Medical Malpractice News and Views


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

The Rise of Autoimmune Diseases

April 15, 2024

A few weeks ago, a dear friend and close relative of my wife woke up one morning to find herself becoming paralyzed below the waist.  Her husband took her to the hospital where doctors struggled to figure out what was going on.  Almost all of the diagnoses they entertained involved some component of autoimmunity.  In autoimmune diseases, the body’s immune system goes haywire and attacks healthy organs or systems.  The final working diagnosis was Neuromyelitis Optica,  an autoimmune disease with a spectrum of presentations.  Her immune system was attacking her spinal cord.

Autoimmune disorders found to affect around one in ten people | University of Oxford

There are over 80 different autoimmune diseases.  Some are well-known, such as Type 1 diabetes and rheumatoid arthritis.  Some, such as Neuromyelitis Optica, are much less well-known.  It is estimated that close to 10% of the population of the developed world has some form of autoimmune disease.  Individually, however, any single autoimmune disease is relatively rare, which makes research into it and treatment of it, more difficult.

The cause of autoimmune diseases is not well-understood.  The evidence is strong that there are components of genetic predisposition as well as environmental factors involved.  One other thing that is known is that the incidence of autoimmune diseases is rising faster than can be explained by genetic predisposition alone.

One potential explanation for the increase of autoimmune diseases in the developed world is called the “Hygiene Hypothesis.”  The essential point of the hypothesis is that our immune systems, which developed over millions of years to deal with threats posed by waves of bacteria, viruses and fungi, are now sitting relatively idle as a result of our insistence on an environment free of germs.  As the old saying goes, “Idle hands are the devil’s workshop.”  Speculation is that the bored immune system, with nothing else to do, goes off the rails and confuses our bodies’ healthy tissue with an alien invader, which must be repulsed at all costs.

Another part of the “Hygienc Hypothesis” postulates that we are being separated from the good bacteria, viruses, and fungi that are an essential part of our microbiome.  A healthy and diverse microbiome is believed to be an important component of a healthy body.  If we are not exposed to these helpful microorganisms, the theory goes, our microbiome will not develop properly and, over time will lose whatever diversity it has managed to develop, leaving us less well and more susceptible to autoimmune diseases.

The incidence of autoimmune diseases in the United States is just over twice that of Brazil.  The lower frequency of such diseases in the less-developed world is seen as evidence that, when allowed to perform its intended function, the immune system is less likely to malfunction.  There is also evidence to suggest that pollutants, medications, dietary intake, stress, and viral illnesses may all be associated with a rise in autoimmune diseases, especially in people with genetic predispositions to immune system malfunctions.  There is increasing evidence that Covid infections are triggering autoimmune responses in patients.

There really does not appear to be a lot we can do to prevent autoimmune diseases.  The best advice is to choose your parents carefully.  After that, eat healthy and try to avoid pollution and other bad environmental conditions.  And don’t worry quite so much about germs in the house.  They may be your friends.

 

 

Posted in antibiotic resistant bacteria, General Health, health, healthy living, Infection, medical research, science news, Type 1 Diabetes |

Pray You Always Get A Common Disease

April 08, 2024

Most people pray that they remain healthy.  Since we know it is unlikely we will always remain healthy, may I suggest a more practical prayer?  Pray you only get common diseases.

Zebra - Africa Geographic

Before a doctor can treat you, she needs to figure out what ails you.  This involves the art of diagnosis, and it is an art.  Misdiagnosis, either the failure to accurately diagnose an illness or the failure to reach a diagnosis at all, is one of the leading causes of injuries due to malpractice that I see in my work.

When a doctor is confronted with a sick patient, she must create a differential diagnosis, a list of the things that might be wrong with the patient in the order of their probability and lethality.  A good diagnostician begins inquiring about the chief complaint of the patient.  A good diagnostician is always a good listener.  Why is the patient here?  The doctor then moves on to a medical history of the patient.  What significant illnesses has the patient had?  What vaccines has the patient received?  What about the patient’s family?  Alive?  Dead?  If dead, of what did they die?  Any family history of major diseases?  The next step is a physical examination focused on the areas which might be involved in the patient’s chief complaint.  Before or after the examination, the doctor may order laboratory tests of blood and urine or may order imaging studies.  All of these may be pieces of the puzzle presented by the patient.  When all is said and done, hopefully the doctor will have reached a diagnosis.  The next best thing will be a differential diagnosis which can be further pursued to rule out items on it until there is only one thing remaining.

If you have a common illness and you have what medical science recognizes as classic symptoms of that disease, you are in luck from a diagnostic standpoint.  The doctor should have little trouble diagnosing your problem.  A 60 year-old, obese, male, smoker presenting with crushing, substernal chest pain and an abnormal EKG is likely going to be diagnosed with a heart attack.  A young person presenting with acute pain in the lower right abdomen, fever and nausea is likely going to be diagnosed with appendicitis.  On the other hand, if you come in with vague complaints that are not consistent and that come and go, you are at risk of being misdiagnosed and the consequences can be fatal.

So why the zebras in the picture above?  When there is a case of misdiagnosis and the disease or medical problem is uncommon, the malpractice defense attorney always says the same thing by way of excusing the doctor’s mistaken diagnosis, “When a doctor hears hoofbeats, he thinks of horses, not zebras.”  In other words, doctors think of common illnesses when they see symptoms that some common diseases have.  They don’t usually think of rare conditions that may have many of the same symptoms, even though those rare conditions should be on the differential diagnosis along with the common diseases.

So your best bet when you get sick is to have a common condition and a classic presentation.  Even doctors who are not very skilled in diagnostics will probably get it right and get you treated appropriately.  Rare conditions are much more likely to be misdiagnosed and to fail to receive appropriate treatment.  Watch out for doctors who jump to quick conclusions or who do not seem to be listening to you when you try to explain what is wrong.  Your life may depend on it.

 

Posted in Doctors, health, healthy living, heart attack, medical errors, Medical Malpractice, medical mistakes, Misdiagnosis |

More On The Malpractice You Are Almost Powerless To Prevent

April 01, 2024

Last week I wrote about medication mistakes in hospitals and the factors that make them so common and so deadly.  This week I want to write about the Tennessee nurse whose medication error killed a patient and who ended up being prosecuted and convicted in the death.

Digital QR codes on pills offer customised patient care | Article | Packaging Europe

RaDonda Vaught was only two years into her nursing career in 2017 when she made a mistake that will haunt her for the rest of her life.  She was assigned to administer a sedative, Versed, to an elderly patient who was about to undergo an MRI scan and who was anxious about the procedure.  Instead of Versed, she mistakenly administered a powerful paralyzing agent, Vecuronium, and left the patient to be taken to the MRI scan by an orderly.  When the orderly arrived at the patient,  he found she had stopped breathing due to the medication and was in cardiac arrest.  She was brain dead and died a few hours later.  Nurse Vaught was charged by local authorities with reckless homicide and with gross neglect of an impaired adult.  She was acquitted on the homicide charge but convicted on the charge of gross neglect.  She was sentenced to three years probation and lost her nursing license.

As is almost always the case, there were a number of contributing factors and Nurse Vaught may have been one of the least culpable participants in this tragedy.  The death and resulting investigation revealed many systemic problems that threaten patient safety today and yet persist in hospitals across this country.

The death in question occurred at Vanderbilt University Medical Center, one of the most prestigious hospitals in the United States.  That pretty well assured that, if prosecutors were going to go after anyone for this death, it was not going to be Vanderbilt University Medical Center, even though an agent of the Tennessee Bureau of Investigation testified its investigation found Vanderbilt to be greatly responsible for the death.  Unfortunately, Vanderbilt’s status as a sacred cow increased the odds for Nurse Vaught that she was going to be the one left holding the bag.  There were many issues at the hospital that set the stage for this error.

Nurse Vaught had to get the medication from an automated drug dispensing machine. To obtain a drug from the machine, she had to enter the first two letters of the name of the drug.  The machine would then produce a drop down list of drugs beginning with those two letters.  Because there are so many drugs with similar names and because there had been problems with nurses selecting the wrong drug, the manufacturer had sent out a software patch that, when installed, would require the nurse to enter the first three letters of the drug name.  At least in part because this slowed down the process, some hospitals had not installed the software patch.  Vanderbilt was one of those hospitals that had not installed the patch.  Requiring three letters would have greatly reduced the number of drugs on the drop down list and would have prevented this particular mistake.

The hospital was switching over to a new electronic medical record keeping system.  The rollout was not yet complete and there were many problems.    The drug dispensing machine was supposed to communicate with the electronic medical record to confirm that the medication selected by the nurse was one ordered for the patient.  The machine was not able to communicate with the electronic medical record because the switchover was not yet complete.  It therefore did not list any medication for the patient beginning with the letter VE.  This type of problem was widespread and the hospital had instructed the nurses to use the machine’s override feature when it was not responding properly.  Nurse Vaught used the override feature to get the machine to offer a larger list of medications beginning with VE from which she selected Vecuronium.  Nurse Vaught thought little of having to override the machine since it was done so frequently.  She admits she should have checked to make sure her assumptions were accurate at this point before proceeding.

At the time she was drawing the medication, Nurse Vaught was introducing a new hire to the hospital and its procedures.  She was explaining things to him and this was a distraction that certainly played some role in her mistake.

Nurse Vaught was required to administer the medication within a certain time frame or the patient would have to be sent back to her room and rescheduled for the scan.  Her haste to meet the time deadline played a role in her error.

The paralytic agent dispensed by the machine was a powder, which was different from the way Nurse Vaught had seen Versed in the past.  However, because recent hurricanes had disrupted supply chains, the hospital was getting many drugs that looked different from the way they usually appeared.  Many of them had to be reconstituted from powder where before they had not.  This was another point at which Nurse Vaught could have stopped and reassessed her actions, but did not.

Confirmation bias is a strong factor in many human actions and was important here as well.  Nurse Vaught expected that she would be given the correct medication by the machine and saw what she expected to see.  Confirmation bias remains a problem in hospitals today.

Nurse Vaught came forward and reported her error.  Although that is what hospitals and the medical profession says it wants, it did not work out well for Nurse Vaught.  She was fired, criminally prosecuted and lost her nursing license.  Her experience is unlikely to encourage others to be similarly open about their mistakes.

There was nothing this poor patient could have done to prevent her death.  This type of error continues to not only be possible but inevitable.  As we build more and more complicated systems, we tend to rely more and more on their infallibility with tragic consequences.

Posted in electronic medical records, Hospital Negligence, Hospitals, medical charts, medical errors, Medical Malpractice, Medication Errors, never events, Nurses, Secrecy |

The Malpractice You Are Almost Powerless To Prevent

March 25, 2024

Over the years, I have suggested a number of strategies to prevent or at least reduce the risk that you will be the victim of medical malpractice.  There is one form of malpractice, however, that is very difficult to prevent.  It is the risk of a medication error while you are in the hospital.

Digital QR codes on pills offer customised patient care | Article | Packaging Europe

Hospitals are complicated places.  Patients are constantly coming in and leaving.  Nurses are constantly coming on and off shift.  Many medical specialists may play a role in the care of a single patient.  All of these health care providers must communicate with each other in a clear and accurate manner to prevent medical errors.  The most common medical error which occurs in hospitals is the medication error.  It is no wonder.  There is probably not a patient in the hospital who is not administered some form of medication during their stay.  That is a lot of patients and a lot of medication.  Some studies have found that 6 out of 100 hospitalizations involve a medication error and that 1% of those errors result in death.

You can do some things to reduce the risk of a medication error and I have discussed them in the past.  Make sure you know what medications you take at home and in what dosages.  You should always have a list of these with you and take it to the hospital.  Make sure you receive these medications and in the correct doses while you are hospitalized.  Sometimes a home medication must be discontinued because it may interact with a medication you are being administered in the hospital.  If this happens, fine, but be sure you know the reason you are not getting your home medication.  Don’t take a medication you brought from home as it may interact badly with something the doctors have ordered for you in the hospital.

Ask the nurse to confirm that the medication he or she is offering you is actually intended for you.  There may be other people in the hospital with the same or similar names.  It never hurts to check.

Always ask what medication you are being offered and why.  Make sure that it was prescribed for you by one of the doctors participating in your care.

In order to be effective and to avoid injury, medications need to be given to the right patient, in the right dose, at the right time and by the right method of administration.  Unfortunately, there are many people involved in getting a medication to you that you never see and never get a chance to speak to.  These people can make mistakes that harm you and there is nothing you can do to prevent it.

Let’s see what happens when a doctor orders a medication.

First, someone has to enter the doctor’s order into your record.  This order has to be entered in a timely fashion and must be accurate.  Lots of room for mistakes here.

Next, the order is transmitted to the hospital pharmacy, where a technician must fill the order.  Lots of pills look alike and many have confusing, similar sounding names.  Mistakes can and do happen at this stage.  The medication is set aside to be taken to your floor.

An orderly takes the medications to the floor where they are distributed or administered by the nurse.  The nurse, despite her best efforts, may get the medications mixed up or may not notice that what comes up from the pharmacy is not the right medication for you or is not the correct dose.  The medication may come up late or early or not at all.

The bottom line is that we all take a leap of faith when we enter the hospital.  We have to trust that the people caring for us have our best interests at heart and are trying to do the best job they can.  Unfortunately, the people who work at hospitals are people.  They have families, bills to pay, and all the concerns and distractions the rest of us have.  To expect them to leave all of these problems and concerns at the door when they report to work is not realistic.  Mistakes will be made.  Do what you can to reduce the likelihood that you will be injured by a medication error and, after that, say a prayer, because that is pretty much the only recourse you have left.

 

Posted in Doctors, electronic medical records, Hospital Negligence, Hospitals, Medication Errors, never events, Pharmacies, Pharmacy Malpractice |

The Medicare Advantage Trap

March 18, 2024

More and more eligible Americans are signing up for Medicare Advantage plans.  And why not?  Celebrity spokespeople promise low to no premiums and benefits not available under traditional Medicare.  It sounds almost too good to be true.  “Get the benefits you are entitled to.  Call now and an insurance specialist will take your call and explain this wonderful offer to you.”  Of course, as you should know by now, there is no such thing as a free lunch.

Medicare Advantage (Part C) health plans

First, just a quick reminder of how Medicare Advantage works.  The companies that participate in the Medicare Advantage market are usually existing health insurance companies.  Pretty much all the big names in health insurance offer Medicare Advantage plans.  The federal government pays these companies a fixed amount per year to care for each eligible person they sign up.  The amount depends in part on a number of factors, including location of the enrollee.  The company is required by law to provide coverage for certain services.  Any money it does not spend caring for the enrollee, it gets to keep.

Clearly, there is an incentive for the company to keep its costs low.  This usually involves limitations on enrollees that they do not face in traditional Medicare.  In traditional Medicare, the enrollee can see almost any doctor or go to any hospital they choose.  They can see a specialist without getting permission first.  Things are quite different for the Medicare Advantage enrollee.

One of the most common forms of controlling costs is to set up a network of doctors and hospitals, who have agreed to give the Medicare Advantage company favorable rates.  Enrollees are required to go to doctors and hospitals who are “in network” or pay extra.  In some places, the networks may be large with lots of options from which to choose, but in other locations there may be few choices available.  Suffice it to say, you may have to change doctors from time to time as the company changes its network of providers.

Another common way of controlling costs is to require prior permission before any significant medical treatment.  Permission may be slow to arrive or may not arrive at all.  It is a frequent complaint against Medicare Advantage companies that they often deny needed care and force their enrollees to either file an appeal or to go without needed care.  Some hospital chains have decided not to accept the enrollees of certain Medicare Advantage plans because of high rates of denials and slow payment of bills.   Some doctor groups are similarly refusing to accept some Medicare Advantage patients.

These limitations may not be very important to you, if you are still relatively healthy when you sign up for a Medicare Advantage plan.  You don’t need a lot of medical care so these restrictions don’t interfere with the care you need or at least don’t interfere much.  It is when you get sicker and need significant care that these restrictions really start to bite.

Well, “OK”, you say, “I can always switch over to traditional Medicare, if I get sick and start having problems getting the care I need.”  Not so fast.  This is where the Medicare Advantage trap gets in your way.  Yes, once every year, during the open enrollment period, you can either change Medicare Advantage plans or leave Medicare Advantage altogether and sign up with traditional Medicare.  Traditional Medicare must take you and cannot charge you extra premiums because you are now sick with a major health problem.  So far, so good.

The problem is that traditional Medicare does not cover all of your care.  It has co-pays and deductibles.  Enrollees are expected to pay 20% of the cost of their treatment after reaching a certain point.  For that reason, most people signing up for traditional Medicare, also sign up for a “Medigap” policy that covers these co-pays.  If you sign up for a Medigap policy when you first sign up for traditional Medicare, the Medigap insurance company cannot charge you extra because you are sick or have a major medical condition.  This is not the case, however, if you are coming to traditional Medicare from a Medicare Advantage plan.  If you are coming from a Medicare Advantage plan, the Medigap insurer can take your health status into account and, if you have a major medical condition, you can expect to pay extra for the Medigap insurance.  For many people, the extra charge is too much and they can’t afford to leave the Medicare Advantage plans.  They may switch to another Medicare Advantage plan, but they will never be able to afford to switch to traditional Medicare, regardless of how problematic Medicare Advantage is proving to be.

As I have written before, Medicare Advantage may be the best option for you, but look before you leap.  There are substantial trade offs that you must make in order to receive the benefits they promise you.  There is no free lunch and you may find yourself trapped in Medicare Advantage when you get really sick.  Take your time and be careful when making your initial choices.  They may end up being life-long choices.

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

Maybe, Just Maybe, Science Will Save Us From The Superbugs

March 11, 2024

Superbugs!  That is the name given to antibiotic resistant bacteria.  Because of our indiscriminate use of antibiotics, more and more bacteria are developing resistance to them and posing an ever greater threat that we will be forced back to the bad old days before antibiotics when bacteria killed wide swaths of the population, especially the young and the infirm.  Already it is estimated that superbugs kill 5 million people a year and that this number will increase to 10 million by the year 2050.  10 million a year is one person every three seconds.

Oxford-led study shows how AI can detect antibiotic resistance in as little as 30 minutes | University of Oxford

The rise of the antibiotic resistant bacteria did not occur overnight.  It is the result of years of foolish use of antibiotics by farmers, industry, doctors, hospitals, and individuals.  Instead of recognizing the importance of antibiotics and doing everything in our power to assure that they continue to be effective against the bacteria that cause significant illness, we have wasted their power and virtually guaranteed that they would become useless.  We made the rise of the superbugs inevitable.

We always assume that science will save us by developing another antibiotic that will replace one that has lost its effectiveness.  So far, science has not disappointed.  It has come through for us time and again, but the superbugs are nothing if not persistent and there are trillions of them.  There are only so many ways to kill bacteria and scientists have already thought of most of them and have incorporated them into existing antibiotics.  There aren’t many avenues left.  Maybe it’s time for something completely different.

How about viruses?  For countless millennia, viruses and bacteria have been at war.  Some viruses evolved to prey on certain types of bacteria.  They are called bacteriophages, or phages for short.  Researchers are now trying to identify which phages are effective against which superbugs.  Bacteria have some defenses against these natural enemies.  After all, they have been warring for a long time and if the bacteria did not have defenses, they would have been wiped out long ago.  So far, however, the research has suggested that a combination of phages and antibiotics are a one-two punch that the superbugs cannot resist.

There is still a long way to go in perfecting our ability to use these natural predators in a safe and effective way.  In the meantime, use existing antibiotics wisely so they don’t lose their effectiveness any sooner than absolutely necessary.  Here is a good resource on the wise use of antibiotics.

 

Posted in antibiotic resistant bacteria, blood infections, Doctors, General Health, science news, Sepsis |

Arizona’s Notice of Claim Statute

March 04, 2024

Arizona has inherited the ancient common law doctrine of sovereign immunity.  Without its permission, you cannot sue it or any other state.  Like the other states, Arizona has waived its immunity, but it has done so with some limitations.  One of these is that, before you can bring an action against the state or a subdivision of the state or a state employee, you must first serve a Notice of Claim.  Arizona’s Notice of Claim statute, A.R.S. Section 12-821.01, sets forth the requirements of the notice.  It is a highly technical statute and, if its requirements are not followed to the letter, you lose your right to sue the state, its subdivisions, and any of its employees who injured you while acting in their capacity as state employees.  While the legislature will permit you to sue the state and its employees, it does not want to make it easy to do so.  The Notice of Claim statute is a trap for the unwary.

Former County Attorney alleges corruption of former officials – Parker Live

The stated purpose of the Notice of Claim statute is that it gives the state an opportunity to investigate claims against it and to settle those which are meritorious.  Given that the state almost never accepts one of these claims without forcing the injured party to sue, this statement of purpose by the legislature is highly suspect.  More likely, the intended purpose of the statute is to allow the state to throw out as many claims as possible for failing to meet the statutory requirements.

The very first requirement is one which catches many victims off guard and disposes of many claims.  Arizona has a two year statute of limitations for personal injuries.  This means that an injured victim can file suit up to two years after the event giving rise to the injury and still get her day in court.  Not so if the claim is one against a state entity or employee.  A Notice of Claim must be served on the appropriate officials or employees within 180 days of the event giving rise to the claim.  I cannot begin to count the number of times someone has come to me with what seems like a strong claim only to find that it is against a state entity or employee and that the event occurred over 180 days ago.

The second requirement is that the Notice contain facts “sufficient to permit the public entity, public school or public employee to understand the basis on which liability is claimed.”

The third requirement is closely related to the second.  The Notice must state a specific amount for which the claim can be settled and “the facts supporting that amount.”  These two parts of the statute have spawned a lot of litigation as the state routinely claims that the amount stated was not sufficiently specific or that the plaintiff did not include enough facts for it to understand the nature of the claim and to determine if it is worth the amount plaintiff is willing to accept in settlement or both.

The fourth and final requirement also trips up many would-be plaintiffs.  The Notice must be served on the “person or persons authorized to accept service for the public entity, public school or public employee as set forth in the Arizona rules of civil procedure . . . .”  It cannot be just mailed.  It must be hand-delivered and it must go to a specific person, who will usually be different for each state entity.  If you serve the Notice on the wrong person, or don’t serve it on all the persons who should receive it, you will be tossed out of court.

After the Notice is served, the state entity has 60 days in which to decide whether to accept it or not.  They almost never do.  The Notice is presumed denied after 60 days has passed without an acceptance, unless it is specifically denied before that.

A companion statute requires that all actions against the state, its entities or employees be brought within one year from the time of the event giving rise to the action.  This means that after the Notice of Claim is filed, the plaintiff has until the one year anniversary of the event to file suit.  The two year statute of limitations for personal injury does not apply.

There is an exception for minors and others under a disability.  The 180 days and the one year limitation period do not begin to run for them until they reach the age of majority (18) or until the disability is lifted.

There is one final exception.  If a reasonable person would not realize he or she has been damaged and the cause or condition that caused the damage, the Notice of Claim period does not begin to run.  This may happen from time to time but there will almost always be an argument by the state that the period ran more than 180 days before the Notice of Claim was eventually filed.

If the state argues that the Notice of Claim was not filed in time, that issue must be resolved before trial and as soon as possible.

You may think that this is pretty straightforward but these requirements are the subject of appellate case after appellate case as the state routinely argues the requirements of the statute were not met and the trial courts agree.  There may be questions about who is an employee or agent of the state.  For example, doctors participating in residency programs through the University of Arizona are considered state employees.  In a very recent case, someone sued a county for actions taken by the county sheriff.  The appellate court held that the claim failed because the county is not responsible for sheriffs, who are elected officials and should be sued on their own.

The bottom line is that if you have been injured by a state employee or anyone who might even remotely be considered to be a state employee, get to a lawyer as soon as possible and get legal advice.  It will take time to investigate and prepare a Notice of Claim, if one is required, so you better get to the lawyer in time for the necessary investigation to be completed.  I cannot even consider taking a case requiring a Notice of Claim that arrives in my office less than 45 days before the expiration of the 180 day period.  It is just too risky.  Don’t lose your right to sue because you failed to comply with the Notice of Claim statute.

 

Posted in Lawsuits, personal injury lawyers, Statute of Limitations, trial |

The Impaired Physician

February 26, 2024

Doctors are only human.  They are prey to the same frailties that plague the rest of us.  Like the rest of us, some of them become addicted to alcohol or use narcotics or other substances that can affect their judgment and performance.  Unfortunately, when this happens, their human frailty can affect the health of those of us who are or who become their patients.

Injection Drug Use and Wound Botulism | Botulism | CDC

If you think you are unlikely to encounter an impaired physician, you are wrong.  Current estimates are that 10 to 15% of physicians will experience impairment due to alcohol or drugs at some point during their careers.  Many of the same character traits which draw them to medicine and which help them become successful physicians are the same traits that predispose them to depression and substance abuse.  Physicians often find it difficult to admit to human failings, even to themselves.  They will vigorously deny any suggestion that they have an impairment problem.

Over the years I have been practicing law, I have seen a number of instances of impaired physicians harming patients.  I am sure that what I have seen is only the tip of the iceberg, however.  The statistics suggest that there are far more impaired physicians causing far more harm than ever comes to my attention or to that of the Arizona Medical Board.

Although I am frequently critical of the Arizona Medical Board, I do congratulate them on the diligence with which they approach the impaired physician.  Once an impaired physician is identified, the Board does a good job of getting them away from patients, suspending their license to practice, and of assisting them to get off substances and to return to treating patients responsibly.

The big problem for the Board, however, is recognizing the impaired physician in the first place.  Unless the Board receives a complaint, it has very little way of knowing a physician is impaired.  Many impaired physicians go unreported.  Not only are impaired physicians adept at hiding their impairment, they can count on the reluctance of those around them to report suspicions they may have, especially if the person with the suspicions is a nurse or other health professional who is rungs below the physician in the pecking order.  Those who report a doctor for suspected impairment can expect retaliation, if the allegation is not substantiated by testing.  Sometimes, friends of the impaired doctor may retaliate, even when the allegation is substantiated.  Many nurses and other health care professionals decide that it is just not worth the hassle or the risk to report their suspicions of impairment and choose to look the other way.

If you encounter a physician whom you suspect may be impaired, get away from that person as quickly as possible.  This is what you should do no matter how simple you may think the doctor’s care for you may be.  An impaired physician need not be a heart surgeon to cause you harm.

You are under no obligation to report your suspicions to anyone and there are any number of excuses you can offer for wanting to change physicians.  On the other hand, if you believe your suspicions are well-founded, you do the public a service by reporting impaired physicians.  As in all other matters medical, be alert.  Trust but verify.

 

Posted in Arizona Medical Board, disclosure of medical mistakes, Doctors, health, Hospitals, medical errors, medical ethics, Medical Malpractice, medical mistakes, Medical Negligence, Nurses, Secrecy |

Medical Tourism – Almost Always A Bad Idea

February 19, 2024

As you can probably guess, medical tourism is the name given to the practice of going to a foreign country for medical treatment, usually because it is cheaper there.  One of the most common treatments sought by medical tourists is cosmetic surgery and one of the most common places American medical tourists go is Mexico.  There are always risks associated with cosmetic surgery but they are much higher in Mexico.

Travel to Mexico for high-quality medical care - Medical Tourism - YouTube

Americans are nothing if not cost conscious.  Look at this advertisement.  Who could resist?  Affordable health care with a nearby beach and margaritas to boot.  What could go wrong?  The answer is plenty.

Mexico is plagued by shortages of medicinal drugs and some medical equipment.  In response to these shortages, some clinics resort to purchases on the black market.  They may also resort to trying to stretch the medications they do have by using a single vial to medicate two or more patients.  Last year, practices like this led to the deaths of 12 Americans who went to Mexico for cosmetic procedures and came home with aggressive fungal infections that attacked their brains.  The Centers for Disease Control has documented 14 probable and 10 possible cases of fungal meningitis among people who went to Matamoros, Mexico last year for cosmetic surgery.

The fungus is one which is common in the environment.  Those who have studied this outbreak believe the fungus was probably introduced into the spinal column through the use of epidural anesthesia, a procedure in which anesthetic agent is injected directly into the cerebrospinal fluid that bathes the spinal cord and the brain.  Normally, the blood/brain barrier keeps intruders such as this fungus out of the spinal fluid and the body handles it without much difficulty.  That is not the case, however, if the fungus is introduced directly into the cerebrospinal fluid.  Its introduction through epidural anesthesia makes the most sense.  This is where the frailties of the Mexican medical system can cause these outbreaks.

When you go to a foreign country for a medical procedure, you place yourself at the mercy of whatever healthcare system that country has.  In the United States, we have strong regulation and are vigilant about drugs and medications used on patients.  It would be very unusual, although it does occasionally occur, that you would receive a counterfeit drug here.  This is far more common, however, in foreign countries, especially if the country’s regulatory agencies are weak or if the system is corrupt.  Sadly, both are true of Mexico’s health care system.

Because their treatment occurred in Mexico, when the tourists fell ill after returning home, it was hard for their doctors to get the information they needed to diagnose the problem.  Although the doctors were pretty sure they were dealing with a fungal infection, it was difficult to pinpoint the particular fungus and different fungi respond to different treatments.  To top it all off, this particular fungus is highly resistant to most anti-fungal treatments.

Victims would report a headache one day and have a stroke the following day.  Early treatment would have helped but doctors in south Texas, where most of these people were from, had no way to identify those who had received epidural anesthesia in Mexico and were most at risk.  Public service announcements brought some people in for treatment, but for many the realization that they were very sick came too late.

In addition to the risk that you will receive a medication purchased on the black market or that a needle or other instrument used in your procedure will be contaminated, there are many other risks associated with medical procedure in foreign countries even under the best of circumstances.  Here is a post from last year on some of the other risks of medical tourism in Mexico.

An epidemiologist with the CDC recommends that, if you do go to a foreign country and have a medical procedure there, be sure to tell someone on your return so that, if you fall ill, doctors will have a head start in trying to figure out what is wrong with you.

Posted in antibiotic resistant bacteria, blood infections, Doctors, Health Care Costs, Medical Costs, Medical Devices, medical errors, meningitis, Pharmacies, Plastic Surgery, science news |

Doctors Who Steal

February 12, 2024

I have been writing lately about medical ethics, which are sometimes more ignored than followed.  The following are instances of doctors being greedy and trying to steal from insurance companies or from Medicare and Medicaid.  It doesn’t matter who you are or what you earn or what is your level of education.  Money can be tempting and some doctors, for a variety of reasons, find the temptation to be irresistible.  And remember, this is only the tip of the iceberg.

Former 'Planet Money' co-host Jacob Goldstein talks about inflation and the Fed : NPR

  • A Michigan doctor has been charged in a scheme along with a pharmacist to create fake prescriptions for specialty drugs that could be diverted and sold.  The scheme allegedly netted the participants over $7,000,000.
  • Telemedicine doctors in the Pittsburgh area were involved in a kickback scheme in which they were paid for ordering cheek swabs that were processed at the laboratory of the scheme organizer.  Medicare was billed over $60,000,000 for the unnecessary tests.
  • A Maryland doctor was convicted of defrauding Medicare and health insurers by submitting false claims for over $15,000,000 for Covid testing at laboratories he owned.
  • A Tennessee doctor was convicted of prescribing narcotic drugs that he knew his patients did not need for medical purposes and in spite of signs that they were addicted.  He was put on probation by the medical board for overprescribing narcotics, but as soon as his probation was lifted, he resumed overprescribing.
  • A suburban Chicago doctor has agreed to pay Medicare over $750,000 in restitution as part of a settlement of a civil action against him for illegal billing practices.   When he removed multiple moles from a single patient on a single office visit, he would bill Medicare for each mole and represent that each was removed on a different day.
  • Doctors from Missouri and Texas have agreed to pay the Federal Government for accepting over $525,000 in kickbacks from laboratories to order testing to be performed at the labs.  They have also agreed to cooperate in the prosecution of others involved in the scheme.
  • A Kansas chiropractor has pleaded guilty to money laundering in connection with the government’s Covid loan programs.
  • A Chicago area pain doctor pleaded guilty to Medicare fraud and has been sentenced to prison.  She signed prescriptions for narcotics to be given to her patients when she was not in the office and had not examined them.  Upon her return to the office, she billed Medicare for the examinations that never took place.
  • A dermatologist who operates clinics in southeast Tennessee and north Georgia has agreed to pay the government $6,600,000 to resolve claims that he committed Medicare fraud by falsely claiming procedures performed on a single day were performed on multiple days, and charging for multiple office visits that never occurred.

This list can go on and on for pages and pages.  The dollars involved are astronomical.  The point of this post is simply to remind everyone that doctors are human beings like the rest of us.  They are subject to the same temptations and have the same frailties as the rest of us.  You should keep this in mind when dealing with doctors.  Just because a doctor says it does not make it true.  Be trusting, but not too trusting.  Use your common sense.  Get a second opinion before agreeing to any major surgical or other type of procedure.

 

Posted in Doctors, Fee for Service, Health Care Costs, Health Insurers, Medical Costs, medical ethics, Medicare, Pharmacies |