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Articles Posted in Medical Malpractice

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Excessive bleeding caused by Warfarin can lead to wrongful death if not addressed promptly. This anti coagulant medication is commonly prescribed to address blood clots but it has a very serious side effects that leave patients at risk of very heavy bleeding. In the US when emergency room doctors are faced with warfarin anticoagulation they commonly use fresh frozen plasma to reverse the bleeding.

Frozen Plasma therapy is slow and unpredictable and most emergency room doctors around the world have been replacing it with Prothrombin complex concentrates (PCCs), a therapy that can reverse Warfarin anticoagulation in minutes according to an article from the American College of Emergency Physician based on a study by Kenneth Frumkin, PhD, MD of the Naval Medical Center in Portsmouth, Va. published in Annals of Emergency Medicine.

Hopefully the use of these life-saving products will increase in the US since the Food and Drug Administration accepted a form of PCC specifically intended for warfarin reversal last April.

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In this medical malpractice case the plaintiff was diagnosed with Stage 1 breast cancer in her right breast. She underwent a right breast mastectomy. She had a family history of breast cancer. Seven years later in 2007 she was diagnosed with ovarian cancer. The plaintiffs alleged that, given the plaintiff’s own medical history and that of her paternal family, as well as her father’s Ashkenazi Jewish ethnicity, defendant’s failure to recommend, prior to November 2007, “BRCA” genetic testing or prophylactic surgery removing her ovaries, which could have prevented the onset of her ovarian cancer, constituted medical malpractice. In reversing the Court below and reinstating the complaint the Court held:

“Here, the allegations in the bills of particulars concerning the period from March 2001 through November 2007, when the patient was under defendant’s care, were that defendant departed from the accepted medical practices of that time by failing to recommend “BRCA” genetic testing and “prophylactic oophorectomy or bilateral salpingo-oophorectomy” to the patient, given her personal and family medical history. Since the respondents’ expert failed to provide any information as to what the accepted medical practices were during the period at issue with regard to BRCA genetic testing, and did not refute or even address (see Berkey v Emman, 291 AD2d at 518) the specific allegations regarding the failure to recommend prophylactic oophorectomy or bilateral salpingo-oophorectomy, the respondents did not meet their prima facie burden on the issue of whether there was a departure from accepted medical practices.

Accordingly, the Supreme Court should have denied the respondents’ motion for summary judgment dismissing the complaint insofar as asserted against them.” See: Mancuso v. Friscia, et al., 2013 NY Slip Op 05515.

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An elderly woman with an history of pancreatitis was admitted for an emergency laparotomy after she showed symptoms of acute abdominal pain, nausea and vomiting. The diagnosis was small bowel obstruction. Her heart stopped during anesthesia and she had to be resuscitated and sent to the ICU. She died there the day after. The hospital’s case review committee concluded it was a misdiagnosis: the patient suffered acute pancreatitis and not a small bowel obstruction therefore surgery was contraindicated and death could have been prevented. This type of cases raises questions about the decision process in emergency surgery, specifically for elderly people. The complete case as well as a medical commentary, references and World Health Organization Surgical Safety Checklist can be found at Web M&M.

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Doctors should be vigilant when they decide to send home some pediatric cancer patients who still need to use a central venous catheter for their treatment. Because the central line is a tube that is placed directly into a major blood vessel, it can easily become a gateway for bacteria in the blood stream if it is not handled properly. Central line-associated bloodstream infections (CLABSIs) can lead to serious personal injury such as organ damage and sometimes death.

A recent study from Johns Hopkins Children’s Center published yesterday in the journal Pediatric Blood & Cancer followed 319 children with cancer between 2009 and 2010. Most children were first treated in the hospital and then sent home to continue their treatment. 19 children developed a central line-associated bloodstream infection (CLABSI) while hospitalized and 55 while at home.

Hospitals have been fighting for a long time against bloodstream infections and they have made serious progress in reducing them. They have experienced clinicians following precise protocols.Things are different when children are treated at home by family members. More should be done in preventing development of CLABSIs at home.For example teaching family members how to handle and clean central lines should be part of the formal discharge protocol. It is not the case yet.

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Failure to diagnose cancer most commonly breast cancer, colon cancer, melanoma, lung cancer and malignant tumors in the female genital tract are the most common misdiagnoses in the primary care setting. The second most common type of misdiagnosis is failure to diagnose myocardial infarction. Failure to diagnose meningitis in children is also among the most misdiagnosed conditions by primary care doctors.

Medications errors such as prescription errors, contraindicated medication, administration errors leading to adverse reactions are the second most common types of medical malpractice committed by general practitioners.

These findings are the result of a computerized literature search that compiled 34 relevant studies mostly in the US but also in Canada and Europe. The complete results of the research, led by Dr. Emma Wallace from the HRB Center for Primary Care Research of the Royal College of Surgeons in Ireland Medical School, in Dublin can be found at BMJ open.

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Children exposed to anti-seizure medication in the womb have a higher risk of suffering from early developmental issues according to a study led by Dr. Gyri Veiby from Haukeland University Hospital in Bergen, Norway.

The study covered a 9 year time frame and looked at the risk of adverse outcomes in children according to epilepsy in the mother or father, and with or without antiepileptic drugs (AEDs) exposure in the womb. At 18 months, the children exposed to AEDs in utero had increased risk of abnormal gross motor skills and autistic traits and at 36 months an increased risk of abnormal gross motor skills, sentence skills, and autistic traits compared to unexposed children.Further analysis determined that AED-exposed children had increased risk of birth defects compared to children not exposed to the drugs in utero.

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The Affordable Care Act is at the origin of a fast growing trend of Primary Care Doctors who are reorganizing themselves into “patients-centered medical home”. These reorganized practices effectively improve patients care and lower medical costs according to a recent article in ConsumerReports.

Below is a table that shows what type of improvements patients can expect form these new type of practices.

primary%20care.jpg Source: ConsumerReports July 2013

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Gross Medical Malpractice related to blood transfusion seems to occur again at Coney Island Hospital in Brooklyn, New York. According to the New York Post, the hospital blood lab was shut down yesterday after a 40 year old man died following a botched transfusion in which he was given blood that had been mislabeled by a lab technician. Today the Daily News reports that an 86 year old lady died after she was given the wrong type of blood on June 9th, just a month ago.

According to statistics the probability for a patient to receive the wrong type of blood is one out of every 14,000 transfusion.

Coney Island Hospital has a history of serious malpractice in handling blood. From 1990 to 1994 the hospital recorded five nonfatal transfusion mistakes. In 1995 , Ira Medjuck , a 30 year old paramedic, agonized for a month before her death after she was given a botched blood transfusion.

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Prostate cancer is is the second most common cancer among men. Delay to treat or failure to diagnose prostate cancer may have fatal consequences but so far it has been difficult for doctors to diagnose how aggressive prostate cancer is. Additionally the role played by the nerves around the tumor was never well understood.

A new study led by by stem-cell expert Paul Frenette, M.D., professor of medicine and of cell biology and director of the Ruth L. and David S. Gottesman Institute for Stem Cell and Regenerative Medicine Research at Albert Einstein College of Medicine of Yeshiva University, Bronx, New York demonstrates that nerves commonly found around cancerous tumors play an important role in the development and spread of the tumor.

This innovative study opens the door to new ways to prevent and treat prostate cancer.

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A 2004 landmark study found that medical interns working a 24-hour shift in ICU committed 36 percent more serious medical errors than when they worked 16 hours. This study started the debate that lead to the creation in 2011 of a new rule that required the maximum allowable shift for medical interns to change from 30 straight hours to 16. This rule created a lot of controversy in the medical world and some recent studies question the real benefit of shorter shifts for interns.

In her new article Sandra G. Boodman from the Washington Post gives a detailed overview of the situation then and now.