A US-based transcription company that employed typists in India has been found guilty of the wrongful death of a hospital patient in Alabama. Precyse Solutions, together with Thomas Hospital, has been named as responsible for the death of diabetes patient Sharron Juno. In early December, a jury returned a $140 million (£85.9 million) wrongful death verdict against Thomas Hospital where she was treated, Precyse Solutions and two Indian transcription companies it subcontracted work to.

Ms Juno was discharged from hospital in March 2008 and the Discharge Summary dictated by her physician was outsourced for transcription. The previous year, Thomas Hospital had given Precyse Solutions permission to send its dictations to India for typing in order to reduce costs. As a result, Sam Tech Datasys in New Delhi and Medusind Solutions in Mumbai were employed to provide transcripts for the hospital.

A critical error

The transcript of Ms Juno’s Discharge Summary was used as the basis of new orders for a rehabilitation facility Ms Juno was admitted to, despite the document not being reviewed. Because of this the three critical errors it contained, which included prescribing the patient with a dose of 80 units of Levemir insulin rather than eight units, were not spotted.

Based on the admission orders, Ms Juno was given a fatal dose of insulin. She suffered brain injury and died shortly after, on March 27th 2008. The dosage of 80 units of Levemir insulin noted in her Discharge Summary was ten times more than the eight units it was supposed to be, but had been incorrectly transcribed in India. The hospital, Precyse Solutions and the two Indian subcontractors were found guilty of the wrongful death of Ms Juno, although the hospital said it was “disappointed” by the jury’s decision.

Traditionally, dictation at Thomas Hospital was passed on to a medical transcriptionist employed by the hospital, who would type it up to create the written summary. However, the cost of these services were just short of $20 an hour, so a more economical alternative was sought. The new system supplied by Precyse Solutions saw doctors dictate their notes down the phone to a computer, with the recording then sent to India.

The dosage error was not spotted by the Indian transcription firm, where the quality checks used fell short of US standards. Yet the mistakes made by the typists were not the only contributing factors to Ms Juno’s death. The plaintiff’s attorney also noted that the physician’s original notes should have been used to prepare the orders for the rehabilitation facility, but this was not done as the document was not available. Instead, the nurse copied the information in the Discharge Summary from India on to an admission order with the doctor’s signature, although the physician did not actually sign off the medical information.

Skip Finkbohner of Cunningham Bounds, which represented the plaintiff, said: “[Ms Juno] died because the hospital administrators approved using transcriptionists in India to save 2 cents per dictated line.”

According to Alabama Live, Mr Finkbohner claimed the large sum awarded by the jury reflected the catalogue of serious errors made in the case. “If the transcription had been correct, there would have been no death […] if the nurse had been allowed to get the document from the records department, there would have been no death,” he explained.

Handle with care

Medical transcription services are valuable resources for hospitals, saving them time and providing a fast turnaround on dictations. While traditionally provided in-house, transcription services of this nature could be costly due to the expense of hiring such a team full-time. Because of this, outsourcing to a professional transcription firm is a popular option today. However, such companies should be carefully considered and hospitals thinking of outsourcing their dictation should first ensure it will be subject to a vigorous quality control procedure.

Here at Language Insight, we have achieved the ISO 9001 standard for quality management systems. Just one element of this is ensuring every one of our medical transcriptions undergoes a careful quality control process, which we conduct in-house. Any errors can be identified and corrected at this stage before being returned to the client.

However, our practice of assigning medical dictations to a typist with prior experience in and knowledge of the sector whenever possible means that errors are less likely to be made to start with. Transcriptionists who have worked in the healthcare industry before will be familiar with any technical language contained in the files and so will not slip up when transcribing it.

As this case proves, quality-assuring medical transcriptions is vital. After all, someone’s health could be at stake.