Medical Malpractice News and Views


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

What Makes a Good Medical Malpractice Lawyer?

November 08, 2018

Based on Arizona’s population and the number of deaths nationally due to medical error, almost 5,500 Arizonans die due to medical error each year.  The number of Arizonans injured but not killed by medical malpractice is many multiples of the number of dead.  Certainly, over 100,000 Arizonans are injured by medical malpractice in any given year.  While very few of the victims or their families choose to sue, the number of well-qualified medical malpractice lawyers is way too small to provide good representation to all those who want to make a claim.  The result is that many victims of medical malpractice find themselves represented by a lawyer who talks a big game but has little or no experience.  This can lead to some people being victimized a second time, often with tragic results.  Don’t let this happen to you.

If you have looked at my biography, you have seen that when I began representing clients in medical malpractice cases almost 40 years ago, I started out representing doctors and hospitals.  When one of my clients was sued by a good medical malpractice lawyer, it was immediately obvious.  The case ran hard and smooth.  The lawyer knew what he or she was doing and usually got the best possible result for the injured client.  They didn’t always win but they fought hard and fair and did the best that could be done for the client.

By contrast, some of my cases involved lawyers who claimed to be medical malpractice lawyers but who would have had a hard time doing a good job on even a simple automobile case.  The complexities of a medical malpractice case left them flailing around in the dark.  They would miss deadlines.  Their expert witnesses were often not very expert.  They did not know how to effectively cross-examine my experts.  They misevaluated cases and took cases that had no merit.  They usually lost and almost never got the best result for their client.

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I remember one case in particular because it was so tragic.  I represented an emergency room doctor.  The plaintiffs had brought their young son to her emergency department because he was very sick.  Although they did not know it, by the time they arrived at the emergency department, their son’s lungs were being reduced to shreds by a virulent infection that had overwhelmed his immune system.  He was only a few hours from death.  My doctor did the very best any human being could do to save this little boy but it was never going to be enough and he died.  As sad and tragic as the little boy’s death was, the parents were victimized a second time – this time by a lawyer.

The lawyer convinced the parents that their son had died needlessly and that, had my client just done some things differently, their son would still be alive.  As the case went on, it fell apart, as it was always going to do.  Their expert had to concede the terrible nature of the little boy’s infection and the strong likelihood that he was going to die regardless of the treatment my client gave him.  The parents had to drop the case and walk away.  I felt very bad for them.  They perhaps could have found some peace in the belief that God had called their child home.  Instead, they walked away believing their son had died needlessly and that the legal system had failed them.  No parent should have to go through that.

There are probably not more than 30 well-qualified lawyers representing patients in medical malpractice cases in the state of Arizona.  Contrast that number with the number of attorneys who claim to be experts in medical malpractice as well as experts in divorce, bankruptcy, corporate formation and you name it.  If there is an area of the law, they are experts in it.  No single human being has the time to be an expert in multiple areas of the law.  Medical malpractice cases are as complicated as the medical issues they involve.  You need and deserve a specialist in medical malpractice.

A good medical malpractice lawyer must first be a good trial lawyer and those are few and far between to start.   He or she must understand medicine and be able to read medical records.  He must be able to locate and retain highly qualified experts in whatever area of medicine is at issue in the case.  She must be able to identify cases that are not going to end well for the client.  Due to inequities built into the system by politicians and the medical profession, only the most egregious cases have a chance of succeeding.  A good malpractice lawyer must be able to separate those cases from other cases which might involve malpractice but will not be able to succeed for a variety of reasons.

Should the time come for you to find a medical malpractice lawyer for yourself or a family member, take the time to carefully examine the credentials and experience of the lawyers who would like to represent you.  Meet with them.  You will get a free meeting with any reputable malpractice lawyer.  Ask questions about his or her cases and experience.  Choose wisely.  Don’t be a victim a second time.

 

 

Posted in Doctors, Finding a Medical Malpractice Lawyer, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical malpractice lawsuits, medical malpractice lawyers, medical mistakes, Medical Negligence, medical negligence lawyers, plaintiff |

What To Do When You Have Been The Victim of Malpractice.

November 05, 2018

On your own.  The first thing to know about being the victim of malpractice is that you are going to have to figure it out on your own.  It is highly unlikely that anyone will tell you about the malpractice.  To the contrary, whenever something really bad happens, the health care providers either don’t talk about its cause or say they don’t know what happened, even when they all know someone made a mistake.

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Ask questions.  If something bad happens to you or a loved one while you are under medical care, you need to ask the doctors and nurses what happened and why.  Be persistent in your questioning.  Don’t take “We don’t know” for an answer, even though sometimes that is all they will tell you.  Other times it may be obvious that something went wrong.  When that happens, the patient will often be told that it was just one of those unavoidable things that happen from time to time.

Be a little skeptical.  Whatever you are told, take it with a grain of salt.  Just because you are given an innocuous explanation does not mean that no one made a mistake.  Go on the internet.  The internet is the best tool available to level the playing field between the public and the medical profession. Read what you can about your condition and what may be the causes of whatever has happened to you.

Look at your medical records.  Once you are out of the hospital or once the dust has settled over whatever happened to you, give consideration to looking at your medical records.  You are entitled to see your records and to be given copies of them.  Be aware, however, that when you ask for a copy of your records, the doctor or hospital may ask why and, if it is a doctor, it may affect your relationship with the doctor.

Talk to someone.  When you have gone as far as you can on your own and you still have questions or concerns, the next step is to speak with someone who has more knowledge than you.  This may be a neighbor or friend who works in the medical profession.  It may be a lawyer who specializes in medical malpractice cases.

To sue or not to sue.  After you have asked all the questions and done all the research, you may still be unhappy about what happened to you.  Every injury is significant to the person to whom it happens.  Unfortunately, in our current climate, juries have a hard time finding against doctors and hospitals when the injury is not a permanent one that causes a big change in the life of the victim.  Doctors and hospitals win 9 out of every 10 cases tried in Maricopa County.  This means that only those with the most severe injuries and the clearest evidence of malpractice are likely to be able to convince a jury to find in their favor.  This is sad but true and it means that many victims of malpractice are left without justice.  Even if you can bring suit, you need to ask yourself if you are willing to put up with the stress and strain that a malpractice suit always entails.  Are you ready for a jury to tell you that the doctor or hospital did nothing wrong?  In my experience, true healing cannot begin until lawsuits are over.  It may be best to just turn the page, accept that you have been wronged and move on with your life.  This is a difficult decision that can only be made by the person who has been harmed.  The answer will be different for each such person.  I hope you never find yourself having to make this decision.

 

Posted in disclosure of medical mistakes, Doctors, Hospital Negligence, Hospitals, Lawsuits, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice lawyers, medical mistakes, Medical Negligence, Secrecy |

Lots of Malpractice – Be Careful Out There.

October 29, 2018

Regardless of what the medical profession would have you believe, there is a lot of medical malpractice out there.  Many patients are victims but few end up suing.  Most just choose to walk away.  Many more were never told that they were the victims of malpractice and never had a chance to decide whether to make a claim or not.

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Most malpractice is the result of a health care professional just making a mistake while trying to do the right thing.  On the other hand, some malpractice is the result of a health care professional, usually a doctor, trying to cut corners and make a quick buck.  You need to watch out for both.  Let me talk about some recent examples of cutting corners to make that quick buck.

A California doctor was sentenced to six months in jail for defrauding his patients and their insurance companies.  He was buying unapproved IUD’s on the internet and implanting them in his patients.  He told the patients and their insurers that the IUD’s were FDA approved and billed accordingly.

A California man, who was not a doctor, claimed that he was and was arrested when authorities caught him administering injections out of his house.  Although the news article did not say what was in the injections, you can probably draw some conclusions from the fact that there were ten people lined up at his door when the police came to arrest him.  Note to self, always check the credentials of any “doctor” before allowing him or her to provide medical care.

Closer to home, a number of Arizona doctors apparently conspired with a drug manufacturer to administer its artificial painkiller, which was approved only for use in terminal cancer patients, to patients who did not have cancer and were not supposed to be receiving the drug.  The drug is highly addictive and for that reason was limited to terminally ill patients with extreme pain.  The Arizona doctors were paid to administer the painkiller and phony up their records to make it look like the patients were in the approved group.  It appears that the drug manufacturer paid doctors nationwide a total of $14M to prescribe its painkiller.

A Colorado doctor deliberately diagnosed patients as having Multiple Sclerosis when they did not.  He ordered expensive infusion therapy to treat the MS and made lots of money administering the infusions and testing the progress of the patients after each infusion session.

A Detroit oncologist deliberately diagnosed patients with cancer when he knew they did not have cancer.  Like the Colorado doctor, he made a lot of money treating the non-existent cancer in his patients.

In New Jersey, doctors have been convicted and sentenced for taking kickbacks to send blood tests to a particular lab for processing.  While this might not seem like such a big deal to the patient who just wants his or her blood test properly processed, many of these patients may not have needed the testing at all.  The doctor may have ordered the test just to get the kickback.

A New York doctor plead guilty to manslaughter in the death of a patient on whom he had performed a uterine procedure in his office.  During the course of the procedure, he damaged an artery and the patient began to bleed profusely.  He tried to repair the artery but could not.  Instead of calling 911 to take the patient to the hospital to address the bleeding, he sent her home with her sister so he could see the other patients waiting in his office.

There is a lot of money to be made in the practice of medicine and sometimes it tempts health care providers to do the wrong thing.  Be careful out there.  Try not to let it happen to you.

Posted in disclosure of medical mistakes, Doctors, drug companies, Fee for Service, Fraud, Health Care Costs, Lawsuits, Medical Costs, Medical Devices, medical errors, medical ethics, Medical Malpractice, medical mistakes, Medical Negligence, Misdiagnosis, Secrecy, Surgical Errors |

The Hospital You Choose Makes a Difference.

October 24, 2018

Just a few days ago I wrote a post about hospital malpractice.  Today comes news of a viral outbreak at a New Jersey pediatric center that has already killed six children and sickened many more.  The facility is not a general hospital but a long-term care facility for children, some of whom may be as old as 18.  Authorities in New Jersey are trying to determine why the viral outbreak occurred and, until they get everything under control, have prohibited the facility from accepting new patients.

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Significantly, the long-term care facility in question has only two stars out of five on the ratings given to facilities by Medicare and Medicaid.  A rating in this range suggests, at least to me, that there are problems at the institution and that parents should be wary about sending their children there for long-term care.  That said, I don’t know if there are any reasonable alternatives for specialized, long-term pediatric care in this area of New Jersey.  This may be the only option for some parents.  The state of New Jersey ought to have been investigating this facility before six children died to determine why its rating is as low as it is.

When the time comes for you or your children to go to a facility, be it a hospital, nursing home, rehabilitation facility, or a long-term care facility, use the tools available to you and ask yourself if this is the kind of place you want to stay.  Don’t entrust your health or that of your family to a facility with low ratings.  You are just asking for trouble.  Malpractice occurs even at highly rated facilities.  It occurs more often at facilities that do poorly on the ratings.

Posted in Hospital Negligence, Hospitals, Infection, Medical Malpractice, medical mistakes, Medical Negligence, Medicare |

Protecting Yourself From Hospital Malpractice.

October 22, 2018

If you spend more than a few days in the hospital, you are likely to become the victim of hospital malpractice.  Modern hospital medicine is so incredibly complicated, it is news if there is no mistake made in your care.  Hospital malpractice may come in many forms but the most common form is a medication error.  The good news is that most of the time medication errors do not result in a serious injury.

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Medication errors occur with alarming frequency.  Common medication errors are wrong medication, wrong time, wrong patient, wrong dose, wrong method of administration, failure to administer, and failure to consider allergies.  Depending on the magnitude of the error, the results can be anything from trivial to fatal.  One of the first malpractice cases I worked on as a young lawyer involved the administration of a medication to an infant.  The decimal point in the order was in the wrong place and no one noticed.  The little boy was given a dose 100 times stronger than was intended.  He was permanently brain damaged as a result.

A study which was published in a prestigious medical journal attempted to determine just how frequent medication errors were.  The researchers selected 36 hospitals in Georgia and Colorado.  The institutions fell into three categories, hospitals that had been certified by the Joint Commission of Accreditation of Health Care Organizations, hospitals that had not been accredited, and skilled nursing facilities.  The researchers monitored medication passes by the nurses for up to four days.  When an error was found, a panel of physicians determined the clinical significance of the error.  Errors were common.

In the 36 institutions, almost one in every five medications was dispensed incorrectly.  The most common errors were among the usual suspects: wrong time, failure to administer, and wrong dose.   The panel of physicians determined that 7% of the medication errors were potentially harmful.  This works out to 40 per day in a typical 300 bed institution.  That is a lot of potentially harmful errors.

So what can you do to protect yourself from becoming the victim of a medication error?  The first thing is to make a list of your medications and the correct dosage.  Ask nurses to let you know if the doctor prescribes a new medication or orders that you stop taking one of your current medications.  If a new medication is ordered, ask whether it conflicts with any of your current medications.  If a  medication is stopped, ask why it was stopped and what has been done to replace it.  Keep your medication list updated with this information.

Be sure you know to what medications you are allergic.  If you have a serious allergy, be sure to ask the nurse if that allergy is reflected on your chart.

Whenever a nurse comes into your room to administer a medication, make sure the nurse is actually coming to see you.  Have the nurse state your name in full.

Have the nurse identify the medication and the dosage.  Check it against your list.  Do not take any medications not on your list or in different quantities or strengths than on your list.  This can be a problem as nurses may be insistent that this is indeed a medication or dose you were taking at home when you know it is not.

Is this the right time for your medication?  Was another nurse just in here with your medication?  Where is your medication?  If the nurse has not come with a medication you know you should be taking, ask where it is.

Have a friend or a loved one with you to help with the medications as often you will be too drowsy or impaired to know whether the nurse is giving you the right medication or not.

You have the right to refuse a medication.  Don’t hesitate to ask questions.  Don’t hesitate to ask for a supervisor, if you have questions that remain unanswered.

There is much in a hospital that happens out of sight of the patient.  No matter how many questions you ask of a nurse, you can’t be sure that the doctor did not make a mistake in ordering a new medication for you or in stopping one of your current medications.  That is not something the nurse can address no matter how careful he or she may be.  These suggestions will improve your chances of getting out of the hospital without a serious medication created problem.  Good luck.

 

Posted in Doctors, Hospital Negligence, Hospitals, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, Medication Errors, Nurses, Pharmacies, Pharmacy Malpractice |

Arkansas Supreme Court Tosses Out “Tort Reform” Ballot Measure.

October 19, 2018

The business and medical communities have been busy over the years pushing laws they claim will end a flood of frivolous lawsuits and unleash a wave of economic growth.  Most of these laws have been aimed primarily at medical malpractice cases.  A feature common to all these laws is a cap on the amount of non-economic damages an injured patient or her family can recover.  They may have other provisions as well which further restrict the power of the jury to fully compensate the patient or to limit the amount of money the patient can pay an attorney to represent her.  When the state constitution stands in the way of these laws, as it does in Arizona, they try to get the constitution amended to take away the right of the citizens to be fully compensated when they are injured by medical negligence.  Arkansas is the latest state where these deep pockets have attempted to get rid of constitutional provisions protecting injured persons.  The Arkansas Supreme Court yesterday ruled the ballot measure that would have amended the state constitution to itself be unconstitutional.

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I have to give these interests their due.  They have been incredibly effective in convincing the public that the civil justice system is broken, that juries give away too much money and, on top of that, give it to people who don’t deserve it.  These carefully cultivated attitudes on the part of the public extend to all kinds of cases in which an individual has been harmed by negligence and comes to court seeking compensation but are particularly pronounced when it comes to malpractice cases.  The effect of these attitudes shows up in the number of cases where the jury either returns a verdict for the defendant or awards only a small amount to the injured person.

The business and medical interests are helped by the fact that these cases in which someone is sent home with nothing or very little are never the ones that make the headlines.  Only the rare case in which there has been a large award makes the news.  When the public only hears about large verdicts against doctors or hospitals, they can be forgiven for thinking those verdicts are the norm.

The business and medical interests count on the gullibility of the public.  They count on the public not to do any fact checking and to simply accept the proposition that frivolous lawsuits are flooding the courts and driving doctors out of the profession.  That reliance is critical because, were members of the public to look at the facts, they would see that there is no truth to these claims.

There is no flood of frivolous malpractice lawsuits in Arizona or pretty much any other state.  In a study which appeared in the Journal of the American Medical Association (JAMA), the authors found that between 1992 and 2014, the rate of paid claims against doctors fell by over 50%.  That is a huge drop over a period when the public was being told that claims were rising sharply.

The ballot measure the Arkansas Supreme Court tossed would also have limited the amount of fees an injured patient could pay a lawyer to represent them.  When these limitations are pushed, they are always described as a patient protection measure to prevent patients from being taken advantage of by unscrupulous lawyers.  In fact their real purpose is to further limit the number of people who have cases which are large enough to bring to court by making their cases so unattractive that no qualified lawyer can take them.  Of course there is no limit on the amount a hospital or doctor can pay their lawyers, only a limit on what patients can pay.  When there is a limit on the percentage a lawyer can be paid, the value of the patient’s claim must be that much larger in order for a qualified lawyer to be able to receive a fee that reflects the risks she takes when accepting one of these cases.  If your case is not big enough, no matter how clear the negligence of the doctor or hospital that injured you, you can’t get a lawyer and you can’t get justice.

Kudos to the Arkansas Supreme Court for tossing this ballot measure.   May other supreme courts have the nerve to protect patients in their states and declare their similar laws to be unconstitutional.

Posted in Doctors, Finding a Medical Malpractice Lawyer, Hospital Negligence, Hospitals, Malpractice caps, Malpractice costs, Medical Costs, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical malpractice damages caps, medical malpractice lawsuits, medical malpractice lawyers, medical mistakes, Medical Negligence, plaintiff, tort reform, Verdicts |

I’ll Take Lobbying for $2 Billion, Alex.

October 15, 2018

The answer is, “They spent $2.3 billion on lobbying over the last 20 years.”  If you answered, “What is the pharmaceutical lobby?,” you won.  Actually, you didn’t win.  You lost because all that drug money flowing into Washington did exactly what it was intended to do: keep drug prices in the United States higher than anywhere else in the world.

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Examples of drug company disregard for fairness or for common decency are found in the news on a daily basis.  A drug company in 2015 gained control of a 62-year-old drug for treating parasitic infections and promptly raised the price from $13.50 per pill to $750.  That is an increase of 5,450%.  Another drug company purchased the patent on an important drug for treating drug-resistant tuberculosis and raised the price for 30 pills from $500 to $10,800, a 2,000% increase.  Even generic drugs are not immune from this behavior.  Still another drug company bought the right to produce two generic heart drugs.  This company was much more considerate of the public good as it only raised the prices of these generic medicines by 535% and 212%.  With generic drugs there can be no argument that the company is just trying to recoup the costs of development.  The only justification for raising prices like this is greed.

As I noted last week in the context of life-saving insulin, these high prices often prevent Americans from getting the medications they need.  A recent survey by the Kaiser Family Foundation found that 20% of Americans have difficulty affording their prescriptions and 24% have failed to fill a prescription, cut pills in half or skipped doses to try and save money.

One of the reasons drugs for older Americans cost so much is that Congress, that is your United States Congress, has passed a law forbidding Medicare from negotiating price cuts from the pharmaceutical industry.  That lobbying money was well-spent.  It would have been a bargain had they spent twice as much.

The New York Times just reported that there is a new drug for treating HIV.  If taken, the drug keeps the HIV from making the patient sick and keeps the HIV from spreading to others who might come into sexual contact with the patient.  These are important things.  The drug costs $75 a year in Africa.  Essentially the same drug costs $39,000 a year in the United States.  There are some predictable results.  Fewer that half of the HIV patients living in the United States take medications which keep their HIV under control and non-contagious.  This is a lower percentage than in Zimbabwe, Kenya and Malawi.  What is going on when African states, which are much poorer than we, do a better job of keeping their citizens alive and healthy than we do?

Stop being played for suckers and do something, people.

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

Big Pharma and You.

October 08, 2018

Forgive me for getting on my insulin soapbox again.  Because of my young grandson’s Type 1 diabetes, I am very interested in all things Type 1 related.  I am especially interested in what it takes to keep him alive.  Every day he has his blood tested multiple times.  He needs alcohol wipes, test strips and lancets for the blood tests.  He wears a glucose monitor, which must be changed out every few days.  He wears an infusion pump.  The pump has an infusion site which needs to be changed out every few days.  He needs insulin to fill the pump.  He needs glucagon for emergencies when he goes really low.  He needs juice boxes and glucose pills for when he just goes a little low.

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All in all, it costs over $25,000 per year in diabetes supplies to keep my grandson alive.  Here is a blog post by a woman (God bless her) with two Type 1 children.  One of her children costs about $40,000 per year to keep alive while the other is a relative bargain at only about $30,000 per year.

About $1,000 a month of the costs for a Type 1 diabetic is for insulin alone.  Without regular insulin injections, a Type 1 diabetic will die.  If he or she skimps on insulin because she wants to buy food, the resultant high blood sugars will likely cause blindness, nerve damage, possible amputations, heart disease, kidney disease and the list goes on and on.  When the effects of uncontrolled diabetes get really bad, we taxpayers pick up the tab for treating the patient.

There are only a few insulin makers in the world.  In the United States, they are allowed to charge what the market will bear.  Here is a story about “Jane” who illegally buys her insulin from Canada.  In the United States, her insulin costs $450 for a 10 ml vial.  She needs about 6 vials a month to stay alive.  When she buys illegally from Canada, the cost is $21 per vial.  We pay more for insulin and other life-saving drugs than any other country in the world.  Why do our elected leaders allow this disgrace to continue?  Well, the obvious answer is money in the form of campaign donations and lobbying efforts.

On a regular basis the big pharmaceutical companies that manufacture insulin change the formulation of the product.  The “new and improved” insulin is priced higher than the “old” insulin.  The manufacturers then stop producing the “old” insulin.  There is simply no way to know whether the cost increases associated with the “new and improved” insulin are justified or whether diabetics would be better off with the old formulation at a more affordable price.  This issue is a common one as Big Pharma rolls out new formulations of many medications for which they can obtain patent protection.  Setting aside the fact that we are charged more than anyone else in the world, are we being sold a bill of goods when we are told that what we are now getting is “new and improved?”

People should not die because they don’t have health insurance.  People should not die in the greatest country in the world because they cannot afford the insulin necessary to keep them alive.  Big Pharma should not be able to raise prices ever higher for life-saving medicines that are available more cheaply everywhere else in the world.  It is no coincidence that as the cost of insulin has gone up hundreds of percent, the profits of the large drug companies that manufacture it and the related products that keep diabetics alive have gone up by hundreds of percent as well.

Tell your Congressperson and Senators that enough is enough.  It is time to force Big Pharma to treat Americans at least as well as they treat everyone else in the world.

 

Posted in drug companies, General Health, Health Care Costs, Health Insurers, Medical Costs, Medical Devices, Type 1 Diabetes |

Power Morcellators Revisited

October 01, 2018

I have written in the past about power morcellators and the harm they have caused patients.  I have links here, here and here.  Despite their risks, power morcellators continue to be used by surgeons for minimally invasive gynecological surgery.  In this post, I will discuss some of the pros and cons of their use and why they continue to be used despite the risks they pose.

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Let’s start with the reason power morcellators were developed in the first place.  In the old days, uterine surgery meant an open laparotomy.  The surgeon had to cut open the uterus and operate under direct vision; there was no other way.  Then came minimally invasive surgery or laparoscopy.  In minimally invasive uterine surgery, a hole or holes are made in the abdomen and instruments are inserted into the uterine cavity.  Gas is used to inflate the cavity.  A camera is inserted as well and the surgeon manipulates the instruments in the cavity to perform the procedure.  Minimally invasive surgery has a number of advantages over an open laparotomy.  Among other things it is less traumatic for the patient, the recovery time is less, there is less scarring and fewer complications.

Sometimes the uterine procedure involves the removal of tissue, such as uterine fibroids.  Often this tissue is too large to be removed through the small openings being used for the laparoscopy.  One solution is to cut the tissue into pieces small enough to be removed through the holes.  This is time consuming and often difficult.  This is the problem power morcellators were designed to solve.  The tip of the morcellator is inserted into one of the holes and a blade is slid out from the tip.  The blade spins and chews up the tissue much the way a blender does.  Then the uterus is washed out and the chewed up tissue comes out with the irrigation fluid.

Normally, all this goes well.  The problem arises when the patient has unknown uterine cancer.  One or more of the uterine fibroids may be cancerous, for example.  The process of chewing up the cancerous tissue spreads it throughout the abdominal cavity and makes a bad situation much worse.  Doctors say the cancer has been upstaged.  In other words, the staging of the cancer just got worse.

Morcellators were used for many years before the problem of cancer spreading gained enough attention that the FDA took action.  The FDA issued a directive that all power morcellators have a prominent warning on them about the risk of spreading cancer.  The warning stated that the use of a power morcellator was contraindicated in women who had suspected uterine cancer and in older women, who were more at risk for uterine cancers.  The FDA also directed that women undergoing procedures in which power morcellators were to be used be advised of the risks associated with their use.  Following the FDA’s action, the use of power morcellators fell but many surgeons continued to use them.  The controversy continues.

In defense of the power morcellator, the manufacturers and the surgeons who use them argue that the incidence of unknown uterine cancers in younger women of childbearing age is very low.  Accordingly, the risk that cancer will be spread is very low.  They also argue that just the process of entering the uterus creates a risk of spreading any cancerous cells which might be present, even if a power morcellator is not used.  Lastly, they point out that returning to open laparotomies will expose women to more risks than do power morcellators.  They argue that more women will be injured by the use of open laparotomies than would ever be injured through the use of a power morcellator.

A number of surgeons and companies have tried to reduce the risk of power morcellation by designing bags which can be inserted through one of the operative openings into the uterine cavity.  The surgeon places the uterine tissue in the bag and introduces the morcellator into the bag to chew up the tissue.  In theory, the use of the bag keeps the pieces of potentially cancerous tissue contained and the bag is then removed through one of the holes being used for the procedure.  It is still not clear exactly how effective the use of these containers is in keeping any unknown cancer from spreading.

It looks as though this issue will continue to inspire discussion and attempts to prevent the spread of unknown cancers.  For those of you who are undergoing a laparoscopic uterine procedure, make sure you discuss with your surgeon whether he or she intends to use power morcellation and what are the risks and benefits as they apply to your particular situation.  As always, be an informed consumer and good luck.

 

 

 

Posted in Cancer, Doctors, hysterectomy, Informed Consent, Medical Devices, medical ethics, Medical Malpractice, medical research, Power Morcellators |

Secret Conflicts of Interest

September 24, 2018

By now I am sure it is common knowledge that doctors are often paid by drug companies and by the manufacturers of medical devices.  There is a strong correlation between the amount of a company’s drugs a doctor prescribes and the amount he or she receives from the drug company.  The more you prescribe, the more you usually get paid.  Similarly, those who use the most devices from a manufacturer receive the most payments.  Doctors typically feel no great urgency to inform their patients that they may be receiving what some would call a “kickback” for prescribing a medicine or a device for the patient.  These payments raise questions of medical secrecy, ethics and conflicts of interest.

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Similar issues arise when a doctor writes an article for a medical journal.  These articles are used to announce medical advances, medical discoveries, and the results of studies.  They are an important source of information for doctors about news which may affect their practices and their patients.  Virtually all medical journals require that authors disclose any conflicts of interest they may have so that readers can take those potential conflicts into account in assessing the weight to give to the article.  Turns out many authors do not disclose their conflicts.

In a recent article in the online version of JAMA Surgery, a team of researchers compared public data about drug company and device manufacturer payments with conflict disclosures in articles written by doctors who had received these payments.  The researchers identified the top 100 recipients of payments, looked for articles they had written in medical journals and then checked to see if their payments had been disclosed.  They discovered that the payments were reported only about 1/3 of the time.

The payments in question were not small.  For calendar year 2015, the top 100 recipients received a total of almost $12,500,000.  The average payments received by each of them was $95,000.

The researchers hypothesized that the failure to disclose may have resulted from a conclusion by the author that the payments did not create a conflict of interest for the article in question.  Of course, the authors may have been wrong about the existence of a conflict or may simply not have wanted the payments to be disclosed.  Better that all payments be disclosed and let the readers decide if there is a conflict or not.  For that reason, the researchers propose a uniform conflict policy for all medical journals regardless of whether the author believes the payments to be relevant to the article or not.

Over and over again we see the pernicious effects of secrecy and lack of transparency in all aspects of the delivery of medical care.  Malpractice is hidden; bad doctors are hidden; costs of medical treatment are hidden.  One thing that is certain is that secrecy and lack of transparency do not benefit patients or the community as a whole.  Secrecy is used to make it harder for patients and others to know what is going on and to make decisions accordingly.  As long as hospitals and doctors run the system, there will be little change.

 

Posted in disclosure of medical mistakes, Doctors, drug companies, Health Care Costs, Hospital Negligence, Hospitals, Medical Devices, medical errors, medical ethics, Medical Malpractice, medical mistakes, Medical Negligence, medical research, science news, Secrecy |