The pediatricians' group issued its statement for two reasons. First, while the number of home births in the U.S. is currently quite low -- fewer than 1 percent of births -- its popularity is rising. According to the Centers for Disease Control and Prevention, the number of planned home births grew by 29 percent between 2004 and 2009, with their greatest popularity among white women who had given birth before. The choice was most common in the Pacific Northwest.
The second reason is that a planned home birth is, indeed, a choice. A similar policy statement in Feb. 2011 by the American College of Obstetricians and Gynecologists was taken by some women as an edict. Instead of providing women with the information they need to make an informed decision, some felt, the organization simply wished to prohibit the practice.
]]> Taking that feedback into consideration, the American Academy of Pediatrics’ statement is less directive. As long as the pregnancy is low risk, involves a single child and a healthy mother, and the baby’s birth position is normal, planned home births can be safe, the group says. However, to prevent potentially deadly birth injuries, mothers should have a hospital aware and standing by. When choosing a professional to help with the birth, the AAP recommends choosing a physician or a nurse midwife certified by the American Midwifery Certification Board.The policy also emphasized the importance of having a trained professional on hand who is able to revive the infant should resuscitation be needed.
“For any baby, whether born in the hospital, a birthing center or at home, there should be one person at the delivery whose primary responsibility is the care of the baby, and that person should have the training and the skills to resuscitate the baby should it be necessary,” said the study’s lead author.
The safest place to give birth is a hospital, according to the American Medical Association, or at an accredited birthing center. As long as a mother fully understands the potential risks and benefits, however, all of the medical groups support her right to make the final decision.
Source: American Medical News, "Pediatricians offer newborn care standards for home births," Kevin B. O'Reilly, May 13, 2013
]]>It's always a tragedy when something goes wrong during birth, but it's especially heartbreaking when medical staff may have missed obvious signs that the delivery wasn't going well. A St. Louis-area woman has just filed a lawsuit against the obstetrician and the certified nurse midwife who delivered her daughter, along with the hospital where she was born. She believes they ignored clear signs of fetal distress but took no action. As a result, she claims, her daughter was born with a catastrophic brain injury.
]]> As a result of the doctor and nurse’s failure to deliver her in a timely fashion, the lawsuit claims, the little girl will never lead a normal life. She won’t be able to walk, talk or work, and she is apparently severely cognitively impaired. It is likely she will never be able to live without assistance, and the brain injury will likely require tens of millions of dollars in medical care.Press reports do not make clear exactly what the hospital may have done, but hospitals are often held partially liable for in malpractice cases brought against the medical professionals who work there. While no specific allegations were mentioned, the theory may be that the hospital failed to properly supervise the work of the doctor and nurse midwife or of other staff involved. Or, the lawsuit may allege the hospital was negligent in allowing the doctor or the nurse to work there, if it turns out that there have been previous instances of malpractice.
Birth injuries caused by medical malpractice are among the most heartrending of cases for many reasons. Not only do they represent a tragedy when something wonderful was expected, but they also leave parents with questions for which there may never be satisfactory answers. A child’s life has been irretrievably damaged, perhaps by the negligence of a medical professional. Grieving parents are often left with no option but to file lawsuits to cover the immense financial costs and to get the answers they need.
Source: The Madison-St. Clair Record, "Obstetrician and midwife accused of failing to timely deliver infant," Kelly Holleran, May 2, 2013
]]>Unfortunately, he isn’t the first person to sue Health Centers of America for diagnostic failures like these. Since 2009, eleven other patients have sued the clinic and its founder for malpractice after having experienced virtually identical problems.
]]> In this case, the man claims that the Health Centers of America doctor diagnosed him with 18 separate medical issues before she ever met him or received any test results: beta strep; chronic fatigue syndrome; chronic sinusitis; constipation; cortico-adrenal insufficiency; general memory loss; generalized anxiety disorder; hypercoagulation; hypertension; hypoglycemia; insomnia; iodine deficiency; irritable bowel syndrome; Lyme disease; nutritional deficiency; systemic candidiasis; tremors; and vasculitis.According to the lawsuit, these were the doctor’s “pet” diagnoses -- apparently she negligently diagnosed these for most of her patients on their first visits without bothering to examine them or obtain supporting test results.
The man says Health Centers of America employees then urged him that he needed important lab work on his blood, saliva, stool, brain and body. After they took some 40 vials of blood for the tests, which costs thousands of dollars, the man discovered that many of the tests weren’t even scientific.
Diagnostic failures cost people their health and their lives. Through his lawsuit, this man seeks not only compensation for his actual costs, but also the chance to stop this outrageous medical malpractice with punitive damages. He is also suing for fraud, negligence and Missouri Merchandising Practices Act violations.
Source: Courthouse News Service, “Doctor Under Heat From Irate Patients,” Joe Harris, April 10, 2013
]]>The study was a statistical analysis of medical malpractice claims in a national database that were filed between 1986 and 2010 and which resulted in payouts to the victims. The researchers analyzed some 350,000 such claims representing an inflation-adjusted $38.8 billion in total payments. To their shock, they discovered that diagnostic errors accounted for a full 35 percent of those payouts.
This may be simply because failure to accurately diagnose an illness throws the entire treatment plan off track from the beginning, the study's lead author points out. "It can be wrong diagnosis, no diagnosis or delayed diagnosis," he explains. "If you get the diagnosis wrong, the chances of getting the therapy right are greatly reduced."
]]> In some cases, that failure to diagnose can quickly result in a patient's death. "If someone has a headache, and you say 'take two aspirin and call me in the morning,' but the headache is really a brain aneurysm," he said, "the patient could die before morning."Hospital misdiagnoses were the most likely to lead to fatalities, the study found. However, the majority of diagnostic errors occur in ordinary doctors' offices.
"These are the most common and the most costly of all malpractice claims," concluded the researcher. "We have to pay attention to this because it is too big of a problem to ignore."
Patients, often enough, are in no position to know whether their physician has failed to diagnose a potentially disabling or deadly condition. Holding practitioners strictly responsible when they do make diagnostic errors is not enough, but it could be essential if we want to prevent those 160,000 people from suffering preventable injuries or deaths each year.
Source: HealthDay News, "'Misdiagnosis' Leading Cause of U.S. Malpractice Payouts: Study," April 23, 2013
]]>Ten years after the girl suffered oxygen deprivation that caused her cerebral palsy, a third jury finally awarded her $130 million.
"I'm humbled, in all honesty," commented the attorney. "I believe justice has been done"
The lawsuit accused the obstetrician and medical staff at a local hospital of failing to recognize the signs of fetal distress as the baby's brain was being deprived of oxygen. The now 10-year-old girl cannot speak or walk and will require round-the-clock care for the rest of her life.
]]> "The saddest part of this case is that despite the litany of errors, this baby could have been rescued," explained the girl's lawyer. "Had the nursing team communicated with the obstetrician just 15 minutes sooner - and delivered the baby - this terrible tragedy could have been avoided."According to the attorney, the little girl's mother, elated and relieved by the much-needed jury award, said "the agony of the last 10 years is finally ended with the knowledge that our beloved daughter will be protected for the rest of her life."
The lawyer representing the hospital believes the judge will knock the $130 million to substantially less, however. He also indicated that the hospital might appeal, or even lodge a professional misconduct complaint.
Hopefully, the girl will finally receive the compensation she deserves for the substantial harm caused by the birth injury, along with whatever she needs to make her life as healthy, safe and full as possible.
Source: New York Post, "This lawyer turned down $8M... and got them $130M," Julia Marsh and Bob Fredericks, April 18, 2013
]]>But a recent story out of Washington reminds us that this isn't always the case, and that despite our best efforts, we can't always protect ourselves from someone else's negligence. It's a story that began in 2004; and despite a mistrial and years of waiting, one doctor's failure to diagnose cancer ended in a court victory for the patient.
]]> In March 2004, when the female patient went to see the physician, he originally diagnosed her with terminal cancer. In reality, she was suffering from pneumonia. But because of the misdiagnosis, she never received treatment and eventually lapsed into a coma which later resulted in the amputation of her left foot.But this wasn't the first time the doctor had been accused of erroneous diagnoses. According to state regulators, the doctor had been cited several times by a disciplinary board for misdiagnoses and for providing methadone to patients with drug addictions. With this information in hand, the woman decided to take her medical malpractice case to court.
Her case went to trial in 2008; but because of several racist comments made by several jurors during deliberation, the judge ordered a mistrial. It wasn't until late this March that the Washington woman was awarded $813,000 in the lawsuit against the physician.
"There is no question that justice was delayed, but it wasn't denied in the end," explained the woman's lawyer.
Source: The Spokane Spokesman-Review, "Suit against doctor yields $813,000," Thomas Clouse, March 29, 2013
]]>How many of these fatalities were cases of wrongful death is not clear. What JAMA did find, however, is that while the mortality rate was improving over the study period in U.S. hospitals as a whole, it was worsening at these remote hospitals.
"This carved-out group of hospitals seems to be falling further and further behind," said the study's lead author, a doctor with the Harvard School of Public Health.
]]> The reason for the higher death rates is not entirely clear. It may be that these hospitals are simply too distant -- or too few -- to meet the emergency medical needs of their patients. Or it may be, as the study's author suggests, that these isolated hospitals can't afford the latest technology or dedicated specialists in unusual practice areas, which more urban hospitals can at least share with other facilities.However, the diseases people are dying from don't suggest the need for more expensive technology or specialists. According to the study, patients died from heart attacks, heart failure and pneumonia 13.3 percent of the time in isolated rural hospitals in 2010, but only 11.4 percent in others.
A spokesperson for the National Rural Health Association said that "mortality is just one small part of the picture" when judging hospital quality. That may be true, but if those higher mortality rates indicate higher rates or wrongful death due to medical malpractice, the other parts of the picture may not matter.
Source: The St. Paul Pioneer Press, "Study says death rates worse at rural hospitals," April 7, 2013
]]>The evidence appears to be less convincing, however, when it comes to birth injuries. It appears that C-sections, while still carrying some risk, result in fewer injuries to the infant during birth.
Currently, as many as 2.5 percent of all births in the U.S. are performed by C-section for no medical reason but at the mother's request. Often, women choosing C-sections say they're worried about the potential for urinary incontinence or sexual function from vaginal childbirth. Others simply cite their fear that natural childbirth will be too painful.
"If [a mother's] main concern is a fear of pain in childbirth," the group wrote, "then prenatal childbirth education, emotional support in labor, and anesthesia for childbirth should be offered."
]]> As for the prevention of birth injuries, however, C-sections may be preferable. Although the procedure carries an increased risk over vaginal birth for respiratory problems, vaginal birth increases some other risks for babies, such as infections, intracranial hemorrhage, neonatal asphyxia and encephalopathy. C-sections also appeared to have a lower overall risk of fetal mortality.At the same time, the risks and benefits to birthing mothers do appear to weigh heavily in favor of vaginal birth. Natural childbirth typically results in a shorter hospital stay, less risk of birthing complications and infections, and a lower chance of bowel or bladder injuries. C-sections do, however, offer the advantages of fewer instances of hemorrhages requiring blood transfusions and a short-term reduction in urinary incontinence. Planned C-sections also have the advantage over unplanned C-sections in having a reduced risk of surgical complications.
In an interesting development, the group found no evidence of any difference between the two types of birth in the risk of sexual dysfunction or long-term urinary incontinence. No differences were also found in the areas of postpartum pain, general pelvic pain, pelvic fistulas, or the risk of anorectal dysfunction, pelvic organ prolapsed, postpartum depression, subsequent stillbirths or maternal mortality.
Weighing all the risks and benefits together, the group concluded that the choice most likely to result in a healthy birth experience was vaginal birth. Every family, however, should work with their doctor to consider each of the risks and benefits in their individual situations.
Source: MedPage Today, "ACOG Advises Against Planned Cesareans," Todd Neale, March 22, 2013
]]>The new guidelines, which were published this week in the organization's journal "Neurology," were determined based on a review of the best available research on concussions and brain injury by a committee of experts in a number of medical specialties. It has already been endorsed by a broad range of groups representing athletes, patients and doctors.
"Among the most important recommendations the Academy is making is that any athlete suspected of experiencing a concussion immediately be removed from play," said one of the study's lead authors. "If in doubt, sit it out," added an AAN member who works at the University of Michigan Medical School.
]]> The researchers confirmed that certain sports carry a greater concussion risk than others. For boys and men, the highest-risk sports were football, rugby, hockey and soccer. Football helmets are critical, and the group says it doesn't matter which type, as long as it is well maintained and fits properly.For women and girls, soccer and basketball carry the highest risk. Also, athletes who have had at least one concussion in the past are at a greater risk for another, particularly within the 10 days following the first. And, the youngest girls and boys are at the highest risk for concussion.
Repeated concussions can, in some cases, lead to a condition called chronic neurobehavioral impairment, particularly in professional athletes. There is a gene that contributes to an athlete's risk, as does the length of time the person plays the sport.
To the great relief of many concussion patients, the group determined there is no clear evidence that patients need absolute rest, which had been interpreted to prohibit even activities such as reading and watching TV. Instead, each patient's progress and ability to return to play should be evaluated individually.
Perhaps most important, it is absolutely critical that any suspected concussion be evaluated by a doctor. "Being seen by a trained professional is extremely important after a concussion. If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor," said the doctor from the University of Michigan. "You only get one brain; treat it well."
Source: MedicalXpress, "American Academy of Neurology issues updated sports concussion guideline," March 18, 2013
]]>Such an event is extremely rare, and it is even more unusual that the patient died more than a year after the organ was transplanted. However, it is unknown whether any hospital negligence was involved in the deadly transplant.
According to the CDC, while potential organ donors are routinely screened for infections that could risk the health of the recipients, rabies is not among the infections screened for. This is the case for two reasons. First, rabies, although deadly, is extremely rare in the U.S., occurring in only one to three people annually. Second and equally important, rabies testing is very slow, and the short period of viability for organs limits the time available for testing. As a result, doctors and hospitals generally think the risk that an organ donor could have rabies is one worth taking.
]]> Even though a biological test for the rabies virus is not performed, potential organ donors are screened through interviews with family and friends, where possible, and a physical examination is performed that might reveal evidence of an animal bite. Rabies is virtually always transmitted through animal bites, most commonly raccoons, skunks and bats, with bats being the most common source.Basically, if there is no reason to suspect a rabies infection, hospitals don't test organ donors for it. The irony is, of course, that additional patients were exposed because the rabies test results were not available immediately after the first recipient of the tainted organs died. Maryland's health agency was only able to detect the disease by testing tissues recovered from the deceased, who died in 2011.
The three other patients who received rabies-tainted organs from the original donor have already been given rabies vaccinations and immunoglobulin treatments. The recipients of the deceased organ beneficiary have not yet been identified, but the CDC is working with public health officials in Illinois, Maryland, North Carolina, Georgia and Florida to find and treat them.
Rabies is rare, but it's so deadly that it might be worth the effort for researchers to develop a faster test for it. It may be that there was no negligence by the hospitals, surgeons or organ procurement organizations involved, but surely more could be done to prevent such deaths.
Source: Centers for Disease Control and Prevention, "CDC confirms rabies death in organ transplant recipient," March 15, 2013
]]>St. Luke's cardiologist and researcher Paul Chan had previously shown that people who have no health insurance are substantially more likely to delay going to the hospital, even when they are experiencing symptoms of a heart attack. They are also less likely to be given CPR by bystanders.
In this new study, Chan and his colleagues looked at data combined from 61,000 patient records from some 30 practices across the nation. Then, they compared the healthcare options accessed by the uninsured with those who had health insurance.
]]> According to the study, uninsured heart disease patients were 6 to 12 percent less likely to have been prescribed medications essential for the care of heart disease. They also received the least competent care in practices that serve a lot of uninsured patients. When they went to clinics with fewer uninsured patients, they received better care.Why? Chan pointed out that practices that largely serve the uninsured are often "safety net" practices that are crowded with very sick people. That could mean that doctors only have time to treat the most urgently sick patients or only the most serious issues for each patient. Some doctors, he says, may not bother writing prescriptions for the poor because many drugs are too expensive for them to fill. And, doctors who are willing to work in low-cost clinics for the uninsured might be of lesser quality and more inclined to medical negligence.
If these suppositions are true, when the majority of Americans have insurance through the new health care law, the situation ought to improve out of the simple application of market forces.
"If a practice is underperforming, now patients will have more options," he explained. "Patients may not know what medications they need, but they do know if they've been short-shrifted with face time."
Source: The Kansas City Star, "Alarming holes in the medical safety net," Alan Bavley, March 7, 2013
]]>With childhood stroke in that top 10 list, it may shock you to learn that the average time doctors take to recognize a childhood stroke is 28 hours. Tragically, a delay in diagnosis, or a failure to diagnose the stroke at all, can be debilitating or deadly because immediate treatment is essential.
]]> A stroke is a problem with the blood supply to the brain. Brain arteries might be blocked by a blood clot (ischemic stroke), or trauma or malformation could cause a brain artery to burst and bleed into the brain (hemorrhagic stroke). Since blood carries oxygen to the brain, an interruption in blood flow to the brain from either type causes oxygen deprivation, which damages or kills the affected tissue.Strokes can cause both cognitive and physical problems and unfortunately, according to Dr. Friedman, pediatricians often fail to recognize that a stroke has occurred until those deficits begin to show up.
The good news is that kids who survive strokes have a very good chance of recovery, although about 20 percent have another childhood stroke. Unfortunately, they can be hard for parents to detect in children who are too young to explain their symptoms.
The symptoms of stroke are typically an excruciating headache along with nausea and sensitivity to light -- similar to those of migraines and concussions. The frequency of pediatricians' delays in or failure to diagnose them might be due to this symptom similarity, especially if the child has been hit on the head.
Getting the immediate treatment needed for pediatric strokes may require strong advocacy on your child's behalf. Until pediatricians and emergency medical professionals get better at recognizing strokes in children, parents may simply have to insist on answers.
Source: ABC News, "Pediatric Stroke Often Misdiagnosed, Treatment Delayed," Susan Donaldson James. Feb. 11, 2103
]]>The CDC recently released its latest report on this data and found an impressive 41 percent reduction over baseline in infections surrounding central-line venous catheters, which are inserted in into the right heart ventricle or vena cava through the jugular, subclavian or femoral veins. These catheters are used for a variety of important purposes, such as administering drugs or fluids and to measure central vein pressure. Central line infections can be deadly.
]]> The report also noted a more modest reduction in infections surrounding urinary tract infections caused by catheters and in infections associated with surgical sites.While these were certainly positive developments, both the CDC and the non-profit consumer advocacy group Consumers Union caution that the results were not spread evenly across all hospitals and, even though lower than the baseline expectations were not sufficient.
"There're still far too many healthcare-associated infections. We have to do more to better protect patients," said the director of the CDC.
In fact, only 22 percent of the hospitals reporting to the National Healthcare Safety Network actually showed statistically significant drops in hospital infection rates. Two percent had actually gotten worse.
The director of the Consumers Union's Safe Patient Project pointed out the difference between those hospitals where concerted action had apparently been taken to reduce their infection rates and those who had not.
"A small percentage of hospitals have been able to attain zero infections, showing that it can be done," she said. "Unfortunately, most hospitals have not shown statistically significant improvement since 5 years ago."
In fact, the sheer number of central line infections was up in 2011, the latest year studied. According to the CDC, 3,472 hospitals reported central line infections in 2011 -- up 55 percent from 2010, when 2,242 hospitals reported infections associated with central lines.
The report calls out the slow but steady progress being made to reduce dangerous hospital infections. Unfortunately for individual patients suffering from these deadly infections, slow but steady progress is not enough.
Source: MedPage Today, "Hospital Blood Infections Down, CDC Says," Michael Smith, Feb. 12, 2013
]]>Now, their failure to diagnose the cancer has left her with only six months to a year to live.
She is a single mom with a 15-year-old autistic daughter. "She is going to be left without a mother," she told reporters. "What is going to happen to my little girl?"
According to press reports, she first went to a local hospital in 2010 because she had chest pains. She was treated by a first-year resident, who ordered an EKG and a chest X-ray but apparently did not read those tests or did not know how. He told her to take an over-the-counter painkiller and to follow up with her doctor.
]]> From the radiologist's written report, it is clear that he had found a suspicious nodule in her lung that was about two centimeters in size. The radiologist recommended a follow-up X-ray within the next three months, along with a CT scan if the nodule was still of concern. That recommendation was never mentioned to the patient at that time or at any of her subsequent visits to the hospital or her primary care physician, which she continued due to a chronic cough.The test results seemed to have disappeared into a void, and her own doctor and the hospital continued to treat her for asthma.
In May 2012, she returned to the emergency room complaining of wheezing and shortness of breath. A new chest X-ray showed the nodule in her lung had doubled in size and was clearly cancerous. Worse, it had metastasized to other organs, making it extremely unlikely she could survive.
Of all types of medical malpractice, failure to diagnose cancer can be the most deadly. This unspeakable litany of errors by numerous medical malpractice may have just cost a woman her life, and a child her mother.
Source: News Inferno, "Botched Hospital Care Leaves Single Mom With Six Months to Live," Cynthia A. Diaz-Shephard, Feb. 13, 2013
]]>For example, in an effort to reduce motorcycle accidents rates, federal regulators can give states grant money as incentive to institute certain safety-related programs or to enact certain pieces of legislation related to safety. While it is ultimately up to the states to decide whether to accept grant money and its terms, this exchange generally provides the federal government with an opportunity to advance safety initiatives and the states with the funds to do so.
]]> However, the Government Accountability Office (GAO) recently informed Congress that federal regulators should be granted increasing flexibility in their offers of state grant money specifically related to prevention of motorcycle fatality rates. In this area of concern, the GAO insists that Congress has put ineffectively narrow restraints on how the states may use money granted for this purpose.In particular, the National Highway Traffic Safety Administration (NHTSA) has reported that fatal motorcycle crashes are continuing to rise and bikers currently comprise one in seven Americans killed in road-related accidents. The agency insists that strong helmet laws and broader law enforcement initiatives are the best strategies states can employ to prevent motorcycle fatalities.
However, Congress currently only allows states to receive grant money for general motorist education and biker training due to pressure from anti-helmet lobbyists. In the end, it should be up to the states whether or not to accept money that may or may not be used for helmet initiatives and enforcement efforts. The GAO is currently calling on Congress to work for the benefit of bikers everywhere rather than prioritize the wishes of the anti-helmet lobby by easing restrictions on motorcycle fatality prevention grant money.
Source: Detroit News, "GAO: Give states more flexibility to reduce motorcycle deaths," David Shepardson, Nov. 28, 2012
]]>