DC Metro Area Medical Malpractice Law Blog

By Catherine Bertram                                                                 

There was an interesting article in the New York Times recently that seems to suggest that doctors and hospitals would be more forthcoming about errors in the delivery of health care that injure patients if only they were fully protected from the consequence of their errors.  That is not the right answer and we all know it.   The answer is just what our parents and teachers taught us in kindergarten.    Tell the truth and accept the consequences.  No profession in our country is held to any lesser standard, nor should they be. 

As a former risk manager at a major teaching hospital,  I can tell you first hand that admitting errors and working toward resolution with patients and their families is not only the ethical thing to do, but it is the only way to honor the doctors and nurses as well.  Doctors and nurses come to work every day to help people but they are human and they make mistakes.    They feel horrible when an error occurs and they deserve support and resolution.   Disclosure is hard to do but in my experience, in the end,  it is the only way to help both the family and health care provider heal. Truth and transparency followed by support is critical.

The article cites several examples of hospitals who have made a commitment to tell the truth and accept responsibility and the outcomes have been overwhelmingly positive.   Of course.    The key question is when an error occurs is the health care team supported by the entity or not?  When proper support is provided the patient and the health care worker are both honored but that requires full disclosure AND acceptance of responsibility for the consequences. Saying you are sorry is great, but only if the institution takes the next step and everyone has closure.   Otherwise, who pays for the consequences of the error?  If there is a cover up, or disclosure without acceptance of responsibility for the harm, the patient is still injured and often is facing a lifetime of care costs and no ability to work.   There is no resolution in that scenario for anyone.  The health care worker has to live with that burden in silence.    We all pay when there is no acceptance of responsibility.  We pay with higher health insurance premiums and higher taxes for those patients who have medicare/medicaid or who lose their coverage. 

The focus must be on prevent errors and supporting both the health care workers and patients when errors occur. Not on saving the insurance companies money by hiding a legitimate claim.    It is only through truth and demanding transparency that the system will ever become safer.  We have the airline industry as a perfect example.   The system of cover up and denial in health care has not worked and never will.   We need only look at Texas as a recent example.  The legislature put a strict damages cap in place effectively ending a patient's right to a civil remedy for malpractice in that state.  The number of annual complaints against doctors almost tripled.  Texas health care is not safer, doctors making errors are not being supported and the patients are still being injured. 

Honesty and accountability work.

Posted by: Salvatore J. Zambri, founding partner     

The DC Department of Health recently released a report, making clear that medical errors are killing more DC residents than all types of car and truck accidents combined.  Per the February, 2010 report, "The leading causes of preventable death in the District of Columbia...were tobacco use (estimated 860 deaths; 16.6 percent of total DC resident deaths), poor diet and physical inactivity (estimated 780 deaths; 15.1 percent), microbial (infectious) agents—excluding HIV—(estimated 240 deaths; 4.6 percent), alcohol consumption (estimated 150 deaths; 2.9 percent), firearms (estimated 140; 2.7 percent), and medical errors (estimated 140 deaths; 2.7 percent). 

According to the comprehensive study and report, motor vehicle accidents account for .6% of the overall deaths in DC--that's 4.5 times less than the deaths caused by preventable medical errors.

The complete report can be viewed by clicking here.

There is a lot of discussion in politics about "tort reform".  The term--"tort reform"--is actually a misnomer, and is better understood as "tort deform".   Some powerful business groups and industries wish to strip Americans of their rights and their access to justice when injured due to medical errors.  Instead of robbing Americans of their fundamental rights and compensating them for the devastating damages they incur as a result of medical negligence, the focus should be on preventing the medical errors in the first place.  That's true reform.

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Posted by: Salvatore J. Zambri, founding partner     

“A happy life consists not in the absence, but in the mastery of hardships.” - Helen Keller

Cerebral palsy is a condition that can involve brain and nervous system functions, limiting a person's ability to move, learn, hear, see, and think.  Palsies develop due to damage to the developing brain.  Cerebral palsy usually develops by age two or three, and it is a non-progressive brain disorder, which means that the brain damage does not continue to worsen throughout life. However, the symptoms due to the brain damage often do change over time; sometimes getting better and sometimes getting worse. Cerebral palsy affects between two and four children out of every 1,000 live births. The United Cerebral Palsy Association estimates that more than 500,000 Americans have cerebral palsy. 

It is estimated that between 35% and 50% of all children with cerebral palsy will have an accompanying seizure disorder and some level of mental retardation.  Affected children also have a tendency to develop learning disabilities, along with vision, speech, hearing, or language problems. 

Symptoms are usually seen before a child is 2 years old, and sometimes begin as early as 3 months. Parents may notice that their child is delayed reaching certain developmental stages such as sitting, rolling, crawling, or walking.  There are several different types of cerebral palsy. Some people have a mixture of symptoms.

Symptoms of spastic cerebral palsy, the most common type, include:

• Muscles that are very tight and do not stretch, which may tighten up even more over time;
• Abnormal gait with arms tucked in toward the sides, knees crossed or touching, legs make "scissors" movements, walk on the toes;
• Joints are tight and do not open up all the way (called joint contracture); and
• Muscle weakness or loss of movement in a group of muscles (paralysis).
   

Although there is a wide spectrum of symptoms, some other common symptoms of cerebral palsy include:

• Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress;
• Tremors; and
• Loss of coordination.

Decreased intelligence or learning disabilities are common, but intelligence can be normal.  Many people with cerebral palsy have speech problems, hearing or vision deficits, seizures, and suffer pain and discomfort.

Cerebral palsy is caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb or during the delivery process, but they can happen at any time during the first 2 years of life, while the baby's brain is still developing.  Sometimes, these injuries are preventable, yet brought about by medical errors.

Examples of cerebral palsy caused by the failure of medical providers to meet applicable standards of care, include:

• Undiagnosed or untreated infections during pregnancy that may damage a fetus' developing nervous system;
• Undiagnosed or treated jaundice in the infant;
• Bleeding in the brain that goes untreated;
• Severe oxygen deprivation to the brain or significant trauma to the head during labor and delivery;
• Leaving the child in the birth canal too long causing a lack of oxygen to the brain;
• Failure to detect a prolapsed cord (the umbilical cord can wrap around the child's neck, cutting off oxygen to the brain);
• Failure to perform a cesarean section in the presence of fetal distress;
• Improper use of forceps during delivery;
• Excessive use of vacuum extraction;
• Failure to recognize and treat seizures following delivery;
• Not responding to changes in the fetal heart rate; and
• Failure to plan a cesarean with a high birth weight infant.

Although life can be extremely challenging for  those with cerebral palsy, as well as the parents, siblings, and other family members, there are many organizations and support groups that can help people face and overcome those challenges.

The following is a list of readings, organizations, and special agencies whose purpose is to provide education about cerebral palsy and other disabilities and information to assist families with their needs, which I hope you find useful:

United Cerebral Palsy
http://www.ucp.org/
1660 L Street, N.W., Suite 700
Washington, DC 20036
(800) 872 – 5827/(202) 776-0406
E-mail: info@ucp.org

UCP is a national organization for people with cerebral palsy and their families. Through its local chapters, it provides a variety of services, including information and referral, parent support, advocacy, and educational and work programs for people with cerebral palsy. Fact sheets on selected issues related to cerebral palsy are available, as well as publications from a variety of publishers and organizations. Many publications can be downloaded from the website at no charge.

Association of University Centers on Disabilities
http://www.aucd.org/
1010 Wayne Avenue
Suite 920
Silver Spring, MD 20910
(301) 588-8252

The Association of University Centers on Disabilities (AUCD) is a membership organization that supports and promotes a national network of university-based interdisciplinary programs.  Through its members, AUCD is a resource for local, state, national, and international agencies, organizations, and policy makers concerned about people living with developmental and other disabilities and their families. Members engage in a range of interdisciplinary activities including: exemplary services for children, adults, and families; academic training; basic and applied research; training and technical assistance to schools, communities, and all levels of government; policy advocacy; program evaluation; and dissemination of best practices and new information.  AUCD programs also train the next generation of leaders in disability-related research, training, service delivery, and policy advocacy to insure that this essential work continues.

American Physical Therapy Association
http://www.apta.org/
1111 N.  Fairfax Street
Alexandria, VA 22314
(800) 999-2782/(703) 684 - 2782

The APTA has a free list of publications, "Publications of Interest to Parent and Educators of Handicapped Children." They can also direct you to the APTA chapter in your area.

ABLEDATA
http://www.abledata.com/
8455 Colesville Road, Suite 935
Silver Spring, MD 20910
(800) 227 - 0216

ABLEDATA is a national database covering information on assistive technology and rehabilitation equipment. Those interested can search the database free of charge from the ABLEDATA web site, or can have an information specialist perform a search for a small fee.  ABLEDATA publishes an assistive technology fact sheet and consumer guides.

Brian Injury Association of America
http://www.biausa.org/
1608 Spring Hill Road
Suite 110
Vienna, VA 22182
(703) 761-0750

The Brain Injury Association of America (BIAA) is the leading national organization serving and representing individuals, families and professionals who are touched by a life-altering, often devastating, traumatic brain injury (TBI). Together with its network of more than 40 chartered state affiliates, as well as hundreds of local chapters and support groups across the country, the BIAA provides information, education and support to assist the 3.17 million Americans currently living with traumatic brain injury and their families. 

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Posted by: Salvatore J. Zambri, founding partner     

According to the Chicago Tribune, Baxter International Inc. announced a recall of its "in-home dialysis device that has been linked to serious injury reports and at least one death in the last two years." In addition, the "Food and Drug Administration has classified the action as a Class I recall, the agency's most serious, for the Baxter's HomeChoice and HomeChoice Pro peritoneal dialysis cyclers, because the device is causing an 'overfill' of fluid in the patient's stomach," states the Tribune report.

A Class I recall applies to problems that can cause serious adverse health consequences or death. According to an AP report, "Baxter said it is still investigating the source of the problems and is working on changes to labeling and software to prevent patient errors."  The company nevertheless claims that the "machines do not need to be physically returned to the company and can still be used."

Dow Jones Newswire reported on the recall as well.

If using a Baxter device, we urge you to speak with your doctor immediately to determine if it is safe for you to continue using it.  Your doctor should be aware of the problems and the consequential risks to be able to provide you with the information you need to make the best decision possible for your health.

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Posted by: Salvatore J. Zambri, founding partner     

Shriram Harid blogged at the Huffington Post, "President Obama is widely expected to toss Republicans a bone at Thursday's health care summit, by publicly embracing what's known as 'tort reform.'" But as she pointed out, tort reform advocates ignore "how punitive damages [are] essentially the only way that patients have of holding medical professionals and organizations accountable when they kill, maim or injure people through their negligence, ignorance or even malice." Harid remarks, "According to the American Association for Justice . . . legislators ought to be focused primarily on reducing the frequency of malpractice, rather than malpractice litigation, since a mere 2 to 3 percent of all instances of malpractice lead to claims."  And she quotes the President of the Association, Anthony Tarricone, who stated, "The idea of bargaining away the life of injured patients is a very, very bad idea... Opponents of health care have seized on tort reform as a panacea. ... They're bankrupt of any real reforms. The only real solution is eliminating malpractice itself."

Nearly 100,000 people die every year in America due to preventable medical errors--that's like two 747 airplanes fully loaded crashing to the ground every single day.  The last thing the government should ever seek to do is limit these innocent victims' ability to seek justice.  What the medical and business industries should be focusing on is improving medical care to avoid the medical errors that are seriously injuring and killing Americans.

I represent people who have been devastatingly injured due to preventable medical errors, as well as families of those who have been killed due to medical negligence.  If you have any questions about our civil justice system and its impact on overall healthcare costs, please feel free to give me a call.

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Posted by: Salvatore J. Zambri, founding partner     

As you know, President Obama has called a summit to address the issue of healthcare reform.  The insurance industry, Big Business, the pharmaceutical industry, the American Medical Association (the doctor lobbying group), and other corporate industries have been shouting for limits on patients' rights.  The inescapable truth, however, is that capping damages and otherwise limiting the ability victims of medical errors have to obtain justice will have no appreciable impact on overall health costs.  Medical Malpractice litigation accounts for merely 1/2% to 1% of overall healthcare costs according to the Congressional Budget Office.

During the summit, Senator Dick Durbin (IL) delivered an impassioned defense of the civil justice system. I recommend taking the time to watch this terrific clip by clicking here.

The president of the American Association for Justice recently appeared on CNN’s Anderson Cooper 360 to discuss this issue. That clip is available by clicking here and using the password "justice".

Nearly 100,000 people die every year in America due to preventable medical errors--that's like two 747 airplanes fully loaded crashing to the ground every single day.  The last thing the government anyone should ever seek to do is limit these innocent victims' ability to seek justice.  What the medical and business industries should be focusing on is improving medical care to avoid the medical errors that are seriously injuring and killing Americans.

I represent people who have been devastatingly injured due to preventable medical errors, as well as families of those who have been killed due to medical negligence.  If you have any questions about our civil justice system and its impact on overall healthcare costs, please feel free to give me a call.

About the author:

Posted by: Salvatore J. Zambri, founding partner     

The New York Times, in a front-page report, announced, "To help ensure that medical radiation is safe, Medicare insists that certain highly technical cancer treatments be administered only when a patient's radiation oncologist is present or nearby." Federal officials say physicians who fail to adequately supervise technicians during radiotherapy risk patient safety. But, the issue also "raises questions about financial incentives and the overuse of high-tech, and highly reimbursed, treatments" when "less advanced and cheaper ones would have served just as well."

As a result, "Congress passed an antikickback law designed to stop doctors from" unnecessarily ordering "tests or procedures in which they have a financial interest," according to the report.  In addition, "radiation safety will be the subject of a Congressional hearing Friday." For its part, "the American College of Radiology has said that self-referral endangers patients because doctors tend to order more tests."

Before undergoing any diagnostic test or invasive procedure, your doctor should describe all benefits and  risks of the procedure and he or she should explain all alternative options as well.

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 Posted by: Salvatore J. Zambri, founding partner     

The AP reported that "Drugmaker KV Pharmaceutical Co. says it will shut down its Ethex generic division, plead guilty to criminal charges" that the company failed to immediately notify "regulators of safety hazards."  The embattled company will "pay $27.6 million to resolve government investigations," according to the report.

The settlement requires Ethex to "plead guilty to two felony counts for failing to file 'field alerts' for two drugs, dextroamphetamine and propafenone," the St. Louis Post-Dispatch reports. In addition, "KV was ordered to stop making some time-release cough, cold, and gastrointestinal drugs in 2008," but despite that order, "the FDA said KV continued to make the drugs."

This smacks as another instance in which a big company decided to mock the law and put profits over safety.  There is no place for such greed in this country.  I hope the criminal consequences send a message to all greedy executives that they better change the way they do business and start putting people over profits.  Americans shouldn't be seriously injured or killed just so executives can pad their pockets.

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 Posted by: Salvatore J. Zambri, founding partner     

The front page of the New York Times reported that "Hundreds of people taking Avandia [rosiglitazone], a controversial diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports." A Senate Finance Committee review cites internal FDA documents that highlight a dispute among regulators that "has been brewing for years but has been brought to a head by disagreement over a new clinical trial."

The Wall Street Journal reports that the Senate committee concluded that Glaxo was aware of the risks, but minimized the issue and attempted to suppress concerned physicians. The FDA's documents also indicate that agency scientists said the drug should be pulled from the market in 2008, but FDA chiefs rejected the recommendations. Now, agency commissioner Margaret Hamburg is expected to meet "with FDA scientists and outside experts to gain a full understanding...of all of the data and issues involved," a spokeswoman said.

The AP reported that the Senate committee is asking the FDA "why it allowed a clinical trial of Avandia to continue even after the agency estimated that the drug caused 83,000 heart attacks between 1999 and 2007." Glaxo agreed to an FDA request for "a six-year study between its drug and" the Pfizer diabetes drug Actos [pioglitazone] "to give a definitive picture of Avandia's safety."

If the senate report proves to be accurate, this once again smacks of a company putting profits over patient safety, leading to serious injuries and death.

If prescribed Avandia, please contcat your doctor immediately.  Your doctor should not prescribe any medication without first warning you of all known risks, and only if the benefits of teh medication outweigh the risks.

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By Catherine D. Bertram                                                     

According to an article in the Chicago Tribune, a company called RF Surgical Systems of Bellevue, Wash., created the RF Surgical Detection System which is essentially a scanning wand that can be used by surgeons to find any tagged items remaining in a patient. Tags (or seeds) about the size of a rice grain are imbedded in gauze, sponges and the like. One wave of the wand over the patient will reveal if the coast is clear.

According to an article in the New England Journal of Medicine, retained objects were reported "1 in 8,801 to 1 in 18,760 inpatient operations" which essentially is the equivalent of one case or more each year for a large hospital.  Unfortunately, this study was based on malpractice claims not just reported events,  so some experts say those numbers are most likely an underestimate. 

Does it work?  According to the article, more than 100 hospitals are using the system at a cost of about $15 per surgery.

Our firm has extensive experience with local cases involving surgical errors, including local hospitals where retained objects caused patient death. If you have any questions about this type of case feel free to email me at cbertram@reganfirm.com or call me at 202-822-1875.