In this issue:
Perspective: Should consent to life-saving procedures have a “sunset clause?”
By Charles A. Pilcher MD FACEP
Your 88 year old mother has just been admitted to the ER with a severe stroke. The doctor comes out of the resuscitation room, explains the gravity of the situation, and says that because of brain swelling, an endotracheal tube and artificial ventilation is needed. He asks for your consent to do the procedure. Should your consent have a “sunset clause”? More ->
Neutral radiologists fail to detect x-ray abnormalities found by “experts”
In a recent study of radiologic abnormalities alleged by experts to have been present and missed by board certified radiologists in malpractice suits, 32 neutral radiologists failed to find the abnormality found by the “expert.” Both plaintiff and defense attorneys will want to keep this in mind for future reference.
What specialty is a doctor practicing? Michigan Court of Appeals sides with plaintiff, says Urgent Care doctor was practicing Emergency Medicine
When a patient died of a heart attack 5 days after presenting to an Ann Arbor urgent care center with symptoms that were allegedly incompletely evaluated, the family sued. At trial, jury instructions included a hybrid definition of the physician’s specialty, with emphasis on her Family Practice board certification. The plaintiff’s successful appeal (2 to 1 ruling) was based on the assertion that the doctor was in fact practicing Emergency Medicine at the time, and that the standard of care applicable to emergency physicians should have been presented in the jury instructions. The Court of Appeals ruling is instructive. Reality check: The fact that the defendant’s employer was “Emergency Physicians’ Medical Group” seems to support the plaintiff’s case.
Two rulings from New Jersey support arbitration agreements
In August, the New Jersey Appellate Court ruled that arbitration agreements are enforceable in that state. New Jersey previously excluded certain defendants from mandatory arbitration. In the first case, the court ruled that the 1925 Federal Arbitration Act supersedes state restrictions against arbitration, particularly in nursing home malpractice. The second ruling applied to a patient in labor and said that an arbitration agreement she had signed was indeed valid, but did not apply to her husband, who was free to take his issue to court.
Disclosing errors reduces claims and costs for hospitals
A study in Annals of Internal Medicine reports that there were fewer lawsuits and claims after the University of Michigan began a program to disclose medical errors to patients and families. The program handles such errors “by initiating discussions with patients and families, conducting internal investigations, and offering apologies with offers of compensation should those investigations reveal medical errors.” A summary of the study was published August 19 in the New York Times
Personalize informed consent gives more specific risk estimates
Two US hospitals are exploring the value of “personalized informed consent” for patients undergoing cardiac cath and potential angioplasty. According to the article’s author, the typical patient signing an informed consent form is neither informed nor consenting. Previous studies show that about half of patients signing such forms don’t really have a clue. “Everything that could be wrong with informed consent is wrong,” says one commentator.
If you don’t think “Big Pharma” is political, read this.
Last month this newsletter published a “Perspective” on the Avandia (rosiglitazone) issue then in the news. There was heated debate at the FDA on the safety of the drug, and now it appears that the minority (apparently linked to competitors) who want the drug off the market are pressing harder, though both drugs have their drawbacks. It is hard to read materials like this and not believe that there is more to these debates than just patient safety. When billions of dollars are at stake, other motives may come into play. Check each of the three links, then you decide.
Washington Health Department Database Now Shows Adverse Medical Events By Hospital.
As reported in the Seattle Post-Intelligencer, the Washington Health Department is now reporting medical errors and accidents at state hospitals and care facilities.” Consumers can look up medical mistakes, such as maternal deaths, bedsores, surgical deaths, etc. by hospital and date.” The DOH database is available online.
Electronically Stored Information a potentially huge cost in the litigation of medical malpractice issues.
With more and more medical information being stored electronically (ESI), and more and more physicians using electronic medical records (EMR), changes are occurring in the evaluation of medical malpractice allegations. This includes the need for high-powered technical assistance to both physicians and attorneys to sort out all the hidden details of ESI. Those details include large volume, dynamic nature, content, availability, and custodial issues, among others. Retrieving the details of such information can be a huge hidden cost. A readable overview by Denny Maher, MD JD and Tim Layton JD MPA from “WSMA Reports” is available here.
Camp Korey: Former Carnation Farms property is now a summer camp for kids with medical challenges.
I again spent a week this summer providing medical care at Camp Korey in Carnation. Camp Korey offers a free summer experience to kids with diseases so debilitating – like organ transplants, cancer chemotherapy, congenital anomalies, and dialysis – that they are only able to attend a camp with 24 hour physician care. This worthwhile project is in the final stages of accreditation as one of the “Hole in the Wall Gang” camps begun by the late actor, Paul Newman.
Schizophrenics who smoke pot think better
In the “silver lining” category, Time Magazine’s “Wellness Blog” reports on a meta-analysis published in Schizophrenia Bulletin which found that people with schizophrenia who had a history of smoking marijuana had better cognitive functioning. Surprisingly, the research found that the earlier the patients started smoking, the better they functioned. Does that explain why Cheech did so well on Celebrity Jeopardy?