A Lifesaving Tool Against Cervical Cancer Remains Underused

Preventing cervical cancer may be the last thing on the mind of the average 11-year-old girl. But by getting vaccinated for human papillomavirus, or HPV, the virus that causes nearly all cases of cervical cancer, a girl reduces her lifetime risk of developing the disease by 70 percent, studies suggest. The vaccine, called Gardasil and made by Merck, protects against the two types of HPV — 16 and 18 — responsible for most cervical cancers, the second leading cancer killer among women worldwide. It also immunizes against HPV 6 and 11, the types of the virus that cause 90 percent of genital warts, which are not life-threatening but can be distressing and difficult to treat. The federal Advisory Committee on Immunization Practices recommends vaccinating girls between the ages of 11 and 12, and as young as 9 at the discretion of doctors. It also advises that girls and women ages 13 to 26 receive the vaccine if they have not yet been immunized. But the vaccine is controversial, and only 24 percent of eligible girls and women have gotten at least one of the three recommended doses. One reason for the controversy is that the vaccine is relatively new. The Food and Drug Administration approved it in 2006, and this leaves some parents, and doctors, questioning its long-term safety and efficacy. “Studies have been done on fewer than 2,000 girls ages 10 to 15, and to know if a vaccine is safe, millions of people have to get it and have a chance to report any adverse events,” said Dr. Diane Harper, director of the Gynecologic Cancer Prevention Research Group at Dartmouth Medical School. “It’s a public health experiment, but that’s the nature of vaccines.” Proponents counter by pointing to Gardasil’s track record. An estimated eight million girls and women in the United States have received one or more doses of the vaccine, with fewer than 7 percent reporting serious side effects — about half the rate for vaccines over all.

Please click on the link below to read the New York Times article:

http://health.nytimes.com/ref/health/healthguide/esn-cervicalcancer-ess.html?ref=health

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Study: Drugs to Build Bones May Weaken Them

New questions have emerged about whether long-term use of bone-building drugs for osteoporosis may actually lead to weaker bones in a small number of people who use them. The concern rises mainly from a series of case reports showing a rare type of leg fracture that shears straight across the upper thighbone after little or no trauma. Fractures in this sturdy part of the bone typically result from car accidents, or in the elderly and frail. But the case reports show the unusual fracture pattern in people who have used bone-building drugs called bisphosphonates for five years or more. Some patients have reported that after weeks or months of unexplained aching, their thighbones simply snapped while they were walking or standing. “Many of these women will tell you they thought the bone broke before they hit the ground,” said Dr. Dean G. Lorich, associate director of orthopedic trauma surgery at New York-Presbyterian/Weill Cornell and the Hospital for Special Surgery. Dr. Lorich and his colleagues published a study in The Journal of Orthopaedic Trauma last month reporting on 20 patients with the fracture. Nineteen had been using the bone drug Fosamax for an average of 6.9 years. Last year, The Journal of Bone and Joint Surgery published a Singapore report of 13 women with low-trauma fractures, including 9 who had been on long-term Fosamax therapy. The doctors emphasize that the problem appears to be rare for a class of drug that clearly prevents fractures and has been life-saving for women with severe osteoporosis. Every year, American adults suffer 300,000 hip fractures.

Please click on the link below to read the New York Times article:

http://www.nytimes.com/2008/07/15/health/15well.html?_r=1&ref=health&oref=slogin

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Massachusetts High Court: Doctors Liable for Patient’s Lessened Chance of Survival

The Massachusetts Supreme Judicial Court has ruled that physicians can be held liable in a wrongful death action when their negligence lessens a patient’s chance of survival. The ruling, which for the first time upholds the “loss of chance” doctrine, came in an appeal of case where a jury found that a physician’s negligence deprived his patient of a less than even chance of surviving stomach cancer. “Where a physician’s negligence reduces or eliminates the patient’s prospects for achieving a more favorable medical outcome, the physician has harmed the patient and is liable for damages,” wrote Chief Justice Margaret Marshall. The court said that permitting recovery for loss of chance is “particularly appropriate in the area of medical negligence” but added that the decision is limited to such claims. The plaintiff in this case, Kimiyoshi Matsuyama, died of gastric cancer in 1999 at the age of 46. In 2004, a jury found that he had complained for several years to his physician, Dr. Neil Birnbaum, about stomach pains, but Birnbaum did not order diagnostic tests until May 1999. The testing supported a diagnosis of gastric cancer but Matsuyama died five months later. The jury awarded $160,000 to his estate for pain and suffering caused by the physician’s negligence. It also awarded $328,125 to Matsuyama’s widow and son for the decedent’s loss of chance. On appeal, the defendants claimed that the state’s wrongful death statute does not recognize loss of chance. Birnbaum’s lawyers also argued there was no evidence that the doctor’s actions contributed substantially to his patient’s death. But the high court sided with the jury on the appeal, ruling that the loss of chance doctrine “views a person’s prospects for surviving a serious medical condition as something of value, even if the possibility of recovery was less than even prior to the physician’s tortious conduct.” According to the decision, “recognizing loss of chance in the limited domain of medical negligence advances the fundamental goals and principles of our tort law. ” In a brief filed along with the case, a liability watchdog group expressed concern that a ruling in favor of the last chance doctrine could lead to higher malpractice insurance costs for doctors and hospitals. The members of the organization, the Professional Liability Foundation, include the Massachusetts Medical Society, Baystate Health System, Caritas Christi Health Care System, the Massachusetts Hospital Association, the Tufts-New England Medical Center, ProMutual Group, and the Risk Management Foundation of the Harvard Medical Institutions Inc.

Please click on the link below to read the Insurance Journal article:

http://www.insurancejournal.com/news/east/2008/07/24/92172.htm

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Study Questions Breast Self-Exams

Although most women are told to examine their breasts every month for lumps, new research confirms that the practice – on its own – may do more harm than good. Self exams, and those by healthcare providers, actually produce an increase in benign biopsies, but don’t get the patient into treatment earlier or save her life. “At present, screening by self-examination or physical examination cannot be recommended,” the researchers wrote in today’s issue of The Cochrane Library, in which they reviewed previous research on nearly 400,000 women. Many cancer organizations changed their guidelines to reflect the original research after it was published five years ago, while maintaining that women should still be aware of what their breasts look and feel like, and to report any changes to their doctor. “What this research does is [say] breast self exam by itself doesn’t increase survival and it never did,” said Cindy Geoghegan, executive advisor for scientific community relations at the Susan G. Komen for the Cure. “But as part of a comprehensive plan for women for early detection” that includes maintaining a healthy lifestyle and knowing your medical history, “we’re not going to say don’t do it.” The study focuses on two studies – a 2003 study of over 120,000 Russian women and a 2002 study of over 266,000 Chinese women. While the Chinese study provides the stronger evidence – the Russian study was conducted amid the fall of the Soviet Union – both suggest that self-examination can actually pose potential harm in the form of increased benign biopsies, while no evidence can be found for potential benefits. “Publications like this are very useful for informed decision making by women,” said Dr. Barry Kramer, associate director for disease prevention at the National Institutes of Health. “Sometimes the messages that are out there are not connected to the literature and women and physicians themselves may not be fully aware of these results.” The study does not suggest that women should not perform the exams themselves, or have medical professionals perform them, but the authors write, “that the lack of supporting evidence from the two major studies should be discussed with these women to enable them to make an informed decision.”

Please click on the link below to read the Boston Globe article:

http://www.boston.com/news/health/blog/2008/07/study_questions.html

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Monet? Gauguin? Using Art to Make Better Doctors

Dr. Joel Katz’s class of Harvard Medical School students meets on Friday afternoons at the Museum of Fine Arts, where they discuss the Seated Bodhisattva, a towering figure carved in ancient China, Joseph Mallord William Turner’s Slave Ship, and other artworks Katz believes will make them better doctors. On one Friday this spring, 24 of the country’s most promising future physicians circled the limestone Bodhisattva as art instructor Alexa Miller posed a question: “What’s happening here?” The students initially observed that the figure was made of stone and appeared peaceful. But she pushed them further. “What do you see that makes you say that?” she asked. After an hour at the museum, the class walked back to Harvard Medical School to apply what they had learned about examining art to diagnosing breathing problems, skin rashes, and neurological disorders, and to reading lung X-rays. Katz’s class is one of a growing number of art courses offered to medical students nationwide and aimed at improving their observation and diagnostic skills at a time when doctors are increasingly relying on CT scans, Maris, biopsies, and other technology to do their work, even though it is far more expensive – and sometimes unnecessary to pinpoint illnesses.

Please click on the link below to read the Boston Globe article:

http://www.boston.com/ae/theater_arts/articles/2008/07/20/monet_gauguin_using_art_to_make_better_doctors/

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Trying to Save by Increasing Doctors’ Fees

Cutting health costs by paying doctors more? That is the premise of experiments under way by federal and state government agencies and many insurers around the country. The idea is that by paying family physicians, internists and pediatricians to devote more time and attention to their patients, insurers and patients can save thousands of dollars downstream on unnecessary tests, visits to expensive specialists and avoidable trips to the hospital. Nationally, Medicare and commercial insurers pay an average of only about $60 a visit to the office of a primary-care doctor and rarely if ever pay for telephone or e-mail consultations. Many health policy experts say the payments are not enough to let the doctors spend more than a few minutes with each patient.

Please click on the link below to read the New York Times article:

http://www.nytimes.com/2008/07/21/business/21medhome.html?_r=1&ref=health&oref=slogin

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Surgeon Sued for Giving Anesthetized Patient Temporary Tattoo

In a lawsuit filed recently, a Camden County woman accused her orthopedic surgeon of “rubbing a temporary tattoo of a red rose” on her belly while she was under anesthesia. The patient discovered the tattoo below the panty line the next morning, when her husband was helping her get dressed to go home after the operation for a herniated disc, her attorney, Gregg A. Shivers, said in a phone interview yesterday. “She was extremely emotionally upset by it,” said Shivers. The suit, filed on behalf of Elizabeth Mateo in Camden County Superior Court, seeks punitive and compensatory damages from Steven Kirshner, a board-certified orthopedic surgeon with offices in Marlton and Lumberton, both in Burlington County. Kirshner does not deny placing the tattoo – and has left washable marks on patients before to improve their spirits, his lawyer, Robert Agre of Haddonfield, said last night. He said none have complained.

Please click on the link below to read the Philly.com article:

http://www.philly.com/philly/hp/news_update/20080716_Surgeon_sued_for_giving_anesthetized_patient_temporary_tattoo.html

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Trial Intensifies Concerns About Safety of Vytorin

In a clinical trial, the cholesterol lowering drug Vytorin did not help people with heart-valve disease avoid further heart problems but did appear to increase their risk of cancer, scientists reported. The scientists who reported on the trial, called Seas, cautioned against panicking over the cancer findings, saying that even well-designed clinical trials sometimes produce chance results. A review of two other, much larger trials did not find a similar risk, they said. Vytorin and Zetia, a companion drug, are prescribed each month to almost three million people worldwide and are among the world’s top-selling medicines. But other cardiologists and epidemiologists said that the cancer risk could not be so easily dismissed. The findings of the Seas trial will heighten concerns about Vytorin’s safety and effectiveness, said Dr. Steven Nissen, a former president of the American College of Cardiology and a longtime critic of Vytorin. Six months ago, a fourth clinical trial, called Enhance, also failed to show that Vytorin benefited patients, leading a panel of top cardiologists to recommend using Vytorin and Zetia only as a last resort. Since that recommendation, Vytorin and Zetia prescriptions have plunged.

Please click on the link below to read the New York Times article:

http://www.nytimes.com/2008/07/22/business/22drug.html?_r=2&ref=health&oref=slogin&oref=slogin

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Rise Seen in Medical Efforts to Treat the Very Old

When Hazel Homer was 99, more than one doctor advised that there was little to be done about her failing heart except wait for it to fail a final time. But Mrs. Homer was not interested in waiting to die of what many would call old age. Now, at 104, her heart is still ticking, thanks to a specialized pacemaker and defibrillator that synchronizes her heartbeat and can administer a slight shock to revive her if her heart falters. Her operation, a month before her 100th birthday, reflects what some doctors are hailing as a new frontier in medicine: successful surgery for centenarians. But others say that such aggressive treatment for what are euphemistically known as the late elderly can be wasteful and barbaric, warning that the rush to test the limits of technology can give patients false hope and compound their health challenges with surgical complications. “She’s just a peek into the future,” said Dr. Steven M. Greenberg, a Long Island cardiologist who performed Mrs. Homer’s surgery, for which the average Medicare reimbursement at the time was $35,000. Data is hard to come by, since people over 75 are scarcely represented in clinical trials, but several geriatricians said that procedures that two decades ago were seldom considered for people in their 90s are now increasingly commonplace. They include hip and knee replacement, cataract surgery, heart valve replacement, bypass operations, pacemaker implantation and treatment for slow-growing cancers that afflict areas like the prostate.

Please click on the link below to read the New York Times article:

http://www.nytimes.com/2008/07/18/health/18old.html?_r=1&hp=&adxnnl=1&oref=slogin&adxnnlx=1216988142-vY0R2nOz7hzfR9dQ7QFevA#

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Cost, Workflow Disruption Blamed for Slow E-Prescribing Adoption Rate

Prescribe drugs electronically? Chances are, you don’t. More than 35 million electronic prescriptions were issued nationwide in 2007, but only 6 percent of doctors wrote them, according to a study released in June by a group made up of healthcare organizations and microchip maker Intel Corp. The report, “Electronic Prescribing: Becoming Mainstream Practice,” was published by the eHealth Initiative and the Center for Improving Medication Management, which includes representatives from Intel, the American Academy of Family Physicians, Humana Inc., the Medical Group Management Association, and SureScripts, an e-prescribing software maker. The study shows that 35,000 doctors were actively e-prescribing last year, but those physicians wrote only 2 percent of all prescriptions issued in the year. The Center estimates that by the end of 2008, there will be at least 85,000 active e-prescribers. “E-prescribing works, and its benefits for many stakeholders are proven,” Kate Berry, executive director of the Center, said in a press release from the group. “However, education, incentives, and implementation assistance are needed.” The top obstacle to widespread adoption is cost to doctors, according to the report. Investing in more hardware and software, and confusion over whether to integrate the system into their practices’ EHR or buy a stand-alone e-prescribing system make most doctors want to hold on to their paper pads. Workflow disruption is another major stumbling block, the study shows. The Center offered recommendations to encourage wider use of e-prescriptions, which its backers claim will reduce errors and improve efficiency by speeding renewals.

Recommendations in the report include:

• Incentives should be developed by federal and state governments, payers, employers, health plans, and health systems to encourage adoption.
• Termination of the DEA ban on e-prescribing of controlled substances, which accounts for about 20 percent the market. (Less than a month after the study’s release, the DEA was already moving to repeal the ban.)
• Create a public-private e-prescribing advisory body, made up of diverse stakeholders across every sector of health care, to accelerate the effective use of e-prescribing.

Please click on the link below to read the Medical Economics article:

http://medicaleconomics.modernmedicine.com/memag/InfoTech+Bulletin/E-prescribing/ArticleStandard/Article/detail/528195?contextCategoryId=44149

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Wyoming: Medical Review Panel Has Modest Impact

Medical review panels, created to weed out frivolous medical malpractice lawsuits, have had a modest impact on claims filed through the end of 2007, a report says. Of the 89 claims filed since the panel went into effect on July 1, 2005, 24 were either withdrawn or dismissed, settled or partially dismissed, or a lawsuit was filed but it was settled before trial. Overall, the panel has had an impact on 26 percent of the claims. “I’d say that I think the program has helped to some extent,” said Eric Easton of the attorney general’s office, who administers the panels. “There are certainly some cases we can point to and say that going through the process led to the early compromise of a claim, or dismissal of a claim,” he added.
But there are a lot of claims that have gone through the process but were waived before a hearing and either ended up in District Court or some other settlement. Because many of these cases are complicated, Easton said, it is difficult to say if going through a hearing would have kept them out of court. “I certainly feel that in a lot of those cases the process has helped settle cases ahead of time and reduced costs and kept them out of court,” Easton said. “That’s a good thing, and so we’re accomplishing something,” he added. It has been a bit of a surprise, he said, that so many health care providers — physicians, nurses, dentists and hospitals — waived the panel hearing process, which now is voluntary. It is up to the Legislature, Easton said, to decide if this is enough or if the law should be changed to make panel participation mandatory.
In 32 of the 89 cases, the health care provider failed to answer the claim or waived the panel. In 34 cases, the claimant and the health care provider jointly waived the panel. In six cases, the claimant dismissed the claim.

Please click on the link below to read the Casper-Star Tribune article:

http://www.casperstartribune.net/articles/2008/07/15/news/wyoming/d5f826ac6baff028872574870002d989.txt

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Maine: Panel to Examine High Emergency Room Use

With hospital emergency room use in Maine significantly higher than the national average, the state is planning to commission a study to determine why. A special task force is expected to meet today for the first time to begin planning the details of the study. A description of the problem developed for the study shows that Maine’s rate of emergency department use per 1,000 residents increased by nearly 20 percent between 1999 and 2005. Emergency department use in Maine was 27 percent above the national average in 1999 and is now 43 percent higher than the national average. Trish Riley, director of the Governor’s Office of Health Policy and Finance, said in an interview Tuesday that inappropriate and unnecessary use of emergency room services drives up health care spending in Maine and may reflect less-than-optimal health care from primary care providers. The study is intended to identify problems within the health care system that drive people to seek routine medical care in emergency departments, she said. The new study will analyze emergency department use at all Maine hospitals and by all patients, regardless of who pays — or doesn’t pay — the bill. Data will be drawn from a statewide hospital reporting database, which collects information that has been stripped of patient identification. Riley said the study is likely to have implications for hospitals and primary care providers. While there is no question that Maine’s largest emergency departments are overwhelmed with patients seeking care, she said, many of those patients could have avoided a medical crisis if they had gotten better health care from their regular providers or if they had access to non emergency care and advice during nighttime hours.

Please click on the link below to read the Bangor Daily News article:

http://bangornews.com/news/t/news.aspx?articleid=167202&zoneid=500

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

AMA President Says New York Needs More Primary Care Physicians

The president of the American Medical Association, Dr. Nancy Nielsen, was already quite busy before taking on her new role: The Buffalo, New York, native is a mother of five, a practicing physician, and a medical school dean. Elected president last month, Dr. Nielsen is charged with articulating the positions of the AMA, which has more than 240,000 physician members. Among the association’s most recent efforts was a successful battle to urge Congress to halt a 10.6% reduction in Medicare fees for physicians. She also believes that there is a crisis situation regarding physician shortages nationwide. “One of the big problems is not unique to New York. We have a tremendous need for primary care physicians. It’s because of the way that reimbursement is structured, because primary care is not reimbursed adequately for what is being done. In my own location of Buffalo, we’ve just been through a wrenching situation because of the hospital closings and mergers that were ordered. It has not been easy, but the right things have been done.”

Please click on the link below to read the New York Sun article:

http://www.nysun.com/health-fitness/ama-president-says-ny-needs-more-primary-care/81803/

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Problems Persist With Red Cross Blood Services

For 15 years, the American Red Crosss has been under a federal court order to improve the way it collects and processes blood. Yet, despite $21 million in fines since 2003 and repeated promises to follow procedures intended to ensure the safety of the nation’s blood supply, it continues to fall short. The situation has proved so frustrating that in January the commissioner of food and drugs attended a Red Cross board meeting — a first for a commissioner — and warned members that they could face criminal charges for their continued failure to bring about compliance, according to three Red Cross officials who attended the meeting and requested anonymity because Red Cross policy prohibits public discussion of its meetings with regulators. “If fear is a motivator, we’re happy to help out in that way,” said Eric M. Blumberg, deputy general counsel at the Food and Drug Administration, though he declined to confirm what the commissioner, Andrew C. von Eschenbach, said at the meeting. Some critics, including former Red Cross executives, have even suggested breaking off the blood services operations from the rest of the organization, as the Canadian Red Cross did a decade ago. The problems, described in more than a dozen publicly available F.D.A. reports — some of which cite hundreds of lapses — include shortcomings in screening donors for possible exposure to diseases; failures to spend enough time swabbing arms before inserting needles; failures to test for syphilis; and failures to discard deficient blood. In some cases, the lapses have put the recipients of blood at risk for diseases like hepatitis, malaria and syphilis. But according to the food and drug agency, the Red Cross has repeatedly failed to investigate the results of its mistakes, meaning there is no reliable record of whether recipients were harmed by the blood it collected.

Please click on the link below to read the New York Times article:

http://www.nytimes.com/2008/07/17/us/17cross.html?ref=health

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Repeat “Super Users” Are Swamping Emergency Rooms

Bean-thin and sallow, George tugged on a cigarette in the blistering parking lot of a Camden men’s shelter. Standing on the pavement, his foot on a picnic bench, he recalled how he took his first drink at 13. The hard living shows in the lines of George’s face — and in his medical history. When he gets sick, which is often, the 55-year-old has no place to go except one of the city’s emergency rooms. George is a “super user,” a new name coined to describe people who turn to the ER with astonishing frequency and at an astonishing cost to a health system under siege on all fronts. George said he has been admitted to a Camden emergency room 30, maybe even 40, times in the past year alone; sometimes with crushing chest pains, other times from shortness of breath, or surging blood pressure. Mostly, he said, it’s the pain from cirrhosis of his liver that sends him there. “I don’t like going to the hospital,” said George, who allowed himself to be photographed but asked his last name not be published. “But sometimes I have no choice. I get pain I would not wish on an enemy.” Researchers studying the crisis of America’s overcrowded emergency rooms are beginning to focus on this largely undocumented phenomenon, the super users who turn to hospital emergency rooms dozens, even hundreds, of times. Researchers say a seemingly intractable problem could be solved, in large part, by focusing on just the top 1 percent of emergency room users, who in Camden alone cost $46 million over five years.

Please click on the link below to read the NJ.com article:

http://www.nj.com/news/index.ssf/2008/07/repeat_super_users_are_swampin.html

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Commentary: “Computers Wouldn’t Have Helped in Overdoses of Texas Babies”

After 17 babies got overdoses of the blood thinner heparin at a Texas hospital, a hospital-quality group pointed to the incident as one more reason to push for computerized systems for ordering drugs within hospitals. The call to action invoked one of the health-care buzz-phrases of the moment: computer physician order entry, or sometimes automated physician order entry. It means doctors give their orders electronically, instead of verbally or by scrawling instructions on paper. The idea is to reduce errors and complications. Computers can also check automatically for drug interactions, implausible doses and more. There’s just one problem in this case: automation wouldn’t have done much for the tots in Texas. A pharmacist made an error mixing heparin solution, often used to flush IV lines — and IV flushes often aren’t part of physician orders anyway. You can read the statement from Christus Spohn, which also says there’s no indication as yet that heparin contributed to the deaths in the NICU. Doctors typically prescribe a dose of a particular drug over a particular time, and whether it should be administered intravenously or by mouth, for example. But a pharmacist often decides just how the drug will be prepared, whether by syringe into an IV or pre-mixed with saline. The pharmacist may note that a heparin flush is indicated before and after administration, or the nurse may know that it’s just part of the standard procedure. “You wouldn’t order a tongue depressor to do a physical – you’d just expect it to be there,” says Dennis Tribble, a 30-year hospital pharmacist and chairman of the pharmacy-informatics section of the American Society of Health System Pharmacists. “There are lots of good reasons to be a strong proponent of computerized physician order entry. It simply doesn’t solve this problem.” CPOE might not have prevented the infamous overdose of actor Dennis Quaid’s twins either. That happened when a medication cabinet contained vials of heparin a thousand times stronger than the sort that should have been there.  Another up-and-coming technology might have helped the Quaids, but not the Texas tykes: Bar Code Medication Administration, or BCMA. Those systems require medications to be labeled with bar codes in the pharmacy identifying drug, dose and patient, and then checked — via scanner and computer — against codes in the medical record and a patient armband. But if the wrong dose is mixed and mislabeled in the pharmacy, overdoses can still occur.

Please click on the link below to read the Wall Street Journal article:

http://blogs.wsj.com/health/2008/07/11/computers-wouldnt-have-helped-in-overdoses-of-texas-babies/#more-2953

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Physician, Google Thyself

Patient privacy is enshrined in ethical and legal statutes, but what about their doctors’ privacy? Two psychiatrists at Massachusetts General Hospital counsel their colleagues on the lengths their patients may go to in order to dig up digital dirt on them, from how much they paid for their houses to what their sexual orientation may be. Perhaps just as worrying as Internet stalking is the ease of stumbling onto suspect sources, they say in a commentary that warns older doctors not conversant with the Web that they ignore it at their peril. “There may be slanderous information about a physician on the Web, published in a blog or on a Web page, by a vengeful patient, colleague, or ex-lover,” Dr. Tristan Gorrindo and Dr. James E. Groves write in the Journal of the American Medical Association. “Equally vexing, there may be slanderous information published about someone with the same name as an unlucky physician.” What’s a doctor to do? First, take a spin through Google to see what’s out there, they advise. Then take control. Fight back with a plain vanilla Web page containing a basic bio and contact information. “Such information may satisfy a patient’s desire to find some digital connectedness to his or her physician, thereby discouraging deeper online probing,” they write. Of course, they can also talk to their patients about it. “If a physician suspects that an Internet-savvy patient is engaged in seeking personal information about him or her, we recommend that the physician talk with the patient about the garnered information.”

Please click on the link below to read the Boston Globe article:

http://www.boston.com/news/health/blog/2008/07/physicians_goog.html

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Costs, Quality of Life Drive Doctors from the Baby Business

When they tell their pregnant patients someone else will have to deliver their babies, it is not unusual for the doctors of Brookside Obstetrics and Gynecology Associates in Greenwich to get a special request. “They’ll say, ‘How about just one more?’ ” said Dr. Gaetane Francis. “Or ‘Can you make an exception for my baby?’ ” said Dr. Michele Rohr. The answer, the doctors said, is a regrettable no. Not after Sept. 1. On that day, the three Brookside doctors who still deliver babies will stop. Francis, Rohr and Dr. Caroline Filor will still see patients, but only for gynecological care, related surgeries and first-trimester pregnancies. It is a decision the doctors – who as a group deliver about 400 of the approximately 2,000 babies born at Greenwich Hospital annually – said they arrived at with a mix of grief and relief. The Brookside doctors’ decision makes them part of a growing trend as doctors in Fairfield County and beyond consider leaving the baby business behind. Many of the doctors cite skyrocketing medical malpractice premiums, reduced compensation from third-party insurers as well as the taxing demands on the personal lives of doctors who preside at labor and deliveries as reasons for the exodus. “This news at Brookside, unfortunately, is a microcosm of what we’ve seen happening in obstetrics for several years,” said Dr. Lawrence Bruck, chairman of obstetrics and gynecology at Stamford Hospital. “It is a crisis for the profession and ultimately, it will impact the patients, if not in this generation of mothers, the next.” A 2006 liability survey by the American College of Obstetrics and Gynecology found that 8 percent of its members stopped practicing obstetrics. In Connecticut, one of 20 states the AMA has labeled a malpractice “crisis” state, the trend appears worse.

Please click on the link below to read the Greenwich Time article:

http://www.greenwichtime.com/ci_9883267

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

North Carolina – Medical Board Voted to Post Medical Malpractice Records Online

The North Carolina Medical Board voted unanimously Wednesday in favor of adding medical providers’ medical malpractice judgments and settlements to its Web site. Since 2001, the medical board has posted basic professional and licensing information about physicians, physician’s assistants and other health care providers as well as any charges, allegations and disciplinary action the medical board has taken against them. Wednesday’s decision means malpractice judgments and settlements over a seven-year period that are greater than $25,000 will also be posted to profiles. Information on payments less than $25,000 will not be collected for public purposes. Twenty-five other state medical boards already make malpractice awards available to patients online. But North Carolina’s plan would not include payments before Oct. 1, 2007 – the date a law went into effect that requires the additional information to be posted online. “We felt the public did have a right to know more,” said Dr. Jan Rhyne, the medical board’s president. “We are seeing this as one way to regain the public trust, but also, we are trying to be transparent.”

Please click on the link below to read the WRAL.com article:

http://www.wral.com/news/local/story/3215463/

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.

Doctors Discover Ways to Keep Practices Healthy: High Costs Push Physicians to Join Forces, Diversify, Switch Careers

As a solo-practitioner working longer hours but making less money, Dr. H. Douglas Holliday didn’t think twice when presented with an offer to join a new internal medicine group practice where the physicians would be employees of Saint Thomas Hospital. Since joining West End Medical Group last year, Holliday has seen a decline in his overhead costs, including a nearly 80 percent dip in health insurance premiums for himself and his wife, who helps in the office. Joining to form larger groups or becoming employees of hospitals is one way that doctors are dealing with what many see as a financial squeeze from tighter reimbursement policies by insurers and government health programs. Other physicians are giving up private practice to join corporate America, or they’re adding new services to boost fee income. Primary care doctors like Holliday rely on office visits for much of their income, making them vulnerable to reduced payments from Medicare or private insurers. Currently, doctors who treat Medicare patients face prospects of a 10.6 percent overall pay cut effective July 1, but legislation pending in Congress could prevent that from taking effect. “About the only thing a physician can do when his income is being squeezed from increasing expenses — and decreasing reimbursements — is to see more patients to maintain his income,” said Dr. Michael Minch, past president of the Tennessee Medical Association. “And that gives you less time with each patient.”

Please click on the link below to read the Tennessean.com article:

http://www.tennessean.com/apps/pbcs.dll/article?AID=/20080619/BUSINESS01/806190338/1003/NEWS01

For more information on defending medical malpractice and nursing home matters in Florida contact Howard Citron at The Citron Law Firm, P.A. – www.citronlegal.com.