In this issue:
- Perspective: The IME: Does time heal all wounds?
- FDA issues warning on long-acting asthma meds
- Texas nurse cleared of charges after reporting physician for unsafe practices.
- “Medical Mafia” case in Las Vegas coming to a close
- What are the chances? Explaining risk to patients
- Good Samaritan defense depends on the circumstances
- Emotional injury triggers lawsuits more often than negligence. Business model of patient safety challenged.
- Are the monitors being monitored? Patient dies when monitor turned off.
- Does HIPAA prohibit defendant physician’s access to another physician’s information? Michigan case moving forward.
- “You get what you ask for” says Connecticut Supreme Court.
- If at first you don’t succeed… SB 6508, 2010 edition, remains alive
Perspective: The IME: Does time heal all wounds?
By Charles A. Pilcher MD FACEP
How does one measure pain? How does one objectively evaluate limited functionality? Who says that time is required to heal all wounds? Does the absence of objective findings negate the patient’s complaints? And what is the value of the “Independent” Medical Exam, or IME?
One recourse for plaintiff attorneys (or defense attorneys who suspect that an IME will go against their client) is to have a knowledgeable medical advocate attend the IME with the patient/client. That person can then report the nature of the exam and assure that the examiner’s report is consistent with the exam conducted. There are several Certified Legal Nurse Consultants in this area who provide this service, or a physician expert can be retained to assist with a specific injury. MORE ->
FDA issues warning on long-acting asthma meds
The FDA has called for new limits on long-acting beta agonists (LABA’s) used as inhaled bronchodilators by asthmatics. The agency advised that patients should first use a corticosteroid inhaler for prevention of attacks, short acting beta-agonists for attacks, and LABA’s only if attacks cannot otherwise be controlled, and then for only the shortest time possible. The ruling is a response to a higher complication rate for those on LABA’s, with or without a corticosteroid. The drugs involved are Foradil (formoterol), Serevent (salmeterol), Advair (fluticasone and salmeterol) and Symbicort (budesonide and formoterol).
Texas nurse cleared of charges after reporting physician for unsafe practices.
It took a West Texas jury less than an hour to acquit a nurse for reporting unsafe practices on the part of a physician. She had been charged with “felony misuse of official information.” Prosecutors argued that “personal — not professional — reasons motivated the nurse to file the complaint. The jury found no proof that she had done anything illegal, according to a NY Times article.
“Medical Mafia” case in Las Vegas coming to a close
The case of malpractice conspirators Kabins, Gage, Awand, et al. made progress in Las Vegas courts in February when Dr. Kabins pled guilty to misprision of a felony, admitting he knew about federal crimes being committed by others but did not report them. Originally, he had arranged for a local “fixer,” Awand, to get attorney Gage to name someone other than Kabins in a malpractice suit. In return, Awand would funnel more lucrative malpractice cases to Gage. Federal investigations found the conspiracy to be much broader. Awand was convicted in Federal Court of tax evasion this month. A further trial for both Awand and Gage on the conspiracy charges is pending. Kabins will reportedly testify against the two.
What are the chances? Explaining risk to patients
Medical Economics published a nice article in a February edition that teaches physicians some great ways of explaining risk to patients. This would be excellent reading for all physicians, and can help attorneys understand the processes involved in educating patients. The concept of “relative” and “absolute” risk are well described. [Editor’s Note: I highly recommend Against the Gods: The Remarkable Story of Risk, by Peter Bernstein, one of the 3 most influential books I’ve ever read. It is a fantastic treatise on the subject of risk.]
Good Samaritan defense depends on the circumstances
Emergency Physicians Monthly just published a nice article on the “Good Samaritan” concept. It contains many excellent illustrative examples.
A recent article in Archives of Internal Medicine challenges traditional thinking that negligence generates malpractice lawsuits. The authors make the case that, while injured patients are 20 times more likely to sue, many of those suits could be prevented by better handling of the emotional issues involved in the error and the patient’s subsequent care. The article does not excuse errors or deny negligence, but only points out what generates the bulk of the lawsuits, and suggests that, from a strictly business perspective, equal effort should be directed at managing bad outcomes as preventing them. [Editor’s note: I agree it’s hard to read this article (summary linked) from a “strictly business perspective.”]
Are the monitors being monitored? Patient dies when monitor turned off.
When a patient died recently at Mass General Hospital, the heart monitor alarm was found to have been turned off. Patient-safety experts say that “numerous deaths have been reported, because alarms malfunctioned or were turned off, ignored, or unheard.” Meanwhile, “JCAHO…said it also has seen a surge in alarm-related incidents.”
A physician being sued in Michigan has been denied access to the records of another treating physician under the HIPAA law. At issue is whether the defendant can seek a court order allowing his attorney to interview the other doctor.The matter, previously reported in this newsletter, is now before the Michigan Supreme Court. Click here for the Court of Appeals Decision.
“You get what you ask for” says Connecticut Supreme Court.
When a plaintiff sued for just over $1 million dollars and was awarded nearly $1.6 million by the jury, the Connecticut Supreme Court overturned the award, telling the plaintiff they could either pay back the difference or start over. The court ruled that the larger amount was not supported by the evidence presented by the plaintiff’s experts. [Editor’s Note: Didn’t the the Rolling Stones have a song called “You can’t always get what you want.” Well, I guess you can, but no more than that.]
If at first you don’t succeed… SB 6508, 2010 edition, remains alive
A bill to expand the wrongful death statutes in Washington State has been introduced regularly but has yet to be passed. This year’s version, SB 6508, remains active as of this writing. Those defending wrongful death claims are opposed to the bill.
