Hospital Ratings Draw Skepticism, Debate

The medical community is strongly ambivalent over new Medicare statistics that rank hospitals based on certain quality criteria which makes some of the most prestigious hospitals in the nation seem to be some of the most ineffective.

Hospitals Disregard Charity Care Law; NY Times Reports

According to the NY Times, hospitals nationwide and specifically in New York are skirting a law designed to offer health care for the most unfortunate emergency cases without insurance.

How Do You Prove Liability in a New York Medical Malpractice case?

You might think you have the greatest case in the world but if you are unable to prove that there was wrongdoing, you'll never achieve a successful result.

New Hospitals Collective Seeks to Improve Services on LI East End

An association of hospitals known as the Physician Hospital Organization (PHO) is being set up on the east end of Long Island.

Why do Upstate Doctors Pay Less for Medical Malpractice Insurance Than Do Downstate Doctors?

A new study by Excellus BlueCross BlueShield has released a report that pegs liability insurance costs for doctors in the New York City area are 3.5 times

New Study Links Acid Reflux Rx to Bone Fractures

A new study confirms prevailing opinion that proton pump inhibitors, or PPIs, render the user more susceptible to bone fractures. Proton pump inhibitors are med

Bullying a Cause of Medical Errors; Report on NY Times Op-Ed Piece

An important, yet often overlooked cause of medical errors is workplace bullying, a phenomenon that is tackled in a NY Times weekend op-ed by practicing nurse

Hospital bigwigs earn big bucks while your health insurance premiums skyrocket

Do you think there's any correlation between your ever-increasing health insurance premiums and the fact that hospital administrators are earning millions of do

Diabetics: Top 10 Strategies for a Successful Vacation

When you have diabetes, being prepared on vacation can mean the difference between a great vacation or a miserable one. So how do you plan your travel? Listed here are 10 methods for traveling if you have diabetes: 1. Keep your supplies readily available. Whether you're traveling by plane, train, or automobile, be sure your diabetes supplies are easily accessible. If you are flying, make sure you put all of your supplies inside your carry-on bags. Back-up insulin also needs to be placed inside your carry-on, because checked baggage might be subjected to extreme cold or heat which could spoil insulin, and ruin glucometers. In case you are employing a device to maintain your insulin cool, be sure it's a cold pack, and never a freezer pack--freezing insulin destroys its usefulness. The identical rules apply for storing supplies while driving or on the train.

Is this the end of medical malpractice lawsuits in New York?

Today, Renal and Urology News reported that five hospitals in New York city would be participating in a $3 million dollar, federally funded program to reduce medical malpractice errors. That's a good start. Here are some of the details. Beth Israel Medical Center, Mount Sinai Medical Center, Maimonides Medical Center, and Montefiore Medical Center will focus their efforts on reducing errors in obstetrics. The fifth hospital, New York Presbyterian Hospital, will focus on the prevention of surgical errors.

Medical Practice Guidelines-Are They Useful?

Guest Post by California Emergency Medicine Physician Charles Pilcher, M.D.

The Institute of Medicine has been an advocate for clinical guidelines for many years. Although the value of guidelines has never really been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve.

 

A few years ago Dr. Robert Ewart discussed the ethics of using guidelines to screen patients for medical conditions in a review entitled “Primum Non Nocere and the Quality of Evidence: Rethinking the Ethics of Screening” (J Am Bd Fam Pract. 2000:13(3):188-196). Dr. Ewart concluded that many of the “guidelines” in use at that time had insufficient evidence to be used as a standard for clinical practice. He pointed out that there is a marked difference between “investigation” (seeking to better define a known problem) and “screening” (seeking to find if there is a problem) in terms of four ethical principles: beneficence, nonmaleficence, autonomy, and distributive justice. Since the healthy bear the harms of screening, nonmaleficence takes ethical precedence over beneficence in individual cases. Both the cost of and the consent for such screening programs for both the individual and society have ethical implications and differ for screening vs. investigation. This review/essay is worth the consideration of attorneys, especially, for example, those who may be involved in situations where “loss of chance” is an issue.

Now, Dr. Pierluigi Tricoci et al. have revisited the value of clinical practice guidelines in an article in JAMA, (JAMA. 2009; 301(8): 831-841). While guidelines published by the American College of Cardiology and the American Heart Association have become important benchmarks for quality of care, the vast majority are based on inadequate evidence or biased expert opinion. They find that the evidence from which clinical practice guidelines are derived as well as the process of writing guidelines needs improvement.  A variety of print and online media provide more comprehensive analysis. Check out the articles in the Wall Street Journal, Bloomberg News, and USA Today.

In an accompanying editorial titled “Reassessment of Clinical Practice Guidelines: Go Gently Into That Good Night” (JAMA, February 25, 2009. 301(8):868-869), Dr. Terrence Shayneyfelt and Robert Centor find that:

Guidelines have become marketing and opinion-based pieces with a widely recognized financial bias.

Guidelines are being developed and used as “marketing tools for device and pharmaceutical manufacturers.”

As many as “87% of guideline authors had some form of industry tie.”

• Guidelines need greater individualization for specific patient situations.
• The guideline development process needs major changes to prevent conflicts of interest, reduce bias, improve flexibility and decrease redundancy.

In summary, they state that “clinical guidelines are supposed to be guides, not rules.” Because one size does not fit all patients, the authors suggest that “perhaps guidelines should be avoided completely,” and add that, given the present state of guidelines, “clinicians and policy makers must reject calls for adherence to guidelines. Physicians would be better off making clinical decisions based on valid primary data.”

They conclude that, because of the disarray found in guidelines, many clinicians (appropriately) do not use them.

Nor, in this editor’s opinion, should malpractice attorneys for either plaintiff or defense use them as a place to hang one’s hat.

About Chuck Pilcher

Chuck provides expert witness review and testimony in medical malpractice cases related to the fields of emergency medicine, urgent care, EMS and general inpatient and outpatient hospital practice.

Experience:

He has 35 years or experience as an emergency physician, most of those years as Medical Director of a now 50,000 visit per year suburban Emergency Department. Board certified in both Emergency Medicine and Family Medicine, he has has helped both plaintiff and defense attorneys with malpractice litigation for over 25 years. He is proud that attorneys on both sides have found his assistance valuable, and is especially honored when he has been retained by opposing counsel in a subsequent case following a deposition or trial. His CV can be found here.

Charles A. Pilcher MD FACEP

MRSA Infections-Are They a Big Deal?

There’s lots of recent hype about infections with MRSA (methicillin resistant staphylococcus aureus). The media uses that hype to sell ad space, but for the medical profession it’s old news. Here’s a reality check: Many of us are infected with MRSA already and don’t know it. Blame your friends, blame your family, but it ain’t always the doctor’s fault. As a medical student many years ago, one of my tasks was doing cultures on my patients. Lots of germs would grow, some bad, some common and innocuous. Out of curiosity one morning at Harborview Hospital in Seattle, I decided to culture the floor of the nurses station. Picking an area near the baseboard where I thought germs would likely be lurking, I did a swab and submitted it to the microbiology lab. Expecting to find a veritable menagerie of single-celled killer bacteria, I was surprised a few days later to find that the only things growing were 3 colonies of common staph. Is the hospital really a bastion of infection? Or is the housekeeping staff that good?

Filing Complaints against Hospitals: How to Be an Effective Advocate

Many hospitals consistently provide quality care to their patients, but there are always instances where certain individuals don’t receive the professional attention they deserve. This is to be expected in any business, but in hospitals, the consequences can be more serious and could lead to life-threatening situations. Hospitals also present more difficulty because patients are not always in a sufficiently stable mental or physical state to be their own care quality advocates. The following are steps to be taken by patients or their family members and should serve as a guide to proceeding through the proper channels to achieve fast and effective results.

Child Chemotherapy Mishap

Most of us have had a family member or loved on go through a battle with cancer. While some people are fortunate enough to be victorious, others are not. Although most cancers affect people later in their lives, some people face the disease while they are still children. Children who suffer from cancer have some things working in their favor, namely their energy and ability to quickly recover from trauma. However, their smaller bodies make administering medicines such as chemotherapy more difficult.

Diseased Heart Transplant

“New Heart, New Problems” Organ transplants are a medical advancement that has saved countless lives. For people on an organ transplant list, waiting to receive a heart, kidney, lung, etc. can be one of the most anxious periods in one's life. After all, successfully receiving an organ often means life itself. But even after an organ becomes available, there are still risks involved in the procedure, and even after the procedure, in post-op care. Despite these inherent risks, patients almost always opt for the chance at a healthy life rather than the certainty of death.

Residents Performing Unsupervised Operations

What happens when doctors-in-training perform surgery unsupervised? Think it doesn't happen? Think again. As more hospitals cut back on expenses, training and personnel, who do you think suffers the most? The nurses? The technicians? The doctors? Wrong. The patient suffers. Read the article to learn why.

Gerry Oginski wins $1.5 Million Verdict in Podiatry Malpractice Case

On Friday, July 23, 2010, a Westchester County jury in the Supreme Court of the State of New York determined that my client, Annemarie Flannery was entitled to be compensated $1.5 million as compensation for injuries caused by a podiatrist during bunion surgery. Her husband, David Flannery was entitled to be compensated $50,000 for his lost services claim. The case involved a claim of a failure to properly perform foot surgery involving my client's bunion on her right foot. It was our claim that the podiatrist removed too much bone during the procedure, and improperly positioned the first metatarsal. As result, this changed the dynamic forces of her foot and forced her to bear most of her weight underneath the second and third metatarsals in her foot. We also claimed that the patient should have had her second and third metatarsals surgically shortened during her first bunion surgery. This would have prevented the problem from arising.

NY Medical Malpractice lawyer has solution for medical malpractice

Have you ever wondered why there's so much friction between lawyers and doctors? Doctors don't like lawyers, believing that we are evil and only look to sue undeserving doctors. Lawyers believe there are doctors in practice who are truly harming patients. The friction can be palpable. One smart lawyer has the answer that will solve the problem...

Mysterious Pain or Telltale Sign? Should Doctors be Liable for Failing to Diagnose Illnesses?

What is the most important tool in communication? Speaking? Writing? The most important tool in communication is listening. When patients communicate with their doctors, this is what they should be focused on, listening. Doctors are taught in medical school to listen carefully to what complaints the patient has since the patient is in the best position to tell them what’s going on.

Why Getting Sick at St. Vincent's Hospital In New York City May Be Hazardous To Your Wealth

Did you know that getting sick and going to a hospital that has declared bankruptcy may be hazardous to your wealth? It's true. Here's why: In cases where you are injured by a doctor or hospital, your only recourse is to bring a lawsuit to recover compensation for your injuries. When the hospital has declared bankruptcy, it is impossible to bring a lawsuit against the hospital until the bankruptcy proceeding has been completed. Declaring bankruptcy means that the hospital does not have enough money to pay their bills; similar to a personal bankruptcy. Where a hospital is self-insured, which means that they do not buy malpractice insurance from an outside company to pay any judgments or settlements arising out of a lawsuit against them. Instead, they set up a fund (where they are self-funded) and set aside money in the event they have to pay out money for any lawsuits; both accident cases and medical malpractice cases.

New Jersey Lawyer Liable for Not Telling Medical Malpractice Clients of Settlement Offer

According to Law.com, a Mercer County, N.J., jury on March 22 found veteran litigator Gerald Stockman liable for legal malpractice for failing to convey a $400,000 offer to clients in a personal injury case, which ended in a verdict substantially lower.

Any attorney who handles personal injury cases has an obligation and ethical responsibility to convey to their client any offer that is made to them by the defense. It is then the attorney's obligation to discuss with them the merit and value of the offer. Ultimately, is the client's decision about whether to accept or reject an offer. However, like with many things, it's all in the presentation.

What do I mean?

I will often be questioning a doctor and ask how they presented the treatment plan. The doctor will usually say that he made various recommendations, and ultimately it was the patient's choice about which procedure to choose. This explanation usually rings hollow since most patients do not have any medical knowledge and rely entirely on the physician to make a recommendation.

There is a big difference between a doctor saying "Don't worry, we're going to do this procedure, and you'll be fine." Compare that statement to "You have the following three alternatives in this situation; you can do procedure number one, which has the following risks and benefits, or you could do procedure number two which has these limited risks or you could do procedure number three which has no risks. Which would you prefer?"

Likewise, when an attorney presents a settlement offer to their client, it's all about the presentation. An experienced attorney will tell the client about the settlement offer, then give his advice about what they think of the offer and whether it should be accepted. The client will then make a decision. Often, the client relies on the attorney to offer professional advice and experience since they have been in this position many times before.

In this case, there was a clear dispute between the experienced medical malpractice attorney in New Jersey, and the client's recollection of events immediately after trial. A jury listening to the legal malpractice case evidently believed the victims and not their attorney.

In cases that have significant settlement offers, a good attorney will often put their client on the witness stand, outside the presence of the jury, and under oath, ask their client whether they have been advised of the large settlement offer, and whether they are rejecting it of their own free will. This protects the attorney in the event a verdict comes in for less than the offer or, a verdict comes in for the defense. This way, the client can never turn around and say that he or she was never told about the settlement offer.

MEDICAL MALPRACTICE IN NEW YORK; FACTS AND TRENDS

FACT: Patients sue doctors and hospitals. They’re unhappy with the outcome of a procedure; they’re upset because a doctor misdiagnosed their condition and now they have a permanent injury or disability. That’s a fact. However, the facts and trends show an entirely different story. Fact: Most victims of medical malpractice in NY don’t even know they’ve been a victim of improper medical care because nobody tells them.

HAVE YOU EVER HEARD OF A DOCTOR SAY "I'M NOT GOING TO ORDER A TEST OR PROCEDURE, BECAUSE IT COSTS TOO MUCH?

When two prominent physicians say in an editorial of a medical journal that they edit that robotic surgery, fetal surgery and cord blood collection has no proven benefit because it costs too much for healthcare, I can't help but wonder what agenda they have going on. Read the blog post to learn more about this outrageous editorial.

$2.9 Million Settlement for Death of 6 Year Old While in MRI

In a horribly tragic case in Westchester, New York, a 6 year old boy was killed while undergoing an MRI in 2001. A technician had been walking by with an oxygen cannister that should never have been in the area because of the powerful magnet being used. The cannister became a missile and struck and killed the little boy.

Excessive Radiation Kills 2 New York Patients

Today, January 24, 2010, the New York Times exposes two severe instances of cancer patients in New York, who died not of their cancer, but of excessive radiation doses to TREAT their cancer. This is a moving video.