Archive for the ‘Medical-Legal’ Category
Saturday, August 4th, 2012
Sent from a reader …
Because stool obviously transmogrifies as it exits the rectum.
Stool contained on the end of one’s finger after performing a rectal exam and then transferred to a hemoccult card causes hemoccult cards to give wrong readings and therefore the results “may not be accurate.”
However, stool that is plopped in the toilet, mixed with water, possibly urine, and whatever else is growing in the toilet bowl … no problemo. Definitely accurate.
This “results may not be accurate” disclaimer is reportedly added to every stool sample the hospital reports because the hemoccult card manufacturer said that the cards are only to be used for “formed stool”. Not sure how the lab tests to determine whether the sample is “formed” or is “diarrhea,” but I’m not a lab technician. Perhaps they test the moisture content of the sample prior to actually applying the requisite number of drops of hemoccult developer.
The hospital also reportedly had an entire committee meeting where multiple educated professionals and administrators thought it was appropriate to include the “results may not be accurate” disclaimer given the manufacturer’s guidelines.
That then begs the question that if the stool results “may not be accurate,” then why is the hospital reporting on the results at all?
I’m sure that a fear of liability for not following the manufacturer guidelines in using the product had nothing to do with the committee decision, either.
Posted in Medical-Legal, Random Thoughts | 17 Comments »
Wednesday, April 25th, 2012
 North Carolina Board of Dietetics and Nutrition threatens to sue a diabetes blogger and potentially subject him to 120 days in jail for recommending the “Paleo diet“, alleging that the blogger is practicing “nutrition” without a license (which is a misdemeanor [.pdf file]).
The NC Dietetics Nutrition Practice Act really doesn’t state what is permissible, though. Section 90-368 states what practices are not affected under the Act. What can people do without a nutrition license, though?
Charla Burill, the board’s director, states that bloggers have “a First Amendment right to blog about his diet, but he can’t encourage others to adopt it unless the state has certified him as a dietitian or nutritionist.”
To be fair, on some of the blogger’s pages, he offers to sell individual “support packages” for one on one counseling with blog readers which does cross the line. But there are many other issues that show how expansive this North Carolina law really is.
Is Michelle Obama breaking the law when she recommends that people eat broccoli? Oh, wait, the government can tell you what products to buy and can even fine you for not buying them. That’s what the whole Affordable Care Act is about.
Are North Carolina moms going to jail for advising their kids on what to eat at dinner?
Have the publishers of the South Beach Diet book been hit with an injunction in North Carolina?
What happens when a sponsor at Alcoholics Anonymous personally advises another member on how to limit alcohol intake? Watch it, buddy. You’re going to find yourself in the Greybar Motel for doing that.
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Another hat tip to Glenn Reynolds at Instapundit for the link.
Oh, and by the way, everyone in North Carolina who has diabetes should eat less refined carbohydrates and eat more sushi and broccoli like I do. It’s the bomb! I’ll just call it the “modified Paleo diet.”
Posted in Medical-Legal | 6 Comments »
Tuesday, April 10th, 2012
 I’m surprised that this case hasn’t gotten more press.
A patient named Anna Brown was unhappy with the care she received at several hospital emergency departments. When she was discharged from the last emergency department, she refused to leave. Police were called and the patient was carried to a police car. She said that she couldn’t walk. Police took her to jail, carried her into the cell and left her laying on the floor. About an hour later, she was still laying there … dead.
From the public’s point of view, the case appears outrageous. But as I read through the description of what happened and thought about what could have been done different, from a physician’s point of view, I’m not sure what else could have been done.
Christine Byers wrote an excellent article describing events that took place, and then wrote a follow up article in which the hospital defended its care. I’m hoping that the St. Louis Post-Dispatch commends her for her work. She did a great job with the stories.
Background
A summary taken from Ms. Byers’ article shows that Anna Brown was admitted to the hospital for spraining her ankle while walking near a ditch. EKGs, blood tests, and lab work were performed. Ms. Brown was in the hospital from Sept 13 to Sept 15 and then discharged. She walked on crutches after her discharge.
(more…)
Posted in Medical-Legal, News Commentary | 43 Comments »
Tuesday, March 20th, 2012
Why does the Huffington Post allow Joanne Doroshow to keep posting misinformation?
For those of you who didn’t know, Ms. Doroshow is an attorney who is the executive director for New York Law School’s Center for Justice and Democracy.
Attorney Doroshow’s latest blog post on HuffPo alleges that medical malpractice caps are an “attack on women” and therefore any Republican who votes for medical malpractice caps is risks alienating himself (or herself) from half of all the voters in the United States.
Yeah.
Half of Attorney Doroshow’s post cites opinions from others that the Republican party is engaging in “mass misogyny.”
When she finally tries to justify her kindergarten logic, Attorney Doroshow quotes University of Buffalo law professor Lucinda Finley, stating that
“[C]ertain injuries that happen primarily to women are compensated predominantly or almost exclusively through non-economic loss damages. These injuries include sexual or reproductive harm, pregnancy loss, and sexual assault injuries.”
Let’s look at the legal arguments that Attorney Doroshow has adopted.
Sexual or reproductive harm happens primarily to women.
Is Attorney Doroshow attempting to argue that there are so many fewer lawsuits relating to testicular/prostate cancer, male urologic injuries, testicular torsion, and hernia-related injuries such that malpractice caps would be de facto misogynistic? I notice a deafening lack of statistics to support her assertions. Professor Finley’s article didn’t address the issue, either, but Professor Finley’s article wasn’t limited to medical malpractice caps — it discussed general caps on noneconomic damages.
Pregnancy loss happens primarily to women.
True. Women are the ones who get pregnant. But is Attorney Doroshow attempting to argue that only one parent is allowed to file a lawsuit on behalf of the child when there is a pregnancy-related loss? As an attorney, what is her legal basis for such a claim? How are malpractice caps on a “pregnancy loss” lawsuit discriminatory toward women?
Sexual assault injuries happen primarily to women and are compensated predominantly or almost exclusively through non-economic loss damages.
I agree that sexual assault injuries primarily happen to women. However, sexual assault injuries have little to do with medical malpractice caps. Sexual assault is a criminal issue. Often, victims of crimes receive compensation from a Crime Victims Compensation Fund. Caps on medical malpractice have nothing to do with sexual assault injuries – unless the physician is the one assaulting the patient. And even if a physician did sexually assault a patient, the litigation wouldn’t be a “medical malpractice” issue subject to malpractice caps, it would be a civil tort issue where malpractice caps do not apply.
As further justification for how noneconomic medical malpractice damage caps are discriminatory toward women, Ms. Doroshow again cites Professor Finley, stating
“[J]uries consistently award women more in noneconomic loss damages than men … [A]ny cap on noneconomic loss damages will deprive women of a much greater proportion and amount of a jury award than men.”
There is no comment from Attorney Doroshow on why it is acceptable for juries to discriminate against men in awarding noneconomic damages. However, if legislatures take some action that would potentially neutralize the “discrimination,” Attorney Dorshow alleges the action would constitutes a sleight so severe to the female gender as to amount to instant political suicide. That is simple pig pen effluent.
I agree that $250,000 caps on noneconomic damages are not fair to patients. I also think that we need to find some middle ground where patients can be fairly compensated for their injuries but where medical providers are not subject to bankruptcy from “super losses“.
Joanne Doroshow’s attempts to scare people into opposing H.R. 5 through a campaign of misinformation is wholly inappropriate. Based on her writings, I can only come to one conclusion:
Attorney Joanne Doroshow’s writings demonstrate misandry more than medical malpractice caps demonstrate misogyny.
Tsk. Tsk. Tsk.
Posted in Medical-Legal, News Commentary | 9 Comments »
Thursday, March 8th, 2012
 Someone forwarded my the link to this story about a Connecticut woman who filed a multi-million-dollar lawsuit against a hospital and emergency physician for failing to diagnose pulmonary emboli which ultimately killed her husband.
According to the article, the patient went to Stamford’s Tully Hospital emergency department complaining of flank pain. The emergency physician performed a CT scan on the patient’s abdomen “without performing further testing” and then discharged the patient home.
Nine days later, the patient returned to the emergency department in critical condition with blood clots in both lungs. He died the following day.
It is hard to comment specifically about the case without knowing more facts. However, in general, pulmonary emboli are notoriously difficult to diagnose. We do a lot of chest CT scans looking for them, and a vast majority of the time the chest CT scans come back normal. Of course, after the negative result is known, then everyone accuses you of ordering an “unnecessary test” to look for a pulmonary embolism, but that’s another topic for later discussion. So in a patient who comes to the emergency department complaining of flank pain, a blood clot in the lungs is probably not going to be near the top of any reasonable physician’s differential diagnosis list. Flank pain is usually due to kidney problems and the kidneys are in your abdomen at about the level of your belly button. The pulmonary emboli that kill people lodge in the central parts of the lungs, in the center of the chest just to the sides of the heart. See the diagram.
The thing that really bothered me about the article was that the plaintiff’s attorney, Craig Yankwitt, from the Stamford law firm of Silver Golub & Teitell, was quoted as saying:
“They were simply not permitted to discharge without ruling out whether he was suffering from a life-threatening condition.”
This is ridiculous confabulated unsubstantiated calumny. And the purpose of this calumny is to try to bolster the retrospective claim that Mr. Yankwitt will try to use to make millions of dollars:
“Had they performed the additional testing, Mr. Hermann would still be alive.”
There is no rule that a physician or hospital is “not permitted to discharge” a patient without ruling out whether the patient is suffering from a life-threatening condition. To require so would demand perfection in medicine: Doctors are not allowed to miss any life threatening conditions ever, regardless of how obscure or tangential the complaint. Think about if this really were the case.
You come to the emergency department with pain when you urinate and a little bit of blood in your urine. Sounds like a simple UTI … but wait, we are “simply not permitted to discharge you without ruling out whether you are suffering from a life-threatening condition.”
Your could have a pulmonary embolism. That is a life-threatening condition. According to Mr. Yankwitt, you can’t be discharged until a pulmonary embolism has been ruled out. We’ll have to do a CT scan of your chest before you can be discharged.
Kidney cancer is also a life-threatening condition. Add a CT scan of the abdomen and pelvis to the list of tests.
And you *could* be suffering from brain cancer. That’s a life-threatening condition. According to Mr. Yankwitt, you can’t be discharged until that potential life-threat is ruled out. May as well do a whole body CT scan and get it over with.
But wait, you *could* also be suffering from leukemia. That’s a life-threatening condition. We’ll need to get an oncology consult for a stat bone marrow biopsy just to “rule out” that life threat.
You could also have been poisoned by some unknown chemical. We should probably draw a few dozen tubes of blood and send them to the Mayo Clinic to rule out every possible poisoning “life threat.” Been exposed to any strychnine lately? We’ll have to test for that before we’re “permitted” to discharge you. Looks like you’ll be in the emergency department for a while until the tests come back.
Oh, and you *could* be suffering from a Naegleria fowleri infection. That’s verylife-threatening and it doesn’t show up on CT scan. We’ll call the neurosurgeons for a stat brain biopsy as soon as the oncologists are done with you.
By this time, we’ve increased your risks of cancer from all the extra radiation, have increased the risk of a bad outcome from performing surgical procedures, have left a hole in your brain, and have caused you to incur tens of thousands of dollars in extra testing … and we haven’t even scraped the surface of all the “life-threatening conditions” that we allegedly must rule out before we are “permitted” to discharge you.
According to plaintiff attorney Craig Yankwitt’s logic, we’d have to do this testing on every person who comes to the emergency department – even if it was for a hangnail – because we are “simply not permitted to discharge without ruling out whether [patients are] suffering from a life-threatening condition.”
When you wonder why physicians perform low yield testing and why defensive medicine abounds, think of plaintiff attorneys like Craig Yankwitt who perpetuate medically unjustified myths and who use hindsight bias as a means to become wealthy.
Posted in Defensive Medicine, Medical-Legal | 22 Comments »
Wednesday, January 25th, 2012
Want more evidence about how many people expect perfect outcomes in medical practice?
Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro.
As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and treat their problems. Said patients then went to a “mecca” to have their workup completed where … amazingly … the problem is “discovered” and “properly” treated. Even though the initial provider in all likelihood would have done the same testing that the “mecca” performed after reviewing the results of the initial testing – had the patient stuck around long enough to have the testing performed. Even though the “standard of care” may have been to do things exactly the way that the initial provider was doing them. Nope, they’re wrong because they didn’t get to the answer sooner.
When reading about all these “errors” I couldn’t help wondering: Did Ms. Landro have a neutral physician review the patients’ medical records to see whether the care provided to the patients was appropriate? Did Ms. Landro interview the initial treating physicians to determine what the next step in their treatment plans would have been? If so, she kind of left those points out of her article.
I understand the idea that second opinions can be useful and I agree that misdiagnoses are sometimes made. Until we find a single test that is 100% sensitive and 100% specific for diseases such as cancer or complaints such as abdominal pain, there will always be misdiagnoses made. Even once a diagnosis has been made, there are disagreements about how to proceed with treatment. Some prefer one medication for treating certain types of cancer, some prefer another medication. Does that make one side “wrong” and the other side “right”? Hardly.
The title of this article and the slant of this reporting make it appear as if doctors are “wrong” just because they don’t make a diagnosis after the first round of testing. Did Ms. Landro even explore how often the “meccas” get their diagnosis “wrong” on the first visit? Are the “meccas” that much better?
If patients want to mortgage their house to get the tens or hundreds of thousands of dollars necessary for a “down payment” at MD Anderson (original link to WSJ article here) or some other “mecca” when they likely would have gotten similar testing done had they stuck with their initial providers, that’s free market medicine at work.
When journalists imply that excluding diseases on a list of differential diagnoses in the midst of a workup or coming up with “inconclusive” results during testing is “wrong”, shouldn’t we start looking into journalistic malpractice?
What if the Journalist is Wrong?
Posted in Medical-Legal, News Commentary | 9 Comments »
Friday, October 28th, 2011
I just read an article in American Medical News about medical malpractice insurance costs. Included in the article was a small graphic about how much internists pay for medical malpractice insurance.
Internists in Dade County, Florida paid medical malpractice insurance premiums that were 1400% higher than internists in the state of Minnesota. Illinois internists in Chicago paid more than 12 times as much in malpractice insurance premiums as their Minnesota counterparts. In other words, internists in select Florida and Illinois counties pay more for malpractice insurance in one month than internists in the state of Minnesota pay for an entire year.
There are similar premium disparities for general surgeons and obstetricians, with Long Island, NY and Las Vegas NV also consistently being on the list for high malpractice premiums
Does that mean that the Florida and Illinois physicians were 1200% to 1400% more negligent than doctors in Minnesota? Doubtful. It just means that Miami, FL; Chicago, IL; Las Vegas, NV; and Long Island, NY are places where insurance companies have determined that it is much more risky to practice medicine.
When doctors search for the best states in which to practice medicine, they should consider the medical malpractice environment when making that decision. Given these statistics, doctors should not practice in Miami, Chicago, Las Vegas, or Long Island if they want to reduce their medical malpractice risk.
Yet Florida lawmakers reach out to news stations and claim that the state “desperately needs more doctors.”
Suing your way to better health care doesn’t work very well, does it, Senator Nelson?
Posted in Medical-Legal, News Commentary | 6 Comments »
Monday, October 3rd, 2011
More medical news from around the web at the Satellite Edition of this week’s update on ER Stories …
Australian emergency physician punches and slaps restrained patient who spat in his face. He was terminated from his position. A court held that the termination was unfair. Australian doctors considered going on strike after learning how the doctor was treated after the incident.
When you read the comments section of articles describing patients who assault emergency department staff, many people seem to think that staff should accept abusive behavior due as being “part of the job.” Shouldn’t patients therefore accept abusive behavior from medical staff as being “part of the visit”?
A view of medical malpractice reform misconceptions from physician-attorney William Sage. I disagree with several of his premises. For example, one question Dr. Sage asks “How likely is it, really, that ‘sinister forces’ outside [of medicine] are the reason why tens of millions of Americans lack access to services, or why even those who can afford it often get mediocre care at inflated prices?”
Ask physicians who don’t provide care to patients with certain government insurance plans and who stop taking emergency call or stop performing certain procedures (such as brain neurosurgery) due to liability concerns. Ask doctors who won’t or can’t prescribe medications that are safe through billions of prescriptions because the FDA issues a black box warning that the drugs might have caused adverse reaction in one millionth of a percent of the people receiving them. Then ask patients who can’t afford to purchase certain drugs such as albuterol, colchicine, or (soon to be) Primatene Mist because drug companies jacked up their prices based upon a governmental technicality in approving the medications.
Nah. No “sinister forces” here.
Recent Massachusetts Medical Society survey shows many interesting findings. Specialties in critical short supply included internal medicine, urology and psychiatry. Primary care specialties had severe shortages for 6 straight years. More than half of physicians would be unwilling to participate voluntarily in either global payment programs or accountable care organizations. Oh – and “the fear of being sued continues to be a substantial negative influence on the practice of medicine, affecting access to and availability of physician services.”
Nah. No “sinister forces” here, either.
Another timely rebuttal to some assertions in Dr. Sage’s article. Study in Archives of Internal Medicine shows that 42% of physicians believe that their patients are receiving too much care. Guess what factor contributed to more aggressive care in 76% of cases. Click this link to find out. Hint: “Sinister force” alert.
CMS coming out with bundled payment plans for 2012. Look for the pendulum of clinical care and testing to swing the other way. And look for more people to accuse “greedy doctors and hospitals” of limiting care in order to make more money when, in reality, the government is limiting care through underpayments to providers.
Another reason that getting a ZeePack for your cough might not be a good idea (aside from the fact that it won’t work) … it might cause you to get Crohns disease or ulcerative colitis. Twelve percent of patients diagnosed with Crohns or UC had been prescribed three or more doses of antibiotics in the two years prior to their diagnosis. Only 7% of patients who had developed Crohns or UC had not been prescribed antibiotics. In other words, people prescribed frequent antibiotics were up to 50 percent more likely to get Crohn’s disease or ulcerative colitis within next two to five years. My guess is that they were more likely to get MRSA and C. difficile as well. Study abstract here.
More Florida shenanigans. Physicians Regional Medical Center in Naples, FL has tells specialists that they have to take call for the emergency department in both the system’s hospitals or resign. Many doctors call the hospital’s bluff and resign or change to inactive status. Now emergency patients have less access to specialist care. The comments section has many people blaming “greedy doctors” for the problem.
This case was from last year, but still surprised me. A physician was sued and settled for $500,000 after failing to recommend a pneumococcal vaccination.
Excellent post over at ACP Internist about the costs of medical malpractice.
LA Times reporter gets a glimpse of an evening in one of the busiest emergency departments in the country. Read her story here. Then read the comments section for insight into how “illegal aliens” are causing the problem. The multimedia presentation also has some great pictures.
$4.9 million awarded to patient who suffered brain injury in hospital.
$4 million verdict against emergency physician who diagnosed a 42-year-old patient with “chest pain of unclear cause and bronchitis.” Patient found unresponsive at home 11 days later. Jury decided that a more thorough examination in the emergency department “would have revealed warning signs of an impending heart attack.”
Finally, if you want to learn a more about evidence based medicine, go check out Graham Walker and company’s site at TheNNT.com (the number needed to treat). Lots of new studies and interesting information that is in an easy to understand format for physicians and patients.
Posted in Access to Care, Defensive Medicine, Healthcare Update, Medical-Legal | 10 Comments »
Friday, September 16th, 2011
Get ready for a “black box” warning on Zofran.
The FDA has just issued a “safety alert” stating that Zofran may now be potentially deadly.
The FDA is now recommending ECG monitoring in patients who receive Zofran who have potential “electrolyte abnormalities (e.g., hypokalemia or hypomagnesemia), congestive heart failure, bradyarrhythmias, or in patients taking other medications that can lead to QT prolongation.”
After all, Zofran has now gone generic like previous anti-nausea medications that have also received black box warnings. The FDA approved Zofran for use in 1991, meaning that Zofran has been on the market for twenty years.
Now, through diligent research, the FDA has decided that that Zofran may cause QT prolongation — just like most of the other anti-nausea medications. As a result, GlaxoSmithKline has been ordered to perform studies to determine whether Zofran could prolong QT intervals, and, if so, to what extent.
Since the FDA states that it has been performing “ongoing safety studies” … for the past twenty years … why doesn’t the FDA actually publish the results of those safety studies that led to the posting of its alarming “safety notice”?
Now we have one less medication in our armamentarium to treat nausea and vomiting. I suppose we can always give ginger root until that gets a black box warning, too. It’s only been around for a few centuries.
Whoa. I think that my heart just skipped a beat. Reading FDA safety notices may have caused me to have QT prolongation. I think that we need to put black box warnings on FDA safety notices and no one should read them without proper EKG monitoring.
Who do we get to study that?
Posted in FDA, Medical-Legal | 51 Comments »
Saturday, September 3rd, 2011
Yet another reason to stay away from Florida if you are a physician. The inspectors and health care agencies down there leave quite a bit to be desired.
The Florida Agency for Healthcare Administration cited an emergency department’s staff for failing to give “adequate care” to 13 week pregnant patient before she had miscarriage of twins.
The timeline of events for the patient was outlined in this article.
At 9:45 a.m. the patient came to the emergency department with pelvic pain and vaginal bleeding.
At 10:30 a.m., the patient was diagnosed with pain and bleeding, a urinalysis and a battery of blood tests ordered, but there was no test ordered that would have revealed her glucose level. There was also no discussion of whether to discontinue or maintain the patient’s insulin pump. Ultrasound tests were ordered, then changed, which “caused a delay.”
At 11:45 a.m., the patient was bleeding heavily and was “in obvious labor” according to state inspectors. The ultrasound scan showed both fetuses had normal heart rates. The state inspectors stated that the emergency physician “failed to initiate any immediate response to the ultrasound report, the patient’s continued labor pains and the profuse bleeding.”
At 12:25 p.m., the physician performed a pelvic exam and suctioned some large blood clots from the vaginal canal. The patient then “spontaneously aborted one of the fetuses.” Inspectors noted that the patient was not informed of any risks of performing a pelvic exam, nor did she give informed consent for the pelvic exam.
A second ultrasound was ordered.
By 2 p.m., the second ultrasound showed a normal heartbeat in the remaining fetus. At that point “the doctor took no steps to stop labor or maintain the second pregnancy.” Additionally, the emergency physician’s report showed that the second fetus had no heartbeat, which conflicted with the radiologist’s report.
At 4 p.m., the patient’s blood-sugar level was measured and found to be “critically low.” She then received orange juice and IV dextrose.
At 5:30 p.m., an obstetrician arrived and performed a pelvic exam. He ordered no additional procedures or medications.
At 6:15 p.m., the woman passed the second fetus.
The inspectors stated that the physician failed to monitor blood sugar levels, failed to respond to the patient’s bleeding and pain, and failed to intervene to stop her labor.
In eight of ten other cases that inspectors reviewed, the hospital was cited for failing to document the amount of the patient’s blood loss, failing to record vital signs, and failing to record other case information.
We need more information about the other cases, but even without extra information, I’m still calling out the inspector and the Florida Agency for Healthcare Administration. Many of these citations are uninformed and inappropriate.
#1 No discussion documented about whether to continue or discontinue the patient’s insulin pump.
Such discussions are rarely held in the emergency department. Should the patient’s blood glucose have been checked sooner? Probably. However, if a patient is not having symptoms suggestive of low blood glucose, how often should the glucose level be checked — especially with an unrelated complaint? Should hospitals be cited when glucose levels aren’t checked in a diabetic patient with an ankle sprain or laceration?
#2 The emergency physician “failed to initiate any immediate response to the ultrasound report, the patient’s continued labor pains and the profuse bleeding.”
How much bleeding was there? What were the patient’s vital signs? Notice how the report is vague about the findings? Also notice how the report doesn’t state what the emergency physician should have done, and only made vague accusations about what the emergency physician didn’t do? Expert testimony like this in court would be tossed. In state investigations, it is apparently normal procedure. The treatment of bleeding during a miscarriage is generally either letting the fetus pass or performing a D and C.
#3 The patient was not informed of the risks and benefits of performing the pelvic exam and did not give informed consent.
This citation is so far out in left field, that it makes me wonder whether the inspector knows anything about medicine. It also puts the emergency physician in a no-win situation. Let’s say that the patient doesn’t consent to a pelvic exam – even though she’s having vaginal bleeding. Then the physician would have been cited for failing to do the pelvic exam.
But the physician didn’t discuss the risks and benefits of pelvic exams? OK, oh wise state inspector … what are the risks and benefits that the physician egregiously failed to discuss? Again, you and your department allege error, but then fail to provide all of us other dangerous physicians with the proper procedures to use.
Then there was no consent on the chart. The concept of “implied consent” is well established. If a patient with a gyne problem is told that the physician wants to perform a gyne exam and she gets up in the stirrups, chances are pretty good that she has consented to the exam. But, oh wise state inspector … what procedures require consent and do not require consent? Educate all of us dangerous practitioners. While you’re at it, give us some shred of written documentation that supports your assertions.
#4 After the patient passed one fetus, “the doctor took no steps to stop labor or maintain the second pregnancy.” This has to be the nadir of medical misinformation. Most pre-med college students know that a fetus is not viable until roughly 24 weeks of gestation. If a woman is having labor with a gestation less than 20 weeks, it is called a miscarriage. There is no treatment to save the pregnancy. A 13 week fetus is never, and will never be, viable outside of the uterus — unless the patient is a lion or some other member of the animal kingdom with a short gestation.
So, oh wise state inspector, exactly how should medical personnel “intervene” to stop the labor of a patient who is 13 weeks pregnant? You’ve accused the medical staff of doing something wrong, what should they have done different?
To illustrate the problems in lay terms, imagine being arrested for failing to drive the correct speed. You aren’t told what the correct speed is, you just have to pay a fine because you weren’t driving the correct speed. You have to apologize and promise to drive the correct speed in the future in order to keep your driver’s license.
Or imagine that you were arrested for failing to properly raise your child. No allegation as to what you should have done different, only the assertion that what you are doing is wrong.
These are they types of allegations that the inspector is making against the medical staff in many of these instances.
I hope that everyone realizes the significant effect that “investigations” such as this have on the access to medical care in the communities.
Doctors are publicly accused of inappropriate medical care.
The public trusts that the publicized accusations are accurate … when they may not be accurate.
Public perception that medical care at a hospital or by a caregiver is “bad” then increases.
Hospitals then increase expenditures to correct the publicized “bad” care and to comply with inane and unsubstantiated governmental citations.
Fewer funds are then available to provide medical care.
More doctors leave the state or leave medicine entirely because they’re sick of the administrative burdens.
More hospitals close.
Less care is available.
Safety is paradoxically worsened because fewer providers are available to manage patients.
Oh and throw in some unjustified lawsuits as well. You know that if a governmental agency states that doctors “didn’t do anything” to stop a patient’s 13 week old miscarriage, however uneducated and inappropriate the statement may be, the patient is going to believe that she was wronged and will find a malpractice attorney to file a suit against the physician.
Don’t take this post as me advocating for less oversight of medical practice in the states. I fully believe that there needs to be oversight of medical care and that dangerous physicians need to either improve or have action taken against their licenses. Investigations need to be based in sound medical practice, though.
The issue I have here is that the investigator in this case made multiple vague unsubstantiated and medically inappropriate opinions about several providers’ care and those opinions were taken as fact when instead they should have been recognized largely as calumny. Based on the investigator’s calumny, the hospital was cited and the medical practitioners were publicly chastised. I’d bet that there was action taken against the providers at work as well.
By the way, if someone can get me a copy of this inspector’s actual report, I’d love to post it for further discussion.
Yep, between the “three strikes” rule, the criminalization of medicine, the high medical malpractice premiums, and the quality of the state inspections, doctors would be plum crazy to practice medicine in Florida right now.
Sorry, Senator Bill Nelson, things like this are going to drive doctors away from a state that “desperately needs more doctors.” Have fun rearranging the deck chairs on your Titanic, though.
Posted in Medical Topics, Medical-Legal, Medicare, News Commentary | 8 Comments »
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Anna Brown And Appropriate Emergency Medical Care
Tuesday, April 10th, 2012A patient named Anna Brown was unhappy with the care she received at several hospital emergency departments. When she was discharged from the last emergency department, she refused to leave. Police were called and the patient was carried to a police car. She said that she couldn’t walk. Police took her to jail, carried her into the cell and left her laying on the floor. About an hour later, she was still laying there … dead.
From the public’s point of view, the case appears outrageous. But as I read through the description of what happened and thought about what could have been done different, from a physician’s point of view, I’m not sure what else could have been done.
Christine Byers wrote an excellent article describing events that took place, and then wrote a follow up article in which the hospital defended its care. I’m hoping that the St. Louis Post-Dispatch commends her for her work. She did a great job with the stories.
Background
A summary taken from Ms. Byers’ article shows that Anna Brown was admitted to the hospital for spraining her ankle while walking near a ditch. EKGs, blood tests, and lab work were performed. Ms. Brown was in the hospital from Sept 13 to Sept 15 and then discharged. She walked on crutches after her discharge.
(more…)
Posted in Medical-Legal, News Commentary | 43 Comments »