Bergen County Personal Injury Lawyer - Medical Malpractice

Awake during anesthesia

Donald Caminiti — Thu, 13 Mar 2008 14:44:56 GMT

The Anesthesia Awareness Campaign, Inc. ("AAC")
is a non-profit organization founded in 1998 that is
dedicated to helping victims, providing education,
and working to prevent anesthesia awareness.
Anesthesia awareness, also called intraoperative
awareness or conscious paralysis, is the phenomenon
of being mentally alert while supposedly under full
general anesthesia. In some instances, victims are
able to feel excruciating pain but are unable to
communicate their awareness because they are
paralyzed by a neuromuscular blocker.

Originally posted at InjuryBoard by Donald Caminiti

Reporting Medical Errors

Karen Gatlin — Thu, 06 Mar 2008 13:39:36 GMT

Ninety percent of New Jersey residents would like hospitals to report adverse incidents and medical errors, such as patient falls and hospital acquired infections, to the public. One fifth of state residents have a family member who has experienced a preventable medical error, and between 44,000 and 98,000 U.S. citizens die yearly from preventable medical errors. Hospitals do supply data as to the number of adverse incidents at their facilities; however, this information is not made known to the public. Residents argue that they need this information to make decisions about where to seek medical care; hospitals counter that such a reporting requirement will have a "chilling effect" on providing data to the state. New Jersey already discloses to the public information about physicians, including the number of lawsuits that a physician has settled or has been found negligent at trial. The New Jersey Department of Human Services has stated that it will study whether to institute a program of reporting hospital medical errors to the public.

Originally posted at InjuryBoard by Karen Gatlin

Pain and Suffering Caps on lawsuits are unfair

Donald Caminiti — Tue, 26 Feb 2008 14:08:38 GMT

Former Dallas Cowboy Ron Springs, who has been in a coma since the fall after surgery to remove a cyst, is one of 11 plaintiffs challenging Texas' medical malpractice cap in a lawsuit filed Monday.

The lawsuit, filed in the U.S. District Court for the Eastern District of Texas in Marshall, challenges the 2003 Medical Malpractice and Tort Reform Act, which limits awards in Texas. The lawsuit asks the court to declare the cap unconstitutional.

The law caps awards for pain and suffering at $250,000 for doctors, $250,000 for hospitals and $250,000 for nursing homes and other institutions for a maximum of $750,000 per claimant.

The plaintiffs are asking for class-action status.

In January, Springs' wife filed a medical malpractice lawsuit against two doctors she said caused her husband's brain damage during a routine surgery to remove a cyst.

Originally posted at InjuryBoard by Donald Caminiti

Back Pain - Injury or Accident

Donald Caminiti — Tue, 26 Feb 2008 12:57:21 GMT

11/04 Neuroscience article shows objectively that those in chronic pain have resultant cortical atrophy. i.e. the brain shrinks. Great article. It is not the only one, by the way. Here is abstract:

1: J Neurosci. 2004 Nov 17;24(46):10410-5.

Chronic back pain is associated with decreased prefrontal and thalamic gray
matter density.

Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR.

Department of Physiology and Institute of Neuroscience, Northwestern University
Feinberg School of Medicine, Chicago, Illinois 60611, USA.
a-apkarian@northwestern.edu

The role of the brain in chronic pain conditions remains speculative. We
compared brain morphology of 26 chronic back pain (CBP) patients to matched
control subjects, using magnetic resonance imaging brain scan data and automated
analysis techniques. CBP patients were divided into neuropathic, exhibiting pain
because of sciatic nerve damage, and non-neuropathic groups. Pain-related
characteristics were correlated to morphometric measures. Neocortical gray
matter volume was compared after skull normalization. Patients with CBP showed
5-11% less neocortical gray matter volume than control subjects. The magnitude
of this decrease is equivalent to the gray matter volume lost in 10-20 years of
normal aging. The decreased volume was related to pain duration, indicating a
1.3 cm3 loss of gray matter for every year of chronic pain. Regional gray matter
density in 17 CBP patients was compared with matched controls using voxel-based
morphometry and nonparametric statistics. Gray matter density was reduced in
bilateral dorsolateral prefrontal cortex and right thalamus and was strongly
related to pain characteristics in a pattern distinct for neuropathic and
non-neuropathic CBP. Our results imply that CBP is accompanied by brain atrophy
and suggest that the pathophysiology of chronic pain includes thalamocortical
processes.

Originally posted at InjuryBoard by Donald Caminiti

Women and Heart Disease

Karen Gatlin — Tue, 19 Feb 2008 11:02:03 GMT

While there are classic symptoms of myocardial infarction (heart attack), such as chest pain, sweating, shortness of breath. and pain radiating to the left arm, women often show atypical symptoms such as nausea, light-headedness, anxiety, weakness/fatigue, pain between the shoulder blades and heartburn. Physicians must be alert for these symptoms. An EKG is essential to rule out heart attack and echocardiogram and angiography should be done if symptoms persist. Patients should not ignore symptoms that are not "classic" signs of heart attack. It is better to go the emergency room to rule out problems than risk cardiac damage. Heart disease is the leading cause of death in women and is the most preventable. Heart disease kills more women than all forms of cancer combined. Risk factors are family history of heart disease, smoking, high blood pressure, Diabetes, obesity and high cholesterol; however, even women without these risk factors may suffer from heart disease.

Originally posted at InjuryBoard by Karen Gatlin

Prednisone and Fractures

Karen Gatlin — Mon, 28 Jan 2008 12:00:19 GMT

Corticosteroids such as Prednisone are used in inflammatory conditions for their anti-inflammatory effects. When used properly, these drugs save lives and avert injury to bodily organs. They have a rapid onset of action, and profoundly affect many parts of the immune system as well as most other body systems. Corticosteroids are used to treat a variety of conditions such as vasculitis; arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders such as colitis; severe allergies and asthma; and to relieve inflammation (swelling, and pain). Prednisone is also used with other drugs to prevent rejection of transplanted organs and to treat certain types of cancer. Side effects of steroids are related to the amount of steroid a patient takes and the length of time the patient remains on the medication. One major side effect is osteoporosis or "thinning of the bone".
While steroids do decrease inflammation, they also decrease the formation of new bone, increase the breakdown of old bone, and decrease the absorption of calcium from food by the body. This can lead to osteoporosis ( "thinning" of the bone) and susceptibility to fractures. Osteoporosis may result in fractures of the spine, ribs or hip joint with minimal trauma.

Prednisone should be taken exactly as prescribed by the doctor. Studies have shown that physicians are not investigating and treating glucocorticoid-induced osteoporosis. See Shinil, Shah study cited in the Journal of American Osteopathic Association, Vol. 106, No. 11, November 2006.

Originally posted at InjuryBoard by Karen Gatlin

NJ Patient Safety Report

Donald Caminiti — Fri, 18 Jan 2008 10:47:40 GMT

In the first two years of New Jersey's Patient Safety Initiative, hospitals worked with the Department of Health and Senior Services to analyze more than 800 serious patient safety events and make comprehensive changes to prevent such errors from recurring, Health and Senior Services Commissioner Heather Howard, J.D., announced today.

Nearly all hospitals reported adverse events in 2005 or 2006, and conducted a thorough Root Cause Analysis (RCA) to find the factors leading to each error, according to Patient Safety Initiative: 2006 Summary Report, the second annual program report.

"Patients have a right to expect safe, high-quality care," Commissioner Howard said. "When a hospital steps forward to report an error, it helps make care safer for its own patients and for patients statewide. We are committed to collaborating with hospitals to create a safer environment for patients."

The report noted that the number of events a hospital reports is not an absolute measure of its overall quality. A larger number of reports may reflect a hospital's strong focus on patient safety and commitment to finding solutions when events occur.

The most common adverse events continued to be falls and pressure ulcers, also known as bed sores, followed by surgical errors. These events resulted in patients needing longer hospital stays, more tests, or additional monitoring by staff, among other complications. Forty-two patients died.

When an error is reported, the Department requires that the hospital perform a Root Cause Analysis. Hospitals must identify the problem's root causes and develop systematic solutions to correct the problem. DHSS has the authority to require a more comprehensive analysis or set of solutions from hospitals, if warranted.

DHSS issues a periodic Patient Safety Newsletter as well as special industry alerts identifying urgent problems with potential statewide impact.

At the request of hospitals, the Department developed a workshop on falls that was offered three times in 2005 and 2006. Fifty-one hospitals created and launched their own falls reduction project, participated in periodic conference calls, and then met again with the group to present their results.

Pressure ulcers were the focus of a recent initiative of the New Jersey Hospital Association's Quality Institute. The Pressure Ulcer Collaborative allowed hospitals to work with leading experts and with each other on issues relating to patient care and prevention.

Possibly because of increased awareness and improved hospital reporting, the number of reported falls and pressure ulcers increased in 2006 and they accounted for a greater share of the total than in 2005. Surgery-related adverse events declined over the two years. Few medication errors were reported in either year.

The top three causes of system failure leading to an adverse event were: communication among hospital staff, the patient care planning process, and staff orientation and training, according to the report.

Under the patient safety law, hospitals are required to report serious preventable adverse events that meet certain criteria.

For example, pressure ulcers are reportable when they meet a certain level of severity. Falls must be reported if they are linked to patient death, loss of a body part, disability, or loss of bodily function lasting more than seven days or still present when the patient is discharged. Surgery-related events include surgery on the wrong person or the wrong body part, and coma occurring during or after surgery, among others events.

Later this month, the proposed patient safety reporting regulations will be considered for final adoption by the Health Care Administration Board. If approved, they will take effect when published in the New Jersey Register.

For more information on this subject, please refer to the section on Car and Motorcycle Accidents.

Originally posted at InjuryBoard by Donald Caminiti

Doctors fail to report medical errors

Donald Caminiti — Wed, 16 Jan 2008 16:07:00 GMT

Most doctors agree that medical errors should be reported to their hospitals, but a significant number admit they don't always report their own, a University of Iowa study shows.

Researchers surveyed 338 physicians at three unidentified teaching hospitals around the country. Seventeen percent of the doctors admitted anonymously that they had failed to report minor errors, defined as mistakes that "prolonged treatment or caused discomfort." Four percent admitted they had failed to report mistakes that "caused disability or death."

The researchers, led by U of I medical-ethics professor Lauris Kaldjian, published the survey results Monday in the Archives of Internal Medicine.

Besides being asked about their own records, the physicians were asked whether they would report a hypothetical situation involving a medical error: A doctor prescribes an antibiotic to a 67-year-old pneumonia patient whose medical chart says he is allergic to the drug.

Forty-three percent of the doctors said they would likely or very likely report the incident if no apparent harm came from the mistake. Seventy-three percent said they would report it if the man suffered a temporary rash because of the mistake. Ninety-two percent said they would report it if the man suffered breathing problems and a heart attack.

Kaldjian said in an interview that he was encouraged that most of the doctors believed reporting errors was an important way to improve health care quality. But he said he was troubled by the fact that fewer than half of them would have reported the hypothetical error if it didn't cause problems. He said doctors and other medical workers should take their cue from the airline industry, which encourages pilots to report every error so it can be analyzed for possible systemic flaws.

The researchers noted several limitations to their work. The survey was done in 2004 and 2005, and may not reflect recent emphasis on reporting errors, they said. And the survey was limited to doctors specializing in family medicine, internal medicine and pediatrics.

Kaldjian also noted that only 36 percent of the doctors admitted ever making a mistake, and he said he was skeptical of that figure. "I have a hard time believing either a resident or an attending physician never made even a minor error," he said.

The professor said he was surprised to find that physicians who have been sued were as likely as their peers to say they would report errors. He hesitated to make too much of that finding, because the sample size was relatively small, but he said it was interesting.

"My intuition would have said that once one was stung by a lawsuit, it would be more difficult to talk about errors with anyone," he said.

A Des Moines physician who studies ways to improve safety said he found several positive things in Kaldjian's study. Tom Evans, president of the Iowa Healthcare Collaborative, said few doctors saw medical errors as a major problem when he started practicing medicine in 1983. The survey clearly shows those attitudes have changed, he said. "I'm encouraged by the traction this shows," he said. "Doctors are getting it."

Evans noted that industry leaders have talked a lot recently about the need to cut down on medical errors. He said he suspects the survey results would have been better if they were more current. "I'd love to see this measured over time, to see if we're on track," he said.

Although the study did not identify the three teaching hospitals whose doctors were surveyed, it says they were in the Midwest, Northeast and mid-Atlantic regions of the country. It also lists contributing authors at the University of Iowa, Yale University and Penn State University. Kaldjian declined to comment on whether those schools had the three hospitals in question.

For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.

Originally posted at InjuryBoard by Donald Caminiti

Pointless procedural hoops on lawsuits

Donald Caminiti — Wed, 02 Jan 2008 14:33:46 GMT

The Charleston Daily Mail recently reported on made up absurd courtroom situations in an effort to pass so called medical malpractice lawsuit reform legislation. State Supreme Court Justice Larry Starcher was qoted in a dissent as having stated:

"I dissent to express my hope that, in the future, the court or the Legislature will recognize the absurd and unconstitutional effects of the (reform) and either strike down or repeal (the reform) in its entirety," Starcher wrote in a dissenting opinion last week.

Starcher's comments arose from the appeal in a class action lawsuit over the use of contaminated surgical sutures.

The plaintiffs sued Charleston Area Medical Center and Thomas Memorial Hospital as well as the makers and distributors of the sutures.

The Kanawha Circuit Court dismissed the lawsuit last year because of the way the plaintiffs sued.

The plaintiffs brought the suit against the hospitals as a straight products liability issue, not a medical malpractice issue.

The lower court found - and justices agreed - that the lawsuit should have complied with the requirements of the Medical Professional Liability Act of 1986 because it stems from the administration of health care.

The state Supreme Court reinstated the lawsuit, but still ordered the plaintiffs to comply with the act.

The act has been tweaked in recent years as legislators have tried to limit malpractice lawsuits in the state. Critics said a high number of unfounded complaints were causing malpractice insurance to skyrocket and wreaking havoc on the state's legal system.

Under the act, plaintiffs have to file pre-lawsuit notices to the defendants and a qualified expert has to say the suit is valid.

Also, under the act, the plaintiffs' non-economic damages will be capped at $250,000 and $500,000 for other damages.

Starcher called the pre-lawsuit requirements "pointless procedural hoops" because a jury could determine whether or not the sutures were safe.

Starcher said the act itself wouldn't affect a jury's finding as to whether or not the sutures were contaminated.

"To the contrary, application of the (Medical Professional Liability Act) to the instant case clearly demonstrates the absurdity of the (act), and demonstrates why the Legislature should exercise restraint when it attempts to meddle with centuries-old common law principles," Starcher wrote.

He continued, "The only impact the (act) might have is to deprive injured plaintiffs of their rightful damages, by capping the damages that can be recovered at an arbitrary amount that has no relationship to the evidence."

In harmony with Starcher's dissent, Chief Justice Robin Jean Davis, in a footnote to the original opinion in this case, declared that the pre-lawsuit requirements violated the state constitution, which says the Supreme Court makes such rules, not the Legislature. The constitution also guarantees access to the courts for all people and justice administered without "sale, denial or delay."

Lawmakers passed the act in 1986 as a way to stem what was a perceived explosion in health insurance costs and what, even back then, many in the community said was a drastic rise in frivolous medical malpractice lawsuits.

Controversy arose again earlier this decade as surgeons went on strike and insurance companies complained. Lawmakers spent a couple of years mired in debate over the issue, before voting on a series of reforms intended to lower damage caps and institute the pre-lawsuit requirements.

Starcher called the act "cookie-cutter" legislation that has created "absurd conundrums." He said the courts are more responsible and adept at making meaningful changes than the Legislature.

Courts amend the common law narrowly and incrementally, on a case-by-case basis and usually over many years," Starcher wrote.

"But the Legislature, when changing the common law, often makes drastic statutory changes in response to real or perceived crises, and often without a clear understanding of the impact those changes might have on individual cases.

For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.

Originally posted at InjuryBoard by Donald Caminiti

Preventing preventable infections

Donald Caminiti — Wed, 12 Dec 2007 11:52:50 GMT

Drug-resistant infections are headline news lately, especially the illnesses and deaths caused by tough and evolving bPreventing MRSA Infections and Deaths Becomes Bigger Priority

The U.S. Centers for Disease Control and Prevention (CDC) came right out and said it: MRSA infections, primarily those related to health care, are a "major public health problem." Upfront in its report in the October 17 issue of the Journal of the American Medical Association, the CDC acknowledged that what was once a problem linked to health care facilities has now moved into the community. In places where close contact is common between individuals (such as schools, athletic facilities, and prisons), MRSA has become a threat requiring closer attention--and better hygiene.

Deaths from MRSA infections were far more common than previously thought, the CDC observed in its first benchmarking report. The CDC studied nine U.S. communities representing 16 million people and calculated national projections from the data. Although the news was not good, the country now has a baseline of information from which to track new MRSA cases. The report estimated that nation-wide in 2005 (the latest year for which information is available) drug-resistant MRSA caused the following:

More than 94,000 invasive infections (in which sterile body fluids, not skin or tissue, were affected)
Nearly 19,000 deaths

About 85% of the worrisome infections in 2005 could be linked to patients' exposure to the bacteria in a health care setting (for example, a hospital, nursing home, dialysis center, or other facility providing care), the CDC emphasized. News media, meanwhile, have brought to light another aspect of MRSA in America: the deaths of otherwise healthy children and the antibiotic-resistant bacteria they may have picked up in their schools, sports activities, and locker rooms.

In the Community, Watch Those "Spider Bites"
In community settings, the bacteria are most often spread by direct skin-to-skin contact or contact with items or surfaces contaminated by someone with MRSA. Community-acquired infections are usually mild, involving a minor skin infection that may look like a spider bite or pimple (red and swollen, may be painful or pus-filled) or an ingrown hair. Although these bacteria are resistant to a widely used antibiotic, they remain susceptible to other antimicrobial agents that can be used and, therefore, death from these MRSA infections is unusual and can be avoided with a few common-sense actions:

Use basic hygiene: Wash hands often and shower after sports activities. Don't share towels, washcloths, soaps, razors, athletic gear, soiled uniforms, or other items that have had contact with other people's skin. For more on the proper way to wash your hands, click here.
Attend to wounds, broken skin, and minor infections: Keep damaged skin clean. Apply antibiotic ointment. Keep broken skin covered with a clean, dry bandage.
Seek prompt treatment: If skin is inflamed or possibly infected, seek medical attention early. Doing so helps you avoid serious and costly problems and obtain effective treatment (draining the pus and/or receiving appropriate antibiotic therapy).
Avoiding MRSA in Health care Settings
As noted in the CDC report, the risk of MRSA infection is highest when undergoing an invasive medical procedure such as surgery or when an open wound, cut, or abrasion comes in contact with a contaminated surface. A weakened immune system increases susceptibility to developing an infection.

There are recommendations on hygiene and ways to detect, prevent, and control these infections, but the CDC noted in its report that "Interventions for MRSA prevention are inconsistently implemented in U.S. hospitals."

Finding the Infected: Who Should be Screened?
Some health care facilities screen high-risk patients for MRSA when they are first seen for care, whether they are seen in the emergency department or for planned procedures. States have passed legislation mandating MRSA screening of patients as one of the steps to control the spread of MRSA infection.

Screening high-risk patients identifies when extra infection control precautions are required to lessen the chances that MRSA infections might occur. Intensive-care units and acute-care hospitals used to be the primary concern, but the problem, the CDC notes, is no longer limited to these areas.

A few health care facilities in the United States now conduct MRSA surveillance testing on all patients. The first to do so were in major metropolitan areas. The 155 Veterans Affairs medical centers began phasing in MRSA testing in the spring of 2007 and in 2008 plan to test each patient. Critics argue that universal screening of hospital patients for MRSA may not be the best approach, that it may waste resources and time and interfere with the quality of care of an isolated patient. Supporters say that when universal screening has been used, MRSA infection rates have dropped substantially.

Steps You Can Take
Patients are being asked to help address the problems at the point of care, so don't be afraid to speak up or ask questions about what should be done to best protect you. Health care providers should adhere to key practices to reduce the risk of transmission for all health care-acquired infections, not just MRSA infections. These include:

Hand washing: Personnel need to use soap and water or an alcohol-based cleanser before and after contact with each patient or items in a patient's room.
Cleaning and correctly disinfecting all patient care areas and supplies are critical, including radiology departments, outpatient imaging suites, and waiting areas.
Clean gloves and gowns are appropriate to wear when the patient is known to have MRSA. These must be disposed of promptly and properly.
Extra care in intensive care is required. Ventilators, central lines, and other equipment can house harmful bacteria.
You can ask caregivers to wash their hands before touching you or any equipment or supplies used for you. Ensure health care workers and any facilities staff put on clean gloves before they touch an opening in your body (including your mouth when they are taking a throat culture, your skin where they are inserting a needle to obtain a blood sample, and any place where the skin is broken). You can ask for a clean, unused tourniquet when getting your blood drawn, or ask when surfaces or equipment were last cleaned or disinfected.

For more information on this subject, please refer to the section on Medical Malpractice and Negligent Care.

Originally posted at InjuryBoard by Donald Caminiti