The expert’s words sound harsh, but his tone is matter-of-fact: People die from melanoma all the time. People also die from medical error—100,000 each year according to an Institute of Medicine report. On July 6, 2002, Ashley Pierce died. A lawsuit filed by her parents against the Curry Health Center of the University of Montana reads, “Ashley’s injuries and death were caused by the negligence of employees and/or agents of Curry.” Curry responded two weeks ago with the claim that “Alleged damages were caused in whole or in part by Ashley Pierce’s own negligent conduct.” Then, in bold caps, “Demand for Jury Trial.”
Curry is part of a state institution. Any damages awarded would be billed to Montana taxpayers, says Dana Christensen, Curry’s attorney. The maximum possible award: $750,000.
The accusation—blame for a person’s death—is a weighty one, but the suit did not catch the center’s director off guard.
“Lawsuits sometimes occur even when the quality of care is high,” says Dr. Dave Bell, director. “Any head of a health care clinic has to be aware that that’s a risk.”
Another lawsuit, based on allegations that Curry had failed to diagnose cervical cancer, was settled two years ago, says Christensen. Curry denied any liability, he says, and paid the patient an undisclosed amount of money.
“It’s not unusual that claims are made,” says Christensen. “People become ill, and when people become ill they look to institutions to reimburse them.”
This institution, the Curry medical clinic, will see 78 percent of the student body this school year, says Bell. That’s over 10,000 students. What kind of care will they receive there? What kind of care did Ashley Pierce receive? And who is responsible for ensuring the quality of medical care?
According to the suit, events unfolded like this: Pierce notices a growing mole on her leg and visits Curry in November 1997 to “have the mole checked and treated, as appropriate.” No one from Curry notes the mole on her medical chart’s summary sheet, and no one schedules a follow-up appointment for her, although she was told to return in three weeks. Three months later when she returns for unrelated issues, no one checks on the mole. Almost two years later, she returns specifically to check on the growth, described as “irregularly shaped, multi-colored, scaly…purplish brown/red.” The doctor recommends the mole be removed, though it was probably benign and “could wait until after school finished.” The school term would finish in December; the school year in May. This detail is ambiguous.
What follows is disturbing. In May 2000, doctors diagnose malignant melanoma; they discover cancer in Pierce’s liver. Two years later, “Despite exhaustive and aggressive cancer treatment, including chemotherapy and surgery, Ashley died.”
Her parents’ attorney recommended they not talk about the case or about their daughter, so the court filings are the sole source of events.
Christy Schilke’s eyes widen as she reads them. She is the student association vice president and a member of Curry’s advisory board. She knows student opinion of the UM health center. “They love it. It’s quick,” she says. “Yet at the same time they feel they’re getting quality care, and that’s key.”
A patient survey confirms her report: 93.5 percent of patients listed the service at Curry as excellent or good; 0.8 percent ranked it as poor or unsatisfactory. These results are from 1998; results from the latest survey are currently being compiled, but the preliminary estimates don’t look much different.
In addition to patient review, Curry has submitted itself to outside scrutiny. The health center set aside $7,000 of its student-approved budget for voluntary accreditation, says Laela Shimer, medical clinical director. Public Health examined the program, she says, but their review is “minimal.” The accreditation process is described by Victor Leino, research director of the American College Health Association: “The evaluation is fairly rigorous.” It’s an approval for which many student health centers strive, he says. In 2000, Curry was accredited for three years, the maximum allowable term, says Bell. In the summary of the hundred-plus page report, the health center receives the highest mark in every single category. Recommendations imbedded within the report are sparse. One comment suggests using a highlighter to note allergic reactions on patient charts. Another asks doctors to remember to initial the reports they dictate. The reviewers praise the “highly competent staff” and the “excellent statement of patient rights and responsibilities.”
It’s impossible, though, to measure a stellar accreditation report against the loss of a life. Despite its superb review, Curry may need to cast a safety net for serious and potentially deadly conditions. Currently, the only follow-up protocol at the medical center is for pap smears, says Bell. Will Curry begin to systematically follow-up with patients with troubling moles? Bell is indirect. “Nothing is static in life. We like to all think that we learn,” he says. “It is the goal of any good health care facility to always re-evaluate its current practices and try to improve on them.”
As the student voice, Schilke recommends more systematic follow-ups. “I do realize we are adults, but life gets so crazy,” she says. “Give us a call. That would be simple and easy to do. Then, it’s up to the students to follow up on their own.”
Bell isn’t allowed to speak directly about the suit—attorney’s orders—but when asked about following up with patients, he does make an admission: “There will be situations where you wish you had.”
But patients are part of the equation, too. Following a treatment plan, says Shimer, is a shared responsibility.
“Doctors used to be gods. You did what they told you,” says Shimer. “Now, we encourage consumers to question.”