say what you want about whether holding anticoagulants for ESIs is medically "correct", easily more than half of injectionists still hold them. of the 10 injectionists in my group over the last 20 years, every one of them recommended holding blood thinners.
Plavix before epidural
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My question as well. If you follow guidelines and checked with other docs, I don't see how you can be found negligent no matter how good the attorney is. I have seen some crazy things in court cases and in the medical board room but have never seen this.
Yeah....and that is the problem if you don't hold them. Standard of care is considered what the docs in the community do and what their societies say. The vast majority of the docs in my area consult with prescriber and hold thinners. Some even still hold for MBBs and RFAs.
In the end we are talking about a rare complication no matter what you do. You can be defended either way but I can tell you that it is hell of a lot more comfortable when you are following the "community standard" and the standard set by your society. That comes from someone who does a lot of defense work.
Its funny. I did get a call from a plaintiff attorney on a SCS case concerning thinners that he wanted me to take (found my name somewhere). He told me that it was 4-6 hours of work and they would pay me $25000 plus more if I had to go to court. Man...it was hard to say no but I did. I just cant do plaintiff malpractice work. I don't think I could sleep at night but it obviously doesn't bother some people. I referred him to a guy that I know that does this work. I am sure that I made his day.
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Cards ok with stopping plavix for dead guy.
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Preventable death.
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I often wonder if getting cardiac clearance to stop meds is pointless. I mean most likely they’ll sue both the cards and pain doc and both will settle out of court or lose. They’re going to include as many as they can in the case and probably equally implicate all parties. Lawyers are dirty
We are all perseverating but it is rare either way.
You guys do what you want. If you live in my area, you would be in the minority (an ultra minority) for doing epidurals on plavix. I just don't think that is a good place to be but to each his own.
You guys do what you want. If you live in my area, you would be in the minority (an ultra minority) for doing epidurals on plavix. I just don't think that is a good place to be but to each his own.
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If you live in my area, you would be in the minority (an ultra minority) for doing intadiscal ozone and laser therapy. I just don't think that is a good place to be but to each his own.
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Stents placed 5 years prior and need for Plavix at this point was judgement call and not a necessity. Rebound hyper coagulation.
But there is not a position statement from our society as there is on holding blood thinners. There are multiple RCTs supporting both of those treatments even if you find them personally objectionable....so really not the same argument.
In the courtroom, professional society opinions usually trump community preference.
If both are in line against you as in this issue, then that is likely worse but I am sure your will disagree.
Really unfortunate case. I have trouble seeing negligence but of course I know nothing about the case other than the few things mentioned.
For my own knowledge especially in my expert work, I would like to review this case and it should be public record. Please PM me and send me name of at least one litigant when you have a minute and I will look it up.
Thanks.
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I do not think there was actual negligence. But a dead guy. And great lawyering.
CleanUp
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I think you’re really getting hung up on the community part correlating to the standard of practice. Are you suggesting that there will be some magical poll where all the physicians get subpoenaed? Is the community standard 50%? Is it 49%? What happens when there is one vote that carries more weight such as an expert? Of course you know that defense will hire someone that I am describing.
Is your area a 5 mile radius? 10 mile radius? Statewide? You get what I’m going for.
The point is the mere fact that we are arguing over the standard of practice supports the fact that this is not a black-and-white issue. And therefore picking the more proactive side is not necessarily malpractice.
I accept the fact that anything could happen in the court of law.
If you have the case, I would like to review for my own edification. Just need one of the parties.
Thanks...feel free to PM
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On a side note, are ppl doing ppx abx with stents? My partner does. I thought there was a pain medicine fact or fiction on it but can’t find it
Its actually real simple. The medical board expert or the hired malpractice expert will simply say that "your society guidelines suggest holding blood thinners for epidurals and the vast majority of the docs in your city follow this (all of which is true). "So why is this behavior not outside of the standard of care"
I then as a defense expert are left with coming up with a defense and I am immediately put in an uphill battle. I wish that I could just say that Lobelsteve, MitchLevi and other student doctor pain physicians say otherwise but that is not going to help my client. Not saying I cant defend it but there just can't be any other thing that sticks out because then the guy is cooked.. All I am saying is that it is a lot easier for me and others like me if the accused is following the guidelines. I really am having trouble understanding why any of this is controversial or hard to understand.
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Nope.
For what procedure is he doing abx other than pre-op?
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I don't think that anyone is actually saying you're wrong medicolegally. As an outside observer, it seems like you and Steve (and some others) are arguing separate points. You're saying that you should follow guidelines or you're harder to defend in court. That makes perfect sense.
Steve is arguing that he believes that stopping AC is a greater risk than not. When it comes to lawsuits, he has evidently been involved in cases where people did follow guidelines and were sued in part or entirely because they followed those guidelines.
The most recent comment you replied to is obviously geography dependent. There are undoubtedly parts of the country where basically everyone holds AC and places where it's more of a mix. I don't doubt that you could make the argument in areas where you're part of the 10% that doesn't hold it that this makes you harder to defend. In more of a mixed environment, this goes back to the society guidelines argument as above.
My question (likely unanswerable) is: what's medicolegally safer? Having someone stop AC with the blessing of neuro/cards and then getting sued when something bad happens? Or having someone continue AC and documenting the risk/benefit discussion with the patient and then getting sued when something bad happens?
My takeaway: You're likely f***ed no matter what if you have a sympathetic plaintiff with a good lawyer regardless of what you did or didn't do.
Personally, I'm in the camp of following the guidelines, getting cards/neuro/whoever to sign off and having a thorough risk/benefit discussion with the patient about doing so while reminding them that everything that I do is elective. After hearing Steve's stories, I will likely be documenting significantly more aggressively about the risks of holding AC than I might have previously.
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same. did not have to be admitted. took months to resolve. was from the diagnostic injection.
most importantly, establish and maintain good rapport with the patient and their family so that they have no interest in suing you.
s&!t happens.
Good points....
I am not saying that I don't believe Steve but I have not seen any case where a jury or a medical board was able to prove negligence on someone who followed accepted guidelines. When they have, there were other intervening circumstances.
I don't pretend to know everything about medical legal outcomes in all states, but I have been doing this work for over 15 years and I have seen more than my fair share of cases. For this reason I have asked Steve to give me the plaintiff or any party in the case he mentions.
If I see that there was in fact an adverse judgement in a case where someone followed the guidelines but got a poor outcome, then obviously I will need to change my advice. I have not seen it yet.
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In malpractice, there has to be damages so obviously all of your cases had something catastrophic happen to the patient from a failure to timely diagnose and treat.
The literature states epidural hematomas can still develop up to two weeks after insult. In your review of cases, how long did it take for them to develop?
Most were in the first 12 to 48 hours