?" (2019).

3) Brenda Goodman and Andy Miller, "Deprived of Care: When ERs Break the Law," WebMD and Georgia Health News, Nov. 29, 2018.

4) Ziad Obermeyer et al, "Early death after discharge from emergency departments: analysis of national US insurance claim data," BMJ, Feb. 2, 2017.

5) Lena M. Chen, Anup Das and Jun Li, "Assessing the Qualithy of Public Reporting of US Physician Performance," Jame Intern. Med, May 6, 2019; University of Michigan, "System Grading Doctors is Inefficient, Needs Revisions," May 7, 2019; Lisa Rapaport, "U.S. government website for comparing doctors lacks data on most MDs," Reuters, May 6, 2019.

6) Heather G. Lye et al, "Medical Harm: Patient Perceptions and Follow-up Actions," Journal of Patient Safety, November 13, 2014.

7) Americans for Insurance Reform, "Stable Losses/Unstable Rates 2016" (November 2016).

Cyber Security

Report: Healthcare, Manufacturing

Top Targets for Cyber Attacks

    NEW YORK -- (BUSINESS WIRE) -- July 5, 2021 - Avanan, a leader in Cloud Email and Collaboration Security, announced on June 30 the release of the company's 1H 2021 Global Phish Cyber Attack Report, which analyzes today’s threat landscape, phishing vectors, and industry-based attacks, exposing healthcare and manufacturing as two of the top industries being targeted by hackers in the first half of the year.

    “With hospitals around the world being hit with ransomware attacks and manufacturers experiencing supply chain disruption due to cyber-attacks, the Avanan research shows that hackers are using one of the most basic tactics to get in ‒ phishing attacks,” said Gil Friedrich, CEO and Co-Founder of Avanan.

    According to Avanan’s security research and analysis, the most attacked industries are IT, healthcare, and manufacturing. IT saw over 9,000 phishing emails in a one-month span, out of an average of 376,914 total emails; healthcare saw over 6,000 phishing emails out of an average of 451,792 total emails; and manufacturing saw just under 6,000 phishing emails out of an average of 331,184 total emails.

    These industries are the most targeted because they hold incredibly valuable data from health records to social security numbers, combined with the fact that healthcare and manufacturing tend to use outdated tech and often have non-technical board of directors. In healthcare, in particular, the industry is largely unprepared. Though every industry gets attacked, the ones that hold the most data are the most at risk.

    For this report, Avanan security researchers analyzed over 905 million emails spanning a six-month period. Since Avanan works as a layer of security behind Microsoft’s EOP, ATP/Defender, Google Workspace, or any SEGs, this analysis only looks at the emails these other layers did not quarantine. The report reflects an analysis of the most sophisticated and evasive attacks in use today.

    Key Findings:

• Because threats have gotten so advanced, AI is required to stop the majority of attacks missed by legacy solutions. Without the use of sophisticated AI, 51% of attacks would be missed and reach end-users.
• Impersonation and credential harvesting attacks remain top phishing vectors. Credential harvesting, 54% of all phishing attacks, has risen by nearly 15% when compared to 2019; 20.7% of all phishing attacks are Business Email Compromise (BEC); and only 2.2% of phishing attacks are extortion.
• Hackers are starting to target lower-hanging fruit rather than C-level executives. Now, 51.9% of all impersonation emails attempted to impersonate a non-executive in the organization. In fact, non-executives are targeted 77% more often.
• Misconfiguration is playing a rising role in phishing. Over 8% of phishing emails ended up in the user’s inbox simply because of an allow or block list misconfiguration, a 5% increase from last year, and 15.4% of email attacks are on an Allow List.
• The most commonly used tactic is using non-standard characters and limited sender reputation. Non-standard characters are used in 50.6% of phishing links and 84.3% of phishing emails do not have a significant historical reputation with the victim.
  

    Avanan anticipates that cyberattacks will continue to explode with healthcare and education being hit hardest, predicting that attacks on the education sector will surge over the next six months with massive increases when school returns in the fall. In addition, Avanan predicts COVID related phishing emails will decrease, while office place related phishing emails will increase. As workers around the globe return to the office, there will be a spike in phishing attacks leveraging services like fax, scanners, copiers, targeting the things used in office life that sat dormant for the last year and a half.

    For more information and to download the report, please visit: https://www.avanan.com/resources/white-papers/1h-cyber-attack-report.

 

The Political Divide

 New Studies Confirm 

Perceptual Differences Between

Political Parties

WASHINGTON -- (BUSINESS WIRE) -- June 27, 2021 -- The 2020 election was unique in American politics. For the first time, an incumbent president lost the popular and electoral college votes but refused to concede the election, claiming without evidence that widespread fraud tainted the results. Yet U.S. history is rife with examples of contested election results and fraud claims. Was 2020 different in significant ways, and does that raise serious concerns about the health of our democracy?

The Democracy Fund Voter Study Group releases two reports on June 24 that shed light on these crucial questions. The reports – “Theft Perception: Examining the Views of Americans Who Believe the 2020 Election was Stolen,” by Lee Drutman of New America, and “Crisis of Confidence: How Election 2020 Was Different,” by Robert Griffin and Mayesha Quasem of the Democracy Fund Voter Study Group – suggest that 2020 was indeed unique and that faith in our democracy has been shaken to an unprecedented degree.

    “Free and fair elections are a cornerstone of our democracy, but it’s also important that the public trusts the results of those elections. Unfortunately, the 2020 election cycle and actions of former President Trump have shaken that trust,” Voter Study Group Research Director Robert Griffin said. “These reports provide details that help us understand how Americans perceive the electoral process, which may help policymakers address this serious crisis in confidence.”

    “It’s not uncommon to have some claims of voter fraud and lower trust among the losing party after elections, but 2020 stands out for the intensity and scale of mistrust in the election,” said Mayesha Quasem, research associate at Voter Study Group. “All of this raises serious concerns about the stability of our democracy going forward."

    Key findings – Crisis of Confidence

• A week after the 2020 presidential election, the overwhelming majority (93%) of Biden voters said that they were confident that the election was conducted fairly and accurately, but only 29% of Trump voters said the same. There was almost no difference in confidence between these groups in the week before Election Day.
• The percentage of Trump voters in 2020 who said they were not at all confident that their vote was tallied accurately was more than four times as high as the percentage of Clinton voters who said the same in 2016 (35% vs 8%).
• Fifty nine percent of Americans said that permanent harm had been done to the United States as a result of the election process.

    Theft Perception takes a closer look at the rise of the Stop the Steal movement sparked by former President Trump’s claims of a stolen election.

    “Republican politicians across the country have continued to support the narrative of a stolen election,” said Lee Drutman, senior fellow in the Political Reform program of New America. “While the sentiment is not necessarily surprising, in practice, we’re seeing a doubling down of this narrative, which is driving a new wave of state laws that restrict voting access.”

    Key findings – Theft Perception

• Republicans widely support Donald Trump and believe his claims about a stolen election. While Republicans support all elements of the “Stop the Steal” narrative in high numbers, the overall electorate largely rejects these claims and propositions.
• Among Republicans, 85% believe it was appropriate for Trump to file lawsuits challenging election results in several states, and the same proportion believe that vote-by-mail increases voter fraud.
• Republicans most committed to both Trump and the narrative of election fraud share a few other views in common: extreme antipathy toward Democrats and immigrants, belief that racism is not a problem, support for nationalism, belief in traditional family values and gender roles, and preference for a very limited role for government in the economy.

    Throughout the summer, Voter Study Group will release reports examining other Trump-era topics with implications for the future of American democracy including views on race, populism, trust in institutions and issue prioritization and the change and stability of the American electorate. The reports show the consequences and dangers of our leaders being irresponsible and spreading mis- and dis-information.

Interactive Data on Voter Views: Nationscape Insights

    From July 2019 to January 2021, the Democracy Fund + UCLA Nationscape survey asked hundreds of thousands of Americans in every region of the U.S. about some of the nation’s biggest issues — including the economy, guns, healthcare, and climate change — and it tracked changes over time.

    First launched in partnership with USA TODAY, Nationscape Insights makes week-by-week Nationscape survey data available with interactive visualizations you can sort by race, gender, income, geography, education level, and political leanings. With Nationscape insights, it’s possible to dive deep on the policy preferences of groups once too small to examine but who were pivotal to election outcomes — to help make sense of an era, and election, like no other in America’s history.

    Refreshed with the final Nationscape dataset fielded November 12, 2020, through January 12, 2021, Nationscape Insights is now available on voterstudygroup.org.

About Democracy Fund Voter Study Group

    The Democracy Fund Voter Study Group is a research collaboration of more than two dozen analysts and scholars from across the political spectrum. Created in the wake of the 2016 election, the Voter Study Group’s goal is to better understand the American electorate by examining and delivering insights on the evolving views of American voters. Research and analysis from Voter Study Group members can be found at www.voterstudygroup.org and on Twitter @democracyfund.

Illinois Politics

J.B. Pritzker Has Brought 

Sanity and Leadership to Illinois

Governor Gets High Marks For Handling of Pandemic, Economy

By Steve Rensberry
Opinion / Analysis

    EDWARDSVILLE, Ill. - 5-31-2021 - The year 2018 was a good one for J.B. Pritzker, but more importantly, for the state of Illinois.

    As you might recall, Pritzker, a Democrat, all but trounced former governor and Republican Bruce Rauner in that year's gubernatorial election, garnering a decisive 54.5 percent of the vote to Rauner's 38.8 percent. It was a big change from 2014, in which Rauner beat former Illinois Governor Pat Quinn with 50.27 percent of the vote compared to Quinn's 46.35 percent.

Illinois ranks No. 5. Source: statista. Click to enlarge.

    Proving that politics has indeed become a rich man's game, Rauner (a multi-millionaire) dumped some $26 million of his own money into the 2014 race, and another $70 million into the 2018 campaign. (1) But even with such an enormous investment in one's own election, it wasn't enough to fend off Pritzker (a billionaire), who spent $171 million of his own money to get elected. (2) This isn't counting all the additional campaign revenue raised by the two men.

    However, it wasn't just big money that decided the 2018 race, but the fact that the Republican's front-man simply failed at governing. "Rauner Deficit Increased 52% in FY17 to $14.7 Billion," one news release from Pritzker's election team reads (3). Talk is cheap, and Rauner, like most Republicans, was under the naive delusion that all the state needed to do was lower taxes and cut spending and its problems would be solved. One of his worst decisions was refusing to sign a budget for two years, essentially holding the state hostage until lawmakers approved a list of partisan demands. The fallout was felt by school districts, service organizations, and others all across the state, ultimately leading to a downgrading of the state's bond rating. (4)

    Bottom line: neither tax increases alone nor tax cuts alone are likely to solve the state's fiscal problems, we need both. That's what most economic experts I've read insist. But Republicans have been myopic and uncompromising on the issue -- and consequently have made the situation worse. (5)

    The scary part is that Rauner was not conservative enough for some, like his challenger Jeanne Ives, who narrowly lost to Rauner in the 2018 Republican Primary. Ives claimed she was motivated to run after Rauner signed into law HB-40, a bill that ensured abortion would remain legal in the state, and allow coverage for women with Medicaid or state-employee insurance coverage. (6)

    Pritzker, meanwhile, has stayed the course and acted as a governor should, with integrity, all the while taking a responsible lead on the pandemic and approving extended aid to unemployed workers. Nor has he dwelt on his losses, or become vindictive when rejected, as Rauner was prone to do. When voters gave Pritzker's graduated income tax proposal a thumbs down, he moved on to the task of governing and looked for other ways to balance the budget, including cuts. As luck would have it, the economy did better than expected and it was ultimately determined that no income tax increase would be needed to close a projected $3 billion budget deficit. (7)
  
    "Before JB became governor, for over two years a dysfunctional state government couldn’t even pass a budget. Services were cut, schools suffered, and families throughout the state paid the price because of a governor who didn’t get the job done," the governor's campaign site reads.

    One big disappointment in the 2018 state election was that the Illinois Chamber of Commerce still gave Rauner its endorsement, despite his dismal performance on the economy, citing opposition to Pritzker's "support for a graduated income tax, a $15 minimum wage, support for trial lawyers' agenda and lack of a meaningful commitment to reforming pensions and restoring fiscal integrity to our finances." (8)

    The Chamber's position on such contested issues was revealing in terms of showing its ideological biases, and unfortunately fits a pattern of siding against Illinois families, against poor and underpaid workers, and against people injured through medical malpractice or negligence.

    So here we are, a year and a few months away from the next gubernatorial election, set for Nov. 8, 2022. The opposition is ready with their "Pritzker Sucks" signs, their accusations that Illinois' population is "dramatically" shrinking because of a high tax burden and Democratic policies, and claims that Pritzker's tax policies will destroy businesses and hurt downstate residents. None of it is true, but I'm not sure the opposition cares because in their minds winning is everything. It's the new paradigm.

    What has Pritzker done while in office? Does he deserve a second chance? Consider the following list of achievements, as posted on Pritzker's official campaign site, here.

Government

• Passed a balanced, bipartisan budget that begins to pay down debts from the prior administration.
• Improved our bond outlook to “stable” for the first time in years.
• Passed a public safety pension consolidation bill to help lower property taxes and reduce future budget pressure.
• Reduced state pension liabilities with an employee pension buyout program.

The Economy

• Launched the bipartisan Rebuild Illinois capital plan, the largest in state history, to rebuild roads, bridges, and communities and create and support hundreds of thousands of good-paying jobs.
• Prepared our children for the jobs of the future by expanding skills development and focusing community college programs on the fastest growing industries.
• Raised the minimum wage to a living wage for all Illinois workers.
• Made college more affordable for Illinois students by expanding in-state scholarships and making more merit scholarships available for high-performing students.
• Created a minority business loan fund.
  

Business

• Launched an effort to bring high-speed broadband internet to every corner of the state
• Created a minority business loan fund.
• Developed new incentives for job creation on new construction and renovations in underserved communities.
• Refocused community college workforce development programs to concentrate on high-growth industries.
• Signed the most equity-centric cannabis legalization plan in the nation to invest in communities hit hardest by the war on drugs.
• Encouraged new job creation and workforce development with an apprenticeship tax credit for businesses.
• Extended the film industry tax credit, creating and supporting thousands of entertainment industry jobs in Illinois.
• Elevated the innovation economy with new business incubators and an extension of the research and development tax credit for manufacturers.
  

Early Education

• Expanded child care assistance eligibility to 10,000 more children.
• Strengthened early childhood education and child care with the biggest investment ever in Illinois into early childhood programs and facilities.

K-12 Education

• Provided historic funding levels for K-12 students across the state.
• Raised the minimum salary for teachers.
• Expanded skills development with new investments in vocational training in high school.
  

    Illinois is a lot of things, and by no means perfect, but to call it a failed state, never mind a haven for "judicial hell holes," is pure partisanship. It is often compared to surrounding states as though there were any real parity, but considering the state's contribution to the nation's overall GDP, Illinois is a powerhouse of productivity and opportunity by comparison, ranking No. 5 nationwide and outranked only by Florida, New York, Texas, and California. Neighboring Indiana is ranked No. 18, Wisconsin No. 21, and Missouri No. 22. (9)

    Although Pritzker has not yet officially announced his candidacy for re-election, the Chicago Sun-Times reported this past March that he had already made a $35 million campaign contribution, so it seems likely. (10)

    I don't think I'm alone in recognizing that the Republican Party has a problem on its hands, not just because of Pritzker's popularity and success, but because of the growing influence of extremists within its ranks.

    A May 14 story written by Sarah Nardi for WGLT is insightful. Reporting on a meeting of the Lincoln Club of McLean County, in which former Gov. Jim Edgar, Rep. Dan Brady, and former Illinois Republic Party Chairman Pat Brady served as panel members, Nardi writes: "Edgar said the problem facing Republicans in a gubernatorial race is the growing chasm between a state that's moving left and a party that's moving right . . . . To reclaim the governor's office, Edgar said Republicans will have to unite behind a moderate candidate -- something hard-line conservatives will resist. But a shifting electorate means that in the Chicago suburbs, a once reliable source of GOP votes, people aren't casting ballots for Republicans the way they once did." (11)

    Nardi writes that Edgar acknowledged the shifting political landscape, and how much things have changed. "My definition of a moderate (Republican) is what would've been an extreme conservative 20 years ago," Edgar is quoted as saying.

    So there you have it. An admission, by at least one prominent Republican, that Illinois' second major political party is definitely not what it used to be, is conflicted, and has essentially normalized its most extreme elements.

    Is that the kind of leadership we need in Illinois? I think not.

    Illinois has had bad luck with governors, both Republican and Democratic, but today's Democratic Party -- and Pritzker specifically -- have earned my confidence. He is what Illinois has needed. If Pritzker goes the way of Ryan, Blagojevich, or Rauner, making things worse instead of better, then he should be held accountable, but in today's climate of extremism, I wouldn't hold my breath waiting for a Republican challenger worth considering. 

Citations
1) Rauner 2018 Race Campaign Finance (politico)
2) Rauner, Pritzker Spending For Governor (NBC Chicago)
3) How Bad is the Illinois Deficit (politico)
4) Fitch Downgrades Illinois (Fitch Ratings)
5) Governor's Budget Cuts Costs, Corporate Tax Breaks (Bloomberg)
6) Jeanne Ives (wikipedia)
7) No Income Tax Hike Needed (WTTW)
8) Illinois Chamber Endorses Rauner (Effingham Radio)
9) States and Territories Ranked by GDP (wikipedia)
10) Pritzker Re-election Campaign Contribution (Chicago Sun Times)
11) GOP Leaders Say Moderate Governor Candidate Key (WGLT)