Have Medical Malpractice Lawsuits Caused a Dangerous Rise in C Sections? (Part 2)

In our last post, we discussed the curious implications of a highly cited, provocative medical paper, Yang et. al's "Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section," which obliquely blames medical malpractice attorneys for skyrocketing rates of C-Sections.

The New York Post also recently brazenly asked: “Do Medical Malpractice Threats, Real Or Imagine, Lead to More C-Sections?”

As tantalizing as the thesis that "pressure from medical malpractice attorneys --> more C-Sections" may seem based on superficial analysis, upon deeper inspection, it just doesn't hold up.

There are two compelling problems with the thesis.

Problem #1. The correlation could be spurious.

Just because two trends “go together” does not mean that one causes the other. Correlation, as they say, does not imply causation. Spurious correlations happen all the time, for many different reasons. A popular website, http://www.tylervigen.com/, lists a whole bunch of ridiculous correlations. For instance, the consumption of organic food has been correlated very, very tightly with increasing rates of childhood autism over the past decade. But no one would say that eating more organic food causes babies to be autistic or that autistic children somehow make people more crave organic food. The correlation is just an odd statistical artifact with no meaning.

Problem #2. We could be overlooking other, better explanations for the trend.

In some cases, one unseen driver can cause both trends. In other words, some third force can lead to more malpractice pressure AND more C-Sections at the same time. That would nicely explain any correlation. Tellingly, Yang et al included, as one of their metrics, "increased malpractice insurance premiums."

So maybe the insurance companies' decisions to raise their rates -- which may or may not have been caused by any actual, real changes in lawsuits filed -- caused both the "increase in malpractice pressure" and the spike in C-Sections. By this read, the real "bad guys" would be the insurance companies, not the trial lawyers.

As this blog and many other more objective sources have confirmed, insurance companies have their own agenda and often work very hard to blame malpractice attorneys for problems that they, themselves, either create or exacerbate.

Perhaps the insurance companies raised premiums for their own insurance company reasons, which in turn scared doctors into taking overly-precautionary methods (such as opting for C-Sections instead of VBACs). Meanwhile, the medical malpractice attorneys were innocent. The broader point is that, to understand the cause and effect relationships in complex systems, you need hard science, not just epidemiological observations. (For a more detailed explanation of the problems with many epidemiological studies, see journalist Gary Taubes' fascinating 2007 New York Times piece, "Do We Really Know What Makes Us Healthy?")

For thorough, effective assistance dealing with your potential case, call the medical malpractice attorneys here at Regan, Zambri & Long for a confidential consultation at (202) 463-3030.

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Have Medical Malpractice Lawsuits Caused a Dangerous Rise in C Sections? (Part 1)

Have medical malpractice lawsuits changed how American women give birth?

That thesis, while seemingly far fetched, is growing in popularity among academics and tort reformers alike. Why do people believe this idea? How much good research supports it? In today's post and one to follow, we'll follow this discussion.

In 2009, researchers Yang et al published a provocative paper in the journal Medical Care, entitled “Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section.” The paper tried to answer the question of whether our modern, increasingly litigious environment has caused a spike in the rate of cesarean sections ("C sections").

The authors in the abstract made the following observation: “Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior reducing obstetricians' exposure to malpractice litigation.”

The researchers tried to figure out how and whether the malpractice environment impacted VBAC and cesarean section rates. They used “state level longitudinal mixed effects regression models” to take a look at birth statistics in the U.S. from the early 1990s to 2003. They also tried to operationalize “malpractice pressure” by measuring the effect of tort reform and the size of liability insurance premiums.

The researchers DID find an association between increased “malpractice pressure,” as they defined the term, and an increase in a number of cesarean sections and VBACs. The New York Post jumped on this story and published its own interpretation, making it sound like medical malpractice lawyers caused a dismal, dangerous trend in the birthing industry.

Even the Post's headline -- “Do Medical Malpractice Threats, Real Or Imagined, Lead to More C Sections?” -- is a leading question, if there ever was one. The Post quoted an expert, Naomi Riley, who said “there’s universal agreement in the medical community that too many C-sections are taking place, but the fact is that doctors don’t have much choice.”

The implication is clear: malpractice lawyers have made the birthing system more complicated and dangerous for moms and doctors alike.

Or have they?

In fact, this seemingly cut and dry case is anything but. In our next post, we'll explore two huge problems with this thesis.

For now, if you need help with a potential D.C. medical malpractice case, contact the attorneys at Regan, Zambri & Long at (202) 463-3030 for immediate assistance.

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A Look into the VA Waiting List Debacle

The Veterans Health Administration is responsible for the healthcare of 8.76 million veterans and their families every year, representing “America’s largest health care system.” The VA’s crucial role in the life and wellbeing of some of our most honored citizens makes the recent waiting list scandal exponentially more appalling to medical malpractice attorneys as well as the public at large.

The Cover-Up

The VA crisis emerged in April, when a retired clinic director came forward with allegations that the Phoenix VA had falsified their electronic waiting list. Their “secret waiting list” concealed the number of veterans waiting for care, as well as their exorbitant wait times.

Since word of the cover-up has come out, investigators have identified at least 18 veterans that died while waiting for medical care. It is currently unclear whether these individuals’ deaths directly resulted from the delay in care. However, autopsy reports, death certificates, and medical records should provide more conclusive evidence.

The Solution

As the investigation continues, the VA has responded by opening up several mobile medical units throughout Phoenix to give more veterans access to the care they need. In addition, the Senate Veterans Affairs committee is working on a bill that would help veterans by expanding their network of healthcare facilities and providers, eliminating ineffective executives and administrators while increasing facilities and hiring across the country.

Hopefully, these measures will begin to turn around a seriously flawed system whose mismanagement and dishonesty have harmed countless American heroes. However, as more information emerges, we will likely learn that many more veterans have died or suffered needlessly due to the practices of VA facilities across the country.

Medical Malpractice

Each state creates its own medical malpractice laws, but the National Institutes of Health defines medical malpractice as “any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes injury to the patient.” The VA, like any other medical provider, has an obligation to provide its patients with timely and effective healthcare and to abide by the law while doing so.

When healthcare organizations break their trust with those who depend on them for their care, they must be held accountable. Washington D.C. medical malpractice attorneys Regan Zambri & Long work with individuals who have suffered harm at the hands of their medical providers. For a free consultation to explore your legal options, contact us at (202)463-3030.



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Virginia Medical Malpractice Suits Against VA Clinics Settle for Over $1 Million

The Center for Investigative Reporting just released a report announcing that the families of four deceased military service members will collect around $1.4 million in settlement money. Caregivers treated the veterans at the Coatesville Veterans Affair Medical Clinic in Virginia.

  • One VA medical malpractice case (which settled for $100,000) concerned accusations that caregivers did not monitor a veteran who later died.
  • Another case, which closed back in February 2008 for nearly $500,000, concerned the VA's failure to manage a psychiatric patient.
  • A third case closed in August 2011: A misdiagnosed VA patient died.
  • A fourth case closed in December 2011 for $500,000: a caregiver failed to monitor a sick veteran.

Amazingly, those four cases constitute just a drop in the bucket. VA facilities around the country currently face over 1,000 wrongful death actions; the government has already settled various matters for over $200 million.

Why is this happening, and what are lawmakers doing about it?

Patrick Mayhem, a Democratic Congressman, lashed out recently against President Obama for allowing the situation at VA facilities to get so bad. Mayhem said “the President spoke of accountability at his press conference today but is showing none… The horrors that have been exposed at the VA facilities across the country are shameful, and addressing them requires less talk and more decisive action.” Among other things, Mayhem had wanted Obama to fire VA Secretary Eric Shinseki.

Obama did meet with Shinseki at the Oval Office, and he exchanged harsh words. The President said: "I told the Secretary I will not stand for [what is happening with the VA facilities] – not as Commander-in-chief but also not as an American.”

Nationwide outrage has been building, following repeated allegations of patients dying at VAs due to misdiagnoses or bad treatment. Patients and their families also complain about costly, nonsensical delays.

There has been a massive influx of soldiers back from campaigns in Iraq and Afghanistan over the past several years. These people often need more than just temporary assistance with medical problems. They also need long term psychiatric help as well as therapy for chronic issues caused by head injuries, PTSD and war-related depression.

Patient rights advocates want to see positive action to fix the VA facilities to make them more functional and make the system fairer. Obama reassured voters last week: “we are going to fix whatever is wrong, and so long as I have the privilege of serving as Commander In-Chief, I am going to keep on fighting to deliver the care and benefits and opportunities that you and your families deserve, now and for decades to come.”

Hopefully, that will be the case.

If someone you love was hurt, misdiagnosed, or otherwise poorly treated at a VA facility or any other medical center, call Regan Zambri & Long today for a free consultation at (202) 463-3030.

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Impassioned Forbes Magazine Piece Shows That Malpractice Lawsuits "Aren't Just About Money"

How widespread is medical malpractice? What are the real costs for patients, for the medical system, for doctors and for insurers? And what can be done to fix the system's fundamental structural problems? A compelling recent piece in Forbes Magazine, “Malpractice Lawsuits Aren’t Just About the Money,” dissects the scope and breath of the problem; it’s truly breathtaking.

The piece begins with the tale of a woman named “Karen,” a Board Certified physician whose mother had been rushed to the hospital, because she had been on the wrong medication. Terrified and enraged, Karen called her mother’s doctor, who proclaimed that he was “on vacation” and could not be bothered to come in and see the sick patient.

Even though Karen was “Board Certified in three specialties,” she felt helpless to navigate the system. Should she file a lawsuit? Perhaps she could complain to the Joint Commission on Safe Accreditation – a watchdog organization that promotes safety and quality care at hospitals. Good idea in theory. Unfortunately, only a third of the 3,000+ hospitals accredited by the Joint Commission have the distinction of being “top performers.” What's more: 2,400 hospitals throughout the country do not even have this accreditation.

The Scope of the Malpractice Debacle

Nearly 100,000 people die and 300,000 people suffer injuries every year at U.S. hospitals due to avoidable errors, per the National Institute of Medicine. This is simply an unacceptable situation.

And reformers are frustrated.

In 2004, reformers created the Institute for Health Care Improvement, which urged hospitals to sign on to evidence-based strategies to protect people from the dangers of malpractice, using objective metrics, and to implement positive changes. 1,000+ hospitals signed on, but these hospitals were notoriously slow to implement key recommendations and often behaved in recalcitrant fashion.

Hospitals have not been the only institutions resistant to change.

The American College of Obstetricians and Gynaecology (ACOG) famously failed to implement powerful changes that helped New York Presbyterian Hospital drop its rate of “sentinel events” (those causing death or serious injury) from 1 out of a 1000 to zero, over a span of just a few years.

Why did ACOG refuse to make these changes? According to the Forbes article, ACOG rejected the reforms “on the grounds they [might] infringe on individual doctor or hospital prerogatives.”

In other words, ACOG made a choice that it's more important to preserve doctor/hospital autonomy than it is to prevent sentinel events in patients.

That's a cynical calculus, if there ever was one.

By contrast, consider what the American Society of Anesthesiologists did back in the early 80s, in the wake of a series of awful patient incidents. That organization did a thorough work over of its processes and, within a decade, dropped the rate of death from anesthesia from 1 in 6,000 to 1 in 200,000.

If you or somebody you love needs legal assistance with a potential case, contact the Washington D.C. malpractice attorneys at Regan Zambri & Long today at (202) 463-3030 for a free consultation.

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Don't Buy into These Four Myths about Tort Reform

Medical malpractice attorneys are refuting the notion that claims are out of control. Many lawmakers, insurance companies, and medical practitioners, however, are championing tort reform, which seeks to place limitations on litigation or damages awarded in civil claims. These non-legislative proceedings have long been a way for individuals who have suffered harm to gain compensation from those responsible.

Tort reform proponents, however, believe (or would like the rest of us to believe) that medical malpractice claims pose undue hardships to doctors, insurance companies, the legal system, and the economy. Their messages often capitalize on several misconceptions about tort litigation, including:

•    Medical liability expenses hurt the economy. According to the Harvard School of Public Health, the United States spent $55.6 billion, or 2.4 percent, of 2008’s healthcare spending on “medical liability costs.”

•    High claims payouts lead to financial burdens on medical malpractice insurance companies. Regardless of whether a state imposes caps on claims payouts, insurance companies continue to rake in enormous earnings. For example, between 2003 and 2010, insurance companies in Florida reported 4300 percent profits, a staggering amount that should leave no question as to their profitability.

•    We need damages caps in medical malpractice cases to keep insurance costs down. According to a ruling by the Florida Supreme Court, no apparent correlation between medical malpractice settlement caps and insurance rates exists. The American Association for Justice further cites several sources that attribute high insurance rates to stock speculation and “mismanagement” of insurance company resources.

•    Healthcare providers will abandon states without medical malpractice caps for states that do. This myth is based on the faulty premise (see #3) that caps lower insurance rates. According to the American Association for Justice, the overall number of practicing physicians in every state has been steadily increasing.

Examining these falsehoods propagated by tort reform enthusiasts seems to reveal either a lack of understanding in the financial realities of medical malpractice claims, or a determination to increase profits for insurance companies at the expense of vulnerable patients.

The medical malpractice attorneys at Regan, Zambri & Long have been working with clients for many years to obtain fair and equitable compensation for those who have suffered harm. If you or someone you know has suffered from medical malpractice, contact us today to set up a free consultation.

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Could 12 Million People Be Really Misdiagnosed Every Single Year?

A very alarming new study puts DC medical malpractice cases -- and indeed, the entire issue of malpractice -- in a disturbing new light.

Researchers at Houston Veterans Affairs Medical Center, publishing in BMJ’s Quality and Safety Journal, suggest that one out of 20 Americans every year gets misdiagnosed by a physician. That means that doctors misdiagnose 12 million Americans every year.

Fortunately, most of these misdiagnoses likely do not result in serious injury or death. But that is still a staggering number, and if it’s even remotely accurate, it should set off alarm bells throughout the medical care system and instigate process improvements ASAP.

The researchers concluded that up to 50 percent of the errors in diagnoses could lead to major harm (not that they necessarily DO, fortunately). They wrote that their analysis “should provide a foundation for policyholders, healthcare organization, and researchers to strengthen efforts to measure and reduce diagnostic efforts.”

Traditionally, it has been challenging to identify misdiagnosis statistics outside of hospital and clinical settings. In this study, researchers examined hundreds of patient medical records as well as records of clinical doctor visits, and they then made estimates based on these data and extrapolated their conclusions to the population at large.

Obviously, this study has its limitations. For instance, perhaps the sample that they analyzed was just unlucky; and they endured many more misdiagnoses than typically happen to the patient population. Or perhaps the methodology was somehow flawed or the statistics used to measure and compare patient groups were not accurate or appropriate.

Most Costly Errors?

The researchers noted that “delayed cancer diagnoses is believed to be one of the most harmful and costly types of diagnostic care in the outpatient setting,” especially since early treatment can save lives for patients who develop some cancers and progressive, chronic diseases.

Whether the study accurately gauged the “true” number of misdiagnoses or not, many patients (and families of patients) don’t understand their rights or possible means of recourse after a misdiagnosis-related injury or illness.

The team here at Regan, Zambri & Long can help you understand your legal options. Our Washington D.C. medical malpractice attorneys are standing by to provide a free and confidential case evaluation at (202) 463-3030. Call or email us now for sound insight.

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The Data Are in: National Practitioner Data Bank (NPDB) Publishes Info on Medical Malpractice Payouts

Every year, the National Practitioner Data Bank (NPDB) creates a compilation of data about medical malpractice payouts in the United States. These data can be helpful, because they can help identify trends in medmal, state-to-state, and effectively “take the temperature” of how the country feels about the industry and about tort reform. Surprisingly, the report found that 93% of all payouts in 2013 came from settlements -- only 4% of the money came from verdicts. The survey also illustrated that trial can be quite a risky proposition, from a plaintiff's point of view. Doctors win substantially more cases than they lose in court. Perhaps doctors who feel confident in their positions don't mind going to trial to defend them, while doctors who feel less sure choose to settle.

The NPDB data only focus on medical malpractice cases against practitioners, not hospitals. Some analysts have expressed quibbles with aspects of the NPDB methodology, but these issues are too fine grained and technical to cover here. The data can certainly enlighten us about the key trends, however.

State by State Medical Malpractice Payouts for 2013

In terms of per capita payouts, New York State led the charge -- nearly $40 of per capita. Washington D.C.'s per capita was higher that average at $19.31 per capita. Maryland, meanwhile, had a basically identical rate of $19.27. Virginia fared slightly better at $10.26. North Dakota was on the low end -- just $2.96 per capita was paid out.

For the first in time in over a decade, the total number of payouts went up, as did the amount of payouts. Analysts suggest that this trend may reflect a national push back against the “tort reform” movement. The data do show significant variation from state to state, indicating a volatile industry in transition.

Three years ago, 308 medical malpractice practice cases were settled or decided in court in Maryland for total of $91 million. Meanwhile, in Virginia, 199 cases either settled or got decided in court for $77 million. Even though Virginia settled few cases, the total average payout amount was much higher in VA.

The distribution of medmal payouts roughly follows the Pareto Principle (also known as the “80-20 Rule”), in that just a handful of cases led to the majority of payouts.

Author Michael Krauss analyzed the NPDB data on the Forbes blog and asked penetrating questions about what these numbers might mean: “How much underreporting to the NPDB… goes on? Why is New York so seemingly different from every other state? Do statutes inadvertently skew results?”

When analyzing any data – even carefully controlled surveys that have been vetted and professionally assessed – you need to be careful to avoid jumping to conclusions.

The reality is that survey data like these need to be understood in context and supported by other studies and evidences. If you need a medical malpractice lawyer in Virginia, D.C. or Maryland, please contact Regan, Zambri & Long today for a free consultation at (202) 463-3030.


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California Advocates Push to Raise Golden State Medical Malpractice Cap -- Would Be First Increase Since 1975

Under California law, damages in medical malpractice cases are capped at just $250,000.

If that figure sounds anachronistic… well, that's because it is: literally!

The $250,000 cap has been in place for nearly four decades – it became law way back in 1975, when then-Governor Jerry Brown signed the Medical Injury Compensation Reform Act (MICRA). Forty years later, that same cap remains in place. (Curiously, Governor Brown is, once again, Governor of the Golden State).

But that old cap may not last much longer.

Passionate California consumer advocates and attorneys have demanded reform to make the system more fair and modern. Thousands of signatories hope to qualify the "Troy and Alana Pack Patient Safety Act" to go on California’s November ballot later this year. The Act takes its name from a tragic accident: in 2003, two children (Troy and Alana Park) died in a horrific car crash, after their mother felt asleep because her doctors overprescribed her pain killers.

Bob Pack, the father of the two children, wrote the bill. He said the Act would accomplish several things:

•    It would force doctors to undergo random drug testing;
•    It would curb drug abuse related to “doctor shopping” by leveraging the state’s current prescription drug data base;
•    It would increase the cap for pain and suffering in medmal cases, which is still stuck at the 1975 level of $250,000.

Pack told reporters that: “inside these boxes [the ballots for the vote] are the voices of many victims and many Californians who want to see this change." Unsurprisingly, hospitals, doctors, and community clinics have resisted moving the cap. They fear that doing so might spark a wave of lawsuits and increase patient costs. The California Medical Association’s President, Dr. Richard Thorp, did not mince words: “this initiative is bad for patients, bad for taxpayers, and bad for California’s entire system of healthcare delivery.”

Sacramento Democrat, Darrell Steinberg, hopes to ward off a ballot initiative by seeking a legislative solution to get the MICRA cap bumped up to $500,000. This rate, as he noted, would "still be far below the rate of inflation, since MICRA became law 39 years ago."

Steinberg hopes to avoid a political bloodbath: “initiative battles [are] costly and uncertain and will damage the reputation of two fine professions… The issue cries out for a legislative solution, and what I'm offering is a conservative increase that's fair to injured patients as well as the medical and legal communities.”

Steinberg maintains that his compromise number ($500,000) is reasonable and that it would fairly compensate injured patients without significantly increasing medical costs.

But a group called Consumer Watchdog is not so sure. That group's director, Jamie Court, said “legislators have had years to make this change… if there is no popular legislation for patient safety, then the people will make the change.”

The situation in California illustrates the complexity of the medmal cap debate and its divisive tenor. Fortunately, if you or someone you love got hurt due to a doctor or hospital’s negligence or carelessness, you don’t have to fight your legal battle on your own. Call a D.C. medical malpractice attorney here at Regan Zambri & Long today at (202) 463-3030 for a free consultation.

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Over 200 Patients Die Daily From Hospital-Associated Infections, Report Shows

Posted by: Salvatore J. Zambri, founding member and partner

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Results from the recently-published Centers for Disease Control and Prevention (CDC) 2011 hospital survey indicate that, despite progress in recent years, the deadly health-care problem of infection continues. According to survey results reported in The New England Journal of Medicine, an estimated 648,000 patients suffered from 721,000 healthcare-associated infections and 75,000 died from them. In his press release, CDC Director Tom Frieden said, "Today and every day, more than 200 Americans with healthcare-associated infections will die during their hospital stay."  The most common infections include:

  • pneumonia  -22%
  • surgical site infections - 22%
  • gastrointestinal infections - 17%
  • urinary tract infections - 13%
  • blood stream infections - 10%

Many antibiotic-resistant bacteria are prevalent in hospitals, including Clostridium difficile (C. diff) and methicillin-resistant staphyloccus aureus (MRSA). As a result, new approaches to controlling bacteria in hospitals have become necessary. Overuse of antibiotics is now discouraged with the hope that some will become more effective again. The proposed federal budget for 2015 includes additional funding for battling antibiotic resistance.

In his statement about the survey results, Mr. Frieden said, "We go to the hospital hoping to become better, and mostly we do, but not always." I hope that hospitals take more aggressive measures to protect their patients from hospital-borne infections. Lives depend on it.

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