Medical Malpractice News and Views


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

Birth Injuries

February 17, 2019

In many ways, there is no more heartbreaking injury than a birth injury in what had been a low-risk, completely normal pregnancy.  For nine months the expectant mother had been carrying new life and nourishing it inside her body.  The pregnancy was developing as expected and everything appeared to be going well until the labor began.  When the baby is born severely damaged or dies in childbirth, the pain and suffering of the parents is beyond description.

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Being born is a difficult thing.  The baby must transition from life in the womb to life outside where it is cold, loud and harsh.  To get to the outside in a vaginal birth, the baby must travel down the birth canal and be pushed through a small opening by the contractions of its mother.  Even with a Cesarian section, there are a lot of things that can go wrong during the delivery or before the decision is made to proceed to a surgical delivery.

Birth injuries come in many forms.  Some will heal quickly and the baby will develop normally.  Some will cause permanent injury throughout the life of the child.  In some cases the child will not survive the birth or the first few days of life.  Sometimes these birth injuries will occur in spite of the best medical care.  But sometimes, they will be the result of some failure of the medical care.  That is when the parents come to see me.

Some of the factors which increase the risk of a birth injury are things which can be identified before the birth.  For example, a large baby is more likely to have difficulty with vaginal birth.  Similarly, there is a condition called cephalopelvic disproportion in which the head of the baby is too large for the pelvic opening of the mother.  This can occur even when the baby is of normal or even small size.  Prematurity increases the risk of a birth injury as does an abnormal birth presentation, such as a breech presentation.  Competent physicians and nurses should recognize these conditions and address them for the safety of the baby.  Some of them may require that the mother proceed to a Cesarian section.

In some cases, however, there is no reason for anyone to suspect there will be a problem.  The onset of the fetal distress may slow and insidious.  In my experience, this can produce the worst outcomes because the distress sneaks up on the doctor and the nurses, who are lulled into a false sense of security by everything going normally at first.  Even when this happens, the baby may end up being fine.  When the parents come to me, however, it is because the baby is not fine.

Over and over, I see charts and fetal heart monitor strips that show a baby becoming progressively more distressed.  Sometimes the team members caring for the mother recognize the developing problem but hope to deliver the baby before the problem gets too bad and the baby is injured.  I see the parents when the medical team misjudged how much time they had left to safely deliver the baby.

Sometimes the doctors and nurses caring for the mother fail to recognize that a problem is developing with the baby until it is a big problem and it is too late to prevent an injury.  It is surprising to see this happen at a major Phoenix hospital with all its well-trained nurses and physicians and with all the modern equipment available to monitor the baby during the delivery process.  Frankly, it is surprising to see at pretty much any hospital in Arizona as they all have access to good monitoring equipment.

If your baby was injured during birth or died, it may have been the result of mistakes by the doctors and nurses involved in the delivery.  If you have questions, you should see a qualified medical malpractice attorney and get those questions answered.

Posted in Birth Injuries, Cesarean Section, Doctors, Hospital Negligence, Hospitals, medical errors, Medical Malpractice, medical malpractice lawyers, medical mistakes, Medical Negligence, Nurses |

Large Medical Malpractice Verdicts and Settlements.

February 11, 2019

The first thing to know about large medical malpractice verdicts and settlements is that the data surrounding them is largely unreliable.  The reason for this is at least twofold.

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With regard to verdicts, the verdict which is reported to the news media is just that, a jury verdict.  It often bears little resemblance to the amount the defendant or defendants may ultimately pay.  Large jury verdicts are almost always attacked, first in the trial court and then on appeal.  In states with malpractice caps on non-economic damages, the court is required to reduce the non-economic damages to the level at which they are capped.  Even if there is no cap on damages, in the case of large verdicts, defendants are frequently successful in getting some relief from the trial court.  News reports of large jury verdicts are rarely followed by reports about what happened to the verdict during post-trial motions or on appeal.

In post-trial motions, which are directed to the trial judge, the defendants will claim trial court or jury error and request a new trial.  The grounds can be many, including error by the trial court in ruling upon evidentiary issues or in instructing the jury, jury misconduct, attorney misconduct, excessive awards not justified by the evidence, and jury awards which were the result of passion or prejudice.  Depending on the circumstances, a new trial can be granted on both liability and damages or just on damages.  Obviously, if a new trial is granted on all issues, the parties start all over.  If granted on damages alone, the new jury will be told that the plaintiffs have prevailed on liability and that its sole function will be to determine the amount of damages.

In addition to moving for a new trial, or alternatively, defendants will argue that the jury verdict was excessive and ask the court to order what is called a remittitur.  Should the court agree that the verdict was excessive and grant the remittitur, the judge will decide what she considers to be a fair, lower amount and tell the plaintiffs that if they do not accept the court’s reduction in the verdict, it will grant a new trial to the defendants.

If the court denies the post-trial relief requested by the defendants, they can appeal on all of the grounds raised before the trial court in the post-trial proceedings.  In weighing the appeal, the appellate court will give substantial deference to the rulings of the trial court on many matters since the trial judge was in the courtroom and was in a better position that the appeals court judges to evaluate the witnesses and the evidence.  The appeals court may deny the appeal and affirm the actions of the trial court, it may reverse the trial court’s decision or, it may affirm in part and reverse in part.  Depending on what the appeals court does, the case may return to the trial judge for a new trial or some other action.

When a trial court reduces a verdict or grants a new trial or when an appellate court overturns a large jury verdict in whole or in part, those actions are rarely given the same attention as the original verdict.  The public never hears about the change and is left to assume that the large verdict still stands.  By way of example, virtually everyone has heard of the McDonald’s coffee cup case in which an older woman suffered severe burns to her genital area when she placed a hot cup of coffee in her lap.  Most people correctly believe that the jury gave her a large award.  In fact the jury found her total damages to be $2.86 million, which included a punitive damage award of $2.7 million.  The jury found the woman to be 20% at fault, so the judge reduced her compensatory award by that amount and further reduced the punitive damages to $480,000.  Even after those reductions, McDonald’s appealed the award and, while the matter was on appeal, the parties entered into a confidential settlement for less than $600,000.  Very few people know of the post-trial reductions in the amount awarded this woman.

When a medical malpractice case is resolved by way of settlement, the problem of getting an accurate report is complicated by the same thing that happened in the McDonald’s coffee cup case appeal: the settlement is confidential.  This is almost always at the request of the defendants, who do not want their dirty laundry aired in public and who do not want to encourage other injured patients to sue.

When you hear about a large verdict or that someone received a big settlement, take the news with two grains of salt.  In the first place, the reality may be quite different.  Secondly, the medical profession, the insurers and the business community as a whole would like the public to believe that runaway juries are common and that it is the public’s duty to put a stop to this by being very conservative should they ever serve on a jury.  Don’t let them fool you.

Posted in disclosure of medical mistakes, Doctors, Hospitals, Lawsuits, Malpractice caps, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice damages caps, Medical Negligence, Secrecy, tort reform, Verdicts |

Drug Costs Continue To Soar.

February 04, 2019

I have often written about the fact that drug prices in the United States are a disgrace.  See here and here.  We pay more for the same drugs than anyone else in the world.  A recent article in the New York Times traces the trajectory of drug prices from the early 1980’s until the present.  The authors conclude that something happened in the 1990’s that caused prices here to skyrocket compared to the rest of the world.

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In 1980, the cost of prescription drugs in the United States was not that much different than in the rest of the developed world.  Residents of each country spent about the same for drugs.  Then things began to change.  The yearly cost of prescription drugs in the United States tripled in the ten years between 1997 and 2007.  What happened?

Americans don’t take more drugs than people in other developed countries.  They don’t avoid generic drugs in favor of high-priced alternatives any more than residents of other countries do.  Even our generic drugs cost way more than the exact same generic drug in most countries in Europe, for example.  The same drug in Canada costs about half of what it costs in the United States.

The authors of the Times article point to the obvious answer:  other countries don’t let drug companies charge an arm and a leg for medications but we sure do.  In my blog post last month on drug prices, I pointed out that the pharmaceutical industry has spent billions lobbying Congress to keep its hands off drug prices.  The money has been well-spent.  Congress, for instance, has forbidden Medicare, the entity that pays for a large percentage of all prescription drugs taken in the United States, from negotiating price with the drug companies.

In the 1990’s, the failure of the government to do anything to control prices, coupled with an explosion of new, blockbuster drugs, led to a rapid increase in the per year cost of drugs here as compared to the rest of the developed world.  Medicare and Medicaid also expanded their coverage so people who in the past might not have been able to afford the higher prices could now pay them.

Also, as has often been pointed out, most Americans do not pay directly for their health care.  They have either private insurance or some form of government coverage.  For that reason, most of us are insensitive to price.  We pay a co-pay when we go to the drugstore.  Very few of us, if asked, could tell you the actual list price of the medicine we just picked up at CVS.  All we know is the co-pay.  When consumers are insulated from price like this, price no longer plays a role in choices they make.  The free market  for drugs is broken and does not act as it should.  The entities that do pay the rest of the price are either forbidden from acting to reduce prices or don’t care that much because they are getting their piece of the action.  According to Michelle Mello, a health law scholar at Stanford quoted in the Times article, “Though we pay high prices for some drugs of high value, we also pay high prices for drugs of little value. The U.S. stands virtually alone in this.”

President Trump has been making noises about bringing down high drug prices by freeing up the government to negotiate with the drug companies.  It would be a wonderful thing for everyone but the drug companies if he actually followed through on this.

Posted in drug companies, General Health, Health Care Costs, Health Insurers, Medical Costs, medical research, Medicare |

A Most Unusual Lawsuit.

January 30, 2019

There are a number of medical mistakes that involve mistaken identity.  There are wrong site surgeries in which the surgeon operates on the wrong side of the body or the wrong body part.  There are wrong dose mistakes in which a patient is given a wrong dose of the proper medication.  There are wrong medication mistakes in which the patient is given an improper medication.  There are wrong time mistakes in which the right thing is done at the wrong time.  And then there are wrong patient mistakes.

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An example of wrong patient mistake would be a surgery or other procedure in which the wrong patient is brought to the operating room.  Almost every hospital has a procedure in place today to prevent this type of mistake.  Prior to the procedure, there is a “time out” during which the nurses compare the name of the patient to undergo the procedure with the identification bracelet the hospital put on the patient at the beginning of the stay.  The “time out” may also involve asking the patient who he or she is and if they are to have the scheduled procedure.  These “time out” breaks have been very successful in reducing the number of wrong patient mistakes.  Sometimes, however, the system just doesn’t work the way it is supposed to.  According to news reports, such a breakdown occurred in a Bronx hospital in New York City and it led to a most unusual lawsuit.

The sequence of events began when a man was brought to the hospital in a coma following a drug overdose.  The doctors quickly concluded that there was little chance he would survive.  The hospital called the man’s sister to come and see her brother and make decisions about his care.  The problem was that the comatose patient was not the brother of the woman the hospital called.  He had a name which was very similar to that of the brother and the hospital misidentified him when he was brought in.  Unfortunately, he looked enough like the brother that the sister was unable to tell the difference.  At least in part this was probably due to swelling of the facial features and ventilator tubes covering part of the man’s face.

For nearly two weeks the sister stayed by the man’s bed and never realized it was not her brother.  Other family members were summoned to say last goodbyes and they did not recognize the man was not their relative either.  Meanwhile, the real brother was in jail and not in communication with his family.

Finally, the doctors caring for the patient asked the woman for permission to terminate life support as there was no real chance that the patient would ever wake up.  He was brain dead and only being kept alive by the machines.  Though she hated to let her brother go, she gave permission.  It was only when an autopsy was performed on the dead man that the mistake in identity was recognized and the woman informed that it was not her brother who had died in the hospital.

Now the woman is suing the hospital for the mental anguish she suffered while grieving for her brother and for ending the life of a stranger.  A most unusual lawsuit indeed.

 

Posted in disclosure of medical mistakes, Doctors, Hospital Negligence, Hospitals, Informed Consent, Lawsuits, medical errors, Medical Malpractice, medical mistakes, never events, plaintiff |

Medical Malpractice and Off-Label Use.

January 28, 2019

Off-label use is the use of a medication or a medical device for a purpose other than the purpose the Food and Drug Administration has approved for it.  Doctors sometimes prescribe a medication originally developed to treat one medical condition to treat a completely different condition.  This usually takes place after studies have shown that the drug has some benefit for the new use.  The same goes for medical devices.  Sometimes, they can be successfully used for a purpose other than the one for which they received FDA approval.

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It is not always malpractice to use a drug or a medical device for a purpose other than the one approved by the FDA.  It is definitely not illegal.  Once the FDA has approved a drug or device, it can be lawfully prescribed for other uses.  On the other hand, this off-label use of a drug or device may be malpractice in certain situations.

The definition of medical malpractice is conduct which falls below the standard of care for the physician or other health care professional in question.  The standard of care is defined as that minimum level of care that would be provided in the same or similar circumstances by a reasonable health care provider in the same specialty as the provider in question.  So if the doctor in question is a Board Certified Cardiologist, the issue is what would a reasonable Board Certified Cardiologist do in the same or similar circumstances.  The standard of care is almost never written down.  It is what doctors and other health care providers say it is.

Using the definition of standard of care, if a reasonable physician would prescribe the medication or use the medical device to treat the problem, then it is not medical malpractice for another physician to do the same thing, even if the use is not the one for which the FDA approved the drug or device.  In deciding whether something is what a reasonable doctor would do, it is not a counting contest.  Something can be disapproved by a majority of doctors but still be within the standard of care if a “respected minority” of doctors would do it that way or if there can be a reasonable disagreement about how to do it.

Of course, in a trial, the jury does not get to hear what a majority of doctors would do.  The patient gets to bring in one expert per medical defendant to offer an opinion that the defendant doctor fell below the standard of care.  The defendant doctor gets to testify that he or she acted reasonably in using the drug or device AND gets to bring in an independent expert to say the same thing.  Bottom line is that the defendant always gets two witnesses to say the standard of care was met and the patient only gets one to say it wasn’t.

When the FDA approves a drug or a device, there is a label that goes along with the approval.  It describes the approved use and gives warnings and advice about possible adverse outcomes and reasons not to use the drug.  Any time a provider is prescribing a drug or device for a different use, he or she is taking a chance that the jury will conclude that there was not enough basis for the off-label use and that it was malpractice to use it that way.  This is most likely to happen if the use is one that the manufacturer includes in the warnings or in the adverse outcomes.

As always, make sure you understand what your doctor is doing with your care.  Learn about the medications being prescribed for you.  Read the labels and the package insert.  You can find these on line.  Read about any devices your doctor intends to use before you agree to have them placed in or on your body.  Don’t be a guinea pig by mistake.  If they are going to experiment on you, make sure you know about it in advance and approve.

 

Posted in Doctors, drug companies, Informed Consent, Lawsuits, Medical Devices, medical errors, Medical Malpractice, medical malpractice cases, medical mistakes, Medical Negligence, medical research, Medication Errors, Orthopedics, plaintiff, Secrecy |

Never Underestimate The Corrosive Effect Of Money

January 21, 2019

When I look back on past blog posts, I am surprised at the number of times money is involved in whatever bad thing I am writing about.  Doctors, people to whom we entrust our lives and those of our family, will cheat, lie, steal, commit fraud and even intentionally harm patients in order to keep the money flowing.  Sometimes, even when they are making hundreds of thousands of dollars a year, they are not satisfied and will do whatever is necessary to get still more.  Others also involved in health care will cheat and steal from patients as well.

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Here is a link to the web site maintained by the Office of the Inspector General of Health and Human Services reporting on fraud prosecutions involving Medicare and Medicaid.  When you go to the site, you will find nearly a report a day.  While all of them are frauds by health care providers, not all of the providers defrauding the government are physicians, but all are people you may encounter in obtaining health care.  Many of these reports involve frauds of millions of dollars.  It amounts to billions of dollars each year.  The scale is staggering.  It is also naive to believe that the government is catching all of the crooks.  In all probability, this is just the tip of the iceberg.

Here are some examples of doctors betraying the trust of their patients to make a buck.

A Michigan oncologist lied to his patients by telling them they had cancer when they did not.  After he told them they had cancer, he administered expensive chemotherapy to them.  As I am sure you know, chemotherapy is the administration of poison in which the goal is to kill the cancer without killing the patient.  The chemotherapy sickened his patients, caused hair and teeth to fall out and undoubtedly shortened lives.  The government proved that he had done this to 553 patients and had defrauded the system of $34 million.  He also took kickbacks to send his patients to hospice and ordered unnecessary tests, which were conducted at a laboratory he owned.  He was discovered and sentenced to 45 years in prison.

Doctors accepted bribes from a drug company here in Arizona to administer its painkiller to them.  The painkiller was so powerful and so addictive that it was only to be prescribed to patients who were terminally ill with cancer and had unbearable pain that could not be controlled with other painkillers.  As part of the deal, the doctors taking the bribes falsified their records to make it look like their patients were eligible for the drug when they were not.  At least four doctors have been sent to prison for accepting bribes and the investigation is ongoing.  Here is a link to a story about one of them, a prominent Ivy League doctor.  If even this prominent doctor will take a bribe and intentionally injure his patients this way, who is safe?

While we see the opioid crisis as a tragedy, some doctors see it as a profit opportunity.  They take advantage of their medical license to prescribe medically unnecessary narcotics to patients in return for kickbacks or bribes.  Here is the story of one of these faithless doctors.

Kickbacks from labs are such a recurring problem that we have special laws just to address them.  Doctors prescribe unnecessary tests and then direct their patients to a laboratory that will give them back a cut of the fee for the test.  If asked about the test, many of these doctors claim that they only ordered the test because of fear of being sued if they didn’t.  They call it “defensive medicine” and argue your rights should be restricted so they don’t have to do this in the future.  In a far-reaching New Jersey scheme, 38 physicians and physicians assistants were convicted for accepting bribes to send patients to a certain lab for tests.  The bribes included cash, concert tickets, vacations, high end automobiles and prostitutes.

All of this just goes to show that doctors are human like the rest of us.  Like the rest of us, they are not perfect and they are perfectly capable of acting badly to make a dollar.  Always keep that in mind when discussing your care with a doctor.  Do you really need that test the doctor wants to order?  Do you really need the surgery the doctor is recommending?  Be a careful consumer.  The doctor is trying to sell you something.  Don’t just assume that because he or she is a doctor whatever they say must be true.

Posted in Defensive Medicine, Doctors, drug companies, Fee for Service, Fraud, Health Care Costs, Medical Costs, medical ethics, Medical Malpractice, Medicare, Secrecy, tort reform |

Hospitals Can Be Dangerous To Your Health.

January 14, 2019

The Depression Era bank robber Willie Sutton was famously quoted as saying that he robbed banks because, “That’s where the money is.”  Today, hospitals can be dangerous to your health because, “That’s where the sick people are.”

When you go to today’s hospital, you are entering a large, complex system where there are lots of communicable diseases and lots of opportunities for those diseases to be transmitted to you.  There is even a special name for it:  Hospital Acquired Infection.  If you weren’t that sick when you got there, you just may be after staying a few days.  Here are just some of the risks you face in a modern hospital.

Evolution is alive and well in hospitals.  Bacteria, which could have been knocked out easily with just a shot of penicillin seventy-five years ago have evolved to become resistant to even the latest wonder drugs.  Much of the development of antibiotic resistance has been attributed to overprescribing of antibiotics in the past.  According to the Centers for Disease Control, there are at least six superbugs thriving in hospitals today.  They include Carbapenem-resistant Enterobacteriaceae (CRE), Methicillin-resistant Staphylococcus aureus (MRSA), ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases), Vancomycin-resistant Enterococcus (VRE), Multidrug-resistant Pseudomonas aeruginosa, and Multidrug-resistant Acinetobacter.  Each of these is capable of killing a person.  For some of them we still have one or two drugs that can treat them but, if past history is any guide, the superbugs will soon develop a resistance to them as well.  This is an arms race with bacteria that we are unlikely to win.  There are so many of them and so few of us.  The best solution is to keep patients from getting an infection in the first place.  This is easier said than done.  One thing is recognized as true: Doctors must exercise more discipline in prescribing antibiotics and make sure their patients know how to use them when they are prescribed.

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It is important for hospitals to prevent the spread of infections by isolating patients.  If a patient has a highly infectious disease, that patient should not be in a room with other patients.  Patients who are particularly susceptible to infections, such as older patients or patients who are immunocompromised, should not be exposed to others who have communicable diseases.  Unfortunately, hospitals are run by human beings and are imperfect institutions just as are all other human endeavors.  Mistakes can and will be made.  We just have to hope those mistakes don’t kill people.

It is no secret that doctors, nurses and other health care workers at hospitals spread bacteria from one patient to another on a daily basis.  Doctors’ ties are a well-recognized home for many bad bugs.  The doctor goes from room to room and from patient to patient wearing the same tie and it is rarely, if ever, disinfected.  For that reason, some hospitals have told doctors to get rid of the ties.

Hands that have touched a sick patient should never touch another patient without being thoroughly washed.  This has been recognized since at least the time of Louis Pasteur but is still a problem.  There is not a hospital in the United States that does not require thorough washing after coming into contact with a patient and before coming into contact with the next patient but doctors and nurses continue to skip the hand washing from time to time.  Rules and reminders are apparently no match for human nature and the temptation to skip a step now and then.  Don’t let anyone touch you unless they tell you they have washed their hands.

When you or a loved one are in the hospital, watch for proper hygiene and ask that you not be exposed to other patients who may make you sicker than you already are.  Good luck.

Posted in antibiotic resistant bacteria, blood infections, Doctors, health, healthy living, Hospital Negligence, Hospitals, Infection, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, Nurses, Sepsis |

Malpractice Myths Don’t Match The Facts.

January 07, 2019

Last week I wrote about a study which examined over 20 years of reports to the National Practitioners Data Bank about payments made on behalf of doctors to resolve medical malpractice claims.  I discussed the study findings about the most common forms of malpractice.  This week I want to discuss some of the other findings of the study.

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A common myth perpetuated by the medical industry and the insurance industry is that there is a medical malpractice crisis that requires the government to take away your rights.  As usual, campaigns of this type are based on fear and assume that you won’t take the time to investigate their claims.  They want you to believe that the courts are flooded with frivolous claims and that good doctors are being driven out of practice by frivolous suits.  They want you to believe that, if something isn’t done to fix this, you won’t be able to get medical care, or that what care you do get will cost more than you can afford.  None of this is true.

The data from the National Practitioners Data Bank shows that since 1992, the rate of paid claims against all physicians has declined by over 55%.  During that same time period, the population of the United States has increased by over 62 million people.  That is an increase of almost 25%.  So at the same time that the population has increased by almost 25%, the rate of paid claims has decreased by over 55%.  Claims aren’t going up, they are going down and going down a lot.  Sound like a crisis to you?  Sound like the government should take away some of your rights to solve this crisis?

Many, many studies have found that, while there is a lot of medical malpractice, very few of the victims of malpractice make a claim.  The information at the Data Bank supports this conclusion.  A study by medical researchers at Johns Hopkins Medicine has determined that there are approximately 250,000 deaths each year attributable to medical error.  By contrast, from 1992 to 2014, there were only 35,000 claims paid on the basis of a patient death.  Over the same period of time, according to the Johns Hopkins researchers, there were 5 1/2 million deaths due to medical error.  Why do so few people make a claim?  Much of the disparity is due to the medical profession sweeping malpractice deaths under the rug.  No one goes out of their way to tell families that their loved one died due to medical mistakes.  Secondly, people are not as sue crazy as those who want to take away your rights would have you believe.  Most people just want to put the tragic loss of their loved one behind them.  They are not interested in making a claim, even if they suspect that mistakes were made.

Another important finding to result from the Data Bank information is that there are repeat offender doctors out there who are responsible for a disproportionate number of the paid claims.  The 5% of the doctors with the most claims were responsible for almost 25% of all of the claims paid.  Far from good doctors being driven out of practice by frivolous malpractice claims, bad doctors are allowed to continue to practice and to continue to harm patients.  The bad doctors are ruining things for everyone.  Before you allow the government to take away any of your rights, you should insist that these bad doctors be put out of business.

There is a lot of misinformation out there about medical malpractice.  Take the time to learn the truth.

Posted in disclosure of medical mistakes, Doctors, Health Care Costs, Lawsuits, Malpractice caps, Malpractice costs, Medical Costs, medical errors, medical ethics, Medical Malpractice, medical malpractice cases, medical malpractice damages caps, medical malpractice lawsuits, medical mistakes, Medical Negligence, medical research, plaintiff, Secrecy, tort reform |

Happy New Year – Big Pharma Is Raising Drug Prices Again And People Are Dying As A Result.

January 04, 2019

The price of drugs has been going up and up for the last 20 years as the big drug companies have raised prices over and over again for no reason other than a desire for record profits.  No one in the world pays more for drugs than we do in the United States.  Large campaign donations have made sure that Congress remains docile and does what it is told.  Last year, President Trump announced that he was going to do something about this on behalf of the American people.  Either he is not very good at what he does or he can’t do much as the major drug companies have announced price increases for the new year.  For example, Allergan is raising prices by an average of 10% on a number of drugs.

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Because my 8 year-old- grandson is a Type 1 diabetic, the price of insulin is of major concern to me.  This is a drug that every Type 1 diabetic must have every day or they die.  According to the American Diabetes Association, 7,500,000 Americans rely on insulin.  Its price has tripled over the last 15 years for no apparent reason.  Many who rely on insulin do not have insurance or, if they do, have insurance that does not pay enough for them to be able to afford it.  This has led many to ration their insulin.  According to some sources, as many as 45% of Americans who rely on insulin have rationed it due to cost concerns.  For some, even rationing is not enough and they have died because they could not afford their insulin.  Here and here are stories about young men who died because they could not afford their insulin.

Why does this happen in the richest, best country in the world?  It happens because we let it happen.  We let it happen when we do not demand that our elected representatives make health care affordable.  We let it happen when we do not demand that our elected representatives keep drug companies from ripping us off with price increase after price increase.  It is time to stop letting this happen.  No more Americans should die because they cannot afford their insulin or other life-saving medicine.

Posted in drug companies, General Health, Health Care Costs, Health Insurers, healthy living, Medical Costs, medical ethics, Pharmacies, Rationing |

What Is The Most Common Form of Malpractice?

December 31, 2018

I am often asked what is the most common form of medical malpractice.  Well, now we don’t need to rely on my opinion.  We have an answer based on over 20 years of malpractice suits and payments.

In 1986, Congress established the National Practitioner Data Bank.  It serves as a centralized database for all medical malpractice payments, whether by settlement or verdict, against individual doctors in the United States.  It keeps records of the amount of the payment, the doctor for whom the payment was made, and the nature of the malpractice claimed by the patient.  This information is not available to you or to me but it is available to those who study malpractice issues for research purposes.  A recent article in a prestigious medical journal analyzed over 20 years of payments and discovered some interesting information.  I will address some of the other noteworthy findings in a post next week.

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While this image of a hemostat left inside a patient during surgery is pretty dramatic, surgical errors are not the most common form of medical malpractice, although they are a close second.  The most common form of malpractice is the diagnostic error.  Errors of diagnosis cover a lot of ground but generally mean that a physician reached the wrong conclusion about what is wrong with the patient.

The two medical specialties that had the highest rate of payments for diagnostic errors were pathology and radiology.  I know that I have handled a number of cases in which a pathologist said a tissue sample was benign when it was, in fact, cancerous.  I just finished a case in which the pathologist got it right and identified a cancer but no one bothered to tell the patient, who didn’t learn about the cancer diagnosis for almost two more years.  Radiologists review hundreds of films a week.  From time to time, they miss something.  As with pathologists, the miss usually becomes an issue only when the thing they miss kills a patient or causes a significant injury short of death.

The second most common form of malpractice is the surgical error.  Due to good operating room practices, cases of instruments left in patients have declined greatly.  They still happen on occasion but are rare as the use of checklists has helped make sure that all instruments used in a surgery are accounted for at the end.

One of the most common surgical errors I see is cutting the wrong body part.  A cardinal rule of surgery is that a surgeon must identify the body part before cutting it out.  With the increase in laparoscopic surgery, in which the surgeon is operating while watching a video of the instruments inside the body, the ability to see is not the same as when the patient is “open” and instances of mis-identification are on the rise.  I have had a number of cases in which the surgeon removing the gall bladder and the duct that connects it to the common bile duct coming from the liver cuts and removes the common bile duct by mistake.  Oops!  These cases of mistaken identity are rarely recognized at the time of surgery.  Usually, it takes a few days and some unfortunate complications before the surgeon realizes the mistake.

Third place for most common malpractice goes to medication and treatment errors.  I have written about the fact that medication errors are common in hospitals.  Treatment errors involve everything from failing to be familiar with the patient’s medical records to making a mistake about what is the appropriate treatment for the patient.

There are lots of ways for doctors to make a mistake in your care.  Be as vigilant as you can and you will reduce the chance that you will need to come see me.

Posted in Doctors, Lawsuits, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical mistakes, Medical Negligence, Medication Errors, robotic surgery, Surgical Errors |