Archive for March, 2010

Time nearly up on malpractice suit against missing doctor -Texas style

March 30, 2010

In an article recently published online through the Austin-American Statesman website, one of the many harsh realities of our legal system is exposed.  The significance of procedural deadlines, and what may ultimately happen if such a deadline is not met (despite best efforts) is highlighted in this tragic story.  The following is a very brief summary, as taken from the article:

Debbie Stockton didn’t know her obstetrician was a drug addict when her son William was born in 1989 with extensive nerve damage to his left arm.

But when the boy grew into a teenager and his atrophied arm didn’t improve, Stockton sought legal advice and learned that Dr. Howard Offenbach had checked himself into a drug treatment center within a week of William’s birth to kick a years-long Valium and hydrocodone habit.

So in 2007, Stockton sued for an unspecified amount, claiming that Offenbach caused William’s injury by failing to order emergency surgery when the boy’s shoulder became pinned beneath his mother’s pubic bone during a difficult delivery.    

The Stocktons, however, ran into a legal roadblock that derailed their lawsuit before it went to trial.

Texas malpractice law gave them 120 days after filing suit to serve Offenbach with their medical expert’s report and résumé, but Offenbach couldn’t be found. After losing his medical license in 2000 for drug abuse, Offenbach had moved from his Dallas house, been evicted from two apartments and disappeared from public records.

Even Offenbach’s lawyers — acting on behalf of the former doctor’s insurance company — have been unable to locate their client and say that Offenbach is “not findable.” Still, they asked the trial court to throw out the Stocktons’ lawsuit for blowing the 120-day deadline.

The case has traveled its way up through the Texas court system over the past several years, before ending up at oral argument last week before the Texas Supreme Court.  The article also details the extent to which the Stocktons’ lawyer went to attempt to serve Dr. Offenbach with the lawsuit.

Sadly, Debbie Stockton passed away last fall from cancer.  The injured victim, William Stockton, is fighting for his cause, as the case has been continued under his name.  The Court now has the case under review.  We do not know what the Court will hold.  The article leaves us with this:

Justice Dale Wainwright mused aloud about the court’s dilemma.

The language of the law clearly directs judges to dismiss any lawsuit that exceeds the 120-day deadline, he noted: “On one hand, we don’t want defendants dodging or hiding to let the 120 days lapse. On the other hand, we don’t want claimants to be lax in any way when the Legislature used this kind of strict rule.”

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MRI Beats X-Ray for Spotting Fractures in ER

March 30, 2010

A recent article in Medline Plus reports that the National Institute of Health (NIH) announced recently the results of a new study, which called into question the accuracy of x-rays in detecting hip and pelvic fractures.  In the study, researchers at the Duke University Medical Center analyzyed data on 92 patients who received both an x-ray and an MRI (magnetic resonance imaging) to evaluate hip and pelvic pain.  The results:

“Thirteen patients with normal X-ray findings were found to collectively have 23 fractures at MRI,” the study’s lead author, Dr. Charles Spritzer, said in a news release from the American College of Radiology/American Roentgen Ray Society.  In addition, the study found that, “in 11 patients, MRI showed no fracture after X-rays had suggested the presence of a fracture,” Spritzer said. “In another 15 patients who had abnormal X-ray findings, MRI depicted 12 additional pelvic fractures not identified on X-rays.”

While x-rays tend to be the front-line study in the emergency room setting (primarily because of cost), this new study suggests that MRI may be a better approach for suspected fractures, which will hopefully lead to more patients getting an accurate diagnosis and proper treatment.

Cerebral Palsy: new research to improve dexterity by home therapy using modified gaming instruments.

March 30, 2010

Today I came across yet another interesting and common sense concept in the quest to help those with cerebral palsy for performing important dexterity exercises in the comfort of their home.  The article – Daily Targum – Researchers spawn new therapy for cerebral palsy patients – recounts a small study (3 teenage patients) taking place over the last year at Rutgers University and Indiana University using a modified Sony PlayStation 3 gaming glove to improve dexterity for victims of cerebral palsy.  

One of the keys in this research project is to find a way to move therapy into the patient’s home utilizing an activity that all kids enjoy – gaming.  The basic goal is to not only move important therapy into the home but to provide a method for young cerebral palsy patients to perform this therapy without the need of costly and time-contrained supervision.

The program is the product of a collaborative effort of these universities headed by Grigore Burdea, a University professor of electrical and computer engineering, and Moustafa Abdelbaky, an electrical and computer engineering graduate student.  Another key player in this endeavor is Meredith Golomb, an associate professor of neurology at Indiana University School of Medicine.  She found out about Burdea’s work through the Internet and said the combination of her skills with Burdea’s was perfect.

“I’m a pediatric neurologist and know how to assess the kids medically,” Golomb said. “He is an engineer and knows how to get the systems working — it has been a great collaboration so far.”

Some weeks ago, I posted a story about research underway at the University of Michigan in the use of a treadmill to help improve the neuromotor development of younger children with cerebral palsy.

It is through the work of such researchers and many others devoted to helping discover the causes of cerebral palsy that key progress in making the lives of these people with special needs better will be made.  We will  keep you posted on similar studies and research efforts.  Hopefully, if you are the parent of a child with cerebral palsy, you will find one of these techniques of interest and potentially useful in maximizing the chances of a better life for your child.

Tort Reform – Consider the Consequences – Lesson #1

March 28, 2010

Lost in all of this discussion about how tort reform and caps on damages will save the medical profession has been a discussion of what is really behind all this nonsense.  The Republicans claim that the reason the healthcare system is broken is because of the rising costs of malpractice insurance due to high verdicts, ‘out of control’ juries, the plaintiff lawyers and every other specious argument that sounds good but has no basis in reality.  Study after study has demonstrated that jurisdictions with caps do not affect malpractice insurance rates.

Has anyone really thought about why these naysayers are incessantly calling for a cap of $250,000 on non-economic damages?  It’s a simple matter of mathematics.  This number is not based in any reality of insurance rates – now is it?  Have you seen a single study that uses this ‘magic number’ to demonstrate how this will save healthcare?  If you have, please share it with the rest of us.  That comment will be posted in a heartbeat.

So what is behind this ‘number’?  What is the usual contingent fee being charged these days – 33 1/3 or 40 percent?  How much does it cost to investigate, file and try to conclusion a medical malpractice case of any consequence?   Answer: it can range anywhere from $75,000 to $150,000 (rough averages but pretty accurate). What is the largest cost?  Answer:  medical experts, who charge anywhere from typically $350 to $1,000 per hour.  What part of the population typically receives less than optimal (read ‘Cadillac’) care – answer: lower income patients without any coverage or without ‘the best coverage. ‘ When those patients seek care, how are those bills often financially covered?  Answer:  Medicaid or Medicare.  Do you have any understanding of what a ‘super lien’ is?  Answer: Medicare and Medicaid have an absolute right to complete reimbursement of any related medical expenses paid out in such cases.

So how do all these numbers, issues and forces play out in the real world of medical malpractice? What effect would a cap of $250,000 on non-economic damages have on whether a bona fide lawsuit (read: awful care causing serious injury) could ever be brought to court?

So that this posting can stay within the realm of reason in terms of length, I’ll just give you the above factors to ponder for a bit.  Later posts will give you more concrete examples of how, in the real world of malpractice cases, these specious arguments for caps and ‘tort reform’ are nothing more than an attempt to deny patients and their families of access to the courts.

Let’s leave you with a thought – a patient on Medicaid receives awful medical care leading to horrible injuries requiring hundreds of thousands of dollars in past and future care needs.   What do you think a client would recover in such a situation under ‘tort reform’ and a cap of $250,000?

Recovery of those costs do not go to the patient but are the subject of a reimbursable lien.  That potentially leaves recovery for non-economic damages only.  Apply a fee of one-third (answer:  just over $80,000) and costs of (let’s say) $125,000 (totally within the ‘usual’ range).  Have you done the math?  That’s about $45,000 to the client.  How does a lawyer satisfy a client’s needs in that scenario?  You can’t.  Do you do the case ‘on the cheap’ and not hire the experts or do the discovery you need to do?  You can’t – that runs of the risk for the client of not winning – in which case the recovery is nothing.

Now are you starting to get the picture what is really behind the proposed ‘tort reform’s cap’?  Don’t think for one minute that the medical profession and its insurers haven’t done the math.

More to come….

Angina : The Efficacy of Percutaneous Coronary Intervention vs. the Efficacy of Non-Surgical Treatment

March 28, 2010

Angina is characterized by chest pain resulting from insufficient blood flow to the heart. In this context, abnormal blood flow is caused by the build up of plaque in the coronary arteries or as a result of coronary artery stenosis. Consequently, angina symptoms are usually indicative of heart disease. It is estimated that nearly seven million people in the United States have angina and that nearly 400, 000 patients present with new cases of angina each year.

A recent study published by Annals of Internal Medicine compared the efficacy of percutaneous coronary intervention vs. the efficacy of non-surgical medical care in treating angina in patients with stable coronary artery disease. Percutanious coronary intervention refers to coronary angioplasty. The study in question involved cardiac angioplasties with and without cardiac stents. Non-surgical treatment refers to drug treatment of angina symptoms.

Researchers performed a comprehensive review of 14 previous trials, which compared the efficacy of coronary angioplasty (with and without stents) vs. non-surgical medical care. In total, the 14 trials involved 7818 patients. Researchers concluded that older trials suggest that percutaneous coronary intervention was only marginally more effective in the treatment of angina. This, however, did not appear to be true in more recent trials. The study suggests that coronary angioplasty may not be necessary or recommended to treat angina in patients with stable coronary artery disease if proper evidence-based medications are employed.

Contributing author: Jon Stefanuca

Maryland House advances bill raising auto liability limits

March 26, 2010

Earlier this week, Maryland came one step closer to mandating increased bodily injury liability limits for their vehicle owners.  In a 97-36 vote, the Maryland House of Delegates approved a measure to increase the coverage.  Here are some of the key details, as reported by Insurance and Financial Advisor:          

The measure, sponsored by 18 Maryland legislators, increases the minimum amounts of coverage for bodily claims or death from a motor vehicle accident from $20,000 to $30,000 for one person, and from $40,000 to $60,000 for any two or more individuals. The proposed legislation would apply to all vehicle liability insurance policies issued, delivered or renewed in the state on or after Jan. 1, 2011, according to the text of the bill.

The fiscal note accompanying the bill said there is not enough data to show an impact on Maryland’s general fund as a result of the measure, but that special fund revenues for the Maryland Insurance Administration may increase by about $25,000 in fiscal year 2011, assuming 200 motor vehicle insurers pay the $125 rate filing fee to comply.

If the Senate Finance Committee gives a favorable report, the bill would then move to the full Maryland Senate.

The increased liability coverage requirement, if passed, would provide an opportunity for injured victims of automobile collisions, depending on the circumstances, to seek additional compensation for their injuries through the increased liability coverage.

Evenflo Recalls Top-of-Stair Plus Wood Gates Due to Fall Hazard

March 26, 2010

The Consumer Product Safety Commission (CPSC) has just announced that they are working in conjunction with Evenflo in regard to a voluntary recall of approximately 183,000 wood gates, used primarily to assist in preventing small children from having access to stairs, where they could fall and sustain serious injuries.  Here is some of the important information in regard to the recall:

Name of product: Evenflo Top-of-Stair™ Plus Wood Gates

Units: About 150,000 in the United States and 33,000 in Canada

Manufacturer: Evenflo Co. Inc. of Miamisburg, Ohio

Hazard: The slats on the gate can break or detach, posing a fall hazard to children.

Incidents/Injuries: Evenflo has received 142 reports of slats breaking and/or detaching from the gate. Three children gained access to stairs. One of those children fell through the gate and down five steps; another fell down one step. Injuries included four children who sustained bumps and bruises to the head and seven children who sustained minor injuries including scratches, scrapes and bruises.

Description: The recall involves Evenflo models 10502 and 10512 Top-of-Stair Plus Wood Gates made from October 2007 through July 2009. The model number can be found on the bottom rail. No other Evenflo model numbers or gates are affected by this recall.

Sold at: Toys “R” Us, Burlington Baby Depot, Kmart and other juvenile product and mass merchandise retailers nationwide in the U.S. and Canada, and on the Web at Amazon.com and other online retailers from October 2007 through March 2010 for about $40.

If you have this product at your home, here is the remedy and consumer contact information:

Remedy: Consumers should stop using the recalled gate and contact Evenflo to obtain a free newer model 10503 or 10513 Top-of-Stair™ Plus Wood replacement gate.

Consumer Contact: For additional information, call Evenflo toll-free at (800) 233-5921 between 8 a.m. and 5 p.m. ET Monday through Friday or visit the firm’s Web site at safety.evenflo.com

The Efficacy of Drug-Eluting Stents and Bare Metal Stents in Heart Transplant Recipients with Coronary Artery Disease

March 24, 2010

A recent study published in Kardiologia Polska (Poland) compared the long-term results of drug-eluting stents and bare metal stents in heart transplant patients. Various stents are routinely used in patients post heart transplant surgery to correct blood flow abnormalities caused by coronary artery disease. Coronary artery disease is generally defined as the build-up of plaque on the interior wall of coronary arteries causing decreased or obstructed blood flow to the heart.  Despite the routine use of stents in heart transplant recipients, there is very little scientific research tracking the efficacy of drug-eluting stents vs. bare metal stents in this population.

The study in question retrospectively evaluated the long-term impact of all available coronary stents used to correct transplanted heart coronary artery disease. Researchers focused on 23 patients. The goal of the study was to identify the mortality rate and the rate of restenosis in this population of patients. Researchers found that 7% patients with drug-eluting stents had restenosis vs 61% of restenosis in patients with bare metal stents. Researchers also found that there was an 18% mortality rate in patients with drug-eluting stents vs. a 31% mortality rate in patients with bare metal stents.

Contributing author: Jon Stefanuca

Light Rail Train, Tractor-Trailer Collide – Baltimore News Story – WBAL Baltimore

March 23, 2010

At around 9:30 a.m. today, a light rail train and tractor-trailer collided just north of Baltimore in Cockeysville, Maryland. A partial derailment of the passenger train has caused disruptions in traffic and predictably delays on the area’s light rail system.

For ongoing coverage from the scene and what led to the accident, follow – Light Rail Train, Tractor-Trailer Collide – Baltimore News Story – WBAL Baltimore.

According to an updated report posted at 11:15 a.m., the light rail operator was trapped in the train and has now been flown to the University of Maryland’s Shock Trauma Unit. According to the report from WBAL, her injuries are fortunately not considered life-threatening.

It is also reported that seven passengers on the light rail were treated at the scene for non-serious injuries.

There does not appear to be any report on the condition of the tractor-trailer driver as of this time.

Since it is clear that light rail operations will be affected by this accident, those of you who use the light rail system may want to check on the MTA’s website for scheduling/delay information.

The cause of the accident is still under investigation.

Earphones Connected to More Injuries and Deaths

March 22, 2010

A report last week, as published on http://www.myfoxdc.com, states that there is an increase in the number of both pedestrians and bicyclists being killed or seriously injured, as a result of wearing earphones.  The article refers a warning issued by the American Automobile Association (AAA), whose officials state that this troubling trend is occurring across the United States:

Local officials are seeing a rise in the number of pedestrians and bicyclists who are being killed or seriously injured while wearing earphones.              

Transportation officials say several people have been killed in the Washington, DC area. Recently, a 51-year-old jogger was killed by a tractor-trailer truck while crossing Constitution Avenue. DC police say the woman was wearing headphones.

AAA officials say across the United States the number of pedestrian injuries and deaths are increasing because people wearing earphones are not aware of their surroundings.

This is a good time to remind everyone of the rules of the road, as cherry blossom season is upon us, and our local traffic significantly increases.  Please remember, regardless of whether you are a pedestrian, bicyclist, or operator of an automobile, be safe and follow all applicable safety and traffic laws.