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UPDATE: AAP Compromise Statement on Female Genital Cutting – RETRACTED!

May 25, 2010

Please see UPDATE at end of article!

On April 26,2010, the American Academy of Pediatrics (AAP) issued a new policy statement seen by many as essentially advocating the practice in this country of female genital mutilation (FGM)[sometimes  this ‘tradition’ is referred to as female genital cutting (FGC) as well].  In pertinent part, the policy advocates for “federal and state laws [to] enable pediatricians to reach out to families by offering a ‘ritual nick’,” such as pricking or minor incisions of girls’ clitorises.

Yes, I said this was issued by the American Academy of Pediatrics. How, in the world, you ask, could such an august body promote such a misogynistic practice?

For those who may not be familiar with this barbaric (you fill-in the other adjectives – the list is simply too long) ‘ritual,’ a recent online article by PRNewswire sets the chilling background of this controversy.

FGM is a harmful traditional practice that involves the partial or total removal of the female genitalia and is carried out across Africa, some countries in Asia and the Middle East, and by immigrants of practicing communities living around the world, including in Europe and the U.S.  It is estimated that up to 140 million women and girls around the world are affected by FGM.

Putting aside my personal opinions regarding the overall chauvinistic cultures of – to name a few – Africa, Asia and the Middle East, what would motivate any culture to engage in such a ritualistic practice?

In an NPR interview of Professor of Law, Cleveland-Marshall College of Law, Cleveland State University, Dena Davis, on May 14, 2010, Professor Davis,  a consultant to the AAP and the lead author of the policy statement, the ‘rationale of this ‘tradition’ is explained.

RAEBURN: Do you have a sense I’m just I can’t help but interrupt. Do you have a sense of why in these cultures, there may be different reasons, but why this is done or what is supposed to be the benefit of it?

Ms. DAVIS: Right, it’s a wide array of things. On a positive side, it’s seen as a growing-up ritual, as a celebration of ethnic or national identity. It became politically important as a response to colonization, for example, but it’s also done to remove sexual pleasure from women so that they can be controlled, to guarantee women’s virginity so that they are marriageable and to protect the family’s honor.

So just how did this ‘celebration of ethnic or national identity’ work its way to our shores? How did it conceivably become a part of a policy statement by the AAP?

Professor Davis offers the following explanation:

Ms. DAVIS: Well, I want to start by reiterating what you already said. The statement ends with four recommendations, and none of those mention this compromise. The recommendations are that the American Academy of Pediatrics opposes all forms of female genital cutting that pose risks of physical or psychological harm, encourages its members to educate themselves about the practice, recommends that members actively seek to dissuade families from carrying out harmful forms of FGC and recommends compassionate education of the parents of patients.

Having said that, the controversial part, as you made mention, is a discussion toward the end of the possibility of pediatricians offering what would literally be a nick. And in the statement, we analogize it to ear piercing.

And the idea here was that we knew that some pediatricians in Seattle a number of years ago who had a good relationship with the Somali immigrant community around their hospital had been asked by mothers of girls for this kind of compromise. And they had gone down the road of – they’d had meetings with mothers and so on, and they were about to do that…

RAEBURN: So this was mothers from some of these cultures where this is practiced had suggested that…

Ms. DAVIS: Right, were Somali immigrant mothers.

RAEBURN: Okay, so it was their idea?

Ms. DAVIS: Well, I’m not sure whose idea it was, but they embraced it to the extent that they held off on doing something worse until the doctors could get set up to start offering this. But before that could happen, Congresswoman Pat Schroeder wrote to tell the hospital that it would be criminal under her new law that had recently passed in Congress.

The concern is that we know that in many cases, when pediatricians turn down parents, girls are taken back to Africa for the worst possible procedures done, you know, with no painkilling and no, you know, no infection control and extremely severe forms of these procedures where girls’ labia are scraped away, for example.

And there’s really that’s very difficult to stop…

The uproar from this AAP statement advocating a ‘compromise’ – ostensibly premised on the concept of the ‘lesser of two evils’ – comes from virtually every group in this nation.  One I quite frankly didn’t anticipate was posted by Jihad Watch: “[T]here are those four words of the Hippocratic oath that the American Academy of Pediatrics seems to have forgotten: First do no harm. And if it is supposed to be harmless, let the AAP doctors line up forthwith for their own “ritualized nick.” The comments to this posting by Jihad Watch, which refers to this practice as being “primarily enforced in Muslim countries, ” are also quite revealing. One person identified as ‘Ccoopen’ had this to say:

I’m not sure why this is listed under dhimmitude, considering that FGM is not Islamic. Sure, it is practiced by Muslims, but it is not a Muslim practice. It is a cultural practice which predates Islam by hundreds, if not thousands of years. In fact, the majority of practitioners in Africa are of the African Tribal religions, not Muslim. While it is a horrific practice, it doesn’t need to be tied to Islam since it has nothing to do with Islam, but with culture.

For those who have dedicated their life’s work to obtaining equality among the sexes, the AAP’s attempt at a ‘neutral’ statement of compromise has been vehemently rebuked:

“Encouraging pediatricians to perform FGM under the notion of ‘cultural sensitivity’ shows a shocking lack of understanding of a girl’s fundamental right to bodily integrity and equality,” says Taina Bien-Aime, executive director of the human rights organization Equality Now. “If foot-binding were still being carried out, would the AAP encourage pediatricians to execute a milder version of this practice?”(See “An End to Female Genital Cutting?”) See our source – Time online article.

In its online posting, Time, a partner of CNN, reports (as do many others) reports a legislative twist to the timing of the AAP’s policy statement:

On the same day the AAP published its new recommendation, the Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress. “I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether FGM is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said one of the bill’s sponsors, New York Representative Joseph Crowley, speaking to the New York Times. Davis counters that such a law would be extremely difficult to enforce.

So where do you stand on the issue? Has the AAP done more harm than good? Is the ‘compromise simply dangerous folly or adoption of ‘the lesser evil’ for the safety and well-being of these children? You be the judge. Share with us and our community of readers your reaction.

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UPDATE: in response to my posting this blog on Twitter, one person using the Twitter name kvetchingguru brought to my attention a posting which is a ‘call to action.’ It is entitled “Urgent Alert: Call on the American Academy of Pediatrics to retract their endorsement of Type IV FGM.” A form letter is made available and the names of the Executive Director/CEO of AAP, the Chair of AAP and the President and CEO of the American Board of Medical Specialties are provided.

As I wrote earlier today, this ‘endorsement’ in any fashion – call it ritual snip or piercing – has created a groundswell of reaction.

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UPDATE: May 27, 2010

It appears that the uproar reported in this article has taken its toll.

The American Academy of Pediatrics has retracted its policy statement on female genital cutting after sparking controversy by apparently endorsing the illegal practice of “ritual nicks” to forestall more extensive mutilation.

“The AAP does not endorse the practice of offering a ‘clitoral nick,'” according to a new statement by the organization’s board of directors. “This minimal pinprick is forbidden under federal law, and the AAP does not recommend it to its members.”

The following from the AAP president about says it all:

In a new statement, AAP president Judith Palfrey, MD, of Harvard Medical School, clarified the academy’s position. “Our intention is not to endorse any form of female genital cutting or mutilation,” she said. “We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere in the world.”

The source for these quotes: medpagetoday

Why would anyone write a White Paper on how to get an #autopsy report?

May 24, 2010

On Saturday, April 22, 2010, I posted a new White Paper on our website, which deals with a number of issues of concern to many of our past clients – “They did an autopsy after my loved one died, but I can’t get them to give me the results. What can I do?”

In one week alone with had three calls from people saying the same thing in different plaintive words.

Last year, we successfully tried a lawsuit in Salisbury, Maryland relating to the death of a 19 day old infant. The parents knew that an autopsy had been performed as a result of their child tragically dying in his father’s arms. Patient for months, he called his now-deceased son’s pediatrician’s office several times and was basically told to not worry about it, they would let him know when they got word. Many months later, totally frustrated by the lack of caring and information and only wanting to know what had caused their baby to die so horribly, they sought out an attorney. The autopsy report finally surfaced – I wonder why.

I take  these wonderful people at their word. They had no intention of filing a lawsuit. As the months of frustration passed, they started to ask themselves – “Are they trying to hide something?” None of us will never know why such utter disregard and insensitivity to these grieving parents led to a failure by the doctor to provide the report and discuss it with the family. What it did was buy him a lawsuit and a multi-million dollar verdict.

So let’s examine why we just did a White Paper entitled “Having Trouble Getting a Hospital or Physician to Release an Autopsy Report?” Picture yourself in such a horrible situation. You just lost your spouse or child totally unexpectedly. An autopsy is done or requested. You don’t know which way to turn. All you want to do is try to understand what happened. You are put-off, ignored or  even berated for your persistence in simply wanting to know. This White Paper is offered to those in that horrible situation. Get some guidance on how to get  the information you so want.

While we hope you never need this information. If you do, it’s there for  the taking.

Update: Funeral home license suspended after cadavers found stacked on property.

May 21, 2010

Just a short two weeks ago, CNN News reported that a Riverdale, Maryland funeral home was under investigation for the tasteless and shameful treatment of bodies.

Chambers Funeral Home received an unannounced visit from a state inspector who discovered an estimated 40 body bags haphazardly stacked close by. During a routine inspection of a refrigerated area located in the garage, the inspector noted:

…a “large pile, approximately 12 by 12 feet, of body bags containing human remains strewn on the floor of the garage in front of a removal van. There was visible leakage from the body bags as well as a pungent odor.”

The inspector also noted in his report that he had been informed by an employee, who remains unnamed, not to be alarmed by the number of bodies in the area.

The Baltimore Sun reported that many of the identification tags were no longer attached to the body bags. Many tags were found loose within the pile, and damaged by the body fluids leaking from the bags. Co-owner of Chambers Funeral Home, Thomas Chambers, claimed that the tags were not necessary and that the bodies could be identified through the process of eliminaton.

Chambers’ owners claimed many of the bodies were cadavers received from Georgetown University’s School of Medicine awaiting cremation. The school had contracted with the funeral home to remove and cremate the bodies. William Chambers, a second co-owner of the funeral home, stated that  this led to many cadavers arriving at once; although this practice was discouraged, it was agreed upon.

Stephen Mitchell, Georgetwon University’s dean of medical education, confirmed that the university had contracted with the funeral home, but the school had never been informed of these ‘handling’ problems. In another statement, Mr. Mitchell claimed:

The School of Medicine’s contract with the Chambers Funeral Home specifically outlines the school’s requirements that the remains be treated in a ‘respectful and organized manner.’ It appears that this was not the case in this instance.

As a result of the state inspector’s findings, the Maryland State Board of Morticians and Funeral Directors enacted an emergency suspension of the licenses of both Thomas and William Chambers’ as well that of Chambers Funeral Home as a business.

The president of the state funeral board provided the funeral home three days to complete the cremations and all additional funeral arrangements. The funeral home was closed Saturday, May 8, 2010.

Althought the funeral home was closed, the owner’s feel very differently about the decision.

William Chambers, one of the funeral home’s owners, said he would fight the license suspension at a hearing at the end of the month.

“We felt we handled things appropriately, but the board felt differently…” “We have limited space, and things were in disarray. It was unacceptable.”

The actions of Chamber’s Funeral Home and Crematorium were just that, unnacceptable. Coincidentally, Maryland Governor Martin O’Malley signed into law on May 4, 2010 a reform of state crematory regulation. The law will be enacted beginning October 1 and will provide additional regulation of such institutions to prevent similar occurances.

Medical Malpractice:woman awarded $3.5 Million for paraplegia after graft surgery.

May 19, 2010

53 year old Victoria Little, of Harford County, MD, walked into the hospital to have  surgery wearing four inch heel, but when the surgery was over, she was left a paraplegic unable to walk. Ms. Little underwent a grafting procedure in 2007 for blocked arteries.

Ms. Little filed suit in 2008 claiming that Dr. Rodger Schneider and Dr. Mark Gonze, partners and surgeons of Vascular Surgery Associates, used an improper grafting technique. Plaintiff’s counsel, two good friends of ours, Jim Cardea and Scott Kurlander,  argued that the procedure led to blood loss and damage to Ms. Little’s spinal cord, which left her a paraplegic.

The Baltimore Sun reported that after hearing all arguments and nine hours of deliberation, the jury awarded Ms. Little $1.3 million for non-economic damages, $2 million for future medical costs and over $200,00 for prior medical bills.

Attorney for the defendants, E. Phillip Franke, III, claimed that Ms. Little  simply had a poor outcome and that her injuries wee not the result of malpractice. The defense is currently reviewing the case for appeal. In light of Maryland’s cap on non-economic damages (e.g. pain and suffering) we expect that in the interim that the award will be reduced.

Harford County has traditionally been viewed as a conservative jurisdiction and not plaintiff-friendly. Well, the good people of Harford County got it right! Congratulations, Scott and Jim!

Medical Malpractice: Newborn Carbon Dioxide Poisoning Results in Verdict of $16.5 Million

May 19, 2010

Dwight Peterson, Army Staff Sgt., and his wife Shalay presented to Tripler Army Medical Center in Honolulu, HI for an elective cesarean section in January of 2005. Their son Izzy was born a healthy child, but now requires 24 hour care.

The Star Bulletin reported that within just one minute after the birth of Izzy Peterson, pediatrician Army Major Danielle Bird mistakenly administered carbon dioxide, used for stomach surgery, to the healthy newborn. It was not until nearly 42 minutes had passed, and the carbon dioxide tank was almost empty that someone realized this tragic error. Oxygen was supplemented, but by the time this intervention was attempted, Izzy had sustained irreversible brain damage.

Soon after Izzy’s birth, the Peterson family relocated to San Antonio, TX where they have obtained specialized care for Izzy. Izzy is fed through a gastrostomy tube and breathes through a tracheostomy, which he will do for the rest of his life.

Rick Fried, the Peterson’s attorney, filed suit in which it was alleged that Major Bird, a pediatrician doing her fellowship in neonatology, should have noted the difference between the carbon dioxide and oxygen tanks prior to administration. You think?!

Bird…would have had to adjust the upright regulator of the free-standing cylinder clearly labeled carbon dioxide, different from the clocklike regulator attached to oxygen tanks…

Attorneys for the defense tried to claim early on that Izzy had been born with some type of defect; an at-home video of Izzy’s birth as a healthy baby boy proved otherwise.

“You see him take his hand, trying to brush it (the carbon dioxide) away,” Fried said. “Even at birth he knew it wasn’t good for him.”

Although severely brain damaged, Izzy maintains self awareness, can track movement with his eyes and recognizes and responds to his parents. Izzy can feel pain and kick a ball, but will never perform as an average child.

Not present for the decision, the Petersons were informed that federal judge, David Ezra, ruled in favor of the family. Dwight and Shalay Peterson were awarded $16.5 million, which will help to pay for Izzy’s extensive medical care.

Tripler’s Maj. Gen. Carla Halwey-Bowland said in a news release: “Tripler Army Medical Center accepts responsibility for this tragic incident and respects the decision made by the Honorable David Ezra. Our command and well-trained staff are committed to doing whatever it takes to ensure an incident similar to this never happens again, such as improvements in medical gas safety — how they are labeled and handled and staff education.”

Tripler Army Medical Center is the largest Army hospital in the Pacific basin. It contains over 200 hospital beds and provides medical care to almost 400,000 eligible patients. The Medical Center is accredited with providing the best medical care in it’s region, but even in the best hospitals, mistakes can be made.

Social Media and the Attorney-Client Privilege: Waiving Your Privilege – Be Forewarned and Use Common Sense!

May 17, 2010

Last week I attended a brown-bag lunch meeting conducted by the Baltimore City Bar Association entitled “Ethical Considerations for Social Networking for Lawyers.” (Yes, you cynics – we do have ethics – most of us do at least.)

As the crowd gathered in the bar library, I was somewhat fascinated by the demographics of the group attending. Many of the attendees were from my generation and beyond. No, I’m not going to make it easy, you can click on the ‘About Brian Nash‘ link on our blog page and figure out my age. Let’s put it this way – I’m not just out of law school.

Initially I was impressed that the older folks even knew what ‘social media’ meant. Well, it turns out many of them have a different definition than we Tweeps, Friends and Followers. Guess they thought it had to do with advertising in the Sears, Roebuck & Co. catalog. (Boy, I hope they’re not reading this! – chances are they are not since it would require a computer.)

Let’s get down to the subject at hand. One of the topics that surfaced during the discussion was the issue of whether or not a client could be found to have waived the attorney-client privilege by communicating with their friends, followers and/or connections on social media networks. Further time was devoted to how ‘those-in-the-know’ have been dealing with this potential nightmarish issue. I want to share some of the group’s thoughts and some of my own on further reflection. My hope is that these ‘tips, tricks and warnings’ will prove to be of some help – not only the public as clients but to my fellow lawyers, who may not have considered these issues before.

The Attorney-Client Privilege:

Let me start by giving the requisite disclaimer: No, you are not my client because we are Friends on Facebook or following each other on Twitter or you are reading this blog. No, this is not legal advice. That’s the short version.

What is this privilege? I could quote Black’s Law Dictionary, but in the spirit of the internet, here’s what version 1.0 and 2.0 of the cyberspace’s bible (read: Wikipedia) has to say:

The attorney-client privilege is one of the oldest recognized privileges for confidential communications. The United States Supreme Court has stated that, by assuring confidentiality, the privilege encourages clients to make “full and frank” disclosures to their attorneys, who are then better able to provide candid advice and effective representation.

So how could a tweet, a posting or a comment potentially waive such a sacred and revered protection?

While what constitutes a waiver can at times vary from jurisdiction to jurisdiction and certainly from one fact pattern to another, there are some common principles of law that seem to apply.

  • the disclosure must be voluntary and inconsistent with the confidential nature of the attorney-client relationship.
  • the disclosure of the communication with one’s attorney by a client has been made to “unnecessary third parties.”

While law libraries are filled with cases interpreting and ruling on issues of waiver of the privilege, these two elements (intentional disclosure to an unnecessary third party) are sufficient to frame the issue for our discussion.

Does voluntary mean ‘intentional’ – or put another way: “Geez, I didn’t mean to do that.” The short answer (albeit being overly simplistic) is “no, not necessarily.” One of the central issues is – was the disclosure voluntary. Some courts and legal writers suggest that if the disclosure is “inadvertent” (therefore, not voluntary) that this is not a waiver of the privilege. Well, as with most things in the law, there is a laundry list of factors that can be considered to determine if a defense of inadvertent will withstand a challenge to waiver. Some of these might be as follows:

  • the reasonableness (a favorite legal word that can mean anything to anyone) of the precautions taken to prevent inadvertent disclosure
  • the number of inadvertent disclosures
  • the extent of disclosure
  • the delay and measures taken to rectify the disclosure

Well what if you didn’t intend it – or so you say? First of all, I’m not quite sure I want to be standing in front of a judge arguing that when you broadcast a communication you had with your lawyer on Facebook, Twitter or whatever other networking site you live on, you really didn’t intend to type what you typed and then hit ‘enter.’

Can there also be an implied waiver? – another meaningful legal term that keeps all of us lawyers in business. Without getting into a dissertation (more the subject of a law review article) on what constitutes an implied waiver, suffice it to say that this can occur when the client places the communication with their lawyer which goes to the heart of the controversy.

Intent (just like reasonable) generally speaking is one of those fuzzy terms that breeds litigation. For purposes of this article, let’s just focus on whether you intended to put this disclosure out there for your friends and followers. Was the topic you were communicating to your friends/followers (i.e. more than likely defined as “unnecessary third parties”) a confidential communication you had with your lawyer or maybe with your lawyer’s staff?

If it meets these two tests, you will have a difficult if not impossible hurdle to overcome in defending a claim by the opposing lawyer that you waived the attorney-client privilege.

You have now been warned – don’t do it! I know the devil made  your fingers fly over the keyboard when you told your 482 friends about what your lawyer just told you –  about how your case is progressing, or key information your lawyer just discovered, or even your lawyer’s brilliant strategy for getting you a top dollar settlement in your case. The “devil defense” is probably not going to work.

The same goes for lawyers. First of all, the privilege is not the lawyer’s; it belongs in modern jurisprudence to the client. I fully realize that you are just dying to share with your network of legal eagles your most recent brilliant strategy that even Clarence Darrow would never have thought of; however, if you reveal the strategy of a client’s case on such a public forum and it is discovered, you can probably expect a letter from your local attorney grievance commission.

While there are a host of related issues that I will be writing about in the future (e.g. tips and tricks for lawyers during the intake process to identify social media platforms your clients are frequenting, notifications in your fee agreements, and the like), I leave you with one final piece of advice (free at that!!): DON’T DO IT! Keep your communications with your lawyer (clients) off the public social media platforms.

I’m sure you are confident that your user name is so ingenious – LegalBoy528AZ  or imgonnaberichsoon – that you will never get caught. You type away figuring that you’re smarter than any dumb opposing lawyer. Trust me – you don’t want to make that assumption. In fact, in a future blog, I’ll discuss court rulings on this topic of discovery of social media data that may surprise you  – and not in a good way.

To borrow a catchphrase from the TV show Hill Street Blues – “Let’s be safe out there!” I might also add – “Let’s be smart our there!”

Hot Air Balloon Goes Up in Flames – Canada

May 14, 2010

A pleasant hot air balloon ride in Vancouver proved deadly for some.

Twelve passengers gathered aboard the balloon and prepared for takeoff, when suddenly flames erupted from above. It was discovered that the tubing of the balloon providing the propane to the burners which heat the  air came loose. When the tube broke loose, fire began spraying wildly into the basket where  passengers had been patiently awaiting lift-off.

MSNBC News reported that Canadian authorities confirmed two of the twelve passengers aboard did not make it out. As the balloon began to rise and the fire spread, there was no chance for escape.

Of the survivors, Jack Ziyone and his family escaped with relatively minor injuries; while others suffered burns and other injuries. The two passengers that did not escape had been the wife and daughter of a survivor.

“When I was on the ground, he was crying and pointing up,” Jack said. “‘My wife and daughter are up there!’ He was crying. He couldn’t do a thing about it.”

The veteran pilot, whose name was not released, had taken 10,000 passengers aloft throughout his career. He escaped with severe burns and was also hospitalized.

Nigel Vonas, an onlooker, who caught the sight on video stated:

It was just excitement to see something very strange going on in the sky. Those thoughts quickly turned to morbid thoughts that perhaps there was something very wrong going on up there.

All I can come up with is just a very simple message: Life is precious… We need to stop for a second. Put down the iPhones, put down the guns and just realize that life is beautiful. You never know when it’s going to be your last chance to say ‘I love you’ to the person beside you.

He’s right – you never know. Tragedy strikes so quickly. The common and expected things in life we take for granted so often. Sometimes, the unexpected happens and our lives are never the same again. But you know that – just keep remembering it.

Semi-Paralyzed from a Steroid Injection earns FL Woman $36 Million

May 14, 2010

Kathleen Ramey presented to Dr. Andrew Weiss, a pain management specialist, for a steroid injection in September of 2000 after having been in a motor vehicle collision. Believing she would leave pain free and on the road to recovery, Ms. Ramey got anything but that result.

The injection left Ms. Ramey with a four inch hole in her spinal cord, which according to the report of The Palm Beach Post, left Ms. Ramey suffering constant pain and with a disfigured right arm. A Palm Beach County jury awarded Ms. Ramey $23.6 million; her husband was awarded an additional $13 million in damages.

Apparently, Dr. Weiss did not put up a very strong defense. In fact, he was not even at the trial. Moreover, he did not have any legal representation on his behalf in the courtroom.

Why in the world would that be, and where was he? The Palm Beach Post advises, “He is in the midst of serving a 12-year federal prison sentence after pleading guilty in 2006 to four counts of illegally distributing oxycodone. His state medical license has been revoked.”

I’ve heard of ‘paper judgments’ before, but this story is truly tragic on so many levels. One of those is not the incarceration of Dr. Weiss. Though Ms. Ramey won her case, it could be a long time (if ever) before she sees any compensation for her horrible injuries.

Non-Cardiac Surgery Too Soon After Cardiac Stenting Increases Risk of Complications

May 14, 2010

According to a recent study published in Circulation: Cardiovascular Interventions (an American Heart Association journal), patients should attempt to postpone having surgeries for at least six weeks after a coronary angioplasty procedure with stenting.  Researchers found that patients who wait at least six weeks before having another surgery are less likely to develop reduced blood flow to the heart (a.k.a. heart ischemia) and heart attacks.

The study data revealed that 42 % of patients who had other surgeries within the six-week period developed these complications. Only 13 % of patients who had surgeries beyond the six-week period developed the same complications. The study focused 1,953 patients with an average age of 64 who had cardiac angioplasty with stenting between 2003 and 2007.

According to the American Heart Association:

  • Over 70 percent of coronary angioplasty procedures in the United States also include stenting.
  • In 2006, approximately 65 percent of PCI procedures were performed on men, and approximately 50 percent were performed on people age 65 or older.
  • In 2006, an estimated 1,313,000 PCI procedures were performed in the United States.
  • In 2006, approximately 76% of stents implanted during PCI were drug-eluting, compared with 24 percent bare-metal stents.
  • In 2006, there were 652,000 PCI procedures with stents — 425,000 in men, 227,000 in women.

If you recently had cardiac stenting and require another surgery, make sure to ask your doctor about waiting to have the next surgery. This is particularly true if your next surgery is an elective one. If your doctor or surgeon is not a cardiologist, you may want to consider asking your doctor for a referral to a cardiologist.  You may also want to make sure that your physician or surgeon obtains cardiac clearance before proceeding with another surgery.   Don’t assume that your doctor will do these things for you. Be proactive; ask questions.

For related blogs, please see:

Contributing author: Jon Stefanuca

Best Hospital Rankings – A reply to Dr. K – what’s best for YOU?

May 13, 2010

As readers of our blog know, Dr. Kevin’s blog serves as the source for a number of our posts. Recently, Dr. Kevin posted somewhat of a spin-off –Top hospital rankings doesn’t mean the best medical care | KevinMD.com – of a post he had done earlier about “Top Doctors” does not equal (necessarily) “Best Doctors.” Then today, as I was going through my News Feed on Facebook, lo and behold, here it is again.  I agreed wholeheartedly with him then and  now, and I find myself saying “Amen” to his post.  Problem is – what is the answer, Dr. K?

Check out his blog. He identifies the issue, but does he really suggest the answer? My humble opinion: afraid not!

Let’s explore some ‘tips and tricks’ for you to get close to the right answer. I say ‘close’ because there really is not a perfect answer. If you get great care and all goes well, then that was the best hospital for you and your problem. These after-the-fact answers are always 100% accurate when seen through the best medical instrument available – the retrospectroscope. If you are interested in some tips and tricks for picking an institution for future, non-emergent care, read on.  Let’s see if we can provide you some guidelines for your selection process.

Having been involved with issues relating to the care rendered at numerous hospitals in Washington, D.C., Baltimore and far beyond for many years, I have my own personal opinions where I would go to be treated and where I most assuredly would not go.  In fact, I have often joked that I need to get a medical alert bracelet reading – ‘in event you find me unresponsive do NOT take me to Hospital X (fill-in the blank).”

Lawyers doing medical malpractice have a pretty darn good sense of which hospitals give the best care.  Does the general public? As Dr. Kevin points out, reputation and marketing of that reputation is not the end-all-be-all of defining which hospital (also insert ‘doctor’) gives the “best medical care.”

There’s a certain hospital here in Baltimore that is constantly listed as the “Best.” While that institution does have some of the ‘best’ doctors and allied health specialists, it is also well known to provide substandard care at an alarming rate. The local maxim goes – “If I wind-up having a rare disease, that’s the place I want to go for treatment; however, if it’s garden variety, no way – no how!” Why? Just too busy, too arrogant, not patient- friendly, too willing to turn patient care over to resident-staff-only surveillance and so on. Maybe they are just bored by the ordinary health issue – not complex enough. Who knows?

But here’s the catch – just as ‘top hospital’ rankings doesn’t mean (necessarily) best medical care, nor does overblown reputation mean that there aren’t some, if not many, outstanding physicians at these same institutions. Titles, marketing banners and magazine covers simply do not answer the search for the best institution for your care.

Let’s face it, in an emergency situation you are going to the nearest available institution at least until you are stabilized medically. Whether you elect to stay there for ongoing care may well be a different issue. The more common situation you will probably face is when you are going to undergo elective procedures or care.

Since you are reading this blog, you undoubtedly have a computer. Have you done your homework? Going online to learn more about your medical condition is a good place to start. No, I’m not suggesting you check-out what ranking your doctor or his/her hospital has; that information is precisely at the heart of the problem.

Let’s take one example of putting research into the decision-making process. An obese patient determines that he/she would benefit by bariatric (weight loss) surgery. Putting aside those who see this as a quick-fix alternative to Jenny Craig or Weight Watchers, John Doe (J.D.) – our hypothetical patient – might consider researching the various forms of bariatric surgery. Does J.D. know if he should have gastric bypass surgery or gastric banding? If gastric bypass, does his doctor specialize in open procedures or laparoscopic surgery? Does he know the different approaches a doctor can take? What are the risks of malabsorption or the post-operative complications associated with that form of surgery? Had J.D. just typed in “bariatric surgery” in whatever search engine he likes, he would see there is a world of information out there about the types of bariatric surgery, the risks associated with such surgery and so on. Did that handout he received from his doctor really fully educate him on the alternatives to what was recommended to him?

Okay – let’s focus on J.D.’s surgeon. Does he/she have a ‘preference’ for doing open versus laparoscopic procedures? When is the last time, if ever, he/she did one laparoscopically? Consider: did J.D. think that might be the reason why he/she is recommending J.D. undergo an open Roux-en-Y? Is this really in J.D.’s best interest?

Let’s put you in J.D.’s shoes. Would you ask your prospective surgeon what his/her complication rate is? How about  mortality rate? If you think surgeons don’t know their morbidity/mortality rates, think again. What is the most frequent complication your surgeon  encounters following the surgery or treatment you are considering? Are you, for some reason, at greater risk than other patients for encountering this risk?

Hopefully by now you get the drift. This is your body – protect it! Last time I checked, we’re only here one time around. If your doctor makes you feel ‘uncomfortable’ because of his/her reaction to your questions or  the time it takes for  you to understand what you are agreeing to undergo surgically or medically, that might just be a telltale sign to move on.

Best Doctor/Best Hospital? Hopefully, by doing your homework and having a meaningful discussion with your doctor and understanding better the hospital where this will all be taking place, you will determine exactly who is the “best doctor’ and which is ‘the best hospital‘  for YOU! At least this approach will give you a better chance of a good outcome and experience than making your choice based on a title, magazine cover or a banner hanging on the hospital’s facade.

By the way, the same can be said of lawyers. Are we listed as the ‘best’ and ‘super’? We sure are, but you should ask us (or any lawyer you have occasion to meet) the same type of tough questions. Be pro-active. You’ll be better-off for it.