Charlottesville Personal Injury Lawyer - Medical

Database of Medical Malpractice Unavailable to the Public

Paul Thomson — Tue, 01 Dec 2009 21:13:24 GMT

Tulsa World reported that there is a national database of medical malpractice data that the public is unable to fully access. The database is maintained by the U.S. Department of Health and includes about 460,000 records of malpractice lawsuits. However, the public can only view the lawsuit's allegations and the patient's health, while the remaining information is only open to hospitals, managed care organizations, and state licensing agencies.

The American Medical Association believes the information should remain private because it is unreliable. Supposedly, data is often submitted late and some of the information is untrue or misleading. The AMA argues that it is a flawed program. However, many individuals believe that this is just a way to protect doctors. The information should be available to the public because people have a right to know if their physician has been involved in a medical malpractice claim. Medical professionals need to be held accountable and potential patients should not be kept in the dark. If the patient is able to obtain this information he or she can then question their doctor about it and make an informed decision as to whether they wish to remain under the doctor’s care.

Originally posted at InjuryBoard by Paul Thomson

DOJ Indicts Stryker Biotech On Charge Of Fraud

Greg Webb — Mon, 16 Nov 2009 14:45:31 GMT

The Justice Department has reported that Stryker Biotech LLC, the medical device manufacturing division of Stryker Corp., and its top management have been indicted on federal charges of fraud due to a marketing scheme for bone-growth products OP-1 implant and OP-1 putty. These two products were promoted for use in a manner different from the use approved by the Food and Drug Administration (FDA). Although Stryker did have a federal exemption that authorized it to sell the products for "humanitarian" reasons to treat a rare condition, it instead promoted a combination of the devices with a bone void filler called Calstrux and provided "recipes" on how to combine Calstrux with OP-1 in ways never approved by the FDA.

The indictment charged Stryker Biotech, its former president, and three current sales managers with a scheme that involved devices used during invasive long bone and spinal surgeries; the former president and the company were also charged with making false statement to the FDA. If the company is convicted, it could face serious fines and possible exclusion from participating in federal and state healthcare programs. The former president and the three sales managers could also face jail time if convicted of wire fraud conspiracy and misbranding charges.

Because of the potentially negative ramifications of a conviction, Stryker is expected to aggressively pursue a settlement.

Originally posted at InjuryBoard by Greg Webb

Hospitals Rarely Disclose Adverse Events to Patients

Paul Thomson — Fri, 13 Nov 2009 09:30:00 GMT

Medpage Today reported that hospitals rarely give their patients explanations when they experience adverse effects of treatment. A survey revealed that over sixty percent of the time, patients do not receive explanations for adverse events. However, when patients were told about adverse events, they were twice as likely to rate the quality of care highly. About 31% of the events were preventable; and some 40% of the effects were related to medications started during the hospital stay. The physician review also determined that three quarter of the effects were severe.

Disclosure was associated positively with favorable patient impressions of the hospital care they received.

This is because an increased level of communication can lead to greater trust from the patient, an more positive perception of care, and possibly even a lower risk of malpractice. Dr Wachter in an editorial stated that the study "adds to the accumulating evidence that disclosure is not only ethically correct but, if done well, can lead to higher levels of patients’ trust, increased perceptions of quality and perhaps even lower malpractice risk." Hopefully, studies like these will provide physicians the confidence to start fulfilling their ethical duties and advising patients of adverse events and effects.

Originally posted at InjuryBoard by Paul Thomson

New Study Shows Imaging Tests Expose Patients To Excessive Radiation

Greg Webb — Tue, 08 Sep 2009 01:00:00 GMT

According to a new study in The New England Journal of Medicine, at least four million Americans under the age of sixty-five are exposed to high doses of radiation annually from medical imaging tests; more than 400,000 of these patients receive very high doses, more than the maximum annual exposure permitted for staff at nuclear power plants or anyone else who works with radioactive material. The use of imaging tests has risen dramatically over the past two decades. Many researchers attribute this increase to more physicians buying CT and PET scanners to use in their offices. In 2007, the Department of Health and Human Services estimated that the number of CT scans given to Medicare patients almost quadrupled from 1995 to 2005, while the number of PET scans rose even faster. The use of scans has even increased from 2005 to 2007.

The paper was based on a survey from 2005 to 2007 that covered almost one million patients insured by UnitedHealthcare; it did not, however, estimate the number of cancer cases the radiation may cause over the next several decades. One doctor who has extensively studied the use of medical imaging believes it will probably result in tens of thousands of additional cancers. Although each patient is only at a minor risk for developing cancer from the test, because tests are now conducted on so many patients, the cumulative risk is significant. By looking at the study, researchers have calculated that the amount of radiation Americans receive averages about three millisieverts each year from all sources. The study found, however, that in at least one of the three years, 1.9 percent of the UnitedHealthcare patients received at least seven times the average exposure, or 20 millisieverts of radiation. Of that group, about ten percent, or 0.2 percent of all patients, received at least fifty millisieverts, which is more than the annual maximum limit that nuclear regulators permit; these figures suggest that about four million Americans each year receive cumulative doses exceeding twenty millsieverts.

The radioactive tests are given for hundreds of different reasons but have become particularly common in cardiology, where doctors use them to check for the buildup of plaque in the arteries and the heart’s ability to pump blood. Some cardiologists are now encouraging patients to have routine heart scans even if they are having no clinical symptoms of heart problems, such as shortness of breath or chest pains. Unfortunately, however, the study did not show what percentage of these test are medically necessary. Though physicians are allowed to profit from the use of scan machines, researchers believe this is only part of the reason the number of tests has risen. Culture is another cause because doctors use imaging as opposed to examination. One researcher suggests patients ask if scans are really necessary because in many cases it has been proven that scans are not better than examinations.

In an editorial accompanying the paper, the director of prevention and epidemiology at the National Heart, Lung and Blood Institute called for large clinical trials that would determine whether the potentially hazardous scans improve care and lead to better outcomes for patients. Until then, he asks that patients and physicians discuss the risks of the tests and keep a close eye on the overall radiation dose the patient is receiving.

Originally posted at InjuryBoard by Greg Webb

Family Medicine Doctor Numbers Declining

Greg Webb — Tue, 01 Sep 2009 17:40:44 GMT

In recent years, there has been a decline in the number of medical students who want to pursue family medicine, though many say it is the frontline for wellness and preventive-care programs that can help reduce healthcare costs. According to the American Academy of Family Physicians (AAFP), the number of U.S. medical students going into primary care, which includes family physicians, general internists and general pediatricians, has dropped 51.8% since 1997. Medical specialists have cited the decline to such factors as longer days, lower wages, less prestige and less administrative headaches. Some experts believe the biggest problem is the payment model because the more procedures a doctor performs, the more money he or she makes. This encourages medical students to pursue a procedure-based specialty as opposed to a primary-care track.

Because it takes about ten to eleven years to educate doctors, health-care experts are worried that the decline will cause a shortage of 40,000 family physicians in 2020 when the demand is expected to spike. Eleven of the top conventional medical schools in the U.S., including Johns Hopkins and Harvard, do not even have a separate family-medicine department. Finding a doctor will become increasingly difficult; there will be longer waits in the waiting rooms and more people will turn to the emergency rooms to get help because the waves of patients will be enormous. When patients visit the doctor’s office, they may also see a nurse practitioner or physician’s assistant instead of the doctor due to the increasing demand. This practice of involving nurse practitioners and physician’s assistants in care is already in place to alleviate physicians from time-consuming tasks in order to focus on the continuity of quality care.

While the U.S. healthcare system has about 100,000 family physicians, it will need 139,531 in ten years; the current environment is only attracting half the number needed to meet the demand. At the heart of the rising demand for primary-care physicians is not only the current group of underserved patients, but the baby boomer generation also, born from 1946 to 1964. This generation will be turning sixty-five in 2011 and will need increasing medical care. If Congress passes healthcare legislation that extends coverage to a significant part of the forty-seven million that do not have insurance, the number of people requiring care will continue to escalate.

In March 2009, U.S. medical school graduates only filled forty-two percent (1,083) of the 2,555 resident positions for family medicine. More than two hundred positions were left unfilled nationwide. More than half of the other spots were filled by non-U.S. students educated internationally, U.S. citizens educated internationally and graduates of colleges of osteopathic medical schools, though graduates of international medical schools and osteopathic medical schools seem to be losing interest in primary care also. This presents the problem of some foreign students with poor English skills not being able to communicate well with their patients.

Members of Congress have taken notice of the potential “crisis” associated with the lack of primary care physicians and have begun looking into bills that could help doctors who choose primary care with loan forgiveness or other debt relief and payment increases for their services.

Originally posted at InjuryBoard by Greg Webb

Hospitals In VA, MD, DC Must Report Avoidable Mistakes

Greg Webb — Thu, 06 Aug 2009 14:11:50 GMT

Over the past year, there have been hundreds of incidents of death or serious medical harm that were disclosed by hospitals in the Washington DC area, preventable errors that until recently have not required public reporting. Under laws that took effect last year in Virginia and a few years earlier in DC and Maryland, hospitals must report to health officials the many serious injuries that patients may suffer in the course of treatment. For example, in one case in DC, a patient was readmitted to the hospital complaining of serious leg pain after the surgeon operated on the wrong part of his spine.

While the public record in Virginia discloses the names of the hospitals involved, DC’s and Maryland’s do not. All three regions, however, give the American public a glimpse into the mistakes health experts call “never events”, because they should never happen: operations on the wrong body part, sponges being left in patients after surgery, and medication errors. At least twenty states require hospitals to report any incidence of hospital-acquired infection as well.

Patients, insurers and regulators are beginning to use this information to nudge health-care providers to ensure that such events never happen. In the past, insurance companies were billed when a doctor, nurse, or technician was responsible for injuring a patient; Maryland health regulators estimate that insurance companies paid $522 million last year to cover preventable complications in hospitals, which occurred in 55,000 of the state’s 800,000 inpatient cases. Now, however, many private and public insurers are following Medicare’s lead by refusing payment as a punishment to hospitals. They hope this act will encourage hospitals to make improvements in their system of care. For example, they will not pay for treating a urinary tract infection caused by a catheter.

In Maryland, the hospital association has agreed not to bill insurance companies for eight mistakes, such as transfusions using the wrong blood type and surgery on the wrong side. As part of a new initiative program, the state commission will begin ranking its hospitals on how often they commit fifty-two preventable mistakes; hospitals that commit the most mistakes will be required to bill insurers at a lower rate than hospitals who commit fewer mistakes. Fines will also be implemented as punishment for mistakes.

Additionally, the hospital association in Virginia has agreed not to bill insurance companies for several errors caused by hospital staff. Anthem Blue Cross and Blue Shield, Virginia’s largest private insurer, has stopped paying hospitals for four surgical mistakes: when the wrong body part is operated on; when the wrong procedure is done; when a foreign object is left in the patient requiring additional surgery, and when the wrong patient is operated on.

Finally, in DC, hospitals, nursing homes and clinics have reported 529 mistakes form July 2007 to June 2008; fourteen of these led to the death of a patient. So far, the District has tried not to use financial incentives to affect the hospitals’ behavior.

Originally posted at InjuryBoard by Greg Webb

Many College Athletes Have Insufficient Health Insurance

Greg Webb — Sun, 26 Jul 2009 19:58:05 GMT

In 2005, the National College Athletic Association (NCAA) began requiring universities guarantee their athletes have adequate health insurance due to many years of concerns that college athletes had insufficient health coverage. The association did not, however, establish clear standards for this coverage, which allowed colleges to decide for themselves what was adequate. Although some colleges assume almost all medical expenses, many others accept almost none. In order to turn this problem around, the National College Player’s Association is lobbying for legislation to protect college athletes; the Association believes the NCAA is too focused on doing “right” by the schools themselves, not the players.

Many people claim medical insurance should be required as a cost of having an athletic program. Middlebury College, for instance, ensures all of their varsity athletes and students in club sports have accident insurance paid for by the college. Spalding College pays for secondary coverage for their athletes, pointing out the fact that student athletes represent the school and insurance is ethically the right thing to do. Large universities such as Michigan State and the University of Iowa also give their athletes comprehensive medical insurance.

Many athletes are unfortunately not this lucky. While the colleges that do not insure their athletes claim they go out of their way to inform athletes about their limits of insurance, many students and their parents still find themselves in horrible situations, having to shoulder large and expensive medical bills. An athlete from Colgate University, for example, piled up about $80,000 in medical expenses after injuring her back and legs while in training with the crew team; insurance only covered about a third of the expenses because of the way her condition was diagnosed, a sickness as opposed to an injury. Also, because many students are insured by their parents, the plan they are under excludes varsity sport injuries, limits out-of-state treatment or does not cover the entire bill. Some colleges buy secondary plans to fill in these gaps, however, these plans have holes as well. Additionally, only players that are hurt enough to require extensive care can turn to the NCAA for coverage; its catastrophic insurance deductible is currently $75,000, but will change to $90,000 next year.

Another problem with health insurance for athletes is how difficult it is to attribute every symptom to a sports injury that the plan will cover and a virus that the plan will not cover; there is an ambiguity in paying for care and treating an athlete who has more than one health concern. Sustaining an injury while sick would be a bad situation, and in the case of an athlete having a disease intermingled with an injury, it is unclear where one stops and the other begins. Within a single state university system, such as the University of Wisconsin, health coverage can vary widely. While at the university’s main campus at Madison, all varsity athletes fall under secondary sports coverage, at the university’s Division III campuses, only treatment for minor sports injuries that can be fixed in the training room is covered. Because it would be too expensive for universities to insure all athletes in the current economic times, it is unlikely the NCAA will require they provide more insurance anytime soon. Many believe health-care reform is the only answer.

Originally posted at InjuryBoard by Greg Webb

Most Bankruptcies Caused by Medical Bills

Greg Webb — Sun, 14 Jun 2009 22:27:50 GMT

A study recently published online in The American Journal of Medicine reports that nearly two out of three bankruptcies are caused by medical bills. This report likely understates the problem, because the data was collected prior to the current economic crisis. Researchers at Harvard Law School, Harvard Medical School, and Ohio University surveyed 2,314 randomly-selected bankruptcy filers during early 2007, discovering that medical problems contributed to 62.1% of all bankruptcies. This proportion represents a 50% rise since 2001.

The authors noted that the financial strain from medical bills affects middle-class families as well as the poor and uninsured. Among families bankrupted by medical bills, those with private insurance averaged bills of $17,749, while uninsured families faced an average of $26,971. Those families who had health insurance but lost it during their illness reported average bills of $22,568. About half of these expenses were hospital costs, followed by prescription drugs (18.6%), doctor’s bills (15.1%) and insurance premiums (4.1%), with medical equipment and nursing home care at the bottom of the list. Neurological problems left patients with the highest out-of-pocket expenses at $34,167, followed by diabetes, injuries, strokes, mental illness, and heart disease.

Originally posted at InjuryBoard by Greg Webb

Vermont Law Makes Payments to Doctors Public

Greg Webb — Sat, 30 May 2009 22:06:08 GMT

In an attempt to crack down on the medical industry’s payment to physicians, Vermont legislators have passed a law that requires drug and device manufacturers to publicly release the amount of all money given to doctors and other healthcare providers, naming names and listing the actual dollar amounts. This law is scheduled to go into effect July 1, and would also ban almost all industry gifts, even meals, to nurses, doctors, medical staff, pharmacists, health care facilities and healthcare administrators. It is believed to be the strictest state effort to regulate the marketing of medical products to physicians, though Minnesota and Massachusetts have less stringent laws in place. Ideally, the measure would allow residents of Vermont to annually learn how much each doctor was paid by makers of the brand-name drugs for which they wrote patients’ prescriptions, or how much money surgeons received from the manufacturers of certain devices, like stents, that they implant.

National legislators and medical groups are monitoring the different state laws, like the one in Vermont, in their quest to discover a link between health care costs and industry marketing. In Congress, Republican Senator Grassley and Democratic Senator Kohl have sponsored a bill that would require disclosure of the pharmaceutical industry’s payment to doctors. Vermont’s law, however, goes even further by showing the issue is inappropriate gift giving. It requires all payments to any health care provider be disclosed, as well as requiring device manufacturers to disclose information as well; the law is also the first to ban all free meals, which was a favored gift used in marketing to doctors, and closed a loophole that allowed companies to not disclose information by calling them “trade secrets”. The required disclosures, however, do not include payments for clinical research on products that are still under examination by the Food and Drug Administration (FDA).

Vermont legislators passed the measure after information was released by the attorney general stating manufacturers of medical products spent about $2.9 million in fiscal year 2008 on marketing to healthcare personnel in their state. About half of Vermont’s physicians were also given compensation from pharmaceutical companies; the manufacturers focused mainly on those doctors they considered “elite”, with only four percent of these doctors receiving more than sixty percent of the payments. The reports also raised the point that if drug manufacturers were willing to spend that much money in the small state of Vermont, what would the results be in the big states of New York and California?

This law is, at least at first glance, a positive step in curbing the corporate greed of the medical device and pharmaceutical industries. It will be interesting to see how this law plays out over the coming years as far as its success in actually accomplishing its goal and, perhaps, curbing health care costs. Hopefully, there are no bad, unintended consequences.

Originally posted at InjuryBoard by Greg Webb

Congress Debates Medical Device Safety Act to Counter Riegel v. Medtronic

Greg Webb — Mon, 25 May 2009 21:25:32 GMT

The House Energy and Commerce Subcommittee on Health began hearing testimony on the Medical Device Safety Act of 2009, which proposes the Supreme Court decision in Riegel v. Medtronic, Inc be overturned. The Reigel ruling prevents patients that were injured by certain federally approved medical devices from seeking compensation via state product liability suits – in other words, federal law trumps (preempts) state law in these cases. The House bill has been a catalyst in the legal community. The American Tort Reform Association, for example, claims the bill would be an economic stimulus for personal injury attorneys. The American Association for Justice, on the other hand, says the bill would restore victims’ rights.

The subcommittee’s hearing was just as divided. While the arguments within the subcommittee hearing were relatively tame, an argument broke out between Subcommittee Chairman Henry Waxman (Democrat) and Steve Buyer (Republican). Waxman argued the FDA’s ability to protect the American public has plummeted due to severe underfunding. Buyer claimed this was “bizarre logic.”

A former chief counsel of the Food and Drug Administration (FDA) testified at the hearing and argued ultimate authority should rest with the FDA and not a group of people that listen to lawyers “rant” at them. He further argues that making it easier for the companies to be sued would lead to limits in innovation because companies would be deterred from taking risks in developing new products. David Vladeck, who will become the Federal Trade Commission’s consumer protection chief next month, claims the Riegel decision gave consumers the “worst of both worlds” since the FDA cannot assure every medical device is safe and with Riegel, consumers can no longer rely on the tort system if they are injured.

Mr. Vladeck is dead-on with his comment. There have to be checks and balances on any system. It is no secret that the FDA (and most other federal oversight agencies) do not have adequate resources to police drug companies, medical device companies, automobile manufacturers, and much of the banking industry (Exhibit A being what has occurred in our economy over the past 12-24 months), just to name a few. While lawyers, especially trial lawyers, are not a favorite profession of most citizens, trial lawyers (of which I am a card-carrying member) are needed as an enforcement mechanism. The possibility of litigation is a deterrent, and it is also a means to hold those who place profits ahead of safety accountable.

Originally posted at InjuryBoard by Greg Webb