When malpractice occurs at community health centers, taxpayers pay

Christina Late’s son has permanent brain damage, has trouble communicating, can’t walk, and will never be able to live independently as a Pennsylvania doctor crushed part of his skull with forceps during birth.

Akimbee Burns had a Pap smear that showed abnormal cells at a public health center in Georgia. However, the results were not told to him. About eight months later, she was diagnosed with cervical cancer that had spread to her lymph nodes. Within two years she died at the age of 38.

Rhonda Jones’ baby suffered brain damage because the Chicago area medical team, including community health center doctors, could not perform an emergency cesarean section quickly enough, despite Jones being at high risk for birth complications.

Alleged in court documents as part of malfeasance cases, which were settled without acknowledgment of misconduct, these three cases are one of 485 payments made nationwide covering community health centers from 2018 to 2021. families, according to federal data released to Kaiser Health News in a public records request.

However, none of these health centers and none of the doctors paid anything. US taxpayers got the bill.

The 1,375 federally qualified health centers that treat 30 million low-income Americans in the country are mostly private establishments. They still receive $6 billion in federal grants a year and their legal obligations under federal law are met by the government, just like those of the US Department of Veterans Affairs and the Indian Health Service. This means centers and their staff can be exempted from medical malpractice lawsuits, and the federal government will pay for any settlement or court order.

As a result, the public is often unaware of allegations of misconduct against these centres. Health centers and their employees are not named as defendants in the lawsuits, and the state does not disclose when cases are finalized or court orders will be paid.

In addition, attorneys representing plaintiffs in lawsuits against health centers say federal rules handcuff patients with a short statute of limitations (two years) and do not allow for punitive damages.

“It doesn’t matter how bad the doctor’s care is,” said Regan Safier, a Philadelphia attorney who won a $41.6 million court order in Late’s birth injury case in 2017.

According to data from the Health Resources and Services Administration, which oversees community health centers, the median payout for maltreatment deals or decisions involving health centers was $225,000 from 2018 to 2021. The total was at least $1 million in 68 of 485 payments.

Most lawsuits against health centers involved allegations of misdiagnosis or dental errors. The biggest prizes were for birth injuries or cases involving children.

The $41.6 million awarded to Late, Nathan Armolt and their sons is the largest between 2018 and 2021, according to KHN analysis.

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Late went into labor at 40 weeks pregnant in February 2012 and was admitted to Chambersburg Hospital in southern Pennsylvania. Her birth took a long time, but the nurses and the obstetrician on duty noted in their notes that she was progressing normally, with no concern for her or the baby’s health, all night long, according to court documents.

The next morning, a new doctor took over. Thomas Orndorf, who works at the federally funded Keystone Center for Women, only allowed one push, followed by two unsuccessful attempts to deliver the baby using forceps—contrary to hospital rules requiring such assisted births in an emergency or after the mother has strained, according to court documents. .

She eventually delivered the baby by pushing. But the forceps crushed parts of the baby’s skull, causing permanent brain damage and lifelong disabilities. According to court documents, her son will never be able to live independently and will need to be moved to an assisted living facility when he becomes an adult, and his parents are unable to manage his care alone.

When a federal judge ordered the government to pay nearly $42 million in 2017, Keystone Health CEO Joanne Cochran said that Keystone was “saddened by the outcome of this birth and the hardships this child and family have been through and will continue to endure.”

“Keystone has taken all necessary quality assurance steps to ensure this does not happen in the future. “Every patient is important to us and a part of our Keystone family, and we try to treat them that way.”

The award will allow Late and Armolt to afford the advanced medical care their son will need for the rest of his life, but it did little to hold the doctor or the healthcare system legally accountable, Safier said.

Federally qualified health centers differ from other clinics in that they receive federal grant funding each year. They also receive higher reimbursements from Medicaid and Medicare than private doctors. In contrast, centers are not allowed to turn anyone down and charge low-income patients on a sliding scale. About half of the patients in the centers are covered by Medicaid and 20% are uninsured.

Community health centers pushed and won for government malpractice protection in the 1990s. They argued that their income was limited and that malpractice insurance would divert money that could be better used for patient care.

Immunity means that most federally qualified health center providers are not named as defendants in malpractice lawsuits, and no judgments are made against them as a result.

Malpractice lawsuits are a risk to all healthcare providers and are only a barometer of the quality of care. Conciliations and court decisions against health centers do not measure the overall performance of clinics.

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Even lawyers who sue on behalf of health care patients acknowledge the importance of the facilities. Rhode Island plaintiff’s attorney Amato DeLuca said that health centers play a vital role in the healthcare industry and found “a lot of really great, extraordinarily talented people who are doing really well” at the centers.

Still, DeLuca said, everyone should be held accountable for mistakes.

Akimbee Burns’ case is an example of an overlooked diagnosis, according to her lawsuit against the U.S. government. Burns, who earns $11 an hour at a utility company, had a Pap smear done in 2016 at the South Central Primary Care Center, a public health center in Ocilla, Ga. The test results showed abnormal cells, but he was not informed about the results. according to the complaint. He asked about the test several times in the following months, but claimed he was still not informed about the results.

About eight months later, staff at a different healthcare facility diagnosed advanced cervical cancer. He filed a lawsuit alleging that the community health center was negligent. He had radiation and chemotherapy. However, he died in April 2019, leaving behind two children, one of whom is a minor.

After his death, the government and his estate settled for $2.1 million.

The South Central Primary Care Center did not respond to requests for comment, and the government denied any wrongdoing.

A patient who claims medical malpractice by a healthcare facility must first submit their claim to the U.S. Department of Health and Human Services for review. The government can offer a settlement or reject the claim. If the claim is denied or cannot be resolved, or if the six-month review period expires, the patient may file a lawsuit in federal court under the Federal Claims Act or the FTCA.

To obtain this federal protection, healthcare centers must have quality improvement and risk management programs and demonstrate to regulators that their doctors and other clinicians have reviewed their professional credentials, malpractice claims, and licensing status.

Ben Money, senior vice president of the National Association of Community Health Centers, said the process has improved care and redirected scarce operating dollars to patients’ needs and costly malpractice coverage.

“There are stringent measures in place to ensure that health center grantees follow the rules and patients receive the best care,” he said. “FTCA is making health centers more mindful of quality, not less.”

Christy Choi, spokesperson for the Health Resources and Services Administration, said that as of September, about 86% of community health centers fall under the FTCA due to medical malpractice coverage.

He said the government has implemented “strong quality improvement and patient safety efforts” as part of the program.

Lawyers involved in lawsuits against health centers said the system makes it more difficult for patients to recover damages compared to going to state courts for malpractice lawsuits. In addition to the ban on punitive damages, such cases are decided by federal judges rather than juries. They added that the absence of a jury was important because judges are less likely to be affected by emotions, which could mean lower dollar amounts in prizes.

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Christopher Russomanno, a Miami attorney, said plaintiffs are also at a disadvantage because the federal government has unlimited resources to defend cases.

“These cases cost us hundreds of thousands of dollars to prepare for court,” said Jack Beam, Illinois attorney representing Rhonda Jones. “Our record in case costs was $900,000.”

All these factors can prevent patients from finding a lawyer.

Deborah Dodge, a Missouri attorney, said some attorneys are reluctant to take cases because the government has limited their fees to 25% of the settlement amount. By contrast, plaintiff attorneys typically take about 40% in successful state court malpractice cases.

Rhonda Jones was one of the deals. According to her lawsuit, her baby was taken to a children’s hospital just after she was born by emergency cesarean section at West Suburban Medical Center in the Chicago area in December 2016. The baby, named Alayna, was treated for brain damage caused by lack of oxygen and is currently suffering from cerebral palsy.

When Jones arrived at the hospital at about 39 weeks pregnant, she showed signs of high-risk labor: She was 40, this was her 11th child, and had severe preeclampsia and possibly gestational diabetes.

Alayna’s case alleges that she was not adequately monitored at the hospital and that the surgery was not performed in a timely manner to avoid Alayna’s injury.

Jones agreed to a $21 million settlement, $15 million of which was paid for by the federal government because some of the doctors involved were employed by the PCC Community Wellness Center. The health center and hospital declined to comment. In court filings, the government and hospital denied guilt.

The money, most of which is in a custody overseen by the court, provides a livelihood for Alayna, who will be in need of care for the rest of her life.

“Before what happened to Alayna, I loved them,” Jones said of the health center that Alayna went to for many of her previous pregnancies. “They were great for me as they were open late at night when I was working.”

“Still, I would tell someone to go to the PCC because maybe when they go to have their baby, they’ll find the right doctors,” Jones added.

Inquirer reporter Sarah Gantz, KHN intern Alander Rocha, and KHN reporter Colleen DeGuzman contributed to this article.

Kaiser Health News covers health issues.

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