Medical Malpractice News and Views

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State Medical Boards Continue To Fail The Public – Part 2

Posted by Bill Sandweg.

July 17, 2023

I always advise people looking for a doctor or getting ready to have surgery to check the web site of the state medical board to see if the doctor has been disciplined and, if so, for what reason.  Unfortunately, this is only an effective strategy if the medical board is diligent about tracking and publishing information about doctor misconduct or malpractice and many state boards are less than diligent.

AZ Medical Board

Last week I wrote about the problem of medical boards being reluctant to discipline doctors for malpractice or other bad conduct.  When they do finally discipline a doctor, it is not uncommon for that doctor to just pull up stakes and move to another state, where she or he can practice with a clean license.  This should not happen, but many state boards do not do a good job of checking the backgrounds of doctors moving to their states.  As a matter of fact, they don’t do a good job of checking on the behavior of the doctors who have been in their states for years.  These boards pretty much operate on the honor system and bad doctors take advantage of that fact.

Many doctors are licensed in more than one state and keep those licenses active, even though they do not live or practice in all of the states in which they are licensed.  This makes it easy for these doctors, if they are face trouble in one state, to move to another state in which they are already licensed and start over.  Any member of the public who checks the doctor’s history in the new state will likely find a clean slate.  An investigation by USA Today a few years ago found at least 500 doctors who had been disciplined in one state just went to another state and practiced there without limitation.  Of those 500, half had actually surrendered their licenses to their old states rather than complete the discipline process.  They were still able to practice in their new state with an unblemished record.

Most states require doctors to self-report criminal convictions, malpractice suits, and other bad behavior.  Some only require this kind of self-reporting every year or two, which means a doctor could have a conviction that would merit suspension of his license and not have to report it for as much as two years.

Depending on the state, the medical board may independently search for information about the doctors whom they license.  The resources given to the medical board by each state varies from state to state.  Boards with few resources may not be able to keep track of their doctors even if they wanted to.  Some don’t even use the tools readily available to them.

Congress has established the National Practitioners’ Data Bank.  Insurance companies making payments in malpractice cases involving a doctor are required to report those payments and a brief history of the facts to the Data Bank.  Medical Boards are required to report discipline actions and hospitals must report, if they take away a doctor’s hospital privileges.  Medical Boards can inquire of the Data Bank if it has any records relating to the doctors in the state.  The investigation by USA Today found that very few ever do, despite the ease of making an inquiry.  Surprisingly, USA Today found that half of the states checked the Data Bank less than 100 times over the course of a year.  Thirteen didn’t check it even once.  Given the wealth of information kept by the bank, every state board ought to be checking it for all of their doctors at least a couple of times a year.  USA Today found that two states, Florida and Wyoming, made almost 2/3 of the inquiries in one year as both states have automated inquiries that flag any changes in the records of the doctors whom they supervise.

I am sorry to sound like a broken record, but the public has a right to know if a doctor has a history of discipline and for what reason.  A patient’s life is literally in the hands of the doctors who are licensed to practice in a state.  The state medical board has an obligation to create rules and procedures to accurately track the doctors it licenses, including their conduct in other states.  Once it has created effective rules, it must enforce them.  The public the board serves deserves nothing less.

Posted in Arizona Medical Board, disclosure of medical mistakes, Doctors, Hospitals, medical errors, medical ethics, Medical Malpractice, Secrecy, Surgical Errors |

State Medical Boards Continue To Fail The Public – Part 1

Posted by Bill Sandweg.

July 10, 2023

Reuters recently released the results of a lengthy investigation into practices of the Justice Department which permit accused fraudsters and malpracticing doctors to buy their way out of trouble and continue to practice in return for payment of a civil settlement amount.  While such settlements may be in the best interests of the United States as a way to recoup amounts improperly paid to these doctors, the public is not usually informed of them and the doctors are not disciplined by their local medical boards.  This is an outrage.

AZ Medical Board - Find your MD/Resident/Temp License

Over the last ten years, Reuters found that there were many, many actions against doctors and hospitals for defrauding the federal programs that pay for health care.  Some of the actions began as criminal actions, but all of them became civil enforcement actions by their end.  The federal government received over $26 billion in civil settlements.  That is a huge number and probably only represents the tip of the iceberg.

The fraud usually involved some form of misrepresentation.  Procedures were billed as being more complex than they really were or were never actually performed.  Many of them, however, were procedures or other treatment which was not medically necessary.  In other words, the doctors and hospitals subjected patients to treatment they did not need so they could bill Medicare or Medicaid for the treatment.  All treatment involves risks to the patient and some of these treatments left patients permanently damaged.

Criminal cases are hard to win.  The burden of proof is beyond a reasonable doubt.  It makes a lot of sense for prosecutors to seek justice instead through a civil settlement agreement in which the defendant doctor or hospital agrees to reimburse the federal government but is not required to admit guilt or fault.  While this may help make the treasury whole, it does little or nothing to protect the public against these doctors, who are permitted to go on practicing.  The federal government has no power to strip these doctors of their licenses.  That is the responsibility of their state medical boards and the boards are clearly falling down on the job.

In my view, the most startling finding of the Reuters investigation is that, over the last decade, 540 doctors and healthcare practitioners have settled up with the government in response to allegations of fraud, often paying hundreds of thousands of dollars, and not one of them, not one, has had his or her license to practice medicine revoked or even restricted.    How can that be?

Medical boards are run primarily by doctors.  Most of them have some lay people on the board, but they are not medically trained and, of necessity, must defer to the doctors on medical matters.  I have watched the Arizona Medical Board over the years.  I have seen a lot of malpractice during that time but only a few instances of doctors being held accountable at the Medical Board for their malpractice.  The Board is very strong against doctors who have addictions but not so hot when it comes to malpractice.  The public deserves better.

Some of the doctors whose conduct got them in trouble with the feds should never be permitted to touch a patient again and yet they go about their business with nary a restriction on their licenses and the public no wiser about their alleged misdeeds.

One doctor was accused of performing dozens of unnecessary gynecologic surgeries, in many instances removing all of the patient’s female organs.  Another doctor ordered his patients admitted to the hospital for more costly care when they could have been treated adequately as outpatients.  Another doctor administered expensive and dangerous chemotherapy treatments to patients who did not need them.  Still another doctor was subjecting patients to cardiac procedures they did not need.  This doctor, who received no discipline from his local medical board, kept right on performing unnecessary cardiac procedures and was sued a second time by the government and agreed to settle a second time.

Compounding the injustice of letting wealthy doctors buy their way out of trouble is the fact that the public almost never hears about the case against the doctor and the fact of payment.  One patient of a doctor accused of performing unnecessary gynecological surgeries only learned that she might have been the victim of his malpractice when she saw a story on the news about his settlement.  Patients should not have to rely a news station deciding to report on a settlement, which itself may or not be made public.

The whole purpose of the state Medical Board is to protect the public.  These boards, which allowed these 540 doctors to continue to practice without restrictions, and the other boards, which look the other way when there is malpractice, should take their responsibilities seriously and start doing their jobs.

 

 

Posted in Arizona Medical Board, disclosure of medical mistakes, Doctors, Fraud, Hospitals, Lawsuits, medical ethics, Medical Malpractice, Medicare, Secrecy |

Social Media And Plastic Surgery – A Dangerous Mix

Posted by Bill Sandweg.

July 03, 2023

Today’s story is about a plastic surgeon who courted social media and had a large following.  She called herself Dr. Roxy and even live-streamed some procedures and answered viewer’s questions during the surgeries.  She has been sued at least 11 times and may lose her medical license.  As matters stand now, that license has been suspended by the Ohio Medical Board for poor care during social media performances and during routine office and surgical care.

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Plastic surgery, indeed all surgery, is a delicate craft.  It requires great attention to detail.  A slip here or a distracted cut there can cause real damage.  Dr. Roxy often seemed to be more focused on her social media interactions than on the well-being of her patients.

Dr. Roxy does not appear to have been a careful surgeon.  One thing I have learned over 40 years of representing people injured by medical malpractice is that sometimes the bowel can get nicked during abdominal surgery through no fault of the surgeon.  The question then becomes whether the surgeon recognized the bowel nick and repaired it before a major infection could develop.  What I have never seen is what happened to one of Dr. Roxy’s patients.  She underwent abdominal surgery and came out of it with her small intestine punctured SIX times.  Some of the punctures went in one side and out the other.  These were not nicks.  Dr. Roxy was also accused of numerous instances of post-operative infections that went unnoticed and untreated until the patient was very sick and substantial damage had occurred.

Dr. Roxy livestreamed a Brazilian Butt Lift (BBL) procedure.  As I discussed in last week’s post, the BBL requires liposuction to harvest body fat and then injection of that body fat into the buttocks.  The injection is what is called a blind procedure in that the surgeon cannot see the tip of the cannula being used to inject the body fat and must use palpation and visual cues to determine its location.  As the Ohio Medical Board pointed out, when Dr. Roxy was looking at the camera and answering viewer questions, she could not have been devoting the attention necessary to determine the position of the cannula.  The BBL was one part of a number of procedures that Dr. Roxy performed on that patient that day.  At the conclusion of the procedures, the patient had to be hospitalized as a result of a perforation of the small bowel, a liver injury, and a serious soft tissue infection, all of which required prolonged hospitalization and multiple repair surgeries.

A 2021 breast augmentation by Dr. Roxy went so wrong that the patient ended up having to have both of her breasts removed due to severe post-operative infection.  During the course of treatment, Dr. Roxy misleadingly told a subsequent treating physician that she had already removed the patient’s breast implants when the implants were still in place.

Other lawsuits allege Dr. Roxy altered medical records and allowed staff to perform procedures for which they were neither licensed nor properly trained.  Perhaps the most important question is how the Ohio Medical Board could have allowed a doctor with such a terrible record to continue to practice for as long as it did before its emergency suspension of her license.  The public deserves better than that.

Social media plays a large role in the decision-making process for many patients considering plastic surgery.  According to surveys, nearly half of all patients undergoing cosmetic surgery procedures say that social media played a role in their decision to have the procedure.  Knowing that, it is not surprising that many plastic surgeons use social media to reach potential patients.

There is nothing wrong with a responsible use of social media by a plastic surgeon or any other doctor.  However, when use of social media becomes intrusive or threatens patient privacy or patient care, watch out.  Be careful when considering physicians who seem unduly interested in social media fame.  You want a physician who is most interested in the well-being of her or his patients.  Tik Tok is no place to look for a good plastic surgeon.

 

Posted in blood infections, Doctors, Fraud, Infection, Lawsuits, medical charts, medical errors, medical ethics, Medical Malpractice, medical mistakes, never events, Plastic Surgery, Surgical Errors |

The Most Dangerous Operation

Posted by Bill Sandweg.

June 26, 2023

What is the price of beauty?  If you think that beauty includes a well-shaped rear end, the answer may be your life.  According to the statistics, the Brazilian Butt Lift (BBL), a form of gluteoplasty also known as gluteal fat grafting, is the most dangerous operation.  While breast augmentation has a death rate of about one in 72,000, BBL has one death in every 3,000 or 4,000 procedures.  Despite a number of suggested changes to make the procedure safer, it has proved very resistant with death rates remaining unacceptably high.

AED 101015 15mm Cannula 15mm x 11.5cm Multi Function Valve

Image of trochar and cannula used in BBL procedures.

The BBL is performed by taking fat from one part of the patient’s body (liposuction) and injecting it into the buttocks in a series of injections intended to spread it out and sculpt the shape of the buttocks.

The BBL presents all of the problems of other cosmetic procedures.  The patient may have an unrealistic expectation about the outcome.  The body “sculpting” may not be even and may leave lumps or bumps.  There may be scarring, infection, blood clots, excessive blood loss and anesthesia problems.  However, bigger problems also exist.

Grave risk arises if the fat injection is too deep or at the wrong angle.  Fat globules can be injected into a blood vessel and block circulation or can be injected into a vein and carried to the heart or lungs.  These fat emboli, as the fat globules in the bloodstream are called, can cause tissue death, pulmonary embolism, respiratory failure, and death.

Florida is the epicenter of the BBL industry.  The problem is made worse there by the proliferation of low budget, high volume medical clinics in South Florida which do many BBL’s each day.  Some of them use doctors who are not board certified plastic surgeons.  Even those which employ board certified plastic surgeons may also employ less well-trained doctors or non-physician employees to perform some of the tasks required for a BBL.  While a patient should always opt for a well-trained, board certified plastic surgeon for any cosmetic procedure, when it comes to BBL’s the statistics show that even these doctors have unacceptably high rates of complications and fatalities.

The belief among those studying the situation is that high volume practices are inconsistent with the kind of good care that will lessen the chance of a major complication.  Experienced plastic surgeons claim that they can safely do at most three BBL’s a day.  They say safe and effective fat injections require great attention to detail.  Some of the doctors at the low budget, high volume clinics are doing 8 to 10 procedures a day.  Some doctors are even doing multiple BBL’s at one time and rotating from room to room in the process.  In response, the Florida Medical Board has recently passed an emergency rule prohibiting surgeons from doing more than three BBL’s in a day and requiring ultrasound guidance for fat injections.  Whether this will reduce the number of deaths and major complications remains to be seen.

As always, if you are considering cosmetic surgery, take your time and do your homework.  Check out the credentials of the surgeon you are considering.  Ask about complication rates.  Do your best to make sure that your expectations are realistic.  And when it comes to BBL’s, remember the words of a well-respected plastic surgeon addressing the issue, “No one ever died of a skinny buttocks.”

 

 

Posted in Blood Clots, blood infections, Board Certification, Doctors, Infection, medical errors, medical mistakes, Surgical Errors |

Beware The Medication Error

Posted by Bill Sandweg.

June 19, 2023

Medication errors are some of the most common preventable medical mistakes.  They occur in hospitals, doctor’s offices, pharmacies, and in the patient’s home.  The consequence of a medication error can range from insignificant to catastrophic injury to death.  Although a great deal of progress has been made in reducing the incidence of medication errors, they remain a persistent problem.

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We have all heard the term “miracle drug” and there are many drugs that work what would certainly have been considered miracles only a hundred years ago.  As with so many things in life, however, the advent of the miracle drug and its siblings has not been an unalloyed blessing.  Over the last 50 years, researchers and drug companies have created a huge number of drugs with confusing names and overlapping uses.  All this means that there are many, many ways for a medication error to occur and almost no way to assure that a medication error will not occur.

Here is a list of some of the most common forms of medication error.

Wrong Patient.

This one is pretty obvious.  The nurse comes into your hospital room and tries to give you a medication intended for the patient in the next room or just someone with a similar name.  If you are in the hospital, don’t just take whatever medication the nurse brings to your room.  Make sure it is one intended for you.

Wrong Medication.

Also pretty obvious, although this one can happen in a variety of settings.  In the hospital, the pharmacy may give the nurse a medication with a similar name to the one you should be getting.  This can also happen down at your local pharmacy when they are filling your prescription and read the name of the medication incorrectly.  This one may be hard for you to spot.

Wrong Dosage.

For this error, they have the correct patient and the correct medication but the amount is wrong.  One of the first malpractice cases I ever saw involved a pharmacist at a hospital misreading a doctor’s handwriting and putting the decimal point in the wrong place.  A little boy got 100 times the amount of a powerful drug that destroyed his brain.  Another time a local pharmacy filled a prescription incorrectly because of a misplaced decimal point.   The woman receiving the prescription died of the overdose, leaving behind a husband and five children.

Wrong Time.

On many occasions, the time when a medication is administered is critical.  Too early or too late and the desired effect is not obtained.

Improper Administration.

For this one, the drug is right and the patient is right but the drug is administered intravenously instead of intramuscularly, for example.  Or the person administering the drug does it improperly in some other way, such as using non-sterile technique or the wrong equipment.

Wrong Medication Prescribed.

For one reason or another, including the failure to take into account medications the patient is already receiving, the doctor prescribes a medication that will harm the patient.

Failure to Prescribe.

The doctor fails to prescribe a medication the patient needs and should receive.

Failure to Administer.

The doctor orders the medication but someone makes a mistake and the medication is never delivered to or administered to the patient.  This is usually a hospital problem but can occur when there is a miscommunication in a doctor’s office.

Mixing Up Medications At Home.

Lots of people, especially older people who are taking multiple medications, have a problem remembering to take all their medications in the right dosages at the right times of the day.  Never go to the medicine cabinet in the dark to get something for that headache or muscle ache.  Always turn the light on and verify that you are taking the medication you intend to take.

Conclusion.

You cannot stop all medication errors but with careful attention, you can reduce the risk that you will be the victim of one.

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

Unethical Doctors

Posted by Bill Sandweg.

June 12, 2023

For all their education and obvious talents, some doctors just can’t resist their worst impulses.  You should keep this in mind when you look for a doctor or when receiving advice from a doctor where the doctor stands to benefit, if you follow the advice.  As I have said many times, just because a doctor says it does not make it so.

119 Quack Doctor Stock Photos - Free & Royalty-Free Stock Photos from Dreamstime

Health care in the United States is a multi-billion dollar industry.  Some doctors believe they are entitled to more than just the money they can earn taking care of patients.

Unnecessary Treatments

This is a classic and time-tested form of grift for some doctors.  They tell you you need expensive spinal surgery that they will perform on you.  Sometimes, they also make money on the spinal hardware they place in your back.  If you are lucky, your back will feel better after the surgery but for the surgeon, that was never really the goal of the surgery.

It is not just spinal surgery, of course.  One doctor in Michigan told some of his patients that they had cancer and needed expensive chemotherapy treatments.  As you may know, chemotherapy uses poisons to kill or control cancer.  The goal is to kill the cancer without killing the patient.  These poor patients went through hell only to find out later that they never had cancer in the first place.  That doctor is in prison now but there are probably many more out there who have not been caught.

Defrauding Medicare

There seem to be no end to the doctors who are willing to lend their names to schemes to defraud Medicare.  In some forms of the theft, homeless people are recruited and paid to become patients.  Doctors bill Medicare for treatments the homeless people don’t need and often don’t ever receive.

One doctor in New Jersey wrote prescriptions for back braces for “patients” he had never met and who never received any back braces.  The scheme involved many people and billed Medicare over a billion dollars before it was discovered.  The doctor was sent to jail and had to pay over $7 million back to Medicare as restitution.

Sexually Assaulting Patients

Sadly, this form of unethical behavior is not uncommon.  Two gynecologists at top universities in Los Angeles were found to have molested their female patients.  Millions were paid in settlements.  A doctor for the American national gymnastics team molested young women for years.  A doctor at Ohio State molested young athletes in the guise of examining them for injuries that had nothing to do with their genital areas.  These are just the high profile doctors who have come under public scrutiny.  There are lots more where they came from.

Upcoding

Unethical behavior can be fairly mundane.  Medical billing is controlled by coding.  Every procedure has a code that represents the service provided by the doctor and the amount that should be paid to the doctor for that service.  A dishonest practice involves assigning a code for a patient visit that makes it sound like more was done or that the patient was sicker than the patient really was.  This upcoding results in more money being paid to the doctors than they deserve.

Kickbacks

This is another tried-and-true method of cheating.  Doctors order tests, perhaps needed or perhaps not, and send the patient to a specific laboratory to do the tests.  The laboratory inflates the amount of money it charges for the tests and kicks a portion back to the doctor for the referral.  Sometimes the doctor owns a part of the lab, which for obvious reasons is against the law.

Conclusion

Be careful when dealing with medical professionals.  You shouldn’t assume that they are dishonest or that they don’t have your best interests at heart, because most of them do.  On the other hand, don’t leave your common sense at the door.  Don’t hesitate to ask for a second opinion, especially if what is being suggested is a significant surgery.  Ask questions, especially if something doesn’t sound right.  Watch your medical bills, even if you have insurance, to make sure they are accurate and you and the insurance company are not being overcharged.  Remember that medicine is big business and you are the customer.

Posted in Doctors, Fee for Service, Fraud, Health Care Costs, Health Insurers, Medical Costs, Medical Devices, medical ethics, Medical Malpractice, Medicare, PODS, Secrecy |

Large Medical Malpractice Verdicts Usually Have Some Things In Common.

Posted by Bill Sandweg.

June 05, 2023

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

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

A Catastrophic Injury or Death

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

A Large Economic Loss

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

Big Medical Bills and Liens

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

A Loving Family

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

A Good Trial Lawyer

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

An X Factor

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

Appeals

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

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

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

Nurses Get The Short End Of The Stick.

Posted by Bill Sandweg.

May 29, 2023

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

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

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

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

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

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

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

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

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

 

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

The Greedy Doctor

Posted by Bill Sandweg.

May 22, 2023

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

Doctors Come In Many Different Flavors - Sandweg & Ager PC

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

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

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

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

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

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

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

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

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

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

Why Won’t Doctors Tell The Truth?

Posted by Bill Sandweg.

May 15, 2023

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

Secrets Doctors Don't Want You To Know

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

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

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

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

 

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