Honoring Stroke Awareness

During May, we recognize Stroke Awareness Month. Strokes are experienced by about 800,000 people each year and is the number one cause of paralysis in the U.S. Additionally, stroke is included in the top 10 leading causes of death among children per year. There are certain common risk factors associated with a stroke including heart disease, hypertension, diabetes, and cigarette smoking. Damage to the spinal cord is the second leading cause of paralysis. Those living with a spinal cord injury may develop conditions such as Autonomic Dysreflexia (AD), which can also lead to a stroke. It is important to know that strokes can be prevented and treated, although early action and proper treatment is crucial.

What is a stroke and what are the symptoms?

A stroke happens when blood flow to the brain is reduced, which in turn reduces oxygen and nutrients in the brain tissue, causing brain cells to die. There are two types of strokes: ischemic and hemorrhagic. Ischemic strokes happen approximately 80{c939c2bae0617a027b176e0323160458d30d8540f92c3b2366d2d9cd348bfebf} of the time and are caused by blocked arteries to the brain. These can be less severe, resulting in a mini-stroke (transient ischemic attack (TIA)) that only involves a temporary period of symptoms. Hemorrhagic strokes are less common and occur when a blood vessel in the brain leaks or ruptures. Although both types may be deadly, hemorrhagic strokes are more likely to be fatal.

Paying attention to when signs and symptoms begin can affect treatment options. Symptoms include trouble speaking or understanding dialogue, paralysis or numbness, trouble seeing out of both or one eye, headache, and difficulty walking. If you notice any signs that a stroke may have occurred, use the acronym “FAST”:

Face. Ask the person to smile and see if their face shows signs of drooping on one or both sides.

Arms. Ask the person to lift both arms in the air. Watch to see if one arm starts drifting downward or is unable to move at all.

Speech. Ask the person to recite a basic phrase. Watch out for slurred or abnormal speech.

Time. If any of the signs are acknowledged, act fast and call 911.    

What can you do to stay aware?

If you witness someone showing signs of a stroke, seek help immediately. Time is of the essence when it comes to prevention and treatment. The sooner treatment is attained, long-term effects may be minimized. Thankfully, medical advances in the last decade have made it possible for survival rates to increase. With that being said, it is still crucial to be knowledgeable about what procedures to take in the case of someone experiencing a stroke. National Stroke Awareness Month has increased overall knowledge of the “FAST” acronym from 24 to 43 percent since 2013. Let us keep the efforts alive by embracing what the month of May represents in the healthcare field.

In the case that you or someone you know has experienced a stroke and have questions about your care, the attorneys at Bounds Law Group would be happy to speak with you. Call 877.644.5122 for a free, no obligation consultation.

Film Shines Light on Deadly Errors in Medicine
– Death toll in U.S. as high as 440,000 per year

by Ian Ingram, Deputy Managing Editor, MedPage Today
April 06, 2018

Can a film help shift the conversation on reducing deadly errors in medicine?

The documentary To Err Is Human, which is currently in previews and opens to wide release in the fall, attempts to answer that question, highlighting the obstacles, consequences, and attempts to address the myriad factors on both the institutional and individual level responsible for errors in medicine.

“It’s a massive topic to address,” said director Mike Eisenberg, following a recent screening of his film. “We really wanted to maintain a singular focus — what would my dad have done if he made this movie?”

His late father, John Eisenberg, MD, MBA, was one of the early directors for what is now the Agency for Healthcare Research and Quality (AHRQ). He launched AHRQ’s evidence-based practice centers and was viewed as a pioneer for his work in healthcare research. In 2002 he died from a brain tumor, at the age of 55.

To Err Is Human gets its title from the landmark 1999 report on deaths from medical error from the Institute of Medicine, which estimated that between 44,000 and 98,000 hospitalized Americans die from medical errors each year.

Medical error isn’t currently a CDC-approved option when listing cause on death certificates — only diseases, morbid conditions, and accidents can be listed.

In 2016 an open letter from Martin A. Makary, MD, MPH, of Johns Hopkins Medicine in Baltimore, and colleagues urged the CDC to change this policy.

The authors of the letter — who defined death from medical errors as “1) errors in judgment or skill, coordination of care, 2) a diagnostic error, 3) a system defect resulting in death or a failure to rescue a patient from death, and 4) a preventable adverse event” — pointed to the fact that funding for medical research is often based on mortality figures. As such, patient safety gets a short shrift, and little public awareness.

The CDC says its methodology is in keeping with international standards of reporting on the causes of death.

More recent (though controversial) estimates put the number of deaths due to medical error at 400,000 per year or higher, but even conservative estimates would still make it the third leading cause of death in the U.S. following heart disease and cancer.

“In 2006, I had my own medical error and became part of that statistic,” said Sally Roumanis, RN, a patient-safety specialist at Yale, who shared her experience during a panel discussion that followed the screening.

Her husband Dean ended up in the ER at Yale following a cardiac event while cycling. A stent was put in and everything had seemingly gone well. It was late at night and Dean urged Roumanis and their daughter to head home for rest. “I can’t stand you hovering,” he joked, Roumanis recounted.

But at 5 a.m. Roumanis received a call saying her husband’s condition had drastically worsened. She arrived back at Yale to see a team rushing toward the cath lab, then doctors performing chest compressions on her husband.

A couple of days later she was told her husband’s death was a result of medical error.

A coronary artery had been perforated during the stent procedure resulting in bleeding and pericardial collection. “That wasn’t the error — it was a complication,” explained moderator Harlan Krumholz, MD, of Yale’s Institute for Social and Policy Studies. “But throughout the night, as Dean began to struggle, the junior doctors failed to escalate the problem to a higher level and didn’t appreciate the seriousness.”

It was early in the morning and the doctors handling the situation were early in their careers. “Nurses were advocating for escalation,” Krumholz continued, “but didn’t feel empowered to override the situation.”

The inexperienced doctors were treating the symptoms without understanding the cause. Dean’s condition continued to spiral downward until 5 a.m. when he went into cardiac arrest. “His pressure drops dramatically — they realize it needs to be escalated,” Krumholz said. “They rush him to the lab, but it’s too late.”

“This can’t be happening,” Roumanis told herself. “You just think, ‘no, he’s in a hospital, he’s in a safe place.'”

Talking About Medical Errors

In the past, doctors were trained not to talk about mistakes, but that attitude has shifted. The film features one institution that uses actors to train physicians delivering news of a medical error made during care.

Marna P. Borgstrom, MPH, president and CEO of Yale New Haven Health System, said that nothing has changed in the way of medical malpractice litigation, but that organizations — and individuals within organizations — have made the decision that it’s the right thing to do. “Now, whenever there is an error made, whether or not there is identifiable harm to the patient, we encourage the responsible clinicians to talk with the patients about that,” she said.

“Patients still sue us when that happens,” she added, “and that’s not wrong, because in some cases people are entitled to damages.”

Borgstrom, who spoke during the panel portion, recalled that when Yale first started tracking medical errors in an internal patient safety-reporting database there were about 14,000 events the first year, across the network of providers. “That sounds like a lot,” she said. Three years later it was 24,000 and growing.

“We viewed that as a good sign,” she said. “Rather than being afraid of telling people we made a mistake, people are talking about it.”

AHRQ

AHRQ, which has been under constant threat of defunding by Congress, is still in trouble and could possibly be rolled into the National Institutes of Health (NIH). “If AHRQ is dissolved into the NIH, there will still be some form of patient safety effort going on in NIH, where people who worked at AHRQ will hopefully be able to continue their work, but the budgets will be decreased, their efforts will be pared down,” Eisenberg said. “The way it is right now will no longer exist if that happens.”

However, as part of the omnibus bill, Congress passed a 3{c939c2bae0617a027b176e0323160458d30d8540f92c3b2366d2d9cd348bfebf} increase to AHRQ’s budget for the next fiscal year ($334 million total), the first increase in 10 years. “So this is good news. There are caveats — I’m sure that those increases come with responsibilities that are not only focused on patient safety,” Eisenberg said. “The entire budget is never only about patient safety anyway.”

He said there are still people in very powerful positions who don’t think AHRQ’s work is important.

In 2012 AHRQ released a report detailing that a combination of best practices, improved safety culture, and a bigger focus on teamwork could cut central-line-associated bloodstream infections (CLABSIs) in hospitals by 40{c939c2bae0617a027b176e0323160458d30d8540f92c3b2366d2d9cd348bfebf}. Borrowed from lessons learned in the aviation industry, one of the components included use of a procedure checklist, and during the film and panel discussion — countless comparisons were made to the Federal Aviation Administration’s ability to improve safety.

“A lot of these problems are engineering problems,” said Kevin M. Johnson, MD, of the Department of Radiology & Biomedical Imaging at Yale School of Medicine, chiming in from the audience. “And we have almost no engineers around.”

The Film

Between interviews with experts in the field of patient safety, To Err Is Human weaves in the story of Susan Sheridan, whose family’s intersection with the healthcare system was met with two medical errors.

First, jaundice (a sign of too-high bilirubin) in her newborn son, Cal, was ignored and led to brain damage and development of cerebral palsy. Sheridan’s experience led her to become a patient-safety advocate. Today hospitals routinely tests for elevated bilirubin.

Years later her husband Patrick was diagnosed with and treated for a benign brain tumor. Additional tests from pathology had revealed a malignant tumor, yet this was never communicated to Patrick’s physician. Left untreated, the disease aggressively spread until it was too late. He died in 2002.

While the plan is for wide release in the fall, the trailer is now available online and various upcoming screenings have been scheduled in select cities — including Cleveland on Monday, Tuesday and Wednesday next week, and Philadelphia on April 20. The latter will include a panel discussion.

Florida Healthcare Laws: Your Right to a Second Opinion

After receiving a troubling medical diagnosis, there is sometimes confusion regarding the accuracy of the diagnosis as well as the recommended treatment options. Many people often want a second opinion to help decide what to do. Obtaining a second opinion could be costly, but in Florida you may not have to choose.  Florida recognized the need for second opinions after obtaining certain medical determinations and acknowledged that the benefits of a second opinion far outweigh the costs. Soon after, Florida became one of the few states to enact legislation that outlines the instances in which an enrollee is entitled to seek a second medical opinion.

When are you entitled to a second opinion?

In Florida, a health organization is obligated to allow a second opinion when an enrollee disputes a healthcare organization’s or a physician’s opinion relating to a surgical procedure. If you have been to a doctor and you do not agree with the doctor’s finding about the reasonableness or necessity of a surgical procedure, then you have the right to obtain a second opinion.  Additionally, a health organization is also obligated to allow a second opinion when you are subject to serious injury or illness.  In these circumstances, a second opinion will be beneficial unless your condition is life-threatening and requires immediate action.

What are the costs associated with a second opinion?

The reality for many Americans is that there are very little savings accumulated at the end of each month.  With rising healthcare costs, doctor’s visits are a cause for concern.  If you seek a second opinion from a physician that is “in network” with your insurance plan, your fees may be less.  You have the ability to choose the physician that will provide the second opinion.  If a physician is “in network”, the organization may not charge any more than the fees established by contract for a referral contract physician.  If the physician is not “in network”, your health insurance is required to pay the amount of all charges that are usual, reasonable, and customary in the community.  However, you may be required to pay up to 40 percent of the fees for physicians that are not “in network”.

What are the limitations surrounding special opinions?

Generally, you are limited to obtaining three second opinions per year.  After that, an insurance company can deny subsequent costs if they determine that you over utilized the second opinion privileges.  Additionally, you should be aware that there are exceptions for those with chronic and disabling conditions and should ask your insurance company directly about this.

Conclusion

Florida’s statute requiring health insurance providers to cover all or some of the costs associated with a second opinion is a benefit that many Americans don’t have.  However, the process is not seamless.  You should contact your insurance company to ask them specifically about their policy regarding second opinions.

At Bounds Law Group, we limit our practice to Medical Malpractice.  If you believe you or your family may have been a victim of Medical Malpractice, we would be happy to speak with you.  Call us at 877.644.5122.

Using data from the National Practitioner Data Bank, 66,426 claims paid against 54,099 physicians were analyzed from 2005 through 2014.  Approximately 1{c939c2bae0617a027b176e0323160458d30d8540f92c3b2366d2d9cd348bfebf} of all physicians accounted for 32{c939c2bae0617a027b176e0323160458d30d8540f92c3b2366d2d9cd348bfebf} of paid claims.  Results: a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims.  The study was published in the New England Journal of Medicine.

At Bounds Law Group, we are seeing similar statistics.  While the vast majority of physicians and hospitals are excellent, there are many, unfortunately, that are not.  If you believe you or your family may have been a victim of medical malpractice, we would be happy to speak with you.  At Bounds Law Group, we limit our practice to Medical Malpractice.  Call us at 877.644.5122.

http://www.nejm.org/doi/full/10.1056/NEJMsa1506137

At Bounds Law Group, many of our cases are due to misdiagnosis.  Per this report, 1 in 10 contributes to patient death, but the numbers are much higher for patient suffering.  Call us at 407.644.5151 or 877.644.5122 if you think you may be a victim of misdiagnosis.

As we age, various parts of our skeletal system begin to decline in function and can even fail. Often the points of failure are our joints including the knee joint and the hip joint. Medical science has created ways of replacing these joints with mechanical devices. You may know them as artificial hips and knees. The medical device industry calls them prosthetic replacements. These devices are made of exotic materials including cobalt, chromium, titanium and ceramics. We often feel that if a physician proposes these implants, that they have been tested and found to be safe by the FDA to be placed in the human body. Unfortunately, some of these devices have gone through what can best be described as a shortened approval process called a 510(k) submission. An example of a 510(k) submission approval is the Stryker Rejuvenate Modular Hip system which was submitted to the FDA for approval to market on April 4, 2008 and was approved only two months later on June 3, 2008.

Unfortunately, the Stryker Rejuvenate Modular Hip System demonstrated some possible problems to the patients it had been implanted in including corrosion at the modular neck, increased or excessive metal debris in the area of the hip joint which may have led to adverse local tissue responses, tissue inflammation and metallosis in the patients.  These conditions can cause pain or inflammation in the hip area or lumps to form under your skin.  This happens when the two parts of the hip implant rub against each other.  This can send metal debris into the surrounding tissue and bloodstream.  Metallosis occurs when the metal shavings deposit into the healthy tissue surrounding the implant.  This metal debris kills the tissue.  Health pink tissue becomes gray or black in color as the metal settles into the body.

If you have had this device implanted, your doctor can examine you to determine if you have this complication.  They can use a blood test to determine whether you have elevated chromium and cobalt levels.  They will also examine you to determine if you have formed any lumps under your skin.  These lumps are called pseudo-tumors.  They are fluid-filled sacs which are a result of your body attempting to isolate the poisonous metal.  Sometimes these pseudo-tumors can only be detected using an MRI.

Unfortunately, you may be more likely to have these complications if the implant you received was a Stryker Rejuvenate or ABG II Modular type of implant, or a DePuy ASR XL Acetabular or ASR Hip Resurfacing System.  The two companies that manufacture these implants have recalled them due to the significant number of complications resulting from these implants and, as a result, additional surgeries to replace the original hip implant.

While medical science has made great strides in the creation of medicines and devices to improve our longevity and quality of life, not all of their products are as safe and effective as we would hope. Occasionally, a multitude of factors come together to allow an unsafe device to be approved and used in patients. The results can be catastrophic.