As a Houston, Texas medical malpractice attorney, I have successfully resolved a number of lawsuits involving the misdiagnosis of stroke in hospital emergency room settings. Even as I write this article, I am preparing to file another stroke misdiagnosis case at a major hospital in The Woodlands.
One thing has surprised me about all the stroke cases that I have handled. Sometimes the stroke diagnosis is missed and botched even at well-known hospitals that have voluntarily gone through the process of obtaining primary or comprehensive stroke certification.
Many hospital emergency rooms that lack any stroke certification are not equipped to treat strokes promptly.
Primary Stroke Centers have equipment and staffing to diagnose and treat some types of stroke. In the Houston area, these hospitals have been designated Primary Stroke Centers: Cypress Fairbanks Medical Center, Houston Methodist San Jacinto, Houston Methodist Sugar Land Hospital, Houston Methodist West Hospital, Houston Methodist Willowbrook Hospital, Houston Northwest Medical Center, Memorial Hermann Greater Heights Hospital, Memorial Hermann Katy Hospital, Memorial Hermann Memorial City Medical Center, Memorial Hermann Northeast Hospital, Memorial Hermann Southeast Hospital, Memorial Hermann Southwest Hospital, Memorial Hermann Sugar Land Hospital, Memorial Hermann The Woodlands Hospital, North Cypress Medical Center, St. Joseph Medical Center, and West Houston Medical Center.
Comprehensive Stroke Centers are equipped and staffed to handle even the most complex types of stroke. In the Houston area, these hospitals hold the Comprehensive Stroke Center designation: CHI St. Luke’s Health Baylor College of Medicine Medical Center, Clear Lake Regional Medical Center, Ben Taube Hospital, Houston Methodist Hospital, Kingwood Medical Center, Memorial Hermann Hospital, and St. Luke’s The Woodlands Hospital.
National standards for stroke centers
There are two principal organizations that provide stroke certification standards and recognitions to hospitals. The first, and oldest, organization is The Joint Commission. More recently, a for-profit entity, DNV Healthcare, got in the accreditation/certification business. When it comes to stroke certification, most medical and nursing experts agree that the standard required by The Joint Commission and DNV Healthcare are similar.
Primary and comprehensive stroke centers must have policies and procedures in place to guide the timely workup, diagnoses, and treatment of strokes by physician and nursing staff. In addition, stroke centers must have a robust educational program to train everyone from emergency medical technicians (EMTs or ambulance crews) to nurses and physicians on how to handle suspected stroke cases.
Accreditation and certification standards provide hospitals with a guide on how to organize their provision of healthcare in a way that promotes quality and patient safety. Plus, as a former hospital administrator, I can tell you that when it comes time to renew accreditation or certification, it is “all hands-on deck” at hospitals, with careful focus on revising policies, procedures, and staff training to meet the standards.
Accrediting and certification organizations have unique insights obtained from their access to patient outcome data and statistics that are not publicly reported or available. They study this information and, from time to time, update accreditation and certification standards to raise the bar higher where there are common areas of concern.
Recently, The Joint Commission announced new performance measures for Primary Stroke Centers, which will become effective on January 1, 2019. Before the new standards, The Joint Commission did not focus on outpatient stroke care.
One of the new standards is the Stroke Outpatient Measure, which assesses Primary Stroke Center hospitals’ performance in timely transferring stroke patients to a higher-level Comprehensive Stroke Center for appropriate care. This performance measure focuses on patients who are not admitted to a Primary Stroke Center hospital, but rather are only treated in the emergency room. Hospitals will be required to monitor and report the median time, in minutes, for hemorrhagic stroke patient transfers and four different groups of ischemic stroke patients.
A second new performance measure focuses on the proportion of the ischemic stroke patients who are assessed with the National Institutes of Health Stroke Scale (NIHSS) scoring system under two sets of circumstances. In my experience as a medical malpractice lawyer, the Stroke Scale Score is a useful objective indicator that helps physicians and nurses focus on relevant data points in part of the decision-making process of whether patients may be suffering from stroke.
Hospital emergency room standard
Any time I write or speak about medical negligence occurring and a hospital emergency room, I must mention that Texas law imposes a heightened legal standard for bona fide emergency care cases. The standard, which is called willful and wanton negligence, is equivalent to gross negligence, according to a decision of the Texas Supreme Court.
It is hard to overstate the importance of this fact in terms of investigating and preparing a hospital emergency room case for filing and an eventual trial. Patients who have been seriously injured from poor emergency room care should hire an experienced Texas medical malpractice attorney to handle their case. A month rarely goes by when I do not receive a call from an attorney over his or her head in a medical malpractice case with the two-year statute of limitations looming around the corner.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.