Medical Malpractice News and Views


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

The Type 2 Diabetes Epidemic

November 29, 2021

America, we are letting ourselves go and it is costing us.  It is costing us in terms of rising health care costs, loss of quality of life and shortening of life expectancy itself.  We are getting fat and flabby.  We are smoking less, thank goodness, but eating more and eating the wrong foods to boot.  All this is causing a huge rise in obesity, even among children.  With obesity comes Type 2 diabetes.  It is a bad customer and we should all do what we can to avoid it.  This is a self-inflicted injury, if there ever was one.

Tips for Treating and Reversing Type 2 Diabetes - SignatureCare ER

Diabetes refers to a condition in which the body is not able to effectively utilize the glucose that our cells require for energy.  We eat food, which our bodies properly convert to glucose and deliver to the bloodstream.  When things are going as they should, our bodies also produce insulin, which allows the cells to take the circulating glucose and turn it into energy.  The more glucose the body produces in response to food or other things, the more insulin is produced to keep the blood glucose levels from rising too much.  It is a finely balanced system in which many bodily organs play a part in keeping blood sugars in a narrow range.  Insulin is the key to this system.

Unlike Type 1 diabetes, which is an autoimmune disease in which the body destroys the cells that make insulin, the bodies of Type 2 diabetics still make insulin.  They may not make as much insulin as before, but they make it nonetheless.  Even when they do make insulin, however, their bodies may develop a resistance to it, so they need more.  The bottom line for Type 2 diabetics is that the finely balanced system is out of balance and the amount of sugar in their blood goes up as a result.

High blood sugars don’t usually cause any immediate problems, so long as they don’t get crazy high.  They do cause long-term damage to the body, however.  One of the biggest effects is that they create inflammation in the blood vessels, which causes them to narrow so that oxygen rich blood does not flow through them as well as before.  This is a big problem with the small, but critically important vessels, in the eyes, kidneys and heart.  It also interferes with blood flow to the lower extrmities resulting in ulcers, nerve damage and sometimes even amputation.

Not all Type 2 diabetics have the same degree of the disease.  Some are able to control their blood sugars through diet or exercise.  Some need only a little help through one of a number of medications that treat Type 2 diabetes.  Some need regular insulin and need to check their blood sugars multiple times a day.

Don’t be one of these people.  Unlike Type 1 diabetes, for which there is no known cause and no way to prevent it from occurring, Type 2 diabetes can be avoided or at least delayed by living a healthy lifestyle.  Keep your weight down.  That means a responsible diet and moderate exercise.  Do these things and your body will reward you with better health and maybe even a longer lifespan.  It’s up to you.

Posted in General Health, health, Health Care Costs, Medical Costs, Type 1 Diabetes, Type 2 Diabetes |

Hey, Medicare Beneficiaries, There Is No Free Lunch!

November 22, 2021

Recently, I was stuck in front of a television that was showing a nature program.  Every few minutes, it was advertisement time.  Because this was early November and Medicare beneficiaries can change their Medicare plans at this time of year, almost all of the ads were devoted to that subject.  Each featured some well-known performer who urged me to call immediately to see if I was eligible for a Medicare Advantage plan that offered more benefits than traditional Medicare and might even pay me to join.  For those keeping score, this sounds almost too good to be true.  As usual, it is too good to be true.

Medicare cards - Medicare Interactive

Medicare is a health care program created by Congress and operated by the federal government.  It has a set of clearly defined benefits and a clearly defined appeal process, if a beneficiary believes that he or she has been improperly denied a benefit to which they are entitled.  Beneficiaries have a lot of freedom under traditional Medicare, including the freedom to pick any doctor they choose, who is willing to accept Medicare patients, and the freedom to visit a specialist whenever they believe it is necessary.

By contrast, Medicare Advantage programs are run by private companies looking to make a profit.  These private companies are paid by Medicare for each beneficiary they sign up.  The amounts the companies receive is based on a bidding process and depends on where the beneficiary lives.  The companies provide certain medical care for the beneficiaries they sign up and keep any money left over after paying for the care.  As an inducement to Medicare beneficiaries to sign up, the companies usually offer more benefits than regular Medicare.  The benefits offered also may be affected by where the beneficiary lives.

So how can a Medicare Advantage company make any money, if it has to pay for the care its beneficiaries need?  The answer is that the Medicare Advantage company provides “managed care.”  This means that, unlike regular Medicare, a beneficiary cannot just choose any doctor he or she wants.  The Medicare Advantage company will usually have contracted with certain doctors and hospitals to be in a network and will require its beneficiaries to go to the network doctors and hospitals or pay out of their own pockets.  The Medicare Advantage company will usually limit access to specialists by requiring that a primary care physician in its network refer beneficiaries to specialists before the beneficiary can visit the specialist.

These are just some of the ways in which a Medicare Advantage plan keeps down the medical expenses of its beneficiaries.  Its actuaries have carefully determined how much it is going to cost the company to offer the benefits it does.  The company then spells out what it will and won’t cover in a contract with the beneficiary called the plan document.  The company then rigorously follows that plan language.  If it is not covered, you don’t get it, regardless of how badly you need it or think you need it.  The company also controls the appeal process for beneficiaries, who think the company was wrong to deny them a certain procedure or a certain benefit.  There is no outside appeal.  The company may review its decision, but it is the company that is doing the review and not some independent reviewer.  The more care the company pays for, the less money it makes, so the company has to keep the care provided to the minimum required by the plan document.

After over 45 years of practicing law, I have read a lot of contracts.  The Medicare Advantage plan documents are complicated, even for me.  As a practicing lawyer, I understand how important it is to know what you are agreeing to when you sign up for a Medicare Advantage plan.  You are giving up some rights in order to get some additional benefits.  Maybe it is a good deal for you, but maybe it isn’t.  As in every other aspect of life, there is no free lunch.  No one is going to give you extra benefits without exacting a price.  However, after 45 years of practicing law, I also know how few people will actually read the long and complicated plan document detailing what they will get from the Medicare Advantage plan and what they will not.  The vast majority of people will not read the plan document until they have been denied some care and by then it is too late.

This is by no means a criticism of Medicare Advantage plans in general.  Instead, this is is a warning to Medicare beneficiaries to look before you leap.  Read the plan documents before you sign up, not after you have been denied a benefit you thought you were going to receive.  A Medicare Advantage plan may be just right for you or it may be a nightmare.  Only you can decide.

Posted in Doctors, Fee for Service, Health Care Costs, Health Insurers, Hospitals, Medicare, Rationing, Uncategorized |

Practice Makes Perfect

November 15, 2021

“Practice makes perfect.”  How often have we heard that old bromide?  Perhaps the main reason it has lasted so long is that there is a lot of truth to it.  There certainly is when the subject is medical procedures.

The Vineyard Gazette - Martha's Vineyard News | Its Emergency Room Jammed, Hospital Feels Impact of Case Spike

When it comes to quality medical care, I am fortunate to live in a big city with a number of excellent hospitals within a short drive.  While there are a lot of good things to be said about living in a small town, outstanding surgical care is not one of them.  Many surgeries are complex, even the ones we often think of as routine, such as hip or knee replacements.  In small hospitals, the surgeon may only do a few of these procedures each year.  If that is the case, statistics show that the complication rates go way up, as does the risk of death.  Here is an excellent post by U.S. News & World Report on the issue.

All other things being equal, and they rarely are, the more often a surgeon and her operating room team perform a surgical procedure, the better they get at it.  This should come as no surprise.  We see the same thing across many areas of life.  If you have a favorite recipe that you prepare at least a couple of times a month, you can prepare it in your sleep.  Not so with the meal that you only prepare once or twice a year.  For that one, you have to keep going back to the recipe and even then may get something wrong.  You don’t have the same feel for the dish.  In team sports, the play you practiced over and over usually comes off more smoothly than the trick play you only practiced once.

Small hospitals in small towns face many challenges.  It is hard to make ends meet.  They need the big ticket surgeries for which Medicare or a health insurer will pay big dollars.  It is a problem for the hospital’s bottom line, if the local patients go off to the big city for their complex surgeries.  But the statistics show that going off to the big city where the surgeon does your operation at least 3 or 4 times a week may save your life and, at the least, will reduce the risk of post-operative complications.  Try as it might, there is no way the small hospital can give even the world’s greatest surgeon enough surgeries to keep her skills sharp.  There just aren’t enough patients or surgeries to do that.

Based on the available data, even a surgeon of average talent will probably over time have better outcomes than a more talented surgeon, who just does not get to do the procedure very often.  And, of course, the success of an operation is not solely dependent on the expertise of the surgeon.  There is an entire team in the operating room working together to make the surgery a success.  There is also the post-operative care team, which is responsible for taking care of the patient and helping her recover safely from the procedure.  In my own practice, I have seen a number of cases in which a patient who came through an operation with flying colors, died or was seriously injured as the result of mistakes made during the first 12 hours after the surgery.  There are lots of ways to screw up an operation or a patient’s post-operative recovery.  As a patient, you want the practiced, well-oiled team that can do its job in its sleep.

To put an even finer point on it, the statistics show that surgeries done mid-week have lower complication rates than those done in the early part of the week when the operating room team and the surgeon are just getting back in the groove.  If you can avoid it, you do not want to be in the hospital over the weekend, especially if it is a three day weekend.  Bad things tend to happen when the usual crews are off on holiday.

For a lot of people, having the surgery at the local hospital, even with a higher risk of complications or death, is still preferable to driving for hours to the city to get the surgery.  That is fine and there are many reasons for making that choice.  Just be sure you understand that having your surgery at the local hospital places you at higher risk.

 

Posted in Doctors, Hip Replacement, Hospital Negligence, Hospitals, Informed Consent, medical errors, Nurses, Surgical Errors |

The Truth About Medical Malpractice Juries

November 08, 2021

It is an article of faith among doctors that medical malpractice juries are anti-doctor, incompetent to resolve medical questions and overly generous to patients who bring lawsuits.  They have been making the same complaints for the last 50 years at least.  As someone who has been trying cases for almost 50 years, in the old days on behalf of doctors and hospitals but for the last 35 years on behalf of injured patients, I can say with confidence that almost exactly the opposite is true.  This is not just my opinion.  Almost every well-researched study of malpractice juries over the last 30 years has reached the same conclusion:  malpractice juries are skeptical about patient claims, have favorable views about doctors, and do about as good a job resolving medical disputes as do medical professionals.

12 ANGRY MEN

The role of the malpractice jury has frequently been the subject of study by legal analysts.  They have approached the subject in many different ways, which should give us greater confidence in their conclusions when they find the same thing over and over no matter how they approach it.

Let’s start with the simple fact that doctors win about 8 of every 10 cases that go to trial.  This is as true in Arizona as it is in most of the other jurisdictions around the United States.  It is hard to understand how this can be so if juries are as anti-doctor as physicians believe.  In fact, when researchers have questioned jurors about their attitudes towards doctors, they have found them to generally view doctors favorably.  Jurors believe doctors try to help people and that they should not be held responsible for minor mistakes.  As one juror explained to my old partner about why the jury returned a verdict in favor of a doctor when the evidence of malpractice was very strong, “Well, he wasn’t drunk.”  Regardless of the jury instructions, this is a good example of the degree of fault many jurors require before they will find against a doctor.

Doctors claim that jurors give away too much money.  In fact, juries are very skeptical about all injury claims, and especially medical malpractice injury claims.  Juries almost universally think other jurors have given away too much money in the past.  They are determined not to let someone have something for nothing.  They are wary of plaintiffs whom they see as coming into court with their hands out.  If you want a substantial award for your client, you had better be sure that she or he has a solid, objective injury with significant permanency.

What about the argument that juries are incompetent to resolve disputed medical issues?  This claim has also been repeatedly debunked in a number of different ways.  One study interviewed trial judges while the jury was out deliberating.  In most of the cases, the trial judge’s analysis of who should win the case was the same as the subsequent jury verdict.  In other studies, medical doctors have reviewed closed medical malpractice insurance company files to see how the system was working.  The doctors assessed the negligence in each case as either no negligence, weak evidence of negligence or strong evidence of negligence.  They found that only rarely did a jury award money in a case where the doctors did not think there had been negligence.  To their surprise, they found that the jury often returned a verdict for the doctor, even when they believed the evidence of negligence was strong.

If confronted about these studies, many doctors will point to the stories in the news about large verdicts as proof that runaway juries are common.  Again, not true.  As anyone who tries cases knows, you are not trying them to the jury.  You are trying them to the judge and the jury.  If the judge thinks the jury awarded too much money, the judge can reduce the award or order a new trial for the defendant.  Trial judges often use this authority in the months following a big verdict but it rarely makes the headlines that the verdict itself did.  Regardless of whether the trial judge gave the doctor relief from a large verdict, the threat of an appeal is usually enough to induce the successful plaintiff to agree to accept less than the verdict.  The truth of the matter is that large verdicts almost never end up being paid.  They either result in reduced verdicts, a new trial or a compromise settlement before, during, or after appeal.

There is lots of malpractice out there.  Many patients are hurt by it and some are badly hurt or killed.  For a variety of reasons, few patients injured by malpractice ever make a claim.  Only a few of those who make a claim ever receive any compensation.  The system favors doctors, whether they realize it or not.  Instead of looking at the facts, it is easier for doctors to continue to claim that juries are unfair to them and use that to demand politicians do more to protect them.   When the politicians go along with them, and they often do, the system becomes even more unfair for injured patients.

Posted in Doctors, Lawsuits, Medical Malpractice, medical malpractice claims, medical malpractice lawsuits, medical mistakes, Medical Negligence, medical research, plaintiff, tort reform |

Hospital Billing Practices Can Send You To The Poorhouse.

November 01, 2021

The way in which hospitals bill their patients is a sin.  It ought to be against the law, but it is not.  Hospitals can charge whatever they want for a medical procedure and often do.  Some studies have found that even the hospitals themselves don’t know how much it costs them to perform a procedure; they just pull numbers out of the air.   That is not a sound way to run a business but is not far off from normal in the convoluted world of American health care.

Tips for Hospital Patients | Vanguard Communications Research | Denver, CO

Until recently, hospitals kept their prices a secret.  Obviously, if prices were secret, there could not be any price competition between hospitals.  Hospitals wanted their prices secret so they could continue to charge patients whatever they wanted.  After years of lobbying by patient rights groups, the Trump Administration issued an order requiring all hospitals to list their prices on line.  The price list had to be easy for the public to find.  While some hospitals have complied and listed their prices, others have either ignored the order completely or have hidden their prices on line in ways that make it almost impossible for the public to find them.

Not only do hospitals get to make up whatever price they choose, they don’t charge everyone the same price, even for the exact same procedure.  What you pay depends not only on whether you have health insurance but on what prices your health insurance negotiated with the hospital.  Some health insurers get a better price discount than others.  Some health insurers agree to pay more for Procedure X in return for the hospital giving them a lower price on Procedure Y.  This can be a real problem, if you are one of that company’s insureds and are in the hospital for Procedure X.  On top of all that, in some crazy cases, you may pay more if you have health insurance than if you had no insurance and were paying the hospital bill out of your own pocket.

For many years now, reporters at the Wall Street Journal have been investigating health care pricing and reporting on its effects on the American public.  They have been doing a great job shining light on an important topic that the big hospital chains would prefer remain shrouded in mystery.  Last week they ran a story about a couple who were financially ruined by hospital billings, despite the fact that they had health insurance.

There are two parts to the tragedy that befell this hard-working, older couple.  The first is the arbitrary manner in which hospitals choose to bill their patients.  The second is that this couple had to pay these bills in the first place.  We remain the only industrialized nation in the world that does not provide universal health coverage to its citizens.  We pay the most of anyone for health care and get less for our money than almost anyone else.  Why should hard-working Americans run the risk that a health issue will ruin them financially?  Even people who do everything right can be and are being financially ruined.  We can afford billions for questionable government programs but not afford to take care of our own people?

Our lack of universal health coverage is the result of the enormous amounts of money that flow through our health care system.  Hospital chains get some of those billions.  Health insurers get some of those billions.  Big Pharma gets some of those billions.  Physicians get some of those billions.  Not surprisingly, none of those who are raking in billions from the status quo in the health care industry want to see any meaningful reform.  They contribute to politicians and have armies of lobbyists to remind the politicians about the source of their campaign contributions.  So here we sit, year after year, watching good Americans get ruined financially because the big businesses that benefit from the status quo want to keep feeding at the trough.

The couple who were the subject of the Wall Street Journal story ran up large bills when the wife was diagnosed with cervical cancer and had to undergo expensive, if ultimately futile, treatment.  If they had been with a different health insurer, what they had to pay out of pocket would have been less.  Had their health insurer done a better job of negotiating, the amount they had to pay would have been less.  Had they gone to a different hospital, the amount they had to pay would probably have been less.  Sometimes there are huge differences in pricing between hospitals only a few miles apart but, without knowing how much different hospitals charge, patients cannot choose to go to the lower price hospital, even though in some instances the lower price hospital may provide a higher quality of care.

One example of the random and irrational effects of the insurance and hospital billing procedures involving this couple came when the wife needed a PET scan.  Her health insurer had negotiated a rate for those customers it covered for PET scans of $1,497.00.  However, because it was exempt from the provisions of the Affordable Care Act, the insurer refused to cover the wife’s PET scan and the couple were left to pay for it on their own.  The hospital charged them its full price, which was $8,451, a charge which was one of the highest the Journal found for PET scans in the United States.

Not only are we at the mercy of fate in terms of what diseases we get and when, we are at the mercy of fate in what our local hospital decides to charge for the medical procedures we need.  This insanity needs to end.

 

 

Posted in drug companies, General Health, Health Care Costs, Health Insurers, Hospitals, Insurance Law, Medical Costs, Secrecy |

Want To Live A Long And Healthy Life? Be Born Rich.

October 25, 2021

I don’t suppose it has ever been different over the course of human history, but our society is unequal.  More and more research studies are “finding” that inequality makes a big difference in how healthy you are and how long you will live.  When you think about it, the reasons are pretty obvious.

Discipline, not “the Universe” is the Key to Making Money

Where do you live?  Your neighborhood plays a role in your health.  Are there green spaces nearby?  If there are, that is a positive for health, even among communities of equal income.   Higher income people usually live in better neighborhoods with more amenities than do those with lower incomes.

Are there grocery stores near where you live?  Do they sell healthy foods or mostly processed foods and snacks?  Income is often closely related to diet.  People in lower socioeconomic situations don’t usually have the same access to healthy foods as do their more fortunate fellow citizens.  The poor eat more processed food, which is generally less healthy.

What did your parents feed you when you were a child?  The food choices made for you by your parents will have a big impact on your life going forward.  Childhood obesity is on the rise and, when a child is obese, it is highly unlikely he or she will lose the weight as an adult and adopt a healthier lifestyle.

What is your education level?  People born to higher income families usually get more education than poorer people who may not be able to afford college, or be able to take the time away from supporting themselves or their families to go to college.  Studies have shown over and over a strong correlation between education levels and better health.  The better educated are less likely to smoke and are more likely to live in good neighborhoods and to have an active lifestyle.  All of these are things that lead to better health.

How long and well do you sleep?  Recent studies have shown that the poor sleep fewer hours and sleep less well when they do sleep than those higher up the economic ladder. Some explanations are the need to work more than one job, financial stresses disturbing sleep, and the stress of having a life in which you don’t have much control.  Poor sleep leads to poor health outcomes.

All this goes to show that there are underlying causes for a lot of poor health in this country.  The socioeconomic position into which a person is born is important but it does not create an immutable destiny.  Individuals can make changes and escape what might otherwise have been a poor health outcome.  It isn’t easy, but it can be done.  In the meantime, we need to continue to do what we can to make society a fairer place.

 

Posted in General Health, health, healthy living, Obesity, obesity epidemic, science news |

The Importance of Hiring a Certified Specialist in Personal Injury and Wrongful Death

October 18, 2021

I can’t drive down the street without seeing lawyers advertising for personal injury cases.  Their faces stare out at me from the sides of buses, from billboards and from bus stop shelters.  I can’t watch the television for more than a few minutes without seeing lawyers advertising for personal injury cases.  You pick a show, they advertise on it.   Unless you are blind, you see all this advertising too.

After over 45 years of trying cases and representing people injured by the negligence of others, I know who is good and who is not.  I know that many of these advertising lawyers have never set foot in a courtroom.  All they do is appear in advertisements and run an office full of paralegals, who process cases.  They are personal injury mills.  On the rare occasion when they cannot get a settlement and the case needs to be tried, they get someone you have never heard of to actually try it for them.

You haven’t been trying cases for over 45 years.  How can you know who is good and who is not?  My advice is to look for a lawyer who has been certified as a specialist by the State Bar of Arizona.  Although the State Bar certifies lawyers in nine different fields of law, for our purposes, I am going to discuss only the Personal Injury and Wrongful Death specialization.

Thirty years ago, with the permission of the Arizona Supreme Court, the State Bar established a specialization for Personal Injury and Wrongful Death.  The purpose of the certification was to “identify to the public and the Bar those lawyers who have demonstrated superior knowledge, skill, integrity, professionalism and a high degree of competence . . . ” in personal injury law.  This is exactly the kind of lawyer you should want to represent you if you have a personal injury case or if you have lost a loved one due to the negligence of another.

So what does a lawyer have to do to get certified as a specialist in Personal Injury and Wrongful Death?  In the first place, the lawyer must have been practicing for at least five years and the last two of those years must have been here in Arizona.  Just practicing law is not enough.  The lawyer must have devoted at least half of his or her time to personal injury and wrongful death cases.

Just devoting most of a lawyer’s time to personal injury and wrongful death matters is not enough either.   The lawyer must show that she has tried cases and done the things that lawyers do when they try cases, including making opening statements, examining and cross-examining witnesses and making closing arguments.  Points are assigned for each of these tasks and for cases that got settled as well.  An applicant must get at least 180 points to qualify.  This works out to requiring at least 10-15 trials and the lawyer must provide information about all cases she or he has tried.

The lawyer who wants to be a specialist must take a written test to demonstrate knowledge of the Arizona law relating to personal injury and wrongful death.  She must submit recommendations from lawyers or judges who have been involved in her cases attesting to her knowledge, skill, preparation, effectiveness, and judgment as well as her ethics and professionalism.  The committee overseeing the certification process will choose other lawyers involved in her cases who did not submit a recommendation and ask about the same issues of ability and ethics.  The lawyer applying for certification must display ability and ethics higher than that of a general practice lawyer.  Any lawyer discipline may be enough to prevent a lawyer from becoming certified or may result in suspension of previously granted certification.

If a lawyer is experienced enough and good enough and ethical enough to make it through the application process and to become certified as a specialist in Personal Injury and Wrongful Death, she or he must take continuing legal education courses each year in trial and personal injury practice to keep up their skills.  They are also required to maintain legal malpractice insurance, which is not something required of other lawyers.

If you are the victim of an accident and suffer any sort of significant injury or if you lose a loved one in an accident, your choice of the lawyer to represent you is a serious one.  You want someone who can try your case, if it needs to be tried, and who knows how to prepare a case for trial.  This is the kind of lawyer who can get the most for your case.  The goal of the advertising lawyer running the personal injury mill is to process and settle cases.  The insurance companies know who these lawyers are and that they don’t try cases.  They know that most of the time, they will cave in at the end and take what is offered because they are afraid to go to trial.  Get yourself a good lawyer with a proven track record, not just someone who looks good on the side of a bus.

Posted in arizona certified medical negligence lawyers, arizona certified personal injury lawyers, Lawsuits, medical negligence lawyers, personal injury lawyers, plaintiff, trial |

The Important Doctor You Never See

October 11, 2021

There is a doctor whose work is very important to your health.  Her decisions may be the difference between life and death for you.  Her decisions may determine if you undergo surgery.  Her decisions may determine what drugs you receive.  You never see her because she works in a laboratory.  She is a pathologist.

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The pathologist has an important role in the practice and science of medicine.  When tissue is removed during a surgery or when a tissue sample is taken of a suspicious area, these samples are sent to the pathology lab where a pathologist examines them to determine what they are and whether they present a danger to the patient.

Sometimes it takes a while for the pathologist to make a final determination.  This usually happens when the issue is a complex one and the diagnosis is not immediately clear.  When this happens, the pathologist issues a “provisional” diagnosis.  When all the work is done and a final determination is made, the pathologist issues a “final” diagnosis, which may or may not be the same as the provisional diagnosis.

Pathologists generally do an excellent job.  Their error rate is low.  It is estimated to be between 1 and 4 mistakes per thousand pathological diagnoses.  Not only are they good at identifying what they are seeing, they are also good at asking others for help when a diagnosis is not clear.

One of the most important determinations a pathologist makes is whether a tissue sample is cancerous or not.  This is where I often come in.  I have had cases in which the pathologist made a mistake and determined that a sample was not cancer when it was.  I had a case in which samples were mixed up and a patient with cancer was told that there was no cancer.  I had a case in which the pathological diagnosis was very difficult and it took almost a month to get a final report.  The delay in reaching a final diagnosis and the fact that the final diagnosis was different than the provisional diagnosis led to a failure to inform a patient of his cancer.  The patient died as a result.

Not long ago, there was a reported story about a pathologist at a VA hospital in Arkansas who had an alcohol problem that led him to make error after error in examining tissue samples.  There are a lot of lessons to be learned from this sad story.

It appears that many of his fellow doctors and many staff members were aware of his alcohol problem and that he was often drunk on the job.  However, due to concerns about retaliation, no one said anything and he was able to practice there for over 13 years.  A later review found that his error rate was almost 10%, which is 33 times the usual error rate.  His mistakes led to a number of deaths among the veterans being treated at his hospital.  He has been sentenced to 20 years in prison for involuntary manslaughter and fraud.

Among the lessons to be learned is that you cannot count on the other doctors and staff at a hospital to look out for the welfare of the patients and report bad actors.  People are people and they tend to look out for themselves first.  If a hospital does not have a good culture which encourages reporting problems, they won’t get reported very often and patients will suffer.

Another lesson is the need for quality assurance to make sure pathologists are making their diagnoses correctly.  There was a procedure for reviewing the work of others at this hospital but the bad doctor faked the records to make it appear his work had been successfully reviewed.  Weak hospital policies that can be circumvented without much trouble lead to patient injuries.

In the end, we are at the mercy of the doctors and hospitals to a great extent.  The best we can do is request a second, independent pathology review from an unrelated pathologist before making critically important decisions about surgery or chemotherapy.  This includes second opinions to confirm a diagnosis that the tissue sample is not cancer, especially when you have concerning symptoms that suggest cancer.

 

Posted in disclosure of medical mistakes, Doctors, Fraud, Hospital Negligence, Hospitals, medical errors, medical ethics, Medical Malpractice, medical mistakes, Medical Negligence, prostate cancer testing, Secrecy |

Be Careful

October 04, 2021

The physician/patient relationship is one of the most important in our lives.  We place our lives and our trust in the hands of the physicians who provide medical treatment to us and our families.  We want to believe that they are well-trained, honest, ethical, and have our best interests at heart when they make medical decisions and provide care.  As much as we want to believe these things, it is important to remember that physicians are human beings and, as human beings, are flawed.  Sometimes, their human nature means that they betray our trust.  Somehow we need to balance our desire to trust our doctors with just enough caution to make sure we do not become victims.

Dr Death: The gruesome career of a Victorian poisoner | New Scientist

There is a common thread that runs through most of the reports of doctors betraying the trust of their patients.  That thread is composed of two familiar strands:  sex and money.

Some doctors will do anything for money.  A Detroit cancer doctor was charged and convicted of falsely telling many of his patients that they had cancer when they did not.  He administered damaging and expensive chemotherapy treatments to them.  He ruined lives and physically damaged many of his patients, all for money.

He is not alone.  A Virginia doctor was just convicted of doing much the same thing.  This gynecological surgeon told women they had cancer and needed surgery when they did not in fact have cancer.  He removed bodily organs that were perfectly healthy.  He performed other unnecessary medical procedures for which he billed the patients’ insurance companies.  He got away with it for ten years.  The jury convicted him on 52 counts of health care fraud and other crimes and the judge sentenced him to 59 years in prison.

In Louisiana, a cardiologist told at least dozens of his patients that they needed pacemakers when they did not.  He would then implant the pacemaker and charge the insurance company for the procedure.  He would continue to make money by monitoring the pacemakers for years afterwards.  He was convicted and sentenced to prison.

An Indiana sinus surgeon also performed unnecessary surgeries and billed for procedures he never performed.  He made lots of money and lived lavishly.  While under investigation, he went on a vacation to the Greek isles with his wife, who said she woke one morning to find him gone.  Three years later, he was found hiding in Italy.  He was returned to the United States, tried, convicted, and sent to prison.

I don’t have the space to discuss more than a few of the many physicians who used their position or their access to drugs or drugs themselves to sexually abuse their patients.  “Famous” among them is Larry Nassar, team doctor to the USA Gymnasitics team and former professor and team doctor at Michigan State University.  Dr. Nassar was accused of sexually assaulting 265 young women and girls over a nearly 25 year period.  He pled guilty to a few of these assaults and is serving time in prison.

A doctor employed by the athletic department at Ohio State University abused hundreds of male student athletes over a 20 year period.  A New York gynecologist stands accused of sexually molesting dozens of patients.  A former gynecologist at UCLA was recently indicted for sexually assaulting dozens of his patients.   A Montana doctor stands accused of raping patients.  I could go on and on.

Choose your doctor wisely but remember that even doctors with outstanding reputations may be acting in their own interests and not yours.  Be careful.  Be alert.  Ask questions.  Don’t hesitate to ask for a second opinion.  Most of all, don’t assume something is true just because a doctor said it.   If, in spite of your precautions, you find that you have been victimized by a doctor, call me.

Posted in Cancer, Doctors, Fee for Service, Fraud, medical ethics, Medical Malpractice, Secrecy |

Advances in Diagnosis and Treatment of Melanoma

September 27, 2021

A diagnosis of melanoma was often a death sentence.  It was and remains today one of the most dangerous of the skin cancers.  However, as science has marched on, there have been a number of developments in prevention, diagnosis and treatment, which make this disease a lot less lethal.

Melanoma - Wikipedia

We know a lot more about how melanoma develops than we did even 10 years ago.  If you are of a certain age group (looking at you, Boomers), you grew up without sunscreens.  No summer was complete without at least one or two sunburns so bad your skin peeled off.  We now know that this type of intense exposure in our younger years can damage the DNA in the skin so that in our later years, melanoma develops.

We also know that routine sun exposure in our later years can cause changes in the skin which lead to melanoma.  My grandchildren don’t go to the pool or the beach until their mom has covered them in sunscreen and they are wearing rash guards to keep the sun off.

Another piece of new knowledge is the role of heredity in melanoma development.  There are certain genes, which can be inherited, and which make it much more likely that a person will develop melanoma.  If you have a family history of melanoma, you might want to be tested for the presence of these genes.

Having spent a lot of time in the sun when I was younger, I am now spending a lot of time in the dermatologist’s office having him look at my skin.  I am seeing melanomas in every funnily colored and itchy skin growth.  That is not necessarily a bad thing.  So far, I have dodged all the bullets and everything has been nice and benign.  The point here is to monitor your skin and go see the dermatologist as soon as you see something suspicious.  When melanomas are diagnosed early, they can be excised with a good prognosis.

In preparing to write this post, I learned that there are some interesting new alternatives to the traditional excisional biopsy.  In the traditional biopsy, a tool is used to remove the suspicious growth, which is then sent to the pathology lab for examination.  There is an examination now called an optical biopsy.  This device allows the dermatologist to look into the skin to a shallow depth to see if there are enough suspicious traits to justify a traditional biopsy.

A second alternative to a traditional biopsy involves the use of sticky tape applied to the questionable growth.  When the tape is peeled off, it takes skin cells with it which can be examined for the presence of melanoma cells.

As with any cancer, the sooner it is diagnosed, the greater the likelihood of successful treatment.  The definitive treatment for a melanoma is to cut it out.  If caught in time, it has not yet metastasized and excision is all the treatment you need.  If caught after it has metastasized, all is not lost.  New drug treatments, called immune checkpoint inhibitors, have been developed which defeat the ability of the melanoma to turn off the body’s T-cells, which would otherwise attack the melanoma cells.  These inhibitors are the main line of defense against advanced melanomas, which have already metastasized by the time they are discovered.  They have saved the lives of many patients, who would have died only a few years ago.

Knowledge is power and we now know a lot more about melanoma than we ever knew before.  However, none of that knowledge is of any value, if we don’t put it to use by changing our behaviors, being watchful, and getting to the doctor promptly.

Posted in Cancer, Doctors, genetic testing, health, healthy living, Melanoma, science news |