The family of a Massachusetts woman who died after falling from an OR table has filed a wrongful death lawsuit against four hospital staff members believed to be present at the time of the fall.

A surgical team had completed a routine hip replacement procedure on Catherine O'Donnell, 86, at Boston Medical Center on Oct. 6, according to a report published in the Jan. 29 Boston Globe.

After an OR nurse removed a safety strap from the patient's torso in anticipation of transferring her from an orthopedic table to a wheeled stretcher, Ms. O'Donnell fell through a gap in the articulated table, buttocks-first. The five-foot, 123-pound patient -- who was still under anesthesia and who had not yet been extubated -- fractured her skull on the OR floor, an injury that led to internal bleeding.

Ms. O'Donnell underwent a second surgery, which removed a part of her skull in an attempt to relieve the pressure that resulted from the bleeding. She died on Oct. 13 after her family removed her from life support.

An investigation conducted by the Massachusetts Department of Health concluded that the nurse who removed the safety strap neglected to verbally communicate its removal. As the other members of the surgical team were engrossed in post-surgical responsibilities, the stability and safety of the patient suffered.

The Globe notes that Boston Medical Center has since adopted a protocol requiring all OR staff members to position themselves on both sides of the table and place their hands on a patient before the safety strap is removed.

David Bernard

Around 30 ASCs in southwestern Ohio have a tough decision to make: accept Humana's new reduced fee schedule or risk being booted from the giant health insurer's network.

Officials at Prexus Health Partners, which operates four area surgery centers and will soon open two others, says the new rates are so low they had no choice but to reject them. They say the Louisville, Ky.-based insurer is telling ASCs to take it or leave it.

Humana denies a published report that it gave the ASCs such an ultimatum. A spokesman for the insurer tells Outpatient Surgery Magazine, "We don't take that attitude with anyone that we contract with. We negotiate in good faith. We don't strongarm."

This all started in October, when Humana informed ASCs in Greater Cincinnati that it was going to pattern its fee schedule after Medicare's new ASC payment system effective Jan 1, 2008, switching from grouper-based reimbursement to a percentage of HOPD reimbursement. The adjustment would mean a decrease for some centers because Humana says it had been paying them more than Medicare did.

"We, of course, had no problems with a switch in methodology," says Donald J. Jansen, MHA, vice president of marketing and development for Prexus. "But when we ran Humana's proposed Jan. 1, 2008, rates and we found out that Humana was secretly using the Medicare payment methodology switch as an opportunity to reduce reimbursement to ASCs in 2008, we were greatly alarmed."

"We're not asking for more money," says Mr. Jansen. "Just make us whole."

The impact on Prexus translated to a double-digit drop in payment for 2008, which Prexus rejected. For example, Prexus says Humana's proposed 2008 payment schedule would reduce reimbursements to the Surgery Center of Evendale by 12.9 percent.

"Accepting such a significant decrease in reimbursement jeopardizes our facilities' ability to provide quality care, cover operating costs -- including our highly qualified clinical team -- and continue to invest in new technologies and state-of-the-art equipment," says Robyn Finnegan, vice president of managed care for Prexus.

Prexus claims that Humana has threatened to drop from its network any surgery center that doesn't accept its new fees, effective March 31. Humana denies that charge.

Dan O'Connor

A study published in the January issue of the journal Infection Control and Hospital Epidemiology found that although antibiotic gels help increase hand hygiene, they failed to reduce infection rates in two ICUs over a two-year period.

"Hand hygiene may be important, but it's only one ingredient in the overall recipe for preventing infection," says Mark Rupp, MD, professor of infectious diseases at the University of Nebraska Medical Center, medical director of the school's Department of Healthcare Epideminology and the study's principal author.

Exactly why the infection rates did not decrease when hand hygiene compliance increased is unknown, says Dr. Rupp. One theory has to do with fingernail length. They found more, and varied, microbes when the nurses had fingernails more than two millimeters long, wore rings or lacked access to hand gels. According to Dr. Rupp, fingernails are too long for healthcare if you can see them over the skin of your fingers when looking at your palm.

Nathan Hall