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Midwives in Virginia: A Bad Idea

Dan Frith — Tue, 03 Feb 2009 10:57:29 GMT

Virginia is seeing an explosion in the number of midwives....and this is a bad trend!

I see many complicated deliveries where a fetus becomes entangled in the umbilical cord or caught in the birth canal due to the large size of the fetus or the smallness of the mother's pelvis. Both of these situations are medical emergencies and require the immediate attention of well-trained obstetrician or maternal-fetal specialist in a hospital setting. These life or death situations do not, in my opinion, call for delivery by a midwife in the patient's home...where there is often inadequate time to transfer a patient to the hospital after a delivery becomes complicated.

Is the increase due to lack of health insurance? Maybe. Is the increase due to outrageous hospital and physician bills for deliveries? Probably. Is the American system for the provision of health care the best in the world? Absolutely not!

I just reviewed the National Association of Certified Professional Midwives (NACPM) website which states as follows about how the state of Virginia is approaching the issue of midwives, "Midwives, consumers and supporters in the legislature had the amazing foresight to include an explicit reference to the NACPM Standards of Practice in the legislation to license CPMs in Virginia." The NACPM website goes on to state that Virginia did a good thing by making specific reference to NACPM standards, because otherwise the Virginia Board of Medicine would not know what standards are applicable.

What a bunch of hooey! Want to know what the NACPM's first identified "Philosophy and Priciples of Practice is? How about, "NACPM members respect the mystery, sanctity and potential for growth inherent in the experience of pregnancy and birth."

My Take: Virginians deserve better medical care...it's not a mystery people....its medicine!

Originally posted at InjuryBoard by Dan Frith

Midwives in Virginia: Part Two

Dan Frith — Wed, 04 Feb 2009 11:45:22 GMT

Yesterday I wrote a blog on midwives in Virginia...and boy did I raise some eyebrows! I do appreciate my readers' comments and, although I cannot respond to everyone, I do want to follow up on my post with the following comments:

1. I spend a great deal of my professional time representing pregnant mothers and other consumers of medical care in medical malpractice cases. As a result, I have seen (specifically, in-depth review of medical records) more deliveries than any of my critics, except for those in the health care profession who delivery babies on a regular basis.
 

2. I am not a proponent or supporter of the Medical - Industrial Complex. America's system of providing medical care is too expensive and makes too many mistakes, costing billions of dollars and the loss of thousands of lives.

3. I am an advocate for personal choice and if a woman wants to deliver at home it should be her decision. However, it is because I believe in personal choice, it is important for the consumer to fully understand the consequences of making this important decision.

4. I've heard from many people about their wonderful experience delivering their child at home. Those responses do not surprise me. If there are no complications experienced during a home delivery, I am sure everyone is pleased with the outcome...its less expensive...more personal...and more intimate and special than delivery at the local hospital.

5. My concern, and the purpose behind my post, is to make sure all pregnant mothers think about what happens if there is an unanticipated medical emergency or crisis which occurs at the time of delivery at home. What happens when the umbilical cord becomes wrapped around the fetuses' neck and her heart rate plummets? What happens when the fetus' shoulder cannot pass the pelvis resulting in a brachial plexus injury? What happens when the mother experiences DIC (disseminated intravascular coagulopathy) and risks bleeding to death? I have seen and litigated cases with these very facts. All occurred in the hospital setting and I can tell you that either the mother or infant (or both) run the risk of death unless prompt surgical intervention (often with the involvement of multiple medical specialists) is provided. This type of care cannot be provided in mother's home.

For example, the standard of care in Virginia for the speed at which an emergency Cesarean section is performed is 30 minutes from "decision to incision." Do you think a mother who encounters a life-threatening unanticipated complication can be transferred from her home to the local hospital and for an emergency c-section in 30 minutes? I doubt it!

Originally posted at InjuryBoard by Dan Frith

Got MRSA!

Dan Frith — Tue, 24 Mar 2009 10:44:30 GMT

I know it is not a good idea to play on the marketing phrase, "Got Milk," but I just couldn't help myself. My reasoning is that it seems as if MRSA is as common today as cow's milk.

Most people know that MRSA is an infection is caused by Staphylococcus aureus bacteria — often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal...and its everywhere!

At least we can be safe from MRSA at our local hospital emergency room, right? Wrong!

A recent study published in the Annals of Emergency Medicine reports that MRSA often colonizes in emergency department personnel, which can put many patients at risk for contracting the life-threatening infection.

Originally posted at InjuryBoard by Dan Frith

Malignant Hyperthermia in Florida

Dan Frith — Mon, 31 Mar 2008 08:34:52 GMT

We wrote a short blog a couple of days ago on the tragic death of Stephanie Kuleba, an 18 year old who died from malignant hyperthermia, a known complication of anesthesia, after corrective reconstructive breast surgery in Boca Raton, Florida.

The sad story of the unnecessary death of an 18 year old from complications at an outpatient surgery clinic motivated me to write my blog. The purpose of my blog was to note the increased risks presented to patients who submit to any surgical procedure in an outpatient clinic. In my opinion, and based upon my experience in representing victims of medical negligence, few outpatient clinics have the medical equipment and medical experts at hand to deal with rare but life-threatening complications.

I also wrote that most outpatient clinics use nurse anesthetists and not anesthesiologists (medical doctors) to provide anesthesia care. I received several emails from nurse anesthetists taking issue with my position. I respect and invite such comments. However, I did not intend to paint all nurse anesthetists in a bad light...my only point is that a patient is better served by a hospital than an outpatient clinic when disaster strikes! For me, I want an anesthesiologist responding to my medical emergencies and not a nurse anesthetists.

I acknowledge that Ms. Kuleba was attended to by an anesthesiologist and NOT a nurse anesthetist. As we learn more about this sad tragedy it will be interesting to learn if the attending anesthesiologist followed appropriate protocols for treating malignant hyperthermia.

Originally posted at InjuryBoard by Dan Frith

Patients with atrial fibrillation and heart failure are not being appropriately treated

Dan Frith — Tue, 26 May 2009 10:35:00 GMT

Don't take my word for it...take the word of a report in the May 5th Journal of the American College of Cardiology.

Atrial fibrillation (AF or afib) is the most common cardiac arrhythmia (abnormal heart rhythm) and involves the two upper chambers (atria) of the heart. Atrial fibrillation is often asymptomatic (and is not in itself generally life-threatening) but may result in palpitations, fainting, chest pain, or congestive heart failure. People with AF usually have a significantly increased risk of stroke (up to 7 times that of the general population).

Heart failure (HF) is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. It should not be confused with cardiac arrest. Common causes of heart failure include myocardial infarction (heart attack) and other forms of ischemic heart disease, hypertension, valvular heart disease and cardiomyopathy. Heart failure can cause a large variety of symptoms such as shortness of breath (typically worse when lying flat, which is called orthopnea), coughing, ankle swelling and reduced exercise capacity.

The recent study followed drug therapy among patients with AF and HF who were enrolled in cardiology practices of 182 hospitals in 35 countries. The results were disturbing. Only 29% of patients with both AF and HF received the full package of recommended drug therapy. Only one-fifth of all HF patients received the combination of a beta-blocker and digitalis.

My Question: Why?

Originally posted at InjuryBoard by Dan Frith

Herbalife Products: A Lead Risk?

Dan Frith — Wed, 21 May 2008 07:04:00 GMT

Do you know someone who takes Herbalife products? Herbalife is global nutrition and weight-management company, whose stock is traded on the New York Stock Exchange. If you know someone who is taking Herbalife products... you had better sit them down and share this information with them.

The Fraud Discovery Institute (FDI) based in San Diego, California has released an alert warning of dangerously high levels of lead allegedly found in six common Herbalife products. The study was reviewed by Christopher Grell, co-founder of the Dietary Supplement Safety Committee and lawyer specializing in dietary supplement litigation. The alert can be viewed at the Fraud Discovery Institute's website.

The products at issue include: Herbalife's Thermogetics; Herbalife's Shape Works Cell Activator; Herbalife's Multivitamin Complex; Herbalife's Tang Kuei Plus; Herbalife's Shapeworks Protein Drink Mix; and Herbalife's Healthy Meal Nutritional Shake Mix.

The sign and symptoms which can be indicative of lead poisoning in adults may include:

. Pain, numbness or tingling of the extremities
. Muscular weakness
. Headache
. Loss of appetite
. Abdominal pain
. Memory loss
. Mood disorders
. Reduced sperm count, abnormal sperm
. Fatigue
. Depression
. Heart failure

Originally posted at InjuryBoard by Dan Frith

Too Many Malpractice Lawsuits or Too Much Malpractice?

Dan Frith — Thu, 02 Apr 2009 15:15:41 GMT

We've listened to George Bush, various national, state, and local medical organizations, and the insurance industry cry long and hard about the need to reform medical malpractice laws in the United States. Frivolous lawsuits they claimed...running doctors out of the practice of medicine they claimed. My response...BS!

I challenge anyone to deny the reality that:

Most Americans injured by medical malpractice do not sue.
Most lawsuits are not frivolous and courts efficiently weed out weak claims.
Jury awards have not spiraled out of control, and lawsuits have not reduced access to doctors.

Here are the facts:

In a landmark study, the Institute of Medicine of the National Academy of Sciences estimated that medical errors kill up to 98 000 US hospital patients each year (Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System) In 2004, Healthgrades, an independent health care ratings company, reported nearly double that figure. Its examination of 37 million patient records from all 50 states, representing 45% of all U.S. hospital admissions, found 195 000 hospital deaths from preventable medical errors annually between 2000 and 2002.
Evidence that medical malpractice in the U.S. greatly exceeds malpractice lawsuits has been available since 1974, when California's medical and hospital associations sponsored a study intended to support their efforts to get lawmakers to pass tort reform. Instead, it found that doctors and hospitals negligently injured 0.8% of hospital patients (Mills DH, editor. Report on the Medical Insurance Feasibility Study. Sacramento: California Medical Association and California Hospital Association; 1977). A later analysis of the data found that, at most, only 1 in 75 of those injured were compensated (Danzon, Patricia A. Medical Malpractice: Theory, evidence and public policy. Cambridge: Harvard University Press; 1985).
The notion that frivolous lawsuits abound is also unsubstantiated. A 2007 study by Public Citizen showed the court system was "on the whole, a rational one that provides money for valid claims and dismisses invalid ones." Using data from the U.S. government's National Practitioner Data Bank, the consumer nonprofit group concluded that complaints by "the business and medical lobbies are exaggerated and unsupported by the facts."
The evidence is that jury awards are simply keeping up with the costs of medical care, rather than being out of line. In 2005, Dartmouth College economists studied payments made to patients between 1991 and 2003. Actual payments, not jury awards, grew an average of 4% annually — slowing to 1.6% a year since 2000 — or 52% since 1991, roughly equivalent to increases in health care costs. A 2004 RAND study examining 40 years of jury verdicts concluded that average payouts grew by less than real income, with more costly medical care responsible for more than half the growth in jury awards.
Malpractice insurance and claims account for, at most, 2% of U.S. health care spending, according to the U.S. General Accounting Office, the investigative arm of Congress.

Who is willing to take on my challenge?

Originally posted at InjuryBoard by Dan Frith

Forbes Magazine Calling for More Tort Lawyers?

Dan Frith — Thu, 07 May 2009 17:35:59 GMT

You are not dreaming...or hallucinating! Forbes magazine, the mouthpiece for American business and industry called for "more tort lawyers" in a recent article.

The article topic was food borne illnesses which sicken 76 million Americans a year, kills 5,000 and runs up $3 billion in hospital costs. The illnesses arise when the producers, manufacturers, and preparers of what we eat do a poor job of watching out for our health (we know the FDA is not looking out for us). The offending bacteria include campylobacter, salmonella,listeria, and e coli.

The solution according to Forbes magazine - more tort lawyers! Don't believe it? Read the article yourself.

Originally posted at InjuryBoard by Dan Frith

Political Pundit George Will: Is He Sane?

Dan Frith — Thu, 09 Apr 2009 09:55:28 GMT

This week I attended a lecture at a local college given by political pundit George Will entitled "Lessons I learned from the 20th Century." As most readers know, George Will is conservative newspaper journalist (Washington Post) and author.

Although I could take most of his comments as entertainment (he is just a slicker Rush Limbaugh), one part of his lecture was really absurd and made me question George Will's sanity.

Will began by commenting on childhood obesity and what a problem it creates for all involved. Will mentioned that obese children often become obese adults, suffer higher rates of diabetes and cardiovascular disease, etc. Next, he shared with the audience the reason for childhood obesity. Are you ready for this? The cause of childhood obesity in America is trial lawyers! I kid you not.

George Will said the reason so many children in America are obese is because the trial lawyers brought lawsuits against playgrounds and the manufacturers of playground equipment such as slides, swings, monkey bars, etc. alleging such equipment was dangerous. As a result (according to Will), towns and cities closed their parks and removed playground equipment....and that is why kids got fat!

Hey George...how about kids who spend 6 hours each day in front of a television or computer screen?..or how about kids who eat processed fast foods with high contents of sugar and calories?...or how about kids who refuse to exercise on a regular basis?...or how about kids who refuse to walk any distance greater than a trip to the refrigerator?

George Will's comments are laughable!

I am a proud trial lawyer. I am particularly proud of being a part of a national group of law firms (InjuryBoard) committed to making a difference by helping families stay safe and avoid injury. And yes, sometimes lawsuits are filed against the manufacturers of dangerous playground equipment but to suggest that those lawsuits are responsible for childhood obesity is not an intellectually honest comment.

Originally posted at InjuryBoard by Dan Frith

Teleradiology Mistakes Can Kill You!

Dan Frith — Fri, 02 May 2008 09:59:48 GMT

Teleradiology, what is it? It is the electronic transmission of radiological patient images, such as x-rays, CT's and MRI's, from one location to another for the purposes of interpretation and/or consultation....and almost all hospitals today are using these services. Hospitals like to use teleradiology services because it provides around the clock professional services, often at lower cost than having a fully-staffed radiology department on site.

How can it kill you? When the radiologist who is sitting in China, or India, or just hundreds miles away in another state makes a mistake in reading and interpreting the diagnostic studies emailed to them via the Internet.

My firm just settled a case involving just such a sad situation....and the patient died. The teleradiology company involved in the case is one of the largest such companies in the world, NightHawk Radiology Services. Our local hospital, Carilion Roanoke Memorial Hospital, contracted with NightHawk to provide radiologic services. The patient arrived at the hospital with a history of a thoracic aneurysm and complaining of back and flank pain. The attending Emergency Room doctor was aware of the possibility that the aneurysm could be the cause of the patient's symptoms and was also aware that a ruptured thoracic aneurysm meant certain death. So he correctly ordered a thoracic/abdominal CT scan to verify the status of the aneurysm.

No radiologist was available at the hospital so the CT films were sent, basically as an attachment to an email, to NightHawk Radiology Services. NightHawk then forwarded the CT films, again via the Internet, to a radiologist sitting at his home in Louisiana for interpretation. Unfortunately, the radiologist mis-read the CT films and determined there had been no change in the aneurysm and reported his findings back to the Emergency Room doctor, who gave the patient pain medication and sent him home. The CT film actually showed the aneurysm had gotten larger and was leaking, or bleeding. The patient was found dead by a family member 5 days later. The cause of death - ruptured thoracic aneurysm!

I am all in favor of technology but when I go to my local hospital I like to know who is caring for me. Is it a local physician with a known reputation as a competent and caring healthcare provider? Or is it like Dorothy in the "Wizard of Oz" and someone we don't know is pulling all of the levers behind the curtain?

Just something to think about.

Originally posted at InjuryBoard by Dan Frith