Mount Sinai Rehab slapped with lawsuit for wrongful death, recklessness

[SpideRehabMan]

Rehab in Malpractice News:

http://www.newyorkinjurycasesblog.com/uploads/file/Deane%20v%20Mount%20Sinai.pdf

http://abclocal.go.com/wabc/story?se...ors&id=6215788


Apparently, overworked rehab resident and lack of attending supervision, critical to case, and led to rare award of punitive damages to family.

Justice Joan Carey on 8/27/2009:

As a hospital, which is entrusted with the lives of its patients, Mt. Sinai cannot simply have an attending physician not show up for an entire weekend, and have inexperienced, and overworked, resident physicians be solely responsible for the handling of the care of these patients. Based upon the foregoing, a jury could reasonably find that Mt. Sinai participated in or authorized these failures, and find complicity on the part of Mt. Sinai.

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[PMR 4 MSK]

Most likely, it hinged on no attending showing up. If the attending had showed up, it might not have made a difference in outcome, but to a judge or jury, it would mean everything in terms of reparations.

It does not appear that this case has been settled yet.

Also, be careful about comments on this case. The lawyers will likely be watching...

 

[lobelsteve]

I do not think any PMR resident would have picked up on this unusual complication. ENT was consulted and where is the attending.

Lots of unknowns, so fingers cannot be readily pointed, but I'm leaning...

Would like to see the notes from post-op through discharge from the transferring facility.

Lots of mistakes made here. It's a shame. If it was my family and this happened, I'd want in on the punitive damages as well.

 

[rehabdocmd]

This is more than an attending not showing up to work. Lots of mistakes here. They should have settled the case before all the laundry got aired in the court room. Why would Mt Sinai even want to fight the punitive charges when their attending did not show up for work and there was no back-up system in place. Seems like negligence and recklessness to me...

1) Where is the attending? Nurses, Residents, PAs dont notice the attending did not show up to work to call him ?

2) Doesnt the attending on Friday have to give sign-out to the attending on Saturday? Shouldnt this have served as a double-check for the attending on Saturday to know he was on-call?

3) The other attending on call who was seeing the other half the patients did not notice his colleague did not show up to work and half the patients were not being seen?

4) Why did a STAT Chest Xray take 12 hours to get done, and was never read, and no one sought after the results?

5) Why did no one exam the patient? A rehab and ENT resident both saw the patient and never looked in his mouth when he's complaining of difficulty swallowing?

6) An ENT consult took one day? You have to be kidding that there is no ENT attending available to call on weekends?

7) Why was the resident on Friday working from 7am-9am the next day without being relieved. Working more than 24 hours in a row and having a primary role in patient care is a violation. Someone else has to come at the 24-hour point. I heard several residents have left Mt Sinai's program... are they short?

8) Patient is febrile and tachycardic and no progress notes in the chart?

looks like the deposition depended on resident testimony since there were no attendings to claim responsibility for this, and thus the residents were named in the lawsuit.

 

[Ludicolo]

This case was settled (undisclosed amount) before jury selection.

http://www.jdsupra.com/post/documentViewer.aspx?fid=8c957861-4d7a-49e6-8cb0-9e8702f0c0e9

Let the M&M conference begin.

 

[topwise]

Wow, that was scary. It sounds like rehab did a lot of things wrong, but ultimately, it does sound like ENT was responsible. They saw the patient and made an incorrect assessment, and the patient didn't get staffed with an ENT attending. Obviously, a rehab attending should have seen the patient that weekend, but would it have changed the outcome? Likely no.

 

[PMR 4 MSK]

Just as scary is that when I started my first private attending job doing inpt rehab, I only saw the pts 3x/week - MWF.

I also consulted on a pt in the acute care setting where a pt went a whole weekend without his FP or any other doctor seeing him. The FP said he was off that weekend and could not get anyone to cover him.

Let all of us learn from this case.

 

[RUOkie]

Just as scary is that when I started my first private attending job doing inpt rehab, I only saw the pts 3x/week - MWF.

I also consulted on a pt in the acute care setting where a pt went a whole weekend without his FP or any other doctor seeing him. The FP said he was off that weekend and could not get anyone to cover him.

Let all of us learn from this case.

But would you have done that on an acute SCI pt? This guy just got there, after being transferred from 2000miles away by surgeons they don't know. Those are the people you watch closely, or you don't accept them!

I agree, We all need to learn from this. If you are the doc on a rehab unit, and someone is sick, go see them! NO MATTER WHAT! If another doc comes in as well (ie a surgeon or PCP), so much the better, you look good. If no one comes in, you are all screwed and the patient suffers.

 

[jjwallace]

looks like this wasnt the only scary death for Mount Sinai on a weekend.
What is going on at Mount Sinai Rehab?

http://abclocal.go.com/wabc/story?section=news/investigators&id=6215788



No amount of money will ever bring back this patient for his family, but was is most appalling is that the hospital did not recognize their gross negligence and would actually fight this thing in New York Supreme Court and not try to settle it out of court.

Can anyone play the video? I couldnt get it to play.

 

[SSdoc33]

But would you have done that on an acute SCI pt? This guy just got there, after being transferred from 2000miles away by surgeons they don't know. Those are the people you watch closely, or you don't accept them!

I agree, We all need to learn from this. If you are the doc on a rehab unit, and someone is sick, go see them! NO MATTER WHAT! If another doc comes in as well (ie a surgeon or PCP), so much the better, you look good. If no one comes in, you are all screwed and the patient suffers.

the bottom line is that the judgement went to the plaintiff because the attending didnt show up. thats pretty much the only reason. how often do we see SCI patients with secretions, some SOB, fever, elevated HR? all the time. looks like his hardware eroded into his esophagus and hit a big artery. the hemoptysis was sudden, it wasnt occuring before this apparent lack of care. even if they had a closer eye on he guy, he still would have probably popped the artery.

 

[topwise]

Makes you wonder how many times the attending didn't show up when there *wasn't* a death or morbidity.... almost sounds like this is something that happens all the time, but this time they got caught...

 

[Paddington]

Also seems to me like this guy was brought in awfully soon.

Inpatient rehab. seems to have devolved into a contest to see who can bring in the sickest patients, the fastest. Last month, I was on a rotation where they routinely brought in people from the Neuro ICU with still actively evolving strokes with blood pressures in excess of 200/120. It was ridiculous. Listen, I can read the transfer sheet and put in orders for "check blood pressure every X and then administer IV Labetalol every Y", but on a rehab unit, it doesn't happen.

Also from what I've seen compared to my time doing IM rotations, consultants seem to regard any issues that come up on rehab. wards as a joke. If someone's having a heart attack on a Med-Surg unit then its a matter of priority, but the same patient, same history, same symptoms, same diagnostics, etc. on a rehab. ward means I'll check it out tomorrow, or something.

 

[lobelsteve]

Also seems to me like this guy was brought in awfully soon.

Inpatient rehab. seems to have devolved into a contest to see who can bring in the sickest patients, the fastest. Last month, I was on a rotation where they routinely brought in people from the Neuro ICU with still actively evolving strokes with blood pressures in excess of 200/120. It was ridiculous. Listen, I can read the transfer sheet and put in orders for "check blood pressure every X and then administer IV Labetalol every Y", but on a rehab unit, it doesn't happen.

Also from what I've seen compared to my time doing IM rotations, consultants seem to regard any issues that come up on rehab. wards as a joke. If someone's having a heart attack on a Med-Surg unit then its a matter of priority, but the same patient, same history, same symptoms, same diagnostics, etc. on a rehab. ward means I'll check it out tomorrow, or something.

It is very true. I think it is the perception that PMR docs are idiots and pussycats. Pushovers. Bumblefx. And for letting this kind of stuff happen, they are.

 

[E Dubble]

Also seems to me like this guy was brought in awfully soon.

Inpatient rehab. seems to have devolved into a contest to see who can bring in the sickest patients, the fastest. Last month, I was on a rotation where they routinely brought in people from the Neuro ICU with still actively evolving strokes with blood pressures in excess of 200/120. It was ridiculous. Listen, I can read the transfer sheet and put in orders for "check blood pressure every X and then administer IV Labetalol every Y", but on a rehab unit, it doesn't happen.

Also from what I've seen compared to my time doing IM rotations, consultants seem to regard any issues that come up on rehab. wards as a joke. If someone's having a heart attack on a Med-Surg unit then its a matter of priority, but the same patient, same history, same symptoms, same diagnostics, etc. on a rehab. ward means I'll check it out tomorrow, or something.

Very true. With some inpatient rotations I found myself managing medical issues rather than focusing on rehab issues. It does seem that the inpatients on rehab units are getting sicker and sicker. Its getting hard to tell who is an inappropriate patient nowadays. Luckily I wasn't in a freestanding rehab hospital and had easy access to consultants.

 

[paindefender]

It is very true. I think it is the perception that PMR docs are idiots and pussycats. Pushovers. Bumblefx. And for letting this kind of stuff happen, they are.

reality check

 

[PMR 4 MSK]

reality check

Aww crap, somebody baited the troll.

That's right, you got us. We all failed out of medical school and couldn't get into chiropractic, so we chose to go into PM&R. We all have IQs of 16 and unibrows.

Hmm, me admit rehab. No, patient sick, me no help. Patient need real doctor. Patient see pain defender. He good doctor. Fix patient good. Hmm.

I, on behalf of all physiatrists, apologize for the physiatrist who had sex with your mother, ruined her chances of getting married and started you down this path of hatred. I hope you can begin the healing process now.

 

[lobelsteve]

Aww crap, somebody baited the troll.

That's right, you got us. We all failed out of medical school and couldn't get into chiropractic, so we chose to go into PM&R. We all have IQs of 16 and unibrows.

Hmm, me admit rehab. No, patient sick, me no help. Patient need real doctor. Patient see pain defender. He good doctor. Fix patient good. Hmm.

I, on behalf of all physiatrists, apologize for the physiatrist who had sex with your mother, ruined her chances of getting married and started you down this path of hatred. I hope you can begin the healing process now.

I was that guy!

Luke, I am your father (but more like Farley in Tommy Boy than Darth Vader).

 

[ml2001]

I, on behalf of all physiatrists, apologize for the physiatrist who had sex with your mother, ruined her chances of getting married and started you down this path of hatred. I hope you can begin the healing process now.

Seems like the posting about reality check posting made PMR4MSK furious. I have been a silent reader of this forum for the longest time and have never read a post by PMR4MSK that is this hot. By the way, I myself am a PGY2 in PM&R and totally disagree with PainDefender.....

-ML

 

[paindefender]

Seems like the posting about reality check posting made PMR4MSK furious. I have been a silent reader of this forum for the longest time and have never read a post by PMR4MSK that is this hot. By the way, I myself am a PGY2 in PM&R and totally disagree with PainDefender.....

-ML

The truth is painful.

 

[ml2001]

The truth is painful.

Do you mind elaborating on what the truth is? I know you are jealous of us, Physiatrists, for making a wise choice in picking the field, but it is totally OK. I'm sure you will happiness in the field that you picked. No bad feelings....

-ML

 

[PMR 4 MSK]

Seems like the posting about reality check posting made PMR4MSK furious. I have been a silent reader of this forum for the longest time and have never read a post by PMR4MSK that is this hot. By the way, I myself am a PGY2 in PM&R and totally disagree with PainDefender.....

-ML

Not furious, sarcastically amused. This idiot only logs on to peruse the PM&R forums until he finds a post that enables him to take a potshot at PM&R. No one besides himself can imagine why he spends so much mental time and effort directing anger at a field that has no impact on him. So I just fill in the blanks for the rest of us.

The truth is painful.

Yeah, him right, we dumb. Where me club? Go hunt brontosaur now.

Do you mind elaborating on what the truth is? I know you are jealous of us, Physiatrists, for making a wise choice in picking the field, but it is totally OK. I'm sure you will happiness in the field that you picked. No bad feelings....

-ML

Only people very unhappy with their lives would spend this much time directing anger at a whole group of people they don't even know.

 

[Disciple]

Only people very unhappy with their lives would spend this much time directing anger at a whole group of people they don't even know.

I'm tellin' you.
He/she is a Physiatrist, or former Physiatrist.

It's some weird self-loathing thing.

 

[WaterAvatar]

Since this occurred, Mount Sinai has made changes to call-coverage that have made more manageable for the residents. Residents used to cover 100 beds oncall and now cover approx 50 which is much better.

It's a shame that this happened (and my heart goes out to the family), but Mount Sinai still remains one of the top rehab probrams in the country.

I agree to what someone had said earlier.. patients that come to rehab are just more and more sicker nowadays

 

[SSdoc33]

It's a shame that this happened (and my heart goes out to the family), but Mount Sinai still remains one of the top rehab probrams in the country.

dont know what you have invested in this program, but this is not true. has nothing to do with what happened, that could have happened anywhere.

 

[WaterAvatar]

I am confused by your reply, SSdoc3. I was mainly giving my condolences and reassuring our readers that Mount Sinai is still a top notch program.

 

[SSdoc33]

I am confused by your reply, SSdoc3. I was mainly giving my condolences and reassuring our readers that Mount Sinai is still a top notch program.

yeah, its not. dont think it ever really was

 

[MSKmonky]

Not sure what standards you have for a top program, but Mount Sinai has both a model TBI and SCI program, a growing MSK curriculum, elective time which can even be used abroad, a new Rehab research facility that will be done in about 2-3 years, notable faculty members that have been in the PMR game for quite some time, as well as new faculty that are breathing new life into certain aspects of the program. I'd say it's pretty good! Although I am biased I have to admit.

 

[SSdoc33]

ugh, ok, look. im sure everyone wants to protect their little binky. sorry if i ruffled some feathers, but by just about any standard, it is not a "top tier program". doesnt mean you cant get good training, doesnt mean you cant be a great physiatrist if you train there.

 

[fizzziatrist]

Wow, this is disturbing. How did an entire weekend go by and nobody notified any attending physician...

Although I am not surprised. When I was rotating at Mt Sinai they had some huge scandal at one of their hospitals. They were doing unauthorized epidural steroid injections in the neck without flouroscopy and residents were pressured to consent the patients as trigger point injections. They were also pressuring residents to overbill procedures. All the residents had some meeting with the chairman to tell him. They didnt let us med students in, but I overheard the residents talking about it and writing anonymous reports about what was going on.

Hope the family got a lot of $.

 

[MSKmonky]

That had to have been a while ago. I'm a current resident and have not heard anything like that. There was one doc who was booted out from a VA hospital and it could have been him. I heard he was not liked. Since then they've hired two more pain specialists who are excellent.

 

[fizzziatrist]

I rotated there just this passed academic year. All residents (unless you just started) were meeting with the chairman Dr Raggnarson to tell him about it.

 

[fizzziatrist]

I rotated there just this passed academic year. All residents (unless you just started) were meeting with the chairman Dr Raggnarson to tell him about it.

 

[MSKmonky]

In that case it was probably that VA doctor who was booted out.

 

[rehabdocmd]

yes the link and video work. Looks like they re-aired the episode today because of the recent NY supreme court decision

http://abclocal.go.com/wabc/story?section=news/investigators&id=6215788

Can anyone play the video? I couldnt get it to play.

 

[rysa4]

Aww crap, somebody baited the troll.

That's right, you got us. We all failed out of medical school and couldn't get into chiropractic, so we chose to go into PM&R. We all have IQs of 16 and unibrows.

Hmm, me admit rehab. No, patient sick, me no help. Patient need real doctor. Patient see pain defender. He good doctor. Fix patient good. Hmm.

I, on behalf of all physiatrists, apologize for the physiatrist who had sex with your mother, ruined her chances of getting married and started you down this path of hatred. I hope you can begin the healing process now.

Loved this.

 

[rysa4]

yes the link and video work. Looks like they re-aired the episode today because of the recent NY supreme court decision

http://abclocal.go.com/wabc/story?section=news/investigators&id=6215788

Thanks for the link. I interviewed at Mt Sinai and with Dr. Ragnarrson( yes I am probably misspelling his name) as well. He was pretty cool actually.

Mt. Sinai for rehab overall was a bit scary. The issue pointed out in the article link is exactly correct, Mt.Sinai simply doesnt have the support personnel in place to provide conistent attentive quality care. The residents are fine, and most likely the attendings are overall more than decent and well trained. But in rehab, without quality support staff and lot of resources--its not a happy.

My top choices for residency programs were all programs that had enough money and resources available to them to provide a full learning experience and quality care. Mt Sinai was just not in that group, inpt or outpt. Nursing care and everything else- it all has to be there and its expensive!

I remember a female rehab resident at Mt Sinai asking me a key question during my interview day there --she said " You haven't asked the most important question - do you have enough time to get laid." So I asked her..... hilarious.

 

[oreosandsake]

Most likely, it hinged on no attending showing up. If the attending had showed up, it might not have made a difference in outcome, but to a judge or jury, it would mean everything in terms of reparations.

It does not appear that this case has been settled yet.

Also, be careful about comments on this case. The lawyers will likely be watching...

MS here, trying to wrap my brains around this, so please forgive my lack of understanding.

what would have happened if the attending showed up, didn't catch it, wrote a note saying that the patient was doing fine and left for the weekend but the pt still had same outcome?

does it just mean that they are not as "recklessly negligent?" but would still be at fault?

I'm a little confused as to who was found at fault for this in the end. Is it the attending and the resident only, or the entire hospital "mt sinai"
why not ENT?

thanks for helping to explain this to me

edit: and if you happen to have any "teaching points" re this case I would appreciate them

 

[PMR 4 MSK]

MS here, trying to wrap my brains around this, so please forgive my lack of understanding.

what would have happened if the attending showed up, didn't catch it, wrote a note saying that the patient was doing fine and left for the weekend but the pt still had same outcome?

does it just mean that they are not as "recklessly negligent?" but would still be at fault?

I'm a little confused as to who was found at fault for this in the end. Is it the attending and the resident only, or the entire hospital "mt sinai"
why not ENT?

thanks for helping to explain this to me

edit: and if you happen to have any "teaching points" re this case I would appreciate them

My thoughts on it:

If the attending had showed up, it goes a long way toward reducing the appearance of negligence. In a family member or jury member's mind, the lack of showing up is essentially gross negligence.

This was a zebra. You only spot zebras when you think of them. I would not necessarily fault a resident for missing this. An inpt PM&R attending and an ENT should not have missed this.

The resident on call should not have gone it alone and should have called the other attending who was on.

Whether or not the attending had shown up, or they or the ENT had picked up on the problem might not have affected the outcome of the patient's death, but likely would have affected the outcome of the lawsuit. People sue not just for bad outcomes, but for bad outcomes when they think things were not done like they should have been done.

We suffer in rehab from the thought that people are not sick enough to die on rehab. They are "stable." That is usually the case and/or we get them off the rehab floor before they die. But people do die on rehab. The patients you guys are seeing on rehab are much sicker than the folk I saw a few hundred years ago. You have to think more as an acute physician than a chronic one.

Weekends are a very dangerous time to be in a hospital, for both patients and staff.

 

[Ludicolo]

MS here, trying to wrap my brains around this, so please forgive my lack of understanding.

what would have happened if the attending showed up, didn't catch it, wrote a note saying that the patient was doing fine and left for the weekend but the pt still had same outcome?

does it just mean that they are not as "recklessly negligent?" but would still be at fault?

I'm a little confused as to who was found at fault for this in the end. Is it the attending and the resident only, or the entire hospital "mt sinai"
why not ENT?

thanks for helping to explain this to me

edit: and if you happen to have any "teaching points" re this case I would appreciate them

I’m not a lawyer, but my $0.02:

The “gross negligence” here is that the on-call attending didn’t show up and that the resident was essentially practicing unsupervised. If an attending was present and examined the patient but didn’t recognize the findings, he could still be considered negligent, but in this “zebra” case “gross negligence” may be difficult to prove.

However the “reckless indifference” aspect of the case was based on the following: 1) the on-call attending didn’t know he was supposed to be there, 2) the other on-call attending wasn’t made aware that his partner didn’t show up, 3) there was no established back up plan in place for a missing attending, and 4) despite the resident and nurses being aware of the lack of attending coverage – nobody was notified and nothing was done to remedy the situation. From this legal standpoint, the system (Mt. Sinai) is to blame.

Important to note: the missing on-call attending was NOT named in the lawsuit. The suit was brought against Mt. Sinai, the Friday admitting attending (i.e. the last attending note in the chart), and the resident.

 

[fizzziatrist]

Same experience here. Especially $ and lack of support problems. When did you rotate there? I am not ranking them.

Reading this, and their scandal for consenting patients for trigger point injections while they were actually doing unauthorized epidural injections was enough to say thanks but no thanks.

I don't want a lawsuit on my record as a resident. I didn't even know residents could be sued? The resident is directly named in the lawsuit. Why isn't just the attending being named? There were three attendings involved: the last one who saw the patient on Fri, the one who didn't show up on the weekend, and the one who did show up on the weekend, but didn't notice the other patients were not being seen.
Is being sued in malpractice cases as a resident a common occurrence? Does this go on a residents' record?

Mt. Sinai for rehab overall was a bit scary. The issue pointed out in the article link is exactly correct, Mt.Sinai simply doesnt have the support personnel in place to provide conistent attentive quality care. The residents are fine, and most likely the attendings are overall more than decent and well trained. But in rehab, without quality support staff and lot of resources--its not a happy.

My top choices for residency programs were all programs that had enough money and resources available to them to provide a full learning experience and quality care. Mt Sinai was just not in that group, inpt or outpt. Nursing care and everything else- it all has to be there and its expensive!

 

[ampaphb]

Follow the money. Residents are rarely named because it is presumed they have no money. Generally, when residents are named, it's so that they can be deposed, provide useful information, and then be dropped from the suit.

In this case, the real target of the lawsuit is the hospital system, because they have the deepest pockets. Dr. Bryce, the attending who didnt show, may or may not be employed by the hospital. Dr. Stein was not only the last attending to see Mr. Deane, he was also the residency program director. Thus suing hospital employees establishes a connection to the hospital. Even though Dr. Nutini wasn't who the plaintiffs were going after, sometimes innocent bystanders do get hit by stray bullets.

The National Practitioner Data Bank and The Healthcare Integrity and Protection Data Bank only require that adverse actions (settlements and malpractice judgments) be reported. On the other hand, the resident in this case will now have to read questions like "have you ever been named in a malpractice suit" very carefully, and when the question fits her fact pattern, she will have to answer in the affirmative.

 

[Sanchik]

I believe the resident is partly at fault for knowing that she/he had a sick patient and not following up on him for 24h. for not following up on the cxr. i am sure he/she was overwhelmed with so many patients but it looks badly.

 

[rysa4]

Same experience here. Especially $ and lack of support problems. When did you rotate there? I am not ranking them.

Reading this, and their scandal for consenting patients for trigger point injections while they were actually doing unauthorized epidural injections was enough to say thanks but no thanks.

I don't want a lawsuit on my record as a resident. I didn't even know residents could be sued? The resident is directly named in the lawsuit. Why isn't just the attending being named? There were three attendings involved: the last one who saw the patient on Fri, the one who didn't show up on the weekend, and the one who did show up on the weekend, but didn't notice the other patients were not being seen.
Is being sued in malpractice cases as a resident a common occurrence? Does this go on a residents' record?

My experience at Mt. Sinai was solely confined to the interview process and it was in the 1990s. However, I do not believe the monetary situation as it affects staffing and support has gotten better since then. In fact, I think it is worse. That being said, I hold Dr. Ragnarrson in high regard. He's one of the good guys in my book. But chairs don't always have enough influence in resource-strapped situations to make everything right, particularly on issues that fall under other flags, such as nursing and support staffing issues that are institution-wide.

 

[SpideRehabMan]

Medical Malpractice Terminology: What Are Punitive Damages?

Punitive damages in a medical malpractice lawsuit are rare.

In New York State, punitive damages are not covered by malpractice insurance, because this would defeat the purpose of it being punitive. Therefore, these damages would come directly out of Mt Sinai's own department funding and support.

Punitive damages are awarded in addition to actual damages when the defendant acted with recklessness, malice, or deceit.

In this case, the judge agreed, quite strongly, that Mount Sinai Department of Rehabilitation was found to be guilty of recklessness, malice, and/or deceit.

See below link to see how this case directly relates to punitive damages:

http://www.newyorkinjurycasesblog.com/tags/punitive-damages/

" It angered the judge that Mr. Deane was, as she described it, effectively abandoned
for over two days prior to his death and that no one ever even tried to tell hospital
administration that the on call attending was missing. This appeared to constitute gross
negligence, recklessness and gross indifference to patient care as did the hospital's lack of a
system in place that would alert an administrator when an on call attending failed to arrive.
Although this was merely a pre-trial decision on a motion to have the punitive damage
claim dismissed, the judge's strong language all but held as a matter of law that the
hospital was reckless."

 

[rehabdocmd]

Reading this, and their scandal for consenting patients for trigger point injections while they were actually doing unauthorized epidural injections was enough to say thanks but no thanks.

Sorry, but I don't quite understand what you are saying? Can you please elaborate. Isn't this very illegal?

 

[MSKmonky]

Once again. there was a doc that was improperly billing for the above procedures. But as I said before, as soon as Dr. Ragnarsson got wind of it, the doctor was booted out and replaced with two excellent pain docs fresh out of fellowship

 

[fizzziatrist]

That would explain why residents there said they had to pay out of their pocket to present their research at meetings and conferences. It was definitely a red flag for money and lack of support problems. The million dollar punitive payouts from the dept to families I guess could explain the $ problems at a place like MT Sinai... Although a poster above mentioned it's been a problem since the 90s.

Medical Malpractice Terminology: What Are Punitive Damages?

Punitive damages in a medical malpractice lawsuit are rare.

In New York State, punitive damages are not covered by malpractice insurance, because this would defeat the purpose of it being punitive. Therefore, these damages would come directly out of Mt Sinai's own department funding and support.

Punitive damages are awarded in addition to actual damages when the defendant acted with recklessness, malice, or deceit.

In this case, the judge agreed, quite strongly, that Mount Sinai Department of Rehabilitation was found to be guilty of recklessness, malice, and/or deceit.

See below link to see how this case directly relates to punitive damages:

[B] " It angered the judge...B] hospital was reckless."[/B][/QUOTE]

 

[fizzziatrist]

From what I remember last year they were consenting patients for trigger point injections but actually doing epidural injections in their necks. It was unauthorized not to mention unsafe because they didn't have a flouroscopy machine. Residents were pressured to participate. They were also overbilling and not supervising residents. It was at one of their off site rotations. Another poster said this is being corrected (thank goodness!)

I am not surprised though. I did a week of their consult rotation at Elmherst and their resident was seeing like 15 consults a day. We would go over them with the attending and the attending would sign the consults and never come see a single one of those patients with us, to check their residents' work or to even teach at bedside.
As a student I've done an oncology and psychiatry consult rotation and never experienced a consult rotation like that.

I didn't end up ranking them because I already have a safe number on my rank list (10) which I think should be enough?

Sorry, but I don't quite understand what you are saying? Can you please elaborate. Isn't this very illegal?

 

[MSKmonky]

"That would explain why residents there said they had to pay out of their pocket to present their research at meetings and conferences. "

So this I have also found to be incorrect. Those residents that are presenting at conferences are funded. Those that just want to go for the experience may have to pay out of their own pocket. They try their best to fund seniors to go however. In fact there was more than one resident who was funded all three years of her residency for conferences. I cannot stress enough that most of the allegations on this thread have been corrected or are in the process of it.

You need to take comments on Student Doctor with a grain of salt. There was an incident recently with a scornful resident who left the program (and quite possibly ended her medical career) who had been making many false accusations. At any rate, rank Mount Sinai or not.. it's up to you.

As for the Consult Service at Elmhurst. It is quite busy and though you do go over cases with the attendings, they may not see them with you. They will see those patients who are deemed good candidates for the inpatient Rehab floor however. Elmhurst in general is an amazing rotation. We often call it the "brain trust" with great mentors like Dr. Weissman and Dr. Bressler.

So naturally I will defend my program. If you want an constructive review of the program thus far, just private message me.

 

[RUOkie]

As for the Consult Service at Elmhurst. It is quite busy and though you do go over cases with the attendings, they may not see them with you. They will see those patients who are deemed good candidates for the inpatient Rehab floor however. Elmhurst in general is an amazing rotation. We often call it the "brain trust" with great mentors like Dr. Weissman and Dr. Bressler.
.

The question is: Are the attendings billing for the service? If yes, they are committing fraud. Now, if they are seeing the patients without the resident around, then the resident is missing out on teaching opportunities. A consult service is NOT about bringing patients to rehab!! We are physicians, not case managers!

When I was a resident at BCM, as the consult resident at Ben Taub, we could see up to 15 new consults a day if the knife/gun club was busy that day. Even back in the dark ages (before the Medicare changes for billing), we went over every consult with our staff AT THE BEDSIDE! It made for some long days, but that is what residency is all about. We did work solo at the VA (with little to no supervision), but the staff did not bill for the service.

We are at a place now, where every single minute on a rotation should be a teaching opportunity. If you are doing scut work for your attendings, you are not getting the best education you can. If there is a "consult service", where the entire job is determining appropriateness for rehab, then your time would be better served either on the rehab floor, or in a clinic somewhere learning what it is really like to be a physiatrist.