Medical Malpractice News and Views

Welcome to our blog where we discuss current issues in medicine and law. We welcome your comments.

Hospital Infections

November 23, 2020

Hospitals are where the sick people are.  While patients may go home after they get better, they often leave bacteria and viruses behind, where they infect the next round of patients.  You may go to the hospital to get well, but you may end up getting an infection in the hospital that can leave you permanently disabled or can even kill you.

Bacterial Infections | Sepsis Alliance

Every hospital has protocols intended to reduce the risk of infection among its employees and its patients.  Even if these protocols are followed carefully and to the letter, and often they are not, infections persist.  It is a tall order to prevent infections in hospitals for a number of reasons.

Sick people come to hospitals.  Many of them bring with them the germs that made them sick in the first place.  They breathe those germs out when they talk or cough.  They leave germs on the surfaces they touch.  They deposit germs on the nurses or doctors who treat them and those nurses and doctors go on to see other patients.  By their very nature, hospitals are exposed to many different types of bacteria and viruses.

Even worse is the fact that some of those bacteria are resistant to antibiotics.  For many years, we have been giving antibiotics to animals to prevent disease.  We ingest these antibiotics when we eat chicken or beef.  We ask for and doctors give out antibiotics routinely.  Antibiotics have found their way into the water supplies as well as into the food supplies.  Combine these facts with the laws of nature and you have a recipe for disaster.

Bacteria are living creatures.  When exposed to an appropriate antibiotic, most of them will die.  The problem is that not all of them will die.  Over time, after repeated exposure to an antibiotic, some bacteria will develop a resistance to it.  Doctors will then switch to a different antibiotic and use it until the bacteria develop a resistance to it as well.  We are running out of antibiotics to switch over to.  There are now some very aggressive and potent bacteria that have developed resistance to all of our antibiotics.  If they are not already there, these bacteria will eventually be brought to hospitals, where they will be virtually impossible to destroy.

Hospitals are also problematic because so many of the people there are sick and their illnesses weaken their immune systems.  Bacteria and viruses they might be able to resist when they are healthy are now able to overcome their compromised immune systems.

Another problem at hospitals is the use of procedures which bypass the body’s primary defense against infection: the skin.  Our skin keeps bacteria out of our bloodstreams and away from our tissue.  In the hospital, however, we may have an procedure in which an incision is made in the skin or we may need a catheter or a ventilator.  Each of these presents an opportunity for bacteria to bypass the skin and enter the body.

If you are not going to the hospital for an emergency, you may have a choice about where to go.  Doctors who practice in hospitals usually have privileges at more than one hospital.  If you have the ability to choose your hospital or to at least make a suggestion about where you would like to go, visit Medicare’s Hospital Compare site.   It has lots of useful information about hospitals, including information about infection rates and how hospitals stack up against the national averages.

I also recommend you take a look at the information provided by the Centers for Disease Control about infections and what you can do as a patient to reduce the risk of a dangerous infection.  There is some very good advice to be found there.

As always, be aware that health care is a two-edged sword.  While it helps make us better, it exposes us to some risks.  Do your part to keep from spreading infections to others and to keep others from infecting you.

Posted in antibiotic resistant bacteria, blood infections, Doctors, General Health, health, healthy living, Hospital Negligence, Hospitals, Infection, Medicare, Nurses, Sepsis |

Urgent Care or Emergency Department?

November 16, 2020

One of the most obvious changes in the medical landscape over the last 15 years has been the proliferation of urgent care clinics.  You can’t drive down almost any street in a major metropolitan area without passing at least a couple of urgent care centers.  These centers have become common because many people do not have health insurance or do not have a primary care physician.  When they get sick, they need somewhere to go.  Urgent care centers offer convenience and, in today’s world, convenience sells.

How Urgent Care Centers are Changing the Health Care Delivery Landscape

When you become sick or injure yourself and decide to seek medical care, you have to make a decision.  Assuming you are going to seek immediate treatment, you need to decide whether to go to an urgent care center or to a hospital emergency department.  There is a big difference between the two and the choice can be important, almost to the point of being life saving.

Hospital emergency departments are usually staffed by doctors who have extensive training in emergency medicine.  They have available to them the resources of the hospital, which include the ability to perform complex lab tests and radiology studies, such as CT and MRI.  If your condition is serious enough, they have the ability to arrange for you to be admitted to the hospital.

Urgent care centers are not usually staffed with residency trained emergency medicine physicians.  Over the course of my practice, in the cases I have brought, the doctors have often been family practice doctors.  The urgent care center may have an x-ray machine but it won’t be able to administer a CT or an MRI.  It is not likely to be able to do all of the lab tests a hospital emergency department can arrange.

If your condition is a serious one, you want to go to the emergency department.  If your condition does not appear to you to be serious but one you want evaluated and for which you want some treatment, the urgent care center will probably be just fine.  Chest pain, head for the ER.  Stroke-like symptoms, head for the ER.  Just feeling poorly with flu-like symptoms, urgent care is your destination.

Do not rely on the ability of the urgent care doctors or nurse practitioners or physician’s assistants to screen you and decide whether you need to go to the emergency department or not.  They will do their best and send you on to the ER, if they think your condition is too serious for them or if it is one outside their ability to treat, but they sometimes make mistakes.  Because they are not usually highly trained emergency medicine physicians, they may not recognize the seriousness of your condition.  Even if they do recognize it, it may take a while and the time lost before you finally get to the ER may be critically important.

You are the critical decision maker when you are in need of medical treatment.  If it is potentially serious enough, call 911 and let the paramedics decide where to take you.  Don’t take a chance on urgent care, if there is any chance that you are really hurt or have a serious medical condition.

And when you get wherever you are going, remember how important a good history is to the person who is trying to figure out what is wrong with you.  Tell them everything you think may be important.  Be sure also to bring with you a list of all of the medications you are taking.  Have someone with you to keep you company and to keep an eye on the medical personnel to make sure you get taken seriously and get the treatment you need.

Posted in Board Certification, Cardiac CT scan, Doctors, Health Care Costs, healthy living, heart attack, Hospitals, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, Misdiagnosis, Nurses, Stroke |

Melanoma Misdiagnosis.

November 09, 2020

If you, like me, live in Arizona, you are exposed to intense solar radiation nearly all year, but especially in the summer.  Exposure to solar radiation is one of the major risk factors for melanoma.

Melanoma - Wikipedia

Melanoma is a cancer, which most often appears on the skin.  It is a cancer of the melanocytes, the cells that produce brown pigment.  It can appear anywhere in the body there are melanocytes.  The most common area affected, other than the skin, is the eye.

Melanoma is forty times more common in whites than in blacks.  Men are more likely to develop it than women and people with many moles are at higher risk as well.  Fair-haired, white people, who burn easily or freckle, are among those at highest risk for development of melanoma.  Melanoma is the sixth most common cancer in Arizona and it is becoming more common all the time.

There is a good memory device to help you recognize melanoma, should it appear on your skin:  “ABCDE.”

A is for Assymetry.  The two halves of the spot on the skin do not match.  You can see that clearly in the image above.

B is for Border.  The spot has an irregular or scalloped border.

C is for Color.  The spot may have different colors, including black, brown, red, white or blue.  The image above shows different colors.

D is for Diameter.  Although they can be smaller, melanoma spots are usually at least the size of a pencil eraser.

E is for Evolving.  Watch for spots that are changing in size, color or shape.

The spot in the image above is a classic presentation for melanoma.  However, melanomas don’t always have classical presentations.  When they do not, they present the greatest chance for misdiagnosis arising out of a failure to recognize the presence of the melanoma.  Most of the melanoma cases I have handled have been failures by the physician to recognize a non-traditional presentation of melanoma.

One of my first melanoma cases involved a melanoma on the bottom of the patient’s foot.  Its location was probably the first thing which threw off the physician.  The bottom of the foot is not usually exposed to much solar radiation and is an uncommon location for a melanoma.  The failure to diagnose the melanoma was also a reaffirmation of the problem of unconscious biases, in this case confirmation bias.  The doctor did not expect to find a melanoma on the bottom of the patient’s foot and looked for and found a diagnosis that fit his pre-existing conclusion that this was not going to be a melanoma; he concluded it was a wart and tried unsuccessfully to burn it off.  The patient, a lovely, young woman with young children died shortly after we concluded her case.

When melanomas first appear on the skin, they tend to spread and may spread quickly.  During this phase of lateral spreading, they typically do not also grow deeply into the skin.  However, after growing out, they quickly begin to grow deep into the lower layers of the skin and the tissue below it.  It is when melanomas grow down that they also begin to metastasize to other parts of the body.

A melanoma, which is still on the top layers of the skin and has not begun to grow down, is a Stage I and can be treated with excision.  Melanomas addressed at this stage have good survival rates, usually exceeding 90% at five years.  If the melanoma has spread into the local area by the time of diagnosis, more than just excision will be necessary to treat it.  The 5 year survival rate for local melanomas is almost 60%.  On the other hand, if the melanoma has already spread to a distant site by the time of diagnosis, the 5 year survival rate is only 14%.

The lesson here is to be alert to the presence of possible melanomas and to see a dermatologist as soon as you recognize a spot which may be a melanoma.  If you see the doctor and he or she mistakenly says what you have is not a melanoma, you should go see an experienced malpractice lawyer.  Virtually any delay in the recognition of the presence of a melanoma can have fatal consequences as those 5 year survival rates show.  You need to see a lawyer as soon as possible after diagnosis.  Your claim is far more valuable to you and your family while you are still alive than it would be after you have passed.

Posted in arizona certified medical malpractice lawyers, Cancer, Doctors, health, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice lawyers, medical mistakes, Medical Negligence, Melanoma, Misdiagnosis |

Defective Surgical Staplers And The FDA.

November 02, 2020

The surgical stapler is an important tool.  Rather than spend substantial time sewing body parts together during abdominal, thoracic or bowel surgeries, surgeons can use a stapler to close up wounds and attach body parts.  Removable staples are also used to pull together scalp wounds or other skin wounds under tension.  On the other hand, if the stapler malfunctions, it can cause grave damage to the patient up to and including death.

ETHICON Surgical Staplers | ECHELON > A better way to staple

For many, many years the Food and Drug Administration (FDA) has maintained a public database of reports of problems with medical devices.  The database is called Manufacturer and User Facility Device Experience (MAUDE).  Manufacturers, importers and device-using facilities are required to report device malfunctions to the FDA.  Physicians and others can make voluntary reports and are encouraged to do so.  The MAUDE database is a vital tool for hospitals, physicians, manufacturers and regulators in their efforts to ensure that the devices they use are safe and to identify and fix problems.  Patients who are injured by a device can see if it is an isolated incident or part of a larger problem.

Until recently, the system was thought to work well.  Specifically with regard to surgical staplers, there were few reports of malfunctions and the devices were thought to be safe.  However, some surgeons were experiencing problems with staplers.  Sometimes they would jam and not work at all.  If a patient had an open wound that was actively bleeding, the failure of the stapler to work might cause the patient to bleed to death.  Some other surgeons experienced a different problem with staplers; they fired on their own.  Sometimes this caused significant injury to the patient, including death and brain damage.

When these surgeons reported the problems to the FDA and examined the MAUDE database for stapler complaints, they were surprised to see very few.  Some of the surgeons began asking questions of their colleagues and found that many of them were having similar stapler problems.  Stapler problems were actually quite widespread.  What was going on?  Why were significant stapler malfunctions not recorded in the MAUDE database.

After a lengthy investigation by Kaiser Health News, it was discovered that the FDA for almost 20 years had been granting secret reporting exemptions to manufacturers who requested them.  These exemptions allowed the manufacturers to have their malfunction reports go into an “alternative summary reporting” database, which was not available to the public or to the medical profession.  It made their products look far safer than they were and prevented the public and the medical profession from demanding safety changes, where they were needed.

The number of devices covered by the alternative reporting system was large.  There were thousands of  them.  The number of secret reports was therefore also large.  Since 2016, over a million reports were made to the secret database.  In 2017 alone, there were 480,000 reports of patient injuries or device malfunctions that were hidden from public view.

In 2016, for example, there were only 84 public reports of stapler malfunctions or patient injuries made to the public MAUDE database.  In the same year, there were nearly 10,000 malfunction reports made to the secret database.  This is a scandal and an outrage.  The FDA has since mostly ended the special exemption program and publicly-available device malfunction reports have soared.

According to the FDA, the exemption program began innocently enough as a way of reducing duplicative reports of malfunctions which were overwhelming staff at the FDA.  The program required manufacturers to continue to publicly report deaths but other injuries could be reported in a spreadsheet format on a quarterly basis.  The public and the medical profession were never told about this alternative reporting database.

Although the FDA has ended the program for most devices, it refuses to identify the 100 or so devices that were granted the special exemption.  Apparently, the alternative reporting program remains in place for pacemaker electrodes and implantable defibrillators.

Although some progress has been made, there is lots of room for improvement of the FDA’s management of device safety.  I have blogged on a number of occasions about problems with reusable endoscopes and the FDA’s changing guidance.  Medical devices are becoming more complicated and more important to patient care.  We need to demand more transparency on the part of the FDA and greater Congressional oversight to make sure this important task is given the priority and resources it deserves.



Posted in disclosure of medical mistakes, Doctors, health, Hospitals, Medical Devices, medical mistakes, medical research, Secrecy |

“Time Is Brain.”

October 26, 2020

“Time is brain” is what neurologists and neurosurgeons say to emphasize the importance of seeking prompt treatment in the event of a stroke.

There are two types of strokes and they can both be terrible.  The first type is the hemorrhagic stroke.

Surgery for Hemorrhagic Stroke vs. Ischemic Stroke: What Options Exist?

As its name implies, it occurs when a blood vessel in the brain begins to bleed.  Sometimes, the bleed can be small but, at other times, it can be a full-on hemorrhage.  Blood is very irritating to the tissue of the brain.  Its presence can damage the brain and prevent it from functioning properly.  It can cause other vessels in the brain to go into spasm.  It can cause the brain to swell and can increase pressures inside the skull.

What the doctors do in response to a hemorrhagic stroke depends on the size of the bleed and the degree to which pressures rise inside the skull.  If the bleed is small enough, doctors may just wait and watch to see if the bleed stops on its own.  If it does, no invasive brain surgery is necessary.  On the other hand, if the bleed is larger, it may cause dangerous rises in pressure.  Most of the management of a hemorrhagic stroke is devoted to monitoring and managing pressures inside the brain.

The second type of stroke is called an ischemic stroke.

Neurology expert witness discusses ischemic stroke and emergency room  treatment

Ischemia means not enough oxygen is reaching the tissue.  In the case of an ischemic stroke, it occurs because a blood clot has completely or partially blocked an artery in the brain.  As with the hemorrhagic stroke, the part of the brain downstream from the clot does not get enough oxygen and can die as a result.

Doctors treating a patient who is experiencing an ischemic stroke can administer drugs called “clot busters” that can break up the blood clot and restore the flow of blood to the brain.

The sooner the stoke patient arrives at the hospital, the sooner he or she can be evaluated to determine the type of stroke which is present.  The last thing the doctors want to do is administer clot busting drugs to a patient having a hemorrhagic stroke.  Clot busters work by reducing the body’s ability to form blood clots.  If anything, clot busters would make a ruptured artery bleed more freely.

The sooner the doctors can identify an ischemic stroke, the sooner they can determine if the patient is a candidate for clot busting drugs.  The longer the time before the patient arrives at the hospital following the onset of an ischemic stroke, the more likely it is that the brain tissue, which has been deprived of oxygen, will die.  At the present time, patients with ischemic strokes are recommended to receive clot busters only within three hours of onset of the stroke.  While some doctors may give clot busters even after three hours, the chances for successful restoration of brain function are greatly reduced.  At four or five hours, most doctors won’t even try clot busters.

No matter the type of stroke a patient might experience, it is critical to get to the hospital as soon as possible.  Some of the symptoms of stroke are sudden weakness, paralysis of a limb or weakness on one side of the body, inability to speak, drooping of the mouth or eye, difficulty walking, nausea and vomiting, a sudden “thunderclap” headache, confusion, and inability to look at bright light.  If you have any of these symptoms or if you see them in a friend or loved one, call 911 immediately.

“Time is brain.”  The sooner a stroke patient is evaluated and treated, the better the quality of the recovery.

Posted in Blood Clots, Doctors, health, Hospitals, Stroke |

Hospital Greed in the Era of Covid.

October 22, 2020

It is late May 2020 in the Imperial Valley of California.  The sun is high and hot.  Temperatures exceed 110 degrees.  The Novel Coronavirus is also running hot.  The only two hospitals in the entire Imperial Valley are swamped with sick Covid patients.  They have more patients than they can possibly treat.  They need to find hospitals that can take some of their patients.  When they call other Southern California hospitals, they find some are more interested in making sure they get paid than they are in helping out in a time of need.

Greed - Wikipedia                                   1909 Painting, “The Worship of Mammon.”

The Imperial Valley is located in the desert between Yuma and San Diego.  It is an area of intense agriculture.  It is also a very poor area.  Nearly a quarter of the population is below the poverty line.  Most of its residents are of Hispanic descent and work in the fields or elsewhere in agriculture.  Many of the residents are uninsured or, if they are insured, are on Medicaid or Medicare.

The magnitude of the problem facing the hospitals was significant.  The two hospitals were forced to transfer 250 patients over a two week period when things were the worst.

There were at least four hospitals that either outright refused patients from the Imperial Valley or refused them until they were guaranteed that someone would pay for the care of any patients they accepted.  Each of the four was a non-profit entity that operates on a tax free basis.  If you thought that non-profit hospitals, which get their tax free treatment in return for promising to serve the public good, really lived up to their promise, good luck with that.

The hospitals were taking advantage of some loopholes and gray areas in the federal and state laws that require hospitals to provide care to emergency patients regardless of their insurance status.  The care must be provided until the patient is stabilized.  The refusing hospitals took the position that the Imperial Valley patients had been stabilized and that they therefore had no legal obligation to accept them.

While there may be some dispute over the requirements of federal law, there is little doubt that the refusals were a breach of medical ethics.  The Imperial Valley hospitals were overrun and could not provide the care that was needed by the patients arriving at their emergency rooms.  The refusing hospitals had capacity and the ability to provide the needed care.  They should have been willing to accept some of the patients.

When they could not find hospitals willing to accept their patients, the Imperial Valley hospitals did the best they could.  In some cases, they just kept calling till they found a hospital willing to accept a patient.  In some cases, the state of California stepped in and promised to pay for the carer of uninsured patients.  In some cases, the patients were placed in hallways or anywhere the hospital could find space while the search for a hospital that would accept them went on or until room could be made for them.  In some cases, patients who were deemed least sick were sent to an alternative-care site set up at a local community college, where they received limited treatment.  According to news stories about the transfer problems, some patients suffered lung damage and other complications as a result of the delays in getting them transferred out of the overwhelmed hospitals.

Healthcare is a big business.  Hospital chains keep getting larger and acquiring more power.  If you can’t pay, you may not get the care you need.  Don’t be fooled by hospitals trumpeting their non-profit status and asking you to donate money to them or give them some kind of a legal break.  The truth is often a lot uglier than they wish to admit.

Posted in Fee for Service, health, Health Care Costs, Hospitals, Medical Costs, medical ethics, Medicare, Rationing |

Lots of Malpractice Out There.

October 19, 2020

I have spoken to or reviewed records for thousands of patients over the years I have been representing people injured by medical malpractice.  I have also read a lot of articles about the incidence of medical malpractice.  I can say with confidence that in any hospital stay of three days or more, the patient will be the victim of at least one instance of medical malpractice.  Fortunately, most of these instances will cause little harm but the fact of that much malpractice should be of concern to all of us.

Consider change to Guam's medical malpractice law

It is not hard to understand why there is so much malpractice in hospitals.  They are large, complex institutions with many employees performing complicated tasks.  There is a lot of truth to the old adage, “Too many cooks spoil the broth.”  This applies to hospitals as there are lots and lots of cooks helping to care for a patient.

By way of example, I have a friend who is quite sophisticated about malpractice issues as he works for a malpractice insurance company.  He had to be admitted to the hospital a few years ago.  He told me that each night for the first three nights, the nurses brought him the wrong medication.  They insisted it was the medication he took at home and he insisted to them that he had never taken that medication in his life.  You would think that after the first night, the nurses would have discovered their mistake.  You would be wrong.  They just kept coming back night after night with the wrong medication.

Think about a hospital stay for a routine surgical procedure.  This should turn out well.  The surgery is elective and therefore not an emergency.  The doctor, the patient and the hospital should all be well-prepared for the event.

Now think for a moment about all the people who will participate in the care of the patient and how many ways mistakes can be made.  First, the intake people meet the patient and admit her.  Always a chance at this stage for mistakes to be made about patient identity (and what medications they take at home).

Once the patient arrives on the floor, she is introduced to the nurse who will be caring for her on the current shift.  Hospitals run either two or three shifts each day.  Each time there is a shift change, the nurse caring for the patient must give a report to the successor nurse.  This report is to include tests that have been done but not yet reported, scheduled medications, status of the patient and many other things.  When the shifts have been busy, the hand off of the patient from one nurse to another may not go as smoothly as it should and information may get garbled or not given at all.

Even though the patient has been admitted by her surgeon for the procedure and the surgeon is usually the attending physician, many doctors may be involved in the patient’s care.  There may, for example, be a hospitalist, who only sees patients in the hospital for other doctors.  There will likely be other doctors involved, such as radiologists and pathologists as well as many other specialists, if things go a little sideways.  The communications between these doctors can be complicated.  It usually takes place through chart entries.  If one of the doctors does not do a good job charting, it can lead to misunderstandings among the physicians.  Misunderstandings often lead to mistakes in care.

Orders have to be given, recorded and followed.  Often orders are changed as circumstances change.  Doctor A may change the orders given by Doctor B or Doctor A may change them herself.  The old orders must be closed out and the new orders recorded in the chart.  Tests have to be performed, reported and the results evaluated.  Many is the time I have seen important test results that just fell through the cracks.  Many is the time I have seen important orders missed or just plain disregarded.

Most importantly, the nurses who are in direct contact with the patient must keep the doctors fully informed about what is going on with the patient.  Communication is always a problem for human beings.  Even under the best of circumstances, there can be misunderstandings or just plain old failures to act.  I have had a number of cases in which a patient became paralyzed during the night following surgery and, due to a failure on the part of the nurse, the doctor did not learn of the paralysis until he arrived for rounds the following morning, when it was too late to do anything about it.

I recommend to my family and friends that they have someone stay with them in the hospital to monitor things, to act as their advocate, to ask questions and to make sure, to the greatest extent possible, that things go well.  I suggest they be polite but firm in asking questions and insisting people be notified and action taken.  Nothing can guarantee you won’t be the victim of malpractice at the hospital but doing these things will reduce the risk of a major injury.

Posted in Doctors, electronic medical records, Hospital Negligence, Hospitals, Lawsuits, medical charts, medical errors, Medical Malpractice, medical malpractice cases, medical mistakes, Medical Negligence, Medication Errors, Nurses |

Telephone, Anyone?

October 12, 2020

I am sure most of you remember the children’s game of Telephone.  You get a group of people and the first tells a secret to the second.  The second repeats the secret to the third person, who tells it to the fourth and so on until everyone has been told.  Then you compare the secret the first person told with what the last person was told.  There is almost always a big difference.  The message gets garbled and mangled as it goes from person to person.  Like it or not, the game of Telephone accurately describes what happens in your medical records. : EC VISION Rotary Phones for Landline, Retro Landline ...

In the course of my practice, I read a lot of medical records.  It is the rare case in which I fail to find some significant mistake.  My client may be seeking compensation for the results of a head injury resulting from an accident in May.  Her records may say that she has been experiencing the effects of a head injury since March, two months before the accident.  The timing of the onset of problems is one of the most common errors I see.  Another common error is the patient who is having problems at the time of the office visit but they are not mentioned in the chart.  Needless to say, the defense jumps on these mistakes and uses them to weaken my client’s case.

Your medical records are like the game of Telephone because, once an error appears, it is repeated over and over.  Sometimes, it gets worse, as the mistake becomes even more egregious, but it never gets better.  So how do medical records get corrupted in the first place?

The first part of any medical encounter should be a patient history.  It should be careful, thorough and accurate.  It should address not only the chief complaint which brings the patient to the encounter but events which have occurred in the past, which may be relevant to diagnosis and treatment.

Unfortunately, due to the economic realities of running a medical office today, it is rarely the doctor who takes the history.  It is usually taken by an member of the doctor’s office staff.  That person is never going to be as well-trained as the doctor.  The staff member may be well-trained and experienced or may have just started last week.  That person is almost never going to understand the significance of every event in the patient’s history.  That person is not usually going to know what questions to ask to draw out additional relevant information from the patient.

The office person taking the history is not going to write down everything the patient says.  The staff member is usually busy with a number of duties and will usually write down only what seems important to them.  That may or may not be what is actually the most important information for this particular encounter.

Many staff members will look at the patient’s chart and just ask if there have been any changes since the patient last saw the doctor.  If the answer is no, the staff member may just cut and paste the history from the last visit, which may itself just be a copy of the history from the visit before that.  I see these word-for-word histories repeated, sometimes even over a course of years.  Once an error is made, it gets repeated over and over.

Errors which appear in your history may affect the treatment you receive from the doctor.  The doctor may not go over all the history with you on his or her own.  She or he may simply accept the history taken by the staff member.

Errors which appear in your history may affect legal claims you bring.  As I noted above, an error in your records can undermine your claim in a number of different ways.  The defense may argue, for example, that you could not have been severely injured because you didn’t tell the doctor about the problems you are now claiming.  It won’t do you much good to point out that you did tell the office staff but they must have failed to note it in the records.  Juries tend to treat medical records as the Bible.  If it is in the records, it is true.  If it is not in the records, it didn’t happen.

All this means that you should be proactive about the quality of your medical records.  You have the right to see your records and the right to insist that erroneous information be removed or otherwise corrected.  You may not find your doctor or the doctor’s office all that willing to accommodate you in making changes, but you should at least make the effort.  If they refuse to make the changes you believe are necessary, write up your version of the facts and ask them to place it in your chart.  For a whole host of reasons, it is better to do this sooner than later, so get over to the offices of your doctors and see what they have been saying about you.


Posted in Doctors, electronic medical records, health, Lawsuits, medical charts, medical ethics, plaintiff |

Caesarian Sections

October 05, 2020

The Caesarian section can be a life saver for both the mother and her baby.  There are a number of conditions which can develop during pregnancy or during the delivery process which require that the baby be delivered by C-section.  Among them are shoulder dystocia, fetal distress, failure of the labor to progress, malposition of the baby and a baby too large for the pelvis of the mother.  But Caesarian section is not risk free and the evidence is that it is being used when it is not necessary.  This is a serious problem.

304 Cesarean Section Photos - Free & Royalty-Free Stock Photos ...

So what are the risks of a Caesarian section?  In the first place, all of the usual risks of an operation are present:  bleeding, infection, clotting problems, reactions to anesthesia, and surgical accidents.  Mothers who have had C-sections are also usually in the hospital longer and face larger medical bills.  Their recovery takes longer than that of the average mother who has delivered vaginally.  Pain levels may be greater due to the surgical incision.  Finally, there is an increased risk to future deliveries.  While it is possible to deliver a later baby vaginally after having had a C-section, there is a greater risk of uterine rupture during labor.

C-sections present some risk to baby as well.  Babies delivered by C-section are more likely to develop breathing difficulties.  There is also a chance baby will be nicked by the surgical instruments during the procedure.

All of these risks are greatly outweighed, if either the mother’s health or that of the baby are in danger with the continuation of labor and a vaginal delivery.

Since doctors began to keep records of the number of C-sections being performed, the numbers have been going up.  Beginning particularly in 1996, there has been a sharp rise in the percentage of Caesarian births.  In 1996, one in five women had a C-section.  Today that number is one in three.  That is approximately a 65% increase.  If C-sections are being performed to save the mother or the baby from a risk, we would expect to see decreases in maternal and fetal injuries and death.  Unfortunately, there has been no such decrease.  C-sections are clearly being performed for reasons other than the safety of the mother or the baby.  When not done to protect the mother or the baby, a C-section presents greater risks to both of them than a routine vaginal delivery.  For this reason, the American College of Obstetricians and Gynecologists (“ACOG”) has offered guidance to obstetricians about the risks of the procedure in an effort to discourage its use when not necessary to protect either the mother or the baby.

There is no agreement on the reason so many more women get C-sections than in the past.  It does not appear that there are more risky pregnancies or that women are more frequently demanding a C-section.  One factor that some observers have remarked upon is our old friend “fee for service.”  Obstetricians are usually paid for more a Caesarian section delivery than for a vaginal one.

What does all of this mean for the woman approaching labor?  My advice is to think about these issues before arriving at the hospital.  Every0ne hopes that the delivery will go smoothly and the vast majority do.  However, babies have a way of acting unexpectedly and the mother and her partner, if he or she is there, must be prepared to be flexible and to make decisions as the situation changes.  To those mothers who really want a natural, vaginal delivery, I say, “Don’t let that desire outweigh the safety of your baby.”  Don’t delay the decision to go Caesarian wait too long.  The obstetrician should be closely monitoring the situation but don’t count on her or him to the point that you risk the health of your baby.  This is your baby. Ask questions and be proactive.  Lean on your partner.  After hours of labor, you may not be in the best place to ask questions and make decisions.  Have someone there to help you, if possible.  Most of all, good luck.  Mothers have been delivering babies for thousands and thousands of years.  You have the best medical technology available to you in the history of mankind.  Everything should be fine.


Posted in Birth Injuries, Cesarean Section, Fee for Service, Health Care Costs, Infection, Informed Consent, Sepsis |

Hip Replacements.

September 28, 2020

One consequence of our lengthening life spans is that we are wearing out our original equipment.  Our knees and hips were not intended to last 60 or 70 years.  They certainly weren’t intended to support the heavy bodies so many of us now have.  Our remote ancestors were lucky to have anything at all to eat.  You didn’t find any fatties on the savannas in prehistoric Africa.  All of this has made joint replacement, especially hips, an important and lucrative field for orthopedic surgeons.

Total Hip Arthroplasty No Better Than Partial Joint Replacement ...

The hip replacement is a wonderful surgery.  It has improved the lives of many people who suffer from degenerative joint disease.  I am one of them.  I had my hip replacement almost 10 years ago and it is still doing great.  The technology and operative techniques continue to improve so expect even better results in the future.

There are a number of risks associated with hip replacement, the greatest of which is infection.  Other risks are heart attack, pneumonia, sepsis, shock, blood clots, pulmonary embolism, surgical site bleeding and mechanical problems with the prosthesis.  For most patients, the risk of complications, other than infection, are small.  Not all hospitals are the same, however.  Some do a better job of preventing infection or other complications of hip replacement surgery.  If you are a candidate for hip replacement surgery, you can and should look at the data the federal government collects about complications for hip replacement surgery.  You can find it here, at Hospital Compare.

According to the Centers for Disease Control, on any given day a hospital patient has a 1 in 31 risk of developing a Hospital Acquired Infection (HAI).  Some of these infections will be minor, but some of them will be resistant to antibiotics and may be devastating.  Infection rates are also tracked and available for review at Hospital Compare.

Just as all hospitals are not equal when it comes to preventing infection and other complications of hip replacement surgery, not all surgeons are equally skilled in performing the procedure.  You can and should investigate the qualifications and record of the surgeon you are going to entrust with one of the most important surgical procedures you may ever have.

You want a surgeon who is well-trained and experienced.  Go to the web site of your state medical board and look up your surgeon.  Is he or she an orthopedic surgeon?  These are the surgeons who have been specifically trained in joint surgery.  Is she or he Board Certified?  While Board Certification does not guarantee a good result, it does mean that the surgeon is well-trained and experienced and has demonstrated competence to his or her peers.  Does the surgeon have a record of discipline with the Medical Board?  Discipline is uncommon, even with doctors who are not all that good.  If a surgeon has been disciplined by the Medical Board, that should be a giant warning flag.

How often does your surgeon perform hip replacements?  As the old adage goes, “Practice makes perfect.”  The more often your surgeon and his or her team perform a procedure, the more routine it becomes for them and the better they usually are at doing it.

Plan your procedure for a Tuesday or Wednesday, if possible.  You do not want to be in the hospital over the weekend, if you can avoid it.  Bad things are more likely to happen at hospitals over the weekend for a number of reasons.  Go home before the weekend.

When you get home, you have control over many aspects of your recovery.  Even if you had a successful surgery, you can degrade the ultimate result by failing to do what the surgeon and therapists tell you.  Follow the orders of your surgeon and therapists.  Do your exercises.  Avoid weightbearing.

Do these things and you will have done what you can to get the best outcome from your hip replacement surgery.

Good luck.  I hope yours turns out as well as mine.

Posted in Arizona Medical Board, Blood Clots, blood infections, Board Certification, Doctors, heart attack, Hip Replacement, Hospital Negligence, Hospitals, Infection, joint replacement, Medical Devices, Medicare, Nurses, Obesity, Orthopedics, Pulmonary Embolism, Sepsis, Surgical Errors |