Medical Malpractice News and Views


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

Defensive Medicine Hurts Patients in Many Ways

December 02, 2019

Defensive medicine is the name given to actions taken by doctors, not for the primary benefit of their patients, but to reduce the chance they will be sued for medical malpractice.  It is unethical and almost always detrimental to the patient.

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The Hippocratic Oath originated in ancient Greece.  Modern versions of it are still used by today’s doctors.  One of its main tenets, subscribed to by all, is that the doctor will not put his or her interests ahead of those of the patient.  To do otherwise is to act unethically but that is exactly what defensive medicine does and many doctors admit they practice it.

Defensive medicine arises out of what doctors who practice it claim is a legitimate fear of being sued.  This is a fear they have largely manufactured for themselves.  They have been drinking their own Kool-Aid.

For many years, doctors, hospitals and their insurance companies have been trying to get laws passed to give themselves special benefits not available to you or me.  They want laws that prevent or limit suits against them when they make mistakes and injure patients.  To justify this special treatment, they claim that they are special and deserving of special treatment.  They also claim, however, that they are the victims of a flood of frivolous lawsuits.  This is the Kool-Aid they sell to gullible state and national legislators.

It is not true that doctors are subject to a barrage of frivolous lawsuits.  Very few doctors ever get sued.  When they do get sued, juries are very protective of them.  Doctors win about 85% of all cases that go to trial throughout the United States.  Furthermore, the number of medical malpractice claims has been dropping for years.  Despite the increase in the population in the United States over the last 30 years, the number of paid malpractice claims has been declining over that time.  Today the annual number of paid malpractice claims is just over half of what is was in 1990.  There is no tsunami of malpractice cases and, when sued, doctors do very, very well in the courtroom.  They don’t need to act unethically to avoid being successfully sued.

Defensive medicine takes two forms.  In the first, the doctor orders tests the doctor does not believe the patient needs.  He or she says they order these tests so, if things go badly, no one will be able to accuse them of not ordering all possible tests.  Unnecessary testing is bad for patients.  In the first place, some tests are dangerous or at least pose risks to patients.   X-rays expose patients to radiation.  Blood tests have a risk of infection.  All tests have what are called “false positives,” which are positive results even when the patient does not have the condition being tested for.  False positives usually result in even more testing or in actual treatment for a condition the patient does not have.  In the second place, someone has to pay for these unnecessary tests.  Depending on the patient’s insurance status, that may be an insurance company or the patient or some combination of the two of them.  Regardless of who pays, this is health care money that should have gone to necessary testing and treatment and not be wasted protecting the doctor.

The second form of defensive medicine is more harmful to patients than the first.  In the second form, doctors avoid patients with complicated or advanced diseases so they won’t get sued if the patient dies or does not do well.  I have seen this often in my practice.  When a patient has been the victim of malpractice but needs additional treatment, it can be very difficult to find a doctor who will be willing to treat the patient. They see the malpractice and can see the likelihood of a suit and don’t want any part of the care of the patient.  Some of my clients have had to go out of state to get necessary treatment because no Arizona doctor would touch them.

Patients deserve doctors who think of the patient first and themselves second.  When you go to the doctor, say a prayer that you get an ethical doctor who places the interests of the patient first.

Posted in Defensive Medicine, Doctors, Health Care Costs, Health Insurers, Hospitals, Lawsuits, Malpractice caps, Medical Costs, medical ethics, Medical Malpractice, medical mistakes, tort reform, trial |

A New Problem For Hospitals – And Patients

November 25, 2019

When you go to the hospital for an operation, you expect that the hospital will have the surgical instruments and medical devices the surgeon will need to perform the procedure.  With rare exceptions, that has not been a problem in the past.  That is about to change.

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We all know what surgical instruments are.  We often forget, however, how many medical devices are needed for even the simplest of surgeries.  Think of breathing tubes, IV sets, disposable catheters, pads, sponges, needles, prosthetic implants, trays and the like.  The list goes on and on.

Before they can be used on a patient, a surgical instrument or device must be sterilized.  Fully half of all surgical instruments and devices sold in the United States are sterilized through the use of a gas called ethylene oxide.  The gas is a dangerous one to people as well as to the kinds of microbes and germs which can cause illness if left on surgical instruments or devices.  There are only a few factories that use the gas to sterilize instruments and devices before they are sold to hospitals.  Due to environmental concerns arising out of high levels of the gas being released into the atmosphere, the Illinois EPA has closed one plant already.  That plant has announced that it will not reopen.  Another plant, this one in Georgia, is temporarily closed while it remodels to reduce the risk of gas escaping into the environment.  These two plants processed a substantial percentage of all the sterile instruments, devices and supplies sold in the United States.

There has already been a temporary shortage of pediatric breathing tubes.  The FDA has been monitoring the situation and working with manufacturers and suppliers.  Now it is warning hospitals and the public of possible shortages of a wide range of instruments, devices and supplies.  It is looking at alternative methods of sterilization and even the possibility of importing sterile instruments and devices into the United States if manufacturers are not able to meet demand.

Keep your fingers crossed that when you need surgery, the instruments and devices will be available.  If you are facing an elective surgery, it is probably a good idea to inquire about any existing or expected shortages.  You may even have to consider going to another hospital, if it has the equipment your surgeon needs.

Posted in health, Hospitals, Infection, Medical Devices, science news |

Doctor Ethics

November 18, 2019

Doctors win 85% to 90% of all medical malpractice trials in Arizona.  The same figures apply pretty much across the United States.  Doctors win cases even when there is strong evidence of negligence on their part.  The most likely reason for these statistics is that juries hold doctors in high repute and do not want to believe that they make mistakes that kill and injure patients.  While often that respect is justified, doctors are just like everyone else.  Some are good, dedicated, caring people.  Some are greedy crooks who will cheat as necessary to bring in the money they believe they deserve.  A cursory look at the news will show the presence of the crooks in white lab coats.

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In just the first weeks of last month alone, a number of doctors were caught with their hands in the till.  If you think that these are the only ones, you have an unreasonably high opinion of the ability of law enforcement to catch these people.  This is likely just the tip of the iceberg.

On October 8, a Texarkana, Arkansas doctor was arrested for doing his part to facilitate the abuse of narcotic medications by prescribing opiates for no good reason.  That is for no good reason other than he made a lot of money doing it.  Sadly, many of the pills flooding our communities are the result of prescriptions written by doctors who are running “pill mills” or who are just careless about their prescriptions.  Either way, they make money while their neighbors die as a result.

The day before, on October 7, a Houston jury convicted a doctor for her participation in a $16 million Medicare fraud scheme.  She ran a medical clinic and, together with her co-conspirators, signed up people and claimed to Medicare that they needed home health services.  Either the services were not medically necessary or were never delivered or both.  The scheme went on for over four years before federal law enforcement authorities were able to put a stop to it.

On October 4, it was announced by federal authorities that a group of California eye doctors had paid over $6.5 million to settle claims that they had defrauded public health care programs by charging for unnecessary examinations and had violated various regulations.

On October 3, a West Virginia doctor pleaded guilty to his role in a conspiracy to distribute controlled substances for no valid medical reason.  In other words, like his Texarkana colleague, he was writing phony prescriptions for opioid medications.

I point out these few examples, not to vilify doctors, but to point out that they are human like all the rest of us.  They make mistakes like all of the rest of us.  They are not gods.  Patients deserve a level playing field when they go to trial against a doctor.

 

Posted in Doctors, Fraud, Health Care Costs, Lawsuits, medical ethics, medical malpractice cases, trial, Verdicts |

One More Reason You Need A Good Medical Malpractice Lawyer

November 11, 2019

Doctors and hospitals win 85% to 90% of the medical malpractice cases that go to trial in Arizona and that statistic is true pretty much across the United States.  Doctors and hospitals win more than half of the cases even when the patient’s case is a strong one.  One of the many reasons doctors and hospitals do so well at trial is the quality of the lawyers the insurance companies hire to defend them.  If you are going to beat a doctor or hospital at trial, you had better have a darn good lawyer presenting your case for you.

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The companies that insure doctors and hospitals are quite sophisticated.  They are dealing with a specialized area and are knowledgeable about it.  They hire good, experienced adjusters who understand medicine.  They have doctors to serve as resources when they have questions about medical procedures or about whether the doctor in question made a mistake or not.  Often they have doctors on their Board of Directors.

The point is that they know what they are doing.  They hire only the best trial lawyers to represent their insureds.  They usually have a list of trial lawyers and will only allow lawyers on that list to take their cases to trial.  You have to be a seasoned, skillful attorney who has proven your ability in many trials to get on one of those lists.  If, in spite of all the screening they do, they find a lawyer on the list can’t cut it, that lawyer is taken off the list and gets no more cases from the insurance company.

The defense medical malpractice bar is overall the most experienced, most competent trial bar around.  They try a lot of cases and have enviable won/loss records.  Keep this in mind when selecting a lawyer to go up against them on your case.

Over the years, I have written about what makes a good medical malpractice lawyer.  The first and foremost quality of a good medical malpractice lawyer is that she or he is a good trial lawyer.  Good trial lawyers are made, not born.  That is not to say that natural talent plays no role because it plays a big role.  However, no matter how talented you are, you will be a better trial lawyer in your twentieth trial than you were in your first.

Like the defense medical malpractice lawyers, your lawyer must “know” the medicine.  This does not mean that your lawyer has handled exactly the same case before.  What it means is that your lawyer understands medicine, medical procedures and anatomy, is comfortable with medical terms, and knows how to do medical literature research.  He or she will be able to learn the medicine associated with your case, will be able to find qualified experts to testify for you and will be able to cross-examine the defendant provider and the defense experts, who will always try to baffle your attorney with BS, if they can get away with it.  Your attorney has to be able to hold their feet to the fire and pin them down about what happened and their opinions.

Most doctors have a “consent clause” in their insurance policies.  Unless the doctor gives written consent to allow settlement, the insurance company cannot enter into negotiations.  Your attorney needs to demonstrate to the defendant doctor, the defense attorney and the experts that he or she can get your case to the jury and may win it despite the odds.  Doctors who are concerned about the outcome at trial will usually give their consent.

Your attorney must also be able to evaluate your case.  If your attorney does not properly evaluate your case, he or she may demand too much money and may pass on a settlement that should have been accepted.  On the other hand, if your attorney values your case too low, you may end up receiving less than you should have.  Evaluating cases is a difficult job as it involves weighing the contested liability issues, estimating the amount of damages a jury might be willing to award and evaluating the performances of the parties and their experts at deposition and their likely performances at trial.  Newbies don’t have the experience necessary to do a good job evaluating.

Lastly, your attorney must be able to negotiate effectively on your behalf.  The insurance companies always start low and move up only grudgingly.  Your attorney must be able to craft a negotiating strategy that encourages the insurance company adjuster to keep making offers without going too low too fast.

Doctors and hospitals have a lot of natural advantages in medical malpractice suits.  You need to do everything you can to level the playing field.  Selecting an experienced malpractice lawyer is an important first step.

 

Posted in Doctors, Finding a Medical Malpractice Lawyer, Hospital Negligence, Hospitals, Lawsuits, Medical Malpractice, Medical Malpractice Case Value, medical malpractice cases, medical malpractice claims, medical malpractice lawsuits, medical malpractice lawyers, medical mistakes, Medical Negligence, medical negligence lawyers, personal injury lawyers, plaintiff, trial, Valuing Damages in Medical Malpractice Cases |

Consolidation Threatens Doctor Independence.

November 04, 2019

If you are not concerned about consolidation in the delivery of medical services, you should be.  We like to think of the medical profession as individual providers who care about us and also care for us.  We like to think that they have our best interests at heart and give us unbiased recommendations.  Increasingly, there is a yawning gap between what we would like to think and the reality of the medical profession.

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As in so many areas of our economy, consolidation is occurring.  There are almost no independent hospitals in metropolitan areas now.  They are almost all part of a chain which may have many, many hospitals in numerous states.  Banner Health, which is based here in Phoenix, has 28 acute care hospitals in multiple states.  It owns and operates many other facilities.  It employs over 50,000 people and is the largest private employer in Arizona.  All of the major hospitals in the Phoenix area are owned by hospital chains.

The presence of hospital chains in your area is important because studies have shown that consolidation drives up the cost of health care in a market.   While consolidation allows hospital chains to reduce duplication and therefore reduce costs, those reductions do not translate into reductions in price.  To the contrary, prices go up when there is consolidation.  Often patients are given more treatment when there is consolidation.  More treatment means more health care to be paid for by patients and their insurers.

Many of the same chains that are buying up hospitals are also buying up medical practices.  They become the owner of the medical practice and the employer of the physicians and nurses who work there.  The arrangement is attractive to the doctors because they no longer have to worry about billings and collections; the hospital chain handles all that.

Now there is a new player in the race to purchase physician practices:  private equity.  Here is a story about private equity buying an orthopedic practice in Michigan.   The potential for large returns on investment is said to be attracting the interest of investors.

Hospital chains are also looking for a return on their investment when they buy a physician practice.  They usually expect the newly employed physicians to send their patients to the hospital chain’s local hospital or to use the chain’s laboratories for tests.  But what if the chain’s local hospital is not the best one for a patient?  What if the doctor does not send enough patients to the chain’s local hospital for it to make the profit it expected when it bought the practice and hired the doctor?  No matter what the doctor or hospital chain say, the purchase of the practice puts pressure on the doctor employees to generate business for the chain.  The decisions which are made while under that pressure may not be in the best interest of the doctor’s patients.

The pressure from venture capital to return large profits may be even more intense than any pressure a hospital chain may apply.  At least a hospital chain is bound by certain medical ethics and by licensing requirements.  Chains cannot be too heavy handed.  They need the public to consider them “good guys.”  No such constraints apply to private equity.  These are the same people who buy companies, fire employees, and then sell off the pieces, often leaving nothing but a bankrupt shell behind.

I for one don’t want my doctor to feel that he or she must produce a certain level of profit for their venture capital partners or their hospital chain employers when they are deciding whether I need an operation or not.  Neither should you.  Make sure you know for whom your doctor is working.  Seek second opinions from other doctors who don’t have a profit motive to recommend a procedure for you.  Be an informed consumer.

 

Posted in Doctors, Fee for Service, Health Care Costs, Hospitals, Medical Costs, medical ethics, Medicare, Secrecy |

You Are Being Operated On, Do You Know Where Your Surgeon Is?

October 28, 2019

A recent story about a Syracuse, New York orthopedic surgeon casts light on a practice that will likely come as a shock to most patients.  The surgeon is accused of botching a hip replacement in which his patient allegedly suffered a fractured femur and removing too much bone.  During the trial it was revealed that the surgeon performed as many as 14 surgeries a day.  He would do what he contended was the most critical part of a surgery and then leave the patient in the hands of an assistant to conclude the surgery while he went to another operating room.  In the other operating room, he would again perform what he contended was the most critical part before moving on again and again and again.  In this way, the surgeon could earn as much as $56,000 in a day of surgery.

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The jury was not amused  and unanimously awarded the patient, who is in constant pain and must now use a cane, $2 Million.  The award was based on $1.25 Million for past pain and suffering, $250,000 for future pain and suffering and $500.000 to the patient’s husband for past and future loss of services caused by the wife’s injury.  The patient is now 63.  She was 57 at the time of the hip replacement surgery.

As is almost always the case in these situations, the surgeon is appealing the jury’s verdict on the usual grounds:  it is too large; it was the result of passion and prejudice; the patient’s attorney should not have brought up the number of surgeries the doctor did in a day.

All of that is beside the point of our discussion.  How many patients are adequately informed that the surgeon they have chosen to perform their surgery is only going to do a part of it and leave the rest to someone else while he or she goes off to another patient?  How many patients who were clearly informed of this would agree to it?  I am pretty sure that every one of this surgeon’s patients has a disclosure somewhere in the many consents which precede such surgeries stating that other surgeons may perform part of the surgery.  If asked, I am pretty sure the primary surgeon would tell is patients that this is a minor thing and not to be worried about it as he or she will be there for all the important parts.

The bottom line, however, is that your surgeon will not be there for the entire surgery.  It will be in his or her discretion what is important and when to leave.  If an emergency occurs after the primary surgeon has left, he or she may not be able to return to deal with it depending on the status of the next surgery they are doing.  They may not be able to interrupt it to leave.

I am in favor of surgeons who do a lot of the procedure you need to have.  They will usually be more efficient and skilled at the procedure than someone who only does the procedure occasionally.  This case points out that there can be too much of a good thing.  Fourteen surgeries a day is too many in my opinion for the surgeon to be giving each patient the attention that patient deserves.

Ask your surgeon whether he or she will be with you throughout your surgery.  Be concerned if the answer is anything other than an unqualified, “Yes.”

Posted in Doctors, Fee for Service, Fraud, Hip Replacement, Informed Consent, joint replacement, medical errors, medical ethics, Medical Malpractice, medical malpractice cases, medical mistakes, Medical Negligence, Orthopedics, Surgical Errors, Verdicts |

Some Really Good News About Prostate Cancer

October 21, 2019

One in nine men will develop prostate cancer during their lifetimes.  Most will die of something else.  Fewer than 20% will develop the aggressive form of the cancer which is most likely to spread and to kill the patient.  Until now, medicine has not had a reliable way of detecting prostate cancer and then distinguishing between low-level cancers and the aggressive ones likely to cause death.

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The most common form of test for prostate cancer today is the PSA test.  PSA (Prostate Specific Antigen) is a protein produced by the prostate.  When prostate cancer is present, the prostate produces more PSA.  An increase in a patient’s PSA levels may, therefore, indicate the presence of cancer.  The problem, however, is that there are other, reasons why the prostate might produce higher levels of PSA, including infection, inflammation and benign enlargement of the prostate.  A high PSA reading is what medicine calls a “non-specific finding,” that is, it may have many causes and is not necessarily indicative of the presence of disease.

In order to determine if a high PSA reading is the result of prostate cancer, doctors usually perform a biopsy of the prostate.  In the biopsy, a needle is inserted into the prostate and some cells are removed and analyzed.  Biopsies of the prostate are risky and may cause bleeding and infection.  Even if they detect the presence of cancerous tumor cells, the cancer may be of the slow-growing kind that should not be the subject of aggressive treatment.  Most urologists and oncologists agree that slow growing tumors should be carefully watched and aggressively treated only if they show signs of rapid progression.

Many men, however, upon being told they have prostate cancer are reluctant to accept a suggestion of “watchful waiting.”  It may be because they fear any diagnosis of cancer.  It may be because their families insist they “get something done.”  Positive biopsies, therefore, often lead to one of the three main treatments for prostate cancer:  (1) prostatectomy, in which the prostate is removed; (2) radiation therapy; or (3) brachytherapy, in which radioactive beads are placed in the prostate.  While these treatments may be successful in controlling prostate cancer, each is likely to leave the patient both unable to get a functioning erection and incontinent of urine.

For all these reasons, it is widely recognized that the PSA test leads to overdiagnosis of prostate cancer and overtreatment.  A better test is needed and one may be at hand.

A paper recently published in the Journal of Urology found that patients with aggressive forms of prostate cancer could be identified with over 90% accuracy by the presence of circulating tumor cells in the blood combined with elevated PSA scores and a positive 12 gene panel study.  The new test will permit doctors to avoid unnecessary biopsies and treatments and concentrate their resources on prostate cancers which are truly aggressive.  It will also save many men from impotence and incontinence.

Researchers expect the new test, which needs regulatory approval, to become widely available in the next three to five years.

Posted in Cancer, Doctors, General Health, genetic testing, health, Health Care Costs, Infection, medical research, Prostate Cancer, prostate cancer testing, science news |

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 |