$16M Jury Award is a Victory for Healthcare Consumers

Truth in advertising matters in healthcare. An Alabama hospital recently got that message loud and clear with a $16 million jury award against it. The verdict in the Malatesta vs. Brookwood Medical Center court case also sends a message to healthcare consumers that they have a powerful tool for holding facilities and providers accountable for the promises they advertise.

Caroline Malatesta was swayed, in 2012, by an enticing advertising campaign to switch hospitals for the birth of her fourth child, from one that offered a restrictive model of maternity care to one that claimed to offer autonomy and personalized birthing options. The care that she received during the birth, however, was more restrictive and medicalized than her previous birthplace, and resulted in a permanent injury. She took the hospital to court for fraud and on August 5, 2016, a jury awarded her and her husband $16M. That sum includes punitive damages in the amount of $5M, which were awarded for reckless fraud directly relating to the advertising campaign which promised more natural birthing options.

According to a blog post on the Malatesta’s law firm’s website, the Brookwood Medical Center ads emphasized a mother's choice, individual birthing plans, freedom of movement and even mentioned water births. Yet, when Caroline was in labor there she was not allowed freedom of movement or access to a birthing tub, and she was forcibly restrained by nurses, who held her baby inside her for six minutes until a doctor arrived, causing a type of permanent nerve damage. Reports state that water births had been banned internally in the facility since 2013, yet advertisements still included it as an offering at the time Malatesta filed her suit, nurses had not received special training in managing natural births, and the depositions show that there was not a system in place to alert staff that a patient was planning a natural birth. A nurse reported that the messages about natural birth in the advertisements were not communicated to the staff.

In interviews Malatesta has said that she tried to talk with the hospital administration to get answers about what happened to her, but they were not responsive. "Unfortunately I felt like I didn't get any real answers. And they eventually just shut me out. That was when I realized the only option was litigation," stated Malatesta in one of her interviews posted online. One of the claims the lawsuit alleges is that Brookwood “[marketed] natural birth services without sufficient coordination to ensure that the medical staff and other caregivers were aware of, trained in and committed to providing the services advertised.”

Malatesta reluctantly pursued litigation, but she did so because her injury was so debilitating and expensive. Once the media picked up her story, she heard from other women who had also been duped by Brookwood’s advertising campaign and received poor quality care there. In one article she says, "It's meaningful to me that so many women have contacted me and told me that the verdict was their validation that they never got. That gives meaning to an injury that's hard to come to terms with – a bigger meaning than myself."

In addition to Malatesta and the numerous other women who were drawn in by Brookwood’s false advertising and now feel that justice has been served, other healthcare consumers may benefit from this verdict. As healthcare consumers become better informed about their options, competitive hospital markets may be tempted to use “buzzwords” that appeal to savvy consumers without backing up their claims. Competition between hospitals can be intense in many communities, and marketers may be tempted to tap into the latest healthcare technology and trends being hyped in the media without the staff or facility being able to support that type of care. But, large jury awards like this one put the healthcare industry on notice that they must provide what they promise, or risk being held accountable. Also, cases such as this one set legal precedent, paving the way for other similar cases. The fact is, the legal system is one of the few ways that individuals can sway the actions of large corporations for enforcement of laws and standards of care.

While all healthcare consumers won’t get a piece of the monetary award in this case, they will benefit from the awareness that is raised when a large sum is awarded in a legal case, and they will benefit from the precedent that’s been set for truth in advertising about healthcare services. For those who have suffered injury as a result of the medical decisions they made based on the promises of a healthcare facility that didn’t live up to its promises, this case can serve as a reminder that the legal system can help individuals in getting justice in when dealing with giant corporations. 

 

 Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

My Secret Addiction

I’m embarrassed to admit it, but I think I suffer from an addiction. It probably isn’t healthy, and it makes me question my view of reality at times, but still, I cannot stop myself from watching medical TV shows. As a healthcare consumer advocate I am drawn to the show Chicago Med. It offers a view into places where human experience, with all it’s power, uncertainty, emotion, and messiness, is portrayed in Technicolor detail along with bloody surgical procedures. That show really gets my adrenalin pumping! Sometimes the scenarios posed in the show leave me replaying scenes in my head for days. You see, television is a powerful medium that exerts a huge amount of influence. It offers a vision of the world and then leaves us to decide whether the vision is accurate or not. It makes us ask the question, “Is this really who we are, what we do, and what we believe?”

A recent episode of Chicago Med has me pondering some deep questions about the current state of medical care decision-making.

In the show an alcoholic was brought into the emergency room with a broken leg. He was a “frequent flyer;” a regular visitor to the ER, and so one of the nurses was familiar with him as a patient and knew he was an alcoholic. The man began to experience delirium tremens, a painful and potentially deadly symptom of alcohol withdrawal. The man stated clearly that he did not want to stop drinking, and he was not going to take any steps to kick his addiction. He was brought in for an injury, not for getting clean. The patient was having seizures, hallucinations, vomiting, and suffering internal bleeding because of the DTs. All he wanted was a drink, yet the doctor on his case refused to allow him to have one, because the doctor believed that getting the patient sober was what the patient needed. The nurse tried to sneak in a bottle of liquor, but the doctor stopped her and told her, “I’m the doctor. I know what’s right for the patient.”

Who gets to make the final decisions about what the patient “needs?” – the doctor or the patient? What values are wrapped up in the decision-making? This was a juicy scenario to consider for a number of reasons.

First, it raises the question of the ethics of treating a body part or treating the whole patient. Should the doctor have just stabilized the patient enough to treat the broken leg, and not concerned himself with the alcoholism? Does the patient’s assertion that he wants his leg fixed but doesn’t want to be treated for alcohol addiction carry any weight? Does stepping over the threshold of the hospital doors mean the patient must follow hospital protocol, give up his autonomy, and give up his rights to make decisions about his body and the course of his medical care? Medical ethicists and human rights advocates argue that the patient retains those rights, and that doctors are supposed to respect them, even if the patient may suffer or even die as a result of those decisions. In this light, treating only the broken leg and not the alcoholism would have been the appropriate thing to do. It’s understandable the doctor may feel that because he has the training and the resources to treat the whole patient, he should treat the whole patient, but only if the patient consents.

Second, it raises the question of which drugs are acceptable, under which circumstances, and why. The doctor treated the patient with benzodiazepines and with Haldol, which are both prescription medications. He refused to allow the patient to have a medicinal dose of alcohol, even though it’s a substance that anyone over the age of 21 can legally consume without a prescription. Why are the prescription drugs acceptable while the over-the-counter one is not?

Third, how do we judge another person’s capacity to make medical decisions when that person appears to be flawed? In this case, the perceived moral failing of being an alcoholic influenced the doctor’s belief in the patient’s ability to make good life choices. The doctor asserted that his medical authority also gave him the moral authority to override the patient’s authority to make medical decisions for himself.

Lest you be tempted to say, “Michal, it’s just a TV show,” realize that these questions play out in real life every day. As the concept of patient-centered care plays a bigger part in how healthcare is delivered, questions like these, which expose the tensions between patients’ rights and doctors’ responsibilities, cause judgment calls to be made in almost every medical interaction.

Doctors and patients may disagree about what the patient needs to stay healthy or get well. They may have different approaches to health, illness, and questions about quality of life. That’s why things like Do Not Resuscitate orders and living wills came about – so that mechanisms would be in place for patients to express their wishes about how to be treated in circumstances in which they could not speak for themselves. When we are patients, we are dependent upon medical caregivers for their expertise, but we are not required to completely submit to their medical authority. We still retain rights that must be respected. Doctors are human beings who are tasked with using their knowledge and skill to improve the lives of others. Sometimes they use their abilities wisely, and sometimes they make the wrong the choices. There will always be a dance between doctors and patients, and we all need to learn our steps so we don’t trip over each other’s feet.

As a society we make fairly arbitrary rules about things like drug use. The perception is that prescription drugs are safe because doctors prescribe them, yet the over-prescription of narcotics is one of the main causes of epidemic heroin use across the country. Patients become addicted to prescription pain medications, and then switch to using heroin because it is cheaper. And prescription drugs may not be the most appropriate remedy. An over-the-counter product or natural remedy may suffice, but those are unlikely to be used in a hospital setting. When I was in the hospital after giving birth to one of my children, I was told I was not allowed to take the ibuprofen (ADVIL) I had brought from home. There were two main reasons why. First, any medication taken by the patient needs to be noted in the patient’s chart, in case of side effects and to make sure no drug interactions will occur. This is for patient safety. Second, the hospital can charge a premium price for the medications it distributes. They often charge up to $15 for a tablet of Tylenol, which otherwise would cost around 11¢. I was scolded for being a noncompliant patient each time I told the nurse I took the ibuprofen anyway, against their medical advice, so they could mark it in my chart.

Coercive care is a common problem for anyone who is deemed “less worthy.” At a conference I attended recently I heard story after story of patients who were told by medical caregivers something was being done “for their own good,” because they were overweight, a person of color, young, female, transgender, or different from what the mainstream consider to be normal. This is what the Chicago Med episode highlighted; that mainstream medicine does not equal moral authority.

As the practice of medicine continues to change, as it has drastically over the previous few decades, we are challenged with examining the changing nature of the authority and responsibility of both patients and doctors. We need to be mindful of patients’ rights and also be clear about our expectations of doctors and medical care. We need to recognize our biases and morals, and see clearly how they intersect in medical situations.

Watching healthcare scenarios on medical shows like Chicago Med reflects choices back to us and inspires us to compare our beliefs to what we see on TV. Rather than viewing it as straight entertainment, I use the show as a catalyst to examine my own beliefs and to learn more about how these scenarios unfold in real life, for real people. Does that make my compulsion to watch the show an addiction, or a healthy desire? I guess that depends on what the people in the mainstream think.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

Got Healthcare Questions? Use Your BRAIN!

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!

When Should You Go to the Emergency Room?

The way we access healthcare has changed quite a bit in the last two decades, and there are new options available for getting medical help when you get injured in an accident or if you become ill. I attended a talk recently by Dr. Michael Gutman, Medical Director of New England Urgent Care, and he shared important information about when to go to the emergency room and when you can seek out alternative urgent care options.

With the growing shortage of primary care physicians, and the available doctors getting busier every day, there’s a good chance that at some point your doctor’s office may tell you to go to the emergency room if they can’t see you right away. Or, you you might have symptoms that are more than what your doctor treats in the office. But, emergency rooms are meant to handle to the most serious health problems. Going there when you are experiencing a problem that is less acute can keep the most critical emergency patients from getting the quick care they need, and can cost you extra time, money, and hassle. 

Walk-in health clinics are popping up all over in communities around the country. Some of them offer a good alternative to going to an emergency room, except for certain very serious or life-threatening cases.

So, when should you go to the emergency room?

Dr. Gutman says you should call 911 when -

• You think you are about to die*
• Your breathing is so impaired you can’t talk in sentences
• You are having chest pain that you think is a heart attack
• You or your spouse think you are having a stroke
• You have altered mental status
• You used to be able to walk yesterday and today you can’t
• You are injured and you can’t walk as a result

*This is not meant as a joke. Dr. Gutman is an experienced emergency physician with military experience in Iraq. He says that people with anxiety can have this feeling and it doesn’t mean death is imminent, but when an injured or ill person expresses they feel they are going to die, it is not a good sign. Get that person to an emergency room right away.

If the symptoms you are experiencing are not mentioned above, you are a good candidate for a walk-in urgent care clinic. An urgent care clinic differs from other walk-in clinics because it can handle more complicated emergency health issues. Where some clinics offer immunizations, strep tests, checking for ear infections, or treatment for cough, cold, flu, or minor injuries, urgent care clinics can do more. They can take x-rays to check for broken bones and do stitches on small lacerations, and may offer other services too. For example, New England Urgent Care does IV fluids, x-rays, and stitches on larger lacerations, because all their caregivers have at least two years of emergency room experience. They have lab facilities and rapid analysis through St. Francis Hospital, if necessary. They also have on-site pharmacies, and they can expedite your admission to the hospital if transfer to a hospital is deemed necessary.

Some of the benefits of going to a clinic rather than an ER are that the copays are usually the same as a doctor’s visit instead of an emergency room visit, the charges are much less, and there’s usually a short wait time before you are seen by a doctor, nurse, or physician’s assistant.

When my husband slipped and fell on the ice last year, he went to New England Urgent Care. He was taken in for x-rays within 20 minutes of our arrival. X-rays confirmed he had broken two ribs. The physician’s assistant gave him clear, written instructions for care. He left with a filled prescription for pain medication and instructions for follow-up. He was home resting in just about an hour and a half. And, we didn’t have a heart attack when we saw the bill. It was a great alternative to a hospital emergency room.

Check to see if there are any walk-in urgent care clinics in your community. Find out what services they offer, and if they would be a good alternative to the emergency room of your local hospital. It’s a good idea to check clinics out in advance, before you have an emergency such as an injury or illness. When that happens, you might not have the luxury of time to do the research.

Be prepared, and know which urgent care clinic or emergency facility is right for you.

New England Urgent Care has clinics in West Hartford, Simsbury, Bristol, and Enfield, Connecticut. Their website is UrgentCareNewEngland.com.

Michal Klau-Stevens is a professional speaker and healthcare consumer advocate. She is a maternity consultant, pregnancy coach, and expert on consumer healthcare care issues, Past President of BirthNetwork National, a Lamaze Certified Childbirth Educator, and mother.  Her website is TheBirthLady.INFO. Find her on LinkedIn and on Facebook at The Birth Lady page!