Posts Tagged ‘Catastrophic Personal Injury’

Why early settlement is a win-win for all

Friday, May 20th, 2011

There is an old adage in the law that cases settle on the courthouse steps. There is a reason for that. When the parties are actually walking into court to try their case, they seem to suddenly recognize that there are significant risks to going to trial, and that there is serious money at stake. When you go to trial, only one side can win. The other side goes home a loser. Faced with such a stark outcome, both sides tend to become more reasonable in their assessment of their case and more willing to talk settlement. After all, despite all the years of experience that trial attorneys amass, no one can ever predict what a jury is going to do in any specific case. As one mediator I know likes to tell the litigants, going to court is like going to Vegas:  you roll the dice and you take your chances. So often times, the closer a case gets to the trial date the more motivated the two sides are to talk settlement. But is there a better way?

A couple of recent cases made me start to think about settlements and how they come about. (If you missed it, Brian Nash wrote an excellent piece on the frustrations of mediation and trying to settle cases). I’ve recently handled two cases that illustrate how settlements work and how two cases can go down dramatically different routes to ultimately get to the same place. Both of these cases are subject to confidentiality agreements so I can’t divulge the names of the parties or the settlement amounts, but they were both seven-figure cases with significant injury.

In the first case, the patient alleged that her doctor failed to timely diagnose stomach cancer over a period of several years. By the time the patient was properly evaluated by another physician, the cancer had progressed to the point that there was virtually no chance of a cure, and the young woman was likely going to die in the next few years. In the second case, the patient alleged that he suffered serious neurological complications (motor and nerve dysfunction in his arms and legs) as a result of post-operative complications that were not treated quickly enough. In both cases, a lawsuit was filed in court.  At that point, the two cases diverged.

Case Example #1 – Getting it done early

In the cancer case, before any depositions had taken place, the defense attorney called and asked if we might be able to talk about resolving the case. That’s always a great call to get as a plaintiff’s lawyer because it means there is a good chance that you will be able to get a nice result for your client, which is always the ultimate goal. Within a matter of weeks, we had reached an agreeable number and the case was over.

Case Example #2 – Grinding it out to the courthouse steps

In the second case, there was no early talk of resolution. The case proceeded through the normal course of litigation, which in the District of Columbia usually means about eighteen months of discovery, depositions, expert meetings, etc. Twenty-five experts were hired to review records and testify. Twenty-seven depositions ended up being taken. The case got all the way up to the Thursday before trial was scheduled to start on the following Monday morning. At that point, the parties finally reached agreement on a number and the case was settled.

Why the difference in approach?

So we have two cases, both with significant injury and both with questionable care. One case settled right away, and one dragged on for almost two years before settling. Is there a simple reason why? Not that I’ve been able to figure out. After years of doing this, I, like every other attorney, get a gut feeling as to what cases are worth, which ones will likely settle, which ones will go to trial. But it’s still a gut feeling; there’s no science involved.

It’s usually a combination of factors – the quality of the medical care, the severity of the injury, the likeability of the plaintiff and the defendant (more important than most people realize), the specific jurisdiction you’re in, etc. On top of these factors you have a myriad of psychological reactions that pop-up in lawsuits and there is no predicting those. Sometimes people get entrenched in fighting for no other reason than to fight. Some people get a number in their head for what a case is worth and don’t want to budge. So even though I can’t sit here and explain why certain cases settle early and some settle late, I do want to talk about the value of early settlements to all sides.

Common Sense and good economics say “get it done early”

It is easy to see why early resolution of cases benefits everyone, and it comes down to the costs of litigation. In today’s world, it can easily cost $75,000 to $100,000 (if not more in many instances) just in expenses to take a case to trial; it can easily be much higher in complex cases. (I know of one attorney who spent $300,000 on a case that he took to trial; he lost the case). These expenses consist primarily of expert fees paid to doctors to review records and testify. Expert doctors routinely charge at least $400 per hour and oftentimes more for their time. For trial testimony, doctors usually charge around $5,000 per day (some substantially more). If it runs into two days, that’s $10,000 just for one witness. It’s not unusual to spend tens of thousands of dollars for expert fees alone.

On top of that there is the cost of court reporters for each deposition, copying charges, obtaining medical records, long-distance calls, travel expenses, etc. Going through litigation is an expensive undertaking, and the longer the case goes on the more expensive it is. On the plaintiff side, all of those expenses are usually advanced by the attorney (in jurisdictions where this is permitted), but they all get paid back by the client at the end of the case (assuming the plaintiff wins; if there is no recovery, the plaintiff’s attorney “eats” those costs). So every dollar spent on litigation comes straight out of the client’s portion of the recovery.

On the defense side, insurers and self-insured institutions (like hospitals) have those same expenses, but on top of that, they also have to pay legal fees to their attorneys. Defense attorneys charge by the hour for everything they do on a file from reviewing records to meeting with clients to talking to experts to taking depositions. The complexity of medical negligence cases means long hours of work on each file, generating substantial legal fees. Those fees get paid to the defense lawyer whether the case is won, lost or settled at the last minute. The longer the litigation lasts, the higher the legal fees.

Of course it always costs money to investigate a case. There is no avoiding that.  Records need to be obtained and reviewed. Experts need to be retained for an initial opinion. But instead of spending $75,000 or $100,000 (or more) on a case, it may cost only several thousand dollars to work-up a case to get it ready to file – that is, to be in a position where early resolution can be discussed with the defendant. If a case can be settled early on, all of those thousands of dollars that would have gone to litigation costs go straight to the client. That is a huge benefit to the client.

The defendant benefits too. No hospital or insurance company wants to spend money needlessly. Early resolution means that the defendant doesn’t have to spend tens of thousands of dollars in expenses and tens of thousands more in legal fees. The only way it makes sense to spend that money is if, at the end of the day, the “defendant” (read insurer/hospital) believes it can either win the case or settle it for less down the road. But here’s the thing – a case can usually settle early on for less than the case would be worth had the case gotten closer to trial. This isn’t always true, of course, but as a general rule, a good case does not become less valuable over time.

Plaintiffs’ attorneys don’t undersell their cases to get an early settlement, but in practical terms, attorneys and clients are usually willing to consider some discount because they know that an early settlement is to their mutual benefit.The plaintiff gets a guaranteed financial payment now rather than waiting eighteen months for a trial and then a possible appeal that may drag the case out another two years. In that circumstance, the plaintiff is usually willing to take a little less money now because it is certain. It’s the age-old question: would you rather have X amount of money now, or wait eighteen months for the chance of getting more? For most plaintiffs, it’s an easy answer. Also the defense can pay less on a case than it would have ended up paying anyway and save thousands in expenses and legal fees by doing so. It’s a win-win for all parties.

Just do the math!

The big secret with early settlements (and which can sometimes be difficult to explain to a client) is that even though an early settlement might be for less than what a jury might award, the client can actually put more money in his or her pocket with a lower settlement amount. Again, we’re back to the issue of litigation costs. If a firm spends $10,000 to investigate a case and get it ready to file rather than $100,000 to take a case to trial, that is an extra $90,000 that goes straight to the client. Also, some law firms will have a contingent fee agreement in which the fee is higher (usually from 1/3 to 40%) when the case goes to trial, which serves to compensate for the additional time,  risk and expense of going to trial. When you consider the higher legal fees and the increased costs of litigation that have to be paid back, it can actually take a substantially larger jury verdict to put the same amount of money in the client’s pocket as he or she would get with a smaller early resolution.

Some cases may just need to be tried

I don’t mean to imply that every case that gets filed should be settled early. Far from it. Some lawyers undoubtedly file cases that are simply without merit and should be defended vigorously. Other cases – while they may be defensible – fall into a middle category where the care may not be the best but the plaintiff has problems with his/her case too. Some cases can be difficult to evaluate without further investigation and discovery to gauge the strength of the case. In those cases, it is entirely appropriate to proceed with litigation – even on a somewhat limited scale through discovery. No doubt there are instances where insurance companies do need to protect the interest of their doctors, and sometimes that means vigorously defending a case all the way through trial.

Some cases, however, – the cases where the medical care is truly egregious and the damages are clear – need to be looked at early on to see if the two sides can be reasonable and find some middle ground. If a case is going to ultimately settle (and believe me, experienced attorneys and claims adjusters can usually identify those cases early on), it makes sense to talk sooner rather than later. It requires compromise on everyone’s part, but the value to both sides is so great that it makes sense to talk early and get it done.

What has been your experience?

I’d be curious to know the experience of our readers. Has anyone been involved in a lawsuit that settled? Did it resolve early on or did it stretch out for years? Do you think the time involved had any impact on the amount of the settlement? Any tips or tricks you might suggest? Let’s hear from you – maybe we can all learn how to get these cases resolved earlier and stop wasting time, resources and money.

You may also want to read these related posts:

Frequently Asked Questions (FAQ’s)

A View from the Shady Side – The Defense Perspective

Every bad outcome does NOT a malpractice case make! Some practical advice

 

Science Confirms What Women Have Known for Years – We Really Are the Stronger Sex!

Saturday, October 23rd, 2010

Guess the "study" is right!

A new study from Johns Hopkins University led by assistant professor of surgery, Dr. Adil Haider has shown that women have an increased ability and tenacity to survive trauma when compared to men who have suffered a traumatic injury.

Haider and collegues collected data on over 48,000 patients who had suffered a severe traumatic injury.  Only patients whose blood pressure was extremely low – which is considered a sign of traumatic injury - were included in the study.  Male and female participants were placed in three groups – under 12, between 13 and 64 and those over 65.  After taking into account such variables as age, severity of injury, type of injury and manner of injury, women demonstrated a 14% higher rate of survival of traumatic injury than men.  While other variables may have caused the increased rate of survival, Haider suggests that female sex hormones like estrogen are a likely factor in women’s survival.  In some cases, female sex hormones enhance the immune system.  However, it is unclear whether the improved odds of survival are a result of the prescence of female sex hormones or the result of a decrease in the amount of male sex hormones like testosterone that serves as a protector.

Whatever the cause of the improved odds its nice to have science show us who is really capable of survival!

Editorial Comment: Geez…this is what I have to deal with….! (Brian Nash)

New First-Of-Its-Kind Study: 70,000 Children Injured Annually by Medical Devices

Thursday, July 29th, 2010

A new first-time study of injuries suffered by children as a result of medical devices has produced some startling statistics. “More than 70,000 children and teens go to the emergency room each year for injuries and complications from medical devices,” according to an article in The Washington Post, which highlights a study just published by the American Academy of Pediatrics.

Although the study points out that only 6% of all of these injuries required hospitalization, the fact remains that there is still a very large number of children that suffer injuries due to medical devices.  Some injuries are due to malfunction and misuse, while others are from very dangerous events, such as “puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs”. According to the The Washington Post article:

The most serious problems involved implanted devices such as brain shunts for kids with hydrocephalus (water on the brain); chest catheters for cancer patients receiving chemotherapy at home; and insulin pumps for diabetics. Infections and overdoses are among problems associated with these devices.

In addition, the article touches on a recent trend that has come with medical advances: home health care, for such treatments and procedures which previously required longer and more extensive hospital stays:

Dr. Steven Krug, head of emergency medicine at Chicago’s Children’s Memorial Hospital, said the study highlights a trade-off linked with medical advances that have enabled chronically ill children to be treated at home and live more normal lives.

Home care can be challenging for families; Krug says he has seen children brought in because catheters were damaged or became infected.

“Health care providers need to be aware of these kids and their devices and how to recognize or diagnose” related problems, Krug said.

All of this being said, the article suggests that the Food and Drug Administration may soon become more involved, due to the nature and extent of these injuries to children:

The researchers are working to determine how and why the injuries occurred and also are examining the prevalence in adults. Those efforts might result in FDA device warnings, depending on what they find, said study co-author, Dr. Brock Hefflin.

Hefflin and lead author Dr. Cunlin Wang work in the FDA’s Center for Devices and Radiological Health. They note there has been recent concern about medical device safety in children, particularly since many devices intended for adults are used in children.

We leave you with this conclusion, as stated by the American Academy of Pediatrics:

This study provides national estimates of pediatric medical device-associated adverse events resulting in emergency department visits and highlights the need to develop interventions to prevent pediatric device-related injuries.

Is this an adequate response?  What do you think?

With the Fourth of July comes Fireworks. Be Smart!

Thursday, July 1st, 2010

Many people enjoy watching the beautiful fireworks displays that accompany the July 4th Holiday.  Others decide to set-off the fireworks themselves.  Some people do both.  An article posted earlier this week at Springfield, Missouri’s News-Leader.com reminds us how dangerous lighting fireworks can be:

Those fireworks injuries include burns and injuries to hands, fingers and even eyes at this time of year.

Some burns caused by fireworks are minor; others are serious third-degree burns.

Fireworks burns may be small, but they can go deep, said physician Ted McMurry, medical director of St. John’s Emergency Trauma Center.

A Roman candle, for instance, “shoots a little fireball” that can penetrate clothing and skin.

Care providers have also seen eyes burned or injured by foreign bodies from fireworks, or they’ve had to remove fingers or hands ravaged by explosions.

“Typically, they come in with partially amputated fingers or a hand and the surgeons have to amputate (the rest),” said Debbie Mikkelson, nursing director at St. John’s Burn Center.

What causes this to happen?  Just plain carelessness for one. Recklessness or becoming injured when attempting to re-light fireworks are other reasons.  Another factor is alcohol. Kind of common sense, isn’t it? alcohol combined with fireworks can quickly turn a fun-filled family event into tragedy:

Booze may fuel such behavior, even in adults.

“I think as much as anything it’s risky behavior, but quite honestly the other thing that sometimes drives risky behavior is alcohol,” McMurry said. “Alcohol impairs our judgment so people will do things they might not otherwise do.”

It also slows reflexes, he added, so that drinkers lighting fireworks might not be able to move away from fuses as quickly as normal.

Accordingly, the Consumer Product Safety Commission (CPSC) has listed fireworks safety recommendations. It has also put a chilling video on YouTube that brings it home quite vividly.  We wish you a happy AND safe Fourth of July Weekend.

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.

Boating Accident:FL East Coast Boating Incident ends in multiple deaths!

Thursday, June 3rd, 2010

As my parents have now headed back to Florida from their Memorial Day Weekend visit up here to DC, a bit of nostalgia overtook me, and I decided to look at my old hometown paper online, Florida Today.  The first article to catch my eye was a tragic story about a boating trip during the holiday weekend, gone terribly wrong:

Cyril Holley, 46, and his daughter, Madison Holley, 19, were riding in a boat when they were struck and killed by another vessel, which was carrying other family and friends near Disappearing Island.

Two other people were taken to nearby hospitals.

Witnesses told Local 6 that one of the boats appeared to jump over and crash on top of the victims’ watercraft.

I will tell you from first-hand experience that the waterways and ocean along the east coast of Florida are packed with boats of varying sizes on any given Memorial Day Weekend.  Ponce Inlet (where this horrible incident occurred), an area on Florida’s east coast just south of Daytona Beach, is an area known for its significant boat population.  What makes this story even more tragic, is that Ms. Holley was due to give birth in two weeks, and the unborn child’s father was also on one of the two boats involved in the collision.

An eyewitness briefly describes what he saw as the tragedy unfolded before his eyes:

“The larger boat was just jumping off waves,” said Ryan Yadav, who watched the collision from a nearby beach. “I think it just took too much speed on and went right over. Cut the awning right off.”

Our thoughts are with the families who lost their loved ones.

Brian Nash’s comment: For those of you who have been on our wonderful waterways of D.C. and Maryland, I would imagine you have your own tales of accidents and numerous near-misses. A year ago, I saw a father flying around the Bay in a speed boat in the shipping lane with his kids screaming for joy as they hung on for dear life in a plastic raft being towed behind. Jet skiers, drunks at the helm – they’re all out there. Enjoy the water, but for goodness sake, use some common sense. If you are a boater, you know how fast it can all go so wrong.

Child Safety Tips: As mercury goes up, so do safety risks for kids!

Wednesday, June 2nd, 2010

By picpoke.com

Yes, it is really getting hot out there this week!!!  Coming from Florida to DC last year, I thought “OK, so it will not get nearly as hot up here, or at least not as early in the summer.”  Yes, I was wrong.  This thought brought me to thinking about some of the fun things to do in the summer, but also the dangers for our little ones during this time if we are not extra careful.  Lo and behold, I found this article today, courtesy of the Dallas Morning News and reprinted by the Kansas City Star:

Emergency-room professionals have their own name for the long, lovely, lazy days that kids look forward to in summer: trauma season. Because that’s when hospitals see a spike in drownings and heat-related accidents.

The article discusses several myths and related facts associated with those myths.  Here are a few samples from the article:

MYTH: Pool parties are safe as long as adults are around.

FACT: Many drownings happen when adults are close by. The problem is too much commotion. The key is to have a designated adult watching the water because that is where the danger is. The pool should be free of excess toys that can block the view of the water.

MYTH: Floaties keep little ones safe in the water.

FACT: Floaties are designed for fun, not safety. They give a false sense of security, can deflate and can slip off.

MYTH: The kids will be fine in the pool for the short time it takes to answer the phone or get a cold drink.

FACT: In a minute, a child can go under water. In two or three minutes, the child can lose consciousness. In four or five, the child could suffer irreversible brain damage or die. According to the Centers for Disease Control and Prevention, drowning is the second-leading cause of unintentional, injury-related death for children 1 to 14 years old, second only to car and transportation-related accidents.

The article states several other myths and facts, which include the hazards of leaving children unattended in cars and car seats, as well as sun exposure and dehydration.  We encourage you to read the article in its entirety.  Let’s all have a safe summer out there, please!!

Florida's doctor discipline system not tough enough, critics say

Sunday, May 30th, 2010

As a Florida-licensed attorney who spent 15 years working in consumer justice law firms in the ‘Sunshine State,’ I keep a watchful eye on trends and developments within various personal injury practice areas in Florida.  There is currently a real, legitimate concern regarding the system that is responsible for disciplining doctors who are licensed to practice medicine in Florida.  The Orlando Sentinel recently published an article how some believe there is much to be desired when it comes to how the  Florida Department of Health handles these matters.  

Consumer group Public Citizen last month ranked Florida the eighth most-lenient in the nation for disciplining doctors. The ranking stems from the number of serious actions per 1,000 doctors last year, when the state revoked the licenses of 94 and suspended 18 others. The toughest state disciplined doctors at rates three times as high. The trend has been true for a decade, the group said.

Critics contend the state does not act fast enough or toughly enough against the small share of practitioners accused of substandard care, negligence, crimes or improper behavior. Too often, they say, the state lets professionals such as Lan continue practicing while officials probe allegations of crimes or serious violations and injuries.

Regulators dismiss 90 percent of complaints that patients or others file against practitioners, more than 95 percent of those against doctors. When action is taken, the state rarely imposes serious punishments, such as revoking or suspending licenses.

There is ‘the other side’ of the story.  According to the article, some of the advocates for the way the system works take the following position:

State officials and some attorneys defend the system and say the criticisms are overstated. They say any system can be improved, but contend the state focuses on protecting the public from professionals who commit the most serious wrongs, and demands remedial training for professionals who make errors.

“I don’t see the evidence to support [the criticism]. We believe we are doing a good job,” said Lucy Gee, the health department’s director of medical quality assurance.

Gee said the process moves deliberately so it can be thorough. Cases remain secret because laws aim to keep baseless complaints from becoming public and unfairly tarnishing professionals, she said.

What about the doctors and individuals within the medical profession that repeatedly cause harm to patients or are charged with serious crimes (felonies) but are permitted to continue practicing medicine?  What about these same individuals within the profession, who do not receive ANY form of discipline whatsoever, or are allowed to continue practicing, while the investigation against them is pending. Here are just a few examples of such real world cases:

Dr. Stuart F. Tillman, a Tallahassee anesthesiologist arrested in July and charged with soliciting sex online from a police officer posing as a girl of 14.

Dr. Joseph M. Hernandez, formerly of Fort Lauderdale, who was arrested in Lake City in February and charged with trafficking narcotic pain pills and prescribing drugs for monetary gain. In 2006, records show the state banned him from doing surgery and temporarily suspended his license because his vision was severely impaired. In 2007, he was fined $5,000 for leaving part of an IV tube in a patient’s chest.

Dr. John N. Mubang, an internist in the Tampa suburb of Seffner who was arrested and charged in July 2008 with drug trafficking and prescribing controlled substances for monetary gain.

All three have pleaded not guilty, with trials pending. Hernandez and Mubang are practicing, according to their offices. Hernandez declined to comment. Mubang and Tillman could not be reached for comment, despite calls or messages left at their offices.

What does this say about the system that disciplines doctors in Florida?  Sure, there are many great doctors in Florida, but for the ones who put their patients’ lives at risk (through negligent treatment or otherwise) or are charged with serious crimes that may have an impact on their practice/medical license, the question remains: Would YOU want to have a surgical procedure performed by a doctor that has a criminal investigation pending against him or her that may land them in jail? I suspect you would prefer your doctor to be completely focused on your surgical procedure and not thinking about other ‘outside distractions.’  Shouldn’t there be additional aggressive safeguards in place that will IMMEDIATELY prevent the medical provider from committing more harm?

We leave you with this: Yes, emergency suspensions were put into effect 248 times in 2009.  However, compare that with the approximate 24,000 complaints that were filed against doctors and other members of the medical profession the same year, by both individuals and other agencies.  Are we really to believe that only 248 of those 24,000 cases required emergency suspension of one’s practice…??

Actor Dennis Quaid sues drug maker

Thursday, May 27th, 2010

Last month, we reported in a blog through our website, how actor Dennis Quaid is involved as a patient advocate, after his newborn twins nearly lost their lives back in 2007, from a medical error that could have very easily been prevented.  Put simply, the precious twins were given two doses of Heparin instead of Hep-lock (an anti-coagulant medication widely used for children).  Why is this significant?  Heparin is a drug one thousand times stronger than what the twins were supposed to have received.

Earlier this week, it was reported in the Contra Costa Times, that Mr. Quaid has filed a lawsuit on behalf of his children.  As far as the extent of his children’s injuries, the article states “The children suffered internal injuries and shock, but the extent of what happened to them will probably not be known for years, according to the suit.”  The lawsuit alleges that vials of the 10,000 unit Heparin should have been recalled previous to what happened to his children, because other infants had already died from similar medication errors.  The suit also claims that the company responsible for making the drug, Baxter Healthcare, “was obligated to warn healthcare providers of the previous medication mistakes.”

We wish the best for the Quaid family, and hope that the discovery in this case shines a light on not only finding out exactly what happened in this case, but also makes information available that may be able to save the lives of other children from future similar medical errors.  We will continue to monitor the course of this case.

Child Health: Labels Urged for Food That Can Choke

Thursday, May 27th, 2010

Earlier this year, we posted a blog on our website in regard to the American Academy of Pediatrics (AAP) policy statement in regard to the prevention of choking among children.  Earlier this week, the New York Times featured an in-depth story on an issue that is very much a part of this policy statement:  food choking hazards among small children.  The article discusses the advocacy efforts to place warning labels on foods, which pose a choking hazard to small children, as well as the proposition that small children should not be allowed to eat certain foods at all.  The article starts with an all too familiar setting that ended in tragedy:

On a July afternoon in 2006, Patrick Hale microwaved a bag of popcorn for his two young children and sat down with them to watch television. When he got up to change the channel, he heard a strange noise behind him, and turned to see his 23-month-old daughter, Allison, turning purple and unable to breathe.

As a Marine, he was certified in CPR, but he could not dislodge the popcorn with blows to her back and finger swipes down her throat. He called 911, but it was too late: by the time Allison arrived at the hospital, her heart had stopped beating. An autopsy found that she had inhaled pieces of popcorn into her vocal cords, her bronchial tubes and a lung.

Does this story make you think twice before giving your little ones popcorn?  On a personal note, I called my wife immediately after reading this story, and we discussed the fact that we should no longer allow our son, who is now two and a half, to have any popcorn. Ironically, she was on her way to take him to a movie that was going to be serving….you guessed it, popcorn.

Now, some of you may say “Well, little kids can choke on anything.”  Well, that is true.  However, there are some foods that pose an increased risk of choking.  Consider the dynamics of how a small child eats, as well as the size of their airway:

Children under 4 are at the highest risk, not only because their airways are small (the back of a toddler’s throat narrows to the diameter of a straw) but also because of the way their eating abilities develop. Front teeth usually come in at 6 or 7 months — so babies can bite off a piece of food — but the first molars, which grind food down, do not arrive until about 15 months, and second molars around 26 months.

“Between the ages of 3 and 4, they’re developing their ability to chew adequately and prepare for swallowing,” said Dr. Nisha Kapadia, a pediatric resident at Johns Hopkins Children’s Center.

When young children chew foods like peanuts, raw carrots and popcorn, some is ground down and some is not, and they tend to swallow unchewed bits of food that can block the airway or be inhaled into the bronchial tubes and lungs.

This concern and the tragic deaths associated with this concern have prompted several organizations to propose various options to attempt to prevent these injuries and deaths.  One such organization is the Center for Science in the Public Interest:

Some advocates say the government should put hazardous foods off limits to young children.

“The F.D.A. needs to set a uniform standard for cautionary information on food that should not be consumed by children under 5,” said Bruce Silverglade, legal director of the Center for Science in the Public Interest, an advocacy group that lobbied unsuccessfully in 2003 for a bill to require the Food and Drug Administration to develop food labeling regulations.

Where this debate will end up, we don’t know.  However, to think that in 2001 there were 17,500 children 14 years old and younger treated in emergency rooms for choking, with 60% of those events caused by food, there must be a way to create a safer environment for our children when they are eating.  Any suggestions?