Washington DC Metro Medical Malpractice Lawyer Blog

Breast Cancer and Self-Examinations

Fri, 11 May 2012 13:20:40 -0500

If you have been following our blogs and case summaries on our injury website, you can see the many negligence cases in which we have successfully tried or settled for women or their grieving families regarding breast cancer. Over the years we have had clients, through breast self-exam (BSE), find unusual signs and symptoms such as dimpling, puckering or bulging, swelling, discoloration, or soreness, saw their physician and yet the healthcare provider did not think a mammogram at that time was warranted. We have had cases where the radiologist misdiagnosed the mammogram or did not suggest a follow-up sonogram. The patient did everything correctly, but it was not caught early enough to spare their life.

Although there is some thought now that BSE causes unnecessary biopsies and surgery on some individuals (men do get breast cancer, too), it is especially important to be vigilant and contact your doctor if you notice any of the signs and symptoms mentioned above. In addition, if your breasts are dense, you can lower your risk by exercising, eating properly, and maintaining an optimal weight, and reduce or abstain from alcohol (all types) and smoking. Age plays a factor as well. If you menstruated before age 12 or are over age 55, your risk increases for getting breast cancer. Finally, if you have close relatives, especially a sister, mother, or daughter who have breast cancer, your risk is higher than someone who does not have a family history of breast cancer. Make sure when you see your physician or gynecologist that you mention this fact during your examination, as not all physicians will review your entire file before your examination.

By Laurie Amell, Esq. and Sandra L. Thayer, Legal Assistant

Sleepy Doctors

Mon, 07 May 2012 13:14:44 -0500

The culture of doctors working longer hours than most people begins during residency training, when medical school graduates spend 3-6 years learning hands-on skills for the real-world practice of medicine. For decades there were no restrictions on the time worked by residents, and they frequently logged 100 or more hours per week. The effects of sleep deprivation on the quality of medical care gained notoriety in a 1971 article in the New England Journal of Medicine, which showed that the error rate for fatigued residents was twice as high as their rested peers. In the wake of that study the Accreditation Council for Graduate Medical Education (ACGME), which oversees residency training, required 36-hour shifts to be separated by at least 12 hours of rest.

Thereafter, the problem of tired residents committing medical errors did not disappear, and in July 2003 ACGME tightened the rules, imposing caps of 24 hours of continuous duty and 80 hours worked per week, and mandating only one overnight shift every three days, 10 hours off between shifts, and one day in seven free from patient care and educational obligations.

Despite these limits for residents, there are still no rules for doctors who have finished their training, and the problem of their working to exhaustion remains - especially among older practitioners who trained during the unrestricted era. While a resident typically has an attending physician checking his work, full-fledged doctors (who may be over-worked and under-rested because they are highly motivated to begin with) usually have no one scrutinizing their methods and are accountable only to themselves.

Arguably, there are benefits to doctors working long hours, the most notable being continuity of care, i.e., a doctor who follows a patient for an uninterrupted time will do a better job than a doctor who rotates to the patient's care and may receive incomplete information or be less familiar with the problem. Interestingly, some research has found that the reduced hours now worked by residents do not diminish the frequency of their errors, perhaps due to being tasked with the same amount of work in less time, thus negating the benefits of being well rested.

Ample regulations protect the public from the dangers of fatigue in shift workers on whom lives depend. Pilots, truckers, and bus drivers, whose full attention is crucial to safely carrying out their duties, are subject to stringent rules on how long they can work without a break and their total number of hours worked. It seems sensible to place similar limits on hospital shifts in which doctors or nurses may now work 36 consecutive hours with patients' lives on the line as they diagnose and treat medical problems, perform procedures, and write prescriptions.

If you or a loved one sustained injury due to a healthcare provider's error, contact one of our attorneys at Stein, Mitchell & Muse, LLP for a free consultation.

Do you trust your pharmacist to fill your prescriptions correctly?

Wed, 02 May 2012 14:10:49 -0500

The healthcare provider prescribes the medication for us. The patient either takes the prescription to the pharmacy, or the physician transmits the prescription directly to the pharmacist. The doctor and the patient assume that when the prescription is ready for pick-up, it has been filled correctly - that we have the correct number of pills and the correct medication. It is the pharmacist's absolute responsibility to dispense drugs correctly. We doubt that most people actually count the pills when they get home, and if the prescription is new, patients outside of the medical field would not know what shape or color the pills should be.

But mistakes do happen. Pharmacy technicians in many stores are hired without any experience, making minimum wage, and are trained by the pharmacist. If the pharmacist is very busy, there is an increased chance that something can go wrong.

We successfully represented a woman who received an incorrect dosage of Coumadin. Our client had just completed many, many months of aggressive immune suppression therapy with Prednisone and Cytoxan and had just come off dialysis. At the time she had a known diagnosis of SLE (Systemic Lupus Erythematosus) and APS (Antiphospholipid Syndrome) and it was known that without an adequate Coumadin dosage of 10 mg, she would spontaneously develop widespread intravascular coagulopathies. In fact, on her admission to the hospital she was found to have "extensive clot formation in both legs extending from the common femoral vein down to the superior aspect of the popliteal vein on the right and into the popliteal trifurcation on the left." These severe DVTs (deep vein thrombosis) in both femoral veins in the upstream of venous blood to the inferior caval vein undoubtedly affected her.

Plaintiff's expert was prepared to testify that the medication error was part and parcel of the final demise of this young woman's kidney function and was most definitely a substantial factor in her lifelong need for dialysis and kidney transplantation.

By Gerry Mitchell, Esq. and Sandra L. Thayer, Legal Assistant

The Friendly Neighborhood Doctor

Thu, 26 Apr 2012 12:44:57 -0500

Beth (not her real name) discovered the occipital scalp lesion while combing her hair. It was fortunate for her, or so it seemed at the time, that she had a neighborhood friend who was a physician, a plastic surgeon. This healthcare provider lived nearby and being a friend, he offered to take care of removing the lesion. Drop by my office on Saturday morning, I'll take a look, he said. He didn't need his assistant there, it was a simple procedure. So she took him up on his offer, and he removed the lump in the back of her head. Then he simply tossed the tissue in his trashcan. No need to biopsy this, everything looks fine. I'm sure it's just a nevus.

By now a year had passed. The nodule had returned. As before, her neighbor excised it, and discarded the specimen. These nevi often recur, he said. When the lesion reappeared yet a third time, the worried woman consulted a dermatologist, who obtained a punch biopsy, which necessitated a third procedure by her friend.

The third procedure occurred in a hospital. This time tissue specimens were sent to pathology. The results: poorly differentiated malignant neoplasm of uncertain histogenesis. Further consultations with several leading pathology departments did not yield a conclusive diagnosis, but a consensus emerged that the tumor was probably non-osseous Ewing's sarcoma. Had her neighborhood physician/friend submitted the specimen to pathology instead of discarding it that Saturday morning, the diagnosis would have been made much earlier, and Beth would have had an excellent prognosis.

Ewing's sarcoma, which usually presents as a bone malignancy, carries a favorable prognosis if the lesion is surgically removed in its entirety. Unlike most Ewing sarcomas, Beth's lesion presented at an accessible site that invited easy removal. Instead, the lesion was partially excised on two occasions with disposal of the surgical specimens - resulting in loss of the opportunity for early removal and in the releasing of cancer cells for easier spread elsewhere in her body.

Beth underwent administration of chemotherapy. She also underwent administration of radiation therapy.

Despite extensive efforts to arrest Beth's cancer, she developed metastatic disease. It was first evidenced on a CT of the chest which demonstrated a nodule in the right upper lobe, a smaller nodule in the left lower lobe, and a small atelectasis or infiltrate in the right middle lobe base. Because of these lesions Beth was subjected to a thoracotomy and a resection of her right upper pulmonary lobe which was found to be filled with metastasis of the same type that had been found on her posterior scalp, including numerous mediastinal lymph node metastases.

Over the next fourteen months Beth underwent numerous attempts at chemotherapy but experienced a continued deterioration in her medical condition. After a long siege of pain and anxiety, she expired.

The doctor's good intentions were no substitute for meeting the standard of care. With gratuitous medical services it is often true that you get what you pay for. In this case there was a doctor-patient relationship despite the casual nature of the services, and we were able to secure substantial compensation for Beth's two children.

By Gerry Mitchell, Esq. and Sandra L. Thayer, Legal Assistant

When Things Go Terribly Wrong After Giving Birth, Make Your Voice Heard: Part 2

Fri, 20 Apr 2012 13:17:18 -0500

Plaintiffs' experts testified that the healthcare providers failed to document the occurrence of inadvertent spinal anesthesia, a failure that was a substantial factor in the healthcare team's lack of response to decedent's postpartum signs of infection. If a patient has had a "wet tap" or intrathecal catheter, the patient can be watched for complications that may occur with that condition. Inadvertent spinal anesthesia must be noted in the L&D chart and the patient carefully followed to determine "what impact this event may have on the course of the labor and the patient's postpartum period." In particular, for any patient with inadvertent entry into the intrathecal space and persistence of fever greater than 100.4 F, the standard of care required ongoing medical and nursing evaluation to rule out CNS infection.

The failure to assess the new mother's condition over the next eight hours (when the patient and family were pleading for someone to check on their loved one) directly resulted in the failure to recognize the existence of postpartum febrile morbidity and treat her empirically for postpartum infection. Any standard antibiotic regimen for postpartum infection, if timely administered, would have halted the progression of the Strep salivarius infection which eventually resulted in her death. Responsibility for the lack of such an evaluation, and thus for this woman's death, rests upon the physicians for their failure to record the occurrence of inadvertent high spinal anesthesia, with its attendant risks of central nervous system infection.

Plaintiffs' nursing expert testified that the nursing standard of care required that her temperature be monitored closely following the initial recording of elevated temperatures. The standard of nursing care also required that the attending physician be notified with the expectation that empiric antibiotics would be started. The patient's fever persisted, as confirmed by the record and multiple family members, but the progression of her temperatures was not adequately followed by the hospital nursing staff. Persistence of febrile morbidity in a postpartum patient must be documented and communicated to attending physicians, and if no action is taken, must be communicated up the nursing chain of command.

Nursing negligence in the immediate postpartum period is evident in the failure of the nurses to communicate orally regarding the patient's postpartum condition with the attending physicians or the postpartum unit. Likewise, the initial FCCU nurse, failed to apprise the patient's other healthcare providers regarding her postpartum fevers and headache. The nurse's administration of Motrin, coupled with lack of nursing follow-up and lack of communication with the physicians, obscured the patient's condition and contributed to the failure to diagnose and treat this patient in a timely manner.

These initial nursing failures were compounded by the continuing failure to evaluate the patient and summon needed assistance. Despite the persistence of fever following the administration of Motrin at 8:00 p.m., no physician was summoned for many hours. This continuing negligence was highlighted by the late and inadequate report provided by the nurse leaving for the night to the incoming nurse. At that time the departing nurse only communicated that this patient had a history of migraines and emotional anxiety. This history, coupled with the failure to disclose persistent fever and the administration of Motrin, served to obscure the significance of her continuing symptoms and was a substantial factor in the overall failure to recognize and treat the CNS infection.

Lastly, the failure to implement the house doctor's verbal order for ampicillin was a clear departure from applicable nursing standards. This nurse admitted that this medication was ordered but not given. Had an antibiotic such as ampicillin been administered within a few hours of the patient's initial complaints of a pounding headache, it is likely that the progression of her Streptococcus salivarius infection would have been reversed. This pathogen is extremely susceptible to a wide spectrum of antibiotic medications, including ampicillin.

In the context of inadvertent spinal anesthesia, with a large epidural needle entering the intrathecal space containing CSF, the persistence of fever and headache is particularly ominous and mandates a diagnostic evaluation. The duty to undertake such an evaluation, leading to the administration of antibiotic medication, rested upon the shoulders of this woman's team of physicians, and each member of that team contributed to the ultimate failure to provide timely and effective medical treatment. The patient should have been seen by a physician many hours earlier.

All experts agreed that this woman died as a result of a bacterial infection. The disputed issues among the experts were whether the fatal infection was iatrogenic or community-acquired, and whether antibiotic treatment in accordance with the standard of care for treatment of bacterial meningitis or meningoencephalitis would have been effective.

The medical record in this case demonstrates her increasing physical pain and mental anguish, with notations of headache, chills, fever, agitation, eye pressure, neck pain, thrashing around in bed, feeling suffocated, and suffering the onset of severe seizures. As a new mother responsible for her infant son, the decedent was particularly vulnerable to the emotional and psychological effects of such injuries. Her husband testified that his wife repeated in anguished tones, "This is not normal," and "I don't want to die." There can be no more frightening situation for a young mother, with a mounting fear of her own death so soon after giving birth.

Please read Part I - When Things Go Wrong After Giving Birth, Make Your Voice Heard

By Gerry Mitchell, Esq. and Sandra L. Thayer, Legal Assistant

Detecting Oral Cancer

Fri, 20 Apr 2012 10:12:27 -0500

April is Oral Cancer Awareness Month. It has been appropriately publicized that dentists play a critical role in detecting oral cancer. Many dentists perform oral cancer screenings as a part of their standard practice. It is important to make sure that you receive regular oral cancer screenings from your dentist, whether or not that is a standard part of the dentist's examination.

The majority of sores, lumps and bumps that appear in the mouth are not cancerous and disappear on their own after a short time. If a lump persists, a dentist should not reassure you that the lump is benign if it has not been biopsied. It is not necessarily evident without microscopic examination whether a lump has cancerous potential.

We recently handled a case where a patient went to her regular dentist for a routine cleaning appointment and pointed out to him a lump in her mouth that had been present for several weeks. Her dentist examined the lump, reassured her that it was nothing to worry about, and said nothing about monitoring or follow-up. The lump persisted in her mouth, but did not noticeably increase in size and did not otherwise bother her, and having been reassured that it was nothing to worry about, the patient did not bring the lump to any dentist's or physician's further attention. It was not until an ENT doctor treating her for sinus concerns looked in her mouth and saw the lump that she was told that the lump should be biopsied, and shortly thereafter found out that it was a form of carcinoma.

A patient does not have to second-guess a trusted physician's instructions, and the law says that the exercise of reasonable care does not require a patient to obtain a second opinion in a case like this. Dentists and physicians do make errors, however, and sometimes those errors have life-threatening consequences. A mouth lump that persists, like a sore that does not heal, is suspicious. If a mouth lump does not go away on its own after a reasonable period of time, it should be reevaluated.

The National Cancer Institute at the National Institutes of Health in Bethesda, Maryland provides additional information about oral cancer on their website.

When Things Go Wrong After Giving Birth, Make Your Voice Heard: Part 1

Mon, 16 Apr 2012 13:10:28 -0500

A newborn and his father are leaving the hospital to go home to an empty house. Just a few days ago, the father and his wife had been filming their departure from that same home to the hospital where the planned induction would occur. They spoke aloud to memorialize the day that their firstborn would arrive. The pregnancy had been uneventful.

The patient was taken to a room where her vital signs and temperature were taken, and there were no signs or symptoms of infection. The unmasked physician arrived and he began the task of administering the epidural anesthetic. The pregnant woman felt tingling and loss of sensation up to her breast line, so the epidural was stopped, as the healthcare provider knew those symptoms were suspicious for inadvertent administration of spinal anesthesia, meaning that the relatively large epidural needle had probably entered the intrathecal space, i.e., the subdural or subarachnoid space. The doctor returned later and the epidural was again placed; however, this time another problem was encountered: when the syringe was pulled back, there was a presence of clear cerebrospinal fluid which is indicative of likely dural puncture and an absence of preexisting CNS infection. The doctor leaves, but his patient remained in pain for several hours until it was discovered that the lines were not connected. Finally, time passes and vaginal delivery was accomplished.

The new parents' excitement was short-lived. Mom was complaining of a headache and she had a fever. Although she had been given Motrin earlier, the headache worsened, and her temperature continued. Family members began arriving at the hospital. Instead of seeing an excited new mother, they witnessed their loved one in severe pain, and they complained to the staff.

During the ensuing 7 or 8 hours, her pounding headache and fever increased, and notations were made in her chart. Percocet tablets, when finally administered, offered no relief. A short time later, she began complaining of swelling in her neck with a tight feeling, pressure in her eyes, and her headache was worsening. Finally, eight hours after giving birth, the house physician came to see her, and immediately informed the patient's obstetrician of the status of this new mother's condition. The obstetrician ordered Benadryl and ampicillin, but as the patient's condition deteriorated even more over the next two hours, the healthcare providers realized that their patient had not received the ampicillin that was ordered. To compound this situation, several additional hours passed without the antibiotics being administered. By now, the patient was exhibiting signs and symptoms of increased intracranial pressure. Her downward spiral could not be reversed and she eventually suffered brain death due to cessation of cerebral blood flow. Absence of cerebral perfusion was confirmed and this woman, who had given birth and never had an opportunity to know her baby, was pronounced dead.

Please return to read Part II - What Went Wrong?

By Gerry Mitchell, Esq. and Sandra L. Thayer, Legal Assistant

Don't Overreact

Tue, 10 Apr 2012 12:50:22 -0500

How many dental appointments will be canceled today?

The journal Cancer published the largest study performed to date regarding the frequency of receiving dental x-rays and panorex examinations. If you had yearly dental radiology studies done, especially if you began younger than age 10, you are at a greater risk to develop meningioma (a common type of tumor that forms in the meninges - the membrane around the brain or spinal cord). Though the tumors are not usually malignant, these tumors can grow and become large and cause various health issues such as headaches, hearing and memory loss, extremity weakness, and seizures.

This case control study lasted five years, and included slightly more than 1,400 subjects. A case control study relies primarily on the individual's recall of past events versus comparing their answers with the medical or dental records. One difficulty with a control study such as this one is that people will read this dental study and suddenly remember that they indeed had many dental x-rays, whether they actually did or not.

Be mindful that the science community has greatly improved in terms of the amount of radiation exposure patients receive. This latest study reflects the effects of machines used in the past, not necessarily what is in use today. The bottom line: Talk with your dentist and hygienist about your specific dental situation. If you are symptom-free and practice good dental hygiene, exposure to dental radiation can be received less frequently but should not be omitted altogether. If young children must have x-rays, the study states that the risk of developing meningioma is rare.

By Gerry Mitchell, Esq. and Sandra L. Thayer, Legal Assistant

When your child is away at school and becomes ill: What would you have done differently, if anything? - Part 2

Tue, 03 Apr 2012 13:08:42 -0500

The history of recurrent pharyngitis and general malaise in an eleven-year-old African American female who had been residing in a crowded boarding school has to be considered as presenting a high likelihood for the presence of streptococcal pharyngitis, with great concern for the possible presence of strep A bacteria known to cause acute rheumatic fever (ARF). Acute rheumatic fever is an aberrant response to streptococci A characterized by inflammatory lesions of skin, joints, and more rarely, the heart, kidney, and central nervous system. Aggressive antibiotic treatment following serology and bacteriology testing is indicated whenever strep A pharyngitis or acute rheumatic fever is believed to exist.

The pathognomic presentation of this young girl, with streptococcal A pharyngitis and incipient acute rheumatic fever and its attendant risks, was completely ignored by the defendant health care providers. In particular, it is hard to comprehend why an 11-year- old African American female returning from boarding school with a history of recurrent pharyngitis, erythema, and fluctuating temperatures would not be suspected and tested for streptococcal infection and treated accordingly.

The medical records document increasingly worrisome symptomatology of a systemic infectious process which was not evaluated by these physicians despite the availability of simple tests for an elevated erythrocyte sedimentation rate, strep serology (ASO), weight measurements, CBC's and immune reactive testing (C-reactive protein, interleukins, cytokines, etc.).

The failure to meet the applicable standard of care and medicate our minor client with appropriate antibiotics (1.5 million IU of Penicillin) and salicylates (at blood levels of 20 mg/ 100 ml) resulted in persistence of colonization of her throat and upper respiratory tract with type A streptococci and allowed her autoimmune disease to spiral out of control and cause direct permanent, serious damage to her myocardium and mitral, tricuspid, and aortic valves.

The medical condition of our clients' daughter is life-threatening and has placed her at high risk for serious morbidity and potential mortality if intense and appropriate treatment and rehabilitation, including valve replacement surgery, is not provided to her.

The etiology and pathogenesis of ARF in this girl was preceded by multiple pharyngeal infections the year before, and a period of pharyngeal infections and general malaise just before her return home for the summer vacation upon the completion of the school year. The manifestation of ARF with carditis was diagnosed several months after returning home from boarding school, when she was admitted to the hospital secondary to life-threatening congestive heart failure. Her treating cardiologist was shocked to learn that she had not been treated with antibiotics and salicylates by the defendants and that she was not referred in a timely manner to an infectious disease specialist or to appropriate specialists willing and able to take care of a relatively simple and treatable streptococcal infection.

Numerous studies have established the connection between readily available antibiotic medication and the relative risk for acute rheumatic fever and related serious illnesses of carditis, glomerular nephritis, and chorea. These serious diseases are virtually nonexistent in populations where antibiotics and salicylates are admin in accordance with the standard of care in timely and proper dosages.

This is a case in which the failure of the defendants resulted in this young female developing streptococcal A related carditis and valvular disease. The disease could easily have been prevented if she had been treated with antibiotic medication and salicylates in a timely manner.

By Laurie A. Amell, Esq. and Sandra L. Thayer, Legal Assistant

When your child is away at school and becomes ill: What would you have done differently, if anything? - Part 1

Tue, 27 Mar 2012 13:04:32 -0500

Parents often feel helpless when their child is sick. It is even more difficult if the sick child is young and attends boarding school. We successfully handled a case involving an out-of-state school who misdiagnosed a fifth grader.

Many boarding schools have an infirmary where students receive medical care when they are sick. An eleven-year-old girl had complaints of a sore throat, a red and swollen uvula, and positive lymph glands bilaterally. Her symptoms of general malaise and pharyngitis fluctuated for four weeks, when her complaints of sore throat and headache recurred and gave rise to a significant increase in temperature three days later. At that time she also presented with a macular rash compatible with urticaria on the neck and back and under her breasts. She was treated with antihistamines and Tylenol. Her parents arrived at school to pick her up, and the girl and her parents returned to their home in Maryland several days later.

The mother made an immediate appointment for her daughter to see the pediatrician the following day, and ultimately had three additional sick office visits. The medical record is clear that during these visits the pediatrician failed to take a complete history of the girl's medical condition, failed to perform a thorough medical examination, failed to obtain information from the school, failed to respond to parental concerns regarding her general malaise and tonsillitis, failed to perform appropriate diagnostic evaluations, and failed to give his minor patient much needed antibiotic medication.

Over much of the same period the 11-year-old girl was also seen by a general internist without adequate experience in treating pediatric patients. There were two visits with this physician, where he also failed to elicit and record the girl's medical history and perform an adequate physical examination. This physician also failed to elicit the existing evidence of pharyngitis and the highly likely presence of streptococcal infection.

A third health care provider also saw the child on referral from the second. As the two doctors before him, he also ignored the recent history and acute presence of symptoms of serious illness in favor of performing non-urgent testing for allergies that were unlikely to be significant etiologic factors in her condition.

[To be continued in one week. Please return to this blog page
to read the conclusion of this case.]

By Laurie A. Amell, Esq and Sandra L. Thayer, Legal Assistant

Informed Consent is Key to Good Healthcare

Mon, 19 Mar 2012 13:42:13 -0500

The purpose of informed consent is to give a patient sufficient information to make a decision about medical treatment. Inadequate consent can be a basis for a patient's subsequent claim against a healthcare provider. Let's analyze what comprises proper informed consent.

The American Medical Association defines informed consent as a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. During this communication process, the following points should be discussed:

The patient's diagnosis, if known;
The nature and purpose of a proposed treatment or procedure;
The risks and benefits of a proposed treatment or procedure;
Available alternative treatments or procedures, regardless of their cost or the extent to which they are covered by health insurance;
The risks and benefits of the alternative treatment or procedure; and
The risks and benefits of refusing a treatment or procedure.

These points must be discussed thoroughly and to the patient's understanding. The patient must also be allowed to ask and have answered any questions for a better understanding of the proposed treatment or procedure, and should be given adequate time to consider the decision and obtain additional opinions from different healthcare professionals if desired.

Situations requiring informed consent vary among the states, and can be somewhat subjective. While generally not needed before testing a patient's reflexes or listening to the heart with a stethoscope, informed consent is always required in advance of any surgical procedure, experimental treatment, or clinical trial. Providing a patient with relevant information has long been an ethical obligation for physicians, and it has recently become a legal rule across America, as most states require (at least for specific procedures/operations) the communication discussed above, as well as a patient's written consent and receipt of a copy of any signed consent documents.

Most disputes about consent allege that a patient did not receive sufficient information to make a decision. Documentation is therefore crucial for healthcare providers to avoid such claims -- in addition to having the patient sign a form, a thorough entry in the medical record should establish that there was a discussion of a proposed treatment's risks and benefits, and that the patient expressed an understanding and had all questions answered. As a patient, you should make sure you understand everything being explained to you, and ask questions if you do not. Never sign a consent form without understanding it, or be afraid to occupy a physician's time with questions, or even to schedule another appointment before your procedure to ask extra questions. Know all your treatment options (including refusal of treatment), as well as the risks and benefits of each option.

An upcoming blog entry here will discuss the validity of informed consent when an adult's mental competence is in question and when minors are involved. If you believe you have suffered injury due to a lack of informed consent, contact Stein, Mitchell & Muse, LLP for a free consultation.

FAILURE TO GIVE PATIENT TEST RESULTS CAN BE COSTLY

Mon, 12 Mar 2012 11:04:19 -0500

Many healthcare providers -- and their patients -- operate on the assumption that "no news is good news." But when it comes to the results of medical testing, this view can spell trouble. A patient should always follow-up with a healthcare provider to obtain the results of any medical test. Doing so will help ensure that abnormal results are not overlooked, and could eliminate a treatment delay or even worse outcome. For example, if a patient undergoes a blood test for cancer markers, the doctor might tell the patient to assume a negative result if his office does not call in a few days. So the patient hears nothing and does nothing until appearing for an annual exam the following year, when she finally learns of the positive result. Not having that information for a year could mean the difference between a cancer diagnosis of Stage I disease (treatable and curable) and Stage III disease (metastasized, becoming untreatable, and likely terminal).

A 2009 study in the Archives of Internal Medicine ("AIM") showed that approximately 7% of doctors failed to relay or document abnormal outpatient test results for their patients. This is usually the result of an ineffective office communications system which allows test results to fall between the cracks. If a patient suffers harm as a result of a healthcare provider's failure to provide test results, a medical negligence claim may be asserted against the provider.

The authors of the AIM study recommend the following five steps by which healthcare providers can avoid failing to transmit test results to their patients:

Route test results to the responsible doctor;
Have the responsible doctor review and sign all test results;
Inform patients of all test results, whether normal or abnormal;
Document that patients were informed of test results; and
Tell patients to call if they do not receive test results by a specific date.

Unfortunately, many physicians' offices lack the time or resources to implement these recommendations, as they trim administrative costs due to smaller reimbursements from insurance companies and state government insurance plans. So it is more important than ever for patients to take charge of their own healthcare by dropping the "no news is good news" approach. It is always OK for a patient to call a healthcare provider's office and ask about test results - it takes only a few minutes, and could be a life-saver.

If you or a loved one have experienced injury due to a healthcare provider's failure to report abnormal test results, contact one of our attorneys at Stein, Mitchell & Muse, LLP for a free consultation.

Diabetic Ketoacidosis

Mon, 05 Mar 2012 10:59:41 -0500

You feel nauseated, weak, have shortness of breath, and have been vomiting. Your blood pressure is low, and your heart rate is high. When you receive your lab work, it shows that you have a high anion gap and high blood glucose. Ketones and glucose are in your urine. These are typical signs and symptoms of new onset Type 1 diabetes mellitus and diabetic ketoacidosis (DKA), a very basic and treatable medical condition that is a potentially life-threatening condition if not treated properly.

It is rare to die from new onset diabetes because insulin is readily available. Cells require insulin to function, and insulin operates to allow glucose into the cells for energy. Type 1 diabetes is characterized by the absence of insulin, which is incompatible with life. The acute condition of DKA is most commonly precipitated by infection, which creates extra stress on the body and an enhanced need for insulin. DKA makes the heart vulnerable to arrhythmias due to electrolyte imbalance, lack of energy, and lack of oxygen.

Patients can have new onset diabetes mellitus with diabetic ketoacidosis (DKA), a very basic and treatable medical condition that is a potentially life-threatening condition if not treated properly. It is rare to die from new onset diabetes in the modern world because insulin is so readily available. Cells require insulin to function, and insulin operates to allow glucose into the cells for energy. Type 1 diabetes is characterized by the absence of insulin, which is incompatible with life. The acute condition of DKA is most commonly precipitated by infection, which creates extra stress on the body and an enhanced need for insulin. DKA makes the heart vulnerable to arrhythmias due to electrolyte imbalance, lack of energy, and lack of oxygen.

Fecal Impaction Results in Death

Wed, 29 Feb 2012 13:35:08 -0500

Stein, Mitchell, and Muse, LLP represented the family of a deceased sixteen-year-old eleventh-grader who developed acute abdominal pain associated with constipation and vomiting. This teenager was brought to a local emergency room by her mother in acute distress with abdominal pain, abdominal distension, and a three-week history of constipation. The young lady was seen by an emergency room physician who, within ninety minutes of her arrival, diagnosed her with acute abdominal pain, obstipation, and fecal impaction. Her symptoms included "nausea and vomiting" and "crying with pain." Her laboratory studies demonstrated a mildly elevated WBC and mildly abnormal liver enzymes.

An attempt at disimpaction was performed without success by the emergency room physician, who ordered two Fleets enemas which also failed to relieve the fecal impaction. In view of the patient's symptoms of abdominal pain, distention, and leukocytosis (elevated white blood cells and bands which are indicative of infection), the standard of care required that a surgical consultation be obtained STAT. Instead of a surgical consultation, the patient was evaluated by a pediatric team consisting of medical student and a resident who documented the presence of hypoactive bowel signs, severe distension, diffuse enlargement of the abdomen, guarding, tenderness to palpation, pain upon any movement of the torso, and stool in the right lower quadrant. The attending pediatrician wrongly concluded that the patient's abdominal condition was essentially unchanged from her initial presentation to the emergency room and that she did not need a surgical consultation. The patient's condition continued to worsen, and by 6:00 p.m. it was noted that her abdomen was "very distended up to the breasts." Her level of consciousness deteriorated and by 8:30 p.m. she was noted to be difficult to arouse. At 8:40 p.m., a code blue was called due to a cardiorespiratory arrest. Cardiopulmonary resuscitation with mask ventilation was initiated but not before the patient had gone into multi-organ system failure with metabolic and respiratory acidosis, kidney failure, and sepsis, with a principal diagnosis of bowel perforation and septic shock. An exploratory laparotomy was finally performed at 1:30 a.m. and she was found to have extensive fecal material in her colon. She was pronounced dead at 2:21 a.m. An autopsy disclosed that the cause of death was necrosis/autolysis consistent with toxic megacolon, with secondary cerebral and cerebellar edema.

No request was made for a surgical consultation. As a result, no surgeon saw the patient until after she went into a cardiorespiratory arrest secondary to fecal impaction and colon perforation. A timely exploratory laparotomy would have resulted in the removal of the fecal impaction and cured the gastrointestinal obstruction. Thus, a timely surgical consultation certainly would have saved the patient's life.

ELECTRONIC MEDICAL RECORDS ARE AN IMPROVEMENT STILL IN PROGRESS

Fri, 24 Feb 2012 13:47:15 -0500

As technology keeps changing, with new features appearing almost constantly, more and more everyday written materials are becoming digitized, including records generated by hospitals, physicians, and other healthcare providers. The benefits of electronic medical records (EMRs) include:

Readability - No more attempting to decipher doctors' handwriting, which is often notoriously illegible.
Accessibility - Many EMR programs can be accessed from any computer. Thus, if a patient calls after hours, a doctor can easily access the patient's medical record. This can be pivotal when prescribing medications urgently, needing to review allergies or medical history, etc.
Privacy - With paper charts, all records were frequently in one place, and anyone with access to your chart could view your complete medical history. EMRs can better protect such information. For example, a physical therapist writing progress notes into an old paper chart could see all its contents, but with EMR safeguards a patient can make available to that therapist only the records relating to physical therapy.
Communication - While a nationwide medical record database has not yet been established, mainly due to privacy concerns, EMR systems used by most medical centers are integrated among specialties. So if a patient receives care at an emergency room, then later consults a neurologist at the same hospital, followed by an orthopedic surgeon, each successive provider in that system can access the patient's data as necessary. This obviously enhances effective treatment.
Organization - Most EMRs are organized so that information is easier to find than in the older-style paper charts.

But EMRs are not flawless. Some EMR systems use templates intended to simplify data input, and a patient's physical-exam data entered on one visit can easily be transferred to subsequent visits which did not include a physical exam. Thus, EMRs may reflect outdated symptoms or treatment, creating an inaccurate record. This "check-box effect" can render a key evidence source factually incorrect, undermining a patient's claim for medical negligence.

Ultimately, it is up to patients to ensure the accuracy of their medical records. You can and should request a copy of your medical records, review them carefully, and point out any mistakes to your healthcare provider. If you or a loved one may have suffered an injury due to improper medical care or inaccurate medical recordkeeping, contact an attorney at Stein, Mitchell, and Muse, LLP for a free consultation.