Organizing Your Medical Records

It is quite crucial when dealing with a medical lawsuit that any records you are using are organized and complete. Structured and comprehensive medical records will save you time - no wasting time searching for what you need; and money – you won’t have to pay a medical expert a high hourly fee to organize the records.  

What Can You Do to Improve the Organization of Medical Records?

Start organizing the records as soon as you receive them. Records can be arranged in chronological order or by the types of records they are.  For instance, place all lab results in one section and all primary care documents in another. Hospital records should be separated and placed in chronological order. You'll can further separate them into additional types or categories, like subsections. Be sure all pages are numbered, especially if stored electronically. Numbering is vital to make it easier for you and your medical expert to refer to the pages during litigation or review.

Hardcopies of medical records should be arranged in a three ring binder. Once you have them organized, it is useful to make tabs identifying distinct sections in order to quickly locate that which you are seeking.

If you know the records will be evaluated by a medical expert, ask the expert how he/she would like the records prepared. Organizing the files yourself can save plenty of money rather than having the expert invest his/her time organizing or trying to find information.

Effectively organizing all medical files when working with a medical malpractice, personal injury or worker’s compensation case, may be hard. Nonetheless finding the time to do this can make or break your case. Medical records are filled with crucial information that can be critical to a case, therefore, knowing what you have and being able to find it quickly and effectively is essential.

To make sure your documents are organized in a professional way, consider having them analyzed by a medical record review expert. Contact us for more information about the importance of organizing the medical documents, and how you can get organizational support.

Malpractice and the Presidential Race

Dr. Ben Carson had a distinguished 30 year career as a renowned brain surgeon before he decided to run for president of the United States. Somewhat astonishingly, he is not the sole medical doctor in the field of nominees - Rand Paul, an ophthalmologist, is also in the running. Historically, most politicians in the U.S. have foundations in the military, law, or business; yet five doctors actually signed the Declaration of Independence.

Like many U.S. physicians, Dr. Carson confronted medical malpractice lawsuits several times during his 30 year career. He was sued for medical malpractice at least eight times during his years as a neurosurgeon. 

Eight medical malpractice lawsuits may seem to be significant number, yet it is not alarming after considering the high risk nature of Dr. Carson's specialty. Neurosurgeons are more prone to be sued when compared to other specialties. Overall, 7.4% of all doctors face a medical malpractice claim each year, whereas 19.1% of all neurosurgeons face a medical malpractice claim each year according to a 2011 study published in the New England Journal of Medicine.

The researchers suggested that the neurosurgery numbers were higher because frequently the most complex, high-risk cases end up in court. Many times a lawsuit is filed simply because a plaintiff suffered an injury, not always because the surgeon's performance fell below the standard of care. The study also noted that the vast majority of neurosurgery claims were ultimately decided in favor of the neurosurgeons.

Therefore, the eight medical malpractice claims faced by Dr. Carson were statistically relatively low. Whether Dr. Carson ultimately becomes the republican presidential nominee is yet to be determined.

Contact MediPro Solutions, LLC, for all your medical legal questions!

Federal Law and Malpractice

A recent judgement in a Florida appeals court might have far reaching consequences in medical malpractice cases.  Florida has a constitutional amendment that gives plaintiffs in medical malpractice cases expanded access to hospital medical records.

Access to these records became an issue in Florida after a patient suffered neurological injuries and permanent damage after being treated at the Southern Baptist Hospital of Florida, Inc. in Jacksonville. The patient's lawyers filed a lawsuit and requested records from the hospital regarding her injuries. The hospital released just some of her records and withheld others, citing the Patient Safety and Quality and Improvement Act of 2005, which is a federal law. This act stipulates that certain medical records are unavailable to plaintiffs in medical malpractice cases because to release those records would create fear for healthcare providers that their words may be utilized against them in court, thereby preventing open communication in health care.

The trial court initially ruled for the plaintiff and stated that the requested records must be provided by the hospital. The hospital appealed that ruling stating the federal law took precedent in the case and allows for hospitals to legitimately refuse to release records. The appeals court ruled in favor of the hospital noting if there is any contradiction between federal and state law, the federal law prevails.

In order to reverse this opinion, attorneys for the plaintiff can appeal to the Supreme Court. In the event the Supreme Court rules on this issue, then the law would employ throughout the U.S. However, this may take some time because the process of appealing to the Supreme Court normally takes several years.

Contact us for your medical consulting needs.

When Athletes Get Hurt in Training, Can They Sue Coaches for Overuse Injury?

Participation in athletics comes with the knowledge that injuries could occur.  Sprains and bruises are common and even expected by those who routinely participate in athletics.  However, in some cases athletes sustain injuries from activity that would be considered outside of the scope of routine practice. Common overuse injuries include runner’s knee, swimmer’s shoulder, and shin splints. 

Coaching staffs are in charge of overseeing the training and practice of their athletes.  Therefore, if an athlete suffers an injury from the training regimen that was established by the coach, can you sue a coach for an overuse injury?

According to the Stop Sports Injury website, errors in training, typically a rapid increase in the intensity, duration, or frequency of activity, are what can most commonly result in overuse injuries. It can be difficult to pinpoint the exact activity causing the injury and the time the injury occurred since they usually occur during training.  These injuries should be diagnosed by a medical professional who can also recommend an alternate training regimen or physical therapy if needed.

At what point could the diagnosis of an overuse injury warrant questions about liability or lawsuit?  Attorney Roger Manwaring, writing in Lawyers’ Legal Research & Writing, states that if an injury arises from the intentional or negligent conduct of a coach, the athlete may have a legal claim.  Athletes may consider a lawsuit for negligent training or supervision, or for selecting inappropriate protective equipment. However, such claims can be very difficult to prove, especially considering societal pressures to encourage athletes to compete hard on the field. 

Sports injury laws vary from state to state, but in Massachusetts, for example, a coach is considered a public employee and therefore is immune to a lawsuit under the state’s tort claims act.  However, a school or college, which is considered a public employer, can be sued.  These suits are subject to damage limitations.  Massachusetts law also protects volunteer coaches, managers, umpires, or referees in sports programs serving youth under 18 years old. 

Keeping athletic competition on the playing field rather than in the courtroom is a factor driving much of the law governing legal claims for sports injury.  However, there are instances when such claims are allowed. To learn more, contact us!

How Patients' High Deductible Insurance Plans Pose Malpractice Risks to Doctors

High deductible insurance plans require patients to take on more of the financial risk in exchange for lower monthly premiums.  Patients are increasingly choosing plans where they cover their own eligible expenses until costs reach a deductible that can be well into the thousands of dollars.  These high deductible insurance plans can pose a malpractice risk to doctors.

The number of patients with health insurance has increased due to the Affordable Care Act, however, most of these patients choose high deductible health plans.  The number of patients with these types of plans has increase to 17.4 million in January of 2014, up more than 12 percent from the previous year, according to Healthcare Finance.

The issue that physicians are seeing with these high deductible plans is that patients are making medical appointments less often for chronic care, and are also skipping medication refills or declining to pay their out-of-pocket costs for medical tests.

Patient choices to forgo aspects of their health care can have disconcerting implications for physicians.  A case reported in Massachusetts Medical Law Report demonstrates these potential consequences.  A physician was sued for malpractice by the family of a patient who died after a late stage cancer diagnosis.  The patient, a 65-year-old man was a patient of the physician for four years; however the physician never performed a complete physical exam during that time, including colon rectal cancer screening.

The cancer was not diagnosed until the patient went to the hospital with abdominal pain for several hours and no bowel movement for several days.  He underwent exploratory surgery where stage IIIB colon cancer was discovered.  The physician said he did not offer the patient cancer screening because he was only seeing him for blood pressure checks, not for full primary care.  The private-pay patient declined any further medical care beyond those blood pressure checks.  The case ultimately settled for $1.5 million.

The risk stems from the fact that physicians could be held responsible for patients who decline care and this risk is likely to increase as patients put off or skip screenings that are not covered by insurance. 

To protect themselves, physicians must explain the risks of skipping tests and then follow through on whether they have been performed or not.  Physicians must also document everything – the patient chart should reflect whether a patient declined appropriate screening tests, as well as whether the patient understands the possible consequences of that decision.

To learn more about the potential implications of high-deductible insurance on medical malpractice, contact us today.

Spending and Malpractice

Findings from a new study recently published in the BMJ and supported by the National Institutes of Health provide evidence for those who assert that practicing defensive medicine is a realistic alternative for physicians who would like to safeguard their careers and reputations.

The study focused on data between 2000 and 2009 that involved 24,637 doctors and 18,352,391 admissions to acute care hospitals in Florida. The data showed a connection between higher spending by doctors per patient and a decreased risk of incurring a medical malpractice claim.

There were 4,342 malpractice claims made during the time period under review. Generally, the analysis found that higher spending doctors get sued less often than lesser spending physicians. For example, in the obstetrics specialty, the likelihood of facing medical malpractice fell as an obstetrician performed more Cesarean sections and spent more per patient.

Directors of the study did admit limits to the findings, specifically that information on illness severity was not provided and doctors were not directly asked if their increased spending was motivated by defensive medicine. Nevertheless, even if the study doesn't necessarily demonstrate that increased spending was the direct cause of the decreased opportunity of facing a medical malpractice suit, it does demonstrate that there is a correlation and more research is probably needed to understand the link.

Contact us for your medical legal needs!

Comparative Negligence, Expert Witnesses, and Medical Malpractice

One would think that a wrong is a wrong, no matter where it took place and that your compensation for that wrong should also not be affected by where it happened.  However, in medical malpractice every state has different rules.  A recent lawsuit against LabCorp is an example of how those rules can reduce compensation.

A woman in Florida died of cervical cancer three years after LabCorp diagnosed two of her pap smears as negative for cancer.  Her husband filed a medical negligence lawsuit against LabCorp alleging that they misread the tests.  The jury determined that damages to her husband totaled just over $20 million, but reduced this award to $15 million because the patient was found to be 25% liable for her own negligence.

Florida follows a comparative negligence guideline in which a party’s own negligence will reduce any monetary award in proportion to the amount of the plaintiff’s negligence. Many other states follow a modified comparative negligence standard in which a party will lose any right to compensation if that party is more than 50% liable for his or her injuries.

Florida also requires medical negligence plaintiffs to file a notice of intent to initiate a medical malpractice claim, which must include an expert witness’s opinion that the plaintiff has a good basis for a lawsuit.  The notice of intent marks the start of a ninety-day settlement period that may or may not affect the statute of limitations on the case.

Other aspects of medical malpractice cases fall under differing rules in different states.  A plaintiff usually must file his or her malpractice case within two or three years of the occurrence or discovery of an injury.  Some states impose an absolute bar against any malpractice case of seven to ten years after the medical error is committed, regardless of when an injury manifests itself.

Many states have also enacted caps on damages related to pain and suffering (noneconomic).  In some instances courts have struck down those caps, but for now a plaintiff’s damages for pain and suffering can depend on what location the underlying wrong occurred.

The substantive elements of a medical malpractice case may be simple and straightforward, but the laws, rules, and standards which govern the case differ dramatically from state to state.  MediPro Solutions, LLC works with attorneys to navigate those laws and select the most highly qualified medical experts to analyze and verify a client’s malpractice case.  Contact us at your convenience for more information about our services.

Misleading or Misreading: Why Do Radiologists Face Medical Malpractice so Often?

Radiologists make up about 3.6% of practicing medical doctors, however they rank 6th among all specialists in the number of malpractice claims for which they've been defendants. From 1985-2002, radiologists were sued more frequently than plastic surgeons, anesthesiologists, gastroenterologists, and cardiologists.

Medical malpractice cases generally arise from two issues: improper medical care resulting in harm, or a poor doctor-patient relationship.

Radiologists specialize in the analysis of injuries and disorders using techniques and medical imaging equipment such as x-rays, positron emission tomography (PET), nuclear medicine, and ultrasound. Radiologists interpret and review these scans for diagnosis including internal bleeding, cancer, or fractures.

Radiological "misses" generally relate to either missed fractures or missed diagnosis of cancer. Misinterpretations of imaging associated with the breast and breast cancer were the most common cause of misdiagnosis leading to malpractice suits.

A review of 562 breast cancer malpractice claims by medical liability insurers from 2009 to 2014, found that 61% of the claims were related to alleged delays in diagnosis. Almost 48% of those delayed-diagnosis cases included radiology to some extent.

Radiological "misses" can result in serious effects for a patient. In 2012, the National Institute of Health released a scathing report claiming that mistakes in reading radiological scans generally arise from poor technique, lack of knowledge and experience, or failures of perception.

Please contact us for more information regarding medical malpractice.

Politics and Malpractice

Dr. Steven Anagnost is a doctor in Oklahoma and, like many other physicians in the state, works in several practices and sees patients frequently. His career, nevertheless, has been distinct from several other doctors in the United States, as well as Oklahoma, largely due to his involvement with politics.

In 2010, the Oklahoma State Board of Medical Licensure began inquiring and preparing to revoke Dr. Anagnost's license after several patients suffered injury and even death after getting treatment from him. In addition, he was accused of billing for surgeries he had not performed and of improperly implanting spinal devices which he'd been paid to promote. Dr. Anagnost paid several malpractice settlements out of his own pocket rather than use his malpractice insurance.

Prior to the investigation, Dr. Anagnost had made contributions to Rick Perry's political campaign. After learning of the investigation, Perry called the Governor of Oklahoma, Mary Fallin. Fallin's general counsel, Steve Mullins, met in March 2013 with the Oklahoma State Board of Medical Licensure and Perry's phone call was part of the discussion which resulted in the dismissal of the investigation.

The media reports about Perry's phone call and Fallin's involvement surfaced two years later because a civil lawsuit against Dr. Anagnost continued in state court.  The Democratic Party in Oklahoma has called for investigation into Mullins and Fallin for possible ethical and legal violations. Fallin's office has denied wrongdoing, though time will tell whether an investigation will demonstrate otherwise.

Contact us for all your medical legal consulting needs.

Medical Malpractice And Social Media: Is It A Bad Mix?

Social media is an integral part of our culture; it can have bad and good effects on lives. Many things can go wrong when sharing or posting even seemingly benign things. Occasions have arisen where a person who has committed a crime will post or share the things they have done. In medical malpractice cases, social media can have a direct effect on both sides of the case.

For those who have a public social networking account, you are making it open for anybody to view to determine if you are being fraudulent.  If certain things are shared, this can reveal evidence that might have been useful. A public profile can be applied to discern how credible a claim really is.

Using social media during a medical malpractice case can provide the opposing lawyer a good tool. It may seem you are placing a simple photo or post, however it might have a negative effect on your case.

Many lawyers advise clients even to stay entirely away from social-media or to be very aware of the things they post on social media during an ongoing case.

Social media is now a huge section of our culture; nevertheless it might have adverse outcomes. It is crucial that you understand the consequences that may result from social media use.

Contact us today to discover how we can benefit your medical malpractice case.

Why Wisconsin Has the Least Medical Malpractice Claims in the United States

According to the National Practitioner Data Bank, only 6 out of every one million Wisconsin residents received a medical malpractice claim – the national rate is 27 out of every one million.  In 2014, Wisconsin physicians paid the least per capita in medical malpractice claims.  There were only 37 successful claims in Wisconsin in 2014. 

Wisconsin has accomplished this by taking several steps, some would argue overly drastic steps, to reduce its medical malpractice claims.  The state has enacted a $750,000 noneconomic damages cap.  Wisconsin has also included extensive expert witness testimony requirements in medical malpractice cases to establish the standard of care.  And finally, any claims greater than $1 million in total damages (both economic and noneconomic) are paid from the state’s Injured Patients and Families Compensation Fund, which has a budget of $1.2 billion.

The success in Wisconsin has caused other states to take similar steps.  Nationally, successful medical malpractice claims have decreased within the last 25 years.  In 1992, 56 out of every 1 million Americans received a medical malpractice claim.  By 2004, that number had dropped to 49 out of every 1 million, and by 2014, that number dropped to 27 out of every 1 million.

While these numbers are a relief to the health care industry and insurance providers, they are not entirely beneficial to patients with claims which do not have damages high enough to attract a qualified lawyer.  Often times, if the damages are not high enough, injured patients can have a difficult time finding a lawyer who will take their case. 

This national trend has the potential to significantly impact on both the medical and legal professions.  Contact us today for all your medical legal needs.

The Doctor Convicted of Murder

The successful conviction of a physician in a deliberate homicide case for their professional behavior is rare. Most cases of medical malpractice generally entail legal issues like negligence and recklessness resulting in civil claims and damages, nevertheless some cases do grow to the level of criminal accountability.

Dr. Lisa Tseng was recently convicted in California of three counts of second-degree murder for prescribing drugs which caused the overdose deaths of her patients.  Dr. Tseng had been notified by authorities of nine prior patients, primarily males in their 20s and 30s, that had died with drugs prescribed by her in their systems.

The prosecution asserted that Dr. Tseng knew that her patients were junkies and drug-seekers, and that she prescribed them drugs with the knowledge that it would cause their deaths. The defense countered that Tseng was not aware they were addicts and that they lied to her about their drug use. The defense contended that all prescribing was done in good faith.

The jury found Dr. Tseng guilty of overprescribing in 21 counts, and guilty of three counts of second-degree murder. Dr. Tseng will likely spend several years in California state prison.

Prescription drug misuse continues to rise nationwide resulting in the possibility for more doctors to be convicted in criminal cases for their drug prescribing practices.

For more information, contact us today!

Telemedicine and Malpractice

Telemedicine requires interaction and communication between patients and doctors over devices such as phones, computers, tablets, and applications like Skype. While it might seem to be a fresh and upcoming technology, telemedicine has in fact been practiced over the telephone, in the United States for nearly 50 years. With advances in technology, telemedicine is anticipated to grow exponentially in the following couple of years.

The risk for potential malpractice litigations grows as telemedicine grows in popularity. Concern stems from the fact that there may not be a face-to-face assessment together with the medical advice that's given. Telemedicine has wide support among both political parties and is outlined in the Affordable Care Act. Many supporters argue that telemedicine can increase accessibility to healthcare while also substantially reducing costs.

The number of litigations associated with telemedicine has been comparatively low. Experts, however, are anticipating that number to climb as telemedicine grows in popularity. Many malpractice cases involving telemedicine have contained nondisclosure agreements so real numbers and particular issues or concerns and have been settled are difficult to assess.

For more information regarding telemedicine and the law, contact us today!

Petextrians - Dangers of Distracted Walking:

The proliferation of our electronic devices, such as smartphones, has allowed humankind to keep in touch with a universe of information at a finger swipe.  This has not only given rise to the problem of distracted driving, but distracted walking as well.

We have all seen people wandering down a city sidewalk never taking their eyes off of their screen.  ABC News has reported that this trend has caused an increase in injuries and even deaths to people that are walking while distracted.

The problem is not simply these distracted walkers walking into objects or other people while on the sidewalk, but also when they attempt to cross a street without noticing the color of the traffic signal, resulting in pedestrians being severely injured or killed by being hit by traffic.The fatality rate for pedestrians killed while using a handheld device has risen from 1% in 2004 to 3.5% in 2010.  The number of people injured while walking and using cell phones has doubled since 2005.

State and local governments have become concerned over the increases in deaths due to distracted walking.  Some have taken action including lowering speed limits for cars in some urban areas, fining people who are caught while walking distracted, and initiating awareness campaigns.

People who have caused injuries while walking distracted can be sued, according to Find Law.  People who walk into traffic while using their phones can be found at fault for the accident and, at the very least, find their awards reduced by a jury.

Most importantly to remember is, when using the phone while on a city street, it is best to stop walking and get out of the way of pedestrian traffic until finished.

Contact us for all your medical legal needs. 

Nondisclosure Agreements in Medical Malpractice

The amount of a financial settlement in medical malpractice cases often gets a lot of coverage in the media, especially if it is in the millions.  However many settlements include nondisclosure agreements.  Those cases rarely receive any attention even if they can have widespread or significant consequences.

Researchers at the University of Texas recently found that nearly nine in ten settlements withing the university health system involved nondisclosure agreements.  The University of Texas medical care system provides medical malpractice insurance for more than 6,000 physicians at six campuses in five different cities in Texas.   

The Journal of the American Medical Association recently reported on the study that was done by these University of Texas researchers.  Of the time periods that were studied, researchers found that there were 715 medical malpractice claims closed, and 150 settlements were reached.  Nearly 50% of the nondisclosure provisions prohibited discussion by patients and family about the details of the medical errors.  In 9% of these settlements, doctors and hospitals were also prohibited from discussing the cases and any related medical errors.

Although the study focuses on just one medical system, the information can be pertinent to other large medical systems and the healthcare industry as a whole.  Preventing the disclosure of important information, especially to state boards, can have negative long-term effects.  For example: future patients of the physician will not have access to pertinent information regarding the physicians past record; and hospitals cannot address problems or take steps to correct them if all relevant information is kept confidential.

Many healthcare professionals agree that while nondisclosure agreements are legally valid, they can have a negative effect on patient safety because they discourage honest and open discussion of medical errors or mistakes.  It may be time to reevaluate the inclusion of nondisclosure agreements in medical malpractice settlements.

Tell us what you think!  Contact us today.

Do You Need A Medical Record Review For A Nursing Home Resident?

One of the first steps to take if you suspect that abuse or negligence has taken place at a nursing home, is to obtain the medical records and request a medical expert do a medical record review.

A medical record review can help determine if the standard of care has not been met by the physicians working at the nursing home and, if mistakes were made, what the mistakes were.

Obtaining medical records is not always easy due to HIPAA regulations.  In addition, there is confusion regarding laws that are applied to obtaining medical records from a nursing home facility.   There are laws that state a patient or a patient’s authorized representative is entitled to the medical records.  A patient or patient’s representative has a right to view the medical records and any other records that are used during the care, recuperation, or treatment of the patient. An authorized representative for the nursing home resident must be specified on the resident’s contract when admitted to the facility.  A nursing home resident also has the right to state that the medical records are to remain private.

Tips for Seeking A Medical Record Review:

• You do not have to give the facility the reason that you want the medical records
• Keep records of any requests for a medical record review from a medical expert
• Ask for the medical record immediately if you have any reason to think you might need a medical record review

Contact us for additional information or for a consultation.

Surgical Center Found Not Liable For Uninsured Physician’s Mistakes

Dr Richard Kaul, a physician trained in general surgery, anesthesiology, and interventional pain management, practiced in New Jersey until 2012 from 2002. In 2014, the New Jersey State Board of Medical Examiners revoked his medical license after it was determined that he performed back operations without required training.

A former patient of his that he had performed a spinal fusion on in 2005 filed a suit against the Market Street Surgical Center as well as Dr. Kaul.  The patient argued that Kaul improperly placed surgical screws in the patient's foot which resulted in pinched nerves that made it permanently impossible for him to walk normally.

A trial court found Kaul guilty and awarded the patient $750,000, but the claim against the surgical center were dismissed. The patient appealed, but the verdict was upheld. New Jersey state law requires that physicians carry medical malpractice insurance, however, the law stipulates that penalties for not having insurance come from the New Jersey Board of Medical Examiners. The court ruled that surgical facilities could not be held liable for damages. In addition, physicians weren't required to disclose to patients that they were uninsured. The New Jersey Supreme Court ruled, legal damages were not intended under the law.

In light of this recent decision, Kaul announced that he's pursuing reinstatement of his medical license and he continues to run a medical consulting company.

For more information, contact us today!

Digital Records Spark Debate About Whether Patients Should Be Able To See Their Doctor's Notes

The handwritten notes of physician used to be just seen by clinicians. Yet, today's electronic medical records now mean that laboratory results and even medical images are readily available and easily shared. Almost every facet of health care is currently digital which is igniting debate about whether patients should have the ability to see their physician's notes.

OpenNotes, a trial initiative set at 4 distinct medical centers allowed over 20,000 patients accessibility to the notes of 100 primary care doctors.

The trial results imply that patients did benefit from this access. After one year the notes had been read by four out of five patients. A bulk of these surveyed said they felt more in control of their care and had a better understanding of their care.

The trial also found that patient accessibility had little to no influence on doctors' ability to do their work. Doctors who were apprehensive about OpenNotes, are now more welcoming to the notion.

One issue doctors have regarding opening their notes to patients is the need to spend extra time, that they don’t have, with patients explaining their notes. Moreover, understanding that patients will have access to these records could affect how doctors document information. For example, if a patient is found to have a mass on a chest x-ray, clinical practice would be to write down all the possible diagnoses. However, if a patients sees "cancer" among those possibilities, it could result in unnecessary worry and stress to a patient. Doctors could end up altering the documentation from a manner that is exact to a manner in which the information in a readily understandable to patients. There is also a concern that patients could post notes to social media which could expose physicians to criticism.

Many factors must be taken into consideration when choosing whether to share notes with patients. For more information regarding the risks of open notes, contact us.

Patients, Communication, and Malpractice

Malpractice cases involving physicians can occasionally revolve around objections to an unexpected outcome rather than any actual injury or substandard care. 

The Doctors Company, a physician owned insurance provider, analyzed claims filed against orthopedists that resolved between 2007 and 2014.  They found that the top patient claims involved claims of improper management after surgery (16%), followed by diagnosis issues – delays or misdiagnoses (13%).

Upon further analysis, physicians at The Doctors Company found that in nearly 33% of the medical malpractice cases they surveyed, patients did not comply with the treatment plans which were provided by their physicians.  In addition, patient decisions contributed to additional complications in nearly 29% of the cases.

In a significant portion of the cases, patients did not follow instructions, did not go to follow-up appointments, or did not comply with restrictions on activities.  In a slight majority of those cases, documentation by physicians precluded patients’ claims that surgeries were not performed correctly or that they received inadequate care.

Insufficient communication between physicians, patients, and patients’ families was also found to be a factor in patient non-compliance in 12% of claims.  Insufficient communication can include lack of a common language, a poor interpersonal connection between the physician and patient, issues concerning informed consent about the risks of surgical procedures or medications.

Even if adequate care is provided, healthcare professionals must understand that a medical malpractice claim can happen if inadequate communication affects a patient’s expectations, post-surgery actions, or understanding of risks.  Physicians must make effective communication a priority in their practice.

Contact us for more information regarding medical malpractice risks.

State Laws and Institutional Policies for Student Athletes' Head Injuries Now Being Tested in Courts

The challenges brought about in sports medicine liability present many unique ethical and legal questions.  This is especially evident in the context of school and youth athletics.  There has been a lot of media attention, surrounding professional football players in particular, regarding the detrimental effects of repetitive concussions.  However, research shows that children and teenagers actually are more likely than adults to suffer from concussions due to their developing brains and the longer time required for youth to heal from such injuries.

Between 2009 and 2014, all 50 states have now adopted laws regarding concussions in student athletes, including when an athlete can safely return to play following a head injury.  These laws vary from state to state, but typically include three main components:

1.      Education for coaches, athletes, and parents

2.      Mandatory removal of injured student athlete from play/practice

3.      Mandatory implementation of protocols for determining return to play – usually 24hr minimum rest period and clearance from a medical professional.

These laws are now being tested in the courts.  This past spring the New York Times reported on a potential class action lawsuit pending against the Illinois High School Association challenging that organization’s head injury policies.  They are not seeking monetary damages, but rather changes to the head injury policies.

Lawsuits such as these have the potential to define the best policies and practices for youth sports programs.  They can also help to define the baseline duties and standards of care for medical and other professionals who are making decisions in regards to prevention, treatment, and return to play considerations for student athletes.

Please contact us should you need a medical expert with experience in all aspects of sports medicine.

The Worst Case of Medical Fraud in United States History

Dr Farid Fata, a 50-year old married father of three and native of Lebanon, ran a private practice, Michigan Hematology Oncology, with seven offices in the Detroit area and worked as an oncologist. He was sentenced last July to 45 years in federal prison for misdiagnosing and treating over 500 patients. He had been misdiagnosing patients with cancer and then treating them with powerful anti-cancer drugs for years. Dr Fata made nearly $35 million from Medicare and other insurers.

His scam unraveled when another physician who worked for him detected that patients who were receiving chemotherapy treatments were never officially diagnosed with any types of cancer. He reported his findings to federal authorities.

During the case, several victims testified about their experiences with Dr. Fata.  Most of them detailed how they went through intensive chemotherapy and other anti-cancer treatments and medications completely unnecessarily after finding out that they never even had cancer.

Medical malpractice is usually unintentional, although there are cases like Dr. Fata's which involve deliberate fraud and misuse of medicine, most commonly for financial gain.

Contact us for all your medical legal needs!

Do Surgery Score Cards Make Surgeons Avoid the Sickest Patients?

The healthcare environment increasingly links reimbursements to measurable improvements in clinical outcomes. Some hospitals are adopting scoring systems to assess doctors with the aim of inspiring physicians to improve performance and measuring performance. Often times, these score cards can have the unintentional effect of making surgeons avoid the sickest patients in an effort to improve their scores, explains The New England Journal of Medicine.

One website for publicly available surgical scores is the online news site Pro Publica. They have scores for over 17,000 surgeons based on eight elective surgeries from information taken from Medicare claims data. Surgeon John Birkmeyer told The New England Journal of Medicine that the scoring system of Pro Publica cannot account for results and complications that don't have anything to do with the surgeon's ability or performance. In addition, there were too few operations in the analysis to create data that is statistically significant.

The risk of score card data is patients can misinterpret it. How patients identified "the best" surgeon depended greatly on the way in which the information was presented, one study found. The most important figure is risk-adjusted mortality, yet most patients only focused on the amount of deaths. This really is deceptive because some hospitals manage more complex and riskier cases that are referred to them by other hospitals that are not able to handle them.

It is not likely that these surgical score cards will go away. Some hospitals and some states are attempting to address this issue in an effort to mitigate physician avoidance of the sickest patients. Massachusetts, for example, is excluding scores for patients that are classified as “exceptional risk” or “compassionate use”. These groups have a much greater danger of surgical complications, which could lower a doctor's score.

To learn more about the complicated issue of physician scoring, contact us.

Defensive Medicine or Careful Medicine?

Many doctors practice “defensive medicine” even knowing that it might drive up costs, waste time, and ultimately be unnecessary. The United States Congress Office of Technology Assessment formally describes defensive medicine as “when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures primarily (but not necessarily solely) to reduce their exposure to malpractice liability.”

One ethics survey done in 2014 found that most doctors said that they have or would employ defensive medicine as a way to protect themselves, mainly from your threat of a medical malpractice suit.

Healthcare professionals recognize that defensive medicine is an important cause of increasing healthcare costs and do want to see the issue addressed as a problem.  An example of how this problem could be addressed is the Ottawa Ankle Rules, published at the Ottawa Civic Hospital in Canada. These policies establish a complete system of evaluation to determine which patients need x-rays to analyze a fracture in place of giving a costly x-ray to any patient with any kind of foot pain.

Physicians are very aware of the threat of malpractice lawsuits during their careers. For this reason, defensive medicine is unlikely to just go away. Many doctors view defensive medicine as careful medicine since it is one way to safeguard their careers.

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Managing Legal Risks Tied to the Growth in Nurse Practitioners and Physician Assistants

More non- physicians are offering medical care than ever before. Often the first caregiver an patient sees during a doctor visit isn't an actual physician. The growth in nurse practitioners and physician assistants indicates a growth in both their duties as well as their numbers. Midlevel providers can be quite a benefit to doctors, relieving them of some of their workload, however, it also increases legal risks. Doctors should understand those risks in order to mitigate them.

The Academy of Physician Assistants measures 85,000 certified physician assistants in the U.S. This represents a more than 100 percent increase in the last a decade. Nurse practitioners are also rising with over 155,000 nationwide, up 28-percent since 2003 according to The American Academy for Nurse Practitioners.

PAs may prescribe drugs but must function underneath the supervision of a doctor. NPs can practice, but must have a formal arrangement with a doctor. Health costs can be reduced by the additional work performed by midlevels, however, the legal risks are increased.

The most common lawsuits seen by midlevel providers are inadequate supervision, or practicing beyond the scope of training. Courts have ruled that the midlevel can be an agent of the physician, who can be held liable for neglect through vicarious liability even if he or she never saw or examined the individual. Physicians have to be conscious of the degree of supervision essential to retain a low liability risk.

To learn more about the legal risks associated with physician assistants and nurse practitioners, contact us!

Weighing the Risks and Benefits of Playing Music During Surgery

Surgical procedures are extremely serious in nature together with the well being of the patient determined by the hands of the surgeon. Operating Rooms can be filled with sounds other than machines and medical devices.

Music is played in many operating rooms and some surgeons claim it helps them perform better. According to a report printed by The BMJ, music is played 62-72 percent of the time with the music normally chosen by the surgeon. Typically the most popular kind of music chosen is classical, though other styles are also heard. The Bee Gees' "Stayin Alive" and Sade's "Smooth Operator" are seemingly popular tracks, while Queen's "Another One Bites the Dust" and REM's "Everybody Hurts", are best avoided.

This practice, however, isn't without controversy. Some claim that playing music during an operation may be a risky distraction that unnecessarily increases the potential for error. A negative effect has been noted by some surgeons, especially in less experienced surgeons.

Many surgeons say there are benefits to music in the operating room. Operating room staff claim that it can enhance a surgeon's ability to focus, and that playing music can reduce stress, improve communication, and improve efficiency. Patients may also reap the advantages of music which can help have a sedative effect and reduce nervousness.

If noise levels are controlled, surgeons cited in The BMJ report admitted that music could be distracting, but say, the potential advantages of music might outweigh any surgical risks.

The decision to play music or not, the type of music, along with the volume, should be agreed upon by the surgical team with all the goal of the greatest possible surgical result for the patient. For more information, contact us today!

The Weekend Effect: How Saturday, Sunday Hospital Admissions Can Hurt Health Outcomes

One would hope that no matter what day of the week or time of day, precisely the same standard of healthcare would occur. However, data implies that time and day can have a negative effect on health outcomes.

One study published in BMJ Quality & Safety analyzed data from almost 3 million hospital admissions to 28 different teaching hospitals in 4 different countries.  The outcome of the analysis suggested in three of the four nations, that those admitted on the weekend for an emergency had a higher risk of dying within 30 days than those admitted during the week. In the U.S., the risk was 13% higher. The most dramatic difference was in the Netherlands with a 20% greater risk. The study didn't mention causes for the weekend effect.

Researchers indicate that the higher risks might be a result of decreased staffing levels. Study coauthor Paul Aylin of Imperial College London indicates that patients admitted on weekends, particularly stroke sufferers, are not as likely to get a same-day brain scan, less likely to get clot-busting treatment, and have worse outcomes than those accepted during the week.

Often patients or caregivers hear over and over that it was the weekend, that there was only one person here to do whatever for the whole hospital, or that someone was merely cross-covering and did not wish to produce any changes to the plan - the attending would be in next week.

Johns Hopkins University researchers who looked at more than 38,000 head injury patients. likewise documented in a study the weekend effect. They found that the weekend patients were 14% more likely to die from their injuries compared to patients admitted during the week.

Sadly, the clear solution - to increase weekend staffing – is impractical and expensive. Options could include transferring some patients to trauma centers or facilities that have more weekend capabilities.

To learn more regarding the weekend effect and possible solutions, contact us.

Should Medical Marijuana Have a Place in the Hospital?

As of June 2015, 23 states and the District of Columbia have legalized medical cannabis. Should hospitals be following suit?

Many hospitals such as The Cleveland Clinic have stated that they don't recommend using illegal substances to treat health conditions.  However, the top 17 hospitals in the U.S. including the Maya Clinic, Johns Hopkins, and the Duke University Medical center have either taken no public stance on the issue of have evaded making direct statements on the issue.

One argument against medical marijuana in hospitals is the fear of patients falsifying medical documentation in order to smoke marijuana cigarettes or alternative paraphernalia. Some states have handled this problem by restricting legal medicinal marijuana to only the pill or liquid form. New York only permits medical cannabis in pill and oil form and prohibits the sale of the cannabis flower. All other states with legalized marijuana, recreational or medical, currently limit the amounts of live or dried plants a person can have.

Even in states that have legalized medical marijuana, hospitals have been unwilling to allow the administration in their walls. One issue with this is that it can be difficult to abruptly discontinue this treatment upon admittance to a hospital. This is one of the reasons that New York Minnesota, and Massachusetts are allowing use inside their hospitals.

The execution of laws allowing non-smokable types of cannabis is intended to provide aid for those suffering from some cancers, HIV/AIDS, ALS, Parkinson's disease, and more. By implementing the non-smokable forms, hospitals are working to avoid the stigma a 'physician's note' for a headache as a ticket to recreational drugs.

Contact us and let us know how you feel about medical marijuana use in hospitals.

Expert Witnesses Testimony Results in Costly Verdict Reversal

A three-judge panel in in Florida's Third District Court of Appeals recently stopped a $4.1 million judgment and ordered a fresh trial. The defendant in the event, a Florida pediatrician, argued he was refused a fair trial since expert witnesses and their testimony were improperly applied during trial.

The plaintiff was treated by the physician until 2006 from her birth in 2000. In this six-year period, the parents claim that she endured a kidney condition that the doctor did not identify or treat. According to the parents, physician didn't acknowledge or follow up on elevated levels of protein within urine samples which suggested a serious kidney disorder. The girl ultimately needed a kidney transplant and her parents were awarded $4.1 million in a subsequent medical malpractice lawsuit.

The physician appealed the verdict, claiming inappropriate usage of expert witnesses by the plaintiff’s lawyer. The initial judge in the lawsuit had ruled that both sides were limited to one expert per specialty. Prior to the case being concluded, however, that judge retired.  The subsequent judge did not hold the plaintiff’s lawyer to that ruling. The plaintiff’s attorney called four expert witnesses to testify and also misrepresented that expert testimony in closing arguments.

The Third District Court of Appeals said the improper utilization of medical experts and their testimony required a new trial in this instance and agreed with the defendant’s arguments concerning his denial of a fair trial.

Attorneys must follow guidelines regarding expert witness characterization in their testimony and presentation of expert witnesses. Failing to follow these rules can result in unfair trials and delays in settlements for many who have suffered damage.

To discover the best medical expert witness services, contact us.