The New Jersey Supreme Court recently ruled that a hospital involved in a medical malpractice case did not have to turn over the results of its internal investigation concerning an infant’s brain injury during delivery.
The court’s Sept. 29 decision could potentially impact other medical malpractice cases across the country, including in Indiana.
The baby’s parents demanded access to internal documents spelling out mistakes that were made that led to the baby suffering seizure disorder in May 2007. However, the court upheld the confidentiality claim of Valley Hospital in Ridgewood, N.J.
A trial court judge had previously ruled in favor of the hospital, according to an NJ.com article published Sept. 30, on the basis that the internal memos were protected under a 2004 law known as the Patient Safety Act. The law allows hospital personnel to freely discuss mistakes without fear of recrimination in an effort to prevent errors from recurring.
The parents’ medical malpractice attorneys appealed the trial court judge’s decision. They argued on appeal that the hospital was not protected under the Act because it had not performed its internal investigation in accordance with rules the state health department enacted in 2008.
Valley Hospital argued that it could not be in violation of a rule that wasn’t in effect at the time the 2007 investigation took place. That argument ultimately proved successful.
Supporters of the Act told the website they believed the New Jersey Supreme Court made the right decision. They said the law was never intended to protect doctors and hospitals from liability. Patients and family members are still able to subpoena other types of records, and can also attempt to compel doctors and other professionals who participate in confidential investigations to testify in medical malpractice cases.
Medical Malpractice in Indiana
The Indiana Medical Malpractice Act specifies that a panel of healthcare professionals must review any sort of malpractice claim before it can be filed in court. The panel issues an opinion on whether enough evidence exists to show that either the medical facility or its staff members did not provide the correct standard of care. Once the report is filed, it can be admitted in court but it is not binding.
Indiana’s Hospital Medical Error Reporting Rule states that hospitals are required to implement a process that details the occurrence of several types of “reportable events.” These include surgery performed on the wrong body part or the wrong patient, death or disability due to contaminated drugs or devices, and many others. These reports, according to the rule, “shall be used by the department for purposes of public reporting the type and number of reportable events occurring within each hospital.”
The Indiana Code states that medical staff committee members conducting retrospective reviews are immune from civil liability in regard to their deliberations. (Section 16-21-2-8.) However, confidential records and proceedings “may be produced on court order in a cause in which the records and proceedings are relevant or material.”
It remains to be seen what effect, if any, the New Jersey ruling will have on medical malpractice cases in Indiana and throughout the country.
Additive manufacturing, or 3D printing, as it is more commonly known, is being used to produce everything from food to guns to jewelry and clothing. If that isn’t incredible enough, the medical community has been using 3D technology to manufacture human body parts, including skulls, spinal inserts, and other bones, as well as facial prostheses and breast implants for cancer patients. Human organs are even on the horizon, and that could mean the end of organ donor waiting lists. Welcome to the future of medicine.
The obvious advantage to using 3D technology to print human bone replacements is that the procedure itself allows for the bone’s internal structure to be mimicked in a way that makes the replacement part as resilient and light as the original. The bone can can also be printed to perfectly match the break. Additionally, since 3D body parts that are made from titanium or the patient’s own cell tissue will not cause adverse allergic reactions, they will not be rejected by the body. This technology is being used in hospitals and research centers around the world, from Italy to the Netherlands, and the Walter Reed National Military Medical Center in Bethesda, Maryland even has its own 3-D Medical Applications Center devoted to everything from orthopedics to dentistry and craniofacial reconstruction.
As recently as 2012, spinal implants were in the clinical trial stage at Peking University in Beijing where surgeons implanted 3D-printed titanium spinal implants into 50 patients. One year later, team leader, Dr. Liu Zhongjun, reported that all of their trial patients had recovered well with no “undesirable side effects or adverse reactions”, according to an article posted at www.engineering.com. Fast forward to August 2014 and Dr. Zhongjun and his team have successfully implanted the first 3D-printed spine vertebrae into a 12-yr old boy suffering from Ewing’s sarcoma, a type of rare bone cancer. Medical advancements have sure come a long way, but researchers aren’t finished yet.
In April 2013, Organovo, a company that designs “functional human tissue”, produced 3D human liver tissue that retained its function for more than five days. Just six months later, in October 2013, Organovo issued a press release indicating that they were able to extend that timeframe to 40 days. In a period of only six months, Organovo increased the functional longevity of their 3D-printed liver tissue by an astonishing 800%.
Researchers from Harvard University and Sydney, Australia have collaborated on a medical breakthrough that just may lead the way toward the printing of fully functional 3D organs. They have developed nutrient and oxygen-delivering capillaries using the 3D printing process. These tiny vessels allow 3D organs to excrete waste, which, along with the nutrients and oxygen, will allow the organ cells to grow and thrive. Researchers believe that full-sized, fully functioning human organs may be years away from being a reality, however, given the accelerated pace of the research done by Organovo, Harvard and Sydney, among others, the timetable may be overly cautious.
Organ donor lists may one day be a thing of the past, which is lifesaving news for the more than 100,000 people who are on the list at any given time in the United States alone. What researchers have been able to accomplish already, though, is astonishing. 3D printed body parts is a futuristic concept that may leave some people feeling a bit uneasy. However, for those whose health and lives have and will be positively impacted, the future of medicine couldn’t have come soon enough.
When an airplane crashes, the rush is on to find the black box. This is a recording device that can help investigators piece together what happened to cause the accident. A similar device recently was developed for use in the operating room. The researchers behind the device hope it prevents medical malpractice and improves patient outcomes much in the same way it aids in airline safety and accident investigations.
Reducing the rate of surgical errors is an important cause. A 2012 study from Johns Hopkins University found that such mistakes, known as “never events”, happen at least 4,000 times each year. These mistakes include wrong site surgeries, performing the wrong procedure and leaving foreign objects behind in a patient. By helping medical professionals to understand why these seemingly simple mistakes happen, a black box could help surgeons reduce their occurrence.
Black Box Prototype Tested at Three Hospitals
HealthCanal.com reports that Dr. Teodor Grancharov, who specializes in minimally invasive surgical procedures, developed the box where he works at St. Michael’s Hospital in Toronto. Up to this point, the device has been tested at the facility and two additional hospitals in Denmark.
It is about the size of a cable box. The device records everything that goes on in the operating room much like a black box on an airplane records everything that goes on in the cockpit.
The device captures any video from scopes inserted into the body. It also captures the room temperature, patient vitals, decibel levels and conversations among different healthcare workers in the operating room.
For now, the device works only for minimally invasive procedures such as those using small laparoscopic incisions. However, the hope is that its use will be expanded to a wider range of surgical procedures.
The goal is to have a documented account of everything that takes place during a surgery. Understanding where errors happen can help doctors and hospitals prevent additional mistakes and develop training and education.
Dr. Grantcharov says that developers of the black box are looking for performance issues. For example, did a surgeon apply an incorrect technique during an operation? They are also looking at “less tangible” factors that can contribute to surgical errors such as miscommunication between members of the operating team.
In addition to providing surgeons and hospital officials with information on how to improve patient safety, such devices could give medical malpractice victims important evidence of negligence if a mistake results in serious personal harm.
Your Role in Preventing Surgical Errors
While the development of a black box for surgical procedures is a promising advance in patient safety, it may be a long time before such a device is widely used and its benefits are realized in terms of preventing surgical errors.
For now, if you are undergoing surgery, you can take steps to help protect yourself. The Joint Commission (pdf), an organization that accredits healthcare agencies and promotes patient safety, offers the following tips for patients:
- Ask your doctor detailed questions about the surgery before it occurs.
- Ask for detailed pre-op instructions regarding meals, water, medications, make-up, nail trimming and other preparations you should make before the day of surgery.
- Write down any questions you may have as you prepare for surgery.
- Bring someone you trust with you on your operation day and tell them your concerns as they will be your advocate if you are unable to speak or communicate.
- Make sure all information on consent forms is correct before signing them. Ask questions if you have any before you sign the forms.
- Make sure markings put on your body for the surgery are in the right place.
- Ask your surgeon if the team will take a “time out” before your operation.
The outcome of a surgery may not be your responsibility but rather that of the surgeon and team attending to you. Still, speak up if you have questions and hold your healthcare providers accountable for any errors or problems you may experience.
Submitted by Powers & Santola, LLP
The Dangers of Food Poisoning
Food poisoning is very common and happens to people not only here in the US but throughout the entire world. Depending on the type of food poisoning one gets, people even die from it.
There are more than 250 diseases that can cause this type of poisoning but the most common cause is simple bacteria. Here is a look at some of the most common ones.
This bacteria causes one to have acute and sometimes bloody diarrhea, abdominal cramping or pain, nausea, vomiting, fever and malaise. People get this bacteria from contaminated food, milk that is not pasteurized and from pets or other animals. More serious conditions such as nerve and brain problems as well as arthritis have occurred after the initial symptoms. This is rare though.
Salmonella is another bacterial infection but we here about this one more often. It generally comes from eating raw or undercooked poultry products or unpasteurized milk but sometimes it can also come from the people preparing the food. Any time food is prepared on the same surfaces that uncooked poultry has been prepared on without the surface having been sterilized first may become tainted with Salmonella.
Some of the symptoms of this type of food poisoning are fever, diarrhea, abdominal pain, nausea and sometimes vomiting although there are cases where people become carriers but not sick. Salmonella poisoning can also result in a condition called Reiter’s Syndrome which can have symptoms such as pain in the joints, irritation to the eyes and painful urination.
Shigella is one of the more nasty bacteria as it comes from feces. This is why washing your hands after using the restroom is so very important. Symptoms of this type of food poisoning include fever, bloody diarrhea, vomiting, nausea and cramps.
E. coli O157:H7
This is another one that we frequently hear about. According to WebMD each year there are roughly 73,000 cases of this type of food poisoning each year in the US. Causes for this bacteria are things like beef that is not fully cooked or milk that has not been pasteurized. If someone swims in or drinks water that has been contaminated by sewage they can get this type of poisoning.
E. coli poisoning can present as abdominal cramps and bloody diarrhea but also non-bloody diarrhea is present. Infected people may have a fever too. Alternately, there may be not any symptoms at all.
Very rarely this type of food poisoning leads to a condition called Hemolytic Uremic Syndrome which is a medical emergency. This condition causes the red blood cells to be killed as well as kidney failure. It can cause death if not treated promptly.
Food poisoning is something that can and probably will affect most of us at least once whether we exhibit symptoms or not. Most of the time, the effects will go away on their own within 3 – 5 days. If it is a serious case, then there may be lasting effects and even death. If you think you have gotten food poisoning, see a doctor now.
A medical malpractice case can be based on the failure of the healthcare worker to warn a patient of known risks of a procedure or a course of treatment. The law imposes upon physicians and other healthcare workers a duty to secure informed consent from a patient before going forward with a procedure or course of treatment. An Indiana medical malpractice attorney explains that if after being informed of the risks the patient would not have chosen to have the treatment or procedure, then the doctor would have committed medical malpractice if the patient is injured by the procedure in the manner that the doctor should have warned could happen. However, if the patient consents to the treatment or procedure after being warned of the risks, the doctor still may be liable for medical malpractice should the patient suffer injury during the treatment or procedure. A recent medical malpractice case demonstrates that a doctor cannot hide behind informed consent if he was negligent.
Because most medical procedures and treatments involve some risk a doctor or other healthcare worker has a responsibility to let the patient know about such risk. This allows the patient to make a decision as to whether or not to undergo that procedure or course of treatment. Such consent it typically given by the patient in writing. However, in emergent cases where physicians must act immediately to save the patient’s life, the law allows them to do so without first obtaining informed consent.
The Case of Vickie Tatlock
In 2004 Vickie Tatlock was admitted to Bloomington Hospital with a serious heart condition. Tatlock’s condition required a procedure called an angioplasty. There was no issue concerning informed consent, and Dr. James Faris performed the procedure. A known risk of angioplasty is that a coronary artery may be perforated. That is what happened to Tatlock. A perforation of a coronary artery increases the risk for cardiac tamponade, which is a dangerous condition that develops when too much fluid builds up in the sac in which the heart is enclosed, causing pressure on the heart. Thus, when an artery is perforated, the patient must be watched closely.
Negligence Despite Informed Consent
Dr. Faris failed to watch Tatlock closely and instead tended to another patient. Furthermore, Dr. Faris did not request that another physician check in on Tatlock. Tatlock did suffer a cardiac tamponade, her condition steadily deteriorated, and she eventually died. Tatlock was just 49 years old. Tatlock’s husband and son sued Dr. Faris. The case finally came to verdict in October 2013 with the jury awarding the plaintiffs over $5 million in damages. In this case Tatlock consented to the angioplasty knowing that a perforated artery was a risk. However, when Tatlock did suffer the perforated artery, Dr. Faris and the hospital staff had a duty to follow accepted medical practice to treat the condition. Since Dr. Faris failed to do so he was liable for medical malpractice. The type of malpractice that Faris committed was not that he failed to warn Tatlock, but that in treating Tatlock Faris failed to meet the appropriate standard of care.
While informed consent is indeed necessary to ensure that the patient understands the risks associated with a treatment or procedure and to protect the physician from legal liability, in reality is such consent given freely in cases where the alternative is the worsening of a condition or even death?
Ellen was on an annual weekend getaway, downhill skiing with friends, when she tore her ACL. She heard a loud “pop” and knew immediately what had happened. Her husband rushed her home, 2 hours away, and took her to the emergency room. Although her injury was severe, she was sent home with pain pills and was told to stay off of her feet. Ellen met with her doctor later in the week and they agreed that undergoing surgery would be the best option for the condition of her injury and her desire to become active again. Ellen expressed her concern about going under general anesthesia and any anesthesia errors that might occur during the surgery. Her doctor assured her that such errors are rare and she would feel better once her surgery was over. During her surgery, Ellen suffered a small heart attack that added time to her recovery and hospital stay. Ellen and her husband were baffled that she had a heart attack while under anesthesia. She was healthy and had no pre-existing health conditions or history of heart problems. Her doctor explained that the heart attack most likely occurred when Ellen’s oxygenation became dangerously low and the acting anesthesiologist failed to work quickly enough to fix the problem before it occurred. After Ellen is released from the hospital, she and her husband are meeting with a friend, who practices law, to see if they are able to file a medical malpractice claim and receive compensation for her physical, mental, and emotional pain.
Anesthesia Errors: Know Your Risk
When many patients meet with their doctor or anesthesiologist to discuss their concerns about an upcoming surgery, anesthesia awareness might be a big topic of conversation. Anesthesia awareness occurs when the patient regains wakes up briefly (or in some cases for a longer period of time) and sees, feels, or hears parts of the surgery. In extreme cases, some patients are wide awake during the whole length of the surgery and can feel the procedure, but due to the paralyzing effects of the anesthesia, they are unable to move or communicate to the medical staff that they are awake. Fortunately, anesthesia awareness is rare, but there are other complications related to anesthesia that are more likely to occur during a surgery. Before your surgery, it’s vital to discuss your medical history and any pre-existing conditions that may put you at greater risk for an anesthesia error. While it’s a surgeon and anesthesiologist’s responsibility to keep you safe and alive during surgery, you are responsible for sharing any known health conditions or history before your surgery. Serious anesthesia complications include:
- Mental confusion and memory issues
- Lung Infections
- Heart Attack
You are more likely to have such complications if you are overweight, have a history of alcohol or drug use, are diabetic, have high blood pressure, or have other serious or pre-existing health conditions. Additionally, it is important to pay attention to your health during your recovery because in some post-op cases, patients have been known to react to a general anesthesia days or weeks after the surgery.
In Their Hands, We Trust
Going under the knife can be scary and it’s often difficult to put control into other people’s hands. Before you finalize a decision to have a surgical procedure, you have the right to ask for a second opinion. You also have the right to find a surgeon whom you trust and while it may be difficult, you should be able to do some research on their background (i.e. medical malpractice). Surgery is meant to improve the quality of your life. Would you rather go under the knife, internalizing all of the “what if’s” or would you rather have a frank and informative discussion with your doctor about any errors that may occur?
Unfortunately nursing home neglect and injuries are more common than we think. Read below for some of the worst stories we have heard.
The first memory I have is of my mother’s mother – my Gigi. I didn’t realize until I was in my 20′s that Gigi was actually “G.G.” for “great-grandmother.” She was just my Gigi. The memory is of sitting on her lap in her living room. It was dark, as always, since she didn’t want to waste electricity by having the room too bright.
I could feel the bones of her legs under mine through my green corduroy pants and her faded wool skirt. She smelled of moth balls and chicken soup. Knowing Gigi, she had probably dabbed a bit of both behind her ears. She was reading a book to me; a book she was holding with her thin, almost translucent hands.
Help is Needed
Those hands were so delicate and yet so strong. With them she had raised 8 kids, battled the Great Depression, grieved with the country with the Kennedy’s were assassinated and listened to Dr. King’s “I Have a Dream” speech. Those hands, covered with dark spots the size of quarters, whose edges almost overlapped until there was more dark than light in places. Those hands, with rivers of dark blue running in relief, like a 3D map of her life. Those hands that could no longer stay still. Those hands that had soothed and punished her three boys and five girls. Those hands that could no longer take care of her. Gigi started calling me by my mom’s name, by my aunt’s name … sometimes even by her dead sister’s name. Then Gigi couldn’t drive anymore. Then Gigi couldn’t remember where she lived or if she’d taken her medicine or what year it was. Gigi came to live with us for a while, but she left the gas burner on once and started a kitchen fire. Then she went for a walk in the middle of the night and the police from two towns over brought her back.
Shortly after that, Gigi moved into a nursing home. When I was old enough to drive, I would go to see Gigi after school. She was almost always asleep when I arrived, but would perk up as if she had been napping to get extra strength to visit with me. One time, I walked in to find her room smelling of urine. I asked if she was OK and she confessed that she’d had an “accident” and pointed to the panties draped over a lamp. I ignored the accident bit – I’m sure she was embarrassed enough – but just had to tell her that it wasn’t a good idea to hang anything flammable from a heat source.
While I never saw anything as bad as the nursing home horror stories on the news, I know something about nursing home neglect. My poor Gigi, who was such a strong and confident woman, became a shell. The lost nearly 40 pounds that she didn’t have to spare. She always said she wasn’t hungry, but managed to eat if I fed her. I asked the staff several times if they couldn’t please make it a point to have someone help her eat at least once a day. I was always told that they did the best they could and Gigi was eating as she should. I know that wasn’t true. In the end, Gigi had less than 90 pounds on her 5’8” frame. She died of “natural causes” but I knew that wasn’t true. She died for lack of attention, nutrition and entertainment. She died of boredom and starvation. She died of embarrassment because she was too strong to ask for help eating.
Not the Worst Nursing Home Horror Stories … But Not Good Enough
I’m glad that Gigi didn’t die of exposure like the poor man in Oak Lawn, IL. Nor did she ever have sores untended so long that they developed maggots. What she also didn’t have was someone that took care of her on a consistent basis, someone that was held accountable for Gigi’s status. I did the best I could to take care of Gigi while my mom worked 3 jobs to take care of me. I wish I had been able to do more for Gigi. I know that if it ever comes to the point when my mom needs more help than I can give, I’ll hire home health nurses or do whatever I have to do to make sure I don’t lose Mom like I lost Gigi to nursing home neglect.
There are a few good reasons to maintain an organized medicine cabinet, not the least of which is to simplify our lives and make it easier to find the things we need. Another important reason to keep our medicine cabinets in order is to make sure we’re not holding on to any expired medications.Medication errors, ranging from incorrect prescriptions to taking expired pills, injure in excess of 1.5 million people annually. Here are five things you can do to de-clutter your medicine cabinet and ensure that doesn’t happen to you.
First Things First
Start from scratch and clear out the entire medicine cabinet. Throw away anything that is damaged, useless, and most importantly, expired. This article from the Food and Drug Administration talks about the dangers of taking expired prescription drugs.
Next, clean the shelves with disinfectant wipes or a sponge and disinfectant spray. If you are able to remove the shelves, take them out, wash them in soap and water, and thoroughly dry before replacing.
If your medicine cabinet shelves are adjustable, move them up to create more room for the tallest items, such as cologne, hair gels, and toothbrushes and toothpaste. Putting your toothbrush behind a closed door is more sanitary than leaving it out on the counter.
Another great way to maximize space is to invest a few dollars in mini risers. They add an extra shelf to the medicine cabinet, which allows you to neatly store more items.
Location, Location, Location
As you return the items to the medicine cabinet, pay attention to where they go. Anything you don’t use often should be placed on the top shelf, or even in another cabinet. For example, how often do you really use hydrogen peroxide? Save the lower shelve(s) for everyday items.
Think Small and Consolidate
Anything you buy in bulk, such as cotton balls, should be moved to smaller containers with the big bags being stored separately. Place the items in uniform clear jars for ease of identification, place them in the medicine cabinet, and refill as needed. This prevents everything from tumbling out of the medicine cabinet every time you open the door. If it’s feasible, do the same thing with liquids, like hair gel.
When it comes to items that are already small, consider consolidating them into a single clear jar. For example, group together your lip balm, eyeliner, mascara, and lipstick. That way, nothing will roll out of the medicine cabinet, but you can still easily retrieve the items.
To make it easier to find everything once it’s all been organized, group things together by category. All of your makeup should have its own area, as should all of your first aid supplies, medicines, hygiene products, and so on. That way, when you open the medicine cabinet looking for something, you don’t have to move everything around (disorganizing it again!) just to find it.
Keeping an organized medicine cabinet can save you time and help you avoid frustration. It can also serve as a reminder to keep track of the dates on your medications, so you can throw them out once they’re expired. If you need to get rid of old medication, but don’t know how to safely dispose of it, read this article from the FDA, because while it is important to dispose of expired medication, it’s also important to do it properly.