Sunday, August 1, 2010

Never Events: Trojan Horses for Death Panels

These are errors in care that are so outrageous, they should never happen. Should they occur, the payment authority has no obligation to pay for the work done. In the case of psychiatry, these are unjust. Patients who want to kill themselves cannot really be stopped 100% of the time. As to patient elopment, if there are escapes from high security prisons, mental health units should not be held to any higher standard of security. Medicare and Medicaid began denying treatment for these preventable complications. The assumption is that they all stem from clinical error, which are 100% avoidable.

In a study of surgery, factors such as the severity of symptoms, complexity of comorbidity both affected outcomes, and were  beyond the control of the clinician. (Arch Surg, 145: 148-151, 2010). These very sick patients were more likely to develop post-operative pneumonias.

What will be the effects if these never events are permitted to be used as a pretext to not pay for expensive and complicated care?

1) denial of Care. Clinicians will refuse to perform procedures on patients with severe symptoms or complex comorbidities, because of the greater chance of a never event;

2) government entities and their agents, wealthy, powerful insurance companies will  be unjustly enriched at the expense of smaller health care providers;

3) further defunding of health care, and shrinkage of availability, especially to very ill, complicated patients;

4) ironic increases in never events, as these are covered up, and the factor cluster analyses needed will not be done to make system wide changes necessary to prevent them in the future;

5) the non-payment represents a Fifth Amedment taking without a fair hearing;

6) punishment of a person for the intentional acts of another, such as elopment or suicide, violates procedural due process rights;

7) the non-payment may violate the ADAAA rights of severely ill people.

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