Medical Malpractice News and Views

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Large Medical Malpractice Verdicts Usually Have Some Things In Common.

Posted by Bill Sandweg.

June 05, 2023

You read about them in the papers, if you still read the paper.  More likely you hear about them on line or on your favorite cable news show.  They are the large medical malpractice verdicts.  Depending on the politics of the source of your news, the large verdicts may be reported with awe, derision, compassion for those injured, or outrage that a jury could award such an amount.  If you look closely, you will see that these verdicts almost always share certain characteristics.

5 Reasons Why Juries Are Awarding Billion-Dollar Verdicts : Risk & Insurance

A Catastrophic Injury or Death

Before a jury will award a large sum of money, there has to be a serious, permanent injury or death.  In my experience, juries are reluctant to award money in smaller cases or when the patient has made a good recovery from the injury caused by the malpractice.  So if you are hearing about a large verdict, the patient is either paralyzed, in a vegetative state, dying, or dead, or something similarly tragic.

A Large Economic Loss

If the patient is still alive, she or he will almost always need a lot of very expensive medical care for the rest of his or her life.  Life care planners will have testified that the present value of this care is in the many millions of dollars.  There may also be a large component of lost wages.  If the patient has died, there will usually be many years of lost wages, which would have been earned but for the death.

Big Medical Bills and Liens

Catastrophic injuries usually mean large medical bills.  Since Arizona allows the defense to tell the jury if the patient’s medical bills have been paid in whole or in part by insurance, the big verdict usually means that there was no or little to no health insurance or, if there was insurance, there are health care liens that will have to be paid out of any award.

A Loving Family

Juries are like the rest of us.  They like nice people and do not like rude people.  They feel sympathy for those who have been injured and those who have been left behind.  One of my old mentors told me, “Juries give money to people they like.”  I have found that to be very true over the years.  If you see a large verdict, you can be pretty confident that the jury liked and felt sorry for the victim.  If the case is a death case, the jury liked the spouse who was left behind, or the parents, or, even more importantly, the young children who will be missing a parent for many years.

A Good Trial Lawyer

Large verdicts don’t grow on trees nor do they fall out of trees at the feet of inexperienced or poor quality lawyers.  A medical malpractice trial is much like a symphony and the trial lawyer for the plaintiff is the conductor.  She or he must select and bring to the courtroom the expert witnesses who will educate the jury on the issues in the case and the medicine involved.  She or he must understand the medicine and be able to successfully examine the expert witnesses and cross-examine those of the defendants.  He or she must be able to write well to respond to the inevitable motions brought by the defense.  More so than most other kinds of trials, an experienced, talented lawyer is an essential ingredient for a large medical malpractice verdict.

An X Factor

Although not present every time, most large verdicts have an X factor in them.  Something that excites the jurors or makes them mad.  Something that makes them interested in making a large award to the patient or the patient’s family.  It may be infighting among the defendants as to who is responsible for the tragedy.  The surgeon may blame the nurse and the nurse may blame the surgeon.  It may be that records have been altered after the fact.  It may be that the defendant doctor makes a very bad witness and comes across as an unfeeling jerk.  It may be that the jury concludes the doctor was cutting corners to make more money.  All these are examples of an X factor that can turn a significant verdict into a very large one.

Appeals

The final commonality among large malpractice verdicts is that they are almost always appealed.  The defendant is insured and the insurance company has plenty of money to finance an appeal.  Even if the appeal is not that strong, the insurance company may be able to use it to leverage a reduced payment amount.

All of these factors don’t have to be present in every large malpractice verdict, but many of them are present every time a big verdict is returned.  I cannot and don’t want to provide the tragically injured patient but I can provide the good, experienced, medical malpractice trial lawyer.

Posted in arizona certified medical malpractice lawyers, Doctors, Health Care Costs, Hospitals, Lawsuits, medical errors, medical malpractice cases, medical malpractice lawyers, Nurses, plaintiff, trial, Verdicts |

Nurses Get The Short End Of The Stick.

Posted by Bill Sandweg.

May 29, 2023

It is never easy to be a nurse serving on the front lines of health care delivery.  Nurses know this.  Perhaps you have seen the stories about the number of nurses leaving the profession.  The reasons for their leaving are many and reflect poorly on our health care system.  We might be able to get along pretty well without venture capitalists but we can’t get along without a sufficient number of competent nurses.

Is nursing a profession or a job? - American Nurse -

There are two interrelated factors that are cited most frequently by nurses who are leaving the profession or thinking about it.  Burnout/Overwork and pay.  The Covid pandemic has largely run its course, but it was a terrible strain on the health care system and on nurses in particular.  Nurses had to show up for work, expose themselves to serious illness, and deal with a flood of very sick patients, many of whom died in their care.  Many times they were stretched particularly thin because some of their colleagues were sick or dying themselves.  A more potent combination of factors leading to burnout is hard to imagine.

Even though the worst of the pandemic is over, its effects linger on.  The nurses who did not leave the profession find themselves at hospitals or other care delivery locations without adequate staffing.  The nurses who remain are being asked to do more.  To top it off, they are not being paid for all of the extra work they are being asked to do.  Some of the hospital chains for which they work are making money hand over fist.  It benefits those chains to have fewer nurses to pay, if they can get those fewer nurses to care for more patients.  The empty staffing positions pad the bottom line for these hospitals.  The nurses rightly believe that they should share in these profits and, even if the hospital is not raking in the dough, they should be paid for the extra work they are being asked to perform.

Another related problem is that the nurses in general do not feel valued by their employers or by society as a whole.  They believe that some of the staffing shortages they face could be solved by their employers, if the employers wished to do so.  They suspect that their employers are not highly motivated to hire more nurses, if they can get the existing nursing staff to work harder.

Some doctors do not treat nurses with the respect they deserve as fellow medical professionals.  They look down on them.  They yell at them.  They blame them when things don’t go well.  They lord it over them.

Patients often don’t treat nurses well either.  Nurses are assaulted by patients more often than we would like to believe.  Nursing is a dangerous profession for many reasons and patient assaults is one of them.  A lot of mentally ill people, who are not getting the care they need, end up at hospitals where they are dumped in the lap of nurses who should not have to deal with mental illness.

There are, of course, other reasons why nurses are leaving the profession.  Some are reaching retirement age and are ready and deserving of a rest.  Some are returning to school to get a more advanced degree.  Some just want to take a rest.  Some do not want to be vaccinated against Covid or whatever the next infectious disease might be.

Add to all this the fact that we are not producing enough nurses to replace those who are leaving the profession.  In this respect the nursing shortage is much like our teacher shortage.  Little respect plus low pay equals an unattractive profession that few are flocking to join.  To make matters worse, our aging population will require more caregivers than ever.  We cannot afford to continue to treat nurses like this and expect someone to come the next time we ring the call bell next to our hospital bed.

 

Posted in Doctors, General Health, health, Health Care Costs, Hospitals, Nurses |

The Greedy Doctor

Posted by Bill Sandweg.

May 22, 2023

Over and over again, I have recommended that people considering surgery take a close look at the credentials of the surgeon, who is being considered for the operation.  This is especially true in the case of plastic surgery.  Any licensed doctor can hold himself or herself out as a plastic surgeon.  Patients need to make sure their “plastic surgeon” has received training in plastic surgery and is not just claiming to be one.  As I also point out, however, while making sure the doctor is properly trained and credentialed cannot guarantee that the patient won’t be the victim of medical malpractice, it does give the patient the best chance for a good outcome.  Today’s case in point shows that even well-trained and properly credentialed doctors can harm patients when they get greedy and cut corners.

Doctors Come In Many Different Flavors - Sandweg & Ager PC

The patient was a healthy, 36 year old mother of two, who wanted a breast augmentation.  She found the San Diego area surgeon on line.  He was well-trained.  He had gone to a good medical school and had participated in a general surgery residency before switching over to a plastic surgery residency at a very good hospital.  He claimed to be board certified in plastic surgery.  So far, so good.  These are just the kind of credentials you want, if you are planning plastic surgery, although it later developed that he was lying about being board certified.

Plastic surgery is like the wild west.  Anyone can claim to be a plastic surgeon and there is stiff competition for patients.  Based on what happened, it appears the surgeon was trying to keep costs down so he could offer competitive prices while at the same time taking home a big paycheck.

There are a lot of risks associated with breast augmentation.  It is usually performed under general anesthesia administered by an anesthesiologist or a certified nurse anesthetist (CRNA).  While it is occasionally performed under what is called “conscious sedation,” administered by a Registered Nurse (RN), the nurse must be properly trained for the job.  Proper training includes training on the medications to be used to sedate the patient, the risks associated with those medications, how to properly monitor the patient, and how to respond in the event of an emergency.

The surgeon performed the procedure at the surgery center he owned.  He planned to perform the procedure under conscious sedation.  He did not have either an anesthesiologist or a CRNA to administer the sedation.  Instead, he used an RN nurse employee, who, despite being an RN, had not had the training needed to safely administer the sedation, which involved the administration of some very powerful drugs, including fentanyl.  It is cheaper this way, but it increases the risk of a problem developing and, if it does, the RN is not well-equipped to either recognize it or deal with it.

Everything went well at first, but a little over an hour into the procedure, the patient’s oxygen saturations began to drop to dangerous levels and her heart rate rose as her body attempted to compensate for the low levels of oxygen in her blood.  Her blood pressure dropped and her heart stopped.  In the face of this emergency, the proper procedures are clear.  First and foremost, before doing anything else, have someone call 911.  There are a number of possible explanations for what is happening to the patient.  Some the surgeon may be able to address at the surgery center but some may require the services only a hospital can provide.  The patient needs to be taken as quickly as possible to a place where she can be fully evaluated and her problems addressed.

The surgeon did not call 911 and directed that no one else call either.  He began CPR and got the automated external defibrillator (AED) that he kept in the building to try and shock the patient’s heart back into normal rhythm.  He was finally able to get her heart going again and she began to breathe on her own but was not able to keep her oxygen saturations at acceptable levels.  The surgeon and his staff had to keep pushing oxygen into her lungs to keep her saturations up.  Unbeknownst to the surgeon, the patient had suffered a tension pneumothorax, a recognized risk of breast augmentation.  A tension pneumothorax occurs when blood or fluid in the lung space prevents the lungs from fully inflating.  The tension pneumothorax was the probable root cause of the low oxygen levels and the cardiac arrest.  The patient needed more care than the surgeon and his staff could provide, but they did not know that.

Three hours passed before the surgeon finally called 911.  During that time he called two anesthesiologists to discuss how to treat the patient.  One offered to come over to help but the surgeon declined the offer.  In neither case did he tell the anesthesiologists what was actually happening with the patient.  When he finally called 911, he misrepresented the condition of the patient.

The patient was taken to a nearby hospital, where she died a little over a month later due to the effects of the brain injury she suffered during the surgery when her oxygen levels were too low for too long.  The surgeon is facing criminal charges arising out of the death and the California Medical Board has restricted his license.

A well-trained doctor cut corners by having unqualified people deliver anesthesia and then panicked when the patient crashed.  His panic was undoubtedly increased by his knowledge that the patient’s cardiac arrest was likely due to the unqualified people he was using to deliver anesthesia.  You can check and double check a doctor’s credentials, but, sadly, you can never check their greed levels.

Posted in Board Certification, disclosure of medical mistakes, Doctors, Medical Costs, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, Surgical Errors |

Why Won’t Doctors Tell The Truth?

Posted by Bill Sandweg.

May 15, 2023

Medicine is an honorable profession.  Most of the people who are doctors are good people, who do good work, and who are honest and have high moral standards.  That is why it is so disappointing that, when medical malpractice happens, honesty and high moral standards seem to go out the window.

Secrets Doctors Don't Want You To Know

I have been representing people injured by medical malpractice for over 40 years now.  It has been my almost universal experience that when a patient is hurt by medical malpractice, the doctor says two things.  (1) I did nothing wrong; and (2) Nothing I did or didn’t do caused the problem you are complaining about.  Sometimes the evidence of malpractice is overwhelming and yet they still say the same thing.  Where are the medical ethics that require honesty between the physician and her patient?  Where are the moral standards that the doctor follows everywhere else in life?  It is almost as though doctors give themselves a free pass in malpractice cases to be less than candid with their patients.

Human nature being what it is, I guess we should not be surprised that many doctors leave their ethics and morals at the door when a malpractice claim arises.  I get it.  There are lots of bad consequences that flow from being found guilty of medical malpractice.  The state medical board will open an investigation into the circumstances of the malpractice.  While the doctor is unlikely to lose her or his license, the board may take action and that action will be available for the public to see.  The malpractice gets reported to the National Practitioners’ Data Bank.  Every time a  doctor applies for privileges at a hospital or for a license in a new state or for renewal of her malpractice insurance policy, an inquiry is made to the data bank.  A data bank report can result in the refusal of a hospital to grant privileges to the doctor to practice at that hospital.  It can result in the new state either refusing to give the doctor a license or placing some restrictions on the doctor’s right to practice.  It can result in higher premiums on the doctor’s malpractice insurance policy.  The temptation to stonewall the patient or even misrepresent the facts is great and the risks of honesty are many.

At the same time, the medical profession recognizes that honest reporting of errors is not only required by medical ethics, it is good for the profession.  No one learns from mistakes that are swept under the rug.  Mistakes are supposed to be reported without fear of adverse consequences so that they can be investigated and steps taken to prevent them from happening again.  Keeping silent and pretending that everything is just peachy, does not make the practice of medicine better nor does it make the public any safer.

I want to be clear that not all doctors give in to the temptation to be less than honest about what happened and that they made a mistake.  Some doctors admit their mistakes and testify honestly.  They regret their error and want to see their patient compensated for any harm that was done.  Sadly, these upright, honest doctors are the exception and not the rule.

 

Posted in Arizona Medical Board, Defensive Medicine, disclosure of medical mistakes, Doctors, Hospitals, Lawsuits, medical errors, medical ethics, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical mistakes, plaintiff, Secrecy |

Doctors Need Help, Cue the Robots

Posted by Bill Sandweg.

May 08, 2023

One of the most fertile fields for malpractice is the humble diagnosis.  Errors in diagnosis lead doctors down the wrong path and result in either no treatment for a serious condition or a delay in treatment.  The best available evidence is that fully one-third of malpractice cases result from either misdiagnosis or delayed diagnosis.  I am surprised it is not more than that.  I see it all the time in my practice.  The patient sent home from the emergency department with chest pains that the doctor did not think were cardiac in nature.  The spot on the x-ray that the radiologist failed to recognize as lung cancer.  The patient with gradually developing paralysis that no one in the hospital seemed to notice until it is too late.  I could go on and on.  Help may be on the way.

Physician and a Woman Patient, 1665 Painting by Jan Steen - Pixels

I have written about some ways in which artificial intelligence (AI) is already making an impact on the practice of medicine.  Computers have been shown thousands of images of x-rays of the lung with lung tumors present.  With the benefit of this training, computers are able to detect lung tumors years before human radiologists can see something on the image.  There are many other ways in which AI is affecting the delivery of medicine and reducing errors.

Computers can play a role in preventing errors involving prescription medication.  With a list of the patient’s current medications, which can be taken directly from the patient’s electronic medical record (EMR), the computer can cross-check them against whatever new medication the doctor may be considering.  Possible negative interactions can be recognized in advance and decisions can be made about what drugs to discontinue and what new drugs to add.  The computer can also offer suggestions as to what the best medication might be in a certain circumstance and it might be one the doctor has not considered.  The computer can also correlate the patient’s medical history with the intended medication and may identify problems before they occur.  For example, a patient with a bleeding history may be a poor candidate for a particular drug that has the side effect of increased bleeding.  Maybe there is another medication to address the patient’s need that does not increase the risk of bleeding.

Doctors are the product of many years of training.  They know so much about so many things and medical science is providing new things to know every day.  The problem is our human brain.  There is simply no way that we can marshal all of our knowledge at one time.  Furthermore, we are victims of our unconscious biases.  For example, recency bias can make a doctor think of a recent case he had which involved many of the same symptoms, to think he is seeing the same thing again, and to fail to consider other options.  Confirmation bias can cause a doctor to consider a potential diagnosis too soon and then look for evidence that her initial thought is correct.

AI has the ability to marshal all of the knowledge it has at its disposal and devote it to the diagnostic problem at hand.  Better still, AI does not suffer from cognitive biases, although it is no better than the programming it has been given.  AI can “think” of rare conditions that a human doctor might never consider but that just might be what is ailing the patient.  There is an old saying in medicine that when a doctor hears hoofbeats, she thinks of horses and not zebras.  This is fine if the patient has a relatively common illness but can be devastating if the patient has something rarely seen – a zebra illness.

Doctors are increasingly willing to use AI in their practices.  Fewer and fewer of them see it as a threat.  More and more of them recognize its potential to make them better doctors, who can deliver better care to their patients.

AI is already changing the ways in which we live and interact with our environment.  Medicine is no exception and the rate of change is only accelerating.

 

Posted in Doctors, electronic medical records, General Health, health, medical charts, medical errors, Medical Malpractice, medical mistakes, Medication Errors, Misdiagnosis, science news |

A Large Verdict Following a Disastrous Birth

Posted by Bill Sandweg.

May 01, 2023

An Iowa jury awarded nearly $100 million in damages to the parents of a child catastrophically injured during childbirth and to the child himself.  As is often the case in these verdicts, almost half of the money was to pay for future medical and custodial care for the child, who is and will be unable to care for himself.  The rest was awarded to the child and his parents for the general damages, pain and suffering, and loss of future earnings resulting from the botched birth.

Being born by Caesarian section may affect your intelligence | Faculty of Medicine | UiB

The laboring mother came to the hospital to deliver her baby boy.  When the mom was hooked up to the fetal heart monitor, the tracings showed that the baby might already be in trouble. Fetal heart monitors show the contractions of the mother’s uterus and the baby’s heart beat as he or she reacts to the contractions.  There are certain patterns of fetal heartbeat that are recognized as showing the baby is running out of the reserves of oxygen and energy necessary to successfully survive the labor and the trip down the birth canal.  When these patterns appear, the nurses and doctors are required to recognize them and to understand that the baby needs close observation as he or she may need to be delivered by an emergency caesarean section.

The obstetrician who was to deliver the baby didn’t recognize that there might need to be an emergency intervention soon and went off to deliver two other babies.  She left the mom in the care of the nurses, who are trained in the care and monitoring of laboring mothers.  By the time the obstetrician returned, the baby boy’s heart rate was extremely low.  The baby’s heart rate only slows like that after there has been prolonged lack of oxygen to the brain.  The nurses, who should have called for a doctor to come to the labor room when the baby’s fetal heart pattern deteriorated, had been asleep at the switch.  The obstetrician returned to find them trying to deliver the baby vaginally.

By this time, it was too late to perform a caesarean section.  The obstetrician tried to get the baby out of the womb by using forceps and by attempting a vacuum extraction.  Although she successfully got the baby out, during the process she fractured the baby’s skull and caused extensive bleeding in the brain.  Furthermore, before she could get the baby out and resuscitated, he had suffered permanent brain damage due to lack of oxygen, a condition called hypoxic ischemic encephalopathy.

The jury divided the fault 50-50 between the hospital, which was legally responsible for the conduct of the nurses, and the obstetrician and her group.

People hear of large verdicts like this and assume the little boy will be cared for now for life.  As is almost always the case, however, the verdict tells only a portion of the story.  In this case, prior to trial, the hospital and the parents had agreed to cap the hospital’s liability at $7 million.  The agreement was that, no matter how much the jury awarded against the hospital, it would only have to pay $7 million.  The obstetrician and her group did not have enough insurance to cover their share of the nearly $100 million dollar verdict and have declared bankruptcy.  There is also an argument between the obstetrician’s group and its malpractice insurer about how to respond to the judgment and whether the insurance company breached its obligations to the group.  It is an open question how much of the jury verdict the little boy and his family will ever see.

Birth injury cases are always complicated.  Lots can go wrong during childbirth, even when the doctors and nurses are doing the best job possible.  It is usually very difficult, however, for parents to know if the doctors and nurses did the best job possible or were, as in the case here, asleep at the switch.  If your child was seriously injured during or immediately after the process of childbirth, give us a chance to look at the medical records and see if we can answer your questions about how something like this could happen to your baby.

 

Posted in Birth Injuries, Cesarean Section, Doctors, Health Care Costs, Hospital Negligence, Hospitals, Lawsuits, medical errors, Medical Malpractice, Medical Malpractice Case Value, medical malpractice lawsuits, Nurses, trial, Verdicts |

Medical Debt Is Coming To A Household Near You

Posted by Bill Sandweg.

April 24, 2023

Medical debt is coming to a household near you, unless you are well-off.  If you are among the poorer Americans, the chances are high that you are carrying medical debt and that at least some of it is past due.

Most medical debt will be wiped from credit reports. Here's why. | khou.com

There can be no question that medical debt is a problem in this country and that it affects all of us, not just those who can’t pay their medical bills.  It affects all of us because unpaid medical care isn’t really unpaid at all.  Someone has to pay extra to keep hospitals and doctors in business when they don’t get paid for care they provide.  Those paying extra are all those who have health insurance or Medicare or who have no insurance but do have the money to pay their medical bills.  Charging everyone else extra is a terribly inefficient way to pay for the care of those who have no insurance.

Another way in which medical debt hurts more than just the poor is that it forces some hospitals to close.  If a hospital is located in a poor area of town or in a poor, rural area, that hospital is likely to have a disproportionately large number of patients who cannot pay their hospital bills.  Those hospitals don’t have the luxury that hospitals in richer areas have of being able to raise the prices for those who do have insurance and who make up the majority of their patient base.

The problem of medical debt is another aspect of the problem caused by our lack of universal health care.  I could fill many blog posts with the problems we cause ourselves by not having universal health care.  From poor health outcomes to higher than necessary medical bills, the problems caused by our system are many.

A recent survey of Americans between 18 and 64 (so as to exclude Medicare patients) found that 15% of Americans live in a family with past-due medical debt.  Nearly 75% of those families owe at least some portion of that debt to hospitals.

The people who carry medical debt are predictably the poorest among us.  That also means that, predictably, they are people of color.  Of those who had incomes at or below the federal poverty level, 26.4% had medical debt, well over half of which was past due.  When viewed by race, 12.8% of white families carry medical debt compared with 25.9% of black Americans and 19.1% of Latinos.

A hard-working family should not be thrown into debt by an unexpected illness that forces a family member to go to the emergency department.  You don’t have to be an economist to know that unpaid medical debt incurs interest and lowers credit scores, making it even harder for these families to get credit and to make ends meet.  Similarly, you don’t have to be a public health expert to know that uninsured people stay away from doctors and hospitals as long as they can so that when they are finally forced to go, they are often much sicker than they were earlier.  It tends to take more medical care to fix them than if they had come in when the problem began to develop.

Hospitals, many of which are non-profit entities, should not be predators in their communities.  While they are required by their non-profit status to provide free or reduced cost care to those who need it, many make it difficult for people to find that care or to take advantage of those programs.  They act like for-profit businesses and pay their executives high salaries.  Here is a link to an article discussing how non-profit hospitals get billions more in tax breaks than they spend on free or reduced cost care for the poor.

Even if we are going to insist on maintaining our present fee for service system supported by private health insurance, we can do a far better job of caring for our poorer and more needy neighbors.  It is the right thing to do.

Posted in Doctors, Fee for Service, General Health, Health Care Costs, Health Insurers, healthy living, Hospitals, Medical Costs, medical ethics, Medicare |

Think Long And Hard Before Going To Mexico For Medical Treatment

Posted by Bill Sandweg.

April 17, 2023

I drive to San Diego from Phoenix a number of times a year.  As soon as I cross into Southern California on Interstate 8, I see billboard after billboard advertising low cost medical and dental care just across the border in Algodones, Mexico.   The statistics say that many Americans are eager to take advantage of these offers.  Individuals stream across the border in private cars.  Busloads of retirement home residents arrive each day to get prescriptions filled and dental work performed.  This is a thriving market but it has its risks.

Mexico | History, Map, Flag, Population, & Facts | Britannica

One of the costs of this medical tourism has been in the news lately.  Four Americans, who had just crossed the Texas border with Mexico for medical treatment, were kidnapped by members of a drug cartel in what was almost certainly a case of mistaken identity.  Two were rescued but two died at the hands of the narcoterrorists.  Sadly, the threat of violence should not be the only concern of people thinking about going to Mexico for medical treatment.

Mexico is a wonderful country with many generous, hard working, friendly people.  They deserve better than what has happened to them, much of it fueled by our insatiable demand for drugs.  There is great competition among various criminal enterprises to control the lucrative drug trade with the United States.  The competition is incredibly violent.  Judges, journalists, prosecutors, religious figures and police and their families have all been victims of this violence at various times.  Shoot outs are not uncommon and many of the local police, and even some of the federal police and armed forces, have been corrupted.  The first risk any medical tourist faces is the risk that she or he will get caught up in the violence, either because of mistaken identity or the bad luck of being in the wrong place at the wrong time.

Another risk arises out of corruption and lack of strong oversight of the medical profession.   Even in the United States, there are isolated instances of pharmacies selling counterfeit drugs.  This problem is much more serious in Mexico.  It is almost impossible for anyone getting a prescription filled in Mexico to be sure that she or he is getting the medication they are seeking.  It could be counterfeit but look just like the real deal.  It may not work, or, even worse, actually cause harm because of contamination or adulteration.

While there may be some excellent doctors, nurses and dentists working along the border, most of them will not have the training or experience of their American counterparts.  The licensing requirements in Mexico are looser than they are in the United States.  It will be more difficult for you to investigate your doctor and determine her or his credentials and whether they have had complaints against them for poor care.

The quality of the care will likely be different.  Doctors may do things very differently in Mexico than they do in the States.  Unproven treatments are likely to be more commonly offered in Mexico than here.  Overall, the risks of malpractice are higher in Mexico and, if you become the victim of bad care over the border, there won’t be too much you can do about it.

Even if you receive good care, you won’t be able to visit with your Mexican doctor for any problems or just routine follow up as you would with an American doctor.

Lastly, there are bad bugs over the border.  I have been writing for years about the coming Armageddon due to the rise of superbugs that are resistant to our best antibiotics.  Some of those bugs already live in Mexico and have infected Americans who have undergone medical procedures there.  The Centers for Disease Control has warned of travelers returning to the United States from Mexico with highly antibiotic resistant strains of pseudomonas aeruginosa following surgery or other invasive medical procedures in Mexico.

As with everything else in life, there is no free lunch.  Every benefit comes with some risks attached.  Medical care in Mexico may be appropriate for you, just be sure you have thought it through before you decide to go.

Posted in antibiotic resistant bacteria, Arizona Medical Board, blood infections, Doctors, Fee for Service, Health Care Costs, Medical Costs, medical errors, medical ethics, medical mistakes, Pharmacies, Surgical Errors |

Hard To Believe But Insurance Company Policies Hurt Patients

Posted by Bill Sandweg.

April 10, 2023

I get it.  Insurance companies are in business to make money.  I don’t begrudge them a reasonable profit.  However, as evidenced by their behavior over the years, they can’t seem to operate without taking advantage of patients and patients are being hurt by their practices.

25 Best Private Health Insurance Companies In The World

Health insurance is a necessity for most Americans, but it should not be.  As I have pointed out often in the past, we are the only major industrial country without universal health insurance.  This results in a number of bad things happening to Americans that just should not happen.  As just a single example, expectant mothers do not get the prenatal care they and their unborn babies need.  The consequences of this are some of the highest maternal death rates in the world.   Our rate in 2021 was 32.9 maternal deaths for every 100,000 live births.  That is by far the highest maternal death rate among the industrialized nations.  It was four times that of the next highest country.  Give us universal health care and we solve a lot of problems.  That said, don’t hold your breath.  The health insurers have a lot of money and they are not afraid to spend it on lobbying Congress to keep things the way they are.

Health insurance practices which disadvantage patients begin with the underwriting process.  Underwriting is the part of the insurance business that decides what the rates need to be for a particular geographical area in order for the insurance company to be able to make money.  Set the rates too low and the company loses money.  Set them too high and the company may lose business to other companies whose coverage is more reasonably priced.  Unfortunately, competition is not always effective because there just are not enough companies willing to write policies.  What the economists call “barriers to entry” keep a lot of would-be competitors out of the marketplace.

Underwriters often use credit scores as a quick way of determining risk.  The lower the credit scores, the higher the risk is perceived to be and the higher premiums need to be to account for that risk.  It should come as no shock that poorer neighborhoods and poorer people have lower credit scores and are therefore asked to pay higher premiums.

For a lot of reasons related to their economic situation, poorer people are less healthy than people who are further up the socioeconomic ladder.  It is sometimes hard to get fresh food in poorer neighborhoods so people rely on processed foods or fast foods.  These are much less healthier.  People in unfavorable economic situations have higher rates of obesity, with all of the health problems that accompany obesity, such as Type 2 diabetes, high blood pressure, and coronary artery disease.  People with poorer health get charged higher premiums for coverage and, as a result, have still poorer health outcomes because they can’t afford to see a doctor.

Your problems are not over when you get health insurance.  One of the biggest areas of debate today in health insurance is the practice of many insurance companies to require patients to obtain insurance company pre-authorization before they get to see a specialist or before they can have many different kinds of treatment.  And, of course, heaven help you if you need an expensive medication.

Pre-authorization does its job of saving money for the insurance companies by discouraging patients from getting the care they need – care they have paid the insurance company to cover.  Fully half of the doctors surveyed recently by the American Medical Association endorsed the idea that pre-authorization requirements were keeping their patients from getting needed medical care.  Pre-authorization results in delayed, denied and abandoned health care claims.  Although not for the patients, this is just what the doctor ordered for companies looking to save a buck.

Thirty percent of the physicians responding to the AMA survey reported that problems with pre-authorization had resulted in serious health consequences for their patients, including unnecessary hospitalization, disability and even death.  That doctors must spend so much time and effort on obtaining pre-authorization results in higher priced health care for everyone else.  Someone has to pay for the staff needed to jump through the insurance company’s pre-authorization hoops.  The AMA believes that pre-authorization requirements are burdensome, inefficient and result in patients not receiving necessary care in a timely manner.

Older Americans are perhaps affected more by this than younger persons.  You know all those extra benefits promised you, if you sign up for a Medicare Advantage plan?  They get paid for by requiring pre-authorization.  If you are a traditional Medicare beneficiary, you do not have to get pre-authorization.  Medicare Advantage requires you to submit to the plan insurance company and its rules.  All those ads on TV cost money and the Medicare Advantage insurance companies have a lot of it because of policies like pre-authorization.

Thankfully, things may be beginning to change on this front.  Some health insurers, under intense pressure from the American Medical Association, Congress, and some state legislatures are beginning to roll back some of their pre-authorization requirements.  There is a long way to go, however.

Dealing with insurance company schemes is a lot like the old game of whack-a-mole.  You stop one unfair practice and they come up with two more to take its place.  Until we get universal health care, we just need to keep on whacking.

Posted in Birth Injuries, Doctors, Fee for Service, General Health, Health Care Costs, Health Insurers, healthy living, Insurance Law, Medical Costs, Medicare, Obesity, Type 2 Diabetes |

State Legislatures Are Making Your Health Care Less Safe

Posted by Bill Sandweg.

April 03, 2023

As anyone who reads this blog knows, I am not a big fan of state medical boards.  My complaint is that there is a lot of malpractice out there and the medical boards do not do an effective job of weeding out the doctors who regularly make mistakes that kill and injure patients.  On the other hand, while they may not do all the things they could to protect the public, they do provide much needed expertise and oversight of the medical profession.  That important oversight is being threatened across the country by state legislatures.

Capitals of the Arizona Territory and State | Pima County Public Library

A recent piece in the New England Journal of Medicine discussed the extent to which our culture wars have emboldened legislatures to step in and limit the powers of state medical boards to discipline doctors who push treatments that have no scientific basis but are good at separating patients from their cash.  For example, a number of legislatures have forbidden their medical boards from taking action against doctors who prescribed ivermectin as a treatment for Covid-19.  All reputable studies which have considered ivermectin have concluded that it provides no benefit against Covid-19 and can be dangerous to humans, if taken in large doses.  Other legislatures have passed laws protecting doctors who push misinformation about Covid-19.  Covid-19 is not the only area in which legislatures have interfered with medical boards.

Culture wars, while annoying to most, may have a reason for being, but they have no place when it comes to regulating physicians.  The premise of the legislation directed at medical boards appears to be the dangerous notion that there are no facts, just opinions, and that “medical facts” are being used to keep out other ideas that may be just as effective, but are not popular among the “elites.”  This premise inevitably leads to quack medicine which promises cures, but which delivers nothing.

Medical doctors have spent many years learning about the human body and training to heal it when we become sick.  There is no substitute for knowledge when it comes to serious illness.  We spend billions of dollars each year for research into better ways to treat illness and prevent it.  If you wish to go to a faith healer, or to a tribal shaman, or to an acupuncturist to treat your cancer, that is your right.  When, however, you choose to go to a medical doctor, you have the right to expect that this person will treat you in accordance with scientific principles and that, if they do not, the state medical board will step in and take them to task.

If you believe that the pandemic is behind us and that these interferences will not affect medical boards in the future, you are deluding yourself.  Once legislatures adopt the position that there are no real facts, there is no limit to the harm they can wreak.  The public needs to be confident that, if a doctor is licensed by the state, the doctor will adhere to certain basic scientific principles in the care she or he offers.  If legislatures forbid state medical boards from holding doctors to these principles, anything goes.  You only have to open the paper or go on line to see that medical doctors are not immune to greed or to bizarre beliefs.  We must preserve the ability of the medical boards to protect the public, even if it offends the culture warriors at the state legislature.

Posted in Arizona Medical Board, Doctors, Fraud, health, medical errors, medical ethics, medical research, science news |