Why Do Emergency Physicians Practice Defensive Medicine?

Discussion in 'Emergency Medicine' started by southerndoc, Apr 7, 2004.

  1. southerndoc

    southerndoc life is good
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    One poster in a recent thread accused emergency physicians of practicing defensive medicine -- ordering unnecessary tests just to cover their tails.

    Here's why EP's and many other physicians practice defensive medicine: http://www.ama-assn.org/amednews/2004/04/12/prca0412.htm


    Physicians found negligent for not performing CT scan
    In the Courts. By Tanya Albert, AMNews staff. April 12, 2004.

    The federal government estimates that defensive medicine costs $70 billion to $126 billion annually, but any effort to stem the tide of "just-in-case" blood tests, x-rays, CT scans or MRIs could be stymied by a recent $5 million jury award in Maryland.

    A family sued their infant's pediatrician, an emergency department physician and an on-call pediatrician at the hospital for not ordering a CT scan. To the doctors, the 11-month-old boy appeared normal and in no need of the test.

    But after the infant had more serious injuries resulting from an incident at his babysitter's home a couple of weeks later, the parents faulted the physicians for not ordering the CT scan they believe would have shown the boy was being abused.

    While a plaintiff's attorney says the February Charles County verdict shouldn't send physicians running to order CT scans for every child that comes in with a head injury, many doctors say that's the exact effect the ruling could have.

    The babysitter originally brought the baby, Jack, to his pediatrician's office around noon on Nov. 18, 1998. The infant's mother met the two there. The babysitter told the doctor that the infant hit his head on the floor.

    The pediatrician didn't see any signs of injury -- no bleeding, no bruises. The boy appeared alert and neurologically normal. The infant didn't have a history that would lead the physician to suspect child abuse. The pediatrician sent the infant home with his mother, Robyn Sprague. He told her to keep an eye on the boy and call if there were any concerns.

    When her husband John came home from work, he agreed with Robyn that the boy wasn't his usual energetic self. They phoned the pediatrician who saw Jack earlier in the day; he told them to take the infant to the emergency department.

    The Spragues said they believed they were going to the hospital to get the CT scan because their pediatrician wanted it and because their infant was not behaving the way he normally did.

    But, the three physicians told jurors there was no reason to order the scan because the infant showed no signs of trauma that would call for the test. According to the physicians' attorney, Jack's pediatrician said he would call ahead to let the emergency department know that the family would be arriving and that the infant may need a CT scan so the machine would be ready in the event it was needed. Jack's pediatrician could not order the CT scan; that would have to be done after the infant was seen by doctors in the ED, according to the physicians' attorney, A. Gwynn Bowie Jr.

    The emergency physician examined Jack and then called the on-call pediatrician to examine the boy. Similar to the boy's pediatrician, neither of the doctors in the ED saw outward signs of injury, and neurologically the boy seemed healthy, Bowie said.

    The emergency physician described the infant as playful, bright and engaging, and the pediatrician described him as alert and active, according to the physicians' attorney. An ED nurse also described Jack as playful and active.

    The CT order that the emergency physician wrote after the infant arrived at the ED was canceled. The boy was discharged, and his parents were advised to follow up with their private pediatrician in a couple of days. When they followed up, the pediatrician found nothing wrong with the boy, Bowie said.

    "The medical issue in this case was whether a CT scan was required in a normal child" Bowie said. "The physicians met the standard of care."

    However, the plaintiffs maintained they were expecting a CT scan because the pediatrician called ahead, which led them to believe he wanted the scan. When the Spragues arrived at the ED around 10 p.m., the emergency physician examined Jack and wrote that the infant had postconcussion disorder, according to plaintiff attorney Robert J. Weltchek. A technician talked to the parents about nursing the boy to sleep so that he would not need to be sedated for the scan, Weltchek said. The light in the room was shut off, and the mother began nursing the infant. (There was no testimony during trial from anyone working at the hospital that this took place.)

    The pediatrician on call came into the room, turned on the light and woke Jack to examine him, said Weltchek, who also said that from the parents' perspective, the pediatrician didn't spend enough time asking questions or evaluating their son.

    The pediatrician found that Jack appeared normal and canceled the CT scan, Weltchek said.

    "This was an egregious act of malpractice," Weltchek said. "It was black and white."

    The jury agreed with the plaintiffs that the physicians were negligent in not performing the CT scan and awarded damages to the family.

    The physicians, though, plan to appeal that finding. They say the situation they were presented with at the time gave them no reason to do the CT scan: A boy with no history of child abuse who reportedly fell and hit his head appeared to be normal.

    The doctors believe the verdict is based on juror sympathy. They believe they would never have faced a malpractice lawsuit if the boy hadn't been severely injured weeks later.

    Another call from the babysitter
    On Dec. 4, 1998, the babysitter reached Robyn Sprague at work and told her Jack was in the middle of the floor and not responsive. The mother told the babysitter to call 911.

    A helicopter took Jack to Washington, D.C., for emergency surgery. The neurosurgeon discovered a massive subdural hematoma caused that day. The injury left permanent disabilities.

    The babysitter was charged with child abuse. She was found guilty, but on appeal, the court threw out the verdict because of the pending case against the doctors. Her new trial has yet to take place.

    After noting that the surgeon who performed the operation Dec. 4 described a small subdural hematoma that was days to weeks old in addition to the larger one that left him disabled, the Spragues sued for malpractice.

    In addition to telling jurors that physicians were negligent for not performing a CT scan on Nov. 18, they argued that if the earlier scan were done, it would have shown the small hematoma, which would have conflicted with the report that the infant fell and hit his head, Weltchek said. The finding would have indicated shaken-baby syndrome. That, the Spragues argued, would have led to a child-abuse investigation and Jack would not have been in the babysitter's care on Dec. 4.

    But, the physicians said that's a lot of speculation.

    Plaintiffs' experts testified that the CT scan would have picked up the smaller hematoma, but defense experts questioned whether the scan would have been able to see the injury. And then there's the question of whether the smaller injury even occurred on Nov. 18 or another day.

    "The neurosurgeon said he believed the hematoma was older, but it doesn't mean it was there on Nov. 18," Bowie said.

    What's a doctor to do?
    Right now, doctors hope that an appellate court will overturn the jury verdict.

    If not, they fear they'll need to conduct every conceivable test when an injured child comes into their office or the ED.

    "You would observe the standard of care at your own peril," MedChi Executive Director T. Michael Preston said.

    But Weltchek said this case should not lead physicians to practice defensive medicine. If they're going to draw any conclusions, he said they should practice good medicine and do a CT if they believe it's warranted.

    "If anything, doctors should be outraged that the CT scan wasn't done," Weltchek said. "I would hope that they would see there is a reason behind this case being brought."
     
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  2. NinerNiner999

    NinerNiner999 Senior Member
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    What's the source on this story? The date given is April 12, 2004 and, today is April 7th. I think someone had better call those EM physicians in Maryland and warn them before the 12th hits them by surprise!!!! :D

    Seriously - IMO, defensive medicine is probably a misnomer. while many tests are ordered to cover the what-if situations, good clinical judgement, especially in an ED setting, should guide any doctor to follow through on any potentential diagnosis that crosses their mind.

    Patients usually (usually) have a good reason to come the the ED for their headaches or belly pains. While the routine cases may in fact be routine, they are usually deemed so only after the major life-threatening diagnoses (i.e. emergencies) are ruled out. This is IMO the reason for an Emergency Department, and our specialty. What one may view as "defensive medicine" in their field is actually the heart and soul of Emergency practice. I doubt that anyone who has had life-threatening illnesses caught by an EP while being worked up for "routine" illness would complain.

    The litigiousness of our society presents a catch-22 for all front-line medical providers. It is a shame that tests would be ordered for CYA type situations, but ultimately I suppose a jury would decide how we should practice medicine - as was the case with this article.

    I've always thought that physicians should make up half of a jury so we could be tried by a "jury of our peers," but I suppose the layperson will always dictate the future of medicine...
     
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  3. Kalel

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    Ironically, a radiologist was telling me that if the long-term studies eventually show a slight increase in cancer in patients have been exposed to the radiation associated with a CT scan (there probably is a really small increase that requires a really large study population to prove), patients will start suing physicians for ordering CT scans that don't show anything. It's tough to win in today's legal environment.
     
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  4. Apollyon

    Apollyon Screw the GST
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    The article does say "April 12, 2004"; the AMNews may be published on Monday, April 12, but the article available online earlier.
     
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  5. southerndoc

    southerndoc life is good
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    The source was included in the original post as a link.

    American Medical News publishes its newsletter on the web a week prior to the listed publication date on the hardcopy newsletter.

    Even the New England Journal of Medicine dates a journal AFTER it is produced.

    C'mon! Gimme a break here.
     
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  6. beyond all hope

    beyond all hope Senior Member
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    Face it, you'd rather order an extra study for 1000 patients than get sued once. I know I would. I wish medical malpractice influence didn't the way I practice, but it does.

    Sometimes you get X-rays for 'documentation' purposes. Pt comes with pain, you x-ray it because when the patient comes back with a broken bone, you can prove it wasn't broken when you saw it. Otherwise, it's your fault.

    Actually, most patients like defensive medicine. They feel better the more tests, x-rays, and treatments they get, and feel they haven't gotten their money's worth unless they get something more than a good clinical exam.

    Where I work, no one ever pays their medical bills, so the costs go right back to the taxpayer. Frankly that doesn't bother me. Eventually if defensive medicine costs enough, the taxpayers will gather together and do something about it.

    I blame the public for wanting the best medical care 24 hours a day without realizing the cost, but mostly I blame the LAWYERS who create frivolous lawsuits just to settle.
     
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  7. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    The Democratic senators, firmly funded by the American Trial Lawyers Association, voted down S. 2207 today. This will not change anytime soon...

    :mad:

    +pissed+

    :mad:

    - H
     
  8. southerndoc

    southerndoc life is good
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    Ugh, don't the Republicans control the Senate?
     
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  9. Apollyon

    Apollyon Screw the GST
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    The vote was 49-48, but 60 senators needed to vote for it for it to pass.

    And I have to echo what beyond all hope wrote; we were talking in the ED about the Ottawa ankle rules, and I concluded it could only happen in Canada, and that the rules could not be used in the US. One attending extrapolated likewise: you use the rules, send someone home with a dx of sprain (and, since you used the rules, you didn't get an x-ray), and have them follow up with ortho. As a matter of procedure, ortho gets an x-ray, there's a fracture, you didn't see it ('cause you didn't film it), and you're done.
     
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  10. mikecwru

    mikecwru M.D. = Massive Debt
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    I was talking to an attending about EBM rules and he brought up a good point: the only thing that saves money in the ED is time. You can sit and play around with an ankle or you can have the triage nurse film it, check the film, and go see the pt and dispo them quickly.

    mike
     
  11. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Yep, but the vote was on party lines (with one Repbulican defection). Passing it would have required at least 10 democratic senators to grow a set and just say "no" to their masters - the ATLA.

    Strange but true - polling indicated >80% of the population favored the bill, yet the spineless senators still claim to be representing the will of the people. What a joke! :mad:

    - H
     
  12. mrstubbs

    mrstubbs Junior Member

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    We've heard it all before, but is it possible that if the EP and pediatrician on call had thoroughly explained to the parents why they cancelled the CT- there wouldn't be a law suit? Impossible to know. Sounds like the parents were angry that 1. two doctors were telling them two different things 2. the EP and CT tech were not communicating 3. their kid was severely injured. The injury was in no way the EPs fault, but sitting in a chair for 2 minutes and engaging the parents in the discussion might have gotten him/her out of the warpath later on.
     
  13. Kalel

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    Yup, most of the studies that I have seen in malpractice have shown people sue their doctor because of things like miscommunication and because they don't like them or feel that they've been treated badly. Getting sued is not highly correlated with medical errors or negligence. I think that's one reason why everyone who comes to my ER gets percocet for their undiagnosable pain, because they leave feeling that their pain has been addressed.
     
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  14. MacGyver

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    You guys are missing the point to this story.

    In the state of Maryland, you CANNOT bring a medmal lawsuit unless you have MDs in the SAME SPECIALTY testify against the defendants.

    Who are these crackpot doctors who testified for the plaintiff? I want their ****ing names.

    Lawyers cant do a damn thing to doctors without other doctors backing their case.

    We are stabbing each other in the back via "expert" testimony. You want a villain? Take a good look at the plaintiff's medical "expert."
     
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  15. MacGyver

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    Can a lawyer explain this flawed logic to me? What a joke.

    A kid comes in with NO evidence of child abuse, other than what a potential CT scan MIGHT offer. I dispute the notion that CT scan would be definitive proof of child abuse (shaken baby syndrome) but I'll let that go for the moment.

    So this lawyer on one hand is claiming that the docs should have run a CT scan, based on HEAD INJURY ALONE WITH NO OTHER DATA. Yet in the same breath, this same idiot lawyer claims that docs shouldnt order a CT scan for every child with a head injury?

    This is ****ing pathetic.
     
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  16. southerndoc

    southerndoc life is good
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    I would like to get hold of the transcripts. It would be interesting to see who the expert witness(es) was/were.
     
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  17. KGUNNER1

    KGUNNER1 Senior Member
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    If the verdict is in, and if this is true and not one of those "urban myths", http://urbanlegends.about.com/
    then the depositions and testimony is part of the public record and you should be able to access it quiet easily.

    I have reviewed a few charts, and I'll tell you now, document, document, document. AND, read and take very seriously what the nurses write. If you don't correct or counter something you thought was wrong, then the final word is what the nurses wrote.

    If you document well, and explain your differential diagnosis and why, in your reasonable medical opinion that the patient didn't need xyz test, then you should be just fine. However, if you shotgun scan everybody, this is tranparent and the lawyers can use this against you to show that you don't know how to treat a certain disease process that ususally doesn't need a pan scan.

    Kyle
     
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  18. juddson

    juddson 3K Member
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    You have no idea how many lawsuits this sort of thing presents. The fact is that lawsuits do not spring out of a vacuum where an injury automatically leads to the courthouse. Patients understand the unknowns in medicine and ussualy are keen to sue when they feel they have been misstreated. Studies show pretty clearly that communication with patients prevents lawsuits EVEN when there is genuine malpractice.

    The other side of this coin is that you should not be so quick to blaim primarily lawyers for all of this. The fact is that because patients are NOT the ones who ultimately pay for medical care, there is a disconnect between the consumption of medical care and opportunity costs. This leads to over-consumption. You can hate lawyers all you want, but if a patient wants a CT scan (because what does she care - it doesn't come out of her pocket) then you are gonna get sued if you don't provide one (assuming something is wrong). Lawyers aren't the ones wicking up patient demands for unnecessary radiology studies. Patients are.

    judd
     
  19. juddson

    juddson 3K Member
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    I don't think this was the same plaintiff's attorney.

    Judd
     
  20. Sessamoid

    Sessamoid 1K Member
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    Actually...

     
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  21. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    The source is an AMA newsletter. I kind of doubt it is a legend.

    - H
     
  22. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Are you kidding?!? This is EXACTLY why we should blame the lawyers! This case is a perfect example of the lottery mentality that dominates tort law. They make it not only possible, but profitable, to sue because you didn't get want you wanted, even if no provable injury occurs! The case, which on its merits had little chance of of winning, did have everything a personal injury lawyer is looking for. There was a sympathetic plantiff, three deep pockets, and a tragic story. This lawyer rolled the dice and won. Given standard agreements, he now has made 1.66 million plus his costs. Why wouldn't he take the case? In states (like Texas) where tort reform has capped the awarding of non-economic damges, case filings have dropped by more than 2/3. Are the doctors in Texas suddenly better - NO! Medical malpractice is no longer a lawyer's lottery. If we shouldn't blame the lawyers then why is the American Trial Lawyers Association pouring so much money in Washington (and the states) to prevent tort reform?

    BTW - A close friend of mine is a personal injury lawyer. He actually agrees with me :wow:. He told me a quote, apparently oft repeated in law schools, concerning cases like this, "If the law is on your side, pound the law. If the facts are on your side, pound the facts. If neither is on your side, pound the table." He has told me again and again, that is is far easier for him to win a jury trial with emotional appeals than it is to win with facts or the law. To quote him "Juries understand emotion. They don't know the law, and by the end of a trial no one knows the facts."

    Don't blame the lawyers my foot.

    - H
     
  23. southerndoc

    southerndoc life is good
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    I'm sort of offended that you posted the urban legends idea. I don't know whether you think I cannot tell the difference between an actual official American Medical News article, or whether you think the AMA can't tell the difference between a real story or an urban legend. You did view the source of the article, right? I would hope so before you made the urban legends comment.

    I've also been told to always keep the patient informed and treat them nicely. However, it appears that this situation breaks all the rules. Perhaps it's juror sympathy, which has become a major problem lately. Jurors view the physician not at fault, but they think the family deserves compensation because they feel sorry for the family.

    Having said that, I must state that my entire view of this situation is dependent entirely on the news articles which I have read. All seem to indicate that the CT was not necessary. Even reading the transcripts I probably can't tell for sure. Only if we had seen the child the day he presented to the ED could we form a reliable opinion of whether this kid needed a CT or not.

    As I said earlier, I wish I could get hold of the transcripts. I tried accessing them online to no avail. I'm nowhere near Maryland, and quite frankly, it's not worth my money to purchase copies of them.
     
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  24. southerndoc

    southerndoc life is good
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    In the city where I live, lawyers were not allowed to live or practice within the city or county limits until as recently as the early 1900's. Any lawyer found inside the city could be punished by death. No, I am not joking.

    Shakespeare had it right in his famous line spoken by Dick the Butcher in Henry VI: "The first thing we do, let's kill all the lawyers."

    In all seriousness, I think we need major tort reform. Juror sympathy is the reason why large awards are given.

    I think we should support a new tort reform. In addition to caps on non-economic damages, individuals who file lawsuits and who lose should be required to pay for the defense's attorney fees, any lost time by the physician who was spent defending the trial, and any other costs associated with the trial.

    Physicians should start counter-suing patients for defamation of character and loss of revenue. Let's face it, if a private practice physician is sued, he/she will be on display for all the public to see. Chances are this will cause a decrease in his patient load.

    Finally, I think ALL physicians in this country should come together in unity and just drop their malpractice insurance. Transfer everything out of their names. States that require malpractice insurance will find themselves either changing their laws or without physicians in their states. One of the reasons why so many patients sue is because malpractice insurers will often times settle outside of court. Would they be willing to sue someone who doesn't have malpractice insurance or a substantial cash reserve?
     
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  25. Apollyon

    Apollyon Screw the GST
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    An attending from Miami was saying that, outside of virtually EVERY Ob/Gyn's office, is a plaque stating there is no malpractice insurance in place. Right up front, they're saying there's no jackpot.

    I think it's 19 states (NC is one) where EM physicians can go "bare" (no malpractice insurance necessary); there's one group that ponied up a bunch of cash into a trust, and that is their insurance. First time someone sues and wins, the fund is empty, and the next person to come along gets nothing, 'cause there's nothing left.
     
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  26. MacGyver

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    In Florida, doctors can go "bare" and put all their resources into their homes or other low liquidity investments. That way, they can shield their money from lawsuits. According to the Florida homestead act, money put into your home cant be taken away by a lawsuit, even if you are found guilty.

    Every state needs to do this, so we can get rid of malpractice insurance.

    Of course juddson is going to come on here and claim that its not "fair" to do that to patients, but we all know that medical malpractice has NOTHING to do with practicing legitimate medicine and everything to do with covering your ass in the lawsuit lottery.
     
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  27. MacGyver

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    I want to get back to the medical aspects of this case, rather than the legal stuff.

    We all know for a fact that a CT scan is not indicated in this case. Yet somehow, the plaintiffs lawyer found a doctor who said that it was NEGLIGENT to not run a CT scan.

    I want this ****er's name. I want him to be publicly humiliated for his quack opinion. He/she needs to be called out on the carpet. Its doctors like him that give lawyers all the ammo they need to pursue these frivolous claims.
     
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  28. Homunculus

    Homunculus SDN Caveman Administrator
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    but did he also have it right in the line spoken by Timon in Timon of Athens? "Trust not the physician; his antidotes are poison, and he slays more than you rob."

    :D

    i agree with the rest of your post. the breaking point for malpractice is coming very soon, and it's not going to be pretty.
     
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  29. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Actually, we don't know that is what the expert testified to. What might have happened was a twisting of the facts (as the vile, scum-sucking, sub-human lawyers are wont to do). Imagine this obviously creative piece of sh** used the benefit of hindsight to build his case.

    POS: Dr., if you suspect child abuse, is it the standard of care to throughly examine the child, including x-rays and CT scans for head injury?

    Expert: Yes.

    POS: Were such tests performed in this case?

    Expert: No.

    POS: Is it usual for an 11-month old child to simply fall with sufficent force to cause a concussion?

    Expert: No.

    POS: I call your attention to the ED Physician's diagnosis on this report. Is I correct in assuming that "post-concussion disorder" can only occur after a concussion? (The article states "post concussion disorder" was written on the ED chart by the EP)

    Expert: Yes.

    POS: So, an 11 month old child is brought to the ED, with a concussion, and the history given is that of a simple fall. This story is not consistent, is it?

    Expert: No.

    POS: Such an incoherent story could be seen as a sign of abuse?

    Expert: Yes

    POS: The parents' statements that the child was not acting normally would also be consistent with having been abused in the babysitter's home?

    Expert: Yes.

    POS: And we now know that to be the case, correct?

    Expert: Yes.

    POS: So, if a child is brought to the ED, having suffered a concussion, and child abuse is suspected, the standard of care would call for a CT of the head?

    Expert: Among other tests and exams, yes.

    POS: And again, was a CT performed in this case?

    Expert: No.

    POS: Thank-you.

    It is still the lawyer's fault, but on careful reading of the article, it was stupid to write "post-concussion disorder" on the chart. If anyone gets a hold of the transcripts, I'll bet that is what hung them out to dry. It doesn't change the fact that any signs of child abuse, if there were any, were so subtle as to be missed by three different physicians. And there is still no gaurantee a head CT would have shown anything. There is still no question this award was based on jury sympathy and not fact. But a soulless ***** of a lawyer could twist the facts to get accurate expert testimony shown in a favorable light.

    - H
     
  30. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    I think we should just band together, as one, and refuse to treat any trial lawyers or their direct families (unless also directly related to a physician) until the ATLA stops their opposition to tort reform. Before you call me heartless, I just think we should subject these folks to the same pressures their actions are imposing on many Americans. If they like it, great, but if as I suspect, they are disturbed by this lack of access to care, maybe they will stop restricting the access of others.

    - H
     
  31. proman

    proman Member
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    Found this on: http://cut-to-cure.blogspot.com/2004_02_01_cut-to-cure_archive.html


    Cindy W. Christian, director of the child abuse program at Children's Hospital of Philadelphia, said 11-month-old Jack Sprague did not show telltale signs of a subdural hematoma, or bleeding in the brain, when his worried parents brought him to Civista Medical Center on Nov. 18, 1998.
    Her testimony was bolstered by Robert W. Block, chairman of the University of Oklahoma Department of Pediatrics, who also testified Friday in support of Civista Medical Center and three doctors who are being sued for $13 million by parents John and Robyn Sprague, whose son was examined by the three doctors.
    Jack "was basically symptom-free," Block said. "There is no indication that [the doctors] should have had any perception of abuse." ......
    Philip H. Cogen, the Washington Children's Hospital neurosurgeon who operated on Jack, has testified for the Spragues, saying he saw two separate injuries: the massive subdural hematoma caused on Dec. 4, 1998, and another smaller, older hematoma.......
    The Spragues' lawyers contend the smaller, older injury occurred Nov. 18, causing Jack to appear "lethargic" and "not his usual self" for several days, according to his mother.
    But Christian and Block countered that such an injury would have caused more serious and pronounced symptoms. If there was a small injury, it would have healed before Dec. 4, when a CT scan was performed, Block said.
    "It is possible that the baby was injured some time after" Nov. 20, Christian testified. She said Jack had "unexplained vomiting" and other symptoms that she speculated could have been caused by abuse on Nov. 30 and Dec. 1, when the child was again in Brookbank's care.

    I recommend looking up Dr. Cogen's information on AMA doctor finder.
     
  32. southerndoc

    southerndoc life is good
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    Thanks PR for posting that.

    I still would like to see the transcript. According to this, Dr. Cogen just testified that the patient had two subdural hematomas. This doesn't mention anything about Cogen stating that a CT should have been ordered when the child first presented.
     
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  33. Homunculus

    Homunculus SDN Caveman Administrator
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    that's exactly what i thought when i read it. if you make a diagnosis of "post concussion disorder" you've admitted that a concussion has occurred and therefore some type of trauma as well. that one little scribble was an expensive one.

    also, why would they have set the kid up for a CT only to have an on call pediatrician cancel it? if the attending pediatrician and ED physician thought he needed it why suddenly after a hurried exam (i'm guessing from the parent's description of the on call peds actions in the room) would that change? *especially* with the diagnosis made by the ED physician.

    "what we've got here is a failure to communicate"
     
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  34. MacGyver

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    If what you say is true, the judge has a responsibility to throw the suit out of court.

    In order to push forward a case of med mal, you HAVE TO SHOW that standard of medical care was violated, and you have to have an EXPERT for the plaintiff testify to that effect.

    What you need to do is find the expert's deposition. I bet you bottom dollar that he is very clear that the standard of care (i.e. ordering the CT) was violated. If he didnt state that specifically, then the judgment issued by the jury has legal grounds for being set aside.
     
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  35. MacGyver

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    That cant be the whole story, because it says nothing about standard of care.

    In order for a med mal lawsuit to procede to trial, you must have an expert who testifies that the STANDARD OF CARE was broken. Its NOT enough for an expert to simply testify that an injury occurred which could have been prevented.

    The snippet above is entirely insufficient for a case to proceed.

    Another problem is that this fool is a neurosurg, and the doctors being sued are not neurosurgeons. To pursue a med mal case, the plaintiffs expert MUST be in the same specialty as the defendant docs.

    We are not getting the whole story here. Either there are other experts in addition to the neurosurg who testified for the plaintiff, or the testimony of the surgeon is not represented completely and accurately by the snippet above.
     
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  36. MacGyver

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    Found this blurb on the website. This is pretty damning against the defendants, because it says that CT scans are to be routinely done for any of the symptoms above.

    I think the real problem here is that there is no STANDARD of care thats widely accepted. Different docs do different things. Trying to frame that into a standard vs nonstandard thing is bull****.
     
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  37. juddson

    juddson 3K Member
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    What about the bad doctors - the ones who make real mistakes and injure patients? Or are you of the opinion that doctors are super-human, incapable of error?

    Judd
     
  38. juddson

    juddson 3K Member
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    If there is no insurance and no money in the pot, then the physician becomes personally liable for the injury? How is that good for a doctor?

    Judd
     
  39. juddson

    juddson 3K Member
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    Should bad doctors be allowed to do this too, or are there no such thing as bad doctors?

    Judd
     
  40. Homunculus

    Homunculus SDN Caveman Administrator
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    the deep pockets theory.

    can't get blood from a turnip. :)
     
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  41. juddson

    juddson 3K Member
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    You DO!!!??? That's awesome!!! The 12 most knowledgable people on the planet about the particular facts of this case listened to several days of testimony and decided that the doctor was negligent. YOU have read an article about it and decided he was not. As a FACT, no less!!!

    You guys are the SMARTEST and (on top of that) most CLARVOYANT people I have ever read. Perhaps we should have YOU GUYS decide the verdicts for medical malpractice cases from the comfort of your web browsers.

    Awesome!!! Can I get next weeks lottery numbers too?

    Judd
     
  42. Apollyon

    Apollyon Screw the GST
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    No...just sue someone.
     
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  43. Apollyon

    Apollyon Screw the GST
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    No, because they're incorporated (unless they're TOTALLY stupid). Then, there is no "there" there. People just go to the doc to be treated for problems or for well-patient care, and not to look for a means of income.

    As far as "no bad doctors", well, because of standards, there aren't nearly as many as you are intimating. Everyone makes mistakes, but, as is evident, there are some that are softer than others. Hindsight being 20/20, and money talking (spend a lot up front to find a doc who will say what you want, to REALLY clean up in the end), can make any situation look bad for a doc, even if the "negligence" or "malpractice" - isn't.
     
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  44. Homunculus

    Homunculus SDN Caveman Administrator
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    i imagine the standard of care for a suspected head trauma is pretty much the same across the board. CT's are used to evaluate any gomer with a mental status change, why would it be different for a kiddo?

    the bottom line, at least to me, is that the child's pediatrician sent him in to the ED for evaluation of what was *essentially* a mental status change. a diagnosis of "post-concussion syndrome" was made, and a CT was ordered but then cancelled by the on-call pediatrician in the ED. negligent? probably, insomuch that they never evaluated his "post-concussive syndrome". whether or not they would have found anything on CT at that time is debatable.

    hindsight is always 20/20, but can you honestly tell me that this child received good medical care when he was sent to the ED by his pediatrician explicitly (or implicitly) for a CT?

    lessons learned from this should be 1) communication, communication, communication 2) if an attending sends XX patient in for XX, and it isn't completely contraindicated, do it and 3) time spent with patients and at least the *appearance* of concern can do wonders in a litigious atmosphere.
     
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  45. juddson

    juddson 3K Member
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    I thought doctors were supposed to be wealthy.

    Judd
     
  46. juddson

    juddson 3K Member
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    I think an attorney would attempt to "pierce the corporate veil" in this circumstance. The law does not like "undercapitalized" corporations whose sole purpose is to insulate their controllers from liability for injuries caused by them through their corporations.

    If this worked, medical malpractice insurance companies would hardly be able to make a living.

    Judd
     
  47. southerndoc

    southerndoc life is good
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    Seriously, we should have a jury of our peers, so medical professionals should be on the jury just like ordinary citizens. Equally split the jury.

    You have too much faith in the jury system, and that's ok because you have tunnel vision. The "the jury is always right thing." Well, let me tell you, juries make mistakes. Just ask anyone sent to prison for murder who was later found innocent. It's not a fool proof system, but alas, it's all we have.

    Many juries now base "negligence" cases on sympathy. Even though a physician might have done no wrong, the jury still finds him "negligent" just because they feel sorry for the plaintiff. It could be a natural loss (something that will happen regardless of the treatment provided, whether good or bad).

    32-3-26-18-11-5
     
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  48. juddson

    juddson 3K Member
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    FoughtFyr,

    i need some help understanding something:

    Why did you post that hypothetical direct examination of the expert witness, and how does it support your contention that the lawyer twisted the facts?

    I'll try to be specific for you. In your hypothetical,

    1. If the expert lied, please point out the lie.

    2. If the lawyer twisted the facts, point out which facts have been twisted.

    It seems to me that you are rapidly coming to the conclusion (on your own effort) that the finding of "post concussion syndrome" should have indicated a follow-up with CT. That being the case, you YOURSELF appear to have identified at least two peiced of evidence that the standard of care in this case was not complied with. First, you have an expert who claims that a concussion is not normal from a simple fall. AND, you have at least ONE doctor who thought a CT was indicated (because he ordered one).

    Why would it be unreasonable for a jury hearing this evidence to conclude that (1) a CT scan was indicated given the finding of "post concussion disorder" AND the fact that at least one doctor had ordered one, and (2) that the CT scan would have showed the injuries given (I presume) that an expert (perhaps the pathologist or somebody reading the autopsy report) would have testified to this.

    I've been through this thread a number of times and it seems to me (without me prodding it) that many of you have, on your own, determined there to be at least SOME evidence that the standard of care was not complied with. If that's true, why is the lawyer a "piece of ****" for presenting the evidence to the jury as you have presented it here, and why is the jury stupid in finding that it was ever so slightly (at least) more likely than not that things went this way in fact?

    Judd
     
  49. juddson

    juddson 3K Member
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    Actually my posts on other threads suggest quite clearly that i think Juries SHOULD be made up of professionals. I would favor a professional panel that would weed out cases where no negligence is really present. I manifestly DO NOT have too much faith in juries (nor do I have tunnel vision) and believe in fact that they are not the best suited to decide complicated issues of fact (though I think they are more than capable of valueing injuries).

    That said, it seems to me from reading the posts on this thread that this particular case is hardly one which suggests the jury got it wrong. Many of you have, on your own accord, come to the conclusion (or at least made an issue of the fact) that the finding of post concussion syndrome would have suggested that the story about the simple fall was probably no good, and that in any event the CT would have been indicated after such a finding. In fact there is evidence that at least one doctor DID order the CT scan. WHY would a jury be considered too stupid to determine that a CT was necessary when a doctor who actually examined the child ordered one?

    It seems to me that the people who have the most tunnel vision are those on this thread who would admit that the finding of "post concussion syndrome" would indicate the need for a CT scan if the explanation is not persuasive, and would admit that at least one doctor thought it was warranted, BUT WOULD continue to insist that the lawyers who brought the case are liers and the jury who decided it are stupid. The evidence all points the other way.

    BTW, transcripts are rarely posted on the net. You ussually have to go to the coutrhouse and order them for a fee.

    Judd
     
  50. juddson

    juddson 3K Member
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    BTW, Geekmedic,

    That does not answer the question. I need you to explain to me how you can know better than the jury what actually happened in the hospital given that they have heard evidence and you have not.

    I would like to know what superior knowledge of the FACTS you people have which induces you to second guess what a jury who has intimate knowledge of the facts has determined.

    Judd
     

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