Medical Malpractice News and Views

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

Nursing Homes Can Kill You – Even If You Never Set Foot In One

October 14, 2019

As the population of the United States ages, more and more of us will find ourselves or our loved ones in nursing homes or other long-term care facilities.  There is more and more data to suggest that these facilities are harming the health, not only of their patients, but of individuals and patients who never enter a nursing home or long-term care facility.

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Some of the most recent evidence of this hazard comes courtesy of a drug resistant fungal infection called Candida auris.  This highly contagious infection was first identified in Japan in 2009 and came to the United States in 2015.  Since its arrival, it has infected nearly 800 people, half of whom usually die within 90 days of becoming infected.  It is but one of the drug-resistant and other infections that are all too common in nursing homes.

Nursing homes and long-term care facilities play an important role in spreading drug resistant infections throughout the woder community.  The facilities house patients who are either ill or aged or both and whose immune systems are weak.  They are prime candidates for infection.  Additionally, some of these facilities are understaffed or do not train their staff well in infection control or the staff, even if well-trained, does not follow safe practices.  As a result, infections often spread rapidly among the patients who are cared for in these facilities.

While it is bad enough that patients in these facilities are exposed to and infected by the other patients and the staff carrying pathogens from room to room, the greater public health risk arises when one of these infected patients becomes seriously ill.  At that point, an ambulance takes them to a traditional hospital, where they may introduce their infection to the other hospital patients.  Nursing homes and long-term care facilities are reservoirs of dangerous infections, which they repeatedly bring to regular hospitals.

The New York Times recently had an article about the role nursing homes and long-term care facilities play in the spread of infection.  One of the important quotes in the article referred to these facilities, “They are caldrons that are constantly seeding and reseeding hospitals with increasingly dangerous bacteria,” said Betsy McCaughey, a former lieutenant governor of New York who leads the nonprofit Committee to Reduce Infection Deaths. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”

A recent study in the Journal of Clinical Infectious Diseases reported high rates of drug-resistant infections in nursing homes and long-term care facilities.  Patients, staff and family may carry drug-resistant germs around on their bodies without showing symptoms and spread them to other patients and other family members.  The researchers found that 65% of the residents of nursing homes in Southern California carried a drug-resistant pathogen.  Similar pathogens were carried by 80% of the residents of long-term acute care hospitals.  By contrast, only 10-15% of patients in traditional hospitals carried the pathogens.

Nursing homes and long-term care hospitals present a dangerous health risk to all of us.  If they don’t clean up their act, these drug-resistant infections will continue to spread.  It may or may not already be too late to prevent the spread of these infections but it is never too late to begin to observe proper infection control in these facilities and elsewhere.  If you visit a patient in one of these facilities, do your part and observe proper infection control protocols.  Don’t let yourself or your family become infected.

Posted in antibiotic resistant bacteria, blood infections, General Health, health, healthy living, Hospitals, Infection, medical research, Nurses, science news, Sepsis |

Medical Malpractice Down Under

October 07, 2019

A sad story appeared recently in the national press.  A young cricket player in Australia broke her thumb in a game.  She went to a nationally recognized hospital in her area for treatment.  She was correctly told that this could be easily fixed with a surgical procedure followed by placement of a cast over the thumb.  She consented, the procedure was done and she was sent home in a cast.

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Six days later, she returned in excruciating pain.  When the cast was removed, the doctors and nurses were shocked to see that her thumb was cold, dark and almost completely dead.  The cause was immediately obvious, someone had forgotten to remove the tourniquet at the base of the thumb which had been placed to control bleeding during the surgery.  The tourniquet had continued to keep blood from flowing to the thumb after the surgery and the thumb was dying.

When doctors reviewed the medical records to see how this could have happened, they found that someone had checked the box to indicate that the tourniquet had been removed at the conclusion of surgery.  It was unclear who had checked the box when it was obvious that the tourniquet had not in fact been removed.

After attempts to save the thumb were unsuccessful, doctors had to amputate it.  They tried to replace it with one of the patient’s big toes but the result was less than completely successful.  The young woman will never play cricket again.  She has a thumb that is unattractive and not very functional.  In addition, she has problems with the foot from which the toe was taken.

The moral of this sad story, to the extent there is one, is don’t just assume that severe pain you are having after a surgery is normal.  Don’t just assume the doctors and nurses have done everything right.  Pain is the body’s way of telling us something is wrong.  Severe pain is the body’s way of telling us something is seriously wrong.  While there will almost always be pain after a surgery, it should not be excruciating and should get better over the next couple of days.  If it does not, or if it gets worse, start making noise and insisting that someone examine you.

I have seen a number of cases in my practice in which there has been a surgical error and the patient has extreme pain after the procedure.  Often, the patient assumes that the pain is normal and does not call to complain.  They don’t want to be a bother or be seen as a whiner.  When the patient does call to complain, it is often the case that a low level person in the doctor’s office assures the patient that the pain is normal and nothing to worry about.  Don’t let these people put you off.  Be polite but persistent that you want to be seen by someone.  If there is something wrong, the sooner it is recognized and addressed, the better the chance that you won’t suffer a permanent injury like our poor Australian cricketeer.



Posted in Doctors, Hospital Negligence, Hospitals, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, never events, Nurses, Orthopedics, Surgical Errors |

Pulmonary Embolism and Medical Malpractice

September 30, 2019

Pulmonary embolism is a medical condition in which blood clots form in the return, or venous, circulation and are passed by the heart into the lungs where they interfere with oxygen exchange.  The larger the clot or the greater the number of clots, the greater the degree of interference.  Symptoms can range anywhere from mild to severe shortness of breath.  When patients go to the doctor or hospital with symptoms of pulmonary embolism and are not treated properly, great harm, up and including death, can result.  Malpractice suits often follow.

Pulmonary embolism

I have handled a number of pulmonary embolism cases over my career.  All of them involved the death of the patient.  Patients can be failed by the medical system in a number of ways but the most common is the failure of the doctor to recognize and diagnose the pulmonary embolism.  One of my cases involved a man in his 60’s who went to the emergency department with significant shortness of breath.  After working him up, the emergency department physician diagnosed him with a cold and sent him home.  By the time he returned the following day, he was at death’s door and it was too late to save him.

Those who have studied this problem consistently state that doctors seeing patients who are short of breath must have a high “index of suspicion” that they may be seeing pulmonary embolism and test for it.  Most often the source of the blood clots is a larger clot in the deep veins of the leg.  This is called a deep vein thrombosis or a DVT.  Pieces break off the large clot and travel to the lungs where they become trapped in the small vessels where the lung exchanges CO2 for oxygen.  Once they become trapped, they prevent any further flow of blood into the portion of the lung downstream from their location.  The larger the clot, the sooner it becomes trapped and the greater the portion of the lung which is put out of commission.  If a very large piece of clot breaks off, it has the potential to become trapped at the very top of the lungs and cause death within minutes.

Once doctors recognize the presence of pulmonary embolism, the most common form of treatment is the administration of anticoagulants to keep the blood from clotting and to gently break up the clots that are already present.

There are, of course, other ways for doctors to make mistakes that cause or allow a patient to develop pulmonary embolisms.  One of my cases involved a man who had known problems with blood clots in his legs and was on regular blood thinners to prevent clot formation.  Unfortunately, he needed a hip replacement.  You cannot have a hip replacement while taking blood thinners so they had to be stopped prior to the surgery.  There was a lack of communication between the orthopedic surgeon who performed the procedure and the doctor who saw the patient in the hospital after the procedure and who discharged him.  Because of the lack of communication, the patient’s blood thinner medication was not restarted when he was discharged.  A few days later, his wife returned to the house to find him dead on the floor.  A massive clot had formed in his leg and traveled to the lungs.  Another death which never should have happened.

Still another form of malpractice occurs when a patient is on blood thinners for a while because of DVT and the doctor takes the patient off the blood thinners too soon and the DVT reoccurs.

There is not much patients can do to avoid being injured by pulmonary embolism.  The best advice is to remain hydrated, to be alert to pain in the legs which might mean a DVT is present and to make sure doctors don’t forget about your anticoagulant prescription, if you have one and it has to be temporarily stopped while you have an operation.

Posted in Blood Clots, Doctors, Hip Replacement, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical mistakes, Medical Negligence, Misdiagnosis, Pulmonary Embolism |

Just Because A Doctor Says It . . .

September 23, 2019

There is a saying no patient should ever forget, “Just because a doctor says it, doesn’t make it true.”  As I have often remarked before, medicine is a business, and a big one at that, and we are its customers.  Doctors sell us their services.  While most doctors have their patient’s best interests at heart, there are those who are in it for the money and want to sell as much product as they can.  A good example can be found in a recent story which appeared in the Wall Street Journal.

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Heart stents used to be a big money maker for some doctors.  They were placing them even though the science did not show that they were effective in treating coronary artery disease.  Over time, the medical consensus that they were not effective became so strong that the number of coronary artery stents being placed declined significantly.  However, much like the old “whack-a-mole” game, stents have now popped up in a new location.  Now some doctors are unnecessarily placing stents in leg arteries and risking the health of their patients by doing so.

When placed in leg arteries, stents are a form of peripheral vascular intervention.  Another aggressive intervention in the legs is an atherectomy, which is a procedure to remove plaque from an artery.  Both procedures address plaque deposits in arteries of the leg.  Almost every person in the United States who is 80 years old has some plaque deposits in the arteries of their legs.  It is only when those deposits become large enough to interfere with blood flow and cause pain that intervention should be considered.  Some doctors don’t want to wait that long.

The WSJ story was based on a study published in the Journal of Vascular Surgery which found that some physicians were placing stents in leg arteries and removing plaque at rates 4 to 5 times the national average.  The authors of the study examined Medicare records to determine the rates at which various doctors performed the procedure and discovered the large discrepancy between the average doctor and about 320 physicians, who were far more aggressive.  One doctor, who was part of the research team, went so far as to write a letter to the Centers for Medicare and Medicaid Services in which he claimed that these “outlier” physicians “may represent a serious and immediate threat to public safety.”

According to research on the subject, patients who have early leg pain due to narrowing of arteries in the leg have a 1% to 2% risk of limb loss in the next five years.  Aggressive procedures increase that risk to 5% to 10% because they may create blockages in narrow arteries or cause treated arteries to rupture.  The Society for Vascular Surgery has published guidelines which recommend these types of aggressive interventions only after patients who have leg pain when they walk have failed medical and exercise therapy and are experiencing symptoms which limit their activities.

The president of the Society for Vascular Surgery has offered the opinion that patients with leg pain who make positive lifestyle changes may never need aggressive vascular interventions or, if they do, can put them off for many years.  As he notes, the later in life a patient needs an aggressive peripheral vascular procedure, the better.

Be an informed consumer.  Get second opinions.  When a doctor recommends surgery or an operative procedure, ask about less aggressive, less invasive alternatives.  Ask about your doctor.  Look at her or his record at the state Medical Board.  Ask how often he or she performs the procedure being recommended and what the complication rate has been.  You can never guarantee that you won’t be victimized by the medical profession but you can give yourself the best chance of a good outcome by being careful and asking questions.

Posted in Arizona Medical Board, Blood Clots, Doctors, Fee for Service, health, Health Care Costs, healthy living, Medical Costs, medical ethics, Medical Malpractice, Medicare |

Staggering Malpractice at the VA

September 16, 2019

A Veterans’ Administration pathologist sits in jail today.  He is charged with three counts of involuntary manslaughter in the deaths of three veterans who sought treatment at the VA hospital in Fayetteville, Arkansas.  Investigation has revealed that he routinely misread pathology studies submitted to him.  It is believed that his misdiagnoses led to the death of at least 15 patients and seriously harmed many more.  The malpractice went undetected for at least 14 years.

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The obvious question is, “How could this have happened?”  The results of the investigation do not provide a good answer.  The pathologist, Dr. Robert Levy, was an alcoholic and an addict.  He was often impaired at work.  He used a liquid agent which gave him a quick and powerful high but was undetectable on routine drug and alcohol tests.  To cover up his mistakes, he altered patient records.

There were red flags flying for Dr. Levy all over the Fayetteville hospital.  He had a DUI before he was hired by the VA.  He was discovered to be impaired on arrival at work on two documented occasions years before the extent of his malpractice became known.  In spite of this, no one investigated his work.  He was even given performance bonuses for having an exceptionally low error rate.  In fact, later investigation showed that his actual error rate was 10%, an astonishingly high number.

This is particularly distressing when you remember that he was often asked to look at a specimen and determine if it was cancerous or not.  On some occasions, Dr. Levy reported that cancer was not present when it was while on other occasions he reported that cancer was present when it was not.  Patients who were assured they did not have cancer died when their cancers went untreated.  Patients who were told they had cancer when they did not underwent debilitating radiation and chemotherapy treatment, which was completely unnecessary.

Dr. Levy was the Chief of Pathology at the hospital.  Following routine practice, Dr. Levy regularly reviewed a certain number of the tissue and fluid samples analyzed by his subordinate to make sure the diagnosis was correct.  His subordinate reviewed a certain number of his for the same reason.  These reviews showed an extremely low error rate by Dr. Levy, an error rate which sometimes reached zero.  Later investigation revealed that Dr. Levy was using his position as Chief of Pathology to alter the reports of his subordinate and make it look like the subordinate agreed with Dr. Levy’s diagnoses.

While this is an outrageous case, it has a lot in common with other, less outrageous cases.  Hospitals are just not very good at discovering impaired or incompetent physicians.  Nurses, staff and even other doctors assume that their colleagues are competent and unimpaired.  Doctors who have addictions are often very good at hiding their tracks.  As always, patients need to be proactive and informed about their health care.  Ask questions and be sure to get satisfactory answers.  Don’t be afraid to get a second opinion when told you do or don’t have a significant medical condition.



Posted in Cancer, disclosure of medical mistakes, Doctors, Fraud, Hospitals, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, Misdiagnosis, Nurses |

Lawyer Loses Her Race Against Cancer.

September 09, 2019

A Baltimore attorney lost her race against breast cancer last week.  She also lost her chance to have her medical malpractice case decided before she died.  Attorney Katrina Dennis claimed that her surgeon failed to properly advise her when he operated to remove her breasts due to a finding of a cancerous lump.  There was cancerous tissue left behind on the chest wall.  Ms. Dennis alleged that her surgeon should have referred her to an oncologist and that she should have been given an anti-cancer drug to kill off the few remaining cancer cells.  Neither of those things happened.  Two years later, she went to urgent care with pain in her back.  The breast cancer had gone unchecked and had spread to her bones and vital organs.


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Ms. Dennis brought suit but, by the time the trial began, she was in the hospital in terminal condition.  She died during the first week of trial.  She was only 40.

Her fate is shared by many cancer patients who believe that their cancers were misdiagnosed or not treated appropriately.  By the time the medical mistake is recognized, the cancer has spread to other parts of the body and the race is on to get the case filed and resolved before death takes the patient.

These are always challenging cases for a malpractice attorney.  Once the patient becomes a client, the attorney must do everything she or he can to move the case along and get it resolved before the patient dies.  This includes taking a videotape deposition of the patient as soon as possible after filing.

The attempts to accelerate the case are always resisted by the defense and sometimes for good reason.  Speeding the case up can prejudice the defendants by forcing them to respond and go to trial before they have had a fair opportunity to discover all the relevant facts.  On the other hand, were the court to require the defense attorneys to give the patient’s case priority, the necessary preparation could be done in a much shorter time than the defense requests.

Sometimes though, I am forced to wonder if the delays requested by the defense are sought in good faith.  Everyone involved in the case knows that the patient is dying.  We all also know that the case is far less valuable if the patient has passed away than if she is still alive at the time of trial.  The difference in the verdict can be many millions of dollars.  Juries are often quite sympathetic to a patient who has only a few more months to live.  I cannot help but think that the defense lawyers and the insurance companies recognize that time is their friend and push for more of it than they actually need to prepare their case for trial.

It is important for a patient who believes that his or her cancer was not diagnosed properly or not treated properly get to a lawyer as soon as possible.  The clock is running and no one can predict how soon death will come calling.  If the patient is to receive any compensation at a time when they can still use it, suit must be filed quickly and pushed hard.  Understandably, the shock of the diagnosis and the desire to get aggressive treatment usually take precedence and going to see a lawyer is well down the list of things on the mind of a cancer patient facing a terminal diagnosis.  That said, it is important for a malpractice victim to contact a lawyer promptly, if she or he wants any chance at justice.


Posted in Breast Cancer, Cancer, Doctors, Lawsuits, medical errors, Medical Malpractice, Medical Malpractice Case Value, medical malpractice lawsuits, medical mistakes, Medical Negligence, Misdiagnosis, plaintiff, trial |

Misdiagnosis: The Most Common Form of Malpractice

September 02, 2019

A recent article in the peer-reviewed medical journal Diagnosis concluded, “[D]iagnostic errors remain the most common, most catastrophic, and most costly of serious medical errors . . . .”

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The researchers were from Johns Hopkins University School of Medicine and from CRICO Strategies, an insurance program affiliated with the Harvard medical institutions.  They dug into closed insurance files representing a large portion of all malpractice claims in the United States over a recent ten year period.  They found that nearly three-fourths of serious misdiagnosis-related harms occurred in just three major categories – vascular events, infections and cancers.  They concluded one-third of all malpractice claims that result in death or permanent disability were the result of a misdiagnosis or a delayed diagnosis.  There are over 10,000 known or recognized diseases but only a few symptoms or signs lead the way to each one.  There are often overlaps in the signs and symptoms.  Given the complexity of the problem, it is perhaps understandable that mistakes are made.

Another conclusion the researchers drew from the malpractice data was that over 84% of misdiagnosis claims were the result of clinical judgment failures.  They believe this means there is room for significant improvement in reducing misdiagnosis injuries by improving diagnostic decision making for only a relatively small number of high-risk conditions in just a few clinical settings.

The researchers found that most of the diagnostic process failures occurred during bedside assessments and in clinical reasoning arising from knowledge gaps on the part of the physician.

When a patient develops a cancer and it begins to produce symptoms, more often than not, the patient seeks treatment at an outpatient, ambulatory facility.  The patient may return on a number of occasions over time.  Because of the nature of these outpatient visits and the fact that the patient may see a number of different providers on these visits, they create an increased risk of missed communications and discontinuous care that lead to a missed or delayed diagnosis.

We patients have a role to play in improving diagnostic accuracy and avoiding some of the causes of a missed or delayed diagnosis.  The Society to Improve Diagnosis in Medicine (SIDM) recommends that patients ask the following questions of their health care providers:

  1. What is my diagnosis? What else could it be?
  2. Why do you think this is my diagnosis? From test results? From my physical exam?
  3. Can you give me written information about my diagnosis? A pamphlet? A website?
  4. Can you explain the test or treatment you want me to have?
  5. What are the risks to the test or treatment you want me to have? What happens if I do nothing?
  6. When do I need to follow up with you?
  7. What should I do if my symptoms worsen or change, or if I don’t respond to treatment.

They also recommend that you always ask when your test results will be ready and call if you do not receive them.  Do not assume that no news is good news, always call.  Ask for your records and keep copies of your test results.  Play your part to avoid being the victim of a misdiagnosis.

Posted in blood infections, Cancer, Doctors, General Health, Infection, Lawsuits, Lung Cancer, medical charts, medical errors, Medical Malpractice, Misdiagnosis, Sepsis, Stroke |

Another Large Malpractice Verdict – Part II

August 26, 2019

Last week I wrote about what was the largest medical malpractice verdict in Maryland history.  A young girl, now almost 5, was born prematurely with profound brain injuries as the result of a delay in delivery.  Her attorneys argued that the hospital should have done a Caesarean section when the 16 year-old mother arrived at the hospital with dangerously high blood pressure.  The hospital attorneys claimed that the young mother refused the Caesarean section when they offered it to her on arrival.  The jury, perhaps swayed by the tragic birth injury, sided with the child and awarded $229 million against the hospital.  Most of that money was for future care.  Maryland has a cap on non-economic damages resulting from medical malpractice so the young child can only recover $800,000.00 for her pain, suffering and loss of the ability to have a meaningful life.  The imposition of the malpractice cap will reduce the award to around $200 million.  Then will come the post-trial motions by the hospital and the inevitable appeals.

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An excellent article appeared after the verdict in the Baltimore Sun discussing the verdict and suggesting that not much will change because of it.  The article made a number of interesting points.

The little girl will never get the money the jury awarded to her.  The judge will reduce that portion of the verdict that exceeds the Maryland cap for non-economic damages in malpractice cases.  There goes about $29 million.  The little girl must pay her lawyers for their work and reimburse them for the costs they advanced to bring the case to trial.  Because of the risks involved and the complexity of the work, contingent fees in medical malpractice cases are usually in the 40% range.  These reductions are certain.  Less certain but extremely likely are reductions in the award either by the trial judge or by the appeals court.  Instead of simply reducing the verdict to numbers they consider more reasonable, the trial court and the appeals court may decide that the verdict was so influenced by sympathy that the hospital should get a new trial.  If that happens, the little girl goes back to square one.

Patients in malpractice cases lose far more often than they win.  According to the American Medical Association itself, 68% of malpractice claims are either dropped or dismissed by the court.  Only about 7% end up being tried and doctors win almost 90% of the cases that go to trial.

Malpractice claims and judgments are not driving doctors out of practice.   According to a study, 90% of doctors with five or more malpractice claims against them continue to practice medicine.  I discussed the problem of bad doctors continuing to practice in a blog post back in May.

Obstetrical cases generally resulted in higher settlements and verdicts than other forms of malpractice.  This is almost certainly the result of the cost of future care for those babies who are damaged at birth due to medical malpractice.  Even then obstetrics payouts in Maryland only averaged $1.13 million in 2018.  Payouts in surgical cases averaged $737,000 and the average for all non-obstetric cases was only $477,000.  These disparities are likely driven by the increased economic costs of providing care to a damaged baby over the course of his or her life.

As I noted above, the jury’s verdict is not the end of this case.  Assuming the parties do not settle the case at this stage, and that sometimes happens, there are likely many more years of litigation to go for this young girl before she sees any of the money awarded her.



Posted in Birth Injuries, Cesarean Section, Doctors, Hospitals, Informed Consent, Lawsuits, Malpractice caps, Malpractice costs, Medical Costs, medical errors, Medical Malpractice, medical malpractice claims, medical malpractice damages caps, medical malpractice lawsuits, medical mistakes, Medical Negligence, plaintiff, trial, Verdicts |

Another Large Malpractice Verdict

August 19, 2019

Recently a Baltimore jury awarded just over $229 million in a case involving a birth injury.  If that is all you know, you can fill in a lot of the other blanks automatically.  You will know that, as in the Baltimore case, the infant was likely profoundly damaged.  You will know that, as in the Baltimore case, the child was likely to need expensive medical care for the rest of her life.  You will know that, as in the Baltimore case, the case is a very sad one.  Lastly, you will know that, as in the Baltimore case, the defense is likely to appeal.

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Birth injury cases are almost always sad.  What everyone hoped would be a joyous occasion turned out to be a catastrophe that no one wanted and for which no one will usually accept responsibility.

In the Baltimore case, the mother was only 16 at the time of her daughter’s birth.  When she arrived at the hospital she was only 25 weeks of gestation (full term is 40 weeks) and she was suffering from pre-eclampsia, a condition in which the mother’s blood pressure is dangerously high.   Only about half of babies born at 25 weeks survive.  At trial, the mother claimed that the hospital should have given her an immediate Caesarian Section to save her baby’s life and give her the best chance of being born healthy.  Instead, the doctors induced labor and it went on for 22 hours.  During that period of time, the baby did not get enough oxygen and suffered brain damage in the form of cerebral palsy.  She cannot care for herself, her head is too small (microcephaly) and she suffers seizures and is often in pain.

The hospital claims that it offered the mother a Caesarian Section when she arrived but she refused and by refusing “tied the hands” of the hospital.  It had no alternative, it claimed, other than induction of labor and a vaginal delivery.  The mother admits that the doctors offered her a C-section but says she refused when they told her if she had a C-section, her baby would either be born dead or be brain damaged.  Needless to say, the hospital denies telling that to the mother.

This case is not over.  Big verdict cases are almost never over after the jury returns its verdict.  The hospital and the doctors will file post-trial motions asking for judgment in their favor notwithstanding the jury’s verdict or for a new trial or, in the alternative, for an order reducing the amount of the damages.  If they are not successful with the trial judge, they will appeal and seek either a judgment in their favor or a new trial.  Very frequently, during the long post-trial process, the parties will agree to a settlement.

Based on the experience of the past, it is highly unlikely that the badly damaged little girl will ever get to keep all the money the jury awarded her.  This is not a good system for either patients or health-care providers.

Posted in Birth Injuries, Cesarean Section, Doctors, Health Care Costs, Hospital Negligence, Hospitals, Informed Consent, Lawsuits, medical errors, Medical Malpractice, trial, Verdicts |

Technology Comes For The Humble Stethoscope.

August 12, 2019

Two hundred years ago, a Frenchman invented a tube with which he could listen to heart and lung sounds.  This was the first stethoscope.  Heart disease is one of the major causes of death throughout the world.  Often the abnormalities that are part of heart disease make sounds that give them away to a trained listener using a stethoscope.  Among the defects which can sometimes be heard through use of a stethoscope are diseased heart valves, certain heart arrhythmias, congestive heart failure, hypertensive disease, some structural heart disease.  Much of the effectiveness of the stethoscope depends, however, on its use in a quiet environment and the skill of the health care provider doing the listening.  Technology promises to change all of that and make the stethoscope a more effective tool for detecting disease and identifying treatments.

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There is no shortage of ideas about how to improve the stethoscope by taking advantage of today’s technology.  Start ups are incorporating artificial intelligence, algorithms, visual displays, recording devices, and direct internet connections.  If you can think of it, so have they and long before you did.  For the sake of simplicity, let’s call these new devices “digital stethoscopes.”

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First and foremost, the various digital stethoscopes convert sound into electronic signals which can be amplified to a comfortable level.  This lessens the need for a quiet room which is necessary to hear the soft sounds often required for diagnosis.  Some of the digital stethoscopes also use noise cancelling technology.

In programming the digital stethoscope, manufacturers can take advantage of large data sets of patients with heart or lung disease and the sounds associated with those conditions.  They can also receive and make a record of the electrical signals of the heart in the same way that an EKG does.  In some very promising studies, the digital stethoscopes were able to diagnose heart and lung problems with greater accuracy than even highly experienced cardiologists and pulmonologists.  In one study conducted by a manufacturer, it reported that its digital stethoscope recognized heart murmurs in children more often than five trained pediatric cardiologists using stethoscopes.

One of the advantage of the digital stethoscope is that it can “hear” sounds that are outside the ability of the human ear to recognize.  These are important sounds which cannot be heard by even the most talented and skillful human examiner using a traditional stethoscope.  These previously unheard sounds will open new avenues for diagnosis.

In some cases, the new digital stethoscopes were able to detect pre-cursor sounds that indicated a problem was developing that could not be detected yet with other testing.  Many of the stethoscopes allow their results can be stored and shared among physicians.  Even the Apple watch now has a feature that can record and recognize some abnormal heart rhythms.

Digital stethoscopes are going to be part of the telemedicine revolution.  They will allow health care providers in low resource areas to use algorithms for diagnosis and treatment.  They will allow the same providers to communicate and consult with specialists in high resource areas.  Even in high resource areas, they will lead to earlier and more accurate diagnoses which will lead to earlier and hopefully more successful treatment.

Next time the nurse practitioner tells you she wants to listen to your chest, she may be holding a digital stethoscope.  Count this as one of the good results of technology and take a deep breath for her.



Posted in Doctors, General Health, health, heart attack, Medical Costs, Medical Devices, medical errors, medical research, Misdiagnosis, science news |