Jim Nabors Would Just Cry

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by Dr. Michael Miller

For those of you not as familiar with the Hoosier State as you should be, I used to think it was essentially paradise. Jim Nabors of Gomer Pyle fame is our ubiquitous, tuneful icon with his always well-received “Back Home in Indiana” as a mantra to that source of pride.  Our former Governor “My Man” Mitch Daniels was a genius who, using a combination of intelligence, common sense and the persuasive powers of a midwest Svengali, created an economic model that our neighbors can only lust after. Our medico-legal climate is among the best in the US and well it should be.

However, while there are some extraordinary caregivers and facilities here, a recent US News and World Report curiously showed that almost none of our hospitals made their “Best of” lists in any category. That is not to say there is bad care, but to not have a single facility in an entire state even achieve an honorable mention gives one pause to reflect. The state newspapers were notoriously quiet on this concerning fact, despite their trumpeting of who does what well, when and where.

To give an insight into why this may have happened, I offer the following. Several years ago, our Department of Health created a pressure ulcer task force initiative designed to establish guidelines, which were intended to improve prevention, treatment and reporting. There was a great hullabaloo from the department and the many entities invited to participate regarded the creation of this work as a pressure ulcer paper messiah.

Of course, you must remember that development of pressure-based tissue injuries that are currently called Stage 3 and Stage 4 are to be reported to CMS as they are now considered NEVER EVENTS.  (Dare I use this moment to prognosticate my next blog discussing the complex, stupid and illogical systems currently used to “Stage” these?) And more, these numbers are to be reported as part of a medical errors reporting system.

There is a generally acknowledged fact that for better or worse, despite the very rare “unpreventable” pressure-based tissue injuries, the development of a pressure ulcer in a hospital is as ubiquitous as Facebook lurkers.  With approximately 200 acute care facilities, even the most optimistic (and deluded) health care professionals I have spoken with offer numbers anywhere from five (5) Stage 3 and 4 pressure-based tissue injuries up to 200 per month. Nobody has suggested fewer and there have actually been some who thought there were more. Simple mathematics, using even the low number, would result in approximately 12,000 bedsores developing right here in the Hoosier State (5 bedsores x 200 hospitals x 12 months). 

And so, to cut to the chase, the most recent report from our Indiana Department of Health for medical errors in 2013 was recently published.  It identified the names and numbers regarding the facilities that honestly disclosed their medical errors (based on mandates with severe, punitive actions for failing to do so). Forty-five bedsores were reported!!  Moreover, the officials in charge of this program were outraged because the prior year, there had been 30 reported, which demonstrated a 50% increase!

At this point, I will pause and allow you to re-hinge your jaw from the unquestionable drop it took. 45 bedsores, a 50% increase from a year prior and a national report on health care performance demonstrating that there may be health care here, but it is probably better almost anywhere else? And so, regardless of the veracity of these numbers, they still mandated action.

Of course, the powers that be plodded explosively into action announcing new programs to improve care. When my children were naughty, they were punished. When they lied about being naughty, the punishment increased. Closing my eyes, plugging my ears and telling my wife that I will be creating initiatives to improve their behavior sounds good, but trying to put a patch on a badly broken and dysfunctional wheel is simple bureaucratic buffoonery.

IS the grass greener on your side of the wound dressing? What is your state up to in terms of pressure ulcer prevention, treatment and reporting? As far as our state song sung with such vim and vigor by Jim …perhaps the title needs to be, “Back home anywhere but Indiana.”

Until we ramble together next time.


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Dr. Michael Miller is Board Certified in General Surgery by the American Osteopathic Association and initially received his 10-year certification in wound care by the American Academy of Wound Management in 2000 and the American Professional Wound Care Association in 2005.
His practice has been devoted exclusively to wound care and related issues since 1998. He is one of very few full-time physician wound care specialists in the State of Indiana, as well as the U.S. He has published numerous articles in peer-reviewed journals, written chapters in wound care texts, and presented poster exhibits and podium presentations at numerous domestic and international conferences.
Dr. Miller is also a consultant to numerous companies in the wound care industry and provides expert consultations to professionals in the investment and legal industries. In addition to his clinical practice, he owns several patents on wound care devices. Dr. Miller was named the American Osteopathic Foundation's 2010 Physician of the Year.