The highest penalty of $100,000 was assessed on two hospitals:  Mission Hospital Regional Medical Center, Mission Viejo, and  Scripps Memorial Hospital La Jolla. In both cases, patients needed to have second operations performed to remove retained foreign objects after staff didn’t follow proper procedures.

The rest of the penalties were for $50,000 or $25,000. Most were for failure to follow surgical procedure or failing to implement appropriate policies for the safe administration of medication.

You can read the news release — with links to the individual reports for each incident at the California Department of Public Health.

While a surgeon who showed up drunk would be stopped from operating, there’s no realistic enforcement on how much a surgeon drinks the night before surgery. And in surveys, about half of health care workers have admitted they’ve gone to work hungover.

So a research team recently tested a small group of doctors to see if a night of drinking affected their performance, and if so, to what degree.

For the study, six surgeons with experience doing laparoscopic procedures were taken out for a dinner — including all booze they could handle. The doctors were asked to drink until they felt they were intoxicated. (Researchers provided rides home for the physicians.)

The next morning, the doctors were brought to a lab and asked to perform simulated laparoscopic surgeries, while the researchers measured various technical aspects of their performance. Before starting the tests, breathalyzer tests were administered to ensure the doctors were not legally drunk.

The doctors were tested in the morning, at lunchtime and in the late afternoon. Each time, they performed slightly worse than their baseline test. In general, the doctors made more mistakes and were less efficient in using the equipment. Notably, the morning “procedures” took less time than the baseline tests, while the afternoon simulations took much longer.

Although the study was too small to draw solid conclusions about when and how much doctors should be allowed to drink before surgery days, researchers did say that abstaining from alcohol the night before a procedure is probably a wise move to ensure the doctor’s skills aren’t impaired.

Read more about the study in the Archives of Surgery.

What kind of discipline do doctors face when they commit serious violations of patient safety? In many cases, nothing at all.

That’s what Public Citizen discovered after analyzing records from the National Practitioner Data Bank Public Use File for 1990-2009. The research found that of more than 10,000 physicians in the file who had at least one revocation or restriction of their clinical privileges, 45% also had one or more state licensing actions — which means 55% of the docs didn’t.

In one of the states least likely to take disciplinary action, California, the group found that the state medical board had failed to discipline about half of the doctors who had been disciplined by their own hospitals or health organizations between September 1990 and December 2009. That’s more than 700 doctors — most disturbingly, 102 of those doctors had been deemed by their peers as an “immediate threat” to patient health or safety.

Typical actions that landed physicians in the database were alcohol and substance abuse, providing substandard care, wrong diagnoses and leaving equipment in surgical patients.

Yet the state medical board didn’t act.

Since the initial report this spring, the state medical board hasn’t picked up the pace, and Public Citizen sent a letter to the governor outlining both the slow action against potentially dangerous docs and the state’s alarming recent decline in enforcing medical standards.

While these complaints are specific to California, it’s hardly the only state where malpractice is dealt with something less than haste. The real question is why some states seem to make it a practice to do little more than wink at physicians’ serious missteps.

Do physicians get a free pass when it comes to unprofessional behavior? Or is it merely that the process moves slowly? Share your thoughts in the comments.

Attention all germophobes: Latex gloves may actually worsen the hand hygiene of health care workers who wear them. That’s the finding of a recent study published in the journal Infection Control and Hospital Epidemiology.

The researchers found that health care workers who wear latex gloves are less likely to wash their hands in between patients.

That’s a problem because latex gloves are far from foolproof when it comes to protecting patients and health workers from each others’ germs.

Germs can travel through the latex material, or get sprayed through the air when the gloves are removed. Since gloves are most commonly worn when providers are dealing with the sickest of patients or procedures that are most likely to involve bodily fluids, it means even greater exposure to germs through health care workers’ germ-tainted hands.

For the study, researchers reviewed more than 7,000 contacts between doctors and patients, at 15 different hospitals throughout England. They found that the overall hand-washing rate among physicians was just under 48%. But when doctors wore latex gloves — for about 25% of patient interactions — the hand-washing rate dropped to a dismal 41%.

Essentially, when dealing with the sickest and most infectious patients, doctors are least likely to wash their hands. The researchers suspect doctors and other health care workers are lapsing on hand-washing out of the mistaken belief that latex gloves are impervious to germs and therefore, wearing them leaves their hands clean. In fact, latex gloves lower the risk of germ transmission — they don’t prevent it.

In the case, a 20-year-old former patient was involuntarily admitted to HCA Health Services of Tennessee and Skyline Medical Center suffering from hallucinations. While a patient in the hospital, she claimed another male patient entered her room and sexually assaulted her in the shower. Staffers interrupted the attack, moved the female patient and placed her under tighter supervision.

She sued the next year, claiming that the hospital hadn’t monitored her closely enough, hadn’t given appropriate supervision to the male patient who attacked her and took in more patients than it had the ability to care for properly.

The hospital fought the suit, noting among other reasons that medical malpractice guidelines didn’t apply in this case. After a series of appeals, the court ruled that the hospital could be sued on the grounds of ordinary negligence.

Cummings asked five of the so-called “gray market” companies to provide information on their sales of drugs that are in short supply nationwide. Cummings is interested in reports that some companies are selling the drugs at dramatic markups of hundreds of times their normal prices — in at least once case, a drug that normally sells for around $26/dose was priced at $1,200/dose. Cummings is a ranking member of the House Committee on Oversight and Government Reform.

So far, one of the five companies is cooperating with the information request.

Aside from being unfair and potentially illegal, the shortages and the questionable supplies that some hospitals are forced to use have raised questions of patient safety.

Cummings’ office has set up a tip line for information on price gouging.

Helsom said she suffered painful episodes for months which led to hospitalizations, but her doctors could not explain the cause. Helsom feared she would eventually die from the strange condition she was battling.

Eventually, it was discovered that Helsom’s 5 mcg dose had been filled repeatedly with 50 mcg. Helsom’s exact medication wasn’t named, but a pharmacy spokesman said that the 50 mcg dose was within therapeutic guidelines, so it didn’t trigger any red flags as an inappropriate dose.

The pharmacy, part of the Walgreens chain, has offered an apology, but wouldn’t say if any employees have been disciplined for the on-going error.

The Arizona State Pharmacy Board is investigating the incident to determine if negligence played a role.

1. Advocate Health Care, Oak Brook, IL
2. Cape Cod Healthcare, Hyannis, MA
3. CareGroup Healthcare System, Boston
4. Kettering Health Network, Dayton, OH
5. Maury Regional Healthcare System, Columbia, TN
6. Mayo Foundation, Rochester, MN
7. NorthShore University HealthSystem, Evanston, IL
8. OhioHealth, Columbus, OH
9. Partners Healthcare, Boston
10. Spectrum Health, Grand Rapids, MI

Thompson Reuters rated the hospitals on eight key criteria:

• In-hospital mortality
• Medical complications
• Patient safety
• Average length of stay
• 30-day mortality rate (post-discharge)
• 30-day readmission rate (post discharge)
• Adherence to clinical standards of care (evidence-based core measures published by the Centers for Medicare and Medicaid Services
• Hospital Consumer Assessment of Healthcare Providers and Systems patient survey score (part of a national initiative sponsored by the U.S. Department of Health and Human Services to measure the quality of care in hospitals)

That’s the takeaway from a report just published in Health Affairs.

In a new study, researchers at the University of Utah and the Institute for Healthcare Improvement, looked at three methods for identifying adverse events among nearly 800 patients who had been hospitalized.

The study drew on comparable samples of patients from three leading hospitals that had undertaken quality and safety improvement efforts.

Of the reporting methods used, the number of adverse events actually detected varied greatly:

• Voluntary reporting detected four events
• the Agency for Healthcare Research and Quality (AHRQ) Indicators detected 35, and
• the Global Trigger Tool detected 354 events.

According to the researchers, the AHRQ indicators and voluntary reporting thus missed more than 90% of adverse events identified by the Global Trigger Tool — and they consider that a conservative number because they relied on medical record review, which would be expected to pick up fewer adverse events than real-time observation would.

The researchers say that voluntary reporting and AHRQ indicators may be giving a misleading impression that the U.S. health care system is safer than it is.

That’s the sad finding of the study, “The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives.”

According to the researchers, although 85% of health care workers said they had been alerted to a potential patient risk by a safety tool, 58% of those who had received a warning admitted they hadn’t mentioned it to other health staff or resolved the problem.

Respondents cited three main reasons that safety issues were difficult to bring up: Other staffers’ dangerous shortcuts, incompetence and disrespect were seen as “undiscussable.”

While safety devices have an important role to play, their usefulness is hampered when health care staff have such difficulty communicating with each other.

The study was a joint project of the American Association of Critical-Care Nurses, the Association of periOperative Registered Nurses and VitalSmarts.