Reliance on high-tech and high-turnover leading to lawsuits in ‘hospitalist’-heavy San Antonio

Olga De La Zerda went into Metropolitan Methodist Hospital on February 16 to determine if a bit of congestion was a sign of a more serious infection. It should have been a simple day of observation in the hospital, her family alleges, but care for the 87-year-old was transferred over to a “hospitalist” doctor tasked with managing many more patients.

De La Zerda’s daughter, Olivia Reyna, says she waited many hours before getting an opportunity to talk to the hospitalist. When she finally pulled him aside to discuss her mother’s care, the two locked horns almost immediately as Reyna objected to his recommended drug regimen, which, she says she warned him, had caused bad reactions in her mother in the past.

Yet it’s just that sort of engagement that the Institute of Medicine (IOM) urges of families and patients. Doctors are encouraged to educate patients about drug treatments to help prevent medical errors, which kill 15,000 elderly people every month. The strategy also puts the onus on patients and families to take more responsibility for monitoring medication use. Unfortunately, engagement backfired for Olivia Reyna when she found herself banned from Methodist in the days preceding her mother’s March 12 death. “She was sensitive to medication, but the hospitalists did not want to hear what we had to say,” Reyna said.

A death certificate says De La Zerda died of septic shock, with pneumonia and acute respiratory failure as contributing conditions. But relatives are convinced that a multitude of medications — administered against the family’s wishes — caused adverse reactions that eventually shut down De La Zerda’s body after three and a half weeks in the hospital. “My mother wasn’t on her death bed when she went to that hospital,” said De La Zerda’s son, Al, a limousine driver and musician. “If she hadn’t gone there, she would still be alive.”

At the time of her death, De La Zerda was under the care of a doctor employed by IPC The Hospitalist Company, which provides contract “hospitalists” to more than 14 hospitals in the San Antonio area. So-called hospitalists are medical personnel who contract with hospitals to manage large numbers of patients – sometimes two dozen or more in a shift. They are typically compensated per patient “encounter,” an incentive to maintain a high volume of patients.

IPC, the country’s largest publicly-traded hospitalist practice, has been named in seven unrelated, local malpractice lawsuits, including a death involving circumstances similar to the scenario described by De La Zerda’s children.

Both involve allegations that hospitalists failed to review medical histories or consult with primary care physicians before authorizing powerful drugs. Many studies say these types of deaths are preventable. But institutional change is needed across corporate health care, which often regards patients as commodities, making some doctors more accountable to shareholders than the Hippocratic Oath. This is exacerbated in Texas with tort reform, which often means families like the De La Zerdas can never expect medical justice.

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