The CDC’s National Healthcare Safety Network (NHSN) (If you think we have too many governmental organizations now, just wait) has compiled its first (Yes, first) State-Specific Summary and Report on Healthcare-Associated Infections.

The results of the NHSN’s 18 page (including references) report are not entirely clear.  However there are [...]]]> Source:  US Centers for Disease Control & Prevention

The CDC’s National Healthcare Safety Network (NHSN) (If you think we have too many governmental organizations now, just wait) has compiled its first (Yes, first) State-Specific Summary and Report on Healthcare-Associated Infections.

The results of the NHSN’s 18 page (including references) report are not entirely clear.  However there are some interesting things which can be discerned from the Government-speak and statistical analysis.  Between January of 2009 and June of 2009 (That’s 6 months)  The State of New Jersey reported 72 central line-associated bloodstream infections from 100 different healthcare facilities in the state. The facilities are not specifically identified in the report.  Neither do we know, for example, if 1 or 2 of those facilities accounted for the majority of the 72 blood stream infections from central-lines.

During the same time frame, the Commonwealth of Pennsylvania reported 204 central line-associated bloodstream infections from 253 different healthcare facilities. You may be wondering how this compares with infections in the State of Rhode Island.  Well Rhode Island reported only 1-4 central line-associated bloodstream infections from 16 healthcare facilities between January 2009 and June 2009.  New York reported 182 central line-associated bloodstream infections from 182 facilities.

Here’s where it gets interesting.  Well to us anyway.  Between January 2009 and June 2009, 818 hospital-associated infections were observed in the Commonwealth of Pennsylvania. Oddly, the NHSN predicted that number would be 1,176.83 which at first glance might suggest that Pennsylvania hospitals are doing something right.  That is until you recognize that there were 818 hospital-associated infections observed and who knows how many others might have been unobserved or unreported as hospital-associated infections.

During the same time frame, the State of New Jersey reported 183 observed hospital-associated infections which was close to the predicted 222.97.

So what does this all mean?  First of all, the report is the result of a limited mandate to report specifically on central line-associated blood stream infections.  Although it is clear from the total number of observed infections in the report that more types of infections were reported.

The back story: From June 2008 to December 2008, Pennsylvania’s own Department of Health reported 13,771 hospital-acquired infections, the most common were Urinary Tract Infections from catheters (UTI’s) (24.83%), surgical site infections (22.23%) and intestinal infections (18.15%).  So why is the CDC concerned only with central line-associated blood stream infections?  Good question.  30% of Pennsylvania hospitals using central lines had more infections than expected as compared with the rest of the US. Therefore Pennsylvania was flagged for reporting.

The State of New Jersey, late to the infection reporting party, only implemented legislation requiring reporting in 2007.  Accordingly, the NJ Department of Health and Senior Services first report on State hospital-associated infections will not be released until the end of 2010.  We await that report.

~Posted by D.M. Schwadron, Esquire

The US Department of Health and Human Services is a broad agency.  One of it’s charges is the administration of Medicare and Medicaid.  In this time of financial unrest, one of the measures taken by the Department is to reduce the amount of reimbursement to [...]]]> Source:  The US Centers for Medicare & Medicaid Services (CMS)

The US Department of Health and Human Services is a broad agency.  One of it’s charges is the administration of Medicare and Medicaid.  In this time of financial unrest, one of the measures taken by the Department is to reduce the amount of reimbursement to hospitals.  How does one do that?  by identifying things which occur in hospitals that are “reasonably preventable” of course.  Let’s review the Government’s own top 10 list of HAC’s or Hospital Acquired Conditions.

Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are:  (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.

The Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision.  The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.

The 10 categories of HACs include:

1. Foreign Object Retained After Surgery (Seriously? Still number 1 after all these years?)
2. Air Embolism
3. Blood Incompatibility
4. Stage III and IV Pressure Ulcers (Also a big Nursing Home Issue)
5. Falls and Trauma
   • Fractures
   • Dislocations
   • Intracranial Injuries
   • Crushing Injuries
   • Burns
   • Electric Shock
6. Manifestations of Poor Glycemic Control  (If you’re in the hospital they should be controlling this)
   • Diabetic Ketoacidosis
   • Nonketotic Hyperosmolar Coma
   • Hypoglycemic Coma
   • Secondary Diabetes with Ketoacidosis
   • Secondary Diabetes with Hyperosmolarity
7. Catheter-Associated Urinary Tract Infection (Common and preventable)
8. Vascular Catheter-Associated Infection
9. Surgical Site Infection Following:
   • Coronary Artery Bypass Graft (CABG) – Mediastinitis
   • Bariatric Surgery
     • Laparoscopic Gastric Bypass
     • Gastroenterostomy
     • Laparoscopic Gastric Restrictive Surgery
   • Orthopedic Procedures
     • Spine
     • Neck
     • Shoulder
     • Elbow
10. Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

We aren’t suggesting that everything hospitals do is incorrect.  However, if the US Government is limiting reimbursement or withholding reimbursement to hospitals when these incidents occur then it may be a good indicator that a hospital has committed an act of malpractice.

~Posted by D.M. Schwadron, Esquire

Okay before you get all grossed out a little information for all of you, bone used for transplant currently is either your own (taken from a portion of your leg or spine) or from a cadaver donor (yes, that’s from a dead person.  “That’s Frankensteen.”)  So wood isn’t looking so bad now, huh?

Italian [...]]]> Source:  BBC News

Okay before you get all grossed out a little information for all of you, bone used for transplant currently is either your own (taken from a portion of your leg or spine) or from a cadaver donor (yes, that’s from a dead person.  “That’s Frankensteen.”)  So wood isn’t looking so bad now, huh?

Italian scientists, having completed their new tanning and hair products for the Jersey Shore, (I kid) have turned their attention to replacing bones with pieces of rattan, yes the same as in your wicker furniture.  Well, not entirely the same.

After cutting the rattan they add carbon (for all you counting your carbon credits, bear in mind we are carbon-based life forms) and calcium under intense heat and pressure to create…bone.  The rattan has a similar structure to bone allowing blood vessels and nerves to create pathways through it to keep it nice and healthy.

So far the product has been used on sheep (no shepherd jokes please) with promising results.  Apparently with months it becomes difficult to distinguish the faux bone from the real.   So with advance apologies to environmental groups and PETA, this really is an impressive and potentially helpful advance in human medical science.

~Posted by D.M. Schwadron, Esquire

Researchers and soybean growers/marketers have long been touting the benefits of soy to health.  The December 9 Journal of the American Medical Association (AMA) has now published the results of a large population study in China. Because let’s face it, if you want to do a large population study, China is your [...]]]> Source: Medscape Medical News

Researchers and soybean growers/marketers have long been touting the benefits of soy to health.  The December 9 Journal of the American Medical Association (AMA) has now published the results of a large population study in China. Because let’s face it, if you want to do a large population study, China is your place.

Soybeans and MOST products made from them are rich in isoflavones. Iso-whatsas?  These are phytoestorgens (think plant estrogen) which have been linked to reductions in the incidence of breast cancer.

This study of 5042 Shanghai breast cancer survivors aged 20 to 75 were followed for an avergage perord of 3.9 years for recurrence.  Of the 5033 patients who underwent surgery for breast cancer (mastectomy, primarily), 444 unfortunately did not survive and 534 had recurrent breast cancer.

The big story is that the women who consumed soy foods had decreased rates of recurrence and of death. 8% recurrence at the high end of soy intake (11.2% at the low end) and 7.4% mortality (death) at the high end of soy intake (10.3% at the low end).  The daily consumption of soy suggested by the study is a scant 11 grams/day.

Yes, some reading the publication have responded that there is a potential risk with estrogen and estrogen-like substances and the popular breast cancer drug Tomoxifen.  However, anyone who reads this blog will quickly ascertain that I personally believe the risks are likely overstated.  Nature vs. Big Pharma, Inc.? I’ll take nature, thanks.  As always, talk with your doctor before changing your diet.

~Posted by David Marc Schwadron, Esquire

7905 members (8.9%) of the American College of Surgeons (the certifying board) reported their own concern that they made major medical errors over the course of 3 months. I am uncertain as to all of the reporting variables and whether this could be [...]]]> Source: Annals of Surgery, November 19, 2009, Shanafelt, Tait D., MD, et al.

7905 members (8.9%) of the American College of Surgeons (the certifying board) reported their own concern that they made major medical errors over the course of 3 months. I am uncertain as to all of the reporting variables and whether this could be an underestimate.

The vast majority, 70% conceded the errors were personal rather than systemic or institutional issues.  Factors influencing the error rate were not much different than those which affect the rest of us at work, burnout (emotional exhaustion, depersonalization, sense of personal accomplishment) and depression.

The conclusion, not surprisingly, “Major medical errors reported by surgeons are strongly related to the surgeon’s degree of burnout and mental state.” So, while some surgeons will try to convince you that they’re God, it would appear even God has an off day.

~Posted by David Marc Schwadron, Esquire

_ You or a loved one were significantly injured from a surgical error or complication of surgery

_ You or a loved one were significantly injured from improper medical care or treatment

_ You or a loved one were diagnosed with breast, ovarian, prostate or other cancer after a year [...]]]> You MAY have a medical malpractice case if:

_ You or a loved one were significantly injured from a surgical error or complication of surgery

_ You or a loved one were significantly injured from improper medical care or treatment

_ You or a loved one were diagnosed with breast, ovarian, prostate or other cancer after a year or more of having symptoms

_ You or a loved one experienced stroke, heart attack or pulmonary embolism after being discharged from a hospital ER

_ You or a loved one contracted a serious infection while in a hospital

_ You or a loved one have bed sores or broken bones from a fall during a nursing home stay

_ You or a loved one experienced significant injury while being treated at a Veterans’ Hospital

_ You or a loved one were prescribed the wrong medication or too much medication

_ Your baby experienced hypoxia, birth asphyxia or brain injury following delivery due to a delay in delivery

_ Your baby experienced shoulder dystocia or nerve injury to the shoulder, arm and hand following delivery

_ You or a loved one are having a hard time getting answers from your doctor or hospital

_You or a loved one are having problems getting your medical records from your doctor or hospital

_ The records from your doctor or hospital do not accurately reflect the care you received

If you have checked Yes to any of these questions and (IN PA and NJ) the medical treatment at issue occurred within the past 2 years, you MAY have a medical malpractice case.  The Lewis Law Firm, PC will provide you with a free initial consultation to determine whether you have a medical malpractice case.

Complications, including significant injury or death, following medical treatment create confusion in addition to pain and loss.  You may have “a gut feeling” that something went wrong.  You may be too uncertain or even embarrassed about questioning medical care to consult with a lawyer.

The above is a quick check list of “red flags” which might indicate that your “gut feeling” is correct.  Obviously one can never determine from a checklist whether you actually have a medical malpractice case.  But these are certainly some good questions to start with.

Posted by David Marc Schwadron, Esquire

Okay, maybe not for everyone. For those of us aging (You know who you are) there are now more options than ever to not look like ourselves. Those of us intimidated by the prospect of surgery for facial rejuvination (Making your face look younger. Presumably [...]]]> Source: Various, including Dermik, makers of, you guessed it…

Okay, maybe not for everyone. For those of us aging (You know who you are) there are now more options than ever to not look like ourselves. Those of us intimidated by the prospect of surgery for facial rejuvination (Making your face look younger. Presumably the rest of you can go to hell in a handbasket), have the option of using dermal fillers! Dermal what-ers?

A history lesson. Since the dawn of time, or at least the dawn of purely cosmetic surgery in the 1980′s, doctors have been injecting substances under the skin to make it look fuller and more youthful and to get rid of lines and wrinkles. Not botox, which is poison –botulism, and works by paralyzing muscles with toxins, but other interesting substances. The first was bovine collagen (Yes, from cows!). More recently Hylauronic acids, which degrade over time requiring re-addition every 6-9 months and substances that stimulate the body to make it’s own collagen. Oh and returning to the animal kingdom, porcine collagen (From pigs, not porcupines) is said to be even more promising.

Perhaps not coincidentally, none of these treatments appear to last for more than 6-9 months and some considerably less. Draw your own conclusions there. So, if your lips aren’t full enough to resemble that of a famous Hollywood actress who has literally become a characature of herself or those stubborn cheeks of yours are still a little saggy or hollow and you don’t want to go under the knife, maybe injectable dermal fillers are the right thing for you.

The people at Dermik, Sanofi-Aventis and Johnson & Johnson sure would like you to think so.

posted by David Marc Schwadron, Esq.

The 5 year follow up study of 43,000 women with cosmetic breast implants yielded only 48 cases of non-Hodgkin’s Lymphoma where 53.9 cases were anticipated. What this means in layman’s [...]]]> A recent study reported in the Journal of Plastic and Reconstructive Surgery appears to dismiss the association between breast implants and the risk of developing lymphoma.

The 5 year follow up study of 43,000 women with cosmetic breast implants yielded only 48 cases of non-Hodgkin’s Lymphoma where 53.9 cases were anticipated. What this means in layman’s (non doctor’s) terms is that there is no statistically significant difference which can be directly linked to cosmetic breast implants alone. It is worth noting that the follow up study picked up on a 37 year study of the same women and necessarily, the same breasts, albeit now a little less new.

The authors conclude that, to date, there is no credible evidence of non-Hodgkin’s lymphoma originating in the breast of women who undergo cosmetic breast surgery with implants. Good news for all women who desire larger breasts and those who may admire them. That is not a judgment. However, as with all studies, consider the source.

posted by David Marc Schwadron, Esq.

There is a long tradition of [...]]]> As a medical malpractice attorney one quickly learns the indelicate balance between dealing with truly horrific tragedy, to both patients and, for the most part, well-meaning doctors, while still being open to finding the moments of unintentional hilarity which such tragedy occasionally provides. Not nearly as callous as it sounds.

There is a long tradition of “gallows humor.” It’s one of the few things we colonists retained from our British roots. And frankly if you work in the medical or in the medial-legal arena, you strike the balance quickly or you burn out. But I digress.

Imagine my surprise when a patient I was deposing in my former defense life, was able to inform me of the exact moment his surgical misadventure began. “And that’s when I heard the doctor say, ‘Oops!’” Context being key, this was a patient undergoing extensive exploratory laparotomy (stomach opened up and people poking around looking) under…wait for it…general anesthesia (Yes, that’s the one where you are unconscious). Yet despite this, he insisted he was awake and alert enough to hear the “excited utterance of the surgeon.” Yes, we all saw the 60 minutes piece or other about people being “awake” during surgery and the glorious television show House, recently had an episode about “locked in syndrome” with a patient literally trapped in his own body and unable to communicate.

Reality check No. 1: These are extremely rare and infrequently documented medical occurrences. Fine, you smugly say, maybe this was one of those. Reality check No. 2: Any one who has ever been in an actual OR, not a television portrayal of one, knows that the expression “Oops” is the very least likely 4 letter utterance of the string of 4 letter uttererances which would come out of any surgeon’s mouth if a mistake were made.

In the case of Dr. Oops, I actually used this very argument to discredit the patient who experienced a very normal postoperative complication. While I’m sure he and his counsel thought they had the case of the century, sometimes over-embelishment is not adviseable.

Contrast this with the surgeon who loudly asked his receptionist if, “The pain in the ass” had left the office following her postoperative visit. Unfortunately for my defense of the case, the pain in the ass was standing next to the receptionist at the time. Recognizing that a jury might be able to imagine a scenario whereby this surgeon might have been inattentive to his patient’s complaints of postoperative pain which might have delayed her diagnosis and subsequent re-surgery, we made the decision to settle that one.

To demonstrate that I do tend to win far more than I lose, I relate the concluding anectode of “the superstitious expert.” In seeking to establish that the medical complication experienced by a patient was a known and accepted (by the doctors anyway) risk of the procedure, It occured to me to ask the Expert Witness for the patient if it had ever happened to him while performing the surgery. Hoping that he would simply admit that it had, the expert instead provided me with the perfect closing argument, knocking on the ledge of the witness stand (knock on wood) he said, “No, actually that hasn’t happened to me, yet.” Give it a moment. Won at trial and won on Appeal to the Superior Court of PA too.

posted by David Marc Schwadron, Esq.

She began to experience significant pain and symptoms following this fairly routine procedure. An ERCP (a type of diagnostic study) was performed which demonstrated that the doctor had placed surgical [...]]]> Our Case:*Ms. S was a 35 year old woman who entered the hospital for a laparacopic procedure to remove gallstones and her gallbladder (Laparoscopic Cholecystectomy).

She began to experience significant pain and symptoms following this fairly routine procedure. An ERCP (a type of diagnostic study) was performed which demonstrated that the doctor had placed surgical clips across the proximal common duct, causing an obstruction. She was taken back in for surgery which revealed extensive injury to the rest of the ductal system from either the clips or instruments used during the procedure.

Ms. S was required to wear an external bag to act as an artificial drainage system for bile. She endured this humiliation for a number of months, having to change the bag 6-9 times daily. Surgery to reverse the external drainage led to additional complications leaving Ms. S permanently disabled.

Why the Defendants were Negligent: The doctor performing the surgery failed to take the time to identify anatomical structures within Ms. S which would have permitted him to safely perform the surgery without injury to any other structure. The improperly placed clipped ruined the bile duct system. No attending physician saw the patient in the hospital after the procedure until she became symptomatic and severely ill.

Under Pennsylvania law the doctor committing malpractice during the surgery is responsible for all of the subsequent harm relating to that malpractice, including the failed subsequent surgeries and disability.

The Verdict: The Lewis Law Firm, PC was able to recover a substantial monetary settlement of this matter prior to trial.