Medical Malpractice in Delayed Diagnosis of Breast Cancer

Introduction

Medical malpractice occurs when a doctor, a health care center, or a healthcare professional through omission or negligent act causes patient injury. Negligent acts results from errors of treatment, diagnosis, and health or aftercare management. For a claim to be considered as a medical malpractice, it has to meet three characteristics. The first characteristic is that the claim must show a violation of care where it proves that a standard of care is not met. The second characteristic is that the claim should prove that injury caused was as a result of negligence. Thirdly, a claim must prove that the resulting injury cause significant damages (Chun & Bafford, 2014). As a result, this paper focuses on the evolution of delayed breast cancer medical malpractice, analyses and explains how medical agencies are monitoring the situation, and compares the current and 1800s efforts on meeting quality of healthcare.

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Historical Review of Quality of Care.

Describe how current attempts at quality compare to efforts on quality in the 1800s

The quality improvement infrastructure in healthcare that people enjoy today is an s a result of cumulative efforts brought about by experiences of over a century. The efforts started by the acknowledgement of the role of quality healthcare and slowly grew to comprise prioritization of quality improvement and development of systems that quantify, incentivize, and monitor quality improvement (Chun & Bafford, 2014). The concept of evidenced-based quality improvement existed in early 1850 when Florence Nightingale discovered that basic hygiene and sanitation standards reduced mortality when caring for wounded soldiers during war (Reisch et al., 2015). Also, Ernest Amory Codman argued that understanding why treatments were not successful formed the foundation of improvements when caring for patients. The wake of 21st century gave birth to numerous initiatives that target improvement of healthcare quality in large scale. As a result, it is evident that during 1800s, quality of healthcare was poor because of lack of sufficient research and evidence based-practice that is present today.

Analyze why regulatory agencies began monitoring quality in health care

Increasing health concerns lead to the birth of regulatory agencies which came in to place to monitor quality of care and set up minimum standards to ensure quality of healthcare services. Regulatory agency came into existence to protect the public from various health risks and provide numerous welfare and public health programs (Reisch et al., 2015). The agencies protect and regulate public health at all levels. Through the agencies, healthcare standards and regulations were necessary to ensure compliance and provide safe healthcare to patients and other stakeholders in the healthcare system(Chun & Bafford, 2014). 

Describe the history of medical malpractice, when it peaked, why it peaked, and what has been done to address medical malpractice

Breast cancer is the second most common cause of death among women after lung cancer and is the most common cause of death of women aged between 45 and 55 years. In America, about 205,000 women are diagnosed with breast cancer and 40, 000 die of the disease annually. In some cases, deaths are as a result of missed diagnosis or delayed diagnosis. Also, 10,000 out of 180,000 American women diagnosed with breast cancer annually are victims of misdiagnosis (Reisch et al., 2015). Failure to interpret a mammograph properly, disregarding palpable and persistent breast lump, failure to refer patients with abnormal physical conditions to specialists and inaccurate and inadequate sampling of breast cytology are among the major factors that caused misdiagnosis of breast cancer. As a result, advances in mammography have led to detection of breast cancer in its earlier stages and improved chances of survival among women. Consequently, 26% reduction of breast cancer mortality has been realized. Moreover, The American Cancer Society recommend annual mammograph screening of women aged 40 years and older. 

The practice of defensive medicine Discuss initiatives taken by health care organizations to reduce and/or mitigate risks 

The fear of facing lawsuits is common among physicians practicing in high-risk areas such as neurosurgery, obstetrics, and emergency medicine. As a result, the physicians resort to practicing defensive medicine to avoid litigation. As a result, the Center for American Progress recommended a “safer harbor in 2013 for medical practitioners who adhere to the evidence based clinical guidelines (Reisch et al., 2015). Also, the American Society for Clinical Pathology was among 70 national organizations which produced lists of common procedures and tests that mitigate the misuse or overuse of procedures that provide little or no impact to patients.  

Development of Health Regulation and Regulatory Agencies

Hospitals, physicians and other healthcare providers are regulated by state, federal, national, public, and non-governmental regulatory agencies. License boards accredit nurses, physicians and other health professionals in every state that they practice in across various professions (McRae et al., 2017). State licensing boards issue licenses to healthcare practitioners with qualified educational background, renew licenses and enforce basic practice standards through their power to revoke or suspend licenses to practice (Vogenber & Smart, 2018). For instance, in the United States, FDA regulates pharmaceuticals and today it has evolved from legislation that results from responses to epidemics of public health that are associated with unsafe drugs and foods (McRae et al., 2017). Today, the FDA approves new biological products and drugs that comprises of animal testing and testing of humans in four phases. Three of four phases are completed before releasing the drug into the market and one continues when the drug is already released in the market. 

The clinical trial stage takes a couple of years and costs sponsor like the manufacturers a lot of resources. Just like European Medicines Agencies, FDA does not focus on the economic analysis of the drug but ensures that the drug is effective and not cost-effective for approval by FDA (Council of Economic Advisers, 2018). Moreover, FDA regulates advertising of pharmaceuticals that they consider misleading or excessive. Drug companies began advertising their products directly to consumers. In the 1990s. New Zealand and the United States were among the high-income nations that permitted direct-to-customer advertisements of prescribed drugs only (McRae et al., 2017). In the United States, there were no laws restricting drug companies from a direct advertisement of prescription drugs to consumers, however, the FDA could prosecute a manufacturer for an advertisement fooling or misleading the public. As a result, major pharmaceutical companies in the United States have paid off-label marketing and related fines of more than $7 billion (McRae et al., 2017). Following the regulations, drugs manufactured meet the set standards. 

Explain what is meant by “deemed status.” 

“Deemed status” is a status that is conferred to organization by professional standard review organization in a formal recognition that continued stay review, organizations review, and programs of medical evaluations meet stipulated effectiveness criteria (ASHE”, 2019). For instance, a healthcare organization with a “deemed status” is not subjected to certification process or medical survey because an accredited organization has already surveyed it. 

Briefly describe the purpose and goals of the Agency for Healthcare Research and Quality (AHRQ)

The mission of AHRQ is to produce evidence to ensure that healthcare is of high quality, safer, affordable, equitable, and more accessible and works with the U.S. Department of Health and Human Services among other partners to ensure that evidence is understood and used. Therefore, AHRQ help health practitioners to improve quality, keeps patients safe, and develops data to track healthcare system changes. 

Briefly describe the purpose and goals of The Joint Commission

The Joint commission was put in place with an aim of collaborating with other stakeholders in improving healthcare of the general public by evaluating the healthcare organizations and ensuring that they excel in provision of effective and safe care. The commission achieved this through public policy initiatives, patient safety, accreditation and certification, information dissemination, and performance measurement. Also, the Joint Commission ensures that the service provided are of high value, safety and quality across all settings. Hence, the joint commission is a listener, a collaborator, and a convener in healthcare.

Explain how organizations like the AHRQ, The Joint Commission, and other regulatory agencies have impacted quality of care

AHRQ, The Joint Commission, and other regulatory agencies have played a critical role in the improvement of quality of care. The agencies have come up with evidence-based measures and standards which are being used to benchmark healthcare quality. Also, the agencies have ensured that performance measurement linkages are tied to accreditation and quality improves to enhance patient care delivery (AHRQ, 2019). Moreover, the agencies ensure that patient safety is a priority and encourages leadership engagement, transparency at all levels, “back to basics education” and system redesign competency. Also, the agencies foster culture change through investment in staff recruitment and retention and engaging patients in problem solving and reporting.

Improving Quality of Care by Understanding History

According to Ernest Amory Codman, the understanding of treatments was not successful formed the foundation of improvements when caring for patients. Through continuous research, new solutions and treatments are developed with the help of evidence based practices (Reisch et al., 2015).  Through history, it is easier to understand treat a disease because there exists a record of interventions used to treat disease and its recurrence cannot cause serious impact as before.

Conclusion

Delayed diagnosis of breast cancer is one of the major medical malpractices that has led to filing of many suits in the American law-courts. In the United States, the leading cases on malpractice suits are based on delayed diagnosis of breast cancer. As a result, regulatory agencies have come in place and set up minimum requirements to ensure that patients care is of quality, affordable, and all inclusive. Through agencies like AHRQ and the Joint Commission, the quality of healthcare has drastically improved. 

Reference

2018-2020 Senate and Joint Committees. (2019). Retrieved 4 September 2019, from https://www.flsenate.gov/Committees

About AHRQ | Agency for Healthcare Research & Quality. (2019). Retrieved 4 September 2019, from https://www.ahrq.gov/cpi/about/index.html

Chun, J., & Bafford, A. C. (2014). History and background of quality measurement. Clinics in colon and rectal surgery27(1), 5–9. doi:10.1055/s-0034-1366912

Council of Economic Advisers (U.S.),. (2018). The administration’s FDA reforms and reduced biopharmaceutical drug prices.

Deemed Status | ASHE. (2019). Retrieved 4 September 2019, from http://www.ashe.org/advocacy/orgs/deemedstatus.shtml

McRae, A. D., Innes, G., Graham, M., Lang, E., Andruchow, J. E., Ji, Y., Vatanpour, S., … Hiestand, B. C. (2017). Undetectable Concentrations of a Food and Drug Administration-approved High-sensitivity Cardiac Troponin T Assay to Rule Out Acute Myocardial Infarction at Emergency Department Arrival. (Academic emergency medicine.)

Reisch, L. M., Oster, N. V., Frederick, P. D., Elmore, J. G., Carney, P. A., Weaver, D. L., & Nelson, H. D. (December 01, 2015). Medical malpractice concerns and defensive medicine: A nationwide survey of breast pathologists. American Journal of Clinical Pathology, 144, 6, 916-922.Vogenberg, F. R., & Smart, M. (2018). Regulatory Change Versus Legislation Impacting Health Care Decisions and Delivery. P & T : a peer-reviewed journal for formulary management43(1), 34–38.

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