Medical Malpractice News and Views


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

Generic Drug Betrayal

June 24, 2019

The promise of generic drugs is enticing:  quality replacements for name-brand drugs at a fraction of the price.  Regardless of whether that promise was ever anything more than an illusion, it is a proven lie today.

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I read two recent articles which deal with two separate ways in which generic drug manufacturers have betrayed patients.  In both cases, the betrayal is rooted in money.  The first betrayal is discussed in a book about generics and the ways in which it has betrayed its promise by cheating on quality.  Lightly regulated plants in India and China are paying off regulators, using substandard ingredients and cutting manufacturing corners to increase profits.

Most of the bad and dangerous drugs that are produced by these manufacturers end up in places like Africa and Asia but, beginning in the 1980’s, the United States began importing foreign generic drugs.  While the F.D.A. has done a masterful job of overseeing American drug production and made sure that quality control is high, the same is not true of its efforts to assure the safety of these Asian generics.  When the F.D.A. inspectors to get to these plants, and apparently their visits are few and far between, they announce themselves in advance, which gives the manufacturers plenty of time to cover their tracks.  This is not the case in the United States where no notice inspections are the rule rather than the exception.

Some of these dangerous drugs have made it to the United States.  In 2007 a number of dialysis patients died from allergic reactions to a contaminant in a generic blood thinner manufactured in China.  The F.D.A. had never inspected the Chinese plant and someone there had diluted the product to make it go further.

So one betrayal by the generic industry has been its production of poor quality, dangerous copies of name-brand drugs.  The other betrayal has been the generic industry’s price fixing.  Instead of providing low cost alternatives to name-brand drugs, the big boys in the generic industry have been engaging in schemes intended to drive up prices.   For example, the generic antibiotic, doxycyclene, cost about $20 for a prescription in 2013.  A year later, the price had risen over 8,000% to $1,829.  Similar, but not quite so outrageous, increases were seen in other generics.  Manufacturers would sometimes agree to raise prices in lock step.  Other times they would agree to assign certain drugs exclusively to certain manufacturers.

Now 43 states are part of a massive price fixing suit against 20 manufacturers alleging billions of dollars of harm to American consumers.  The likelihood of success seems high as the states have e-mails, text messages and testimony from insiders supporting the claim that the manufacturers were conspiring to raise prices.

There is another betrayal here as well.  It is the betrayal of the American citizen by the federal government.  The F.D.A. did not protect us from bad drugs made overseas.  The Congress did not protect us from generic price fixing at home.  It is a sad day when we must rely upon the attorneys general of the states to get together to address a national problem.  That is supposed to be the job of the federal government.  I am just happy that someone is doing the job.

Posted in drug companies, Fraud, health, Health Care Costs, Lawsuits, Medical Costs, medical ethics, Secrecy |

Misdiagnosis – A Leading Cause of Malpractice.

June 17, 2019

Some recent reports show that misdiagnosis is a leading cause of medical malpractice.  This is not news to me or to anyone who represents patients and families injured by malpractice.  Diagnosis is hard.  Diseases and illnesses don’t always present with the same signs and symptoms every time.  A good diagnosis takes work and patience.

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One medical malpractice insurance company reviewed 1,800 closed claim files involving the doctors it insured to see what was the cause of the claims against the doctors.  It found that 46% of the claims involved misdiagnosis.  In 45% of those cases, the patient died.  Another insurer reported on claims involving the treatment of children and reported that 38% of the claims against its doctors arose out of misdiagnosis.  Still another study concluded that the third leading cause of death in hospitalized patients resulted from misdiagnosis.

It is easy to understand how these figures come to be.  Diagnosis is one of the most difficult tasks a health care provider faces.  It usually involves a series of steps be taken to get to the correct result.  If any one of the steps is done incorrectly, the result may be a mistake in diagnosis.  To top it all off, sometimes the steps must be taken quickly and in emergency circumstances.

The first thing that must be done is to get some basic information.  This is called the “history” and it is an area with great potential for a mistake.  The provider usually asks the patient what is the problem.  Depending on the patient’s answer, the provider may go on to ask directed questions to elicit more information.

There may be a language barrier interfering with this question and answer process and, even if there isn’t, misunderstandings in communication are a common, everyday problem.  The patient may not understand what are the most important symptoms to tell the provider.  The provider may get misled by what the patient thinks is her primary complaint.  The patient may not remember to tell the provider about an earlier doctor visit or test result or diagnosis.  The provider may be in a hurry and not spend the time she should talking with the patient.  The provider may be impatient and this may cause the patient to hold back for fear of angering the provider.  The provider may not ask the appropriate follow-up questions.  In short, lots can go wrong at this stage.

Even if the history taken by the provider is complete and both provider and patient did a good job, there is still lots of opportunity for a misdiagnosis.  One of the sayings often repeated by medical malpractice defense lawyers at trial is, “When you hear hoofbeats, you think horses, not zebras.”  They say this when they are defending a doctor accused of failing to diagnose an illness or problem which is unusual.   They say this because providers will sometimes jump to conclusions about what the problem is without going through all the appropriate steps.  They get something in their heads and they fail to consider other possibilities.  Doctors are supposed to create what is called a “differential diagnosis,” which is a mental list containing all of the possible explanations for the patient’s condition.  They should then “rule out” the more serious of these possibilities until they get down to a shorter list of explanations and then order testing to reduce the list further.

Diagnosis is not an easy thing.  You can do your part by being sure to tell the provider about all of your health issues, your medications, your past doctor visits, hospitalizations and diagnoses.

My best advice to you is not to catch anything too rare.  If you do, the chances the doctor will think horses instead of zebras goes way up.

Posted in Doctors, Hospitals, Lawsuits, medical errors, Medical Malpractice, medical malpractice claims, medical mistakes, Medical Negligence, Misdiagnosis |

Warning: Your Surgeon May Be “All Thumbs”

June 10, 2019

It is human nature to criticize the younger generation.  What’s the matter with them?  They don’t do things the way we did when we were young, etc.  In the world of surgery, there may be valid reasons to be concerned about young people who are entering surgery residency programs.  According to a recent story in the New York Times, those who run these surgery residency programs are concerned that their new residents do not have the manual dexterity necessary in a good surgeon.  The most likely reason is that young people no longer sew, knit, build models, woodwork, play musical instruments or do the other things that children used to do and that build manual dexterity.  Nowadays, instead of developing dexterity of their fingers, young people use their thumbs to play video games or to text their friends.

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The successful surgeons interviewed for the article point out that by the time doctors complete medical school and enter a surgical residency program, it is too late to develop the same level of dexterity as someone who has been doing “hand things” all their lives.  They note that the earlier a person starts developing manual dexterity, the easier it is to develop and the better it becomes over time.  Late starters will rarely be as good as those who start early.  A suggestion has been made to consider manual dexterity among the factors considered in selecting surgical residents.

Another “problem” pointed out by those who run these programs is that there are now limits to the number of hours a resident can work.  For a long time there were no limits and some surgical residents would work as much as 120 hours in a week.  They would literally live at the hospital and operate at all hours, catching a nap here or there when they could.  This was not good for either the health of the resident or that of the patients upon whom she was operating at the end of a 120 hour week so limits were put in place to protect the residents and the public.

Paradoxically, these limits may be affecting the quality of those graduating from surgical residencies today.  One residency program director quoted in the Times’ article stated that today’s residents may complete the program with 900 operations under their belts.  He, on the other hand, had double that number by the time he completed his surgical residency.  The number of operations is important as “practice makes perfect.”  The more surgeries a resident has performed, the more she or he has seen and the more she or he has learned.

As usual, there are lessons for us to learn.  Always check the background and experience of your surgeon.  Always ask how many of your surgery he or she performs a year.  The more the better.  Always ask about your surgeon’s rates of complications.  Always check the medical board web site for information about your surgeon.  If your surgeon is not happy to be questioned by you about these issues, find yourself another surgeon.

Posted in Arizona Medical Board, Doctors, medical errors, science news, Surgical Errors |

Secrecy and More Secrecy

June 05, 2019

I swear it is not just me.  While I have been concerned about the effects of secrecy in health care and malpractice litigation for some time, the news lately is just full of stories about patients being kept in the dark.

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For example, in addition to Monday’s post about secrecy in pediatric heart surgery, I wrote recently about the problem of bad doctors, the ones who get sued over and over.  A study had found that most of them just kept practicing.  One of the main reasons they are allowed to continue to malpractice upon new patients is that their malpractice settlements are always confidential.  The injured patient, who just wants his or her money, is forced to agree not to reveal that they were paid by the doctor or his insurance company.  Everything is kept hush hush and the doctor goes on as before.  Other doctors know who these people are.  Hospitals know who these people are.  The medical board knows who these people are.  Malpractice lawyers know who these people are.  The only people who don’t know are the patients.  It is my strong belief that this is information patients looking for a doctor ought to have.  I don’t want to go to one of these doctors but there is little way for me to know who they are if I am not part of the system.

A physician who writes on medical issues read the same study I did and reached the conclusion that the fact these bad doctors kept on practicing showed the failure of the malpractice tort system.  This is a serious misunderstanding on the part of this physician.  The most the malpractice tort system can do is try to compensate the poor patient who has been injured.  There is no ability of the tort system to take a doctor’s license away.  That is the responsibility of the state medical board.  I respectfully submit that it is not the malpractice tort system that has failed when these doctors just keep on malpracticing, it is the state medical board which has failed in its duty to protect the public.  The medical board is informed of the fact of the settlement or judgment against the doctor and has the right and duty to investigate the facts underlying the malpractice claim.  When it lets the doctor go on practicing, it has failed to protect the public.

Another investigation of medical secrecy found that hospitals with outbreaks of dangerous infections almost always kept that information to themselves.  The story was captioned, “Culture of Secrecy Shields Hospitals With Outbreaks of Drug-Resistant Infections.”  If you hear about an outbreak of infections at a local hospital, you can be pretty sure the hospital did not voluntarily disclose the fact.  Either a whistleblower went to the press or to the local public health authority and the hospital got outed.

Hospitals have lots of reasons why they keep this information from the public.  They all sound nice and reasonable.  “We have to protect the privacy of our patients.”  “HIPAA requires us to keep this kind of information private.”  “If patients knew we were having these problems, they might avoid coming and getting needed medical care.”  “The risk that a patient will get an infection is low.”  “Disclosing this information might do more harm than good.”  All of this is BS.  Hospitals are concerned about one thing above all others: keeping the dollars flowing.  Telling prospective patients that you are having dangerous infections at your hospital is a good way to reduce that dollar flow.

You can pretty much forget about politicians forcing hospitals or medical boards or doctors to be more transparent.  Money talks and hospitals and doctors are savvy political players who spend a lot of money on lobbying.  They get the attention of the politicians in ways the public is rarely able to do.

My recommendation is to do the best investigation you can using the resources that are available to you.  Look at Medicare information about hospital performance.  Look at medical board information about your doctor.  If you have the desire, look at court dockets to see if your doctor has been sued.  Ask questions.  Be an informed consumer so you reduce the likelihood we will meet in my office to discuss your malpractice case.

Posted in antibiotic resistant bacteria, Arizona Medical Board, Defensive Medicine, disclosure of medical mistakes, Doctors, Hospital Negligence, Hospitals, Infection, Lawsuits, medical errors, medical ethics, Medical Malpractice, medical malpractice claims, medical mistakes, Medical Negligence, Medicare, Secrecy |

Secrecy Plus The Desire For Profits Equals Patient Deaths

June 03, 2019

Over the years I have discussed a number of topics which relate to patient safety.  These include secrecy, money, training, medical ethics, and surgical experience.  Every once in a while a story comes along which touches on all of these topics.  Last week such a story appeared in the New York Times.  I hope you can use this link to read the story.  Although it deals with pediatric heart surgery in North Carolina, it has application everywhere, including here in Arizona.

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In 2016, pediatric cardiologists at the University of North Carolina Children’s Hospital began to have grave concerns about the quality of the surgeries being performed at their hospital.  (Although cardiologists are heart doctors, they do not perform surgeries.  That is the role of pediatric heart surgeons.)  Children undergoing heart surgery at the their hospital were dying at an unacceptably high rate.  They complained about it and wondered if their medical ethics permitted them to continue to recommend their pediatric patients have surgery at the hospital, as opposed to sending them somewhere else where survival rates were higher.

Secrecy:  While the pediatric cardiologists had concerns and tried to do something about them, there is no indication in the Times story that the parents of their tiny patients were told of these concerns or of the higher than normal death and complication rates at the hospital.  To the contrary, the hospital refused to disclose to the public its mortality and complication rates, even though many of the best hospitals in the country do disclose this information.  Without the mortality and complication information, parents had no way of knowing that they were placing their children at risk by allowing their surgeries to be performed at this hospital.

Hiding information about surgical outcomes for Medicare patients does not happen as hospitals are required to provide it to Medicare, which publishes it.  This is not the case for non-Medicare patients and many hospitals, especially those with substandard outcomes, keep that information a closely guarded secret.  After all, who would want to come to one of these hospitals, if they knew there was a safer alternative nearby?  Who would want to come even if the safer alternative was in another city?  How far would you take your child to increase the chance he or she would have a successful surgery?

According to the Times’ article, two hospitals in Arizona do not report data on their pediatric heart surgeries.  They are both Banner Health hospitals.  The two are Banner University Medical Center Tucson and Banner Cardon Children’s Medical Center in Mesa.  Since the data is regularly reported by most successful hospitals throughout the United States, you have to ask yourself two questions:  Why won’t these two hospitals disclose their data and do I want to take my child for heart surgery to a hospital that won’t tell me how their patients do?  Given the propensity of hospitals to brag about whatever they do that is good, you have to be concerned about this refusal to provide the data.

Experience:  The Times’ story pointed out that the more pediatric heart surgeries a hospital did, the more successful its outcomes.  This is true across the board when it comes to surgery and is not limited to pediatric heart surgery.  Practice does indeed make perfect and the more operations a surgeon performs, the better she and her operating room team do.  The more surgeries done at a hospital, the better the post-surgical care is likely to be as well.

Money:  At the University of North Carolina Children’s Hospital, they were doing far fewer pediatric heart surgeries than the most successful hospitals in other states.  Why didn’t they let another hospital in the state take over these cases?  The answer is that surgeries and post-surgical care are big money makers for a hospital.  Having a pediatric heart surgery program is also a reputation builder for hospitals.  It is very difficult for hospitals to refuse these opportunities to make money, even when patient welfare suggests they should send these patients elsewhere.

After reading the Times’ story, it is hard to escape the conclusion that when the administrators at the North Carolina Children’s Hospital were faced with troubling problems in their pediatric surgery program that would take years to fix, they sacrificed patient safety to keep the money and prestige of the program.  They say their program is better now but still refuse to release all the data backing up their claim.  Even if the program is better now, that is cold comfort to the parents whose children died while undergoing heart surgery during the troubled period at the hospital.

After reading this story, I am left with feelings of helplessness and anger.  Money and secrecy took precedence over patient safety and there is little the government, the hospitals, or the medical community are willing to do to put an end to it.  There is little patients can do when hospitals hide their data.  I guess the best advice is to go only to hospitals that are transparent about their surgical successes and failures and choose those which are most successful.  Good luck.

Post Script:

June 17, 2019

After word leaked out about the problems it was having with its pediatric heart surgery program, the North Carolina Children’s Hospital has announced that it will suspend heart surgeries for the most complex cases in an effort to restore the confidence of the public in its program.

 

 

 

 

Posted in Doctors, Hospital Negligence, Hospitals, Medical Malpractice, medical mistakes, Medical Negligence, Medicare, Secrecy, Surgical Errors |

When Will Congress Protect The American People?

May 27, 2019

If you needed any further proof of the corrosive effect of unlimited corporate money in politics, look no further than the scandalous profits being made by the big drug companies.  Drug companies are rolling in profits.  They make these profits the old fashioned way.  They make them the same way the robber barons and monopolists of the Nineteenth Century made their great profits:  They gouge the public.  Meanwhile, Senators and Congresspeople wring their hands and hold hearings at which they “grill” drug company executives and tell us how tough they intend to be on them.  And then?  And then? And then, nothing happens.  Nothing happens because campaign contributions are the life’s blood of every politician who wants to be re-elected, and they all do.  Pharmacy giants don’t contribute to the campaign coffers of politicians who won’t support them in keeping profits up.

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We pay more for the same drugs than any other country on the planet.  If this were the result of great innovation by which drug companies were bringing new and wonderful cures to us, the high prices would be worth it.  That is definitely not what is happening.  Instead, drug companies are buying the rights to old drugs that are still patent protected and jacking up the price.  Or drug companies are taking one of their drugs that is coming off patent protection, making some minor changes and getting a new patent on what is essentially the same drug.  Or the drug companies pay generic drug manufacturers to hold off on introducing a generic alternative to their big moneymakers.  Or the drug companies sue the generic manufacturers and claim some sort of patent violation to slow things down.  The list of dodges the drug companies use to gouge us goes on and on.

Congress has the power to get drug prices down but it won’t use it.  First and foremost, it can permit Medicare to negotiate prices with the drug companies.  Undoubtedly at the suggestion of the drug companies, Congress has specifically prohibited Medicare from doing that.

Congress could allow importation of drugs from other countries where the governments keep the prices down.  The imports could and should be overseen by the Food and Drug Administration to assure the quality and safety of the imports.

Congress could change the patent laws to keep the drug companies from applying for and receiving multiple patents on their drugs.  Congress could tighten up the patent laws and assure that patents are given, as intended, only for true innovation.  For essential drugs, Congress could eliminate patent protection completely so that generics could compete with the drug companies and let the market set a fair price for the drugs.

Congress could stop the drug companies from paying off generic manufacturers to keep them out of the market.

Congress could stop the drug companies from using the courts to intimidate and delay their competitors.

Congress could just say “No” to drugs and the drug companies.

Americans are dying because they can’t afford the medicines they need.  The American taxpayer is footing the bill for treatment of patients who become critically ill because they could not afford their medications.  Meanwhile the drug companies don’t know what to do with all the money they are making in this country.

It is time for Congress to stop the madness and get drug prices down now!

Posted in drug companies, General Health, Health Care Costs, Medical Costs, Medicare, Type 1 Diabetes |

Medical Malpractice Victims in Canada Face Many of the Same Problems You Do.

May 20, 2019

As any observer of medical malpractice in the United States knows, there is a lot of malpractice out there but few of the victims make a claim and fewer still make a financial recovery.  Turns out things aren’t much better north of the border.

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The Canadian Broadcasting Company, known as the CBC, is the national broadcaster for Canada.  The CBC recently did an investigation into malpractice claims that revealed many trends similar to those seen in the United States.  The researchers discovered that, even though the number of doctors and patients has been growing, there are fewer claims being made by patients than in the past.  And when patients do make a claim, they are less likely than in the past to be successful in making a recovery.

In the 1970’s, the CBC reports that in cases that went to trial, patients were successful roughly one-third of the time.  In the last five years, however, that success rate has dropped to one in five.  This is roughly similar to success rates for patients in the United States.

Overall, of cases filed in the last five years, just over 55% were either dropped, dismissed or abandoned.  At least some of this may be due to the aggressive defense by the taxpayer subsidized Canadian Protective Medical Association, which insures most doctors in Canada.  Of the filed cases, 36.7% were settled.  This number is also similar to practice in the United States.  The remaining 8% of the filed cases went to trial.  Overall, only 1.6% of the patients who filed suit in the last five years, were successful at trial in obtaining a verdict against the doctor.

According to the CBC investigation, many of the same factors which work against patients in the United States, are also at work in Canada discouraging patients from making claims.  One of the most important factors is cost.  As in the United States, these cases are vigorously defended by the insurance company, which hires excellent, aggressive attorneys to represent the physicians.

As here, patients need to present expert witness testimony to prove their cases and this is a substantial expense with many experts charging over $500 per hour.

According to a lawyer who used to represent Canadian doctors but now represents injured patients, most lawyers won’t consider a case that has a value less than $250,000.00.  That again is very similar to practice in the United States.  The vast resources of the Canadian Medical Protective Association allow it to mount an aggressive and well-financed defense which few patients can afford to match.

Canadian victims of medical malpractice, we feel your pain and know just what you are going through.

Posted in Doctors, Finding a Medical Malpractice Lawyer, Lawsuits, Malpractice costs, medical errors, Medical Malpractice, medical malpractice claims, medical malpractice lawsuits, medical malpractice lawyers, medical mistakes, Medical Negligence, plaintiff, Valuing Damages in Medical Malpractice Cases |

Does Telemedicine Increase Malpractice?

May 13, 2019

Telemedicine allows consumers to use their smartphones or tablets to consult with a health care provider remotely and to get treatment and advice.  All you have to do is to google telemedicine and you will find many providers offering you telemedicine services.  The various companies offering this service promise 24/7 access to board-certified doctors and the ability and willingness to treat a wide range of health problems.  You will even find services being offered to doctors so that they can take care of patients over the internet.

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Human nature being what it is, mistakes in telemedicine are inevitable.  Some of those mistakes may rise to the level of medical malpractice.  The question is whether the use of telemedicine increases the amount of malpractice or not.  The answer is not yet clear and is certainly subject to change as this field of medicine evolves but so far it does not appear to increase the amount of malpractice.

A study recently reported in JAMA, the medical journal of the American Medical Association, looked at malpractice claims arising out of telemedicine and found that in the 551 malpractice claims they reviewed, none of them involved telemedicine.  The authors did not conclude that no one involved in telemedicine was malpracticing.  Instead, they offered a number of possible explanations why there were no telemedicine cases in the ones they reviewed.

The first possibility is that there were claims that were not available to the authors.  The authors reviewed publicly available records of state and federal lawsuits that reached final resolution during a one month period in 2018.   Claims that were made to the provider and settled directly without litigation would not have been in the database.   Claims that did not reach a resolution would not be in the database.  Some states have pre-litigation procedures that screen malpractice cases before they are filed in court.  Cases that went before such screening panels would not make their way into the database, if they were resolved at the screening stage.  The time studied may not have been long enough to capture telemedicine malpractice.

A second explanation is that consumers who were the victims of telemedicine malpractice just decided not to take any action.  This is in keeping with research that finds most malpractice victims do not make claims.  Consumers may have low expectations for telemedicine and figure some level of mistake is acceptable.

Another explanation is that consumers are not taking serious problems to telemedicine providers.  As I have remarked in the past, it is usually only serious injuries that become the subject of medical malpractice lawsuits.  If consumers with serious problems are avoiding telemedicine, the likelihood of serious and permanent injury due to telemedicine goes down significantly.

Lastly, many telemedicine providers may be appropriately sending patients with significant problems or problems that do not respond promptly on to emergency departments or face-to-face visits with live doctors.  This may serve to reduce malpractice exposure for the telemedicine providers.

Telemedicine is growing.  As we become more and more accustomed to conducting our lives on line, it will only continue to grow.  There will be mistakes and some of them will almost certainly result in serious and permanent injuries.  As always be a careful and informed consumer.  Don’t take serious or potentially serious problems to a telemedicine provider and you will be less likely to end up with a serious injury.

Posted in Doctors, Lawsuits, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical malpractice lawsuits, medical mistakes, Medical Negligence |

How the U.S. Health System Puts Diabetics in Danger

May 08, 2019

“How the U.S. health-care system puts people with diabetes in danger” is the title of an article which appeared today in the Washington Post.  The author is an ICU physician who sees and treats diabetics when they become critically ill with ketoacidosis.  He describes his encounters with this condition as “frequent.”  When blood sugars get out of control for a diabetic due to lack of insulin, ketoacidosis can develop.  It is a deadly condition.  The body needs insulin to turn blood glucose into energy and, when there is not enough insulin, the body begins to burn fats for energy.  This process causes acids, called ketones, to form and the blood becomes acidotic.  Nausea, vomiting, confusion and death may follow.  The condition can come on quickly and is often brought on by an illness which interferes with the body’s processing of insulin.  It is more common and more severe among Type 1 diabetics than it is among those with Type 2.

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Dr. Adam Gaffney is the pulmonary and critical care physician who wrote the Post article.  In addition to his clinical duties, he is on the faculty at the Harvard Medical School.  Dr. Gaffney wanted to know whether our health-care system with its spotty insurance coverage and high deductibles was responsible for some of the cases of diabetic ketoacidosis he sees in the ICU.  Since ketoacidosis is more likely to occur if a patient does not take his or her insulin, Dr. Gaffney wondered if there were fewer cases in countries in which insulin was easily available.  As any reader of this blog knows, insulin prices in the United States have skyrocketed in the last 10 years and we pay many times more for insulin than anyone else in the world.  For a Type 1 diabetic, insulin is life and without it the diabetic will die.

I have written about people not able to afford their insulin.  Some try to ration it by taking smaller doses than they should.  They allow their blood sugars to regularly run high.  While this may get them by in the short term, over the long term it leads to irreversible damage to nerves, to the eyes and kidneys.  Blindness, amputation of parts of the legs and feet and kidney failure may result.  Diabetics trying to ration their insulin may also guess wrong about how high their blood sugars are and they may develop ketoacidosis.

The high cost of insulin is a huge problem for those without insurance.  However, as Dr. Gaffney points out, it is also a problem for many people with insurance coverage.  Those who receive their coverage through work are at the mercy of their employer, who may buy skimpy coverage in order to save a few dollars.  This is not a criticism as the increasing costs of so much of our medical care cause premiums to go up and up.  An employer may have only a choice between bad coverage and no coverage.  With bad coverage, insured diabetics must pay large deductibles or large co-pays.  Either way, even with insurance, insulin may be an unaffordable expense for those who also want to eat.

Dr. Gaffney and his colleagues looked at rates of ketoacidosis in Canada and other countries with universal health care.  There were significantly fewer cases in these countries, especially among young adults who, in the United States, often find themselves losing the coverage they had as children.

Why do we allow this?  We are the richest nation on the face of the earth?  We pride ourselves at being the best.  No one in the United States should ever die because they could not afford health care.  We are the only developed nation without universal health care.  I don’t know the best way to get to universal health care but I do know that the present system is immoral and a disgrace.

 

Posted in drug companies, General Health, health, Health Care Costs, Health Insurers, healthy living, Medical Costs, medical ethics, Type 1 Diabetes |

The Bad Doctor Problem.

May 06, 2019

What happens to bad doctors?  By bad doctor I mean those who malpractice over and over.  Turns out that a lot of them are still out there malpracticing.

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A recent article in the prestigious New England Journal of Medicine looked at malpractice payments to see whether they had any effect upon the way in which doctors practiced medicine.  The authors looked at data on payments from the National Practitioner Data Bank to see how common payments were and how often there were multiple payments made on behalf of the same doctor.  They cross-checked names against Medicare doctor data showing who was practicing where.  They collected data on almost 500,000 doctors across the country who were between 38 and 65 and who practiced between 2008 and 2015.

What they found was striking.  Almost 90% of the doctors had no payments made on their behalf.  A little over 8% had 1 claim.  Significantly, the remaining 2.3% had all the rest of the claims.  This 2.3% accounted for almost 40% of all malpractice payments made during the 8 year period studied.  These are the doctors that medical malpractice lawyers call frequent flyers because they malpractice over and over and get sued over and over.  Because their malpractice settlements are confidential and because the state medical boards rarely take any action against them, the public has almost no way to know who they are or to be protected against them.  It is a national disgrace that these doctors are permitted to continue to harm patients.  The state medical boards know who these doctors are but refuse to act.

Contrary to popular belief, these bad doctors did not fold up their tents and move to greener pastures.  With the data available from the National Practitioner Data Bank, their record travels with them, which may reduce the incentive to move on.  A few of them decided to leave the practice of medicine but many just moved to a solo practice and continued to see and treat patients.  It would seem that the bad doctors who practice in a medical group get kicked out by the good doctors in the group who are tired of having the group sued because of the actions of the bad doctor.  A far better solution is to stop them from practicing altogether.

Everybody is in on the joke but the patients.  The medical boards know who the frequent flyers are.  The medical malpractice lawyers know who they are.  The insurance companies know who they are.  The other doctors in their medical group know who they are.  The hospitals know who they are.  The only people who don’t know are the patients and they are the ones who have the greatest right to know.

Demand transparency.  Making medical malpractice settlements available to the public would be a great start.  Stop letting bad doctors hide behind the curtain of secrecy when they settle their malpractice cases.

 

Posted in Arizona Medical Board, disclosure of medical mistakes, Doctors, Hospitals, medical errors, medical ethics, Medical Malpractice, medical malpractice claims, medical malpractice lawyers, medical mistakes, Medical Negligence, Secrecy |