Archive for June, 2010

New Changes in Medical Residency Requirements Announced – The Libby Zion Case Lives On.

Tuesday, June 29th, 2010

Putting aside the issue of avoiding the brand new incoming resident staff, which occurs on July 1st of each year, there are much more serious concerns about the fatigue and supervision factors whenever care is entrusted to doctors-in-training – namely, interns (first year medical school graduates) and residents (post-graduate physicians in specialized fields of training). Over the last decade these “concerns” have finally made their way to the organization that governs the training of medical graduates, the Accreditation Council for Graduate Medical Education (ACGME). The central issue, however, has never changed – patient safety.

A landmark lawsuit from New York – the Libby Zion case – brought to the public’s awareness the dangers inherent in these post-graduate training programs.

For those who may not recall, the Libby Zion case involved the death of an 18 year old college freshman, who was taken by her parents to a New York hospital, on October 4, 1984, when she developed a fever of 103 and became agitated. By 6:30 a.m. the next day, Libby Zion was dead. The story is recounted well in a lengthy but highly informative piece entitled “The Doctor is Out.”

It turns out that this young lady was the daughter of Sidney Zion, the newspaper columnist, lawyer, and well-connected New York raconteur. The essential facts of the case are recounted by The Washington Post in a November 2006 article entitled “A Case that Shook Medicine.The sub-heading is perhaps even more noteworthy – “How One Man’s Rage Over His Daughter’s Death Sped Reform of Doctor Training.

After his 18-year-old daughter Libby died within 24 hours of an emergency hospital admission in 1984, Zion learned that her chief doctors had been medical residents covering dozens of patients and receiving relatively little supervision. His anger set in motion a series of reforms, most notably a series of work hour limitations instituted by the Accreditation Council on Graduate Medical Education (ACGME), that have revolutionized modern medical education.

Residency programs have been in existence for many years – reportedly since the latter part of the 19th Century They were generally characterized as being “notoriously rigorous” with these young physicians-in-training putting in over 100 hours a week in patient care.

What followed in the wake of Libby Zion’s death and her father’s much publicized outrage led to a series of events culminating most recently in the June 23, 2010 announcement of the newest set of residency workload recommendations. In large part, however, it was the intervening history that led to these “newest recommendations.”

In May 1986 Manhattan District Attorney Robert Morgenthau agreed to let a grand jury consider murder charges. Although it declined to indict, the jury issued a report strongly criticizing “the supervision of interns and junior residents at a hospital in New York County.”

In response, New York State Health Commissioner David Axelrod established a blue-ribbon panel of experts headed by Bertrand M. Bell, an outspoken primary care physician at the Albert Einstein College of Medicine in the Bronx, to evaluate the training and supervision of doctors in the state. Bell had long criticized the lack of supervision of physicians-in-training.

In 1989, New York state adopted the Bell Commission’s recommendations that residents could not work more than 80 hours a week or more than 24 consecutive hours and that senior physicians needed to be physically present in the hospital at all times. Hospitals instituted so-called night floats, doctors who worked overnight to spell their colleagues, allowing them to adhere to the new rules.

Finally, in 2003, the Accreditation Council for Graduate Medical Education issued its first set of guidelines, limiting residents to 80 hours of work per week. As noted in last week’s article in The New York Times –

Five years later (in 2008), a national panel of experts criticized the accrediting organization for not limiting those work hours enough and for failing to address duty hour violations among different training programs. They recommended more stringent guidelines, among them an eye-glazing mandatory nap calculation that has residents sleeping for five hours between 10 p.m. and 6 a.m. when they’ve already worked longer than 15 hours but may still have to work an additional nine hours.

What then emerged was last week’s announcement of the newest set of residency workload recommendations.

While the focus throughout the history of these changes in residency training program guidelines has apparently been the modifications and restrictions on resident hours, what simply should not be lost in the discussion is the additional focus on supervision of residents by senior, more experienced physicians.

The following excerpt from the Wall Street Journal Online puts this second equally important aspect of the new guidelines in proper perspective:

The guidelines also include detailed expectations about direct supervision of younger residents by more experienced ones, in the hopes that a supervising doctor would catch any error before it affects a patient, according to Dr. Nasca.

In addition, the ACGME will step up its monitoring and enforcement of the requirements, conducting on-site visits of each institution annually beginning in July 2011. The site visits are likely to cost each institution about $12,000 to $15,000, according to Dr. Nasca.

Those programs that don’t comply with the rules could ultimately lose accreditation and be forced to disband.

The New York Times reporting on these new guidelines provides equal emphasis to the issue of supervision of these physicians-in-training.

“The pivotal dimension of teaching residents in the hospital is supervision,” Dr. Thomas J. Nasca, chief executive of the council and vice chairman of the task force, said during a telephone briefing Wednesday. Supervision “has not been standardized to a great extent. These standards set certain expectations.”

The guidelines are now open for a 45-day public-comment period and if approved by the board in September, will go into effect in July 2011.

The death of an 18 year old girl 26 years ago and the battle waged by her father have led to key changes in not only medical residency protocol – they have brought about a much more important end result – increased patient safety. It’s one thing for a physician-in-training to be exhausted; it’s quite another for patients to be injured and sometimes killed because of overly tired and inadequately supervised medical trainees.

One must wonder, however – would this system that existed for over 100 years have changed at all were it not for who it was who died and whose father it was that had the clout and power to bring about this change? At least Libby’s death appears to have not been in vain. The true test will be in the enforcement of compliance of these new “guidelines.”

Deaths of Infants in Cars Increasing with Summer Heat; Important Safety Reminders!

Monday, June 28th, 2010

The Associated Press (AP) has just posted a troubling article, one that should grab the attention of every parent who has a child that uses a car seat.

Unfortunately, with the summer comes the heat.  Already this season, we are seeing high temperatures that are matching or breaking records in the Mid-Atlantic Region.  It is with this in mind that we share excerpts from the AP article that we want you to remember, especially when transporting the ‘precious cargo’ that sometimes falls asleep in the back seat of a car:

Safety groups such as Kids and Cars and Safe Kids USA urge parents to check the back seat every time they exit the vehicle and to create a reminder system for themselves.

Some parents leave their cell phone or purse on the floor near the car seat to ensure they retrieve it along with the child. Others remind themselves by placing a stuffed animal in the car seat when the child isn’t using the seat and putting the toy in the front seat when the child is tucked in the car seat.

Unfortunately, not all parents are using these and other simple measures, to remember to never leave a child unattended in a vehicle.  Accidents happen, yes; unfortunately, these accidents can turn deadly when a child is trapped in a car in the intense heat.  As the following tragic scenario illustrates, the temperature in the car in this devastating loss was not survivable:

In Portageville, Mo., 2-year-old twins Allannah and Alliya Larry were found dead in their grandmother’s car on June 16 as temperatures pushed into the mid-90s. New Madrid County Sheriff Terry Stevens said the children apparently got into the unlocked car on their own and were locked inside the vehicle for two hours.

When investigators arrived, he said, the temperatures inside the car had surpassed 140 degrees.

The number of heat-related deaths of children in cars is dramatically increasing, so much so that “the government’s highway safety agency issued a consumer advisory this week that included a warning for parents not to leave children unattended in or near a vehicle.”

We leave you with these sobering statistics, including research done by Jan Null, an adjunct professor of meteorology at San Francisco State University:

The spate of deaths in June has caught the attention of safety advocates because July tends to be the most deadly month for children trapped in hot cars. With a week left in June, the number of deaths has already surpassed the previous record of 17 fatalities from January to June 2009, according to Null’s data.

In 2005, when Null counted a record 47 child hyperthermia fatalities, only 12 of the deaths occurred through the end of June.

Since 1998, Null has documented 463 child deaths involving heat exhaustion inside cars and trucks. Safety advocates said the deaths have been more prevalent since the mid-1990s when parent-drivers were required to put their children in the back seat, where they are safer in transit but more likely to be forgotten.

Please take precautions to make sure that you do not leave any child in your vehicle unattended for any length of time.

Over Two Million Cribs Recalled…What About Yours?

Friday, June 25th, 2010

Earlier this week, the Consumer Product Safety Commission (CPSC) made a sweeping recall announcement regarding drop-side and other types of cribs:

The U.S. Consumer Product Safety Commission (CPSC), with the cooperation of seven firms, is announcing voluntary recalls of more than two million cribs to address drop-side hazards and other hazards that affect the safety of young children. The recalling firms are providing consumers with free repair kits to immobilize the drop sides or other remedies. Do not attempt to fix these cribs with homemade remedies.

We previously highlighted crib recalls in several blogs on our website. This recall also includes some fixed-side cribs.  There are authorized repair kits available from the manufacturers involved.  They include: Child Craft (this firm is out of business, according to the CPSC), Delta Enterprise Corp., Evenflo, Jardine Enterprises, LaJobi, Million Dollar Baby, Simmons Juvenile Products Inc. (SJP).  Consumers should contact these companies directly for more information.

The recall notice from the CPSC also discusses their efforts to make cribs safer overall:

“Cribs should be the safest place in the home for infants and toddlers,” said CPSC Chairman Inez Tenenbaum. “CPSC is committed to addressing the hazards with cribs and to restoring parents’ confidence that their child will have a safe sleep.”

CPSC continues to actively investigate various cribs for potential drop-side and other hazards as part of a larger effort by the agency to rid the marketplace and homes of unsafe cribs. CPSC staff is also working on a new mandatory standard to make cribs safer, which is targeted for completion in 2010.

The CPSC goes on to state that “incorrect assembly or age-related wear and tear” may cause drop-side crib incidents.  In addition, the CPSC recommends that a crib more than 10 years old should not be used as “many older cribs do not meet current voluntary standards and can have numerous safety problems.”

If you have precious little ones at home, please check your cribs and follow the proper instructions from the CPSC and companies involved.

Debate about Color Vision -Are you seeing red?

Friday, June 25th, 2010

Theories behind color perception have been a topic of debate, for many years. But new studies suggest several possible reasons for the perception of shades of colors.

CNN News recently reported that among scientists, it is a popular belief that color vision is generally consistent within many cultures and populations. It is further believed that evolutionary reasons are responsible for such consistencies.

Within the human retina lie six to seven million photoreceptors known as cones, which allow us to see colors corresponding to short, medium and long light wavelengths. Hues of purple and blue are located at the short end, while hues of red correspond to the long ends. Some estimates claim that these cones allow the naked eye to distinguish between one and ten million variations of colors.

But some people really don’t see the color red in the way that most do. About 8 percent of men have trouble differentiating between certain colors; less than 0.5 percent of women have this problem, according to the American Academy of Ophthalmology.

In most cases of color blindness, the cone systems for either medium or long wavelengths do not work properly, resulting in reds, greens and perhaps yellows appearing very similar. But different people experience this to varying degrees. In rarer cases, people have trouble telling blue and yellow apart; the rarest of all make people see the world in grayscale.

Mark Changizi, a cognitive scientist at the Rensselaer Polytechnic Institute located in Troy, Ney York, states that:

“Color vision is all about emotions and moods, and it has much deeper and richer connections to the rest of our perceptual worlds…”

But Stephen Palmer, professor of cognitive science at the University of California, Berkeley has a different theory:

“I don’t think that we have a pure sensory experience of the color. I think it’s overlaid with how much we like things…”

Some theories suggest that color visuals have only evolved to serve as a survival skill for animals. Although cats and dogs are colorblind, they have better developed peripheral vision. Pigeons and goldfish are able to see ultraviolet light which is invisible to the human eye. Color perception is believed to have developed within the human ancestry to distinguish between red berries and green foliage.

Despite various theories regarding development and evolution, Mr. Changizi’s research suggests that the cones in our retinas are optimized to recognize changes within the hemoglobin located in our bloodstream. Simply, when physiological changes occur, the human eye is able to detect and recognize them in consistency with the color spectrum. His research further suggests that color perception must be consistent, considering the mode of the eye’s cone’s ability to detect subtle skin tone changes.

However, Mr. Palmer’s research suggests differently – that color perception is related to one’s likes and dislikes. For example, the research showed that people tend to associate colors with preferences and meaning such as blues which are characterized as symbolizing things that are good for us, and others which are associated with bad things. Blue is often associated with blue skies and clear water, both of which are good for human health; whereas yellow-green tones are associated with toxins and poisons which are detrimental to the body.

One expert at the University of Illinois still maintains that the majority of scientists believe that red is the constant color, unchanging between humans in hue perception. But the question remains, why is red the only indifferent color?

Contributing Author: Caitlynn Gillyard

“Hospital Delirium” – a true concern for our society!

Friday, June 25th, 2010

There is a concerning report posted today by regarding “hospital delirium” in elderly patients. While it has long been recognized that elderly patients in hospitals are many times confused during their hospital stays, “contemporary resarch has indicated that such episodes may be accompanied by significant negative consequences” – longer hospitalizations, delayed procedures, increasing health costs, dementia later in life and a sginifciant rise inpremature death.

The American Geriatrics Society estimated that approximately one-third of patients over the age of 70, experience hospital delirium. Intensive-care and post-surgical patients also have an increased tendency to endure such cognitive lapses.

Though the cause of hospital delirium, more often reported as “confusion,” remains unknown, doctors have become more aware of its potential triggers. These included infections, surgery, pneumonia, medical procedures such as catheter insertions, among others.

All of these cases and procedures have a tendency to incite apprehension in many elderly patients. Certain medications have also been linked to hospital delirium.

McKnight’s, an online source for long-term care and assisted living, reports in a posting on June 24th:

A study has been underway by researchers at Indiana University. The report’s author, Dr. Malaz A. Boustani, referred to delirium among elderly patients as “more dangerous than a fall.”

On June 20, 2010, Pam Belluck, a reporter for the New York Times wrote a piece entitled “Hallucinations in Hospital Pose Risk to Elderly.” She recounts a chilling story of exactly how an 84 year old patient, Justin Kaplan, a Pulitzer Prize-winning historian with a razor intellect … became profoundly delirious while hospitalized for pneumonia last year. For hours in the hospital, he said, he imagined despotic aliens, and he struck a nurse and threatened to kill his wife and daughter.”

Doctors once dismissed it as a “reversible transient phenomenon,” thinking “it’s O.K. for someone, if they’re elderly, to become confused in the hospital,” said Dr. Sharon Inouye, a Harvard Medical School professor.

This thinking is now becoming significantly modified.

Some hospitals are adopting delirium-prevention programs, including one developed by Dr. Inouye, which adjusts schedules, light and noise to help patients sleep, ensures that patients have their eyeglasses and hearing aids, and has them walk, exercise and do cognitive activities like word games.

On a personal note, a very close relative of mine had undergone a knee replacement operation. Within a day of surgery, this elderly woman became so disoriented that she was convinced that she was being attacked by a strange man entering her room in the middle of the night. Fearing for her life, she picked up the nearest ‘weapon’ she could find – the bedside telephone – and struck the ‘intruder’ with the phone. It turned out that this ‘intruder’ was a male nurse coming to take her vitals. Hearing of this incident and shocked that this woman – my mother – would ever do such a thing (since she was the embodiment of the description -”wouldn’t hurt a fly”), my sister and I asked the hospital to check her electrolytes. It turned out that they were wildly abnormal. She was administered the necessary replacement therapy and returned to her normal, sweet self – having absolutely no memory of this incident whatsoever.

It is no secret that as the Baby Boomer population ages, the number of people in our country over the age of 70 will soon be very significant. We can only hope that physicians such as Dr. Sharon Inouye and Dr. Malaz Boustani will continue their research and efforts to learn what can be done to minimize the incidence rate of “hospital delirium.” It is good to see recognition of this problem now exists and that the concept of “it’s OK – it will pass; they’re just confused” is becoming a thinking process of the past.

Stent Wars – The Decade Begins

Tuesday, June 22nd, 2010

On June 10th, we did the first in a series of articles regarding the basic medical issues involved in the St. Joseph Medical Center/Dr. Mark Midei stent scandal. This second installment begins in the year 2000 – a period in time the cardiology industry calls the STENT WARS.

The early part of this decade was a period when interventional cardiologists, such as Dr. Midei, were aggressively seeking to demonstrate a short and long term successful alternative to open cardiac bypass surgery for patients. While there is no doubt that these specialists were seeking better approaches for their patients by avoiding, if possible, open heart bypass surgery, it is also evident that these endovascular procedures were quite lucrative for interventional cardiologists as well.  It was reported that drug eluting stents generated a world market revenue of $5 billion annually in the early 2000′s.  In 2001, more then 500,000 procedures involving stents and balloon angioplasty were being performed in the United States annually. The “war” for market position was on. Who would win top position among manufacturers and grab this pot of gold?

The STENT WARS were also being fought around the globe and included familiar company names: Cordis, Boston Scientific, Medtronic, Abbott, Conor MedSystems, OrbusNeich, Biosensors, and Xtent.  Mergers, acquisitions, partnerships abounded.  As you can imagine, clinical trials were also proliferating throughout the medical world. Investment money was flowing. Interventional cardiologists invested in their own technology and made money on both the procedures and their investments. During this period of enormous expansion, Dr. Midei became co-founder of a large cardiology practice in the Baltimore metropolitan region. In the latter part of 2007, he was recruited away from his group practice and hired by St. Joseph Medical Center as its Director of Interventional Cardiology (Cardiac Catheterization).

So what was stent research showing?  What was the science that gave Dr. Midei an open door to placing numerous unnecessary stents at the cost of $10,000 – $15,000 a stent.

Early clinical trials were positive for the industry.  Data revealed drug-eluting stents (DES) reduced re-stenosis (i.e. re-narrowing of the cardiac blood vessel) from 20-30% to single digits and continued to show better outcomes than bare metal stents (BMS) and balloon angioplasty.  These favorable results led to the official FDA approval of two drug-eluting stents in 2003 and 2004 for use in the USA although clinical trials had been underway in major cardiac centers for several years. The stent type, coating of the stent with a particular drug, and key decisions made by the interventional cardiologist during stent placement were reportedly all factors necessary for favorable outcomes.  Using coronary angiography, the interventional cardiologist determined the proper stent length and diameter needed to repair a blocked artery and was able to ensure proper stent placement within the artery.  There was  enough new scientific research data for the American College of Cardiology and the American Heart Associated to update and publish clinical practice guidelines  for both hospitals and cardiologists in 2001.

Landmark studies during this time were also revealing more new information about progressive heart disease.  Research studies demonstrated coronary artery atherosclerosis usually affected more then one vessel and was, therefore, often a diffuse disease.

While these results led to the positive development of conjunctive drug therapies, they also opened the door for exploitation.

An interventional cardiologist, seeking to line his/her own pockets and/or gain a position of power within an organization for whom he/she worked could place many stents in multiple coronary vessels regardless of size or complexity. In other words, stents could be placed in symptomatic large blockages, and stents could also be placed in those small areas that MIGHT, in the so-called clinical judgment of the operator, develop into a blockage. Clinical practice guidelines were silent as to what should be done to lesser size lesions.  In the absence of data, the cardiologist could choose to be aggressive or conservative.  However, clearly an avenue for financial abuse and gain was opened for some interventional cardiologists to push acceptable judgment boundaries.

You might ask: weren’t there provisions and systems in hospitals to prevent such exploitation if it were to occur.  Unfortunately, nether the ACC nor AHA 2001 clinical practice guidelines contained any recommendations for peer review or oversight of this burgeoning stent industry. It was left to hospitals to establish their own monitoring guidelines to oversee the conduct of their physicians.

Join our next blog to learn more about the introduction of peer review guidelines that were finally published four years later in 2005.

In Memory of My Father – Happy Father’s Day, Dad!

Sunday, June 20th, 2010

I spend a good part of my week reading and writing about law, medicine and related topics. Then today came along and as I watched the Tweets fly-by wishing the world a Happy Father’s Day (which I just learned is in September in some parts of the world like Australia), I thought to myself, why not use this medium to tell some other people about the dad who raised me, my brother and sister – and the center of my universe.

He was a quiet, simple man of principle. Strong, religious, caring, loving in his own quiet but definite way. He was born and raised in Brooklyn in 1911 – a die-hard Brooklyn Dodgers fan until Da Bums had the nerve to move to California. He then would open his Rheingold beer and follow with whatever passion he could muster his new baseball love – the Marvelous Mets.

When people came to visit, it was my father who made sure they were welcomed guests in our home. Harry – the name he went by but not the one on his birth certificate – was the rock for all the wayward family souls needing strength, guidance or just a kindly smile.

He made the big trip in those days across the Hudson River and dated a girl from New Jersey (or “Jersey” as those of us on Exit 15W of the Turnpike refer to it). A lovely and loving young girl, who was not permitted to finish high school – because in those days education was a waste of time for girls. They married, had three kids and settled down in Jersey for the rest of their days. She was the center of his universe and the eternal love of his life.

What was my childhood like? The best…simple in all respects. A toy or two at Christmas – the best Christmases anyone could want. Baseball season (he loved baseball) - A glance from me, his son, into the stands during Little League and Babe Ruth baseball season – there he was. Not screaming at the umpire but omnipresent with an encouraging smile for his son.

Summer vacations – in a little hunter’s cabin in the middle of nowhere on the Delaware River in New York. Again – simple, fun and filled with love. Memories that will never fade.

He didn’t have to raise his voice when his kids were just being dumb kids. His “look” said whatever needed to be said. After a full day of work in New York and taking the DeCamp bus back and forth to Gotham City – there he was, at the kitchen table helping with homework or some goofy project we thought was the most important venture man or God could imagine. He made it seem that way too.

Having come from New York, he wasn’t the most patient driver the Lord ever placed behind a wheel. But rather than a string of curse words (I never in my entire life heard him curse), I would hear his famous – “Ya Bum, ya” when someone might cut him off on Route 3 leading into the City. Pass a church? – the tip of his hat was never, ever missed. No big show of religion, just a simple, quiet sign of respect that was not lost of me – ever!

When we lost my Dad in 1992 – a deep, dark hole in my life was created. It can never be filled. The quiet man of grace, humor, love and unending principle has been sorely missed these many years.

I’m glad I thought about writing this today. (My only regret is that I didn’t think about doing this last month for the sweet angel of my life – my Mom. Next year I will NOT forget).

If even one other person reads this – then my task is accomplished – one other person will know just a little bit about the man I loved and always will. Let’s tip our hats together and to all dads – but especially to mine – HAPPY FATHER’s DAY.

Lawsuit claims that Michigan doctor deliberately misdiagnosed hundreds of children with epilepsy for cash.

Saturday, June 19th, 2010

A lot of people must be asking that same question after reading an article posted on-line in theDetroit Free Press earlier this week – could this be true? The article details the allegations against a Dearborn, Michigan pediatric neurologist, Dr. Yasser Awaad, for deliberately mistreating and misdiagnosing children for money at the hospital where he worked, Oakwood Hospital and Medical Center. While these are currently only allegations, here is a sampling of claims taken from the article:

The lawsuit charges that Oakwood failed to properly monitor Awaad after other doctors alerted the hospital about concerns that Awaad was misdiagnosing patients. It also alleges that Oakwood never told patients and their families they needed to return for additional evaluations, once the hospital knew Awaad was under investigation.

The investigation began with concerns raised by a Michigan pediatric neurologist who found no confirmation of epilepsy when he did brain tests on Awaad’s patients.

When Benner and Savageau [attorneys for the plaintiffs] pulled brain test readings of the patients who came to them — files stored on compact discs — they found the readings to be normal, while Awaad’s records showed them to be abnormal.

According to Benner and Savageau, who ostensibly are relying on expert reviews of these brain studies, these test results demonstrate that Awaad made a misdiagnosis of epilpesy for hundreds of children that the good doctor treated.  Their allegations go even further:  Awaad even implanted devices into the brains of several children to control seizure disorders they didn’t have.

It makes one wonder if where there’s smoke, there’s fire. Consider Dr. Awaad’s pay structure as well as the fact that he has already been involved in a prior fraud investigation involving Medicaid, part of which is still pending:

In 2005, he was the top-paid doctor at Oakwood Hospital in Dearborn, receiving $600,692. Only $250,000 was in base pay; the rest of his earnings came from a contract that paid him for bringing business to the hospital.

Last September, Oakwood settled a Michigan Attorney General investigation into Medicaid fraud abuses by agreeing to pay $309,140 to Michigan’s Medicaid program, which paid for treatments of Awaad’s poorest patients. But the office closed its investigation into Awaad. “We did investigate but we didn’t find sufficient evidence to show a crime was committed,” a spokeswoman said.

A separate investigation by the Michigan Department of Community Health, which investigates charges of wrongdoing by health care providers, is pending.

The department began its review of Awaad in 2006 after a Michigan doctor reported concerns. Health care providers under investigation usually retain their licenses to practice until investigations are completed and the provider is found guilty of charges in court.

And what did Dr. Awaad do with his medical practice several months after the beginning of the investigation?  He closed down his Dearborn, Michigan medical practice, packed up and moved his practice to Saudi Arabia. We can’t help but wonder if this is just because he was homesick.

Here is just one of the many tragic stories being told by parents of these children “diagnosed” with epilepsy by Dr. Awaad.

Brian and Angel Guy wanted to have other children.

But Dr. Yasser Awaad, their former Dearborn pediatric neurologist, warned against it.

“(He) told us we shouldn’t have any more kids because our other children would end up with epilepsy,” said Angel Guy, 28, of Detroit.

Awaad diagnosed Brian Guy, the couple’s now 9-year-old son, with a seizure disorder when he was 3. He was put on powerful anti-seizure medicines and ordered to get brain tests four times a year, according to his Farmington Hills attorneys.

When the medicines caused their son to have memory problems and be sleepy and weak, they took him to another Michigan doctor in 2007, who tested him and found he didn’t have epilepsy. “We were just devastated,” the dad said.

The response from the hospital:

“We have no reason to believe Dr. Awaad’s care and treatment resulted in any harm or injury during his tenure with Oakwood,” the statement said. “The diagnosis and treatment of seizure disorders for each patient is based on an individualized basis and we intend to vigorously defend any cases that may result from these claims. We are committed to providing the best care to our patients.”

What about the response from Dr. Awaad’s attorney?  ”Detroit attorney Charles Fisher, who represents Awaad and Oakwood, said Monday he did not think it was appropriate to comment on a pending lawsuit.”

You may ask, if these allegations are true, how could this have gone undetected by the hospital? It turns out that Dr. Awaad was also the Director of the hospital’s pediatric neurology section. It will be interesting to find out if, as apparently was the situation in the Maryland stent scandal (placement of hundreds of unnecessary cardiac stents) involving its director of interventional cardiology, Dr. Mark Midei, if Dr. Awaad was the one in charge of which cases of medical care were subject to peer review. Is this another case of turning a blind-eye in the interest of profit?

“They completely neglected their responsibility under the law and common law to provide safety for their patients. All the time, both of them are collecting a lot of money,” said Benner.

Benner is suing Awaad and Oakwood Hospital. The state attorney general has already accused Awaad of over billing and collected more than $300,000 from Oakwood.

Of course, we may never get to know the full truth behind the story if this is quietly resolved between the parties under a confidential settlement agreement. Let’s wait and see where this one goes. We will try to follow this story and report on any substantive developments.

Contributed to and edited by: Brian Nash

Incomplete Walking Directions: Is Google really responsible?

Wednesday, June 16th, 2010

In Park City, Utah, a woman has filed suit against Google for providing incomplete walking directions. The California native, Laura Rosenberg, had been attempting to navigate from Daly Street to Prospector Street, which Google Maps indicated was approximately a half an hour walk. Ms. Rosenberg did not expect her half hour walk to turn into a hospital admission.  

Directions provided to Ms. Rosenberg, via Google Maps for Blackberry, directed her to walk along Deer Valley Drive, also known as Utah State Route 224. She says she was not warned that by taking this path, she would have no sidewalks to navigate her way safely.

Ms. Rosenberg is suing Google for both medical expenses and punitive damages. Ms. Rosenberg is also filing suit against Patrick Hardwood, the driver of the vehicle that hit her. Her claim against Google states:

Plaintiff Lauren Rosenberg was led onto a dangerous highway, and was thereby stricken by a motor vehicle, causing her to suffer severe permanent physical, emotional and mental injuries, including pain and suffering…

Google Maps is utilized by people world wide; the website clearly states:

Walking directions are in beta.
Use caution – This route may be missing sidewalks or pedestrian paths.

Although the disclaimer appears on the website, it hadn’t yet made it to the mobile world. Viewing directions via her Blackberry, Ms. Rosenberg claims she was led onto a highway with no warning shown on her Blackberry that her safety might be in danger.

It is expected to be argued that the disclaimer should appear on mobile applications because many users may be on foot and without access to a computer. However, some might well argue whether you really need your Blackberry to warn you that you are walking near or across a highway.

We’ll wait for the verdict on this one – if it gets that far!

How can something so deadly be so beautiful?!

Wednesday, June 16th, 2010

This morning, one of my senior trial lawyers, Marian Hogan, brought to my attention a New York Times featured post called “Killer Art.”

If you look at Marian’s biography, you see that she “earned a graduate degree in anatomic pathology from the University of Maryland. In addition to completing that coursework at the University of Maryland School of Medicine, she performed hundreds of autopsies, examined thousands of surgical specimens, and also conducted original medical research.” Her office is adorned with photographs of surgical specimens, which in their own macabre way are fascinating, if not beautiful.

I started this post with a picture of one of the artist’s – Luke Jerram – pieces. What did you think when you first saw it? Was it beautiful, aesthetically pleasing, interesting, mystifying? If I now tell you it is a representation of the swine flu organism in transparent glass, what’s your reaction now?

Jerram’s website offers the following:

Jerram is exploring the tension between the artworks’ beauty, what they represent and their impact on humanity.

The sculptures were designed in consultation with virologists from the University of Bristol using a combination of different scientific photographs and models. They were made in collaboration with glassblowers Kim George, Brian Jones and Norman Veitch.

OK…so this isn’t one of our usual posts involving medicine, law, injuries and the like. That being said – the exhibit does fascinate me. How does it strike you?

Margaret Wolfe Hungerford: “Beauty is in the eye of the beholder.”

Then again – maybe the words of Virginia Woolf are more appropriate in this instance.
The beauty of the world has two edges, one of laughter, one of anguish, cutting the heart asunder.”

Maybe I’ll go take another look at Marian’s autopsy specimen pictures one more time….