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Transparency is Best When It Comes to Medical Mistakes

David Mittleman — Mon, 08 Mar 2010 14:03:32 GMT

Wouldn’t it seem like knowing a hospital’s previous medical mistakes might be important information to obtain prior to deciding to have a procedure performed at a particular hospital? Apparently lawmakers in Connecticut didn’t think so when they changed a law in 2004 that required hospitals to make mistakes, such as inadvertent cuts during surgery or serious falls, public information.

Lawmakers tampered with the law two years after Connecticut ordered hospitals to report adverse events. Specifically, Connecticut hospitals balked at the 2002 decision, thus prompting lawmakers in 2004 to react to the hospitals’ concerns by passing a provision that narrowed the list of adverse events that hospitals are required to report as well as keeping adverse event reports secret until after an investigation is completed. What’s particularly alarming about these “secret” reports is that 3 out of 4 of those reported events, some of which have injured or killed patients, are never investigated.

Connecticut Attorney General, Richard Blumenthal, has drafted legislation to repeal the so-called “confidentiality provision” which would require hospitals to report all adverse events—not just those that fit within a narrow list—as well as those that would have formerly gone “into investigation” for an unknown period of time. Furthermore, the state health department would be required to publicly identify the hospital where the event occurred and provide a summary of the hospital’s action plan to resolve the adverse event. Nevertheless, hospital officials maintain that more events will go unreported without the confidentiality, arguing that personnel will be more reluctant to comply with the law. This argument seems counterintuitive: instead, voluntary compliance as well as diligent attention to reducing medical errors would improve hospitals’ images, making it clear that they have nothing to hide.

Originally posted at InjuryBoard by David Mittleman

The Most Feared Complication of Prostate Biopsy

David Mittleman — Sun, 16 Nov 2008 09:20:00 GMT

For men 50 and over, digital rectal exams and PSA (prostate-specific antigen) tests have become a routine part of the annual checkup. These tests can uncover signs of prostate cancer, a disease that kills roughly 29,000 Americans each year. However, before a diagnosis can be made, a doctor needs to perform a procedure known as the prostate biopsy to confirm the presence of prostate cancer. In a biopsy, the doctor uses a needle to collect a sample of cells from the prostate so that a pathologist can distinguish cancerous from noncancerous cells. Prostate biopsy is generally considered a safe and simple procedure, but the main concern is that significant complications such as infections do occur if appropriate preventative measures are lacking.

Not long ago, a friend of mine underwent a transrectal prostate biopsy. To his surprise, this so-called simple procedure was not as simple or as safe as one may be led to believe, because according to him, the experience had taken him to "hell and back." The procedure itself went smoothly, but the sequence of events that followed was certainly not what he had signed up for. The first unpleasant episode began the very next day after the biopsy, when he found himself shaking so violently and uncontrollably that he thought he was having a seizure. When nighttime came, he suffered yet another violent bout of shakes which, again, lasted for a good half hour or more. Although the seizures discontinued after that, he was pretty much vegged out in bed for several days, and naturally, he became convinced that he was only suffering from a nasty flu. It was not until he had spoken to his friend, who is a physician, about his symptoms that he realized he was in for a long haul. He immediately contacted his doctor, and was told to get himself over to the emergency room ASAP. After running through bags of saline and drips of antibiotics, he was informed that he had E. coli bacteria in his blood stream which, if left untreated, could be life-threatening. If he hadn’t relayed his symptoms to his friend, he would have continued to believe that it was only a flu, and in the meantime, the infectious bacteria in his blood stream would have attacked his organs and eventually causing them to shut down.

As horrifying as it is, the fact of the matter is that about 800,000 men undergo prostate biopsy every year, and not every doctor perform sufficient preoperative preparation such as appropriate bowel preparation or pretreatment with antibiotics. Although different pre-biopsy protocols for bowel preparation have been suggested, there remains a lack of standardized consensus among urologists. However, studies have found a high infection rate associated with self-administered phosphate enema, also known as the traditional bowel preparation. An enema is a way of cleaning out the large intestine by introducing solutions into the rectum, causing it to expand, and thereby allowing the bowel to empty. Studies have shown that phosphate enema with providone-iodine administered at the hospital can reduce infectious complications for people who have poor compliance or inaccuracy when bowel preparations are self-administered.

Pretreatment with antibiotics is another effective way of reducing complications. Studies have shown that fever may be expected to develop in about 23% of patients who do not receive prophylactic antibiotics, and that infection rate was significantly lowered with the use of antibiotics. Furthermore, the cost of antibiotic medication was about $18 per patient and the cost-effectiveness compared to no prophylactic therapy at all was considered good. Although there are a variety of prophylactic regimens available, Dr. Jeffrey Pollen and Dr. Daniel Smiley’s studies indicate that ciprofloxacin prophylaxis substantially lowers the incidence of fever, especially when started preoperatively. Therefore, it is recommended that physicians who have not yet done so should consider a similar cost-effective policy.

The content provided here is for informational purposes only, and was not designed to replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding prostate biopsy and/or the use of antibiotics.

Originally posted at InjuryBoard by David Mittleman

Arizona Couple Wins $16.5 Million in Medical Malpractice Suit Against California Neurosurgeon

David Mittleman — Wed, 10 Feb 2010 10:16:57 GMT

An Arizona couple recently won $16.5 million in a medical malpractice case against a Southern California neurosurgeon who was found negligent in his treatment of Trent Hughes, a man who was injured while off-roading in 2003. Specifically, Hughes suffered a fractured spine and was airlifted to Desert Regional Medical Center in Palm Springs, California, where Doctor Christopher Pham was on call. The Hughes’ attorneys argued that Dr. Pham was required to report to the hospital within 20 minutes of the phone call. Unfortunately, Dr. Pham did not attend to Hughes until the next day and surgery was delayed for two days after the injury occurred. By that time, the damage was already done and Hughes was ultimately left a paraplegic.

Prior to his catastrophic injury and poor treatment, Hughes was an owner of a Phoenix, Arizona air-conditioning company. Thus, Hughes and his wife sued for past and future lost earnings, as well as medical costs, and pain and suffering. They also maintain that they “never received an adequate explanation of where (Pham) was and why he didn’t come, though he did maintain he was present.” Moreover, the Hughes’ attorneys also argued that Dr. Pham attempted to cover his tracks by planting documents that made it appear as if he was present at the hospital when, in fact, he was not.

Despite the couple’s multi-million dollar verdict, one of the Hughes’ attorneys noted that the award would be reduced to $500,000 due to California law limiting the amounts awarded in medical malpractice suits.

Originally posted at InjuryBoard by David Mittleman

Small Smiles Dental Chain Settles With Justice Dept. For Medical Fraud

David Mittleman — Sat, 23 Jan 2010 10:00:00 GMT

No child likes going to the dentist, but for the children who went to the "Small Smiles" dental clinics, the experience was even worse. FORBA Holdings LLC, the parent company of the chain, settled with the Department of Justice for $24 million on Wednesday for allegedly performing unnecessary or substandard procedures on their young patients--a practice the DOJ is calling a "profit-turning" maneuver. According to the DOJ, the unnecessary dental procedures included removing teeth, x-rays, and pulpotomies, or "baby root canals". Sadly, the children who suffered through the unnecessary and often painful procedures at the "Small Smiles" clinics were already from a vulnerable population: they were mainly from low-income families on Medicaid.

Whistleblowers from inside the company recently told ABC that they were instructed to tell parents that their children needed procedures performed on teeth that were already healthy. In fact, the government's investigation was spurred by three whistleblower lawsuits. DOJ Investigations into individual dentists are also ongoing.

Small Smiles has 68 clinics in 22 states and will remain open for business. According to a previous report featured on 20/20, one child claimed to have had 16 baby root canals--that's nearly every tooth in the child's mouth. Other parents also substantiated the DOJ's claims, alleging that their children underwent unnecessary and traumatizing procedures.

Originally posted at InjuryBoard by David Mittleman

Michigan Supreme Court Ruling Protects Victims of Malpractice

David Mittleman — Sun, 21 Feb 2010 14:39:50 GMT

For years, the State of Michigan has been hostile to victims’ rights. This has been particularly true in the area of medical malpractice, where state law imposes complex procedural requirements on injured people. Until just recently, failure to follow these requirements exactly meant that a victim of malpractice would lose his or her case, even if the error was seemingly inconsequential.

One of the most contentious aspects of Michigan’s medical malpractice is the "notice of intent." Before a malpractice victim can commence a lawsuit, he or she must put the potential defendants on notice and allege very specific violations of the standard of care. The problem is that the notice of intent must be filed before any discovery is conducted, when the victim has very little information available. As a result, it is not uncommon for minor errors or inconsistencies to be present in the notice of intent. In years past, those minor deficiencies often resulted in the dismissal of otherwise valid malpractice cases.

Lately, however, the Michigan Supreme Court has helped protect victims of malpractice by looking past technicalities to the merits of the underlying case. Last year, the Supreme Court ruled that a defective notice of intent filed within the statute of limitations period was sufficient to prevent a claim from being time-barred. Last Wednesday, the Court ruled that defendant providers must challenge the adequacy of a notice of intent within 63 days. The recent order will prevent defendants from waiting until the last minute to raise a procedural challenge, and it makes it more likely that injured malpractice victims will be able to correct any error within the statute of limitations period. All of this means that more people will get the chance to let a jury decide the outcome of their case.

Even with these favorable rulings, medical malpractice is a complicated area of the law. If you or a loved one has been injured by the professional negligence of a health care provider, you need an experienced attorney to help guide you through this legal obstacle course.

Originally posted at InjuryBoard by David Mittleman

Vacuum extractor assisted vaginal delivery can cause birth trauma

David Mittleman — Tue, 29 Jan 2008 08:31:57 GMT

A vacuum extractor may be used by a physician to enhance delivery of a baby's head in a vaginal delivery. However, the doctor attempting to use the extractor must be prepared to abandon the procedure when it is not working, according to operational guidelines for use as noted by the manufacturers instructions.

The FDA in may of 1998 issued a public health advisory titled "Need For Caution When Using Vacuum Assisted Delivery Devices." A cover article in the American Family Physician journal identifies several medicolegal concerns when using vacuum extractors during birth. Before vacuum extraction is initiated, the parents should be given clear explanation of the risks and benefits of vacuum extraction for the mother and baby.

Also, avoiding the use of vacuum extraction when the baby is high in the mother's pelvis can reduce the risk of complications. The device literature cautions the user, "do not allow the vacuum to remain at attractive levels for a total of more than ten (10) accumulated minutes." Subgaleal hemorrhage is a serious neonatal complication of vacuum extraction which can lead to anemia, hypotension, and persistent metabolic acidosis, all of which are associated with perinatal asphyxia. This can lead to neurological impairment and cerebral palsy.

If you or a loved one are suffering as a result of a traumatic operative delivery, contact a legal professional using the form at the top of the page to see if your doctor or the hospital failed to provide you with the appropriate care.

Originally posted at InjuryBoard by David Mittleman

Long-Term Care Hospitals Lacking Oversight

David Mittleman — Wed, 10 Feb 2010 14:44:43 GMT

According to Medicare officials, long-term care hospitals have sprouted up all over the country in the past 30 years, when hardly any such facilities existed in the early 80s. Perhaps the repaid growth of long-term hospitals can be attributed to Medicare rules that offer high payments for hospitals that treat patients for 25 days or longer. While it isn’t at all wrong for a patient to stay in the hospital for a longer period of time, what is problematic is that many long-term hospitals are private, publicly traded companies—many of which lack the proper oversight to prevent serious medical problems in the patients that utilize their services.

Select Specialty Hospital of Kansas City is a particularly potent example of the types of problems experienced in long-term care facilities. In fact, lawsuits, state inspection reports, and federal reports found that in 2007 and 2008 Select’s hospitals were cited in violation of Medicare rules almost four times more often than regular hospitals. One such incidence occurred in 2007, when Ms. Bell- Jackman, a 46-year-old with diabetes was hospitalized at Select for five weeks. Ms. Bell-Jackman became increasingly agitated, but could not speak because of a surgical hole in her throat. Although Ms. Bell-Jackman was supposed to be supervised, her sitter left at 8 p.m. on June 26, 2007 without notifying hospital staff. Around 9:30 p.m. Ms. Bell-Jackman tried to get out of bed and walk around and hospital staff responded by tying her down with wrist restraints. Then, around 12:15 a.m., nurses sedated her to further calm her down. No one bothered to notice that Ms. Bell-Jackman was dying. Perhaps if an attending physician was on staff that night, her death could’ve been prevented. However, most long-term hospitals don’t have doctors on staff.

Many patients at long-term care facilities are critically or chronically ill. While they are usually in stable condition, many still require consistent care including dialysis, attention to wounds that won’t heal, or breathing help on a ventilator. Despite Select’s poor history of attending to patients, they maintain that they “quality patient care”. Unfortunately, this may not have been the case with Ms. Bell-Jackman. After receiving the sedative injection at 12:15 a.m., Bell-Jackman seemed to relax. However, the leads on her chest connecting her to the heart monitor came loose around 12:42 a.m. and an alarm sounded—no one noticed. When the nurse that was supposed to be watching her overnight finally came to check on her, Ms. Bell-Jackman was found unconscious and attempts to revive her were unsuccessful. Ms. Bell-Jackman’s family filed suit against Select in January 2008 and received an $800,000 settlement for her death. Nevertheless, Select still denies wrongdoing.

Originally posted at InjuryBoard by David Mittleman

Going to the Hospital May Be More Hazardous to Your Health Than Staying Home

David Mittleman — Wed, 24 Feb 2010 10:21:37 GMT

Feeling sick? Going to the hospital may be more hazardous to your health than dealing with the illness you’re already experiencing. At least that’s been the experience of nearly 50,000 U.S. medical patients who have died from a hospital-acquired infection that they wouldn’t have gotten otherwise. Specifically, according to recent study conducted by the Center for Disease Dynamics, blood poisoning and pneumonia claimed 48,000 lives in 2006 alone, and led to 2.3 million extra patient-days and cost $8.1 billion. Overall, these two illnesses are responsible for one-third of the 1.7 million infections U.S. patients acquire from hospital stays each year.

The study researchers used the largest database that includes hospital discharge records from 40 different states. Overall, they discovered that patients who underwent invasive surgery or elective surgery were at the highest risk for developing blood poisoning or pneumonia. Furthermore, hospital-acquired pneumonia extended a patient’s stay by 14 days and added an additional $46,400 to the initial hospital bill. Similarly, hospital-acquired sepsis also extended a patient’s stay by almost 11 days and added an average of $32,999 to the final bill.

Sadly, the researchers also found that many of the incidences of these infections could have been easily prevented by improving hygiene in clinical setting. Two doctors at John Hopkins, Doctor David Murphy and Doctor Peter Pronovost, also wrote an accompanying editorial to the study published in the Archives of Internal Medicine. In the editorial they stated their concern with the growing problem of preventable hospital-acquired infections:

The knowledge that patients continue to experience harm from their interactions with the health system is unconscionable.

Originally posted at InjuryBoard by David Mittleman

Texas Nurse Stands Trial for Blowing the Whistle on Doctor With History of Inappropriate Behavior

David Mittleman — Mon, 08 Feb 2010 09:21:30 GMT

Anne Mitchell, an administrative nurse at the Winkler County Memorial Hospital, assumed she was simply upholding her professional obligation when she blew the whistle on a doctor at the hospital whom she felt was improperly prescribing medications and performing bad surgeries. However, knowing she could face backlash in the close-knit oil community in Texas, she didn’t sign her complaint letter. What she didn’t realize was that the doctor was close friends with the county sheriff and when the doctor learned of the anonymous complaint against him, he quickly turned to his friend for help.

Doctor Rolando G. Arafiles Jr. has a history of inappropriate behavior. In fact, he performed a failed skin graft in the emergency room without surgical privileges. Furthermore, he also sutured a rubber finger tip to a patient’s crushed finger “for protection”, a move that was later flagged as inappropriate by the Texas Department of State Health Services. Nevertheless, when Dr. Arafiles complained to the county sheriff, a man who credits the doctor with saving his life after a heart attack, the sheriff obtained a search warrant and seized Anne’s computer where the letter was saved.

Anne will stand trial in Texas state court beginning today on “misuse of official information”, a third-degree felony her state with a sentence of up to 10 years in prison. The prosecutor argues that he intends to show that Anne has a history of making “inflammatory” statements about Dr. Arafiles. A second nurse, Vickilyn Galle, who helped Anne write the anonymous complaint letter, was also involved in the case, but was dismissed at the prosecutor’s discretion. Both sides agree that the case has polarized theTexas community—so much so that the judge moved the trial to a neighboring county. The State and National nurse associations have called the prosecution an “outrage” and have raised $40,000 for Anne’s defense.

For another perspective on this issue, check out this story by attorney Lee Tilson who discusses the silence by the medical community about this case.

Originally posted at InjuryBoard by David Mittleman

Christ Hospital Settles Whistleblower Lawsuit That Alleges Hospital Had An Illegal Kickback Scheme

David Mittleman — Fri, 05 Feb 2010 10:04:29 GMT

Cincinnati Ohio—Christ Hospital will pay millions to settle a federal whistleblower lawsuit that alleges that the hospital’s acclaimed cardiac-care center ran an illegal kickback scheme. A retired cardiologist, Harry Fry, filed the lawsuit in 2003 against Christ Hospital and the Health Alliance of Greater Cincinnati. The suit alleges that doctors were given improper financial incentives for generating increased revenues for the hospital. Specifically, cardiologists were allocated time at the Heart Center, housed within Christ Hospital, based on the number of coronary arterial bypass procedures and catheter lab revenues that they generated for Christ Hospital during the previous year.

The Justice Department later joined the suit in 2008, arguing that there were 100,000 Medicare or Medicaid claims filed by the Heart Center between 1999 and 2004 that were a violation, each with a penalty of up to $11,000. Nevertheless, the hospital and doctors maintain that many of those claims were for “$8 EKGs” and that simply assigning time did not encourage doctors to refer patients to Christ Hospital.

While the hospital denies any wrongdoing, both sides are finalizing settlement documents, with a settlement amount that could reach $100 million. Since the lawsuit was filed in 2008, Christ Hospital acquired the assets of Ohio Heart and Vascular Center and withdrew from the Health Alliance of Greater Cincinnati.

Originally posted at InjuryBoard by David Mittleman