Medical Malpractice Breach of the Standard of Care
A breach of the standard of care may come in a number of ways. It may be seen in the way a procedure is done. It may be in the failure to diagnose. In addition it may be in a failure to obtain informed consent.
Doctor In Over His Head
In some cases the result is due to the doctor being in over his head. This may be due to age, lack of experience or lack of training. In cases like that your “Rule” for the case may be that doctors must know when they are in over their head and ask for help. Therefore in those cases you may want to:
- request the hospital billing codes to see how many such procedures this doctor has done
- ask about any privilege restrictions
- get the CME records
- get the contract between the doctor and the employer
- find out if he did ask for help
- find out who was able to help
Wrong Cut Surgery
Doctors sometimes cut right when they should have cut left. The common defense to these cases is that this happens to everyone. That may be true. That does not mean there is no fault present. The “Rule” in these cases may be that the doctor cannot guess what a structure is but should test to make sure he is cutting the right structure. With that Rule you may have a case. The more simplistic rule may be “before you cut, check what abuts”.
Malpractice Cases-Misdiagnosis
Studies indicate that doctors make the wrong diagnosis in 10% to 15% of office visits for a new problem. The average office visit last no more than 21 minutes. Being able to diagnose the problem depends on the patient giving complete info. Therefore that info must include a correct history and a clear statement of symptoms.
Some simple things that can be done to increase the chances of the doctor making the correct diagnosis are:
Lack of Differential Diagnosis
Getting to the bottom of what is going on with the patient may be a matter of putting many things in the target zone. The goal is to cross out all but one of them. That can’t be done if the correct one was never in the target zone. The crossing out is based on exams of the patient, tests and films.
In an article in The Washington Post by Sandra Boodman, she reports that diagnoses are missed, wrong or delayed in 10-20% of the cases. Likewise a 2009 report funded by the U.S. found that 28% of 583 diagnostic mistakes were life-threatening or resulted in long term problems. In 1991 the Harvard Medical Practice Study found that misdiagnosis was a cause of 14% of adverse events. In addition it reported that 75% of these errors involved fault of the doctor.
Many misdiagnosis issues are never detected. Many of them go undiscovered for years until they cause some problem. Call, or contact us for a free consult.
Differential Diagnosis in the Emergency Room
There is no question that the emergency room is a prime place for a misdiagnosis. In that setting the doctor is seeing the patient for the first time. In addition the patient may not give a complete history. Also the doctor is short on time. In other words you have the basics for a bad outcome.
A VA study reported that more than half a billion primary care visits occur each year in the United States. Also it noted at least 500,000 missed diagnostic chances occur each year at primary care visits. Many of them result in harm.
Misdiagnosis Examples
A research team from Johns Hopkins University School of Medicine analyzed data from the National Practitioner Data Bank. This bank is maintained by the U.S. Hopkins reported on the primary cause of medical malpractice claims. In this study they examined 25 years of malpractice payments as reported through the data bank. Furthermore what they found was that misdiagnosis was the most common, the most costly and also the most deadly of all medical errors. The research team reviewed 350,000 different malpractice cases.
In 41% of the misdiagnoses the result was patient death. The average payment for these successful misdiagnosis cases was $389,000. The highest category of claims were obstetrical claims which averaged $695,000.
Multitude of Misdiagnoses
Examples of serious cases of misdiagnoses include mistaking an ectopic pregnancy for appendicitis, mistaking an aortic dissection for severe heartburn. In addition there was mistaking a brain stem stroke for an episode of being dizzy.
To some extent the fear of misdiagnosis has led doctors to over treat. This is seen in emergency rooms where people come in complaining of dizziness. As a result they may get a CT scan of the head. Nationwide these scans cost millions of dollars. In most cases they are useless. Call, or contact us for a free consult.
Commonly Misdiagnosed Illnesses
Commonly misdiagnosed illnesses include such conditions as lupus, celiac disease, fibromyalgia, multiple sclerosis, and Lyme disease. Many of these conditions carry somewhat similar symptoms.
Lupus
Lupus is a chronic inflammatory disease. It carries with it symptoms of fatigue, rash, joint pain and kidney, heart and lung damage. The tests to make a proper diagnosis are complete blood count, chest X-ray and specific DNA testing. In addition various cell testing may be fairly definitive in making the diagnosis.
Celiac
Celiac disease is an autoimmune disorder where the person cannot digest gluten. The symptoms are vomiting, abdominal pain, bloating, diarrhea, weight loss, anemia and leg cramps. The tests to make the diagnosis are blood tests looking for certain antibodies, plus small intestine biopsy and DNA testing.
Fibromyalgia
Fibromyalgia is a chronic arthritis like disorder with widespread pain. There is no definitive test available. A diagnosis is made when the patient reports a history of widespread pain lasting more than three months and the presence of at least eleven tender points that are extremely sensitive to pain.
MS
Multiple Sclerosis is a progressive autoimmune disease. It attacks the central nervous system. In addition it produces muscle spasms, lack of coordination, balance problems, blurred vision, and cognitive impairment. The tests to make the diagnosis are blood tests to rule out other disorders, a lumbar puncture, and an MRI.
Lyme Disease
Lyme disease is an infection that is caused by a tick bite. It produces symptoms of shortness of breath, chest or rib soreness, abdominal cramping, and nausea. In addition there may be symptoms of vomiting, a rash at the site of the bite, neck stiffness, and twitching of the face or eyelids. If there is no rash visible then there is a two-step blood antibody test that may make a diagnosis. Also see the post on this site on Lyme disease.
Fatigue
Chronic fatigue syndrome has long been a subject of debate among doctors. The symptoms can include constant pain, difficulty concentrating and extreme exhaustion. Any personal injury attorney handling a case with a plaintiff who has chronic fatigue needs to appreciate the effect that physical injury can have on these people.
For years people complaining of these symptoms have been subject to ostracism. Some doctors doubt the overall diagnosis.
Many doctors believe there can be different causes of these symptoms. They may include viruses and genetic problems. Some doctors still believe the condition is psychiatric.
In 2010 a committee of the Food and Drug Administration recommended that people with chronic fatigue syndrome be barred from donating blood. Its bona fide existence has received some validation from this.
Chronic fatigue syndrome is not the only illness that has not been taken seriously. Multiple sclerosis was treated as hysteria or chronic alcoholism. Today it is recognized as an auto-immune disease. In addition stomach ulcers were thought to be caused by stress. Later doctors proved that a bacteria was the cause. Call, or contact us for a free consult.
Malpractice Cases-Unnecessary Procedures
Hip replacement surgery has become the bread and butter of many orthopedic surgeons. Many of these are unnecessary. Hip pain, where there is no arthritis typically is a clue to the fact that a new hip may not be needed.
The cause of many hip symptoms is that the ball and socket in the hip do not fit. This is called impingement. It is like putting a square peg into a round hole. The ball of the hip bone puts extra pressure on the rim of the socket. This rim is called the labrum. The socket is encircled with cartilage which provides cushion between the two bones. When that cushion breaks down as a result of the ball not properly fitting it produces pain.
To repair this the surgeon makes half-inch incisions around the hip and then re-contours the ball into a round shape. That way it fits into the hip socket. Next the cushion around the socket is repaired. Finally it is secured onto the bone with stitches that anchor it. As a result there should now be a perfect match between ball and socket.
This type of repair is done outpatient. The patient can go home that day.
Expenses Not Needed
A hip replacement may have served the same purpose as this hip repair. However the hip replacement is more dramatic. It also costs much more. Hip repair in a case where the hip bone is simply a little too big for the socket is the preferred course of action.
However even before this hip repair is done the first course of action is injections. These are designed to reduce inflammation. They are followed by physical therapy. That may solve the problem. However if the hip bone is too big for the socket then some repair is needed.
Anterior Hip Replacement
Every year approximately 300,000 people undergo hip replacements in the U.S. Many of these are posterior where the surgeon enters the joint from the rear.
Another procedure allows entry from the front. This avoids the cutting of muscles and tissues that are part of the posterior entry. Through the anterior entry the muscles are stretched aside. It minimizes any pain from such cutting.
This approach is minimally invasive. As a result most patients are up and walking either the day of surgery or shortly thereafter.
In addition an X-ray can be taken while the surgical site is still open. This allows changes to the placement of the new hip. Although X-rays can be taken during the posterior procedure, it is much more difficult. However most surgeons wait until the patient is in the recovery room before reviewing the X-ray. However at that point it is too late to make changes.
Call, or contact us for a free consult.
Knee Replacement
Knee replacement surgery is needed when the cushion between the bones has worn down. That cushion between the bones is the cartilage. The knee bones themselves are held in place through ligaments that tie the bones together and keep you stable as you walk or run.
This surgery involves the removal of the damaged bone and the placement of metal components. Also a metal plate in placed to have a smooth surface for the bones to glide across.
Bilateral Knee Replacement
A double knee replacement may seem like a lot. However it is becoming more common. The plus of doing both knees is that only one surgery is necessary. In addition there is only one rehab needed. However these patients must be in good health, have equally severe arthritic pain in both knees and be younger than 80 years of age.
The knee implants that are used today are more durable than years ago. Ninety percent (90%) of them will last more than 20 years.
Knee Replacement and Physical Conditioning
It is important prior to a dual knee replacement that the patient be in good shape. This involves working the knee muscles. The muscles should also be stretched in order to improve range of motion.
The need for this surgery is always case specific. It should be gauged not just on function but on pain level. The surgery is open and more often than not is being performed on senior citizens. It carries with it the risks of infection, difficulty with rehab, potential cross-addictions and all of the other problems of old age.
