Re “Ontario insurers leave catastrophically injured at risk” (Jan. 8 ): Alan Shanoff did a public service by commenting on the Court of Appeal’s decision in Kusnierz v. Economical. The Insurance Bureau of Canada suggested in its letter to the editor (Jan. 15) that a review of the CAT impairment designation is underway which will “resolve any uncertainty.” From the perspective of the Ontario Trial Lawyers Association any uncertainty has now been resolved by the Court. The “uncertainty” — whether physical and psychological impairments should be combined in determining the overall impairment of an individual — was resolved in favour of combining those types of impairments. For Mr. Kusnierz, whose leg was amputated, it meant that when assessing the impairment of his entire person, it was appropriate to look at both the physical impairment from the loss of his leg and the psychological impact of that injury. In our experience, no one is startled to learn that this should be the approach. The suggestion that Shanoff is fighting for a generous system that “ensures the legal community will make money” is unfair and unfortunate. Surely Mr. Kusnierz and people like him injured in car crashes would agree that this case was about ensuring the most seriously injured in our society receive the accident benefits they require. To take a swipe at Shanoff and the lawyers who help the injured recover their accident benefits from their insurers was unnecessary and inappropriate.
Andrew Murray
President-elect, Ontario Trial Lawyers Association
(It should have been obvious to the insurer that Mr. Kusnierz’s injuries were catastrophic)
Why is the public paying for doctors’ malpractice insurance?
Unless you’re a doctor or medical negligence lawyer you’ve likely never heard of the Canadian Medical Protective Association (CMPA).
When Ontario government and Ontario Medical Association negotiators sit down to negotiate fee schedules and pay for physicians’ services, there’ll be little or no mention of the CMPA.
It refers to itself as a not-for-profit, medical, mutual defence organization.
Its self-described mission is to “protect the professional integrity of physicians and to contribute to a high quality health care system by promoting safer medical care in Canada.”
To most doctors and to those unfortunate enough to find themselves the subject of a medical malpractice lawsuit, however, the CMPA is a type of insurance company.
It provides professional liability protection for Canadian physicians.
But it’s also a unique insurance company.
Its physician members don’t pay any premiums.
Instead they pay “membership fees.”
But whatever you call it, when doctors get sued they turn to the CMPA to defend them. And aggressively defend them it does, employing the best legal talent money can buy.
There are four unique things about CMPA “insurance.”
First, there’s no deductible or co-payment by doctors on claims.
Second, the premiums, or membership fees, don’t increase if a doctor suffers one or even multiple claims.
Third, there are no limits on the insurance.
Fourth, and most important, taxpayers pay most of the premiums.
That’s right, the public pays most of the premiums for doctors’ medical insurance.
In fact, they are the only professionals who have the public picking up their professional liability insurance premiums.
Don’t be fooled by those who argue CMPA membership fees aren’t the same as insurance premiums. It’s a difference without any distinction.
Ontario taxpayers pay over $100 million a year in CMPA premiums.
That may be a small part of the annual health budget, but Ontario taxpayers have contributed over $1 billion for CMPA premiums over the past decade.
That’s a significant amount of money, especially in these lean times when public sector wage restraint is supposed to be the rule.
It’s not as if the CMPA needs all this taxpayer money.
According to its most recent annual statements, as of the end of 2010, the CMPA held almost $3 billion in net assets.
After deducting funds committed to capital assets and a risk retention reserve fund, the CMPA holds $572 million in unrestricted net assets.
I understand doctors are basically public or civil servants receiving most of their income from a single payer, the government. But the public doesn’t pay other expenses incurred by doctors. So why this one?
Aside from the fact significant taxpayer money is going to a third party, with little or no accountability on how that money is spent, this creates an unfair situation where a person injured due to medical negligence is subsidizing the legal defence of the doctor being sued.
The doctor has the benefit of using the best legal talent money can buy with taxpayer funds, while the injured person must make do with whomever he or she can afford.
Yes, some good plaintiff’s lawyers take cases on a contingency basis but they face substantial obstacles in getting cases to trial — there were only 96 lawsuits against doctors that went to trial across Canada in 2010.
One of these obstacles is the high cost of litigation, which isn’t a factor for doctors.
Worse, the way CMPA membership fees are structured, there’s no penalty for doctors who violate the standards of their profession.
There’s no deductible and no fee increases no matter how many claims are made against a doctor.
If I’m a poor driver and get into several accidents my premiums will go sky-high, or I will become uninsurable.
Not so for doctors who foul up.
Yes, doctors deserve fair compensation, but they don’t deserve this taxpayer subsidy.
Source: Alan Shanoff -torontosun.com Saturday, January 21, 2012, 7:25 PM
While the insurance industry has loudly proclaimed the pervasiveness of insurance fraud, it has been quietly leading a battle to deny benefits to the most seriously injured car accident victims.
That battle is being waged over the definition of catastrophic impairment.
Accident victims in this category are entitled to enhanced medical and rehabilitation accident benefits of up to $1 million.
As of September 2010, those seriously but not catastrophically impaired are entitled to reimbursement of medical and rehabilitation benefits to a maximum of only $50,000 (although this can be doubled to $100,000 for an additional premium).
Prior to September 2010, the limit was $100,000.
But none of this money goes into the pockets of accident victims; the money is to be used solely for reasonable and necessary expenses.
Robert Kusnierz was injured in a 2001 car accident resulting in significant injuries. His left leg was amputated below the knee.
Due to cysts and deterioration of the stump, he often uses a walker or wheelchair rather than a prosthesis.
He has had 10 different prostheses. Even with them, he can walk well only on flat surfaces.
He suffers from headaches and pain in his shoulders, neck, back, hips, knees and right ankle.
He lost his job and suffers from “severe” psychological symptoms, likely meeting the diagnostic criteria for a major chronic depressive disorder.
Not surprisingly with such significant injuries, Kusnierz exhausted his $100,000 medical and rehabilitation limit as of late 2005.
That’s because prostheses, wheelchairs, assistance devices, attendant care, housekeeping services, medication expenses, home modifications and other costs all come out of the accident benefit limits.
It’s easy to exhaust them, particularly in cases of serious but not catastrophic impairment.
You’d be hard pressed to find many people to argue Kusnierz’s injuries don’t constitute catastrophic impairment.
Even his insurer, The Economical Mutual Insurance Company, agreed if his physical and psychological injuries were combined, Kusnierz would have satisfied the definition of catastrophic impairment.
Didn’t meet definition
But ignoring years of precedent, his insurer argued combining physical injuries with psychological injuries is not permitted in making a catastrophic impairment designation, and neither the physical injuries nor the psychological injuries alone satisfied the definition of catastrophic impairment.
In late 2010, Justice P.D. Lauwers of the Ontario Superior Court accepted that argument, ruling in favour of the insurer.
Kusnierz launched an appeal to the Ontario Court of Appeal.
The Insurance Bureau of Canada (IBC), the national industry association representing Canada’s home, car and business insurers, intervened in the appeal, trying to uphold the pro-insurance decision.
It’s hard to overestimate the parsimonious nature of such conduct since there are very few cases where physical or psychological impairments would not be considered catastrophic when assessed separately, but would be considered catastrophic when combined.
Happily for Kusnierz, the Court of Appeal’s decision, released in late December, reversed the lower court ruling, concluding that allowing physical and psychological injuries to be combined in making a catastrophic impairment assessment “promotes fairness and the objectives of the statutory scheme.”
But the battle isn’t over.
The Ontario government is sitting on a report by a panel of experts to the Financial Services Commission of Ontario. FSCO is responsible for the regulation of car insurance in Ontario.
This report, prepared by a group comprised of eight members, two of whom have been consultants to the IBC and two of whom have received research grants from the insurance industry, argues against combining physical and psychological impairment.
These experts argue there isn’t “sufficient evidence that combined impairment ratings are more clinically meaningful than using separate criteria.”
Try telling that to Robert Kusnierz.
Source: By Alan Shanoff ,Toronto Sun First posted: Saturday, January 07, 2012 05:27 PM EST
The Interim Report of the Ontario Auto Insurance Anti-Fraud Task Force released earlier this month is more interesting for what it doesn’t report than what it does.
Naturally, it reports on the apparent increase in claims costs, particularly no-fault accident benefits between 2006 and 2010, with the greatest increase in the GTA.
Naturally, this has led to dramatic premium increases with Ontario having Canada’s highest car insurance premiums.
Certainly there are anomalies which require investigation.
How is it that accident benefits claims frequency has increased while the number of people injured in car accidents has decreased?
Why have accident benefits claims gone up dramatically compared to health care inflation?
Why are costs rising more rapidly in Ontario compared to other provinces?
The possible reasons explaining these anomalies are many, but as illustrated by the very name of the task force, only one reason appears to be on the table: Fraud, with an emphasis on consumer fraud.
That’s where I part company with the task force.
True, it discounted the oft-cited industry estimate of $1.3 billion of fraud per year, stating the “figure cannot be considered a verifiable measure of the extent of fraud at this time.”
But the report is based primarily on facts and figures supplied by the insurance industry.
Clearly, the industry has an incentive to exaggerate claims costs, as well as fraud. That’s not to say there’s no fraud. Certainly, fraud exists. But the extent is debatable.
As stated by the task force, there are several types of insurance fraud: Organized fraud such as staged accidents, premeditated fraud such as fraudulent billings by repair shops and health care providers, and opportunistic fraud.
The first two types are clear cut and require effective steps to stamp them out, but opportunistic fraud is in the eye of the beholder.
As the task force states, “opportunistic fraud occurs when individual claimants inflate the value of their claim.”
That opportunistic fraud exists cannot be denied, but it is surely the most debatable and likely the slowest-growing type of fraud.
Justifies abuses
Sadly, for claimants, it is being used to justify many of the insurance abuses that afflict legitimate accident victims.
Jack Fireman, a personal injury lawyer who represented the insurance industry as defense counsel for many years before switching to the plaintiff side in 2000, argues we need a task force to examine the “rampant abuse by the insurance industry of legitimate claimants.”
Decisions from Financial Services Commission of Ontario (FSCO) arbitrators are replete with examples of the wrongful delay and deny tactics of insurers.
The insurance industry has a penchant for using preferred vendors to provide medical assessments of accident victims.
I recently wrote about a psychiatrist whose prime occupation was conducting psychiatric assessments of accident victims, mainly for insurers.
This psychiatrist conducted up to 50 insurance assessments a month with a projected income from assessments “in the range of some $600,000 per year.”
Often these preferred vendors conduct what are called paper reviews. They don’t even examine the accident victims before rendering their pro-insurer opinions.
And if they don’t render pro-insurer assessments, their lucrative practices may dry up.
Insurers also put forth unqualified experts to deny legitimate claims.
Indeed, arbitration decisions from FSCO arbitrators are replete with examples of unqualified “experts” having been retained to argue against legitimate accident victims. Isn’t that equivalent to opportunistic fraud?
In examining the increasing cost of claims, shouldn’t we be examining the increase in costs attributable to defence or insurer medicals, adjuster’s fees and legal fees paid to insurers’ defence lawyers?
If the task force’s final report is to have any merit, it must obtain independently audited figures and claims costs attributable to both sides, consumers and insurance companies.
Source: By Alan Shanoff ,Toronto Sun First posted: Friday, December 16, 2011 08:58 PM EST
High Levels of Arsenic Found in Some Apple Juice and Grape Juice: Study -------------------------------------------------------------------------
The amount of arsenic found in some fruit juice exceeds the amount considered safe for drinking water, according to the findings of a new study.
Consumer Reports released the results of an investigation into arsenic levels in fruit juices on November 30, finding that the 10 percent of juices tested had more arsenic than what is legally allowed in drinking water.
Part of the problem, Consumer Reports noted, is that there are no arsenic standards for juice and similar beverages.
The Environmental Protection Agency (EPA) has set a limit on arsenic in drinking water of 10 parts per billion (ppb). Some arsenic occurs naturally in some fruits, but there is a type of arsenic known as inorganic arsenic that does not. Inorganic arsenic is a known human carcinogen. Even the 10 ppb level has been hotly contested by health experts, many of whom say it should be higher.
The Consumer Reports study tested 88 samples from 28 different apple juice and grape juice products, and found that 10 percent of the samples tested had arsenic levels exceeding 10 ppb, most of that arsenic was inorganic. The group also tested the samples for lead, and found that 25% exceeded 5 ppb, the legal lead limit for bottled water.
High levels of lead can damage the developing brain of an unborn or young child, causing neurological problems, learning disabilities and lowered intelligence, as well as seizures and death in some cases.
Two samples of Walgreens 100% Grape Juice had 24.7 and 17.4 ppb of arsenic. Both those samples also had high levels of lead, with 10.1 and 14.7 ppb respectively. Another Walgreens 100% Grape Juice sample had 9.71 ppb arsenic, under the drinking water standard, but 15.9 ppb of lead; more than three times the amount of lead allowed in bottled water.
Another juice that tested consistently high for arsenic was Walmart’s Great Value 100% Apple Juice. Three samples tested had arsenic levels of 13.9 ppb, 11.5 ppb and 10.1 ppb. Welch’s 100% Grape Juice also tested high, with two samples that were found to have 12.4 ppb and 10.7 ppb of arsenic.
The juices with consistently low levels of arsenic included Juicy Juice 100% Apple Juice Non Frozen Concentrate, and Red Jacket Orchards 100% Fuji Apple Juice Never From Concentrate (refrigerated). No samples from those two juices ever exceeded 2 ppb for arsenic. Both were also below the bottled water standards for lead, with Red Jacket Orchards juice registering less than 1 ppb of lead in every sample.
Consumers Union, which is the advocacy division of Consumer Reports, is calling on the FDA to establish a 3 ppb arsenic limit for juice and a 5 ppb limit for lead. The group says that the limits are achievable, pointing out that 45% of the samples tested would have met such requirements.
The FDA informed Consumer Reports earlier last month that it is considering arsenic standards for juice, but is still collecting data to determine where those limits should be set. In September, the FDA stated that it believed apple juice consumption posed little or no risk, but since then it has received eight apple juice test samples with total arsenic levels of up to 45 ppb. That, and other data the agency has obtained, has led the FDA to decide that arsenic levels in juice need further investigation, Consumer Reports stated.
The American Academy of Pediatrics has a number of recommendations on the amount of juice children should drink. Those recommendations include:
Avoid giving infants under six months old any juice. Limit the amount of juice consumed by children six years old and younger to a maximum of four to six ounces per day. Limit the amount of juice given to children older than six to eight to 12 ounces per day.
Source: Published December 1st, 2011 - aboutlawsuits.com/
If companies selling auto insurance to Ontarians can't make any money doing it, as they claim, we have a question.
Why did they fight so hard against former NDP premier Bob Rae when he tried to introduce publicly-run auto insurance in 1991?
After all, if auto insurance is such a money loser, why wouldn't the industry have been happy to abandon it?
Instead, it launched a massive lobbying campaign to keep auto insurance private -- including the threat of thousands of layoffs -- that forced Rae to back down.
Auto insurers weren't crying poor back then. The Insurance Bureau of Canada boasted that in 1990, the industry had made a $254 million profit, after earlier losses, and that since the business model wasn't broken, why was Rae trying to fix it?
Today, reports say the auto insurance sector lost $390 million last year, although overall profits for all forms of insurance were $2.3 billion. And while insurers cry poor, annual auto premiums for consumers are rising, often at a double-digit pace, in the middle of a brutal recession.
Now, the government of Liberal Premier Dalton McGuinty is considering a plan to slash maximum benefits for accident victims who sustain severe but "non-catastrophic" injuries from $100,000 to $25,000, which critics say is totally inadequate to cover today's costs for medical rehabilitation.
Insurers argue those costs are out of control -- that a claim costing $2,900 to settle in Alberta, for example, costs $38,000 in Ontario.
But where is that $38,000 going? Most of it clearly isn't helping accident victims, but rather funding a wasteful and adversarial system where victims increasingly find themselves at war with their own insurers over the extent of their injuries.
While Finance Minister Dwight Duncan is soon to announce reforms to "fix" the system and the Liberals argue premiums are still 4% lower than when they took office in 2003, that's cold comfort to consumers facing double-digit increases.
Indeed, it's hard to see how a public system could be any worse than what we have. Food for thought, premier?
Source: SUN MEDIA First posted: Wednesday, July 22, 2009 03:50 AM EDT | Updated: Wednesday, July 22, 2009 03:51 AM EDT torontosun.com/comment/editorial/2009/07/22/10215506-sun.html
William Huang flatlined on the operating table at St. Michael’s Hospital.
It was just ten days before Christmas last year and the 52-year-old millwright was delivering gifts in Etobicoke when a dump truck suddenly ploughed directly into the driver’s side of his van. It took emergency responders an hour to cut him out of his crushed vehicle and when they got him to the trauma centre, his condition was so grave that the father of two was given last rites.
Almost a year later, the memory still reduces his 18-year-old son to tears. “I thought I was going to lose him,” Richard says.
After he was resuscitated, Huang’s family was told he had only a 50-50 chance of making it through the night. The force of impact had shifted all the organs of his body to the right, fractured his spine, his hip, his leg and left him with serious internal bleeding. He would need 20 blood transfusions and numerous operations, but after six weeks in St. Mike’s ICU and another four and a half months in Hamilton General Hospital, Huang was finally discharged in May.
But his tough battle to survive has been nothing compared to the one he’s been cruelly forced to wage with his insurance company.
Huang will never be able to breathe through his mouth or nose. He has a permanent tracheostomy tube and can speak only with a microphone to his voicebox or through a computer that reads out what he’s typed. He needs 24-hour care because if the tube clogs with mucous, he will die.
He is scarecrow thin and terribly weak. He’s in constant pain and sleeps in the den downstairs because it’s too difficult to manage the stairs up to his bedroom. He’ll never be able to return to the job he loved and he’s had to close down his business. He’s on 13 medications, including one that costs $735 a prescription.
He is a proud man. “I was the main breadwinner and I feel like I let my family down,” Huang says slowly.
Life, he says, is as different now as “night and day.” How unfair that with everything he must endure, he also has to withstand the slow torture of dealing with adjusters from Intact Insurance, who seem determined to place roadblocks at every turn: holding up cheques, refusing to recognize his catastrophic injuries, claiming forms have been lost in the mail — all while the family runs through their savings.
“It just makes me angry and frustrated,” he says. “They want their money but when roles are reversed, they’ll do anything not to pay.”
Just getting his income replacement benefit was a struggle. The maximum is $400 a week, but as he lay in intensive care hooked up to machines, they would give only $150 on the chance he could soon work. Intact then failed to pay anything at all for two months over the summer. With no apology, their adjuster blamed it on “system failure.”
“It was our mistake and for that we are deeply sorry,” Intact spokesman Sandra Nunes tells the Toronto Sun. “We took corrective measures to resolve the issue with catch-up payments and accompanying interest.”
He almost couldn’t be discharged, he says, because Intact hadn’t paid for the breathing equipment he needed at home. And now they’re stalling again.
If his insurer determines the accident left Huang with a “catastrophic impairment”, his benefits go from $100,000 to $1 million to cover his very expensive rehabilitation, prescription and medical costs. His trauma surgeon at St. Mike’s filled out the form last May. In September, Intact said their own doctor says Huang’s condition hasn’t “stabilized” so they won’t assess him yet.
Deny and delay seem to be their operative words.
The Huangs have hired a lawyer to help them through the process but she is equally frustrated.
Meanwhile, much of the worry falls on his wife Davanh and their son, who are in constant battle with Intact. “It scares me to death,” Davanh says, breaking down. “How am I going to pay bills and what about my son? How are we going to keep going without help, without money?
“When you buy insurance, you depend on that, thinking insurance is going to help you out. Then you have to fight for everything, every step of the way.”
Source: torontosun.com/2011/11/17/injured-hamilton-man-having-difficulties-with-insurance-company By Michele Mandel ,Toronto Sun First posted: Thursday, November 17, 2011 06:58 PM EST | Updated: Friday, November 18, 2011 11:50 AM EST
A Lively family is calling for a public inquiry into the Ontario automobile insurance industry after uncovering what they believe are excessive payments to medical professionals treating accident victims, and how those payments are being declared by the industry. "We don't have all the answers, but we have some of them," said Shawn Mason, son of Bill Mason, 62, who was seriously hurt in a motor vehicle accident on Municipal Road 55 in August. "Anyone who is a consumer of auto insurance should be aware of these things." Shawn Mason made the charges while speaking to reporters during a press conference in the city on Monday. Shawn was accompanied by father Bill, who did not speak, and Nickel Belt New Democrat MPP France Gelinas. The Mason family has been locked in an ongoing battle with Bill's insurer -- the Dominion of Canada General Insurance Company -- over compensation for Bill's injuries. The family believes Bill fits into the category of "catastrophic care" or impairment, due to changes in his mental functioning and personality. The insurance company disagrees.
The self-employed owner-operator of an automobile supply business, Bill Mason can no longer look after his business. In fact, said Shawn, his father has spent $750,000 of his own money to help run the business in his absence. The Mason family has also launched a civil suit arising from the accident. The suit will be going to court soon. The Mason family also claims the Ontario automobile industry isn't following Insurance Bureau of Canada guidelines on how insurance premiums are spent. The bureau recommends 53.1 cents of every dollar paid in premiums go to policyholder claims, 10.5 cents for profit, 15.9 cents for taxes, and 20.5 for operating and regulatory costs
Using Freedom of Information requests for four different injured drivers, including Bill, the Mason family found similar instances of large payouts of up to $5,350 for insurer examinations, even though the designated limits ranged from $450 to $900. The family suspects those payouts are coming not out of operating and regulatory costs, but out of the policyholders' claims portion of premiums paid by motorists. "Four different incidents with four different drivers that show the same figures," said Shawn. "It led us to believe that everything is systemic. It's right on the books... "We have discovered is the insurance company is dipping into other revenues to pay for something that should be coming out of their own pock-e ts. We even found that an insurance company dipped into the (claims) fund to pay for a private investigator. He is not a medical professional." The Dominion of Canada General Insurance Company was one of the four companies examined. George Cooke, of the Dominion of Canada General Insurance Company, wouldn't talk about the case. "Given the state of the file, the only thing I can do is decline to comment," he said Monday. "It would be wrong for us and it's (also) in litigation." The Mason family says it got nowhere when dealing with the Financial Services Commission of Ontario -- the regulatory arm of the Ontario Ministry of Finance responsible for administering the Ontario Insurance Act. The Mason family asked the commission to investigate the alleged misreporting and insurer examination payouts, but referred Bill Mason to the Ontario Provincial Police because it was "a criminal matter," says the family.
The OPP contacted the superintendent's office, said Shawn, and was told that Bill Mason was incorrect and confused. Gelinas, who is helping the Mason family, wants a public inquiry. Shawn Mason, who also wants a public inquiry, said Finance Minister Dwight Duncan refused to meet with the Mason family. The family then turned to Gelinas. "I had it down (pat), so I could spill the story out in five minutes," Gelinas said of her meeting with Duncan. "He was rude. He didn't want anything to do with it."
At a subsequent meeting with Ontario's auditor general -- the independent person who keeps track of government spending, looks to find waste and propose changes -- Gelinas said she was told the auditor general doesn't take direction from MPPs. Andrew Kovarcsik, an assistant to Duncan, said the provincially appointed Anti- Fraud Task Force is expected to come back with recommendations by the end of the year. He acknowledged that Duncan and staff met with Gelinas. "We responded to France," he said. "We were happy to meet with meet with her on the topic ... I can assure you it wasn't brushing off an MPP." Kovarcsik said if someone believes they have found examples of fraud in the Ontario automobile insurance industry, they should report it to the Financial Services Commission of Ontario. Kovarcsik, however, said, since the Mason family case is ongoing, he doubts the commission would comment on it. Commission officials were unavailable for comment Monday.
A landmark patient safety study has found that there are up to 70,000 preventable medical mistakes in Canada each year. While Canada has one of the best hospital systems in the world, this study highlights the problems that exist in our system and demands change to ensure patient safety.
The Canadian Adverse Events Study
A recent study published in the Canadian Medical Association Journal is the most recent confirmation of an emerging epidemic in health care. The article entitled: "The Canadian Adverse Events Study: the incidence of adverse events in hospital patients in Canada" was published in the May 25, 2004 edition of the journal.
As part of the study, Ross Baker of the University of Toronto and Peter Norton of the University of Calgary, together with 15 other researchers across Canada, collected and analyzed data from over 3,700 patients in 20 hospitals.
The Results
The results of the study confirmed the findings of similar studies in the United States, Australia, the United Kingdom, Denmark and New Zealand. Some of the highlights include:
As many as 24,000 patients die each year due to adverse events. 87,500 patients admitted annually to Canadian acute care hospitals experience an adverse event (mistake). 1:13 adult patients admitted to a Canadian hospital encounter an adverse event. 1:19 adults will potentially be given the wrong medication or wrong medication dosage. 37% of adverse events are 'highly' preventable. 24% of preventable adverse events are related to medication error. the most common areas for an adverse event to occur was surgery followed by medicine related errors.
The Need for Disclosure
One of the clear implications of this study is that in the overwhelming majority of cases, patients are not told that there was an error in their care. Patients have a right to be fully informed of their care, including being told when mistakes are made. Hospitals and the medical profession more generally must take positive steps to move towards a system which encourages openness to patients and objective analysis of medical errors. This may well require a significant change in the medical culture. Solutions
Adverse events occur most often as a result of a series of failures in an increasingly complex medical system. Consequently, hospitals and health care providers must seek out opportunities to improve their own internal systems and processes.
There are a number of steps which must be taken urgently to reduce injuries caused by our system. Here are a few recommendations:
Comprehensive reporting standards must be developed to ensure that errors are disclosed to the patient and tracked for future safety initiatives Patient safety initiatives must receive government support and funding. Health facilities and agencies require additional funds to develop and implement improved patient safety systems, improve infection and quality controls, and provide ongoing education and training Every hospital needs to develop a a comprehensive patient safety strategy and hospital accreditation processes should include an evaluation of patient safety programs.
Conclusion
Medical Mistake is an important public health issue. It is a significant risk factor, associated with a demonstrated frequency and there are clear opportunities for prevention.
We first need to ensure that medical mistakes are reported to patients and tracked to identify potential opportunities to affect system . But there is also a pressing need to re-examine and re-design systems to include safe guards which can protect patients from the human fallibility inherent in our medical system.
source: hartelaw.com Research article: cmaj.ca/content/170/11/1678.full
Bilked by auto insurers? Always crying poor, it’s time for car insurance companies to open their books
You’ve got to hand it to the insurance industry’s public relations efforts. Here we are, eight weeks until the Ontario provincial election and there’s hardly a peep about insurance as an election issue. Nobody seems concerned about the drastic reduction in no-fault car insurance benefits implemented last September. Reimbursement for medical and rehabilitation services for minor injuries was drastically reduced — from $100,000 to $50K for non-minor non-catastrophic injuries and to $3,500 for minor injuries. While catastrophic injury victims are entitled to $1 million in benefits, efforts are underway to modify the definition of catastrophic injury so fewer catastrophically injured people will qualify for the enhanced benefits. (All figures represent maximum reimbursement for expenses deemed necessary and reasonable.) Instead, there’s an abundance of publicity concerning insurance fraud. The McGuinty government has announced an Auto Insurance Anti-Fraud Task Force. Tim Hudak has vowed to crack down on auto insurance fraud, if elected. Newspapers, television and radio broadcasters have reported on the problem. I keep reading and hearing how fraud costs insurers about $1.3 billion annually. The Toronto Star proclaimed in a headline “Shady clinics bilk $1.3 billion in bogus car insurance claims scam.” I didn’t notice any clarification from the insurance industry. The Globe and Mail referred to industry sources who claim fraud is growing and costs the industry “more than $1.3 billion” each year. Strange, since the same $1.3 billion number has been repeated for almost 20 years according to one report. According to the Insurance Bureau of Canada site, fraud costs insurers “about $542 million annually.” The same site says “an estimated $500 million is paid out by home, car and business insurers for claims containing elements of fraud.” From all this, the only thing I can conclude is yes, there’s fraud, as there is whenever money is at stake, but we don’t have a handle on a reasonable estimate. We may as well be picking numbers out of the air. Of course there’s insurance fraud and we need to address it. There are obvious steps to take, starting with requiring all clinics to be owned by a licensed regulated health care professional. But, at the same time shouldn’t we also be looking at the insurance industry? How often have insurers denied legitimate claims or benefits? The Financial Services Commission of Ontario (the body that regulates insurance in Ontario) provides an arbitration service for insurer/insured disputes. A review of the arbitration unit decisions is replete with examples of improper denials. Unqualified experts How often do insurers retain unqualified experts to provide pro-insurer evidence to fight valid claims? Again a review of FSCO arbitration decisions presents an unflattering view of insurers. Let’s have insurance companies open their books. How much are they spending on fraud prevention? How much money are they making (or losing) on car insurance? Are they spending too much on lawyers defending meritorious claims? Are adjusters taking too much money out of the system with unnecessary action? How much money goes to doctors with a perceived pro-insurer bias performing what are supposed to be independent medical examinations of accident victims? The Insurance Corporation of British Columbia publishes an annual list of expenditures. The 2010 list names 19 physicians who were paid a total of $4.7 million or an average of about $250K each. I’m sure most of these doctors are fine people who do their best to present unbiased independent medical reports, but really how independent can anybody be if he earns such large sums from an insurance company? So sure, let’s do our best to eliminate fraud, but at the same time let’s not take our eye off the ball. Insurance is supposed to be there for deserving policyholders. We need to examine insurance industry practices to ensure policyholders are getting fair treatment. The state of the insurance industry isn’t an election issue. It should be.
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