Finding the Right Hospital for You


Here’s a shortened summer issue of our safety newsletter, on a topic of four-season importance: finding the right hospital for your condition.  That’s not always the “best” hospital.  Read on for more.

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The Volume Rule — and an Important Refinement  

The volume rule is all about “practice makes perfect.” The idea is to find the hospital in your area that week in and week out treats lots of patients just like you.  That hospital will have worked out sets of standard practices to ensure the safest, most comfortable experience for you.


How much volume is enough? Here is the yearly volume you should look for with particular common types of procedures.  (The numbers come from the Leapfrog Group, a business-sponsored organization that evaluates hospital performance.)


If these numbers are low, ask your doctor about options. And if the hospital won’t tell you its numbers, that’s a good sign of a hospital to avoid.Now for the important refinement:Surgeon volume.  It does little good to get into an institution with high volume of what you need if your individual surgeon is a relative rookie at it. Some operations, like aortic valve replacement, require lots of practice to maintain sharp skills. Your surgeon should be willing to supply the latest yearly total as well as rates of death and complications for your procedure. If not, or if he or she seems indignant at the request, seek alternatives.

More Reading on Finding the Right Hospital 

Check out this previous issue of our newsletter, which talks about why patient satisfaction surveys can be an excellent guide to the right hospital.  This will give you links to finding the surveys on Medicare’s Hospital Compare website.

Also, U.S. News just published its annual guide to “Best” hospitals.  I don’t always agree with its ratings, which are over-weighted to a hospital’s reputation among doctors in a particular field, and which don’t always reflect the realities of day-to-day medical care.  But this year’s issue has some good reading on patient safety issues and on the key subject of when the right hospital can be wrong for you.

Report from the Malpractice Trenches 

I don’t talk much in this newsletter about our firm’s work representing malpractice victims in lawsuits.  The idea of the newsletter is to arm you with the information you need to avoid darkening our door or some other attorney’s.

But we had a unique day recently, that’s worth mentioning to help dispel certain myths about malpractice litigation.

On a single day, we won two cases in the District of Columbia Court of Appeals.  Both involved appeals that were first filed in 2007.  One was for a malpractice victim who suffered a spinal cord injury because of the combined negligence of her surgeon and her anesthesiologist in administering the wrong drug at the wrong time in the wrong way.  The other case involved a woman who had a stroke due to a misreading of an MRI scan that showed imminent danger ahead.

The spinal cord client won an important legal victory for other malpractice victims.  Her case was about an innovative legal mechanism we devised to enable us to settle part of her case with the one defendant willing to do the right thing before trial — in this case, the anesthesiologist — and then go to trial against the surgeon without the handicap of what lawyers call the “empty chair” defense.  Some defendants hold out and refuse to settle when there is another defendant, because they know that with that defendant out of the way, they can point to the “empty chair” in the courtroom as the sole guilty party.  Most of the time, the rules of court prevent lawyers from telling the jury about the settlement with the absent defendant, and this rightly offends jurors who think someone is getting away scot-free.

Our solution to this conundrum was to have the settling defendant “assign” to our client his cross-claim against the other defendant for not contributing to the settlement.  So we had a trial on whether the surgeon should have contributed.  The trial judge ruled yes, and the Court of Appeals has now affirmed, and has written a long decision guiding future lawyers on how to use this tactic. Read more here, including a link to the appellate court’s opinion.

For our stroke client, the appeals court victory ended an eleven-year odyssey with two trips to the highest court in the District of Columbia.  This second one was about the defense malpractice insurance company trying to shortchange our client to the tune of about $200,000 on interest it should have paid her after it lost its first appeal of the jury verdict in her favor.   Read more on our patient safety blog here.

The point? Not every legal case lasts eleven years, but malpractice litigation is tough work that requires diligence, doggedness and patience.  So whatever you can do to get safer medical care to avoid victimhood is all to the good.


To your continued health!

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Patrick Malone
Patrick Malone & Associates