Study Design. Case-control study. Objective. To analyze patient complaints, potential risk, and malpractice events involving orthopedic spine surgeons over a 10-year period. Summary of Background Data. Unsolicited patient complaints may be associated with risk management and malpractice events. Methods. We analyzed patient complaint, potential risk event, and malpractice event data for six orthopedic spine surgeons over a 10-year period. Patient complaints were analyzed and classified according to the Patient Complaint Analysis System. Baseline demographics were recorded for patients with complaints as well as the surgeons. A control group consisting of all patients seen by the six surgeons during the study period was created to identify patient and physician risk factors for formal patient complaints. Event rates (for complaints, risk, and malpractice events) were calculated by dividing the number of events by the total number of unique patients seen. Results. There were 214 complaint designations among 202 patients with formal complaints, resulting in a complaint rate of 0.79%. Patients were most likely to complain about access and availability (35%) followed by care and treatment (32%). Of the 68 complaints regarding care and treatment, 34 were related to dissatisfaction with surgical outcome. Complications were identified in 26/34 cases. The malpractice event rate ranged from 0.06% to 0.65%. Patients who had surgery (P< 0.0001) or a mental, behavioral, or neurodevelopmental disorder (P = 0.0004) were more likely to file complaints compared with the control group. Conclusion. While infrequent, patient complaints against orthopedic spine surgeons are most related to access and availability. The rate of malpractice events varies widely between surgeons.
Under the landmark 1976 Estelle v. Gamble decision, the U.S. Supreme Court affirmed that prisoners have a constitutional right to adequate medical attention and concluded that the Eighth Amendment is violated when corrections officials display "deliberate indifference" to an inmate's medical needs. 1 The manner in which states manage prison health care services that meet these legal requirements affects not only inmates' health, but also the public's health and safety and taxpayers' total corrections bill. Effectively treating inmates' physical and mental illnesses, including substance use disorders, improves their well-being and can reduce the likelihood that they will commit new crimes or violate probation once released. 2 The State Health Care Spending Project previously examined cost data from 44 states* and found that prison health care spending increased dramatically from fiscal year 2001 to 2008. However, new data from a survey of budget and finance staff officials in each state's department of corrections, administered by The Pew Charitable Trusts and the Vera Institute of Justice, show that some states may be reversing this trend. This report examines the factors driving costs by analyzing new data on all 50 states' prison health care spending from fiscal 2007 to 2011. † It also describes a variety of promising strategies that states are using to manage spending, including the use of telehealth technology, improved management of health services contractors, Medicaid financing, and medical or geriatric parole. The project's analysis of the survey data yielded the following findings: • Correctional health care spending rose in 41 states from fiscal 2007 to 2011, with median growth of 13 percent, after adjusting for inflation. • Per-inmate health care spending also rose in 39 states over the period, with a median growth of 10 percent. • In a majority of states, however, total spending and per-inmate spending peaked before fiscal 2011. Nationwide, prison health care spending totaled $7.7 billion in fiscal 2011, down from a peak of $8.2 billion in fiscal 2009. The downturn in spending was due, in part, to a reduction in state prison populations. • From fiscal 2007 to 2011, the share of older inmates-who typically require more expensive care-rose in all but two of the 42 states that submitted prisoner age data. ‡ Not surprisingly, states where older inmates represented a relatively large share of the total prisoner population tended to incur higher per-inmate health care spending. As states work to manage prison health care expenditures, a downturn in spending was a positive development as long as it did not come at the expense of access to quality care. But states continue to face a variety of challenges that threaten to drive costs back up. Chief among these is a steadily aging prison population. Data from the survey can provide state decision-makers with information to assess both their own state's * The source of these data was the Bureau of Justice Statistics. † States' fiscal years differ. (See Appendix ...
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