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The Dangers of Coumadin

Halli Brownfield — Mon, 05 Jan 2009 09:37:41 GMT

Spangenberg partners, Rhonda Baker Debevec and Stuart Scott, recently handled two separate malpractice cases for clients who suffered severe bleeding complications related to a commonly prescribed anti-coagulant or “blood-thinner” called Coumadin. This medication – also sometimes called Warfarin – is prescribed for medical conditions that increase the patient’s risk for forming potentially fatal blood clots like atrial fibrillation (an abnormal heart rhythm) and deep vein thrombosis (DVT). By inhibiting the blood’s complex clotting or coagulation mechanism, Coumadin prevents the formation of new clots and the growth or extension of old clots.

To test whether appropriate amounts of Coumadin have been prescribed, the prescribing physician must carefully and consistently monitor the patient’s blood for its anticoagulation or INR (International Normalized Ratio) level. If the level is too low, the patient is once again at risk for blood clot formation. If the level is too high, the patient’s risk for severe internal bleeding, hemorrhagic stroke, and death is increased. While Coumadin is an effective treatment, it can also be extremely dangerous for several reasons. First, the therapeutic range for this medication is quite narrow. In other words, the difference between a safe level of Coumadin and a dangerously high level is quite small. Second, several different factors can magnify the medication’s blood thinning properties including the patient’s liver and kidney function, diet, alcohol consumption, age, and prior medical history. As such to maximize patient safety, prescribing physicians must provide dietary guidance to their patients and properly educate them about this drug and its potentially dangerous side effects. Equally critical, physicians must be on the alert for signs and symptoms of excessive blood thinning and know how to appropriately manage it. If a patient’s blood test reveals an excessively high INR level and/or the patient has active bleeding, this is a medical emergency requiring immediate hospitalization and rapid reversal of the Coumadin’s anticoagulant effect with intravenous medication.

In the case handled by Mr. Scott, the patient’s blood-work revealed an abnormally high level of INR or in layman’s terms that the blood was too thin. Moreover, the patient also had blood in his urine which can be an indication of internal bleeding. Instead of informing his patient that he had a life-threatening overdose of Coumadin requiring immediate hospitalization, the Defendant doctor merely told the patient to stop taking Coumadin over the weekend and come into the office on Monday for a repeat test. Left untreated, the patient suffered a severe hemorrhagic or bleeding stroke on Saturday which left him permanently and functionally disabled. Had his physician appropriately provided immediate treatment, the patient’s stroke probably would have been averted. Unfortunately, this particular physician was unaware that rapid reversal treatment for Coumadin overdose existed until after the patient’s stroke. Through the efforts of Mr. Scott, the case was settled at a confidential mediation.

Similarly, in the case handled by Ms. Debevec, blood tests showed that the patient’s INR was exceedingly high and that the patient’s risk of suffering from spontaneous internal bleeding was likewise exceedingly high. Rather than treating the situation as a life-threatening medical emergency, the treating doctor instructed the patient to discontinue her Coumadin, failed to re-check her blood and did not administer the life-saving medication to counteract the Coumadin’s effects. As a result, she suffered internal bleeding and passed away in her home a few days later. This matter was also resolved in a confidential proceeding.

As both of these cases illustrate, the proper management of patients on Coumadin therapy is critically important to patient safety. While some bleeding complications from Coumadin therapy may be unavoidable, many are preventable with effective and competent management. If you or your loved one has been prescribed this medication, please take the medication exactly as prescribed and consult your medical professional to learn more about how to maximize your safety while taking this beneficial medication. If you or your loved one has suffered a bleeding complication from the improper administration and/or management of Coumadin (Warfarin), please contact us to learn whether you may have potential recourse against the prescribing physician.

Originally posted at InjuryBoard by Halli Brownfield

Nurse to Patient Ratios and Quality Health Care in Ohio

Nick DiCello — Wed, 30 Jul 2008 10:43:51 GMT

In 2004, California passed a law setting minimum nurse to patient ratios for hospitals. The law was passed in response to studies and data suggesting that the more patients a nurse has to care for, the more likely one of his or her patients will receive substandard care and attention, and suffer injury, complications, or even die. California's law establishes minimum nurse to patient ratios, in part based upon the level of care required in any given hospital unit. For example, nurses working in critical care units will be assigned to less patients than a nurse working in a unit with patients who have less serious and/or complicated medical conditions and/or who require less monitoring or care. While the ratios fluctuate depending on the type of unit staffed, the maximum nurse to patient ratio allowed in California is one nurse for every four patients. This is a significant improvement over nurse to patient ratios in several Ohio hospitals.

The debate over nurse to patient ratios is a controversial one. Most hospitals claim lower nurse to patient ratios are unnecessary and that laws that define minimum ratios will drive up the already high cost of health care for everyone. Proponents of mandated nurse to patient ratios disagree and suggest that better nursing care will reduce cost by reducing injuries and complications. Furthermore, and more importatnlty, proponents of mandated nurse to patient ratios argue that patient safety necessitates legislation establishing nurse to patient ratios in the hospital setting.

Nurses in Ohio are proposing legislation, in part in response to what they claim to be inadequate legislation already in place. The proposal is nearly ready and is called the Ohio Patient Safety Protection Act of 2008. Proponents of the legislation are hoping Ohio legislators will introduce the Act later this year.

The Cleveland Plain Dealer's Diane Suchetka recently published an article addressing nurse to patient ratios in Ohio and describing efforts to pass the Ohio Patient Protection Safety Act of 2008. See her story. Diane chronicles some of the several e-mails and stories she received about the "horrors" expereinced in Ohio hospitals due to inadequate nursing staff and attention. What is interesting about Diane's article is that she heard from several nurses, many of whom strongly agree that nurse to patient ratios, sometimes as high as one nurse to every 10 or 12 patients, are dangerously high in too many hospitals in Ohio. Some nurses have even left the profession because they are fed up with an inadequate system.

Inadequate nursing staffing patterns place all of us at risk. Furthermore, it places unreasonable burdens on our nursing professionals. Nurses are an integral part of our hospital and health care systems. Indeed, nurses are the caregiver's direct contact with the patient. Hospitals should be staffed with an adequate number of nurses and nurses should not be overloaded with patients. Adequate staffing cannot be viewed as a business decision. Instead it must be viewed, as succinctly stated by the proponents of the proposed new legislation, as a patient safety issue.

Originally posted at InjuryBoard by Nick DiCello

Hospital Acquired Infection Lawsuits on the Rise

Halli Brownfield — Tue, 02 Dec 2008 11:30:40 GMT

The Wisconsin Law Journal reports that a new type of medical malpractice lawsuits are on the rise. These suits allege hospital negligence in failing to prevent hospital acquired infections. Multi-million dollar awards have been reported in these types of cases. Last month, a jury awarded a $13.5 million verdict involving a Massachusetts woman who died from a flesh eating bacterial infection she acquired while undergoing cancer treatment. A Utah woman also entered into a confidential $16 million settlement last month to resolve a lawsuit she filed alleging that a hospital failed to catch a flesh-eating bacteria that caused her to lose three limbs and several organs.

Lawyers and the medical community are debunking the myth that these infections are not preventable. The Centers for Disease and Prevention Control (CDC) estimates that over 2 million hospital acquired infections occur annually and are responsbile for 90,000 deaths. While not all these infections are necessarily the resut of negligence, the founder and chair of the non-profit patient safety organization Committee to Reduce Infection Deaths, Betsy McCaughy, has explained that "the evidence is overwhelming that nearly all infections are preventable."

The standard of care governing prevention of these infections is evolving. The CDC has published guidelines for preventing these infections. Another non-profit that evalutes and accredits health care programs, the Joint Commission, has released its own set of strategies for preventing infections. As Ms. McCaughy puts it, "hospitals that don't follow the proven protocols are inviting lawsuits."

For more information, see

http://wislawjournal.com/article.cfm/2008/12/01/Hospital-infections-spread-so-do-lawsuits

Originally posted at InjuryBoard by Halli Brownfield

Medicare, Others Won't Pay for Medical Errors

Nick DiCello — Fri, 03 Oct 2008 14:59:51 GMT

The Centers for Medicare and Medicaid Services (CMS) will no longer pay for care resulting from certain medical errors widely seen as preventable, including certain "never events." For example, Medicare will not pay a hospital or physician for a surgical procedure performed on the wrong patient or on the wrong body part. Nor will Medicare pay for procedures requred to remove foreign bodies, like sponges, left inside patients during surgeries. Additional events, including certain infections, injuries from falls, and serious bed sores have also made the list of conditions for which Medicare will no longer pay. Furthermore, hospitals are not permitted to charge the patients who have been harmed by these errors.

Finally... instead of rewarding hospitals for the quantity of procedures performed, our health care system, even if only a little bit, is beginning to recognize the need to reward quality of care and prevention. This is a most welcome initiative by Medicare. Some state Medicaid programs have instituted similar initiatives, and private insurers are likely to consider following suit.

While some of the occurrences/conditions on the list certainly should never happen, sending a a baby home with the wrong parents for example, accidents do happen. We all make mistakes, and when we do, we must take responsibility. Now in the health care industry, at least from Medicare's perspective, the providers who make certain preventable mistakes are held accountable like the rest of us. None of us would pay our auto mechanic to replace the windshield he accidentally cracked while adjusting our brakes. And while this is probably a poor analogy, the underlying principal and policy is the same as that espoused by Medicare's recent policy change.

Hopefully measures like the one now in place at Medicare will proliferate and help to make our health care system safer and more efficient for everyone.

Originally posted at InjuryBoard by Nick DiCello

How do I know if I have a medical malpractice case?

Halli Brownfield — Fri, 23 May 2008 14:23:05 GMT

Determining whether someone has a case for medical malpractice can be a complex and costly process. Some medical errors are obvious. Examples of these obvious mistakes are surgical instruments left inside a patient or amputating a perfectly healthy right foot when it was the left foot that should have been amputated. Nobody needs to go to medical school to understand these are obvious mistakes. However, most instances of malpractice are far less obvious. Just because you experienced an unusual complication does not mean your doctor did anything wrong. Sometimes surgeries have bad results that could not have been prevented no matter how careful the doctor was. Other bad outcomes can result even from the most skillful medical care. So how do you know if you were the victim of medical negligence?

The first thing you must do is contact a lawyer. Medical malpratice lawsuits, like all types of lawsuits, are subject to a statute of limitations. A statute of limitations sets forth the amount of time someone has to bring a lawsuit after they have been injured. If suit is not brought within that period of time, no lawsuit may ever be brought. Statutes of limitations vary from state to state. In Ohio, the statute of limitations for medical malpractice actions is one year. While this may seem like plenty of time to contact a lawyer and file a lawsuit, as you will see, it is not much time at all.

Once you have made the first step of contacting a lawyer, that lawyer must investigate the merits of your potential case. In other words, he or she must determine whether medical negligence has occured. While the investigation process varies from lawyer to lawyer and from case to case, there are several steps to most investigations. First, your lawyer will have to get all of your relevant medical records. This may involve requesting records from multiple doctors and hospitals. This process can be very expensive and takes time. These records are not free and you will have to pay to have your health care provider retrieve your records, copy them, and send them to your lawyer. This can cost hundreds of dollars. It can also take months from the time your lawyer requests your medical records before he or she receives them.

Once your lawyer receives all your records, someone with an understanding of medicine must review them. Sometimes an experienced malpractice lawyer can tell from his or her own review of the records that malpractice has or has not occured. Frequently, however, a lawyer must have either a nurse or even another doctor review those records. These nurses and doctors charge for their time. Finding someone qualified to review your case and waiting for their availability can also cause delays.

Another factor that will influence your lawyer's decision to file suit is how much it will cost to get your case ready for trial and how much money a jury is likely to award you for your injuries. Even if a doctor has clearly committed malpractice, the cost of the suit may not be justified by your potential recovery. Preparing a malpractice case for trial is expensive. During the phase of a lawsuit known as discovery, both sides will inevitably have to hire experts and conduct costly depositions. If your lawyer estimates that an expert will cost $7,000, other expenses will be around $20,000, and the most a jury will ever award you for your injuries is $15,000, it will not make any economic sense to bring the suit.

If you think you may have been the victim of medical negligence, contact a lawyer immediately. Calling a lawyer with just one month before the statute of limitations expires is usually not enough time for a lawyer to examine your case and file suit. Also be prepared to provide your lawyer information like the dates you were treated, who treated you and at what hospitals and doctors offices. The more time and the more information you can provide your lawyer the better.

Originally posted at InjuryBoard by Halli Brownfield

Apologies from Doctors for Medical Errors Reduce Lawsuits

Nick DiCello — Wed, 21 May 2008 21:26:01 GMT

People who believe they have been injured by another's negligence or reckless conduct often want an apology from the responsible party. Too often, however, as a lawyer, I have to advise clients that the civil justice system does not compel apologies or acknowledgement of wrongdoing, and that if they are looking for an apology, they won't get one by way of a lawsuit. Rather, justice is only available in monetary or equitable compensation. Given the adversary nature of the civil justice system, apologies and admissions are hardly ever voluntarily offered, or judicially compeled, to the injured. Indeed, even at trial, the "Perry Mason moments," when the witness spills it all on the stand, never actually happen.

The phrase "we all make mistakes" is entrenched in our culture and taught to all of us from a young age. Indeed, we all do make mistakes. Why then, in the context of injured persons seeking redress for mistakes, are we so reluctant to admit what we all know - that all of us make mistakes? There are several reasons those accused of injuring someone refuse to apologize, even where the evidence may be overwhelming or when the accused believes he or she made a mistake or is responsible, if at least in part. Primary among them is that an apology can be interpreted as an admission of negligence or wrongdoing, and perhaps an invitation for litigation or a powerful piece of evidence later on if the matter goes to court. Accordingly, corporations and insurance carriers generally advise against apologizing or taking responsibility.

Recently, however, there has been a movement among some hospitals and doctors to implement a policy of promptly disclosing medical errors and offering sincere apologies and fair compensation. Of course, doctors have an ethical obligation to disclose medical errors, but, what a refreshing approach in a culture of "deny and defend." This approach is radical in the eyes of many, however, if you were to ask a young child what he or she is taught to do when he or she makes a mistake, that child would most likely tell you what he or she learned from his or her parents - tell the truth, take responsiblity and try to make it right (think of the young Beaver Cleaver retrieving the baseball from his neighbor's living room).

As evidence that this approach, implemented by some highly respected medical institutions such as Johns Hopkins, Stanford and the University of Illinois Medical Center, is consistent with our generally held values, promptly admitting medical errors, apologizing to the patient and offering fair compensation seems to be resulting in less lawsuits filed against these institutions and their doctors. For example, since implementing the policy at the University of Michigan Health System, existing claims and lawsuits dropped to 83 in August, 2007, down from 262 in August, 2001 according to the Medical Center's Chief Risk Officer. See http://search.cleveland.com/sp?aff=100&keywords=doctors+apologize+for+errors.

Not only have the number of claims and suits gone down at hospitals implementing this approach of prompt and full disclosure, but because settlements are being negotiated early, the cost for everyone involved is significantly reduced by avoiding litigation.

Unfortunately, as is the case with every profession and every field, errors and mistakes occur. In the medical field, errors and mistakes often result in injuries. This is why doctors and hospitals have insurance and are required to have insurance - because mistakes do happen. Recent studies have demonstrated that one of every 100 hospital patients suffers negligent treatment and that as many as 98,000 people die every year due to medical errors and negligent treatment. Studies also show, however, that as few as 30 percent of medical errors are disclosed to patients. Finally, only a very small fraction of those injured by negligent medical care - some studies suggest as low as 2% - actually pursue legal claims. See http://search.cleveland.com/sp?aff=100&keywords=doctors+apologize+for+errors.

Institutions implementing this approach of promptly disclosing medical errors, issuing apologies and offering compensation should be applauded. However, when analyzed from another perspective, it is disappointing that this approach is considered revolutionary. After all, all this approach boils down to is taking responsibility and doing the right thing. We should not just applaud those who do take responsibility for their mistakes, we should demand it from everyone, including our doctors.

Originally posted at InjuryBoard by Nick DiCello

Class Action Settlement Reached in Lawsuit Over Human Tissue Samples

Jack Landskroner — Sat, 07 Apr 2007 10:41:37 GMT

Previously I have blogged about the cases we are handing on behalf of recipients of transplanted human tissue stolen from cadavers without authorization from the deceased or consent from their family members. In these cases, the billion dollar a year human tissue industry shortcutted required screening processes which would have revealed that many of the unwitting tissue donors were not viable donors. As a result the recipients are now at risk for multiple infectious diseases. This, however, is not the only circumstance where surviving families have been mislead as to their loved ones remains.

A former Los Alamos pathologist has agreed to pay $800,000 in a final settlement over tissue samples taken in secret from hundreds of bodies at Los Alamos Medical Center in a Cold War-era study into radiation. Stewart was involved in a program in which pathologists at the hospital provided Los Alamos National Laboratory with tissue samples from hearts, livers, brains and other organs. Families who signed autopsy release forms were not told of the study nor were they told the tissue would end up in the hands of government scientists, the lawsuit said. The medical center and the University of California, which ran the lab at the time, agreed to settle their part of the lawsuit in 2001. More than 400 families shared $9.5 million under that settlement.

The bottom line is that it is illegal for any person or institution to alter the state of a deceased loved one without the written consent of the deceased or authorization from the surviving heirs.

Originally posted at InjuryBoard by Jack Landskroner

Patient Abuse Leads to Probation for University Hospitals of Cleveland

Jack Landskroner — Sat, 26 May 2007 09:35:38 GMT

The pyschiatric unit of University Hospitals of Cleveland was placed on probation by the Ohio Department of Mental Health after a grand jury indicted Herman Brown, a UH employee since April of this year, on multiple counts of rape, kidnapping, gross sexual imposition and sexual battery. "The hospital on May 18 acknowledged the rape of one patient after Brown's arrest. But the Ohio Department of Mental Health said Friday that four patients were sexually assaulted."

The state agency has put UH on probation, citing its failure to provide patient safety, staff supervision or appropriate background checks of workers.
Brown had worked at the hospital since April even though prior felony convictions should have prevented him from working there. The hospital said a temporary agency that provided Brown failed to conduct a proper background check.

State law requires that individuals employed in a capacity such as Mr. Brown, must clear a criminal background check before they are offered a position. In particular, this is a necessity when an employee will be exposed to and trusted with the care of vulnerable patients in an unstable mental or emotional state. Most mental health professionals would agree that this is a necessary safeguard which should always be followed. In this situation, Mr. Brown had a felony record and under no circumstances should he have been offered the position or the opportunity he was given by University Hospitals which provided him the unsupervised access to the victims. It is the very reason the laws requiring employment screening and background checks were put into place.

The fact that UH was relying on an employment agency does not excuse the hospital from responsibility for the injuries suffered by these innocent victims. Both the agency and University Hospitals should step up and right this wrong. Both entities must provide full public disclosure as to the circumstances of just how this reckless error occurred in order to assure steps can be taken preventing such a grave error from occurring again. The agency and hospital must also address the harm done, in accord with state law, by compensating the victims appropriately for the harm they have suffered including the cost of treatment to date, the pain they have experienced and their mental anguish as well as for their future needs including the necessary treatment and care required to heal these open wounds from the incident and to learn to live with the ugly scars which they will carry with them indefinitely.

Originally posted at InjuryBoard by Jack Landskroner

Doctors Get Immunity - Victims of Medical Malpractice Get the Shaft

Jack Landskroner — Thu, 14 Dec 2006 09:19:51 GMT

The Ohio Supreme Court issued its opinion this week in Theobald .v University of Cincinnati, granting blanket immunity from liability to physicians for their negligent acts when the medical malpractice occurs while the physician is teaching medical students or residents of a state medical school. It makes no difference whether the doctor is being paid privately or whether the doctor is acting outside of his official teaching capacity when the malpractice is committed. The bottom line is that the doctor may now be immune from suit and from accountability whenever a student is present during a medical procedure.

This decision overturns a prior ruling by the Ohio Court of Claims which had previously determined that doctors paid by private practice groups or who are acting outside of the scope of their employment when negligence occurs are not immune from liability for their negligent acts.

The effects of this decision will be chilling on patients injured by medical malpractice. Victims will now be forced to pursue the State of Ohio for damages rather than the negligent physicians effectively shifting the burden of malpractice from the physician and his insurance company on to taxpayers. Cases against the State must also be brought in the Court of Claims in Columbus rather than where the negligence occurred creating additional and unnecessary cost for patients. Finally, injured patients must forego their right to a jury trial when the Court of Claims hears the case.

Originally posted at InjuryBoard by Jack Landskroner

Rise in c. diff cases is concern

Justin Madden — Thu, 22 Mar 2007 09:45:07 GMT

When doctors prescribe antibiotics such as clindamycin, patients need to be alert and concerned about c. diff. When antibiotics overwhelm the bacteria in the colon, a patient can become severely sick and dehydrated, and the colon can suffer. C. diff, if not addressed, can prove fatal. There are occasions where c. diff is the result of medical malpractice.

When prescribed powerful anti-biotics, ask your doctor many questions about what to do if diahrea, and flu-like symptoms, present. Be certain family memebers or a neighbor is aware that you are on theis medication so that they

Originally posted at InjuryBoard by Justin Madden