Erroneous Death Certificates: The True Epidemic Exposed …..Direct From The Disgusted Doctors

There is a blogger here in our WordPress family that I have great admiration and respect for. You see, she is a Mom whose adult son died under very suspicious circumstances. She firmly believes her son was murdered and is looking for justice to be done in his name. But the medical examiner did not rule his death  a possible homicide or even suspicious. The police report states UNATTENDED DEATH, and six sentences of explanation.  The case was closed in 1.5 hours.  No investigation into cause of death.

She reports, “It has been five years and still the local coroner refuses to release all of the autopsy report or allow an investigation into the strange circumstances surrounding his death – or the poison that was in his blood.It has taken all these years to discover that NO ONE oversees the coroner, they are not required to have a medical degree (only high school diploma or equivalent) and do not have to account for their findings to anyone.

It is because of her courageous, exhausting, and unrelenting fight to find answers into the death of her beloved son that I paid very close attention to the article below posted on the exclusive website Medscape. Shirley, this one is for you. Yet, it really concerns us all.

 

Cause of Death: 50% of Medical Residents Fib

by Diedtra Henderson

Some 48.6% to 58.4% of residents from more than half of the residency programs in New York City have knowingly entered the incorrect cause of death on death certificates — errors that have implications for epidemiology, public health research, and disease surveillance — according to result from a recent study.

Barbara A. Wexelman, MD, MBA, from St. Luke’s–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York City, and coauthors report their findings in an article published in the May 9 issue of Preventing Chronic Disease, published by the Centers for Disease Control and Prevention.

As fewer autopsies are performed, Dr. Wexelman and coauthors note, death certificates have become even more important sources of information about how Americans die. Public health researchers rely on death certificates to gauge the leading causes of death and to identify disease outbreaks, and the certificates also influence funding policies and research priorities.

In most teaching hospitals, it falls to resident physicians to complete the forms. To examine their experiences and opinions, the researchers conducted an anonymous, Internet-based, 32-question survey of New York City’s 70 internal medicine, emergency medicine, and general surgery residency programs in May and June 2010. Some 521 residents from 38 residency programs responded to the survey; 178 of the residents were termed “high-volume” respondents, meaning they had completed 11 or more death certificates in the previous 3 years.

Forced to Do It

“Almost half of all respondents (48.6%) and 58.4% of high-volume respondents reported they had identified a cause of death on a death certificate that did not represent the true cause of death. More than half of the residents (54.0%) reported they were unable to list what they felt to be the correct cause of death after guidance from the admitting department in their hospital,” Dr. Wexelman and colleagues write.

“Of all respondents, 70% believed they were forced to identify an alternate cause of death when the patient died of septic shock (compared with 83.5% of high-volume respondents), and 34.2% believed they were forced to identify an alternate cause when the patient died of acute respiratory distress syndrome (compared with 44.3% of high-volume respondents),” the researchers continue.

Only 20.8% of respondents knew they could hedge the death determination by calling it “probable,” “presumed,” or “undetermined.” When the death certificate system would not accept the true cause of death or hospital admitting staff overruled them, 64.6% of respondents reported cardiovascular disease, 19.5% pneumonia, and 12.4% cancer as the cause of death.

Study participation was voluntary, and residents with stronger feelings about the accuracy of death certificates may have been more interested in participating. Other study limitations include the potential for recall bias.

“Residents routinely reported diagnoses on death certificates that did not match their medical judgments. These errors may have lasting effects on the public health priorities of the community. Reform is needed both in the training and education of residents and in the system itself,” the authors conclude.

 

What! Seriously!

Okay, so as a PhD candidate for a Doctorate of Natural Medicine, I find this sickening and disturbing. But what about all the doctors, nurses, administrators, and other licensed healthcare practitioners who deal with this on a frequent and regular basis? What do they think about all this? Below are just a small handful representative of  the comments received about this finding. I have tried to present a wide cross-section of respondents from various locations in the US and even a few international. These comments blow my mind, and I hope they give you pause for thought.

Lane Longo|  Health Business/Administration

 1 day ago
 “Dear Sirs,
Let me say, at the outset, that the  the title of this article would be more properly worded by removing the innocuous sounding euphemism “fib” with the  correct word  “lie”.  That is, to deliberately mislead by falsehood.
Further, the article stated that residents were “forced” by hospital admitting staff or because the program would not accept he actual cause.  While I do not have direct knowledge of the death certificate program used, I assure you that the program did not design the criteria.  Some governing board, after throwing out any sense of .ethics,  weeded out any possible incriminating causes which might redound to the hospital or physicians account. Do you imagine that because the patient is dead that the cause doesn’t matter to the family or the state?

And the final insult…”Study participation was voluntary, and residents with stronger feelings about the accuracy of death certificates may have been more interested in participating.”  This implies that there are many more who do not give a damn about the truth.  Who are you people?

One would think that the much vaunted medical community would eschew debauched ethics.  If you do it in the smaller things, you will blunt your conscience to the larger ones.”

 

Dr. WOOD DEMING|  Cardiology, General

 2 days ago
 “It does not sound like a resident training problem , but rather administrators bent on falsifying records to make billing more enriching or to portray the hospital in a different light .  I would also guess that this issue is discussed openly at meetings for hospital managers..”
Sal Campo|  Other Healthcare Provider

 11 days ago
 “I believe this is happening much more due to hospital errors and trying to avoid law suits. More inspections should be used for larger institutions and the state should not just shrug off family complaints when there family member dies.”
Dr. stephen c

 12 days ago
 “Why does no one mention the elephant in the room? When older patients are admitted with known pathology it is all too easy to let them die of iatrogenic causes such as acute respiratory failure due to over prescription of opiates. When my mother was admitted in light coma with a moderate middle cerebral bleed at 83, I arrived 24 hours later to find she was on regular morphine and already cheyne-stokeing. Apparently, she had groaned on being turned and a relative had asked for pain relief. I got the morphine stopped, she woke up and is now at home with no neuro deficit and only mild confusion enjoying her grandchildren for another year or two. Her death certificate would have read “Cerebro-vascular Accident”. It would have been a lie.”
 

Dr. Raymond Vergne|  Cardiology, Interventional

 12 days ago
 “For the living, medical “coders” love “NSTEMI” and “congestive heart failure”.  NSTEMI is the choice diagnosis for anyone with a minimal elevation of troponin levels, regardless whether it is due to sepsis, stroke, acidosis, respiratory failure,  pancreatitis, pulmonary embolism or atrial fibrillation.  Congestive heart failure is preferred over COPD, acute lung injury, thyroid storm, acute bronchitis or idiopathic pleural effusion.  NSTEMI and CHF yield better reimbursement from Medicare.  One learns fast not to argue with the coders.”
Dr. Anton-Lewis Usala|  Pediatrics, General

 13 days ago
 “This is an excellent description of what happens in the absence of quality systems.  Medicine is the last major industry that doesn’t have quality system assurance built into the delivery of its service.  While pharmaceutical companies are required to have design-reviewed processes in place, with point-of -process quality systems to assure they were completed as intended, the only part of drug development that does NOT require quality system enforcement is the clinical trial portion involving human subjects.  Many hospitals have quality departments, but they review after the fact events, and are not the same as industry quality systems that assure each step in process occurs as intended to prevent an unqualified product at the end.  I think such an approach would be initially difficult to implement (as they are when first applied to any service or industry) but would have profound beneficial effects for our patients, our institution, and our profession.”
Dr. Michael Dubriwny

 May 13, 2013
 “Aside from public health priorities, inaccurate reporting of cause of death is related to health grades and ultimately hospital reimbursement.”
 

I could go on and on, with many more comments, but I think you see the pattern and general consensus emerging. For anyone who wants to view all 79 and counting comments, let me know and I will send them to you. See, I can’t just post the link and have you look it up yourself because it is part of a private, members by subscription only site. All I can do is “Select All”, then ” Copy”, and then “Paste”. What does this mean? Well for one thing it means the news media and ethical investigative journalists of this world probably do not have access to this information to bring it to the public’s attention. And what does this revelation mean when it comes to all the data collected by various organizations that track the rise and or fall in the number of deaths related to a certain disease? Or to biologic family members that might be left in the dark about a possible genetic time bomb in their lineage that was inaccurately stated as the cause of death? The system is broken folks. How are we going to fix it?

 

 

 

 

Breaking News! This Just In…..

To all of us who are concerned with the state of mental health recovery in this world, what follows is important and amazing news. I just found this as reported at http://www.mindhacks.com. I am shocked and saddened that this is not international news being reported by every media station worldwide.  I want more people to know about this, so I am reporting it and hope that others will follow.

National Institute of Mental Health abandoning the DSM

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:

Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.

As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.

For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.

Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.

It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.

It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.

The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.

The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.
Link to NIMH announcement ‘Transforming Diagnosis’.

Movie Alert! Tune Your TV Or DVR Now!

Lifetime television channel here in the US is debuting a fantastic movie at 8 PM EST entitled “Call Me Crazy”! I am so very excited to watch it….and admit that I am totally biased with the title they chose. It  follows five families trying to survive, recover, and thrive in the face of mental illness diagnoses. Check it out!

call me crazy movie

The Complicated Problem Of Receiving Good Mental Health Care: Part 1

When it comes to illness or injury, many of us are able to find good treatment within a relatively short time frame. There certainly are problems and challenges with the universal health care systems, but in the industrialized world most of us can and do find treatment providers in short order. That does not seem to hold true when we examine one aspect of health…..that of mental health. Laws and policies are enacted, psych drugs are promoted, yet the task of receiving quality mental health care treatment is still a daunting task for most. A recent poll being undertaken here in the blogosphere by Mental Health Writers Guild gives us a small snapshot by showing that the largest percentage of respondents waited over one year before getting an acceptable mental health diagnosis. This is admittedly a very complicated problem that belies a quick solution. But to solve this problem, we need to look at all the different factors that contribute to it. I present here one aspect of the problem…..that of insurance companies putting up roadblocks or even denying mental health care treatment. Attention is now being drawn to this issue by way of a class action lawsuit against one of America’s largest insurance companies…..United Health.

 

 

UnitedHealth Sued Over Mental Health Parity

By Kathleen Struck, Senior Editor, MedPage Today
Published: March 13, 2013

Health insurance giant UnitedHealth Group has been sued in a class action for alleged violations of federal and state parity laws that mandate coverage for mental health claims on a level comparable to medical and surgical benefits.

“Despite United’s duty to adhere to these anti-discrimination safeguards, United has systematically implemented unlawful and deceptive practices designed to create the illusion of impartiality, fairness, and due process while simultaneously undermining access to treatment for the most vulnerable segment of our society,” stated the suit filed Tuesday on behalf of the New York State Psychiatric Association and three patients.

The plaintiffs allege that the defendants — UnitedHealth, UHC Insurance, United Healthcare of New York, and United Behavioral Health, referred to collectively in the suit as “United” — engaged in unlawful and deceptive practices that include “undisclosed algorithms to identify high-use beneficiaries” and coverage decisions based on “internal policies that violate federal mental health parity laws.”

The suit, filed in the U.S. District Court for the Southern District of New York, in New York City, asked that United be made to comply fully with the parity laws and reimburse any claims that were unfairly denied, with interest.

Co-counsel Meiram Bendat said United “applies disparate medical necessity definitions” and “reserves unfettered discretion for itself to reject mental health claims.” Bendat, an attorney and psychotherapist in Los Angeles, said he helps patients fight insurer denials of mental health treatment.

United has “developed its own standards of care for mental health treatment that are inconsistent with prevailing, national standards and those adopted by specialty groups within the mental health community,” he said.

United had no comment on the specifics of the lawsuit. “We are committed to helping people with mental health issues reach long-term recovery,” said United spokesperson Brad Lotterman, in Minneapolis, Minn. “We recently received the complaint and are currently reviewing [it].”

Bendat called the case “monumental … by virtue of being the first to invoke the federal parity law. It is also on an enormous scale because it potentially impacts most, if not all, [United] policyholders — and that’s in the tens of millions.” United insures more than 70 million people in the U.S., according to its corporate website.

The suit alleges federal violations of the Affordable Care Act (ACA) as well. United failed to pay for concurrent care claims while internal insurer appeals were being determined, as the ACA mandates, the suit alleged.

The ACA also mandates time frames for beneficiaries to contest adverse insurance decisions, he said, and United ignored those parameters.

Bendat, founder of a California-based mental health insurance advocacy service, Psych-Appeal, said insurers rely on the psychological vulnerabilities of mental health beneficiaries. “They are the easiest group to railroad when it comes to denying care. That’s built into United’s model in doing business with respect to mental health,” he said.

Seth Stein, executive director of the New York State Psychiatric Association, in Garden City, N.Y., said the association received several complaints about recent changes in CPT [Current Procedural Terminology] codes for physician services for which United was not properly reimbursing physicians. Stein said the complaints related to “noncompliance with state and federal parity laws.”

“Over that past year or so, more, we’ve brought all of these issues to the attention of United,” he said, “and we have been unable to resolve them satisfactorily. … We are very pleased we have an opportunity to … get some assistance from the court enforcing state and federal parity law.”

 

 

 

If you have experienced this particular type of discriminatory practice, please speak up. Acknowledging this problem is the first step toward change. Taking action is the next. Let’s keep on going.