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Articles Posted in Medical Malpractice

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In a very sad medical malpractice case a 16 year old girl died of brain cancer after none of the 13 doctors who failed to diagnose the brain tumor ordered an MRI. Natasha Simmons had all the symptoms of a brain tumor: headaches, numbness, back pain, vomiting and problems with her eyesight. She visited 13 doctors over a one year period but none of them ordered an MRI. An ER doctor refused a scan and said they were reserved for life and death situations. 11 months later, an MRI was finally done but it was too late. Natasha Simmons was diagnosed with a cancerous brain tumor and died 8 days later.

Read more in the Huffington Post

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Until recently when a patient with prostate cancer was developing resistance to drugs that block testosterone, the hormone that fuels the cancer growth, his urologist would refer him to an oncologist who would start chemotherapy. The situation recently changed with the arrival on the market of new drugs such as sipuleucel-T, radium 223, enzalutamide, abiraterone, and cabazitaxel. These new drugs target so-called “castrate-resistant” patients and can be prescribed by either the urologist or the oncologist.

As of Today there is a lot of confusion about these new drugs. Urologists and oncologists are not clear on whether patients should be treated similarly or which drug should be used and in what order to be the most effective. The lack of communication between specialists as well as the financial incentive in keeping a patient as long as possible may be detrimental to the patient and may lead to medical malpractice.

In an article published Today in the Journal Urologic Oncology, urologist Ralph de Vere White and medical oncologist Primo Lara, Jr. of the UC Davis Comprehensive Cancer Center provide an in depth look at the situation and demonstrate that better guidelines and coordination between specialists are necessary to deliver cost effective and efficient care to patients with castrate-resistant prostate cancer (CRPC).

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Doctors often fail to diagnose cancer in women with dense breast tissue because mammograms screenings are not reliable for women with this condition. Recent statistics and studies also show that women with dense breast tissue have a higher risk of developing breast cancer. Therefore advocacy groups have been pushing for legislation that requires doctors to report breast density to their patient. In New York, failure to inform a patient about dense breast tissue is now against the law and may support a claim of medical malpractice. The legislation was signed by Governor Cuomo on July 23 2012 and took effect last January. A total of 18 states have enacted dense breast notification laws, and 10 more have laws pending. Who is supposed to do the reporting and what they are supposed to tell patients varies from state to state.

In “Dense Breast Legislation in the United States: State of the States” published in the December issue of the Journal of the American College of Radiology, Soudabeh Fazeli Dehkordy, MD, MPH, and Ruth C. Carlos, MD, MS, from the Department of Radiology at the University of Michigan School of Medicine in Ann Arbor provide a detailed review of the state of this law at states and federal level.

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Medication%20error.jpgEvery drug with two names, brand name and generic name, is a medication error waiting to happen, writes Theresa Brown in her latest Opinion in The New York Times blog.
A system that would keep only the brand name with a “-G” appended at the end of the name for generic would make more sense and reduce confusion.

Read the complete opinion

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telemedicine%20conultation.jpgThe risk of physician-related ED medication errors among seriously ill and injured children in rural EDs can be significantly reduced with telemedicine consultations according to a study published in the current issue of Pediatrics, the Official Journal of the American Academy of Pediatrics.

The study looked at 234 seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children’s hospital. 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors (3.4%) than medications for patients who received telephone consultations (10.8%) or no consultations (12.5%).

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Electronic%20Medical%20Record%20Malpractice.jpgA doctor can commit medical malpractice if he is not properly trained to use the Electronic Medical Record (EMR) system. In a recent case study Web Morbidity and Mortality looks at the case of an epileptic patient who experienced temporary toxicity because of a medication error linked to improper use of EMR.

After being treated in a hospital for seizures, a patient was discharged with an outpatient plan that was to begin phenytoin 500 mg once daily. The resident doctor who prepared the prescription was not familiar with the Electronic Medical Record and failed to notice that the EMR default frequency for phenytoin was “TID” which means 3 times a day. Because the dose was much bigger than normally prescribed an alert was triggered by the EMR but this alert was overridden by the resident doctor who also seemed to suffer from alert fatigue.

Read the complete case and commentary on WebM&M.

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Diagnostic errors are among the most significant medical malpractice areas in the United States. In the current issue of “Current Problems in Pediatric and Adolescent Health Care” entitled “Diagnostic Errors and Strategies to Minimize Them”, Satid Thammasitboon, William Cutrer, Supat Thammasitboon, Amy Flemming, William Sullivan, and Geeta Singhal provide a detailed overview of one of the most important patient safety problems in medicine Today.

More specifically the authors look at

  • the most recent cognitive theories related to how doctors think
  • how to teach diagnostic acumen
  • Contribution of diagnostic testing to the problem of diagnostic errors
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Clabsi%20Toolkit.jpgCentral Line-Associated Bloodstream Infections (CLABSI) are often the result of medical malpractice. An estimated 250,000 CLABSIs occur every year in the US with 800,000 of them happening in the emergency room. More than 30,000 people die from CLABSI in the US every year. The CDC estimates that the yearly cost related to CLABSI is $1 billion.

To prevent these infections, the Joint Commission Today released a very useful toolkit to supplement a previously published monograph entitled “Preventing Central Line-Associated Bloodstream Infections – A Global Challenge, A Global Perspective” . This document provides best practices and guidelines for healthcare professionals who insert and care for intravascular catheters and who are responsible for the surveillance, prevention, and control of infections in all healthcare settings.

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Medication errors in nursing homes are one of the most common types of medical malpractice. Lack of Physician involvement, lack of adequate staff and training are often the reason why significant medication errors are all too common in nursing homes.
Here is an link to an article and a video about medical errors in Michigan nursing homes but there is little doubt that this problem exists at a national level as well.

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Misdiagnosis is the leading cause of medical malpractice claims. 160,000 patients suffer serious personal injury or wrongful death because of diagnostic errors every year. In her recent article “The Biggest Mistake Doctors MakeLaura Landro from the Wall Street Journal looks at solutions that are being developed by healthcare providers and various organizations to reduce misdiagnosis.

New technologies as well a change of culture among doctors are part of the solution. The new healthcare law requiring multiple providers to coordinate care should also help in making sure patients receive a proper follow up. Additional studies such as the one undertaken by the institute of Medicine (See previous blog) or the Society to Improve Diagnosis in Medicine should also contribute to curb this alarming trend.