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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

Medical Malpractice Suits From Botched Deliveries Help Families Deal With Lifelong Medical Costs

David Mittleman — Tue, 24 Nov 2009 14:48:39 GMT

When Misty Tipton's son, Tyler Tipton, suffered a brain injury due to the medical malpractice of hospital staff during his birth, she had no ability to predict how far reaching the effects of his injuries would be. Tyler's birth was induced and nurse midwives used suction to extract him when the doctor who was paged to deliver Tyler never showed up. The delivery was done without physician supervision, which means that Tyler now must live every day of his life with intense supervision at a staggering cost.

Medical Malpractice claims across the country, such as this one for the traumatic birth, face greater uphill battles thanks to "tort reform" legislation introduced in many states. Yet the reality is that parents like Misty Tipton are the ones left with the overwhelming expense, both financially and emotionally, with having to raise their children whom have been permanently disabled with cerebral palsy or some other condition.

As Misty explains, Tyler needs constant supervision, even requiring one parent to sleep in his room every night due to seizures, and he is incapable of speaking. At the settlement proceedings, one of the defense attorneys had to leave for her child's dance recital. Misty remarked that Tyler will never get to do that due to medical negligence. Fortunately for her and her family, at the very least they were able to receive a settlement put into a trust account that would help to pay for Tyler's continuous medical expenses.

Originally posted at InjuryBoard by David Mittleman

Lawsuit Claims Doctor Botched Brain Surgery, Covered Up Evidence to Avoid Wrongful Death Suit

David Mittleman — Wed, 12 Aug 2009 11:55:27 GMT

Cincinnati, Ohio—the family of 16-year-old Jessica Siegel has filed a lawsuit against a neurosurgeon and a clinic, who they claim altered evidence to avoid a wrongful death claim after Jessica died after undergoing brain surgery.

Jessica died in August 2006 after undergoing brain surgery at the Mayfield Clinic & Spine Institute. The family’s suit accuses Dr. Andrew Ringfield of botching the surgery and then trying to cover up his mistakes by excluding the head from an autopsy.

The clinic maintains that it stands by the “high quality of its physicians and staff and that Ringer exemplifies clinic values, including honesty and skill.” However, the clinic refused to comment on the specific allegations in the lawsuit. Siegel’s family also filed a separate lawsuit in 2008 against organ donor companies, alleging that they took Jessica’s eyes without consent.

Originally posted at InjuryBoard by David Mittleman

Marion, Illinois VA Hospital Continues to Have Safety Issues

David Mittleman — Sun, 08 Nov 2009 10:00:00 GMT

Federal Veterans Affairs Officials had assumed that the VA medical center in Marion, Illinois would clean up its act after being under such intense scrutiny for 2 years. However, serious safety issues continue to be a problem at the southern Illinois hospital even after Federal Veterans Affairs officials suspended surgeries in 2007 at the location after an investigation revealed at least nine deaths attributable to substandard care between October 2006 and March 2007.

While the hospital still isn’t performing any major surgeries, outpatient procedures are still performed there. The most recent inspector general’s report indicates that the hospital failed to monitor 87%, or 20 out of 23, of its physicians to ensure procedures were properly performed. Furthermore, there are problems with infection control, specifically staph infections, after a patient with a history of MRSA staph infections was put in a room with two other patients and shared a bathroom. Additionally, there are other problems with poor medication management and monitoring, patient data analysis, and tracking patient deaths. In fact, according to the hospital’s own reports, there were three different tallies for April 2009 deaths and two deaths went completely unreported. These problems are no different than those that occurred a few years ago: the most severe case involved a veteran who bled to death after receiving a faulty gallbladder surgery. The surgeon resigned just three days after the man’s death.

The inspector general has once again ordered the hospital to completely redesign its reporting structure and investigations of the hospital will continue until all the problems are resolved.

Originally posted at InjuryBoard by David Mittleman

Pharamcy error causes patient to receive wrong medication

David Mittleman — Tue, 22 Jan 2008 16:32:52 GMT

Gregory Rossini had a liver transplant in 1996 and eventually developed Hepatitis C. He was prescribed Rebetol for his hepatitis C, but on January 15, 2005, he was given the wrong medication by his local pharmacy. Instead of receiving his Rebetol, he received Reyataz, an HIV medication.

Mr. Rossini was initially suspicious of the pills he received on January 15, 2005, because they were different then normal, but he did not want to challenge the pharmacist. On March 8, 2005, he received a letter from Dr. Max M. Cohen who told Mr. Rossini he was given the wrong medications.

Dr. Cohen explained there was a "robotic malfunction" involved in the mix-up, but no further explanation was given. According to the lawsuit, a pharmacist manually distributed the wrong medication. The mix-up caused Mr. Rossini to have his hepatitis symptoms worsen, as well as chills, dizziness, fever, loss of appetite and weight, and his eyes and skin turned yellow.

Although the letter from Dr. Cohen states there was a clear mistake that occurred, it tries to blame the problem on a machine malfunction. What Dr. Cohen's letter ultimately proves is the pharmacist who manually dispensed the medications did not do the job properly. This was a human error caused by a possibly negligent pharmacist, not a machine malfunction. It's not clear why having to dispense the medications manually would result in a mix-up. While it is true the medications have similar names, they treat very different diseases. The pharmacist should always make sure the proper medications are dispensed under a valid prescription.

If you suspect any medications you have received are not correct, please contact your local pharmacist to make sure the prescription was filled properly.

For more information on this subject, please refer to the section on Drugs, Medical Devices and Implants.

Originally posted at InjuryBoard by David Mittleman

Woman's Experience at Hospital Exemplifies Problems with Mistaken Identity and Wrong-Site Surgeries

David Mittleman — Fri, 13 Nov 2009 10:12:47 GMT

When Kerry Higuera started bleeding three months into her pregnancy, she instantly rushed to the hospital. Fearful that she was miscarrying, she knew that seeing her doctor would most likely give her the best chance to save her pregnancy. Unfortunately, that decision ultimately changed her life for the worse.

Upon arriving at Banner Thunderbird Medical Center in Glendale, Arizona in February 2008, a nurse lead Higuera to a room and was instructed to wait for a doctor. However, just a few minutes later, another nurse poked her head into the room and told Kerry that the doctor wanted her to undergo a CT scan of her abdomen. Kerry questioned the nurse, but followed along anyway, confident that her doctor knew the correct procedures to perform.

After the CT scan, the nurse led Kerry back into a waiting room. Soon, the emergency room physician, two radiologists, and a representative from the hospital’s human resources came to speak with her. With such large crowd, Kerry was positive that it was bad news that she had miscarried. In fact, it was much worse news. According to the group of doctors, there were two Kerrys in the hospital that night: Higuera and another, younger woman named Kerry who needed the CT scan. Immediately, the hospital staffers offered to purchase Kerry Higuera flowers and also offered her coupons for free meals in the hospital cafeteria.

No large studies have been done on the effects of CT scans on fetuses. However, experts say that a fetus exposed to radiation can, in some cases, develop physical and mental growth problems. Kerry is being represented by legal counsel in the matter and appears to be moving toward litigation against the hospital, according to a CNN report. Her child, Nathan, is now 15 months old and shows signs of delayed growth. Kerry feels guilty for going to the emergency room that night in February 2008. However, her story is not unfamiliar: patients trust doctors and other hospital staff to be informed and aware.

Indeed, the five wrong-site surgeries at Rhode Island Hospital exemplify the fact that it isn’t uncommon for a hospital patient to fall victim to hospital errors. However, according to Jim Conway, the senior vice president of the Institute for Healthcare Improvement, there are some steps you can follow to avoid falling victim to wrong-site surgery or mistaken identity blunders. For example:

1. Say: "My name is Mary Smith, my date of birth is October 21, 1965, and I'm here for an appendectomy."

You might feel like an idiot, but say this to every doctor, nurse, and technician who takes care of you.

2. Say: "Please check my ID bracelet."

Hospital staff is supposed to confirm your identity in at least two ways, according to Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. One of those ways is to check your ID, or scan it if it has a bar code. Another way is to ask you for your name and date of birth.

Of course, you should check your bracelet to make sure the information on it is correct.

3. Say: "Please look in my chart and tell me what procedure I'm having."

If a nurse states that you're having an appendectomy and she's right, that's not enough, because that nurse won't necessarily be there with you in the operating room.

"Make sure the nurse is looking at your chart when she tells you what procedure or test you're having," says Ilene Corina, president of PULSE, New York, a grass-roots patient safety organization.

4. Say: "I want to mark up my surgical site with the surgeon present."

Hospitals these days often hand patients a pen and ask them to mark where they're going to have surgery. Corina says you should do it in front of the surgeon who will be with you in the operating room, and not just in front of the person who hands you the pen.

"If you mark it and the surgeon doesn't know about the marking, what's the point of marking it?" Corina asks.

5. Be impolite.

Foster, the executive at the hospital association, gives this example.

"If the nurse comes in and says, 'Are you Mary Jones?' and you're really Miriam Jones, you might just nod your head and say yes because you're too polite to correct her," Foster says. "Don't be polite."

Higuera now wishes she'd been impolite and followed her instincts.

Originally posted at InjuryBoard by David Mittleman

Going Gluten-free: The Realities Of Celiac Disease

David Mittleman — Thu, 16 Oct 2008 09:00:00 GMT

Celiac Disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. The disease can be confused with irritable bowel syndrome, iron deficiency anemia, inflammatory bowel syndrome, diverticulitis, intestinal infections, and chronic fatigue syndrome. While the disease affects one in every 133 Americans, 97% of those who have the disease remain undiagnosed. The risks associated with the disease are malnutrition, anemia, osteoporosis, thyroid disease, type-1 diabetes, infertility and cancer. While there is no cure "per se", one with celiac disease may avoid these complications by adopting a gluten-free diet. Gluten, found in many different kinds of foods including, but not limited to, breads, cereals, pastas, beers, seasonings, and food additives, attack the villi lining the small intestine. This causes nutrients to not absorb into the body and can cause severe long term problems.

My law clerk was just diagnosed with the disease just two weeks ago. After complaining to her doctors for 5 years about extreme abdominal pain, she was finally tested for the disease. Two weeks after adopting a gluten-free diet, she feels amazingly better. Mimi Winsberg, a triathalete and marathon runner realized she had the disease when her health and her athletic performance spiraled downward. Little did she know, the power bars and pasta she had been ingesting for energy caused her great fatigue. Similarly, Dave Hahn, who had reached the summit of Mount Everest 10 times, realized that he had the disease when he became inexplicably weak during his second hike up to the summit. Diagnosing the disease and changing your diet are key to successfully fighting this disease.

The problem that has lead to many underdiagnoses is that many doctors believe that celiac disease is extremely rare. My law clerk saw four different doctors, two of them being gastroenterologists, before her primary care physician decided to run the necessary blood test and diagnosed her with the disease. Dr. Peter H. R. Green, a professor at the College of Physicians and Surgeons at Columbia and the director of the university’s celiac disease center, believes that it is the "lack of pharmaceutical backing for the disease" that is the root of the problem. Because treatment involves a dietary change and not a traditional medicinal one, the lack of research, medical education and public awareness leads to under and mis-diagnoses. Alba Therapeutics and Alvine Pharmaceuticals, Inc. are working towards finding drugs to inhibit the destructive autoimmune response to gluten. Additionally, dietary supplement manufacturers are working to find enzyme formulations that will assist people in digesting gluten, similar to those used for lactose-intolerance.

Until celiac disease becomes more well-known, patients must pay close attention to their symptoms and push their doctors for appropriate testing. Symptoms to which attention should be paid are: abdominal cramping/bloating, abdominal distension, acidosis, anemia, appetite (to the point of increased craving), back pain, constipation, decreased ability to clot blood, dehydration, reduced fat padding, gas, gluten ataxia, mouth sores or cracks in the corners, muscle cramping, night blindness, very dry skin, change in stools, tooth enamel defects, weakness and weight loss. Also pay attention to depression, disinterest in normal activities, irritability, mood changes and inability to concentrate. If you are suffering from any of these symptoms, seek treatment immediately. The long-term effects and consequences are too risky to ignore.

Originally posted at InjuryBoard by David Mittleman

Michigan Medical Malpractice Claims Fraught With Obstacles

David Mittleman — Wed, 04 Nov 2009 15:58:00 GMT

Most of us know little or nothing about the practice of medicine. When we go to our doctors, for everything from a routine checkup to a serious emergency, we trust in them to conduct a proper and thorough examination and to formulate an adequate plan of care. Sometimes, as a result of the carelessness or inattention of the physician or other medical provider, a patient is harmed rather than healed.

Doctors and other medical providers have a legal duty to provide patients with treatment that meets the "standard of care." In layman's terms, the standard of care is what an ordinary and prudent doctor should do in a given situation. If a doctor breaches the standard of care, and the patient is injured as a result, the doctor has committed medical malpractice.

Medical malpractice is more than just a breach of duty, it is a betrayal of trust. However, Michigan law can make it very difficult and expensive for victims to hold the at-fault doctors accountable. There are numerous procedural requirements demanded by law that must be strictly followed. Failure to follow these rules precisely could (and often does) result in the dismissal of an otherwise valid medical malpractice claim. Injured victims have only two years to bring a claim for malpractice, while victims of other types of negligence have three years. Moreover, the victim is required to procure the testimony of other doctors in order to prove his or her case. This is an expensive requirement, and the injured person's doctors must have exactly the same credentials as the at-fault doctor or the claim may be dismissed.

In Michigan, even if a victim of medical malpractice can satisfy all the procedural requirements and prevail in court, their level of compensation may be limited. Medical malpractice damage caps operate to prevent severely hurt patients from fully recovering for their injuries.

Our office handles medical malpractice claims regularly, and our attorneys have extensive experience navigating Michigan's legal obstacle course. If you suspect that you or a loved one is a victim of medical malpractice, contact our office to see if we can put our expertise to work for you.

Originally posted at InjuryBoard by David Mittleman

Three Patients Die From Prescription Drug Overdoses

David Mittleman — Sun, 09 Nov 2008 09:51:00 GMT

A Nevada doctor who has had three patients die from prescription drug overdoses, is still allowed to prescribe narcotics. Investigation by the Nevada State Medical Examiners Board is in the process of being conducted, but during this process the doctor will still be allowed to see patients and write prescriptions.

Four independent medical doctors have reviewed the files of the three patients who have died and have contributed their death to their prescription drugs. The Nevada doctor has also admitted in a sworn deposition that he did not perform a physical examination on one of the patients who overdosed and died. Instead, he admitted to giving her large quantities of drugs because she "asked for them."

Since this investigation, a dozen more complaints have been logged with various agencies. In one such case, a patient and self-described drug addict, was prescribed narcotics with no questions asked and no examinations required. In more than two years the patient has filled prescriptions for 13,760 narcotic pain pills, an average of 510 a month.

The Nevada doctor is not solely to blame, the pharmacy who filled the prescriptions could have been more proactive. Pharmacists are allowed to deny a prescription if they think it’s fraudulent, if they think it’s going to hurt the patient, or if there’s no legitimate medical purpose for the drugs. This puts pharmacists in a tough position to second guess a doctors judgement, but when a patient is filled narcotic prescriptions for 1,020, 1,020, and 1,170 pills in a three month span, something is wrong.

Nevada’s medical regulatory system has to be entirely reformed. The Nevada doctor’s behavior may have never been brought to light if not for a Drug Enforcement Agency (DEA) drug consumption analysis in July 2008. Nevadans rank No. 1 nationally in per capita consumption of Lortab/Vicodin, and 4^th for consumption of methadone, morphine, and OxyContin. Since the DEA’s report, the Nevada medical community is finally taking action, and trying to put a stop to doctors who prescribe narcotics for the wrong reasons.

Originally posted at InjuryBoard by David Mittleman

Radiologists Reluctant to Admit Mammography Errors to Patients

David Mittleman — Tue, 03 Nov 2009 12:54:31 GMT

According to a new study released this month, radiologists may not be so honest when it comes to admitting their mistakes. Specifically, radiologists may not disclose mammography errors to patients, resulting in delayed treatment for progressive cancers.

The study, conducted by the departments of medicine and bioethics & humanities at the University of Washington, surveyed 364 radiologists at seven different Breast Cancer Surveillance Consortium sites located in separate geographical areas. The radiologists were given a hypothetical situation in which comparison screening mammograms were placed in an incorrect order, so that it appeared as if breast calcifications were decreasing in number in a patient when they had actually increased. The doctors were then told that there was an error, which resulted in a delay in treating the cancer. The radiologists were then asked to respond to three questions: 1) how likely they were to disclose the mistake, 2) what information they would share, and 3) what were their actual experiences and attitudes with malpractice.

The results of the study indicated that:

24% responded that they would “not say anything further to the patient”
31% responded that they would tell the patient that “the calcifications are larger now and are suspicious for cancer”
30% responded that they would tell the patient “the calcifications may have increased on your last mammogram, but their appearance was not as worrisome as they are now”
15% responded that they would tell the patient that “an error had occurred during the interpretation of your last mammogram, and the calcifications had actually increased in number, not decreased”

74% of the radiologists claimed that they were more reluctant to tell patients of mistakes because of fears over medical malpractice. Apparently, failure to report errors to patients was not an uncommon practice for many of the radiologists surveyed. In fact, 49% admitted that they had been sued for medical negligence. However, other factors also had an effect in the radiologists’ degree of honesty. For example, physicians have expressed concerns over increasing stress in patients after admitting a medical error. Furthermore, the study author also hypothesized that some physicians feel uncomfortable with their communication skills, and struggle to admit to a patient that they had mad a mistake. Despite these other factors, 15% is not a comforting amount of radiologists who say they would be completely honest about their mistakes. Hopefully, continued studies like this will help to improve doctor and patient communication.

Originally posted at InjuryBoard by David Mittleman