Healthcare Reform

by Michael J. Sacopulos

A Lawrenceville, Georgia jury earlier this month awarded $3 million dollars to the Estate of William Martinez. Mr. Martinez was 31-years old in 2009, when he entered his cardiologist office. There he complained of chest pain that radiated into his arm. His cardiologist found that Mr. Martinez was at “high risk” of having coronary disease and ordered a nuclear test to be performed. The test was scheduled to take place eight days after Mr. Martinez initial appointment with his cardiologist. The cardiologist alleges that Mr. Martinez was instructed to avoid exertional activity until after the nuclear stress test was completed. The family of Mr. Martinez argues that no such instruction was given.

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Your deposition is your best chance to lose your case before it has hardly even started.

That is because it is actually a job interview. Both the plaintiff’s attorney and your own attorney are interviewing you for the position of “defendant” and each wants to see how well you will perform in that role.

In fact, although you may think that the plaintiff’s attorney is the one you have to impress, it is actually your own attorney who matters more to you at this point in your case.

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by “Dr. J.D.”

Allegations of communication failure account for a progressively increasing proportion of malpractice claims.

This is partially the result of the fact that more diagnostic studies and examinations are being performed and expectations of timeliness in reporting have increased with improved technology, but in the day-to-day working reality of consulting physicians communication usually fails for same simple reasons that it has in the past – difficulty in reaching the target recipient, distraction by other work and, frankly, annoyance that leads to giving up too soon

All of these will, of course, be exacerbated in an environment of increased volume and shorter turn-around times. It is therefore necessary to have a systematic approach to turn to.

Let’s therefore look at some of the essential principles involved in the communication of critical findings and some reasonable protections against falling into liability.

1. Duty

Although radiologists and pathologists are the physicians most likely to come across an unexpected finding and to have to communicate it to an absent referrer, the responsibility to communicate appropriately applies to all consultants.

It is a black letter piece of carved-in-stone law – as well as an absolute of medical ethics – that a consultant physician’s duty to communicate a critical finding is not satisfied merely by creating and signing a report or a chart note.

It is not satisfied until that information is in the hands of someone who can act on it definitively enough to relieve that physician of his or her obligation to communicate it.

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by Michael J. Sacopulos

“I’m on jury duty. God help me.” For those of us who have been on jury duty, this thought has probably passed through our head. Perhaps some of us have even muttered it beneath our breath when we received the notice to report into jury duty. But most people know enough not to tweet or write a Facebook post about serving or a jury. Now, enter a Kentucky juror who did exactly that. Her friend then responded “They’re guilty…whatever it is, they’re guilty”.

Earlier this year, this Kentucky juror was sitting on a medical malpractice case. The case involved a newborn child that had suffered a catastrophic and irreversible brain injury due to the umbilical cord being wrapped around his neck. The child lived for 39 days before life support was removed. He died. According to the Kentucky Trial Court Review a $1,183,638 verdict was returned. Thereafter, the hospital sought a new trial/mistrial based on a Facebook posting by a juror.

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This week newspapers reported assorted medical specialty societies are recommending doctors perform fewer tests and procedures. They also urged patients to question the value of these services, if offered.

Some of the over-ordered tests:

1. Routine EKG at routine physical
2. MRI for recent back pain
3. Imaging studies for patient suffering from simple headaches
4. Antibiotics for sinusitis.

 
Two points:

“These all sound reasonable, but don’t forget that every person you’re looking after is unique,” said Dr. Eric Topol, chief academic officer of Scripps Health, a health system based in San Diego, adding that he worried that the group’s advice would make tailoring care to individual patients harder. “This kind of one-size-fits-all approach can be a real detriment to good care.”

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Jeff Segal, MD, JD, FACS

Utah’s highest court ruled that family members can sue a doctor if something goes wrong with their loved one’s care. Doctors, of course, owe a duty of care to their patients. But, if their care affects non-patients…well, that is mostly new territory.

Dr. Hugo Rodier, a primary care doctor, prescribed antidepressants (and other medications with potential psychiatric effects – such as steroids) to his patient, David Ragsdale.

Ragsdale’s wife, Kristy had requested a restraining order against him. Unfortunately, the restraining order was not effective – Ragsdale gunned down his wife. Ragsdale pled guilty to first degree felony murder and is serving a 20 years to life prison term. He supposedly took full responsibility for his actions. One caveat. He said he would not have murdered his wife had he not been on the medications.

Ragsdale’s children (via a conservator) filed a medical malpractice lawsuit. A lower court dismissed the suit noting the plaintiffs were not the doctor’s patients.

Utah’s Supreme Court overruled.

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