Medical-Legal News

Caring for patients in a medical intensive care unit in a hospital and flying a 747 are complicated tasks that require tracking thousands of important details, some of which could get overlooked. That's why the pilot has a checklist and a copilot to make sure nothing slips by.

A new Northwestern Medicine study shows the attending physician in the intensive care unit could use a copilot, too. The mortality rate plummeted 50 percent when the attending physician in the intensive care unit had a checklist - a fairly new concept in medicine -- and a trusted person prompting him to address issues on the checklist if they were being overlooked. Simply using a checklist alone did not produce an improvement in mortality.

Hundreds of hospitals are routinely performing a type of chest scan that experts say should be used rarely, subjecting patients to double doses of radiation and driving up health-care costs.

In a double CT scan, patients get two imaging tests consecutively: one without dye and the other with dye injected into their veins. Providence Hospital in Northeast Washington and nearly one of every six hospitals in Virginia were among those performing double scans particularly frequently, according to the most recently published government Medicare data, from 2008.

The government is taking a closer look at scans because imaging tests are among the fastest growing procedures in health care. Medicare’s Hospital Compare Web site publishes individual hospital rates of double chest scans, along with rates for several other kinds of imaging. Medicare doesn’t restrict the use of double scans or penalize those who perform lots of them.

Lawmakers in Nevada are debating a proposed bill which would give plaintiffs (patients) additional time to file an expert witness affidavit required for medical malpractice lawsuits. Currently, a malpractice lawsuit will be dismissed if it does not contain an affidavit from an expert medical witness supporting the allegations. The purpose of the affidavit is to show that the case has some merit. However, supporters of the proposed bill argue that sometimes the affidavit becomes separated from the lawsuit or cannot be obtained within the one-year statute of limitations, and that dismissing a case for that reason would be unfair.

At a judiciary committee hearing, witnesses testified as to the unfairness of the time limitation. One witness testified about her mother's death due to a medical error during a hernia operation. After over two years of litigation, the malpractice suit filed by the family was dismissed just weeks before trial after defense attorneys successfully argued that the affidavit was not filed along with the suit but instead was filed separately a few days later. The proposed bill would give plaintiffs and additional 45 days from the time the suit is filed to include the affidavit. The judiciary committee is currently considering the bill.

Medical errors don't just happen at the hospital, according to a new study that highlights safety problems in the doctor's office as well.

Researchers found that about half of U.S. malpractice payments -- a proxy for medical errors -- from 2009 involved patients seen outside of the hospital.

Previous studies have focused mostly on the situation inside hospitals, some of which now have checklists and other systems in place to help prevent devastating mistakes.

But "invasive and high-technology diagnostic and therapeutic procedures are increasingly being performed in the outpatient setting," the researchers note, so they decided to compare the number and seriousness of adverse events in inpatient and outpatient settings, as reflected by malpractice claims.

In Justice Douglas E. McKeon’s fluorescent-lighted chambers in the Bronx, a new way of handling medical malpractice suits was on full, and sometimes gruesome, display. Around a polished wood table, lawyers haggled over the price for a lost nose ($300,000) and the missing tip of a finger ($50,000).

The discussion was like some kind of malpractice bazaar, with lawyers blurting out terrible facts and big numbers.

“Our offer of $500,000 is more than we’ve ever had on a dead baby case,” said Margaret Sherman, a lawyer for the New York City Health and Hospitals Corporation, which runs 11 public hospitals.

The patients were not there, but the lawyers and Justice McKeon — who has better-than-average medical knowledge — were. Cajoling, flattering and arguing, Justice McKeon, of State Supreme Court, worked to bring about settlements long before the cases moved toward trials.

Signing bonuses for new physicians have become a common hiring incentive, part of what can be lucrative packages for doctors who have just completed their residencies or fellowship training. Newly trained physicians in some highly sought-after specialties can command incentives worth six figures in exchange for their first years of work.

Surveys by the Medical Group Management Assn. and Irving, Texas-based physician placement firm Merritt Hawkins that examined recruiting packages from 2010 show that signing bonuses -- once an incentive offered on occasion for hard-to-fill jobs -- have become the norm.

"Signing bonuses have gone from carrot at the end of the stick to an expected part of the package," said Travis Singleton, senior vice president for Merritt Hawkins. "It's an extreme negative these days if you don't have a signing bonus."

A continuing decline in the number and total value of malpractice payments made on behalf of physicians argues against the need for laws that would cap noneconomic damages in such cases, according to the watchdog group Public Citizen.

Supporters of tort reform, including the American Medical Association (AMA), counter that Public Citizen bases its conclusions on what they call skewed information from a federal clearinghouse called the National Practitioner Data Bank (NPDB). Any organization that pays a malpractice claim on behalf of a physician, such as a malpractice insurer, is required to report it to the NPDB.

A Public Citizen study released this week states that the number of malpractice payments — jury awards and settlements alike — declined for the seventh consecutive year in 2010, based on its analysis of newly released NPDB data. That number of payments (10,195) also is the lowest since 1991, the first full year for which NPDB tracked these payments.

New York State lawmakers are mulling a proposal that would abolish the long-held right of defendants in medical malpractice cases to informally interview the plaintiff's physician during the discovery process.

The sponsors of the bill, which could come up for a vote in both chambers of the legislature as early as next week, say it would ensure medical records that are irrelevant to a malpractice suit are kept private, and would do away with the ability of insurance companies and attorneys to intimidate physicians into testifying in court.

But opponents of the measure, including attorneys and health care industry lobbyists, say it would drive up the costs of insurance and defense of doctors sued for malpractice, and also make it much more difficult to prepare for cases.

The number of medical malpractice cases filed against Pennsylvania doctors and hospitals dropped in 2010, the sixth consecutive annual decline.

"In reality, medical malpractice lawsuits are not as prolific as people think," Pittsburgh attorney George Kontos said. "Any good attorney is very cautious about taking a case. I probably reject about 90 percent of people that come to me."

In 2002 — the year malpractice lawsuits peaked at 2,904 — new rules designed to weed out frivolous lawsuits took effect, and experts credit those rules with the decline in lawsuits in the years that followed.

After years of complaining that Florida just isn't a friendly place for their profession, doctors say the legislative session that just ended was one of the best they've had in a long time.

The doctors' lobby was a big winner on what it saw as a major medical malpractice bill, one that will make it less likely that plaintiffs will bring in out-of-state doctors as expert witnesses. Physicians have fought to try to ease their medical malpractice burden for years.