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MRSA Diagnosis & Treatment Delayed

Bob Carroll — Sat, 24 Sep 2005 05:29:01 GMT

Reuters Health reports that MRSA infections which are spreading in hospitals are not being recognized or treated as promptly as it should.

"NEW YORK (Reuters Health) - Even with early therapy, infection-related mortality from nosocomial bacteremic Staphylococcus aureus pneumonia (NBSAP) is high, according to a report in the September issue of Chest. [Nosocomial is a fancy word for "acquired in the hospital."]

"Patients with methicillin-resistant S. aureus (MRSA) pneumonia are at high risk to receive initial inadequate therapy," Dr. Peggy S. McKinnon from Barnes-Jewish Hospital in St. Louis, Missouri told Reuters Health. "Early recognition of MRSA as an important pathogen is essential."

Reuters Health reports that MRSA infections, which are spreading in hospitals, are not being recognized or treated as promptly as they should.

Dr. McKinnon and colleagues evaluated the epidemiology, treatment, and outcomes of NBSAP in 60 patients treated from 1999 through early 2004 at a level-1 trauma center. Forty-two patients (70%) were infected with MRSA.

Clinical and microbiological success rates were between 50% and 57%, the investigators report, and 33 patients (55.5%) died during the hospitalization -- most of them (24 patients, 40%) due to NBSAP.

Fewer patients with MRSA than with methicillin-sensitive S. aureus (MSSA) infection received appropriate therapy within the first 2 days of hospitalization (50% versus 72.2%, respectively), the report indicates, but overall clinical and microbiological success rates did not differ between patients with MRSA and those with MSSA.

Primary outcomes did not differ between patients who received delayed versus early appropriate antibiotic therapy, the researchers note. No treatment time breakpoint produced an increased probability of infection-related mortality.

The investigators describe this finding as the most surprising outcome from the study.

"These findings suggest that newer agents with enhanced clinical activity in NBSAP are needed and that these should be evaluated in a real-world setting, where outcomes of the sickest patients can be assessed," the authors conclude....

"The emergence of this superbug along with concerns for the future appearance of avian influenza, potentially further increasing outbreaks of MRSA pneumonia, makes this an important health-care concern for the community as well as the hospital setting," the editorialists conclude.

Chest 2005;128:1414-1422,1093-1095."

Originally posted at InjuryBoard by Bob Carroll

Aggravation Of A Pre-Existing Condition Is Often Part Of An Injury Claim

Bob Carroll — Fri, 01 Sep 2006 07:16:48 GMT

Michael Myers, my fellow InjuryBoard.com blogger from Seattle, has posted a very clear explanation of pre-existing conditions.

Pre-Existing Conditions--What Really Matters is How You Felt Before the Accident

Clients often mention pre-existing conditions. They are concerned that things like degenerative disc disease may affect their recoveries.
Insurance companies dwell on pre-existing conditions. But they can be effectively addressed by common sense and good lawyering.
Many injured persons' medical records show degenerative disc disease, narrowing of the spinal column and or other issues. These are typical for a person who has lived an active life. The key is the contrast between life before and after the accident. If you didn't hurt before the accident and you hurt after, that's the only thing that should matter.

To Michael's post I would only add that in Florida we have a special jury instruction which tells juries how to deal with the aggravation of pre-existing diseases or conditions. The instruction is favorable to the rights of the injured person and seeks to prevent the wrongdoer or his insurance company from benefiting from any inability of medical science to precisely separate the aggravation from what was pre-existing. Insurance companies know that a skilled personal injury attorney will use the wording of the jury instruction to the fullest extent in an appropriate case.

Originally posted at InjuryBoard by Bob Carroll

Coumadin And The Risk Of A Brain Bleed

Bob Carroll — Wed, 10 Jan 2007 06:21:45 GMT

Blood thinning, anticoagulant warfarin (Coumadin) carries risk of a brain hemorrhage. This is a risk of its use that is not always being considered by the prescribing doctor.

Brain Bleeds From Blood Thinner on the Rise

The rate of bleeding in the brain associated with use of the anticoagulant drug warfarin quintupled during the 1990s, University of Cincinnati researchers reported Monday.
Moreover, in people over 80, the rate of brain hemorrhages associated with warfarin, best known as Coumadin and used to thin the blood and prevent strokes, increased more than tenfold, according to the study, published in the Jan. 9 issue of Neurology.
"Warfarin use increased during the 1990s, because it was proven to be effective in preventing ischemic strokes among people who have an abnormal heart rhythm called atrial fibrillation," said the study's lead author, Dr. Matthew L. Flaherty, a neurologist.
The drug is commonly prescribed to prevent blood clotting, which can lead to ischemic stroke, the most common type of stroke. However, warfarin is associated with another type of stroke, called an intracerebral brain hemorrhage, which is a ruptured blood vessel resulting in bleeding in the brain, Flaherty explained.
One expert thinks that doctors need to evaluate a patient's risk of stroke versus their risk of bleeding before prescribing warfarin.
"This study demonstrates that we need to be careful when we use these therapies," said Dr. Michael B. Rothberg, an associate professor of medicine at Tufts University School of Medicine.
Not all patients with atrial fibrillation will benefit from warfarin, Rothberg added. "Not all patients with atrial fibrillation should be getting warfarin," he said. "Patients at the highest risk for stroke will benefit the most, and patients at the highest risk for bleeding will benefit the least," he said.
Rothberg noted that although warfarin is standard treatment for atrial fibrillation, not everyone with atrial fibrillation is at the same risk of stroke. "I don't think that most doctors prescribing warfarin are assessing their patient's risk of stroke and risk of bleeding, but they should be," he said.
In addition, Rothberg also believes that better INR monitoring could help reduce the problem of bleeding.

Originally posted at InjuryBoard by Bob Carroll

Chemotherapy Drugs and Congestive Heart Failure

Brenda Fulmer — Mon, 31 Dec 2007 15:32:13 GMT

A study published on October 30, 2007, in the Journal of Clinical Oncology again noted that the use of certain chemotherapy drugs in breast cancer patients can increase the risk of developing congestive heart failure. This potential was first noted more than thirty years ago, but has become more of a problem in the past fifteen years as more early-stage breast cancer patients are receiving anthracycline drugs (also known as Adriamycin or doxorubicin) as a part of their chemotherapy regimen. The authors noted that previous studies had indicated that the incidence of congestive heart failure in these patients might be as high as 50%, depending upon the dose and other risk factors such as diabetes, pre-existing cardiac disease, and hypertension.

This study reviewed the database information for 43,000 women (ages 66 to 80) who were diagnosed with breast cancer between 1992 and 2002. About 20% of these women received chemotherapy and approximately half of those were given anthraclycline drugs. The researchers then analyzed the numbers of these patients who were subsequently diagnosed with congestive heart failure, and made adjustments for other independent causes and predictors of CHF. The authors concluded that their study confirmed the data previously reported that use of anthracycline drugs in chemotherapy does significantly increase the risk of developing congestive heart failure (with a more than doubling of the risk noted in some groups). The study also noted that further research was needed due to the possibility that the race of the breast cancer patient may influence their susceptibility to development of heart failure after chemotherapy and that consideration should perhaps be given to the patient's race in making a determination as to whether use of anthracycline is appropriate since congestive heart failure is more prevalent and causes greater mortality in African-Americans.

Originally posted at InjuryBoard by Brenda Fulmer

What the heck is going on in VA Hospitals?

C. Todd Alley — Mon, 06 Jul 2009 23:31:13 GMT

Two shocking news reports highlight the growing concern about VA hospital negligence and the quality of care provided to our soldiers stateside.

In the first article, reports from the New York Times and the Philadelphia Inquirer last month indicated that during a six-year period at the Veterans Affairs Medical Center in Philadelphia, approximately 92 of 116 Veterans were given incorrect radiation doses in a common surgical procedure to treat prostate cancer called brachytherapy. During this procedure, radioactive seeds are implanted surgically to kill cancer cells in the prostate. The procedure is considered relatively simple, yet investigators found that most veterans got significantly less than the prescribed dose while others received excessive radiation to nearby tissue and organs. Dale Warman of the Philadelphia VA Medical Center stated that all of the patients affected were notified and received follow up care rectifying the mistakes. Four of those patients have since died, although Mr. Warman indicated to reporters that none of the deaths were related to the botched procedures.

In an even more startling report, last month a congressional panel questioned officials at the Department of Veterans Affairs after 10,000 veterans were exposed to HIV and other infectious diseases from contaminated colonoscopy equipment at three Southeast VA hospitals (Miami, FL, Murfreesboro, Tenn., and Augusta, Ga). Some former VA patients had colonoscopies performed as long ago as 2003. Patients are at risk because according to reports, the equipment used may have been improperly operated or cleaned. As of mid-June, the VA’s Inspector General reported that six veterans taking the follow-up blood checks tested positive for HIV, 34 tested positive for hepatitis C and 13 tested positive for hepatitis B. All but 724 affected patients have been notified of test results.

Questions have been raised whether the problem is isolated to only a few VA hospitals, or if it is more widespread. The patients at the VA are current and former soldiers who have protected and served our country. The men and women of the armed forces deserve the highest quality healthcare in America. But unfortunately, these appalling reports shed light on growing concern that they receiving substandard care.

Originally posted at InjuryBoard by C. Todd Alley

"Foreign Objects" Left In Body After Surgery

Bob Carroll — Thu, 06 Jul 2006 05:59:05 GMT

Time for a quiz. In the law of medical malpractice what exactly constitutes a foreign object? Is it (A) something imported from another country; (B) something accidentally left in a patient's body after surgery; (C) something intentionally left in a patient's body but wrongly placed; or (D) something that can extend the time in which a medical malpractice suit can be filed?

You will have to read the article at Day On Torts to get the official answer.

New Tennessee Supreme Court Opinion on "Foreign Object" Exception to Medical Malpractice Statute of Repose

The plaintiff's theory in the case is that a hemoclip was negligently placed on her ureter during a surgery and left there, later causing her left kidney to fail. The defendants countered that they did not leave any hemoclip on the plaintiff's ureter, but that "hemoclips are used intentionally and are intended to remain permanently," so they could not be foreign objects...

In one of my cases, a huge lap pad (a type of surgical sponge) measuring over 10 inches in length was accidentally left behind in my client's abdomen by the surgical team. In another case, several sponges were accidentally left in my client's brain. Obviously, the sponge count, which is supposed to assure that the same number of sponges placed during surgery are removed before the closing of the surgical incision, was a failure. Nevertheless, the defendants in both cases mounted strong defenses to our claims of malpractice. The most foreign object in a malpractice case is an admission of liability.

Originally posted at InjuryBoard by Bob Carroll

Benefits Of A Doctor Who Takes His Time To Do It Right

Bob Carroll — Mon, 18 Dec 2006 06:54:56 GMT

Some medical malpractice occurs simply because the medical provider does not spend enough time doing the job at hand. It is identical to the plumber who does a poor job making his connections in the rush to get to the next job or on the way home. Or, to the home inspector who has twice as many homes to inspect as he should have in his work day. It is not a failure of training or experience. It is not a failure to make the right choice or options at a critical moment. It is just rushing through the job.

The Daily Kos comments on a medical study of colonoscopies published in a respected medical journal.

One of the main agenda items of Republicans is the need for tort reform, especially in the area of Medical Malpractice. Their argument is that frivolous lawsuits drive up the cost of medical malpractice insurance making health care even less affordable. They blame these increased costs for defensive medicine and insurance on the Democratic Party's alliance with the litigation bar.
No reasonable person will claim that any facet of our legal system is beyond criticism. And certainly, medical malpractice procedures need improvement. However, the need to wield this cudgel against excesses by Medical Practitioners is made clear by this article from the New York Times.
Friday's article "Study Questions Colonoscopy Effectiveness" expands on a report that shows there is wide variation in the thoroughness of this examination among experienced gastroenterologists.
The study, of 12 highly experienced board-certified gastroenterologists in private practice, found some were 10 times better than others at finding adenomas, the polyps that can turn into cancer.

One factor distinguishing the physicians who found many adenomas from those who found few was the amount of time spent examining the colon, according to the study, in which the gastroenterologists kept track of the time for each exam and how many polyps they found.

...it looks like a minimum of several thousand individuals who took the effort to have this uncomfortable examination will die simply because these board certified physicians wanted to squeeze some more patients into their day.
...far from practicing defensive medicine, there is still wide-spread flagrant disregard for the well-being of those who trust their doctors. This was not a report from "The Nation" or a liberal think tank. The primary research came from a report in The New England Journal of Medicine, published for and by physicians.
Medical Malpractice procedures should be reformed, but the threat of serious sanctions for incompetence or blatant lack of concern, must not be lessened.
This study is shocking because it shows the relationship between time expended and outcome so clearly. There must be better ways to control this type of dereliction of medical responsibility than our current tort system. But until that is put in place, we better keep the threat of financial ruin over the heads of those in whose hands we routinely place our lives.

Florida doctors and other medical providers sometimes suffer from the same "haste makes waste" approach to medical care. One common scenario is in post-operative care when the surgeon (carefully selected as the professional to perform the surgery) moves on to his next surgery or surgeries while the patient is in the care of others in a recovery room.

Originally posted at InjuryBoard by Bob Carroll

Malpractice Victims Need To Be Heard By Florida's Board Of Medicine

Bob Carroll — Sun, 22 Oct 2006 07:39:38 GMT

The Florida State Board of Medicine needs to involve more of the patient/victims of botched medical care in its hearings. That is the gist of the article in the Palm Beach Post.

Medical errors, medical malpractice, surgical mistakes...these all have real consequences to real people. And, the real people often have important input into the facts of the medical care as well as an understandable interest in the outcome of the hearing.

State does poor job involving victims

TAMPA -- When the state Board of Medicine meets to discipline doctors for malpractice, state prosecutors, the accused physicians and their attorneys are almost always there to answer questions.
But one source of information is usually nowhere in sight: The patients or their next of kin.
Take Dianne Hedrick. The Wellington woman wasn't told by the state when her surgeon was scheduled in June to have his case heard before the board. Dr. Paul Liebman botched her varicose vein surgery in 1999 and as a result she had to have her right leg amputated.
There's the family of Lynn Draina of Weston. They also weren't advised when the gynecologist whose surgical error led to her death was before the board this month. Draina died in 2003 after Dr. Helen Salsbury burned a hole in her uterus during a procedure to reduce excessive menstrual bleeding.
While medical board members say they want to hear from patients at their meetings so they can get a clearer understanding of the incidents and their outcomes, many patients don't appear to be getting the message.
The 15-member board, all volunteers, meets six times a year to discipline the state's physicians and physician assistants. The board, which includes 12 doctors, hears cases ranging from doctors operating on the wrong body part to not meeting continuing education requirements to doctors convicted of billing fraud.
Board members acknowledge that few patients ever come before the panel. They say they think few patients show up because they don't want to relive the emotional trauma of the incident or don't want to travel far from home for the meeting.
Patients say they're not notified of the meetings.
Health Department officials said they abide by state law, which requires them to periodically notify patients about the status of an investigation into their doctor. That includes notifying them before any appearance before the medical board.

Originally posted at InjuryBoard by Bob Carroll

Doctor, Pharmacist Errors Lead to Acetaminophen Overdoses

Joe Saunders — Mon, 13 Jul 2009 14:50:26 GMT

When doctors prescribe pain medicines such as Percocet and instruct their patients to take one or two pills every four hours, they may be liable for acetaminophen overdoses. While prescribing such pain medicines, doctors often focus their attention on the amount of narcotic prescribed and fail to recognize that the amount of acetaminophen in those doses far exceeds the four gram safe limit of acetaminophen. Such errors may result in liver injury, liver failure and death.

Doctors are not the only health professionals liable for such errors. The pharmacists who fill such prescriptions may also be legally liable for the acetaminophen overdosage. Drugs containing acetaminophen are ubiquitous and healthcare professionals must take into account the overall acetaminophen a patient may be taking at a given time. Acetaminophen is found in commonly prescribed painkillers, Tylenol, cough medicine as well as many other over the counter medicines. Consumers should also be aware of the amounts of acetaminophen they're ingesting. The consequences of ignoring acetaminophen use can be fatal.

Originally posted at InjuryBoard by Joe Saunders

Brittle Bone Disease Caused Fractures But Father Wrongly Accused Of Abuse

Bob Carroll — Thu, 27 Oct 2005 05:17:46 GMT

The headlines report: Parents Get $1 Million in False Abuse Case and Judge Apologizes for Officials' Failure to Recognize Girl's Brittle Bone Disorder. But, reading the full article in the Washington Post will break your heart. Bullheadedness by doctors (and prosecutors) can cause good people and their families unbelievable grief.

The headlines report the final chapter: Parents Get $1 Million in False Abuse Case and Judge Apologizes for Officials' Failure to Recognize Girl's Brittle Bone Disorder. But, reading the full article in the Washington Post will break your heart. To see what harm bullheadedness by doctors (and prosecutors) can cause good people and their families read on.

The federal government has agreed to pay nearly $1 million to a couple whose infant daughter was taken away from them after doctors at the National Naval Medical Center in Bethesda ignored the mother's pleas to test the girl for a genetic condition that causes brittle bones and instead accused the father of breaking the girl's ribs.
The father, Miguel Velasquez, was charged with child abuse.
Miguel Velasquez -- with his wife, Alice, and their children, Tahlia, left, Korbin and Liliana -- said his "heart was broken for a few years," but he feels "much better now that my name is cleared." The two girls, who have brittle bone disease, cannot play sports and can run only on grass.

Liliana Velasquez was tested for osteogenesis imperfecta -- also known as "brittle bone disease" -- only after an Alexandria Circuit Court judge ordered the examination, according to a federal civil lawsuit filed by the girl's parents. The test showed that the girl suffered from the condition. The charge against her father was dropped.
"I feel much better now that my name is cleared," Velasquez, 34, said yesterday. "I love my babies; they're my life. For something like this to happen, my heart was broken for a few years."
On Oct. 14, civil attorneys in the Maryland U.S. attorney's office agreed to settle the lawsuit filed by Velasquez and his wife, Alice. The deal was reached three days after the civil trial began in U.S. District Court in Baltimore.
As he announced the settlement, U.S. District Judge Richard D. Bennett apologized to the Velasquez family on behalf of the U.S. government, according to Alice Velasquez and one of her attorneys, Dorothy M. Isaacs. Bennett said the outcome was a triumph for the legal system, Isaacs said.
The medical center did not return a phone call yesterday seeking comment. A spokesman for the U.S. attorney's office said it would have no comment because the settlement is not final until it has been reviewed by an attorney representing Liliana.
The nightmare began for the family on Feb. 3, 2000, when Alice and Miguel Velasquez took Liliana, who was 4 months old, to the medical center for a routine checkup. Alice Velasquez was an Army medical lab technician, and the family lived in Alexandria at the time.
Doctors found a bump on the left side of Liliana's rib cage, and further examination revealed that the girl had eight broken ribs and a possible fibula fracture, according to the lawsuit.
Alice Velasquez said she told doctors at the medical center that brittle bone disease runs in her family. She said she pleaded with doctors to test Liliana for the condition, but they did not.
Paul Reed, Liliana's attending physician at the medical center, immediately notified Child Protective Services in Alexandria; officials there conducted an investigation with Alexandria police, determining that Miguel Velasquez had caused the girl's injuries. Reed could not be reached yesterday.
Miguel Velasquez was charged with felony child abuse, and Liliana was put in a foster home. As part of the criminal case against her father, an Alexandria Circuit Court judge ordered the September 2001 test, which revealed that Liliana suffered from the bone disorder, according to the lawsuit.
After 18 months in the foster care system, Liliana was returned to her parents, and the criminal charge against Miguel Velasquez was dropped.
Liliana is now 6 and in first grade. She has two siblings, Tahlia, 4, and Korbin, 1. Tahlia also has the bone disorder, Alice Velasquez said. The girls cannot play sports and can run only on grass, she said. The settlement calls for Miguel and Alice Velasquez to each receive $400,000 and for $150,00 to be set aside for Liliana.
The family lives near Martinsburg, W.Va. Miguel Velasquez works as a ramp agent for an airline at Dulles International Airport. Alice Velasquez, 26, worked as an airport police officer at Dulles for the past two years but said she resigned her job this week.
The money from the settlement will allow her to stay home and take care of her kids, she said.

Originally posted at InjuryBoard by Bob Carroll