Ventilator Associated Pneumonia – Bad But is it a “Never Event”?

There are a number of “never events” in hospitals.  The list of never events arose out of recommendations from the National Quality Forum and the Centers for Medicare & Medicaid Services.

These so-called “never events” are according to an article from the American Journal of Managed Care  “medical errors so egregious they should never occur.”  The National Quality Forum includes 29 such errors on their list of never events.

Ventilator Associated Pneumonia (VAP) is one error that did not quite make the list though there is some controversy.  There is no disputing the great harm that is caused by VAP.  The controversy arises out of the preventability of VAP.

Patient Harm from Ventilator Associated Pneumonia

Hospital acquired infections are at near epidemic levels.  According to the article from the American Journal of Managed Care, hospital acquired infections result in annual costs of $9.8 billion to the healthcare system.

A large percentage of these HAI’s are related to VAP, 32% according to the article.  The average costs per patient for VAP is over $40,000.

Prevention of VAP

Reports indicate a number of different interventions that might help reduce the risks of VAP.  However, it seems to be that these interventions will not eliminate VAP completely.

The “important interventions” noted in the report are “daily sedation breaks, elevation of the head of the bed, avoiding unnecessary changes in the ventilator circuit, secretion drainage, oral decontamination, etc. These can decrease the risk, but not eliminate it.”

These closely mirror the best practices for avoiding ventilator associated pneumonia set forth by the CDC:

“The preferential use of oro-tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions;”

VAP Suggestive of Medical Negligence?

The presence of VAP may or may not reflect medical negligence.  The issue will come down to the level of care of the medical providers.  If the care falls below the standard of care, then there may in fact be medical negligence for which a medical malpractice lawsuit may be justified.

The best practices set a standard in the medical profession for prevention of VAP.  However, best practices do not necessarily reflect local practices by which New Mexico doctors will be judged.

It is essential to find appropriate medical experts to provide expert opinion on the appropriate standard of care against which the medical providers should be judged.  You can bet that the medical providers and hospital will find their own expert to say the exact opposite arguing that the VAP in that particular case was unavoidable.

Important to Have Your Case Reviewed

Indeed, it may have been unavoidable.  However, if you or a loved one has suffered serious personal injuries or wrongful death as a result of VAP, it is worth running it by an experienced medical malpractice attorney.

Whether or not it was negligent would have to be determined by medical experts.  Often times, much to the disappointment of the injured patient and/or family, the expert will find that there was no medical negligence.  Without an expert in your corner, your case simply cannot move forward.

Keep in mind that New Mexico medical malpractice claims have unique deadlines and other requirements.  Many of these are dictated by the type of medical provider (governments, private, “qualified healthcare provider”) that is involved.

It is important to move quickly in these cases since the deadlines can be fairly short and just getting the case evaluated by an expert can take a considerable amount of time.  Delay is rarely, if ever, in your best interest in a medical malpractice claim.