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Articles Posted in Medical Malpractice

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Failure to diagnose cancer in teenagers may be medical malpractice. Because cancer in young adults and teenagers count for only 1% of all diagnosed cancers, they have a higher risk of being misdiagnosed. A recent report “Improving Diagnosis: Teenage Cancer Trust Report on Improving the Diagnostic Experience of Young People with Cancer” was recently published by the Teenage Cancer Trust in London. This report discusses challenges to early diagnosis of cancer for teenagers and offers guidance for clinicians and families to improve care for these patients.

 

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To reduce medical malpractice, the Institute of Medicine called for the measurement and reporting of physicians quality in its reports To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001). More than 10 years later, it remains very difficult for patients in most states to find quality information on physicians.

A recent Sate Report Card on Transparency of Physicians Quality Information, authored by Francois de Brantes, MS, MBA, Elizabeth Bailey, MPH, Jessica DiLorenzo, MA and Michael Moses, MS from the Health Care Incentives Improvement Institute in Newtown, Conn shows that only Minnesota and Washington State have a high level of transparency on physicians. California is somewhat transparent but for all other states patients have little access to information on the quality of their physicians.

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Jappa.jpegFailure to diagnose May-Thurner Syndrome may be medical malpractice that can lead to post-thrombotic syndrome, potentially fatal pulmonary embolism, pulmonary hypertension, and in the worst case paradoxical embolism.

In a recent article published in the current issue of the Journal of the American Academy of Physician Assistants, the author Jaclyn Leitner who practice general medicine in Newark, New Jersey describes the case of a 28 year old female marathon runner who visited her office with groin pain. The author explains how to properly diagnose May-Thurner syndrome and the available treatments.

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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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