Medical Malpractice News and Views


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

Technology Comes For The Humble Stethoscope.

August 12, 2019

Two hundred years ago, a Frenchman invented a tube with which he could listen to heart and lung sounds.  This was the first stethoscope.  Heart disease is one of the major causes of death throughout the world.  Often the abnormalities that are part of heart disease make sounds that give them away to a trained listener using a stethoscope.  Among the defects which can sometimes be heard through use of a stethoscope are diseased heart valves, certain heart arrhythmias, congestive heart failure, hypertensive disease, some structural heart disease.  Much of the effectiveness of the stethoscope depends, however, on its use in a quiet environment and the skill of the health care provider doing the listening.  Technology promises to change all of that and make the stethoscope a more effective tool for detecting disease and identifying treatments.

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There is no shortage of ideas about how to improve the stethoscope by taking advantage of today’s technology.  Start ups are incorporating artificial intelligence, algorithms, visual displays, recording devices, and direct internet connections.  If you can think of it, so have they and long before you did.  For the sake of simplicity, let’s call these new devices “digital stethoscopes.”

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First and foremost, the various digital stethoscopes convert sound into electronic signals which can be amplified to a comfortable level.  This lessens the need for a quiet room which is necessary to hear the soft sounds often required for diagnosis.  Some of the digital stethoscopes also use noise cancelling technology.

In programming the digital stethoscope, manufacturers can take advantage of large data sets of patients with heart or lung disease and the sounds associated with those conditions.  They can also receive and make a record of the electrical signals of the heart in the same way that an EKG does.  In some very promising studies, the digital stethoscopes were able to diagnose heart and lung problems with greater accuracy than even highly experienced cardiologists and pulmonologists.  In one study conducted by a manufacturer, it reported that its digital stethoscope recognized heart murmurs in children more often than five trained pediatric cardiologists using stethoscopes.

One of the advantage of the digital stethoscope is that it can “hear” sounds that are outside the ability of the human ear to recognize.  These are important sounds which cannot be heard by even the most talented and skillful human examiner using a traditional stethoscope.  These previously unheard sounds will open new avenues for diagnosis.

In some cases, the new digital stethoscopes were able to detect pre-cursor sounds that indicated a problem was developing that could not be detected yet with other testing.  Many of the stethoscopes allow their results can be stored and shared among physicians.  Even the Apple watch now has a feature that can record and recognize some abnormal heart rhythms.

Digital stethoscopes are going to be part of the telemedicine revolution.  They will allow health care providers in low resource areas to use algorithms for diagnosis and treatment.  They will allow the same providers to communicate and consult with specialists in high resource areas.  Even in high resource areas, they will lead to earlier and more accurate diagnoses which will lead to earlier and hopefully more successful treatment.

Next time the nurse practitioner tells you she wants to listen to your chest, she may be holding a digital stethoscope.  Count this as one of the good results of technology and take a deep breath for her.

 

 

Posted in Doctors, General Health, health, heart attack, Medical Costs, Medical Devices, medical errors, medical research, Misdiagnosis, science news |

Hospitals and the Weekend Effect

August 05, 2019

The weekend effect is a recognized phenomenon in the medical world.  You and I aren’t the only people who like to have some time off on the weekends.  So do doctors and nurses and the many other workers who are necessary to make modern hospitals run.  Oftentimes, it is the most senior, most experienced doctors, nurses and employees who get the time off.  Guess who that leaves minding the store on the weekend?

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Hospitals address this problem by slowing down on the weekends.  Generally speaking, elective procedures or admissions will not be scheduled for the weekend.  Urgent or emergency procedures or admissions have their own schedules and account for most of the weekend admissions at hospitals.  All of this has implications for you as a potential hospital patient.

First lesson to be learned from this is avoid being in the hospital on the weekend, if at all possible.  Holiday weekends are the worst in terms of the care received.  Weekend patients are likely to find lower staffing levels everywhere in the hospital.  Fewer scheduled patients means the hospital doesn’t need as many people there to care for them.  More staff may be in an on call situation, ready to come to the hospital, if called.  All this means that patients may not get the care they need as quickly as during the week when the full staff is present and ready to go.  The Weekend Effect has been linked to a higher risk of death, a higher rate of infection and higher rates of significant bleeding.

In one study the Weekend Effect was examined in the context of pediatric surgery.  The researchers found that children undergoing surgical procedures on the weekend had a higher risk of death, of requiring a transfusion and of other procedural complications than children undergoing the same procedures during the week.

The second lesson is that, whenever possible, get your procedure or admission scheduled earlier in the week.  This will reduce the chance that you will find yourself still in the hospital on the weekend.  It also means that you arrive before the hospital gets filled up with patients.  The hospital gets filled up because it also wants its patients out the door before the weekend so it doesn’t have to keep so many people on duty caring for them.  The middle of the week is therefore the busiest time at most hospitals.  This has often been described as hospital gridlock when the services are overtaxed.  The busiest time is when things can go wrong as doctors and nurses have many demands on their time and tests and studies take a long time to accomplish.  A study also found increased mortality when patient turnover was high with transfers, admissions and discharges, presumably because these events took the nurses away from their duties caring for their patients.

We can’t control our need for urgent or emergent medical care but we can control when we go to the hospital for elective procedures.  When planning an elective procedure, select your doctor wisely using some of the guidelines I have discussed in other posts and try to get your procedure scheduled for Tuesday (best) or Monday.

Posted in Doctors, health, Hospital Negligence, Hospitals, Infection, medical errors, Nurses |

Improving Hospital Care

July 29, 2019

Anyone who has ever been a hospital patient or who has had a loved one in the hospital has seen errors in care.  They occur on almost a daily basis and they come in all shapes and sizes.  Modern medical care is complex and involves many participants.  Human nature being what it is, errors are certain to occur.  Our goal should be to keep errors to the smallest number possible.

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In a landmark study, To Err is Human: Building a Safer Health System, researchers at the Institute of Medicine estimated that between 44,000 and 98,000 patients die in hospitals in the United States each year as the result of preventable medical errors.  That is a shocking number.  While firm figures are naturally hard to come by, other studies have supported these general numbers.  Some have even concluded that these numbers greatly underestimate the magnitude of the problem.  Why are firm figures hard to come by?  The answer is that very few health care providers are willing to admit they made a mistake which caused patient injury, much less one which caused a patient death.

To their credit, most hospitals today are trying to improve patient care by reducing the number of errors.  They have created policies to avoid some of the most common errors.  For example, most hospitals insist on a “time out” just prior to the commencement of surgery to double check that they have the right patient, the right procedure and the right body part.  Another example is a system of checks to assure that providers wash their hands before every patient encounter.  Most hospitals also have Morbidity and Mortality conferences at which cases are discussed to try and learn from what happened.  While well-intentioned, these conferences don’t always work as well as they could.

The problem, of course, is that meaningful change and improvement cannot happen if everyone pretends that things are fine the way they are.  Things are not fine the way they are but health care providers have a great many reasons for keeping their errors hidden.

In the first place, no one enjoys admitting they made a serious mistake.  Admitting a mistake for a doctor can mean a loss of hospital privileges and a loss of privileges will almost certainly mean embarrassment and a loss of income.  Admitting a mistake can also lead to Medical Board discipline, which can range from a simple letter of concern to loss of one’s medical license.  Then, of course, admitting a mistake can lead to an expensive malpractice suit, even though such admissions are generally not admissible in the Arizona courts.

Progress is being made.  It is slow but steady.  On the other hand, medicine continues to become more complex and, while one avenue for error is being closed off, another one may be opening.  We all just have to keep trying.

 

Posted in Arizona Medical Board, disclosure of medical mistakes, Doctors, Hospital Negligence, Hospitals, Lawsuits, medical errors, medical ethics, Medical Malpractice, medical malpractice claims, medical mistakes, Medical Negligence, Nurses, Secrecy, Surgical Errors |

Settling The Wrongful Death Case

July 22, 2019

Most of the cases I handle involve significant and terrible injuries.  No case, however, involves more misery and sadness than a wrongful death case.

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I never get to meet the deceased person.  I meet the loved ones they left behind.  As part of my job, I try to bring the person back to life for the defendants and the insurance companies and, if necessary, for the jury.  No matter how hard I work, however, the best I or anyone can do is create a pale shadow of the person who has passed.  The deceased has left a hole in the lives of those who knew and loved her.

When the time comes to settle a wrongful death case, the family is forced to remember and, to a certain extent, relive the death of the loved one.  This makes it a difficult time.  However, it is important for the case to end because, in my experience, whatever healing the family will be able to do, they won’t really be able to begin the process until the case is over.

Before we sit down to try and settle the case, I have to help the family understand the process.  There are some important rules and considerations.  First and most importantly, the process is not about the value of the loved one’s life.  No one can place a value on the life of another.  That is impossible.  Valuing the life of the deceased is not what we do in the settlement process.  Instead, what both sides do is try to predict what a jury might do, if faced with the facts of our case.  We do this, not because we intend to try the case to a jury, but because that is where it goes if it cannot be settled.  We know it and the insurance company knows it.  The insurance company will not offer one dime more than it thinks a jury might award.  Part of my job is to analyze the strengths and weaknesses of our case and offer an assessment to my clients of what a jury is likely to do.

It is also important that my clients understand that they cannot let the settlement process be clouded by emotion.  This is understandably hard for them.  But the insurance company on the other side will not be letting itself be influenced by emotion.  It will be making cold, unemotional business decisions and the family must do the same or it will be at a disadvantage.

The insurance company has leverage that the family does not and the family needs to recognize this.  The insurance company has many cases and makes settlement decisions all the time.  The insurance company representatives are experienced professionals.  The insurance company can afford to make a mistake in this case.  If it does, it can make up for that mistake on the next five or ten or one hundred cases.  My clients, however, have only one case.  They cannot afford to make a mistake on their one and only case.

Almost every time we get into actual negotiations and the defense makes an offer, my clients will say, “But that is not enough.”  I agree that, whatever the defense offers, that amount is not enough.  It will never be “enough.”  There will never be enough money to bring back the deceased or undo what has been done.  On the other hand, asking whether an offer by the other side is “enough” is asking the wrong question.  The question should be, “How does the offer compare to what a jury might do?”

Valuing a wrongful death case is never easy.  There are many factors that must be considered, including how did the family members do at deposition, how egregious and clear was the conduct of the defendants, are there any skeletons in the closet of the deceased, how did the expert witnesses do at deposition, was there wage loss, what was the overall health of the deceased, and many others.  I also have to recognize that juries will sometimes do crazy things but most of the time juries will be in the same general ballpark.  There will usually be a range of numbers that the jury will most likely award, if they find for the family.  That range is what I call “the zone of reasonability.”  If an offer is made that is within that zone or close to it, it should be given serious consideration by the family.

The family needs to understand that in almost every case, there is a chance that the jury will find against them and for the defendants.  This is especially true in my medical malpractice wrongful death cases.  As bad as the death of the loved one was, it is devastating if the jury comes back in favor of the defendants.  It adds insult to injury.

No amount of preparation or advice by me can make the settlement of a wrongful death case easy for the family.  It is hard but, if the case can be settled, settlement is good for the family.

 

Posted in Lawsuits, Medical Malpractice, medical malpractice cases, medical malpractice claims, medical malpractice lawsuits, plaintiff, trial, Valuing Damages in Medical Malpractice Cases |

Malpractice Can Happen At Even The Best Hospitals

July 15, 2019

Two of the best hospitals in the United States made headlines in the bad way recently when they were called out for deaths following what should have been routine blood transfusions.  The two hospitals were the University of Texas MD Anderson Cancer Center in Houston and its neighbor across the street, Baylor St. Luke’s Medical Center.

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In both cases, the events were what are termed “never events,” that is they should never happen in the absence of a medical error.  That was true in both cases here as well: human error on the part of nurses who were caring for the patients cost them their lives.  As is so often the case, it was not just a failure on the part of an individual nurse but the failure of the system to have the checks and balances in place to make sure these errors never occur.

At MD Anderson, the young leukemia patient was getting a transfusion.  Unbeknownst to her or to the medical personnel, the blood she was given had become contaminated with bacteria.  This is a rare occurrence, but it does happen.  When it does, the patient’s vital signs will begin to deteriorate.  If the nurses administering the transfusion are monitoring the patient’s vital signs, there should be ample time to stop the transfusion and administer antibiotics before any permanent harm is done.  The nurses at MD Anderson were only checking the patient’s vital signs shortly after the start of the infusion and after the infusion was complete.  This meant that hours went by when no one was monitoring the patient.  The nurses testified they had not been trained to continue to monitor the patient.

When they were interviewed after the death, some of the nurses blamed the patient.  They stated that patients were instructed to report if they developed problems and if the patient did not, it was the patient’s fault.  It is scary when nurses expect patients to do their job for them and blame the patient when she is injured by poor nursing care.  Patients are not the best persons to recognize a developing medical complication.  They do not have the same training as the nurses and their illnesses may impair their ability to be completely aware of what is going on.

At Baylor St. Luke’s a patient was given the wrong blood type.  How can this happen you might well ask?  The patient had been brought to the emergency department and needed a transfusion.  When the doctor ordered the transfusion, one of the nurses picked up a vial of blood from an earlier patient and put this patient’s identification sticker on the vial.  Not only did she put it on the wrong vial, she put it on top of the identification sticker of the earlier patient.  The lab analyzed the blood in the vial, matched it and send matching blood to the emergency department.  Unfortunately, while the blood that was sent up matched the blood in the vial, it did not match that of the patient, who died shortly after being given the wrong blood.

These two sad stories remind us that medical malpractice is not as uncommon as the medical profession would like you to think it is and that it can and does occur at even the best hospitals.  In both of these cases, the deaths prompted a review of procedures and changes to training and checklists to make it much less likely that these mistakes will be repeated.  If there is a good thing that resulted from these unnecessary deaths, the improvements in procedures would be that good thing.  It is too bad that patients have to die before hospitals recognize that perhaps their procedures are not adequate or that perhaps their nurses need more training.

 

Posted in Hospital Negligence, Hospitals, medical errors, Medical Malpractice, medical mistakes, Medical Negligence, never events, Nurses |

2018 Malpractice Payments

July 08, 2019

The National Practitioner Data Bank (“NPDB”) was established by Congress in 1986 to be a repository of information about malpractice payments and matters affecting the privileges and licensing of physicians and other health care professionals.  All malpractice payments made on behalf of a health care provider must be reported to the NPDB.  Hospitals, medical boards, insurers and certain others can query the NPDB about health care professionals who are applying for privileges, licenses or insurance.  The public may not review the information kept by the NPDB, except in the most general terms.

What is the NPDB?

LeverageRx is a digital lending and insurance broker for medical professionals.  Every year it analyzes the reports that have been made to the NPDB and produces a report of its own.  Here is a link to its report for payments made in 2018.  The data are quite interesting.

There are a few caveats, however, to the data.  The first is that, as noted, it is based upon reports to the NPDB.  Not all malpractice settlements or judgments are required to be reported to the NPDB.  For example, if a nurse at a hospital makes a mistake that causes an injury and the hospital settles the claim, that settlement need not be reported to the NPDB.  This creates a significant limitation on the ability of the NPDB reports to accurately capture all of the malpractice payments being made in a given year.  Especially in cases involving the most serious injuries, a hospital often plays a role and, given its larger financial ability and insurance, may be making the largest payment of all of the defendants.  It is impossible to determine how many more payments were made that were not reported but the total amount of those payments is likely to be a very large figure.

Another limitation to keep in mind is the effect of insurance limits.  Probably the most common amount of coverage for an individual physician is $1 million.  Certainly, this is the case in Arizona.  Occasionally, if the doctor is a member of a group, there may be a second million but very often $1 million is it.  Since it is almost unheard of for a doctor to make a payment out of his or her personal funds to settle a case, the malpractice policy limit is the maximum that an injured patient will recover, regardless of the magnitude of the injury or the clarity of the malpractice.

Lastly, some states have caps on malpractice recoveries while some do not.  The data does not distinguish between those states with caps and those without.  The caps most often take the form of limiting the amount of non-economic damages (read pain and suffering) a patient can recover.  There is substantial controversy over the fairness of caps (since it is the most seriously injured patients who have their recoveries capped) and the effect of the caps in keeping down costs and payments.

Without further ado, here is the information on reported payments in 2018 with some comparisons going back to 2004.

The total number of payments has been declining since 2004.  There were over 16,000 payments in 2004 and only 11,584 last year.  After gradually declining for a number of years, the total dollars paid out has been gradually rising since 2012.  Last year it was just a little over $4 billion.  In 2004, it had been about $4.6 billion.  The gradual rise in payments is at least in part due to inflation in general and in the cost of medical care in particular.

Total payments in Arizona were on a par with its population.  Last year there were 225 payments totaling almost $84 million.  The average payment in Arizona was $372,397.  This was only slightly over the national average payment of $348,065.

Across the nation, 96.5% of all payments were made by way of settlement.  Only 3.5% were the result of a case that went to trial and resulted in a verdict in favor of the patient.  The data does not tell us how many cases went to trial or how many of those that did resulted in a verdict for the doctor but national statistics are that doctors win about 75% of the cases that go to trial.

The data confirm my experience that the most seriously injured patients are the ones getting paid.  29.7% of the cases arose out of a patient death.  Of those which involved living patients, just over 81% involved a permanent injury.  Of those permanent injuries, only a few were minor in nature.  Most of the permanent injuries which resulted in payments were brain injuries, quadriplegia or other injuries requiring life-long care, or other major or significant permanent injuries.  Not surprisingly, the injuries requiring life-long care were the ones with the highest average payment: $961,185.  The average payment for a death was $386,317.  The smallest payments went to the patients with injuries which were not permanent.

The data show what any experienced medical malpractice attorney will tell you:  These are difficult, expensive cases in which only the most seriously injured are likely to receive significant payments.  Even then, the payments are far less than what one would expect for the serious nature of the injuries involved.  The low numbers reflect the strong bargaining power of doctors in these cases who know they are likely to win if the patient does not take what is offered in settlement.

 

 

Posted in Doctors, Health Care Costs, Hospitals, Lawsuits, Malpractice caps, medical errors, Medical Malpractice, Medical Malpractice Case Value, medical malpractice cases, medical malpractice claims, medical malpractice damages caps, medical malpractice lawsuits, medical malpractice lawyers, medical mistakes, Medical Negligence, plaintiff, tort reform, Valuing Damages in Medical Malpractice Cases, Verdicts |

Passing the Malpractice Buck in Florida

July 01, 2019

By 2004, Florida voters had had enough.  They passed a constitutional amendment to stop bad doctors from continuing to malpractice.  The idea was a simple one:  If there there three instances of malpractice, a doctor would not be allowed to practice medicine in Florida any longer.  Three strikes and they were out.  Turns out it was not so simple after all but no one will accept responsibility for the failure of the amendment to do what voters wanted.

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The constitutional amendment was put into the law books in the part of the Florida statutes dealing with the practice of medicine.  It required either a verdict or judgment or final ruling in an administrative proceeding that a doctor had committed medical malpractice.  It further required that the malpractice be proved by clear and convincing evidence.  The clear and convincing requirement was not in the amendment passed by the voters.  It was a gift to the doctors from the Florida legislature when it passed the amendment into law.  It made it much more difficult to use a finding of malpractice to get rid of a bad doctor.  Multiple studies and investigations have shown that little has changed since 2004 and that bad doctors continue to practice without fear of discipline in Florida.

One of the problems to rooting out bad doctors is that the law requires there be a final verdict, judgment or administrative decision.  The bad doctors of Florida get around this by settling the claims against them.  When a case is settled, it never goes to trial and there can be no verdict or judgment or final administrative decision.  No verdict, no judgment, no administrative decision, no strike against the doctor.

The Florida legislature has done other things to frustrate the will of the people.  It has passed a number of laws making it more difficult for patients to bring malpractice suits in the first place.  If there is no suit, there can be no verdict or judgment.

When there is a verdict or judgment or administrative decision, they are rarely based on a finding of clear and convincing evidence.  Most malpractice claims go to a jury or to the judicial fact finder on a preponderance of the evidence test.  If the evidence shows that the doctor more likely than not committed malpractice, the verdict is returned in favor of the plaintiff.  It is the province of the Florida Medical Board to determine if the malpractice verdict or judgment or administrative decision was supported by clear and convincing evidence.

To no one’s surprise, the Florida Medical Board has rarely found clear and convincing evidence that a doctor committed medical malpractice.  Many studies since the passage of the constitutional amendment have found few doctors affected by its terms.  Here is a study by the Board of Governors of the State University System finding little to no impact six years after passage of the amendment.

A recent investigation by Florida news organizations found that hundreds of Florida doctors had made multiple malpractice payouts and were still practicing.  They found at least 120 doctors with three or more malpractice suits in the last 10 years but only two had had their licenses revoked under the “three strikes” statute.  Astonishingly, they found one back surgeon who had paid out sixteen malpractice claims since 2000, six of which involved the death of the patient, and yet this man was still practicing.  Not only is he still practicing, the Florida Board of Medicine lists his license as “clear/active.”

The following quotation from the Chairman of the Florida Board of Medicine shows why it is failing the citizens of Florida so spectacularly,  “The concerns that the public has are perhaps more related to the policing of medicine and that is not the Board of Medicine’s responsibility.”   If the Board of Medicine does not believe it is responsible for policing the quality of medicine practiced by the doctors it supervises and licenses, it is no wonder doctors can malpractice with impunity in Florida.

Posted in Doctors, Lawsuits, medical errors, Medical Malpractice, medical malpractice cases, medical malpractice lawsuits, medical mistakes, Medical Negligence, Secrecy, Surgical Errors, Verdicts |

Generic Drug Betrayal

June 24, 2019

The promise of generic drugs is enticing:  quality replacements for name-brand drugs at a fraction of the price.  Regardless of whether that promise was ever anything more than an illusion, it is a proven lie today.

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I read two recent articles which deal with two separate ways in which generic drug manufacturers have betrayed patients.  In both cases, the betrayal is rooted in money.  The first betrayal is discussed in a book about generics and the ways in which it has betrayed its promise by cheating on quality.  Lightly regulated plants in India and China are paying off regulators, using substandard ingredients and cutting manufacturing corners to increase profits.

Most of the bad and dangerous drugs that are produced by these manufacturers end up in places like Africa and Asia but, beginning in the 1980’s, the United States began importing foreign generic drugs.  While the F.D.A. has done a masterful job of overseeing American drug production and made sure that quality control is high, the same is not true of its efforts to assure the safety of these Asian generics.  When the F.D.A. inspectors to get to these plants, and apparently their visits are few and far between, they announce themselves in advance, which gives the manufacturers plenty of time to cover their tracks.  This is not the case in the United States where no notice inspections are the rule rather than the exception.

Some of these dangerous drugs have made it to the United States.  In 2007 a number of dialysis patients died from allergic reactions to a contaminant in a generic blood thinner manufactured in China.  The F.D.A. had never inspected the Chinese plant and someone there had diluted the product to make it go further.

So one betrayal by the generic industry has been its production of poor quality, dangerous copies of name-brand drugs.  The other betrayal has been the generic industry’s price fixing.  Instead of providing low cost alternatives to name-brand drugs, the big boys in the generic industry have been engaging in schemes intended to drive up prices.   For example, the generic antibiotic, doxycyclene, cost about $20 for a prescription in 2013.  A year later, the price had risen over 8,000% to $1,829.  Similar, but not quite so outrageous, increases were seen in other generics.  Manufacturers would sometimes agree to raise prices in lock step.  Other times they would agree to assign certain drugs exclusively to certain manufacturers.

Now 43 states are part of a massive price fixing suit against 20 manufacturers alleging billions of dollars of harm to American consumers.  The likelihood of success seems high as the states have e-mails, text messages and testimony from insiders supporting the claim that the manufacturers were conspiring to raise prices.

There is another betrayal here as well.  It is the betrayal of the American citizen by the federal government.  The F.D.A. did not protect us from bad drugs made overseas.  The Congress did not protect us from generic price fixing at home.  It is a sad day when we must rely upon the attorneys general of the states to get together to address a national problem.  That is supposed to be the job of the federal government.  I am just happy that someone is doing the job.

Posted in drug companies, Fraud, health, Health Care Costs, Lawsuits, Medical Costs, medical ethics, Secrecy |

Misdiagnosis – A Leading Cause of Malpractice.

June 17, 2019

Some recent reports show that misdiagnosis is a leading cause of medical malpractice.  This is not news to me or to anyone who represents patients and families injured by malpractice.  Diagnosis is hard.  Diseases and illnesses don’t always present with the same signs and symptoms every time.  A good diagnosis takes work and patience.

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One medical malpractice insurance company reviewed 1,800 closed claim files involving the doctors it insured to see what was the cause of the claims against the doctors.  It found that 46% of the claims involved misdiagnosis.  In 45% of those cases, the patient died.  Another insurer reported on claims involving the treatment of children and reported that 38% of the claims against its doctors arose out of misdiagnosis.  Still another study concluded that the third leading cause of death in hospitalized patients resulted from misdiagnosis.

It is easy to understand how these figures come to be.  Diagnosis is one of the most difficult tasks a health care provider faces.  It usually involves a series of steps be taken to get to the correct result.  If any one of the steps is done incorrectly, the result may be a mistake in diagnosis.  To top it all off, sometimes the steps must be taken quickly and in emergency circumstances.

The first thing that must be done is to get some basic information.  This is called the “history” and it is an area with great potential for a mistake.  The provider usually asks the patient what is the problem.  Depending on the patient’s answer, the provider may go on to ask directed questions to elicit more information.

There may be a language barrier interfering with this question and answer process and, even if there isn’t, misunderstandings in communication are a common, everyday problem.  The patient may not understand what are the most important symptoms to tell the provider.  The provider may get misled by what the patient thinks is her primary complaint.  The patient may not remember to tell the provider about an earlier doctor visit or test result or diagnosis.  The provider may be in a hurry and not spend the time she should talking with the patient.  The provider may be impatient and this may cause the patient to hold back for fear of angering the provider.  The provider may not ask the appropriate follow-up questions.  In short, lots can go wrong at this stage.

Even if the history taken by the provider is complete and both provider and patient did a good job, there is still lots of opportunity for a misdiagnosis.  One of the sayings often repeated by medical malpractice defense lawyers at trial is, “When you hear hoofbeats, you think horses, not zebras.”  They say this when they are defending a doctor accused of failing to diagnose an illness or problem which is unusual.   They say this because providers will sometimes jump to conclusions about what the problem is without going through all the appropriate steps.  They get something in their heads and they fail to consider other possibilities.  Doctors are supposed to create what is called a “differential diagnosis,” which is a mental list containing all of the possible explanations for the patient’s condition.  They should then “rule out” the more serious of these possibilities until they get down to a shorter list of explanations and then order testing to reduce the list further.

Diagnosis is not an easy thing.  You can do your part by being sure to tell the provider about all of your health issues, your medications, your past doctor visits, hospitalizations and diagnoses.

My best advice to you is not to catch anything too rare.  If you do, the chances the doctor will think horses instead of zebras goes way up.

Posted in Doctors, Hospitals, Lawsuits, medical errors, Medical Malpractice, medical malpractice claims, medical mistakes, Medical Negligence, Misdiagnosis |

Warning: Your Surgeon May Be “All Thumbs”

June 10, 2019

It is human nature to criticize the younger generation.  What’s the matter with them?  They don’t do things the way we did when we were young, etc.  In the world of surgery, there may be valid reasons to be concerned about young people who are entering surgery residency programs.  According to a recent story in the New York Times, those who run these surgery residency programs are concerned that their new residents do not have the manual dexterity necessary in a good surgeon.  The most likely reason is that young people no longer sew, knit, build models, woodwork, play musical instruments or do the other things that children used to do and that build manual dexterity.  Nowadays, instead of developing dexterity of their fingers, young people use their thumbs to play video games or to text their friends.

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The successful surgeons interviewed for the article point out that by the time doctors complete medical school and enter a surgical residency program, it is too late to develop the same level of dexterity as someone who has been doing “hand things” all their lives.  They note that the earlier a person starts developing manual dexterity, the easier it is to develop and the better it becomes over time.  Late starters will rarely be as good as those who start early.  A suggestion has been made to consider manual dexterity among the factors considered in selecting surgical residents.

Another “problem” pointed out by those who run these programs is that there are now limits to the number of hours a resident can work.  For a long time there were no limits and some surgical residents would work as much as 120 hours in a week.  They would literally live at the hospital and operate at all hours, catching a nap here or there when they could.  This was not good for either the health of the resident or that of the patients upon whom she was operating at the end of a 120 hour week so limits were put in place to protect the residents and the public.

Paradoxically, these limits may be affecting the quality of those graduating from surgical residencies today.  One residency program director quoted in the Times’ article stated that today’s residents may complete the program with 900 operations under their belts.  He, on the other hand, had double that number by the time he completed his surgical residency.  The number of operations is important as “practice makes perfect.”  The more surgeries a resident has performed, the more she or he has seen and the more she or he has learned.

As usual, there are lessons for us to learn.  Always check the background and experience of your surgeon.  Always ask how many of your surgery he or she performs a year.  The more the better.  Always ask about your surgeon’s rates of complications.  Always check the medical board web site for information about your surgeon.  If your surgeon is not happy to be questioned by you about these issues, find yourself another surgeon.

Posted in Arizona Medical Board, Doctors, medical errors, science news, Surgical Errors |