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Tag Archives: Medical-Legal

Michael J Woods and Celebrity Malpractice Trials

John Ritter died from a ruptured thoracic aneurysm. His family sued the emergency physicians for allegedly failing to treat him quickly enough. Now another celebrity is suing emergency physicians. James Woods, brother of deceased Michael J. Woods, is suing a hospital and its emergency physicians for failing to treat Mr. Woods quickly enough. Michael Woods went to the “fast track” part of the emergency department complaining of nausea and a sore throat. He began “sweating profusely” told doctors that he was having an “anxiety attack.” A doctor in the “fast track” side of the emergency department examined Mr. Woods’ throat and then sent him to the main emergency department when his throat was not inflamed. When taken to the emergency department, the nurses attempted to give him medications and he stated “Stop doing this, I don’t need all this. This is ridiculous.” Eventually he allowed the medications to be given. An EKG was performed that showed “alarming” changes (that were never fully described in the articles) and cardiac monitoring was ordered, but the rooms with monitors were all full. Mr. Woods was then placed in a hall gurney next to the nurse’s station. Ninety minutes later, Mr. Woods slumped over in his bed and went into cardiac arrest. CPR was performed for nearly a half hour, but he was not able to be resuscitated. A coroner’s report showed that Mr. Woods had severe cardiovascular disease throughout his coronary arteries. Experts alleged that Mr. Woods should have been placed on a monitored bed immediately and that the failure to do so cost Mr. Woods his life. From what we are being told, this is just another example of a fallacy being fed to the jurors. There is nothing special about cardiac monitors. They alarm if there is an arrhythmia. They don’t warn medical providers of impending heart attacks or cardiac arrest. By putting Mr. Woods on a monitor, all that would have changed is that the medical staff may have gotten to him 30 seconds earlier when he slumped over in his bed. From the testimony described, the care that Mr. Woods received was by no means perfect. The law doesn’t require “perfection.” The law requires that medical providers act “reasonably.” How do we quantify “reasonableness” when emergency providers are overwhelmed with patients or when there are not enough supplies available to meet the needs of patients? What is reasonable in the midst of chaos? I just hope that jurors keep the “reasonableness” standard in mind when deciding this case. A link to multiple posts about the Woods trial, being held in Rhode Island, can be found on the Providence Journal site at www.projo.com using this link: http://news.beloblog.com/cgi-bin/mt/mt-search.cgi?blog_id=1078&tag=Michael%20Woods

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Quarterback Offense

  Hello all, ERP here. What is the Quarterback offense?  No, it is not some weird audible in football or a Quarterback sneak. It is a tactic used by plaintiff lawyers (and expert witnesses) to sack ER doctors in court.    How does it work?  Let me give  you an example. A guy I know who is an excellent ER doctor (and probably more cautious and careful than most) who was sued along with a neurologist for not giving TPA to a patient who presented with stroke symptoms to the ER within the three hour window for its use. Now, there are MANY, MANY reasons to not give TPA to a stroke patient other than that they presented too late.  The symptoms could be too mild to warrant its risks, there could be a contraindication such as having a coagulopathy, etc.   Regardless, this guy presented to the ER with some RESOLVING symptoms (I can’t remember exactly but I think he had some slurred speech) that was virtually gone by the time he got put into a room in the busy ED.  The ER doc assessed him quickly, and even though he thought himself that it was not appropriate to give the drug, he called the neurologist on call to run the case by him for confirmation. The neurologist agreed and the TPA was not given. The guy was admitted and, and the time of leaving the ED, he had zero symptoms.  Perfect! Right? Wrong.  A few hours later up on the floor he suddenly stroked out big time and after a long deterioration, died.   The ER doc and neurologist were sued for not giving TPA. Now, this is related to the title of the post as such.  The plaintiff-sponsored “expert” witness (an ER doctor whose smiling mug is frequently plastered across the pages of many Emergency Medicine magazine/journals as the “face” of a large contract management company.  (Makes me nauseated)) claimed that my friend was not being a good “Quarterback” by FORCING the neurologist to come in and examine and thus administer the drug. Now, we are supposed to send out a hit man squad to twist the arms of consultants I guess.   Never mind that the guy would not have been given the drug by any prudent ER doc or Neurologist. Well, the good news is that the jury thought this was silly as well and found in favour of the defense and my friend and the neurologist were exonerated. What’s next?  The Blitz?  The Double Reverse? The Hail Mary??!??!

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Michael Jackson's Doctor to be Charged with Manslaughter

Just read an article on Fox News that Michael Jackson’s physician, Conrad Murray, is going to be charged with manslaughter. The DA’s office is allegedly building a case against Michael Jackson’s dermatologist as well. According to the article, the LA District Attorney’s office denies the story, but Fox News is standing firm with its allegations. I’m putting my money with Fox News on this one. There is too much of a public outcry regarding Jackson’s death for the DA’s office not to do something – even though I don’t think it’s right. As Kevin MD highlighted in a post, such are the risks of treating celebrities. If Dr. Murray administered propofol to help Michael Jackson sleep, he was obviously using the medication in an unapproved manner. Doctors use medications in unapproved manners all the time. Many of you are probably being prescribed medications right now that are not FDA approved for the purpose for which your doctor has prescribed them to you. So if we’re going to criminalize some activity, exactly what activity are we going to criminalize? How do we define when a doctor has committed a criminal act? Highly dangerous? Giving tPA for stroke is highly dangerous. People die from receiving that medication. We going to throw all the doctors in jail that use tPA? I’m not condoning what Dr. Murray did, but I also think society has to think very carefully before crossing the line between charges of professional negligence and charges of criminal behavior. It’s one thing to be sued for millions of dollars or even lose your license because you gave a medication that resulted in someone’s death. It’s another thing to be thrown in jail for doing so. Start threatening any health care providers with incarceration for using professional judgment and very quickly you will see how few people will be willing to provide those services. Do we really want to start down this slippery slope? . UPDATE AUGUST 24, 2009 See additional discussion about the criminalization of medicine from Happy Hospitalist, Nurse K, ERP and Reality Rounds. It’s official. Michael Jackson had lethal levels of propofol in his system. The coroner’s office ruled Michael Jackson’s death a homicide. So now that manslaughter charges are imminent, what will happen to the other doctors that prescribed propofol to Michael Jackson in the months and years before his death? Do they get off scot free even if they are the ones who addicted MJ to propofol? Nurse K raises a point that the circumstances of this case are unique and that there wouldn’t likely be a precedent set if Dr. Murray was convicted. I disagree. The publicity that this case has received will make it a tremendous precedent. If a trial occurs, it will be like OJ Simpson’s trial all over again. Happy asked whether criminal charges should be filed if the overdose was of Ativan or another medication used to induce sleep. In other words, if a patient dies, is it the medication causing the death that makes the act illegal or is it the fact that the medication causing the death was given “off label”? Nurse K gave a pretty good definition of what type of acts should be criminalized, but even using her definition, some negligent acts could be unintentionally classified as being criminal. What about doctors prescribing large doses of medications in a pain clinic or an oncology clinic? How do we classify egregious acts as being criminal while excluding acts of simple negligence from the definition? So Dr. Murray will be the personification of a medical criminal. What’s next?

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More Analysis of Healthcare Reform Bill

I put the blog on autopilot while I was away for a few days. I was a little surprised by the reactions to the Health Reform Bill post. My intent in posting that e-mail was to generate discussion and encourage everyone to actually read what our elected officials are putting forth as the law controlling our health care for the foreseeable future. I had planned to do a point-by-point analysis, but didn’t have the time before I left, so I picked the end-of-life issue to comment because the comments made by the person who created the e-mail sounded inflammatory. They were.  It seems as if the mere fact that I posted the e-mail meant to most people that I ratified all of the contents. Not true. However, some of the comments were still on point.  Had hoped that others would analyze the wording similar to what I did with the  end-of-life issue. Oh well. For those who did look at the bill and post specific comments, I want to address them. “Page 22: Mandates audits of all employers that self-insure! (Section 142(b))” Here’s the exact text: COMPLIANCE EXAMINATION AND AUDITS (A) IN GENERAL – The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance. The language “shall” is a mandate, it is not permissive. The wording of the remainder of the sentence is poor, but it appears that the mandate requires the commissioner to conduct audits of whether qualified health benefits plans are complying with federal requirements. Unlike Shadowfax’s assertion, the wording does not “require[] ‘random compliance audits and targeted audits in response to complaints.'” Instead, the plain language states that the mandated audits “MAY INCLUDE” random compliance audits and targeted audits. The language does not limit the audits to those vehicles and states nothing about the degree or extent of the audits. Little different, don’tcha think? Since Shadowfax also picked out the “All non-US citizens, legal or not, will be provided with free health care services” statement, let’s look at that one, too. Section 401 changes Chapter 1 Subchapter A of the Internal Revenue Code to impose a 2.5% tax on a portion of the adjusted gross income any individual who does not have acceptable health care coverage. The exact language is ‘(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of– ‘(1) the taxpayer’s modified adjusted gross income for the taxable year, over ‘(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer. Section 6012(a)(1) of the IRS Code is here and it makes no mention of what the “gross income specified” should be, so I am unclear how the 2.5% tax will be computed. However, the language of the Act creates exceptions for certain classes of people who have to pay this tax. Those exceptions include (2) NONRESIDENT ALIENS- Subsection (a) shall not apply to any individual who is a nonresident alien AND (5) a “RELIGIOUS CONSCIENCE EXEMPTION” where individuals do not have to pay such tax if their religious tenets make them conscientiously opposed to receiving benefits of any private or public insurance. Another part of the Act, Section 246, states SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS. Nothing in this subtitle shall allow Federal payments for affordability credits [note: See Section 241] on behalf ...

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Does Medical Malpractice Affect Access to Medical Care?

In a recent post, I asked the question whether or not people would favor providing some type of immunity to emergency physicians if doing so would increase the availability of emergency medical care. So far, about 75% of people answering that question voted “yes.” Some of the attorneys that read this blog were all over me. In particular, Max Kennerly, an attorney with a plaintiff’s law firm and someone whose opinions are generally cogent, thought that immunity would do little good in improving access to emergency care since “There’s no evidence malpractice — which is at the very most 1.5% of healthcare costs — is a major contributing to the lack of access to emergency care in this country. You could eliminate malpractice liability entirely and barely dent access to emergency care.” In response, I cited an article listing several examples to support my assertion. Highlights from the article are below. A 2005 hospital ED administration survey also lists “malpractice concerns” as the principal factor discouraging specialists from providing ED coverage. Furthermore, because liability premiums have outpaced payments for their services, some surgeons have concluded that they simply cannot afford the added liability risk for a largely uninsured patient population. In addition, younger surgeons, who often take the on-call shifts at trauma centers, are leaving states with the most severe liability problems. For example, according to the Project on Medical Liability in Pennsylvania, funded by the Pew Charitable Trust, “Resident physicians in high-risk fields such as general surgery and emergency medicine named malpractice costs as the reason for leaving the state three times more often than any other factor.” Further, an American Hospital Association study found that more than 50 percent of hospitals in medical liability crisis states now have trouble recruiting physicians, and 40 percent say the liability situation has resulted in less physician coverage for their EDs. The crisis has even forced the closure of trauma centers in Florida, Mississippi, Nevada, Pennsylvania, and West Virginia at various times in recent years. Specialties that have experienced particularly high premium increases—including neurosurgery, orthopaedics, and general surgery—are also among those that provide services emergency patients most frequently require. According to a report from the General Accounting Office, soaring medical liability premiums have led specialists to reduce or stop on-call services to hospital EDs, seriously inhibiting patient access to emergency surgical services. Max then responded to the articles I cited by stating that they were biased “surveys and a summary for a hospital lobbying group.” After all, some of the data were based on surveys of *gasp* doctors. Max, you lost me, there. If you want to know about doctors’ liability fears or if you want to know why doctors are leaving one state for another state, who are you going to ask? Grocery clerks? School teachers? Attorneys? Would the surveys have been more persuasive if they asked a bunch of nuns what effect they thought that medical malpractice liability would have upon the access to medical care? Of course the survey participants were doctors. Those are the people whose opinions everyone is seeking. So I spent about 45 minutes doing some further research on the internet and on some paid medical web sites. I decided to make this a separate post so that if anyone else was searching the internet looking to find out whether malpractice affects access to medical care, you can pick up on the work I’ve done. Below the fold are some more “nonexistent” studies that support my assertion. Funny, but I haven’t seen one link to any study that asserts the opposite. Oh, and if you do ...

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Legal Immunity

Last Friday, Secretary of Health and Human Services Kathleen Sebelius signed a document that provides vaccine makers immunity when they produce swine flu vaccine. Since vaccines are “well known” (wink, wink) to cause such physical maladies as autism … neurologic disorders, hyperactivity, learning disabilities, asthma, chronic fatigue syndrome, lupus, rheumatoid arthritis, multiple sclerosis, and seizure disorders, a federal law provides legal immunity for manufacturers that produce the vaccines. Instead of going through the court system, there is a fund called the Vaccine Injury Compensation Program that is set up to compensate those who have been injured by vaccines. Many vaccines have a low profit margin. In addition, most vaccines have only one or two manufacturers. If you were a vaccine manufacturer and knew that you could potentially spend tens or hundreds of millions of dollars defending and paying out on one class action lawsuit about a vaccine you produced, would you continue to make the vaccines? By immunizing manufacturers from liability for producing vaccines, the public policy argument is that the public benefits vaccines produce far outweigh the potential public detriment to the point that the government wants to encourage manufacturers to make vaccines. Several of the attorneys that frequent this blog have stated that legal immunity for physicians is the equivalent of a “license to kill” but they are also quick to defend legal immunity for judges in performance of their duties. So based on the above, I have two questions related to this immunity topic: [poll id=”2″] [poll id=”3″]

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