About 12 hours later, a hospital staffer found Torres on the edge of the hospital grounds — but it was another 25 minutes until anyone called 911 for help for Torres.

Torres died at the scene. As of the time of publication, the cause of death isn’t known.

Hospital spokesperson noted that medical records indicate Torres received appropriate care, but that it’s possible not all of the care he received was properly recorded.

The hospital issued a statement expressing sympathy for Torres’ family and outlined changes it would be making to its procedures, including:

• Retraining staff to ensure a nurse supervisor and a security guard are both informed when anyone outside the hospital is thought to be in distress.
• Guiding staff in the best ways to get needed help for anyone who might be in distress on hospital grounds.
• Conducting drills to ensure the policies are followed.

After two cases of patients dying in part due to nurses ignoring their alarms, a Boston-area hospital is taking action.  A 60-year-old man died at UMass Memorial Medical Center after the alarms indicating his heart rate had sped up and his breathing was irregular went unheard and/or ignored for almost an hour. The patient died in August 2010, but the circumstances of his death were only reported to authorities a few months ago. This is the second such case at the hospital since 2007.

Officials with the state Department of Public Health indicated so-called “alarm fatigue,” when overwhelmed staff tune out alarms — which are often false alarms — may have played a role in the deaths.

A subsequent investigation showed the patient was restless and frequently removed his monitors in his sleep, which led to his monitors making false alarms for a large part of the day. He also received a too-large dose of a medication meant to relieve anxiety. It’s unclear how much of a role the medication error played in his death.

In the earlier case, nurses didn’t respond to an alarm indicating that the battery on a monitor needed to be replaced. Eventually, the patient went into cardiac arrest, the monitor failed to sound the alarm, and the patient died.

After the ’07 case, hospital officials enacted new procedures to reduce instances of alarm fatigue, but as with most other hospitals, it’s clearly still an issue.

Hospital officials didn’t release a statement about this most recent case, but did reiterate to state officials that it’s working to improve patient care and staff attentiveness to alarms.

The cause of the shortage is a trend toward smaller production runs of less profitable generic injectable drugs as well as manufacturing problems such as contamination that have removed large lots of some drugs from the market.

Vital drugs used in chemotherapy, critical care and treatment of several life-threatening illnesses have been in short supply. The shortages have inspired some middle-market suppliers to essentially scalp the meds, by buying back-stock where they can and offering it to hospitals at jacked up prices.

It’s a steep price difference, too: The Associated Press found that one medication for high blood pressure was being sold for $1,200 a dose instead of the usual $25.90 per dose.

Some hospitals are forced to postpone purchases to either save money or because the supplies simply aren’t available to them at any price. But when those drugs aren’t available, patients have to delay surgeries or other treatments — which leads to extra pain as well as avoidable complications, and in some cases, even death. Patients who receive the drugs bought from the so-called gray market suppliers aren’t necessarily safer. Sometimes hospitals end up unwittingly buying medications that have been stolen and may or may not have been handled and stored properly.

Besides the cost to patients’ health, hospitals are absorbing huge losses on these drugs — an estimated $415 million per year — which they won’t be able to do for much longer.

Chronic under-staffing contributed to two patient deaths at one hospital according to a new report by the Pennsylvania Department of Health. The hospital, Carlisle Regional Medical Center, had chronic problems with dangerously understaffed units according to the report. Investigators said that from June 27 to July 23, there were 233 unfilled nursing shifts in the emergency department alone and that the inadequate staffing played a part in two patient deaths.

In one case, a patient was sent for a scan without an accompanying nurse because the four nurses on duty had their hands full with a packed ER and waiting room. The patient stopped breathing during the procedure and was sent back to the ER and eventually died.

In another case, a cardiologist recommended a patient be transferred to another hospital for valve replacement. The patient wasn’t transferred and died in the ER seven hours later.

Those weren’t just cases of bad timing. The state investigation shows that the having too few staff on site was standard operating procedure at Carlisle. Among the other allegations in the report:

• An emergency department manager was fired after pushing management to address the chronic staff shortage.
• Nurses who complained about staffing levels were deemed troublesome and not taken seriously.
• Wait times in the ER could be as long as 18 hours. During the investigation period, ER beds were used as inpatient slots more than 200 times.
• The patient deaths, which are considered “serious events” which must be reported, were not disclosed to the state’s Patient Safety Authority.
• The hospital didn’t divert or transfer emergency department patients when it was warranted by wait times.
• Patients were billed as if they received in-patient service even though they were in the ER.

Carlisle issued a statement saying that it takes the report seriously and is committed to patient care.

No fines or penalties have been levied against the hospital, but it will have to provide a correction plan shortly which will be monitored by the Dept. of Health.

As her 40th birthday approached, Adriana Da Silva Toledo decided to give herself a little lift — literally and figuratively.

So, according to her family, she went to Destination Beauty MedSpa, in Framingham, Massachusetts, for a breast augmentation. She went to her parents’ home to recover, sleeping much of that day. But she still felt tired and light-headed the next day. That day she slipped and fell in the bathroom, cracking her head on the floor. She died a few hours later.

While no cause of death has yet been determined, Da Silva Toledo’s family has retained a lawyer to investigate the death. And the state’s Board of Registration in Medicine wouldn’t confirm or deny that it’s investigating the incident.

After a prior patient death at a medical spa, the state formed a task force to look into how well-regulated the spas were.

For its part, Destination Beauty MedSpa wouldn’t say if Da Silva Toledo was a patient there, citing patient privacy laws. But through a spokesperson, the owner, Dr. Sanjeev Sharma said he was “extremely saddened” to learn of her death.

Dr. Sharma is fully licensed to practice medicine, including surgery, and hasn’t been disciplined within the past 10 years, according to the Board of Registration in Medicine. But he also does not appear to have a certified specialty in plastic surgery.

Dr. Sam Jahani was arrested in Texas. Authorities are still looking for Dr. Eric Peper, who currently lives in Florida.

Peper worked for Jahani’s clinics in the Denver area between 2006 and 2010.

Prosecutors allege that both doctors defrauded Medicaid, Medicare and Rocky Mountain Health Plans by billing for procedures that weren’t rendered — including some medical services provided after the patients had died. They’re also charged with over-prescribing painkillers to patients that caused their deaths.

The feds estimated the doctors made more than $43.2 million in fraudulent claims in those four years.

A study in the Archives of Surgery compared age-matched patients undergoing the same surgical procedure. Those who had DNRs in place were three times more likely to die in the month following the procedure. The study accounted for the fact that the DNR group was sicker overall, and the difference in mortality rates remained. DNR patients also had more post-surgical complications.

Notably, the study found that the higher risk only occurred after some types of surgeries. For example, exploratory laparotomies had the highest risk for DNR patients, while thighbone fracture repair or appendectomies showed no difference in mortality rates.

The study authors say the results may help doctors advise patients with DNRs on which procedures would be more or less beneficial for them.

A study in the New England Journal of Medicine found that hospitalized patients’ mortality increased proportionally with shortages in nurse staffing.

But another study published in Medical Care, found that effect was muted when looking at “safety net” hospitals that serve the poor, uninsured, etc. At non-safety-net hospitals, patients benefited from fewer deaths from heart failure, fewer incidents involving failure to rescue, lower infection rates and fewer patients who had to stay in the hospital longer than expected.

The researchers say more data is needed to determine what causes the discrepancy, but they suspect it’s related to overall poorer health of the populations using safety-net hospitals.

Alabama public health officials are investigating an outbreak of bacterial infections at six hospitals in the state. So far, 19 patients receiving TPN, a nutritional liquid administered via IV, have become sick with Serratia marcenscens. Nine of the patients have died, although it’s not yet clear they died from contaminated product or from the illnesses that brought them to the hospitals in the first place.

Serratia marcenscens isn’t contagious from personal contact, and there is no threat to the larger population.

The company that makes TPN has halted production and distribution while the matter is investigated.

The report, appearing in the current edition of the New England Journal of Medicine, found that mismanaging staffing levels of nurses — on a shift-by-shift basis — negatively impacted patients’ mortality rates.

According to the researchers, when a hospital had nursing shifts that were understaffed by a significant amount (falling 8 or more hours under target levels), patients’ risk of  mortality went up 2%. The average patient in the study encountered three such shifts per stay, raising the individual’s risk 6%.

Under-staffing isn’t the only issue: In units with high patient turnover from transfers, admissions, etc. (and the co-responding increase in work for nursing staff) the mortality risk also increased. Each high-turnover shift a patient experienced in which turnover had a 4% higher risk of mortality. On average, patients in the study experienced one high-turnover shift.

Of course, over-staffing comes with it’s own issues, and isn’t a feasible solution to the problem. The researchers recommend making an ongoing effort to fine-tune staffing levels for each shift to adjust for changes in workload as the number of patients fluctuates and nurses workloads shift.