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Patients’ Complications from “Never Events” No Longer Covered

Since 2007, many private health care providers and government officials at the Center for Medicaid and Medicare Services (CMS) began to proclaim they would no longer foot the bill for patient complications resulting from "never events". However, many worry that the list of never events has expanded from obvious egregious preventable incidents to incidents that are not necessarily preventable.

The 2007 CMS decision was based on a study done by a national coalition of health care safety and quality experts. The experts created a list of never events, or negligent procedures that should never be performed on patients. The list of events includes such instances as where a doctor performs surgery on the wrong body part (wrong site errors) or leaves an instrument inside the patient's body cavity (a foreign object) during surgery. If any of these types of incidents occur, CMS stated it would not pay for the continuing medical problems resulting from the negligent procedure.

Many agree the coalition's original list of never events is reasonable. But the list of never events has grown and expanded. Never events now include not-so-preventable procedures, such as complications that may result when caring for patients with an increased risk of trouble because of preexisting conditions.

Catheter-associated urinary tract infections, post-operative pneumonia, and inadequate glycemic control are examples of procedures that have been added to the list since 2007. Many argue that these procedures cannot possibly exist in the same classification as a procedure where a doctor negligently operates on the wrong side of a patient's body. However, because they remain on the list, CMS and some private health insurers refuse to cover the cost of additional medical treatment.

Since the list of never events has grown to include not-so-preventable procedures, some argue that doctors will opt to provide care only to healthy patients. CMS and private health insurers, however, argue the list is designed to deter substandard patient care and curtail rising health care costs.

Doctors carry a duty of care to every patient they treat and if a doctor breaches that duty, medical malpractice liability results. If you have been the victim of medical malpractice, or feel that you have been subject to managed care abuse or HMO abuse, contacting an experienced personal injury attorney focusing in this area is vital. You may be entitled to compensation for your medical expenses, pain and suffering, and lost wages.

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