The five things to focus on in a cumulative trauma case.

If the doctor isn't asking about work and how that relates to the medical condition and you can't ask, for whatever reason, find a lawyer who will.

Medicine: Where do they send you for bad behavior?

In a recent decision of the Iowa Board of Medicine the doctor was ordered to obtain an evaluation from the Behavioral Medicine Institute in Atlanta, GA, (BMI).

Medicine: Public versus Private Professional Disciplinary Hearings

Going public with a disciplinary hearing is a difficult decision to make. On the one hand you want to make sure you get a fair hearing and a public hearing seems to some extent make that more likely.

Pottawattamie County, Iowa - Is the Iowa Board of Medicine’s decision wrong?

After reviewing the decision and considering the evidence it’s difficult to justify why the Board took the doctor’s license for a year?

How do I reopen my workers' compensation case?

How do I reopen a workers' compensation case? How do I reopen my workers' compensation case? If you need medical treatment you will need to know how to do this.

Work injuries – It’s about the medical opinions

If you have a claim tell the doctor what is wrong with you and how you were injured while at work. Leave out the histrionics. Attorney Lombardi 515-222-1110

Patient Safety: When hospitalized how do you protect yourself from limb amputations?

Here is an interesting story about a woman’s whose claims against the hospital and physicians were found by a jury to have no merit. The jury found no negligence or liability on the part of the medical team that she alleged misdiagnosed her condition, but saved her life, the condition of sepsis resulting in the amputation of her arms and legs.

She is Lisa Strong, 45 years of age who shares custody of a 9-year old son and a 10-year old daughter. Following the amputations her marriage ended.

What was her condition upon admission to the hospital?

According to the South Florida Sun-Sentinel article -”Despite what she told them, doctors misdiagnosed her condition for several hours. She went into septic shock, forcing her immune system to battle infection by protecting the heart and cutting circulation to her limbs. Doctors had to remove them to save Strong's life.”

Did anyone admit liability? [i.e., Did any medical care worker admit to making a mistake?]

“Both sides agreed there was an error made. Where they disagreed was over who, if anyone, was responsible, and whether there was negligence or malpractice.”

So what if anything went wrong?

Apparently upon admission a team of medical personnel examined her, came up with several diagnoses that conflicted to some degree, and no one doctor took over the care. At trial the doctors blamed each other. What appears to have gone wrong for Ms. Strong was no clear channel of authority making medical decisions and forcing the doctors to make the hard decisions.

Is this an unusual case?

I wish I could say it is but it isn’t. Brazilian beauty queen Mariana Bridi da Costa, 20, a Miss World recently died after a similar situation. Like Strong, the doctors thought Bridi had kidney stones; she went into septic shock, followed by leg and hand amputations. But in Ms. Da Costa’s situation she died.

“The Espirito Santo State Health Secretariat said in the statement she died from complications related to a generalised infection, Associated Press has reported.

It was caused by the bacteria Pseudomonas aeruginosa, which is known to be resistant to several kinds of antibiotics.

Bridi had been in the hospital in the city of Serra in south-eastern Brazil since January 3.

She became ill in December and doctors originally diagnosed her with kidney stones, local media said.

Mariana Bridi da Costa had been in a hospital in Serra, in the south-eastern state of Espirito Santo, and on artificial respiration following the procedures, according to several newspapers.”

Brazilian Model Mariana Bridi has hands and feet amputated

UTI leads to septic shock then to multi-system organ failure – original diagnosis “kidney stones”

Playing the finger-pointing-blame-game to create a red herring.

Defense lawyers use a defense that I refer to as the finger-pointing-blame-game to distract the jury. When the defense case seems hopeless, point the finger at each other, argue the entire case and hope the jury thinks the case so complicated that they find the Plaintiff is lucky to be alive. In this case, if it were used, it was done effectively and worked for the defense.

“Lawyers for the defendants said they felt compassion for Strong, but argued that the medical case was more complicated than it first appeared and Strong is lucky to be alive.

"Forty percent of the people who suffer what she did, die," said Jim Nosich, who represented the emergency room physician who first saw Strong. "It was a complex medical issue," said Isabel del Cid, attorney for the doctor who admitted Strong to the hospital.

But the two lawyers clashed, each blaming the other's client for botching the diagnosis. Strong's lawyer has filed a motion for a new trial, with the dispute between del Cid's and Nosich's clients at the center.

One of the doctors "led all of the subsequent physicians down the wrong path with a diagnosis of cholecystitis," a kidney infection, Shipley is asserting.”

The forty-percent die argument is another red herring. Let me explain. I’m not a gambler but had an occasion to visit a casino in St. Louis. On the wall was a sign, “We return 60% of the money gambled as winnings.” Some people look at that sign and understand they have a “good chance of winning”. I looked at it an thought, “Wow, a 40% tax. For every dollar I bet chances are I’ll see less than .60 cents returned.” And so when the defense lawyer points out that 40% of the people who suffer this condition die, he’s just pointing out the negative obvious. It could also be said that 60% of those who enter the hospital with this condition live and had doctors done their job Ms. Strong would not have suffered the fate she did. Apparently in this case the jury didn't think so.

Was this really a complicated medical issue?

Knowing I’ve not read the medical records or the deposition testimony I’m cautious about drawing any firm conclusions, but I doubt it. Medicine always involves complicated diagnosis and decisions concerning treatment. So what’s different about this case? Nothing really. It was an infection. Isn’t that what doctors and hospitals are trained to diagnose and treat? If beyond their experience the doctors needed to call in for a consult with a specialist or two, run more tests and listen to the expert medical doctors. Did they? Can’t tell from the article. What did the E.R. doctors do for the hours that passed between admission and the realization amputations would be necessary? Who did they consult with and what additional tests did they run? What were the findings and follow-up?

What is sepsis?

Sepsis development and progression

Was Lisa Strong misdiagnosed? “This isn’t Kansas.”

10TH LEADING CAUSE OF DEATH IN THE UNITED STATES LARGELY UNK

How do you recognize kidney stones?

Kidney Stones: A Sign of Something Worse? (Dramatic Health) – Joeseph Del Pizzo, M.D.

Dehydration, not enough water and salt and not a sign of underlying kidney disease.

What is really going on here?

Doctors have a tough job. Some days they have a thankless job. I don’t know these doctor who tended to Ms. Strong’s care and yes, they had to make tough calls, but that’s what they get paid so handsomely to do. They are supposed to be the best and brightest of the professions. In the end these types of decisions come with the territory.

So what is the answer?

Well the answer which many of you won’t want to hear is it’s about tort-reform. The cornerstone of tort reform argues unnecessary tests leading to increased costs and too many lawsuits by injured patients. This case is a good example of the kind of health care we can expect in the future from tort reforming measures. A lack of testing, inconclusive diagnoses, bad results and jury’s who don’t care to put in the time to figure out what went wrong and who look for any excuse to find against the Plaintiff. If the tort-deformers get their way people like Ms. Strong won’t even be able to have their day in court. And neither will you. As you’re reading this don’t think your case will be any different than Lisa Strong’s; it won’t.

The old saying what goes around comes around seems only too appropriate in this instance.

University of Iowa opens the door to medical conflict information.

The University of Iowa announced new rules prohibiting physicians from accepting free drug samples and handing them out to patients. Also doctors and other health care workers will be prohibited from accepting gifts and must disclose financial remuneration paid by private medical companies that can create a conflict of interest with reporting research results.

“At least 25 public and private academic medical centers now have “strong” conflict-of-interest policies, according to a Sept. 3 commentary in JAMA, the Journal of the American Medical Association, by David Rothman and Susan Chimonas of the Institute on Medicine as a Profession at Columbia University.

The institute’s searchable database for conflict-of-interest policies at medical centers and university hospitals, at http://www.imapny.org/coi_database/, shows the U of I’s proposed restrictions are stricter than some, but not the most severe.”

Des Moines Register, January 22, 2009 - U of I beefs up conflict of interest rules for doctors

And if you’re wondering how much a physician can be paid take a look at the Des Moines Register’s article on January 23, 2009, U of I to bar free drug samples, gifts.

“Last year, three U of I orthopedic surgeons were included on a list of doctors across the country who accepted money from the manufacturers of artificial hips and knees.

Dr. John Callaghan, a U of I surgeon, received $2.6 million in 2007 from DePuy Orthopaedics, a Johnson & Johnson company that makes replacement joints. Callaghan said the payments were above-board royalties for other doctors' use of joint replacement devices he helped develop. The U of I knew of the financial ties, but did not know how much Callaghan made in royalties because the university-wide conflict-of-interest policy does not require employees to report payment amounts.”

That’s a lot of money. Then again it seems Doctor Callahan earned it with his participation in developing the joint replacement. Or at least someone earned the right to the royalties. What I’ve always wondered is how State of Iowa employees are allowed to get paid a salary by the State of Iowa, use state equipment and laboratories to develop patentable products and then the employee get to keep the royalties. Why aren’t the royalties owed to the State of Iowa?