Hospitals to Release Medical Mistake Data

September 10, 2014

12134671045_b3dbbf9f31_c.jpgEarlier this year the Centers for Medicare and Medicaid Services (CMS) stopped publically releasing mistakes made in hospitals, despite saying it would not do so. After public outcry CMS relented, stating it would again release the information by the end of 2014. Medical malpractice lawyers at Pintas & Mullins cannot overstate how important it is to have this information available to the public, both for patient safety and to keep hospitals and doctors accountable.

Among the information retracted related to eight types of hospital-acquired infections, which affect at least one of every 25 patients, and kill more than 75,000 people every year. Some of the most deadly infections spreading in hospital are:

• Clostridium difficile, or c.diff
• Bloodstream infections, such as sepsis
• Surgical site infections
• Catheter-associated urinary tract infections

CMS also stopped reporting how often doctors leave foreign objects in patients during surgery, when patients are given the wrong blood type, and other egregious medical mistakes that should never occur. These rare events that should never happen in hospital are referred to as 'never events' and rare as they are, they are critically important for consumers to know about when choosing a hospital or physician.

Why is Hospital Transparency so Critical?

There has been much media coverage recently on the safety and price comparisons between hospitals - specifically, how significantly they can range. Hospital pricing is extraordinarily convoluted and the largest driver of medical care inflation. This isn't news. The New York Times ran an 8-part series starting in June 2013 titled "Paying Till It Hurts: A Case Study in High Costs." The series covers eight different types of patients, from pregnancy to E.R. visits, attempting to uncover why the U.S. spends more money on healthcare than any other country in the world by far.

Nowhere is this more obvious and outlandish than in the pharmaceutical industry. Due to the never-ending aggression of the pharmaceutical lobby, the average price for a cholesterol drug like Lipitor in the U.S. is about $124. In nearly all other developed countries, the price of Lipitor averages around $6. Several studies conclude that, despite the large difference in pricing, Americans do not receive better medical care than patients in other developed countries.

That is another blog for another time. What this is meant to prove is why it is so incredibly important for patients to have access to medical data. In an opaque market with even more opaque pricing practices, patients need to research the hospitals they are considering for surgeries, births, and even vaccinations. This rings particularly true for elective surgeries, such as hip replacements, for which the average U.S. price is more than $40,000.

In a system where patients do not see prices (and are often told to "not worry about the money,") until after the service is provided, data on past pricing and quality is invaluable. Between doctors, hospitals, medical companies and insurance providers, very rarely is anyone looking out for the best value for the patient; in fact, all of these entities have incentives to drive up prices. This means that patients must look out for themselves, and the only way they can do that is if medical care data is publically available.

"Never Events" Actually A Daily Occurrence

Another so-called never event, leaving foreign objects in patients, actually occurs about a dozen times every day in the U.S. This can occur during any type of surgery, and most often involve the cotton sponges doctors use to soak up blood. The sponge may be small, but it can cause a host of serious health issues, from permanent loss of intestines to death. The average amount of a hospitalization caused by a lost sponge averages over $60,000.

One victim was recently interviewed by USA TODAY: Erica Parks underwent a cesarean section in 2010 and left the hospital with a queasy feeling in her stomach. One month later, she was swollen and her bowels shut down entirely. She was sent to the ER, where X-rays showed a large infected sponge left in her abdomen requiring a six-hour surgery to remove followed by three weeks in the hospital.

Making matters worse, there is no federal requirement for hospitals to report such mistakes, despite reports that foreign objects left in patients was in the most serious category of medical mistakes. This type of mistake is completely preventable, yet it continues to consistently occur every single day. While there are numerous technologies that exist to cut the likelihood of this type of mistake, few hospitals (less than 15%) actually employee them.

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Oral Cancer and Medical Malpractice

August 15, 2014

4747536941_b5435b1df0_b.jpgThroughout the country, patients are being diagnosed with oral cancers that should have been detected by their dentists. Overall, these patients are diagnosed at a young age, and suffer poor outcomes in their cancer treatment. Medical malpractice lawyers at Pintas & Mullins dive deeper into this issue and how unsuspecting Americans are being victimized.

Many different types of cancer can fall under the category of 'oral' including tongue, tonsil, throat, esophageal, and mouth. More than 43,000 Americans are diagnosed with oral cancer every year, and this number is only increasing. Most oral cancers are caused by one of three factors:

1. Excessive or long-term tobacco or alcohol use
2. Exposure to the HPV-16 virus (also the cause of cervical cancer in women)
3. Exposure to asbestos

About 7% of those diagnosed, however, have no identifiable cause other than genetic predisposition. Unfortunately, oral cancers are extremely hard to treat and therefore extraordinarily fatal when not caught early - about 43% of late-stage patients pass away within five years of diagnosis.

This is why early detection is so important, and such a critical responsibility for dentists and other medical practitioners. Dental professionals are the first line of defense against detecting and confirming oral cancer. Most Americans see a dentist every year, if dentists performed cancer screenings for their existing patients, it would allow thousands of cancer cases to be caught early.

The public can relate this to the importance of getting regular PAP smears, prostate exams, and mammograms, and how this has positively impacted early detection rates in the U.S. Current studies show that less than 15% of dental patients report having an oral cancer screening at their last checkup.

Medical Malpractice Lawsuits by Cancer Patients

One particular study by the University of Nebraska Medical center analyzed medical malpractice litigation in the U.S. Researchers looked at patients diagnosed with oral cancer who consequently filed malpractice lawsuits as a result of their diagnosis and treatment. They used data from jury reviews between 1984 and 2000, choosing about 50 cases to analyze.

Among the cases, researchers noticed that the average age of plaintiffs was relatively young (45 years), and nearly half died from the disease. Generally, the younger plaintiffs had better outcomes and won higher awards compared to older plaintiffs. The average jury award for younger plaintiffs was just over $755,000, while older plaintiffs averaged just shy of $500,000.

In 43 of the 50 analyzed cases, dentists, general practitioners or otolaryngologist (ear, nose and throat doctor) were accused of failing to diagnose the cancer. Other common allegations were failing to perform biopsies and failing to refer patients to oncologists. Ultimately, researchers recommended that medical professionals should set risk management goals to prevent delays in diagnosis.

In addition to early detection, public awareness is arguably the most important aspect of early detection. Speaking for hypochondriacs everywhere, it is easy to misdiagnose every lesion and abnormality as "cancer," however, oral cancer is actually quite difficult to detect. Most people have some type of oral conditions, such as cold sores, wounds and sores that can mimic pre-cancerous tissue.

It is important to remember to watch these areas over time. Any type of abnormality - whether it be a sore, irritation, swollen tissue, discoloration, or hoarseness - that does not resolve within two weeks should be examined further. Patients should notify their dentist, who should conduct a thorough cancer screening.

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The Problem with Children's Emergency Care

July 21, 2014

my-brave-boy.jpgAmerican parents expect the treatment their children receive - whether it's at school, day care or at the hospital - to be the best, most compassionate care. Unfortunately, the majority of doctors working in emergency care units have had only minimal experience, an average of four months, working with children. Medical malpractice attorneys at Pintas & Mullins further explain this problem and how American children are suffering the consequences.

Children are three times more likely to suffer a serious medication error than adults. Clinically, children are not just 'little adults.' Their metabolic rates are completely different, so medications dissolve at faster rates. Children often have undiagnosed allergies, and doses need to be adjusted for weight and other factors.

To help combat this, some hospitals are hiring staffs of full-time pharmacists in the ER to reduce medication errors and adverse events. Medication errors contribute to approximately 7,000 deaths in the country every year, and are particularly dangerous in children. The Children's Medical Center in Dallas, for example, was recently profiled on NPR for hiring ten new 24-hour pharmacists who specialize in emergency medicine.

The overriding issue, however, is that emergency room doctors are often young with little experience. Millions of children visit the ER each year, however, only one in ten children are able to see doctors with any real experience in pediatrics. The remaining 90% of kids are treated in general ERs, such as at community hospitals, where just four months of training in pediatrics is required.

Statistically, about 30% of ER patients are children; however, the education doctors receive in pediatrics represents less than 10% of their training. In 2006, the Institute of Medicine released a report titled "Emergency Care for Children: Growing Pains." In this report, the Institute describes the unique challenges facing emergency departments in their treatment of children.

Researchers involved in this project found that many general ER physicians feel much more stress and anxiety when caring for pediatric patients compared to adults. Too often, this causes doctors to under-treat and fail to stabilize children who are critically ill. Unlike adult patients, there are no established patterns for treating children in the ER, which leads to a wide array of treatments that may not always work.

Change is Coming

Fortunately, there are concerted efforts throughout the country aimed at fixing this problem. One of these programs, Improving Pediatric Acute Care Through Simulation (ImPACTS), conducted 200 fake pediatric emergencies in 25 emergency departments, the majority of which were in community hospitals. Their findings were alarming to say the least.

Among treatments for pediatric septic shock, only 13% of general emergency departments were compliant with treatment guidelines for children - compared to over 93% of pediatric EDs that were in full compliance. Community hospitals also showed severed deficiency in delivering life-saving fluids and blood pressure medications to children, and were much less likely to administer correct doses of other drugs or comply with other pediatric guidelines for life-threatening conditions, such as cardiac arrest.

So what can be done? Experts agree that doctors need to receive more education regarding pediatric emergency care in their formal training, including mandatory continued education for emergency medicine residents targeted specifically toward pediatrics. There has also been immense effort put into incorporating functioning partnerships between community hospitals and children's hospitals. Collaborations of this kind will allow constant information exchanges, including educational forums, emergency consultations, and opportunities for continued pediatric emergency medicine.

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Florida Wrongful Death Compensation Caps Reversed

July 2, 2014

8572607587_fff58574bf_c.jpgFlorida's Supreme Court recently struck down the state law limiting the amount victims of medical malpractice can collect for non-economic damages in cases of wrongful death. The original case was filed by the family of an Air Force pilot who died from complications while giving birth. Wrongful death lawyers at Pintas & Mullins take a closer look at this case, and what it means for Florida plaintiffs.

The pilot, 20-year-old Michelle McCall, was under the care of Air Force family medical personnel when she passed away, leaving her family not only with an immense loss, but significant medical bills and a newborn son without a mother as well. They filed suit against the medical unit, hoping to receive compensation for her wrongful death.

A Florida District Court determined that the family's financial losses amounted to over $980,000, and their non-economic damages (for grief, pain and suffering, and loss of a mother and daughter) totaled $2 million. Based on a Florida Statute, the court then limited the non-economic damages to $1 million, which was the cap for all wrongful death medical malpractice cases, regardless of circumstance.

The family appealed to the state's Supreme Court, which determined that putting a cap on the non-economic damages irrationally impacted situations, like McCalls, where there were multiple claimants. The Court further stated that the damage cap made it unlikely that those who suffered a devastating loss (or in cases where there are multiple survivors), the claimants would be not be fully compensated for their losses at $1 million.

Why Put Limits on Damages At All?

Proponents of placing caps on non-economic damages argue that placing limits on the amount plaintiffs can collect will reduce the amount of doctors' insurance, thus encouraging doctors to practicing in the state (conversely, higher malpractice insurance would deter physicians from working in the state). Despite years of politicians claiming this to be so, historical data tells us that non-economic damages caps in no way influence where a doctor will work.

This point was reaffirmed by the Supreme Court, when it noted that the number of physicians practicing in Florida actually increased during a recent period when juries were awarding large amounts to plaintiffs. The Court stated that the caps arbitrarily reduce the rights of medical malpractice victims.

In a case like McCall's where there are multiple claimants (her son, her parents, and her son's father), the $1 million would have to be split between all of them. This unjustly prevents all claimants from receiving compensation for their losses. What's more, the basis of these damage caps is largely irrational, as the relationship between non-economic awards and medical malpractice insurance is unfounded.

The Supreme Court wrote in its opinion that Florida's damage cap has the effect of saving a modest amount for many (the state's doctors) by imposing devastating costs on a few (those most severely injured). These grievously injured plaintiffs are subjected to division and reduction of their damages not based on the merits of their case, but simply because of the existence of this cap.

This Supreme Court decision was groundbreaking in many ways. First, and most importantly, it struck down statutory caps on non-economic damages in malpractice cases that resulted in a wrongful death. This means that those bringing malpractice lawsuits based on personal injury in general -where no death was involved - will still be subject to damages caps.

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Trouble at VA Hospitals Nationwide

May 15, 2014

5451372776_cb3fcbee8d_b.jpgFederal authorities are conducting a nationwide review of all VA facilities, though the Hines VA Hospital in Chicago is being singled-out after a whistleblower exposed fraudulent activity resulting in harm to patients. Medical malpractice lawyers at Pintas & Mullins dig deeper into this story and how patients have been affected.

The whistleblower was a social worker at Hines and alleged that a hospital executive - a man who is already under a cloud of suspicion - implemented a "secret waiting list" similar to schemes in other VA hospitals in the country. This waiting list kept names of veterans who were to be denied treatment in a scheme to hit fast treatment goals and collect bonuses.

This prevented hundreds, even thousands of veterans who were seriously ill or dying from getting the treatment they desperately needed. Veterans waiting for physical or mental treatment were forced to wait for weeks and even months, so executives could reap in bonuses.

Local Chicago veterans are devastated by this news, which demonstrates the utter lack of respect in hospitals designated to serve those who once risked their lives for our country. U.S. Attorney General Eric Holder, in response to this federal scandal, stated that the allegations, if true, are unacceptable and being taken very seriously by federal auditors. One local veteran stated that he typically has to wait one to four months for an appointment.

Illinois Senator Mark Kirk stated that the Inspector General, who is already conducting investigations in other VA hospitals accused of keeping similar lists, should immediately investigate Hines VA and provide a report as soon as possible. There will be Senate hearings on secret VA lists beginning Thursday, May 15, 2014, in Washington D.C.

Hines Hospital serves over 50,000 veterans every year. This scandal is not contained to Chicago - VA officials in Texas are concerned that some veterans passed away while waiting for treatments. Similar accusations are directed at the VA hospital in Phoenix, where about 40 veterans have died awaiting treatment and three executives are on administrative leave. Scandal is also stirring at the VA clinic in Fort Collins, Colorado.

Whistleblower Exposes Fraud

The Chicago whistleblower told reporters that employees were coming to her from almost all departments of this hospital, including surgery, inpatient, radiology, and outpatient, regarding the lists. When veterans called for an appointment, instead of logging their names into the computer system for the next available time, the patients were put on secret waiting lists, only formally booking them when an appointment came up within the VA's goal time of 14 days.

This was done because the VA grants bonuses to executives and doctors partly based on short wait times. Thus, patients were secretly waiting on these unofficial lists, to conceal delays in care to make Hines' numbers look better, and to collect cash rewards. This incentive program for 14 day wait times was implemented in 2011.

Many believe this practice is more widespread than just a handful of VA hospitals. The VA Secretary, Eric Shinseki, will be the first to testify during the Senate hearings this morning. Lawmakers are well aware that the VA is operated as a bureaucracy that often moves much too slowly, to the demise of its veteran patients. Shinseki recently ordered in-person audits of the scheduling systems at all VA medical centers in the country.

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New Study Confirms 440,000 Deaths from Medical Negligence Every Year

May 12, 2014

the-stethoscope-31.jpgFor many years, the federal government asserted a very conservative 98,000 Americans were killed each year by preventable medical errors. New studies are finding what many experts know to be true - the number is actually much, much higher. In fact, around 440,000 Americans are killed annually by physician, hospital or nurse errors. Medical malpractice lawyers at Pintas & Mullins dive deeper into these studies and why so many are killed my negligence.

The study was recently published in the Journal of Patient Safety and was conducted to update decades-old data and official opinion on patient deaths caused by error. The Institute of Medicine and medical professionals constantly state that less than 100,000 Americans die annually from medical errors, however, that estimate is based on data from 1984.

Researchers involved in this study compiled medical records and studies published from 2008 to 2011, ultimately finding that the true number of premature deaths associated with preventable harm to patients was over 440,000 per year. The amount of serious harm, but not death, done to patients was about 10 to 20 times more than this.

Those involved in this study called the prevalence of preventable medical errors an epidemic, and we hasten to agree. The reality of medical negligence needs to be taken much more seriously and publicly known if it is going to be reduced or curtailed in any way.

There are several interventions hospitals, patients and medical professionals can take to help lessen the frequency of medical errors. Among these include fully engaging patients and their families during hospital care, transparent and full accountability when mistakes do occur, systemically engaging with patients to identify precise injuries, and purposefully correcting the root of harm.

Medical errors cost our country tens of billions of dollars every year, yet federal and state legislatures limit accountability of doctors and place maximum amounts patients can receive from malpractice lawsuits. Not all states place damage caps on malpractice suits, but the ones that do (most notably California) leave patients at risk for more injuries from negligent care.

One in Three Hospital Patients Experience Medical Errors

One study published in the Archives of Surgery estimates that serious surgical mistakes occur about 40 times per week in U.S. hospitals. Serious surgical mistakes involve procedures performed on the wrong patient, on the wrong body part, or incorrect surgeries performed. These are also often referred to as "never events," because they should never occur in medical practice.

Medical care in the U.S. is extremely complex at all levels, and individual physicians generally do their best to optimize patient care. Guidelines and clinical research on how to apply optimal patient care quickly becomes out-of-date and is often biased, and the continuing education system for doctors is lacking. These among other factors are contributors to the knowledge and performance deficiencies in hospitals.

Patients can suffer injuries from medical errors immediately, or delayed for months or even years. For example, a patient may be injected with a drug using a needle contaminated by a harmful virus, like Hepatitis C, which may not be discovered until much later.

Continue reading "New Study Confirms 440,000 Deaths from Medical Negligence Every Year" »

Deadly New Orleans Outbreak leads to Questions on Hospital Safety

April 29, 2014

pediatric-polysomnogram.jpgSeveral children have died at the Children's Hospital in New Orleans after a horrifying outbreak of a flesh-eating fungus. The infectious fungus was spread by bed linens, towels and gowns, and new reports are raising serious questions about how the infections originated and why nothing was done to stop it for nearly a year. Medical malpractice lawyers at Pintas & Mullins look into the serious and dire issue of hospital-acquired infections.

The details of the deaths at Children's Hospital are gruesome. The first victim was a premature infant in the ICU who suffered an open wound from his groin to his abdomen. The most recent victim was a ten-year-old, who died with her face wasted away almost completely.

Other patients were forced to undergo dozens of surgeries to try to save their small bodies from the flesh-eating infection known as mucormycosis. The invasive fungal infection has an extraordinarily high fatality rate and primarily affects patients with compromise immune systems.

It took ten months after the death of the first victim for doctors to connect the dots between fatalities. Medical researchers identified the hospital's bed linens as the source that carried mucormycosis throughout the facility, where it came into contact with vulnerable patients and killed them between August 2008 and July 2009.

According to investigations, the infections went undetected for so long because of defects in the hospital's infection controls and negligent handling of contaminated linens. Hospital workers would clean all linens on the same dock where medical waste was removed, would transport both clean and dirty linens on the same carts, and store linens in hallways covered in debris from construction.

Hospital officials did not notify the families of the five victims until after a report was published on the issue. Even the head of the hospital's infection control committee told the New York Times that he was not aware of the first infant's mucomycosis at the time.

Hospital-Acquired Infections throughout the Country

About 75,000 patients die every year from infections acquired from health care facilities - and the number of deadly fungal infections is on the rise. In response, the CDC recently started a program to help hospitals communicate with the public about infections and hospital errors. Hospitals taking initiative in this effort are enjoying significant gains in public trust.

Surprisingly, mucomycosis is not on the list of diseases that hospitals must report to the government. The infection can start as a small irritation or small black spot, which later spreads into nearby areas of the body, ravaging the skin and internal tissue.

Fungi can thrive in any moist environment, including a washroom or near water sources. TLC Linen Services, which provided and maintained linens for the hospital, is located just a few blocks from a large lake in New Orleans and includes a 40,000-square-foot washing warehouse. Moldy environments or those with inadequate ventilation systems can also cause fungi to thrive and spread.

Three families of the mucomycosis victims have filed lawsuits against the hospital so far, one of which was recently settled in an undisclosed amount. Hospital linens must always be wrapped in bags or cellophane while being transported; if not, fungi and other infections can spread rapidly.

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Gynecologic Procedure now Banned by Four Top Hospitals

April 28, 2014

6842256759_0613c09bf9_b.jpgOur team of medical mistake attorneys recently reported that doctors throughout the country were calling for a ban on one popular gynecological procedure, known as morcellation. In the wake of public outcry, at least three of the nation's top hospitals have banned the procedure. Importantly, the FDA has also released a statement discouraging surgeons from using morcellation procedures.

Morcellation was generally used during hysterectomy or myomectomy procedures to treat uterine fibroids in women. The practice involved using a laparoscopic power morcellator (a medical device) to divide the uterine tissue into smaller pieces or fragments.

Now, it has become clear that about one in every 350 women who undergo this type of procedure will be diagnosed with uterine sarcoma, which is a type of uterine cancer. This is possible because uterine sarcoma hides in the fibroids that morcellation procedures are designed to break up. If such cancer cells are already present in fibroids when a morcellator divides them, the cancer cells spread into the abdomen and pelvis, significantly worsening the patient's likelihood of survival.

What makes this issue particularly frightening is that there is no reliable method for predicting whether a woman's fibroids contain cancerous cells. Because of this, the FDA is now discouraging the use of morcellators during hysterectomies and myomectomies for uterine fibroids.

This issue was brought to the forefront of public and medical attention when a prominent doctor at Beth Israel Daconess Medical Center was diagnosed with uterine sarcoma after undergoing the procedure. Her husband is a Harvard-affiliated surgeon who went public with the dire news, calling on hospitals and doctors to stop practicing morcellation.

This couple has become the driving force behind the call to ban the procedure. Two hospitals affiliated with Harvard Medical School - Brigham and Women's Hospital and Massachusetts General Hospital - were the first to cease using morcellation procedures. Two more of the nation's most esteemed hospitals, the Cleveland Clinic and the University of Pennsylvania Health System, are the latest to suspend the use of morcellators. Temple University Hospital has also sharply limited power morcellator.

Public Safety Number One Priority

Officials at these four hospitals have gone on record saying that the public called on them to act immediately, so they did. A chairman at the Cleveland Clinic stated that the hospital will decide whether or not it will permanently ban the procedure in the upcoming months.

The FDA also plans to hold a hearing on morcellators in the coming months, which hospitals throughout the country will surely look to for guidance. Over the past ten years power morcellators have become extremely popular because they are used in less-invasive forms of hysterectomies and myomectomies. Known as laparoscopic procedures, these operations use only tiny incisions to break up fibroids instead of previous practices that left large scars and longer recoveries.

Women undergoing hysterectomies or myomectomies need to be completely aware of the risks of the procedure. Once the patient has been counselled on how the surgery will be performed, she reserves the right to request a different method or choose a different surgeon altogether. This is known as an informed-consent process.

It is important to note that there are still other ways to perform surgery on uterine fibroids using minimally-invasive techniques. Among these include vaginal hysterectomies and mini-laparotomy procedures, which do not require abdominal incisions. Temple University Hospital already designates the mini-laparotomy as its preferred uterine fibroid technique.

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How Spine Implants Cause More Harm than Good

April 16, 2014

6087539168_6117cd51b0_b.jpgStimulation therapy is a growing treatment intended to relieve chronic pain in the spinal cord by sending electrical pulses through an implant. In some patients, the procedure works well and pain is well-managed. In others, the operation turns dire, causing permanent paralysis. Medical device attorneys at Pintas & Mullins look into these implants and who is to blame when a patient is paralyzed.

Spinal stimulator devices are manufactured by a variety of companies, including Medtronic, Boston Scientific, and St. Jude Medical. The devices are implanted into patients near the spinal cord, where a pulse generator sends low currents of electricity into extension wires, which are placed on the spine. The leads then transmit an electrical current onto the spine that distracts the brain from recognizing - and therefore feeling - pain signals.

Patients are typically admitted to hospitals for overnight stays, and can return home shortly after implantation with, ideally, a pain-free life. For dozens of patients, the procedure goes too far, causing partial or permanent paralysis or motor weakness.

In most of these cases, the injury occurs after the spinal cord is punctured or compressed by the electrical conductors, which are inserted into a narrow cavity called the epidural space in the lower spine (this is where an epidural anesthesia is administered during childbirth).

According to the FDA's database, nearly 60 patients were paralyzed by spinal stimulators in 2013 - up from nearly 50 the year before. It is worth noting that the FDA's database is far from complete, and many assert that injuries are vastly underreported.

Who is to Blame?

Doctors highlight a potential cause of the problem - insufficient awareness by doctors on the true risks of operating around the spinal cord, and proper techniques for avoiding the most dangerous areas. Much of the blame, they assert, rests on insufficient training and lack of surgical guidelines that leave physicians unprepared.

Part of the reason for this is that spinal stimulation procedures are conducted by various types of doctors: orthopedic spine surgeons, neurosurgeons, or anesthesiologists. Thus, no one medical society (which are typically responsible for developing training standards and practice guidelines) is held responsible for issuing such standards and performance tracking.

It may sound trite to say that surgical outcomes largely rely on the experience and skills of the doctor - but in spinal stimulation implantations this is particularly true. A physician at the Dartmouth-Hitchcock Medical Center stated that the surgery initially seems straightforward and simple, which attracts doctors who are not familiar with how risky a spine procedure actually is.

Medical device manufacturers like Medtronic claim they monitor adverse event reports and update the product labelling to reflect new or increased risks. Among these include the possibility that scar tissue can form around the device electrodes and cause nerve damage (which is also the site of paralysis). Companies like Medtronic offer weekend-long training sessions, however, experts agree that these courses are not sufficient.

Stimulators can cost between $20,000 and $60,000 each, but about a third of patients experience complications because of the device within a year of implantation. Nearly one in four patients have to undergo additional surgeries to fix the adverse side effects.

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The Safety and Risks of Drugstore Clinics

April 8, 2014

1570415819_829c90fc56_b.jpgDrugstores and supermarkets like CVS, Walgreens and Target are expanding their walk-in medical clinic throughout the country to meet high public demand. There are several factors driving this new healthcare trend, and relatively little is known about how this will affect patient wellbeing, if at all. Our team of medical malpractice lawyers offers some guidance on how ill patients can best protect themselves.

Nation-wide, there are now about 1,600 walk-in minute clinics - a number that is expected to double within the next three years because of the newly-enacted healthcare program and an increase in public demand. With more people able to afford health insurance, there is an increase in strain on primary care physicians. Experts estimate that by 2020 there will be a shortage of primary care providers numbering around 45,000.

Because of this, patients with minor ailments like ear infections, coughs and colds, or pinkeye, are choosing to stop by a minute-clinic instead of waiting days for an appointment. At the clinic, patients typically sign in using an electronic system (no appointment needed, and no receptionist) and are given a wait time. Once the nurse practitioner calls your name, you walk into a small room and are given an examination.

Various services can be performed at a minute clinic, including physicals, tests for strep throat, ear infection, and the flu. In recent years, the clinics have expanded their services to screen for and even diagnose chronic conditions like diabetes and high blood pressure. Practitioners also often administer vaccines or write prescriptions.

Minute clinics are staffed by either nurse practitioner or a physician's assistance, but there are never doctors on staff. Many are affiliated with specific doctors or hospitals if they need to call someone to consult with a physician.

When to Make a Doctor's Appointment

Someone who is prescribed many different medications, has a complex medical history, or serious illness, should make an appointment with their physicians. Minute clinics will not accept infants under 18 months or those who clearly need immediate, emergency medical attention. Beyond that, it is up to the discretion of the patient.

They do take most insurance programs, and even for the uninsured, prices are typically listed on company websites or in-store. Various doctors' groups object to this new growing trend, particularly among pediatrics, which is warning parents not to rely on minute clinics over primary care needs. Medical professionals state that it is wisest to consider minute clinics as supplementary services.

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Another da Vinci Robotic System Approved for Market

April 3, 2014

fort-belvoir-community-hospital-astounds-with-groundbreaking-technology-and-devotion-to-patient-care.jpgIntuitive Surgical, the company that makes the da Vinci Robotic Surgery System, recently announced that it gained approval for a new robotic system, called the da Vinci Xi. Our team of da Vinci surgery injury lawyers takes a closer look at this new system and how it could affect patient care.

Robotic surgical systems are aggressively marketed to hospitals throughout the country as the "new, latest, most advanced" technology. In fact, there are no conclusive studies that show that such robotic systems provide better care for patients - quite the opposite. Hospitals are agreeing to pay millions of dollars (an average of $1.85 million) for these systems only to stay up on the competition.

The new Xi features thinner arms than the traditional da Vinci, and is intended to perform more complex surgeries. It also includes a fluorescent imaging system, nicknamed Firefly, which the company believes will improve patient safety by improving surgeon's seeing ability. Other upgrades include new joints for greater range of motion and improved visual definition.

To use the robots, surgeons sit behind a console and operate the device using a control panel, which includes a screen, pedals and joysticks. The system has raised much controversy since its initial 2009 release, and several lawsuits have been filed against Intuitive by patients seriously, some fatally, injured by the robots.

Adding fuel to the fire, the FDA approved the Xi robotic system through a special process (called the 510(k) approval) that requires minimal testing. What makes this so disconcerting is that Intuitive has been reprimanded by federal authorities for withholding information on how many patients have actually been injured by the robots. All injuries and deaths associated with a certain type of medical device are reported by the hospital directly to the manufacturer. The manufacturer is then required to inform the FDA within 30 days of receiving the report, and is also required to investigate the injury or device malfunction, sending the FDA a report of this investigation once it is completed.

According to lawsuits against Intuitive, the company was systemically underreporting the complications caused by da Vinci robots, along with knowingly misclassifying serious injuries and deaths as "other." The FDA was then never informed of the true injury risks from the da Vinci, and the public was never informed. The company also concealed three separate voluntary recalls from the FDA, which involved defective da Vinci parts. Due to their lack of reporting, dozens of patients were injured - specifically, burned - by malfunctioning parts.

According to reports, patients who are obese or who suffer from other serious medication conditions are significantly more likely to suffer an adverse event from the da Vinci. Other studies note that robotic surgery is not at all superior to traditional methods.
The original system was approved for minimally-invasive laparoscopic surgeries on the gallbladder and for gynecologic procedures. It was later approved for more complex procedures, such as chest, cardiac, and urologic surgeries.

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Changes to Come to California Malpractice Laws

March 31, 2014

witkin-ninth-edition-ca-law_l.jpgIn 1975, the California government established a maximum money amount injured patients could receive for noneconomic damages in malpractice lawsuits. Nearly four decades later, the $250,000 cap has yet to adjust to keep up with inflation. Medical malpractice lawyers at Pintas & Mullins explore how and why California advocates are now pushing to raise the cap.

Consumer Watchdog, a nonprofit public advocacy group, is organizing the campaign to raise the damage cap among other changes, which its president believes will significantly impact patient safety for the better. In addition to raising the cap, proponents are also aiming to require doctors to undergo routine drug and alcohol testing.

If the initiative qualifies, this law change will be put to California voters in November 2014. The drug testing aspect of the law change is actually a major move - nationally, physicians are much less scrutinized for this type of impairment than other high-risk professions, like firefighters or police officers. We recently wrote a post on some particularly horrendous cases of surgical malpractice in Texas, which was likely caused by the physicians' addictions to alcohol and prescription drugs.

Why Malpractice Caps at All?

Currently, 35 states have some kind of law placing a maximum on the amount of noneconomic damages patients can recover in malpractice suits. California's cap, at $250,000, is toward the lower end, and prevents many patients from ever bringing claims against hospitals or doctors who injured them at all. The costs of expert testimony and continued litigation can add up quickly, and in many cases, the costs are far too great to make a lawsuit seem worth it, so the injury case is never pursued, and the patient is left without justification or compensation for their pain and suffering.

Earlier this month, the Florida Supreme Court ruled that these types of noneconomic damage caps were unconstitutional. In its decision, the court argued that the caps only protected doctors and hospitals from facing responsibility for medical negligence. They said damage caps are arbitrary, unfair, and hurt the most vulnerable patients. The justices concluded that noneconomic damage caps offended the "fundamental notion of equal justice under the law."

The initiative in California would raise the damage cap to $1.1 million and will make sure that number will be able to adjust to inflation. The law would also require doctors and nurses to check patients' prescription drug histories using a state database. This is meant to identify and monitor people who "doctor shop," looking to get different prescription medications to abuse.

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Florida Supreme Court Strikes Down Medical Malpractice Damage Caps

March 14, 2014

4859672786_88e1695eae.jpgGood news this Friday, the Florida Supreme Court just became the latest state to strike down damage caps for pain and suffering in medical malpractice lawsuits. The court ruled the limits unconstitutional and only shielded doctors and hospitals from liability, at the expense of injured patients. Our team of medical malpractice attorneys digs into this case and others like it throughout the country.

Damage caps for pain and suffering in malpractice cases are common in conservative states trying to lower insurance premiums for doctors and other medical practitioners. Supporters believe that setting maximum dollar amounts for damages from medical malpractice saves doctors, hospitals and insurance companies from having to pay for "frivolous" lawsuits and other baseless claims.

In reality, frivolous lawsuits rarely even make it to court, and if they do, no jury would award a patient clearly only minimally injured millions of dollars for pain and suffering. Setting maximum amounts for these damages hurt those most vulnerable: patients grievously or permanently injured by negligent medical care.

The state Supreme Court explains its decision through a series of examples to illustrate how arbitrary and unfair damage caps really are. They drew one example, where one negligent physician injures three separate patients, who all file claims against him. Patient A was injured moderately and suffers pain and disability of a month; patient B is severely injured and suffers for about one year; and patient C is permanently injured, suffering disability for the remainder of her life.

Say patients A and B were both awarded $100,000 for pain and suffering and plaintiff C is awarded $1 million for lifelong pain and disability. Under damage caps, the award would be automatically reduced to $250,000, without justification, even though the $1 million was reasonable and fair. The court concluded that the maximum cap "offends the fundamental notion of equal justice under the law."

Only Patients in Crisis

We recently wrote about an particular egregious case of medical malpractice in Texas, where damage caps are currently set at $250,000. As stated, caps were initially created to respond to a "medical malpractice crisis," which was based on the claim that doctors' insurance premiums were skyrocketing due to litigation costs.

In response to this, the Court wrote that such a malpractice "crisis" does not and has never existed, as it is not supported by any available data. In fact, jury trials and awards only make up a small fraction of medical malpractice insurance payments.

At present, 19 states have laws establishing caps on malpractice damages. Among those states, only two, or 10.5%, have experienced static or declining physician insurance rates. In contrast, among states without damage caps, physician insurance rates have declined or stayed the same in 18.7% of states.

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Dangerous Doctors, Patient Deaths Reveal Failing Texas Healthcare System

March 11, 2014

299122118_1e0a8cdc8e.jpgDr. Christopher Duntsch arrived in Texas in 2010 to start a neurosurgery practice. By 2013, he had killed two patients from malpractice, paralyzed four others, and had his medical license revoked. Our team of medical malpractice lawyers examines this horrifying story and the problems within the Texas legislature that allowed it to happen.

Throughout the three years he was practicing in Texas, physicians, patients, and malpractice lawyers repeatedly tried to have his license suspended. Their efforts were unsuccessful for so long because of a series of conservative reforms in the Texas court and medical systems. Over the past ten years, these reforms have severely limited the resources and options available to patients injured by negligent physicians.

The medical system in Texas used to be overseen by a connected network between the state medical board, hospital management, and the courts, which prevented and punished cases of medical malpractice. This changed around 2003, when the Republican Texas Legislature set maximum dollar amounts for malpractice lawsuits at $250,000. This is problematic for many reasons that are beyond the scope of this article, but in essence the damage cap does not adequately protect patients who suffer permanent injuries from doctors like Duntsch and deters malpractice lawsuits from being filed.

Other laws were introduced that protected hospitals from being sued for the actions of their doctors. Currently, Texas law states that hospitals may only be held liable for damages if the plaintiff can prove that hospital management knew that the doctor posed an extreme risk to patients and hired them anyway. Compounding this, hospitals in Texas are allowed to keep all their information regarding doctor hiring practices completely private, so neither patients nor plaintiffs can access them.

So, with hospitals deregulated and the court system substantially curtailed, the Texas Medical Board was all that remained to police physicians and protect patients. The board, however, was established to monitor physician licenses and oversee professional standards, not in any way protect the public. The board's intention is to protect physician's rights, and does not revoke medical licenses unless there is overwhelming, inarguable evidence such as a felony conviction or dolling out opioids to addicts.

Dr. Duntsch and His Wake of Destruction

In 2010, Duntsch started a practice, the Texas Neurological Institute and worked at Baylor Regional Medical Center in Plano. Another surgeon at Baylor told the Texas Observer that Duntsch was, by far, the worst surgeon he had seen, even when performing relatively minor procedures.

Reports of serious harm done to patients by Duntsch are long and illustrate consistently dangerous and unconscionable medical care. After the first few botched surgeries Baylor had to bring in senior surgeons to correct the damage done to patients, though most of it was irreparable. Duntsch even operated on a childhood friend, severely damaged his spinal cord, and delayed follow-up tests so long that his friend permanently lost the use of his arms and legs.

Duntsch was suspended for 30 days, after which he was supposed to be supervised during every surgery. This never happened; soon after the first paralysis, a woman named Kellie Martin went to Duntsch to treat back pain. Duntsch recommended a microlaminectomy, a minor surgery which removes part of the spine to relieve pain from nerve pressure.

Duntsch performed the surgery, which was supposed to take 45 minutes, unsupervised. Two hours after she went in the OR, her husband asked to speak with Duntsch, who said there had been some complications and she would have to stay the night. Another few hours later, she was rushed to the intensive care unit. Ultimately, after an excruciating wait, he and his daughters were told Kellie had died.

The medical examiner had to examine her twice because he was so shocked by the state her body was in. It was clear Duntsch severed one of her spinal arteries during surgery (as he had with his childhood friend a month prior), and failed to notice it in time to save her life. She eventually bled to death.

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Popular Hysterectomy Surgery Causing Cancer Spread

February 27, 2014

6025359063_81a0b67b4c.jpgDoctors across the country are calling to change standards for a common gynecological procedure, morcellation, which can spread dangerous types of uterine cancer. Many studies have confirmed this risk, forcing the medical community to reevaluate how and when the procedure is done. Medical malpractice lawyers at Pintas & Mullins take a closer look at this procedure and who is most at risk.

Morcellation is a hysterectomy procedure that involves grinding the uterus so tissue can be more easily removed through small incisions. In women with cancerous or pre-cancerous uterine cells, however, the procedure breaks up the cancerous tissue and scatters them into the abdomen or other organs.

What makes the issue particularly dangerous is the inability to test for cancerous uterine cells before the surgery. These cancerous cells can also often appear non-cancerous or non-threatening in initial tests, so the risk is amplified.

Personal Tragedy leads to Public Change

Among the most vocal physicians fighting to curb the use of morcellation is a Harvard-affiliated cardiothoracic surgeon, whose wife suffered the serious consequences of the procedure. He has written dozens of letters to medical journals and media outlets saying that the surgery endangers women, referring to it as a major public health crisis. The surgeon's wife, who is also a physician, underwent a morcellation procedure to treat what her medical team believed were benign (or non-cancerous) masses in her uterus.

The procedure went smoothly, however during follow-up testing showed that the "benign" cells actually contained a rare and extremely aggressive cancer known as uterine leiomysarcoma. The cancerous tissue was spread throughout her abdomen and lungs during the morcellation surgery, inflicting her with stage four cancer.

She is now going through chemotherapy and additional surgeries to remove cancerous tissue, with the support of her husband and six children. She asserts that neither her gynecologist nor her surgeon informed her of the risk of cancer spread before she agreed to a morcellation procedure. At present, the hospital she underwent her procedure, Brigham and Women's Hospital (where her husband also works), has imposed limits on morcellation procedures, including strengthening the informed consent process and adding restrictions for eligibility.

The couple is now criticizing doctors, hospitals, and medical society that they believe underplayed the risks of morcellation. The issue is quickly becoming a hot topic of debate in the field of gynecology, and many other physicians have joined in on the call to curb the procedure. Already, two esteemed medical journals have published critical articles on morcellation.

Very recently, on February 26, 2014, the FDA announced it would begin investigating information and data on morcellation procedures. FDA spokespeople stated that the agency is extremely concerned about the potential of cancer spread in at-risk women.

Since the couple started campaigning against morcellation, many other wives and their spouses, have come forward to say they suffered similar devastating cancer spread from the surgery. They are calling the procedure flawed and are asking researchers to conduct analyses of morcellation studies and the rate of cancer spread.

Risk Factors Include...

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