A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Not MModal but tragic result of outsourcing - Disgusted

Posted: Jan 07, 2013

I wish every American could see this story and someone put a stop to this outsourcing. People are dying because of it!

http://www2.wkrg.com/news/2012/dec/14/140-million-verdict-against-thomas-hospital-ar-5170702/

They can,,,post on FB, I did yesterday - nm

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x

Wrong conclusion - old and burned out

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I am also opposed to off-shoring but the reason for this death was not off-shoring, it was the result of the physician(s) involved not taking the time to review and sign the report and the hospital forwarding the report without a signature. The MT, who that may be, cannot be held responsible.

It still brought out other good points - nm

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x

It certainly did - old and burned out

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but if the doctor and the hospital had done their jobs properly, the off-shore transcription would not have been the issue. Even if the work had been done in the U.S., there is still a chance there could have been an error and the doctor would have needed to review it. I'm sorry to say this but I think that unless the errors are so frequent and so egregious that it requires too much physician/hospital time to deal with them, they will keep trying to save their 2 cents per line.

I was thinking same - USAMT

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And wasn't it a med dose? Insulin, I think, a dose that really can be anything, not like other meds where MT or dose-giver sees a red flag on an obvious incorrectly dictated/transcribed number.

agree - nm

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I would have to agree with this statement. - sm

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Yes, offshoring is a problem but that could have been transcribed just as well by an MT in the USA or it could have been a speech rec job that went unedited in that portion.

The physician is ultimately responsible, and I'm kind of tired of people assuming it was simply from offshoring. Many MTs make critical errors but it is the responsibility of the author of the report to read over it and sign it off.

Should the MT have questioned the units? Probably. Ultimately though, we as MTs are not physicians and we are not authors of the reports either.

It makes me sick to my stomach to see these types of errors but there are other safeguards as well, for example, dangerous abbreviations, sending it through with a blank.

The other thing I find odd is that the nursing home staff themselves did not question this unit of measurement. One would think a nurse would know more than an MT.

I just see a lot of holes in this story and it doesn't necessarily solely relate to the MT not in the US.

Sorry to burst everyone's bubble, but the blame lies on the physician and the nurse administering the drug, not the MT.

Suprised at posts - me

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This was a tragedy all the way round.

As transcriptionists, I am suprised at some of these replies, especially in a field, where we are losing work due to VR, EMR point-and-click systems, etc. I am sorry, but it was initially the MT's responsibility. I personally market myself and services as a "third pair of eyes" and do think it is our responsibility, as what is transcribed, including errors, can be carried over from the initial reports to others.

Case in point: I transcribe operative/procedure notes for a surgery center, the owner of which I transcribed his office work prior to EMR. They implant drug delivery systems. One day while pulling info from an office consult for an operative note, I noticed a HUGE narcotic dose error, enough to kill the patient several times over. I knew the transcriptionist who transcribed this and contacted her, pointing the error out. She stated it was not her job to look up drug dosages, which I told her it was (I had already fired her from transcribing work for me for pretty much the same thing). The physician's office then saw the error, and the service she worked for was fired. She is out of a very high-paying job, the service owner (who also transcribed on the account) and several other MTs also lost their jobs. She cannot find another job and especially at that pay rate.... The patient is alive though, thank goodness. Ironically, same physician's office, the physician assistant was fired, again, due to incorrect doses.

Yes, it was the physician's responsibility and the nurse's to double check, but they sometimes do not catch errors. Part of the MT's job description is to flag errors/inconsistencies. It is unfortunate this was a fatal error.

to the MT credit - still say it ends with the dr

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The MT transcribed Levemir 80 units. I take Levemir - 80 units. I'm not dead. The MT only has what she/he is given to work with.

The DOCTOR knew if this particular patient should have only a very miniscule amount of insulin. It was HIS order. HE should have been the one to make sure it was correct.

How many times have you listened over and over and OVER to see if a doctor is saying 15 or 50? Sometimes you just don't know. You check the dosages and sometimes they can both be valid. As an MT, I'm highly skilled, but I'm not a mind reader. I don't get to know the patient's entire medical story. I don't get to know if a doctor is trying something off label. I don't get to know what he's THINKING unless he clearly communicates that to me.

I'm sorry this woman died, but IMO, the doctor is who should be shouldering the blame.

when a transcriptionist is told to type "verbatim" - and is "dinged" for not doing so

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with such things as "and", "the," and comma placement, and the doctor dictates 70 mg instead of 70 mcg, it is totally on the doctor first, the MTSO second for demanding verbatim transcription. It is not up to the transcriptionist to "correct" or change anything other than what the doctor speaks, as per punitive QA and the directions of the MTSO ad nauseum. The transcriptionist is not allowed to make those kinds of changes or decisions.

Editing.... - me

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Then shame on that MTSO. I have my own accounts and am expected to "use my head" and catch and flag their mistakes, which they deeply appreciate, and I am compensated for..... I have full editing privileges. I get in trouble for not flagging.

Yes, it was the dictating physician's responsibility and the nurse's, but I believe it is ours also.

terrible - sm

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I don't see this as an outsourcing or offshoring problem, however.

First of all, numerical errors like these are made by U.S. MTs. Second, presumably these documents are overseen by duly fluent speakers and checked against the sound file. Third, a human being at the hospital, like a nurse or the discharge planner, ought to be reviewing the discharge summary for completeness sake. Fourth, a DOCTOR signs off on the whole mess.

It is an overall lack of consciousness, lack of conscientiousness, lack of respect, lack of attention, and lack of oversight that makes these tragic errors possible. Care and attention at any step in this process could have prevented this terrible event.

old news - in the grand scheme

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of things.

The REALITY, however, is that this physician should have been checking his reports before he attached his signature to them. The fact that he didn't is not the fault of the MT or MTSO IMO.

People have been dying due to medical mistakes since the beginning of time. On this one, MTs want to blame the process when in reality, bottom line is the physician needs to READ every report instead of throwing on an autosignature and calling it a day.

and - errors

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A. Why didn't someone who was eligible to be passing meds and should have known better -- catch the med error?

B. Why didn't the doctor catch the error?

C. Why didn't utilization review catch the error?

This is SOOOOO not about this report having been transcribed in India.

The transcription error was agregious but there are so many stops along the way from transcription to utilization that should have caught this error.

Errors - MTtoo

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Regardless of who is responsible, and yes I do agree it was the physician/staff, etc., other than an MT, BUT, the first line states transcription done in India and that is a strong statement. They are blaming the MT in India. Again, you have to realize, J Q Public, doesn't get what we do and to hold a doctor accountable for an oversight????? Of course the doctors don't read those reports or nurses question the dosage, like everything else in medicine, it is a business and they are not in the business of caring or paying particular attn. The nurses want to put their shift in and be done; the doctors are disgruntled as well. This class action sit won't change things at all as far as off shore transcription, but it at least makes it sound like the blame lies in sending the work to India! Big deal, I know, but it's something.

not placing blame where it belongs will not fix the problem - sm

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this isn't about India. It's about shoddy care, lack of quality assurance, and lack of attention.

exactly - India is not the issue

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I hate to see people focusing on or dwelling on the fact that this particular error was done by an MT in India. I can tell ya, these same mistakes get made every single day by MTs here.

There are enough people whose eyes touch that report that it's absolutely inexcusable the error was not caught.

This abbreviated article neglects to mention what original article did... - the amazingly low quality standards in India.

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"Finkbohner said the hospital saved 2 cents per line of text by using the outside firm. But he said it came at a price: Testimony indicated that the Indian firms operate under quality standards that are one half to one twelfth that of the United States in terms of acceptable error rate."

So even if a U.S. MT could have made the same mistake, the odds are MUCH greater that such an error would come from India.

The shorter article that the OP posted is the first time I've seen that there were "three critical errors," though. I wonder what the other two were besides the dosage error?

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