Cape Cod Personal Injury Lawyer - Medical Malpractice

A New Study Shows that Stopping the Heart is the Best Method for Bypass Surgery

Carrie Strasser — Thu, 12 Nov 2009 10:30:54 GMT

A study published last week in the New England Journal of Medicine and reported in the New York Times found that bypass surgery performed using a heart-lung machine, or pump, was more successful in the long term than the recently popular off-pump procedures.

In the study, published Thursday in the New England Journal of Medicine, 2,203 patients were randomly assigned to have their bypass surgery on pump or off. Because the study was sponsored by the Department of Veterans Affairs, the patients were mostly men.

A year later, those who had had off-pump surgery had poorer outcomes. Fewer bypasses stayed open and patients were more likely to have needed a repeat operation or to have had a heart attack or to have died. They were no less likely to have had strokes or difficulty thinking.

Initially, doctors switched to off-pump procedures for fear that the pump could lead to strokes, memory problems or personality changes. The increasingly popular off-pump procedure requires doctors to operate on a still-beating heart.

Off-pump procedure patients had fewer blood transfusions but spent a longer period of time in the operating room. Patients of both procedures spent similar lengths of time in intensive care, on ventilators and in the hospital.

Certain surgeons who have made the off-pump procedure their common practice say they will not change because they have developed an expertise in the procedure and the study does not reflect their actual outcomes.

Approximately 20% of the over 200,000 people having bypass surgery each year opt for the off-pump procedure. In the beginning, this procedure was not easy with surgeons having to operate on a moving, beating heart. Many surgeons were pressured into learning this procedure and instruments were soon developed that assisted in keeping the heart steady.

However, despite the fact that some surgeons eventually became "experts" at off-pump procedure, the purpose of the study, says Dr. Michael Lauer, Director of Cardiovascular Sciences at the National Heart, Lung and Blood Institute, was to determine "how well will the procedure work in the hands of a typical surgeon." Dr. Lauer added that very few surgeons have actually attained a high level of expertise in this off-pump procedure.

Originally posted at InjuryBoard by Carrie Strasser

Some Helpful Hints to Avoid Long ER Waits

Carrie Strasser — Fri, 26 Jun 2009 11:03:21 GMT

CNN reported that, since 2002, the average waiting time for Emergency Room visits had increased 27 minutes. In 2008, the average waiting time in the ER was four hours and three minutes.

The increase in time spent waiting at the ER can be attributed to the increase in people who have lost their jobs and, in turn, lost their health insurance. These newly uninsured usually have delayed seeking medical care and are unwittingly putting strain on an already burdened system.

Here are some hints offered by four Emergency Room doctors to get attention in the ER if you feel that you or your loved ones will be harmed by delaying care:

1) Describe your loved one's worsening condition to the triage nurse:

This would work most of the time. If I got a hostile answer, I would ask to speak with the charge nurse or charge physician. If I felt like I was not getting anywhere, I would ask to speak with the administrator on call. The last resort is to call the hospital operator (dial 0 from the emergency department waiting room phone) and ask to page the patient advocate and hospital administrator. ... I would not use inappropriate or threatening language.

2) Don't be confrontational:

A basic principle of medical care is that 'the squeaky wheel gets the grease.' I would recommend advocating on behalf of your spouse. It's uncomfortable that it has to be this way, but it works the same in any service business. The more you complain, the faster the service. But it's a fine line. Complaining can piss off the staff, so it's important not to go over the top. Family members who are too vocal are sometimes escorted out by security.

3) Empathize with the fact that the ER staff is busy, but be persistent in advocating for your loved one:

I would ask to speak with the Emergency Department director. If they weren't there, I would ask to speak with the charge nurse or shift supervisor. ... I would advise them that you think the patient has an 'emergency medical condition that should be evaluated right away.' Most of us in emergency medicine define the urgency in those terms and should be responsive.

If you don't get a response, advise the individual in charge dispassionately and without confrontation, 'I understand you are busy, but I feel the patient will have a bad outcome if not seen right away.' If the person in charge was a nurse, ask to speak with the physician and repeat the same thing. If there's no response, further advise the individual in charge, 'I feel strongly about this and must call the administrator on call.' If no response, I would call the hospital administrator on call and advise him or her of those same concerns.

4) Name drop if necessary, but only with caution:

As far as invoking the threat of a letter to the CEO, that can trigger the 'VIP Care' response, which may save time, but also may expose the patient to increased risk by changing practice patterns. VIP treatment subverts the normal way we practice medicine and in my experience usually leads to medical errors. I have made my worst mistakes while treating friends, colleagues, and other VIPs. ... Belligerence, histrionics or requests for VIP treatment usually end up working against the doctor-patient relationship.

Basically, if you remain calm, but forceful in seeking medical attention for your loved ones, you may be able to decrease that wait time. The important thing to remember is to try to maintain a balance between respecting the ER staff while advocating for a patient.

Originally posted at InjuryBoard by Carrie Strasser

A New Focus on Patient-Centered Care

Carrie Strasser — Tue, 09 Jun 2009 10:46:00 GMT

A recent article in the New York Times discussed a new approach by some doctors toward a more "patient-centered" approach in an effort to improve the quality of health care. The article included an interview with Dr. Donald M. Berwick, who is a Harvard pediatrician and the president of the Institute of Healthcare Improvement in Cambridge, Massachusetts.

Dr. Berwick explained that this "patient-centered" approach would require shared decision-making, meaning that on occasion, patient preference would be more heavily weighted than evidence-based care. In addition, medical records would belong to the patients, not the clinicians, and family members would be an integral part of health care processes and services.

Here is a short excerpt:

Q. Do you think “patient-centeredness” exists in current health care practice?

A. If you are interested in quality, you have to be interested in patient-centeredness. Good doctors and nurses do try mostly to focus on every patient as an individual. But we have built a system around clinicians that makes it impossible to customize care the way it needs to be. We don’t have a standard of services or processes that are comfortable for patients. We have built a technocratic castle, and when people come into it, they are intimidated.

Patients keep having to repeat their name because the system has no memory. We dress them in silly-looking gowns. We give them the food we make instead of the food they want. We don’t let them look into their medical records unless they have permission. Health care keeps telling patients the rules instead of asking patients about their individual needs. What is said is, “This is how we do things here,” not “How would you like things done?”

People get accustomed to this. They are trained to be passive, and passivity is not a good idea. Studies have shown that people who are trained to be proactive do better and feel stronger. They have more pride and trust in their own capabilities.

When you make someone helpless, in a funny way you make them sicker, even if all you cared about was just the body.

Dr. Berwick went on to discuss the conflict between treatments a patient may want, and treatments that are recommended. Dr. Berwick explained that this conflict must be resolved through a better exchange of information between the doctor and patient.

Not only does Dr. Berwick believe that this approach benefits patients, but he also feels that it would be a more rewarding way to treat from a caregiver's perspective.

I actually think the mode I am counseling would be more satisfying or joyous for caregivers. Not all of the time or always, but it would be a better place to be. You would be putting yourself at more of a level with the patient, as more of a peer. And you wouldn’t have to carry on as if you were mythical. Medicine is imperfect and doctors know that.

The bottom line, Dr. Berwick says, is that patients need to know what is happening to them. Patients need to take a proactive approach to their healthcare in order to get the best treatment available to them. Be prepared with questions and a companion to advocate for you if you are unable to do so yourself. Dr. Berwick says that if your doctor or nurse is not listening to you, then you should find someone who will. For information about finding the right healthcare provider, click here.

Originally posted at InjuryBoard by Carrie Strasser

MGH Temporarily Closes Pediatric Surgery Program

Carrie Strasser — Fri, 17 Apr 2009 09:08:51 GMT

The Boston Globe reported that Massachusetts General Hospital has temporarily stopped its pediatric cardiac surgery program. This comes after two babies suffered serious complications, one experiencing neurological damage, after surgical errors were made during open-heart surgery. State public health officials are currently investigating the two cases.

The suspension of this program calls into question whether small surgery programs actually stand up to their larger counterparts, where nurses and doctors are able to hone their skills by caring for a large quantity of patients.

In Boston, Children's Hospital operates on the hearts of about 1,100 babies and children a year, making it the largest pediatric heart surgery program in the country, officials there said. Mass. General performed 90 pediatric heart surgeries in the last 20 months, while Tufts Medical Center did 24 last year.

For adult heart surgeries, state health officials recommend a minimum of 300 cases a year, but there is no such minimum standard set for pediatric surgeries.

There is no conclusive evidence that smaller programs fair worse than larger surgical programs, though some studies suggest that the results for the smaller programs are more variable. However, because the data is not conclusive, it is difficult to force these small programs to close because many have achieved favorable results.

Dr. Peter Manning, director of cardiothoracic surgery at Cincinnati Children's Hospital Medical Center, explained that with surgical cases falling below the 100 mark, like MGH's, surgeons run the risk of not performing enough surgeries to keep up their skills.

State health officials will examine MGH's internal reviews and decide from there whether to conduct an on-site investigation.

Originally posted at InjuryBoard by Carrie Strasser

Britain Takes Another Look at Mammograms and their Benefits

Carrie Strasser — Wed, 01 Apr 2009 09:57:06 GMT

Advocates and experts urged British health officials to revise informational fliers about mammography in a letter to the Times of London, reported the New York Times on Tuesday. The officials promised to rewrite these fliers to avoid overstating the benefits of mammograms and to include information about the potential harm involved.

In the letter, experts explained that women are not told that up to ten healthy women are given diagnoses (and sometimes surgery) for a slow-growing cancer that was not life threatening, for every one woman actually saved by breast cancer screening. This is a statistic that not many American women are likely to hear either. One survey conducted of American women found that only 7% were even aware that some cancers grow so slowly as to not need treatment.

A 2006 analysis by the Nordic Cochrane Center collaborative, an independent research and information center based in Copenhagen, found that for every 2,000 women age 50 to 70 who are screened for 10 years, one woman will be saved from dying of breast cancer, while 10 will have their lives disrupted unnecessarily by overtreatment. The figures were cited in the letter to The Times.

Director of Cancer Screening Programs in Britain, Julietta Patnick, explained that the informational fliers were being revised but also stated that the figures cited by the Cochrane study were inaccurate. Ms. Patnick said that British studies show that the ratio of women saved to women over treated is more likely one to one.

Often, slow-growing cancers look very similar to aggressive cancers when examined under a microscope so it is not necessarily easy to determine which ones should be left alone.

The United States has more aggressive screening for breast cancer than Britain, where women start at 50 and only get mammograms every 3 years as opposed to the annual mammograms recommended for women starting at age 40 in the U.S.

Dr. Ned Calonge is Chairman of the United States Preventive Services Task Force and explained that in America, mammography is often oversold to women.

“Some women would have the same outcomes, whether the cancer is detected clinically or by mammography,” he said. “And there are women whose cancer is so aggressive we cannot detect it early enough to make a difference in mortality.”

The American Cancer Society still endorses annual mammography and Robert Smith, their director for cancer screening, stated that overdiagnosis is minimal.

In the end, it's obviously the woman's choice and whether you get regular mammograms or regular check-ups or conduct your own self exams, it's always best to stay informed and be aware of changes in your body. Don't hesitate to get a second or third or even a fourth opinion because doctors are human too, and gathering all the information is the only way you will be able to advocate for the best treatment options for yourself. For more information about breast cancer and screening options, click here.

Originally posted at InjuryBoard by Carrie Strasser

Physician Apologies

Bruce Bierhans — Sun, 30 Nov 2008 11:08:51 GMT

The Cape Cod Times recently published an editorial supporting an evidentiary change making physician aplogies inadmissable at trial. The following is a copy of my letter to the Editor, published a few days later.

"Your Nov.22 editorial "When doctors fail" reflects a basic lack of understanding regarding our civil justice system and the rights of victims to be compensated for acts of negligence.

To support your position for an evidentiary change making physician apologies inadmissable at trial, you resort to utilizing figures provided by a physicians "tort reform" (substitute the words "deprive patients of their rights") organization. You ignore the many studies conducted by other organizations such as Public Citizen that indicate that malpractice premiums have risen because of poor financial investments made by liability insurers, not by runaway verdicts.

Our system is based upon the principle of accountability. A professional, whether attorney, physician, accountant or architect, should be held accountable to those who have sustained physical injury or economoc loss. "I'm sorry" is not an adequate response to a family that has lost a family member or a worker who can no longer work for a lifetime as the result of an act of carelessness.

If one adopts the theory espoused in your editorial perhaps we should also let the villians who created the subprime crisis and the resulting economic mess off after a simple "I'm sorry." I don't think so.

Originally posted at InjuryBoard by Bruce Bierhans

Lasik and the Patients Right to Know

Bruce Bierhans — Sat, 26 Apr 2008 11:30:11 GMT

In the summer of 2001, I tried a landmark case in Worcester, Massachusetts. I represented the family of a young man with hemophilia that died from receiving clotting concentrate infected with the HIV in the early 1980s. The tragedy of the 10,000 hemophiliacs that died unnecessarily has , to this day, still not been adequately reported.

In any event, we tried the case on a theory that sounds simple, but was aggressively opposed by the defendants and the medical community. We argued that, even though research regarding AIDS was not completed, that the medical community still had a responsibility to inform the families of children receiving clotting concentrate of the potential risk of AIDS. Although we could not prove what lot of concentrate killed our client, the jury found one defendant physician negligent for failing to adequately disclose known risks. I would certainly feel honored if this case, on which I worked for 6 years, turned out to be my legacy.

However, today we now read that the FDA is beginning to look into the "risks" associated with Lasik surgery. This, after a decade of patients/victims suffering from life altering side effects, including worse vision, dry eye, pain, glare and others. One law school student, Colin Dorrian, committed suicide last year after suffering from a deep depression associated with his eye pain.

Does anyone think, or believe, that these conditions and risks were not known ten years ago. Of course they were. Interestingly, a well known oncologist that I recently worked with on a cancer diagnosis case told me he wouldn't have Lasik surgery if they did it for free. He also would not allow anyone in his family to have the surgery. Unfortunately, the FDA investigation comes years too late for many patients that have suffered permanent damage.

Someday, the medical community and the FDA will learn that patients have the right to know. It is the patients right to have the information required to make an "informed decision" about whether or not to take a medication or have a procedure. In the 1980s it was AIDS. Today you can pick a medication. Did the patient know about all the risks before a medication was prescribed or a procedure was recommended? Did the FDA have all the information that should have been provided by the manufacturer? Simple but essential questions.

In 2001, my jury in Worcester said the patient had a right to know. Hopefully, juries will continue to make this important statement.

Originally posted at InjuryBoard by Bruce Bierhans

Jury Finds Against Notre Dame Football Coach in Medical Malpractice Lawsuit

Chrissie Cole — Sun, 05 Aug 2007 02:41:24 GMT

On Tuesday, a jury found against Notre Dame Football coach Charlie Weis, in his medical malpractice lawsuit. The suit claimed two doctors botched his after-care following gastric bypass surgery five years ago.

The jury reached their decision in less than a day, finding two Massachusetts General Hospital surgeons were not negligent.

Weis, 51, claimed the surgeons were negligent for allowing him to internally bleed for 30 hours before performing a second surgery to correct the complication from the first surgery.

During the surgery, Weis nearly died. During his testimony he said he still has numbness and pain in his feet and has to use a motorized cart.

Originally posted at InjuryBoard by Chrissie Cole

Woman Suing Planned Parenthood Over Failed Abortion

Christina Cole — Wed, 07 Mar 2007 15:14:44 GMT

A Boston woman is suing Planned Parenthood and two doctors in a medical malpractice lawsuit that alleges they failed to terminate her pregnancy. In March 2004, she found out she was pregnant and for financial reasons, had decided an abortion was the right decision.

A Planned Parenthood doctor botched the procedure, leaving her still pregnant. The lawsuit states a doctor at Boston Medical Center failed to detect the pregnancy that July when she was 20 weeks along.

In September 2004, she found out she was still pregnant when she went to the emergency room for treatment due to pelvic pain. Now she wants the doctors and Planned Parenthood to pay for the cost of raising her child.

Originally posted at InjuryBoard by Christina Cole

Mistrial in Weis' Medical Malpractice Lawsuit

Christina Cole — Wed, 21 Feb 2007 01:34:18 GMT

A mistrial has been declared in Notre Dame Football Coach Charlie Weis' medical malpractice lawsuit after a juror collapses and many doctors - including two of the defendants - rush to help him.

The juror started moaning as he was listening to expert testimony in defense of Massachusetts General Hospital Surgeons. Weis's claims surgeons botched his care in June 2002 when he had gastric bypass surgery.

The judge instantly ordered the jurors out of the courtroom, but some of the jurors saw doctors whom were in the courtroom rush to help the collapsed juror.

Spectators were ordered out of the courtroom shortly after the man fell ill. He was taken away in an ambulance; his condition and identity were not immediately known.
Weis accuses Ferguson and Hodin of acting negligently by failing to recognize life-threatening internal bleeding and infection after his surgery. The trial, which featured testimony from Patriots quarterback Tom Brady, was entering its second week.

Originally posted at InjuryBoard by Christina Cole