Posts Tagged ‘Nash & Associates’

We’re Launching a New Facebook Page for Washington, D.C.

Saturday, September 3rd, 2011

Washington, D.C. - D.C. Court of Appeals Building

By: Brian Nash, Editor 

We are very pleased to announce the launching of our new Facebook page, DC Eye Opener. For the many thousands of readers who have read our posts in Eye Opener over the past twenty or so months, we want to let you know that we will be continuing to post there as well.

Our blawgers have been posting articles and commentaries on issues relating to health, law and medicine for almost two years now. We have had over 150,000 visitors to our site since our inception. We thank each and every one of you who have stopped by and read our posts – particular thanks to our many subscribers.

So Why Washington, D.C.?

Well, the answer is quite simple – it’s one of the primary places where we practice law.

I moved from New Jersey to Washington, D.C. in 1965 and attended The Catholic University of America in Northeast D.C. While in college, I worked at the Safeway on 12th Street (sadly no longer there) as a grocery clerk and produce man, just up the road from Turkey Thicket and Providence Hospital. After I graduated from CUA, I taught for two years at Bullis Prep in Potomac, Maryland. I attended law school at the Columbus School of Law (Catholic University Law School) and obtained my Juris Doctor in 1974. I was admitted to the D.C. bar in 1976, two years after being admitted to the Maryland bar. I have been trying cases in the District of Columbia ever since. Frankly, I’ve lost track of the number of cases I’ve handled in D.C. over the years. There have been so many trials in the local and federal courtrooms of Washington, D.C. that some suggested I give up my office space and simply take up residence in the hallways of the Superior Court or in the federal district court across the street.

A number of the lawyers I began practicing with have now become judges on the Superior Court and the United States District Court for the District of Columbia. A few of my former law partners have donned the black robe and have made quite a career for themselves in the Superior Court. I am proud and pleased to call them my colleagues and my friends.

During the early part of my career, I represented numerous D.C. individuals, corporations and healthcare providers as a defense lawyer. As you can no doubt tell from our website, we are now representing people injured through the wrongdoing of others. It has been a wonderful journey, which continues on. Our lawyers at Nash & Associates, Marian, Mike, Jon and Jason, are all admitted to the District of Columbia bar as well as the Maryland bar. (Sarah Keogh is presently admitted to the Maryland bar only – we’re working on her to add D.C. to her impeccable credentials.) Simply put – the District of Columbia is our turf. One of our offices is located on Connecticut Avenue, N.W., just a half a block from the Red Line’s Farragut North Station on Connecticut and K Streets, N.W.

So Why the New Facebook Page for D.C.?

What we have seen and learned in our social media activities of blogging, Facebook, Twitter and LinkedIn is that our message can become diluted through worldwide distribution. We decided we needed to narrow our audience. Put another way, so many times we wanted to post information about what’s happening in law, medicine and health in the District of Columbia, but when your readers are from around the globe, there’s not much interest in the message and information if it’s just about Washington, D.C. Now we want to share our message and get to know you, who live and work in the District of Columbia. Frankly, our readers throughout the United States – “outside the Beltway“ as they say – don’t really care much about what’s happening in D.C.  Well we do and we know you do too!

Our Mission

Simply put, we’re going to bring you information that we hope will keep you informed about topics such as your health, trends in medicine, the laws that may affect you, what’s happening on the legal front in the areas of our expertise (negligence, medical malpractice and the like) and some postings about what’s happening around the city from our legal eye perspective. Our goal is to interact with you, have some fun, provide some useful information – all the things that social media is designed to do and has been doing so well for years now.

For those in the Twitterverse, we’ll soon be launching our new Twitter name/location. Collectively, our tweeps at Nash & Associates have over 5,000 followers. We should have our DC Twitter page up and running this week – we’ll post that new location here. In the meantime, if you want to connect on Twitter, we’re waiting to make your acquaintance at NashLawFirm.

Let’s connect! We’ve met so many great people and businesses on Twitter, Facebook and LinkedIn. We hope to soon count you among our friends and followers.

So, HELLO and WELCOME, D.C. – glad we finally get to share, meet and connect with you!

 

 

 

 

 

 

For close to two years now, our blawgers have been bringing

 

Photo from loringengineers.com

 

Robot Anesthesiologists?

Tuesday, April 19th, 2011

robotic intubationFor anyone contemplating serious surgery, it can be a scary endeavor. From going through it myself and talking to others, I know that the main fear we have going into it is that the surgeon will make a mistake during the surgery, or that we will develop serious complications such as a hematoma, infection, etc. that leads to death or paralysis. While these are very real risks of many forms of surgery, there is another aspect of surgical procedures that gets less attention from patients – the anesthesiologist. While it may get little notice from patients, anesthesiology is a highly complex field of medicine in which doctors (and certified nurse anesthetists) train for years to be able to do it well. This post will focus on just one aspect of anesthesiology known as intubation, and a new development in robotics that may improve the procedure.

What is intubation?

At its most basic, intubation is the process by which the anesthesiologist places a thin plastic tube into the patient’s windpipe to maintain an airway or to facilitate mechanical ventilation. While this is done in a variety of serious medical situations, it is almost always done during major surgery when the patient is under general anesthesia. During such surgery, the patient is rendered unconscious and is unable to breathe on his or her own. Therefore, the anesthesiologist has to essentially breathe for the patient during the surgery, either using a ventilator or sometimes compressing a bag that replaces natural breathing. The process of intubation allows this artificial breathing to take place. Because intubation itself is a painful procedure (remember – a tube is being inserted far down your throat), the patient is usually given paralytic drugs (drugs to induce paralysis) before intubation. This is a key point we’ll come back to later.

Risks of Intubation

While it may sound as simple as sliding a tube down the throat, intubation carries its own risks separate and apart from the risks of anesthesia itself (risks from anesthesia can include death, paralysis, brain damage and a whole host of other less serious injuries). With intubation, there are minor risks such as chipped teeth, lacerations in the gums and sore throat. However, there are many more serious risks as well, including perforation of the trachea, mistakenly placing the tube down the esophagus (a more common occurrence than you might think), aspiration of stomach contents, vocal cord injury, decreased oxygen and elevated carbon dioxide, and nerve injury. Intubation is a serious procedure that requires a high degree of skill and training to do it well and safely.

What if the tube does not get placed properly?

Inability to secure the airway is a major problem in intubation. To understand why, you have to remember that before the tube is placed, the anesthesiologist paralyzes you with drugs. Therefore, before the tube is placed, you stop breathing on your own. It is then critical that the tube be placed quickly and accurately to ensure that you don’t suffer from a lack of oxygen (or ventilation – the exchange of oxygen and carbon dioxide). So what happens when the anesthesiologist has trouble getting the tube in? It just so happens that I have some personal familiarity with that scenario.

A few years ago I had back surgery. The surgery itself was not complex as far as spine surgeries go (it always amazes me how surgeons are able to describe cutting open your back and operating on your spine as casually as they might describe changing a light bulb). It essentially consisted of trimming off a small piece of disc that was pressing on my spinal cord and causing pain to radiate down into my leg and foot.  I was in and out of the hospital the same day, but of course I was under general anesthesia so I had to spend a couple of hours in the Post Anesthesia Recovery Room (PACU) to make sure that I was not suffering from any ill effects of the anesthesia. While waking up, and still groggy, the anesthesiologist walked up to me and said, “I just want to let you know – you were really hard to intubate. If you ever have surgery again, be sure to tell your doctor that you’re really hard to intubate.”

I asked the doctor what he meant by that. He told me that because of the anatomy of my mouth and throat, he had had a really difficult time getting the tube into my airway. Keep in mind, the tube was placed down my throat after I was given drugs to paralyze me. Even in my post-anesthesia addled state, I knew enough to ask the obvious question – what would have happened if he couldn’t have gotten the tube down in time? He was casual in his response. “Oh, we would have given you drugs to wake you back up.” How comforting. My next thought was, “Maybe you could have checked my anatomy out before you gave me paralyzing drugs.” I didn’t ask that because I am sure they did check me pre-operatively.  That is standard procedure before giving anesthesia to make sure that the anesthesiologist knows the patient’s anatomy and can anticipate problems. Apparently, my anatomy was a little more vexing than he had bargained for. However, he was finally able to get the tube in and the surgery went well.

The use of robotics

Because of the ever-present risk of serious complications, researchers are always working on improving intubation to minimize risk. It has always been a hands-on procedure that depended on the skill of the individual performing it. Now we may be moving into a whole new world of intubation thanks to advances in robotics.

Medical News Today is reporting that Dr. Thomas Hemmerling of McGill University and his team have developed a robotic system for intubation that can be operated via remote control. According to Dr. Hemmerling:

The [device] allows us to operate a robotically mounted video-laryngoscope using a joystick from a remote workstation. This robotic system enables the anesthesiologist to insert an endotracheal tube safely into the patient’s trachea with precision.

The system is still in development. It has been widely tested with mannequins that mimic human anatomy, and clinical testing on patients has now begun. Dr. Hemmerling hopes that the new device will allow anesthesiologists to intubate patients using less force and higher precision, which should help to improve patient safety. Even with the use of robotics, I would think that intubation, including pre-operative assessment of individual anatomy, is going to require close hands-on involvement in order to ensure that it is done safely and properly, but it is always exciting to see what was once science fiction being used in real-life surgeries.

What you can do

While robotic anesthesiology is still down the road for most of us, there are still things you can do to minimize your risk of injury. Before agreeing to surgery, most of us do a good job of vetting our surgeon – how experienced he or she is, how many similar procedures he or she has performed. How many times have you heard a friend describe his or her surgeon as “the best?” Yet virtually no one who has been a patient – at least in my experience – makes any inquiry into the experience level of the anesthesiologist, even though a mistake by this person can render you paralyzed or brain-dead (or even dead) in a matter of minutes.

If you are planning on undergoing serious surgery, I would encourage you to discuss the anesthesia care with your surgeon. Find out ahead of time who your anesthesiologist is going to be (if that’s possible), and discuss your situation with that person. No doubt you will be evaluated by the anesthesiology team before your surgery, but it may well be the same day as your surgery, and it will feel like just another routine matter like signing a few forms. Keep in mind, however, that anesthesiology is just as important as the surgery itself. Stay informed and ask questions. Treat your pre-operative session with the anesthesiologist as if your life and health were depending on it – it just may!

And as for robotics, I’m curious what your comfort level would be if your doctor suggested using a robot to intubate you? Would you be willing to try the procedure, or would you prefer the traditional hands-on, human approach?

Image from “Today’s Medical Developments”

Gratitude: We just topped 8,000 monthly readers – Thanks so much!

Saturday, April 16th, 2011

When we started our blog about 15 months ago, we were hoping that someone – other than our relatives and friends – would come and read our posts. I’m sitting at my computer working on a blog for this coming week and decided I would check our Google Analytics to see how we were doing in trying to get our message out there. Well here’s today’s stats -

Nash & Associates stats via Google Analytics - April 15, 2011

The only words that came to mind when I saw that we had just topped 8,000 visits and almost 11, 500 pages viewed by those visitors over the last 30 days were – and are – THANK YOU!

Yes, I fully realize that these are statistics that apply to our website, but a very large number of these visits are due to folks coming to read our blogs and then checking us out or looking at some other other “stuff” on our website. No – we’re not yet ranked among the big boys or women bloggers, but the numbers tell us that we’re not doing too bad a job either. We’ll just liken ourselves to Avis and keep trying harder.

Almost a year ago, I figured out that if we were ever going to increase our website “hits,” we needed to make our blog, which was sitting on WordPress.com, a subdomain of our website. So, with the help of our “website guy,” we moved the blog over to WordPress.org and voila – the visits started growing immediately.

We – as a law firm – wondered how we could not only market our firm but also how we might be able to actually contribute to our community. As I have said in the past, who really wants to connect with lawyers or a law firm on social media channels? As my wife so aptly likened such a venture – “Who wants to connect with a mortician – unless you need one?” Smart person, my wife.

We ventured into the world of social media via Facebook and Twitter. We initially did the standard lawyer stuff of trying to tell our vast following of about 25 people (yes – our relatives and a few invited but brow-beaten friends) just how wonderful we were as a law firm. Then – after reading a ton of posts by social media gurus and blogging experts – we started to figure out the answer. Notice – I did say “started” – we have a long way to go admittedly.

Blogging by lawyers and socializing via channels such as Facebook and Twitter as a group of lawyers has to be about our readers, friends, fans and followers. We’re still working on it – but at least it seems a good number of people – like YOU (since you must be reading this) are looking for information that can help YOU.

We now have over 500 Fans on our Facebook business page, just under 2,500 followers on our firm’s Twitter page and now – as I learned today – over 8,000 monthly visitors to our website – primarily reading our blog! We just want to say THANK YOU to all of you. You have made the hard times of doing blogging and engaging in social media in the midst of a very busy law practice a rewarding, enriching and wonderful experience. Your loyalty and – yes – friendship – have been a fabulous motivating force to keep all of us going.

We are constantly searching to find new and exciting information in the world of law and medicine. As I wrote in our Twitter profile – I – and my team at Nash & Associates are just -

Lawyer[s] trying to get the word out so you never need [people] like us. Newbie[s] but lover[s] of Blogging on tips n’ tricks (and other stuff) to wisely use healthcare.

That’s why we blog, tweet and post on Facebook. Sure – if you need us (and hopefully you don’t) – we’re here for our local friends, fans and readers in the Baltimore-Washington area. But even more important – we will try to reward your loyalty and friendship with our best efforts to provide you with news, insights, tips and tricks and whatever other good stuff we can muster over the coming weeks, months and years to come.

If at any time you want to drop us a message on what YOU would like for us to write about, we would most certainly appreciate any suggestions you may have. Just drop us a line via Facebook, a direct message on Twitter or through our website’s contact form. Your thoughts and suggestions on how we can accomplish our mission and better connect with you will always be most welcomed and appreciated.

So – again – THANKS to all of you who make and take the time to read what we have to write. Don’t forget to hit the comment button and share YOUR thoughts with us and our other readers as well.

Brian Nash – Editor-in-Chief of Eye Opener – Views and Opinions from the Nash Community

Should you sue a healthcare provider? Some guidelines to help you decide.

Thursday, April 14th, 2011

Recently, a CNN article titled “Harmed in the Hospital? Should You Sue?” described the story of a two-year-old baby with a septic infection who waited about five hours in the emergency department before being seen by a physician. The child ultimately needed several amputations as a result of the delay in medical treatment.

Using this tragic story as a point of reference, the article suggests a number of criteria to help patients decide when to sue and when not to sue a health care provider. For example, the article correctly suggests that a patient who has not sustained injury should not sue a health care provider even if the health care provider’s conduct might have been negligent. In medical malpractice cases, a plaintiff seeks monetary compensation for injuries. If there are no identifiable injuries, there simply isn’t a case for medical malpractice.

However, most of the remaining recommendations in the article seem to suggest that a patient can make an educated determination about pursing a medical malpractice case without the advice and counsel of a skilled medical malpractice attorney. While this may possible in some cases, a well-considered determination about the merits of a medical malpractice case is difficult, if not impossible, to make without the guidance of a skilled attorney.

The decision to sue is never an easy one. Engaging in litigation is costly, time-consuming, stressful, and emotionally draining. This is particularly true in medical malpractice cases where a plaintiff’s own physical injuries or the death of a loved one is the subject of litigation. As a consequence, the decision to sue a health care provider must always be well-considered because of the impact the lawsuit might have on the patient, the patient’s family and the defendant health care provider.

Is deciding if you really have a case a “do it yourself” project?

In this vein, the article suggests that a patient should always consider whether her injuries are the result of the alleged negligence or some other unrelated factors. This consideration is particularly important when the patient’s pre-existing medical conditions cause or contribute to the alleged injury. In such instances, however, unless the patient has sufficient medical knowledge and, perhaps some legal knowledge, it may be difficult, if not impossible, to determine the actual cause of the injury.  In most instances, these determinations should be made by a skilled health care provider in the relevant medical specialty in consultation with a skilled medical malpractice attorney. By extension, to suggest that a patient should be able to make this determination on her own is frankly impracticable in most instances.

What’s the process for determining if you have a real case

Therefore, whether or not a patient ultimately decides to pursue a lawsuit, it is prudent to seek counsel from a skilled medical malpractice attorney. Many attorneys offer free initial consultations. More importantly, most attorneys will  (or should) undertake  a thorough investigation of a potential medical malpractice case before a decision to file suit is made. This process involves an internal review of the medical records. Often times, this is done with the assistance of an in-house medical expert. If  an investigation passes the threshold in-house review, the records are then reviewed by outside experts whose sole purpose is to determine the quality of care rendered and whether any of the alleged injuries are related to the care that is being criticized.

This multi-layered review can amass a tremendous amount of information, which in turn can help a patient decide if it is worth pursuing a lawsuit. All of this detail and information is provided to a patient at no cost where contingency fee agreements are in place (generally speaking, under a contingency fee agreement, the client is not responsible for any costs, unless the attorney is able to recover a monetary sum. If recovery is made, the costs are deducted from any such recovery.).

The article further recommends that a patient consider if the injuries are of a type which would be considered within the acceptable risk for a given medical procedure. Yet, another recommendation encourages patients to evaluate if the care rendered was within the standard of care. All such recommendations, although very appropriate, are vague and ambiguous absent context. A mother whose baby was not timely delivered should not be expected to know how to interpret fetal monitoring strips. A patient who undergoes a hip replacement surgery should not be expected to know the proper surgical technique. A patient whose cancer remained undiagnosed should not be expected to know how to interpret blood tests or to read MRIs or other diagnostic tests.

Therefore, the suggestion that a patient should carefully evaluate the merits of his/her case should not be interpreted to mean that a patient should do so without the guidance of a skilled medical malpractice attorney. There is an important distinction between investigating a case and pursing a case.  Just because you decide to employ a lawyer to investigate a medical malpractice claim on your behalf does not mean that you or the lawyer have committed to filing a lawsuit. With this in mind, it is important to realize that medical a malpractice attorney can be a great resource even if the client ultimately decides not to pursue the case. If you are unsure about whether you have a case or you are uncertain about the strenght of your case, take advantage of the resources and counsel of a skilled medical malpractice attorney.

How to tell if a lawyer is really a specialist

Throughout this post, I have emphasized skilled medical malpractice lawyer. Admittedly, sometimes it’s simply not that easy to tell from advertising or websites which attorneys are really specialists in medical malpractice investigations and litigation. If you have doubts, ask questions! Most people are pretty savvy and should be able to tell if the lawyer they are considering has a real grasp of the medicine and the law – both of which are required to be a skilled medical malpractice lawyer. Remember, you are entrusting your case to someone you really don’t know.

You ask questions in your daily life’s affairs and form judgments on whether or not you would entrust your childcare to some, which mechanic you’ll let fix your car, which home repair specialist you’ll permit to enter your home and do needed repairs. You get a sixth sense feeling sometimes as to whether or not the one your talking to (i.e. interviewing) will be a good fit for the task at hand. Why should it be any different with a lawyer, who claims he or she is a medical malpractice specialist. Just as we constantly preach about choosing a doctor, make informed decisions after asking the right questions.

If you need some guidance on what questions to ask, take a look at the White Paper we posted on our website – “Choosing a Lawyer – a Primer.” Hopefully, this will help you make an informed decision before you sign that fee agreement.

Related Posts:

The Reality of Medical Malpractice Lawsuits: Demystifying and Dismantling the Medical Profession’s Arguments

Every bad outcome and injury does not a malpractice case make! Some practical advice.

 

Week in Review: If you missed this past week’s blogs – catch up!

Sunday, April 10th, 2011

This past week was a busy one for our bloggers. It was also a very busy week in our law practice. Over the last two months, we have also had two new lawyers join us – Sarah Keogh and Jason Penn. Sarah has contributed a number of posts already. Jason , who just started this past Monday, will soon be sharing his contributions, thoughts and comments with you as well. We’re very happy to have both of them. I’m sure you join us in wishing them a very warm welcome.

Last week our writers covered a number of topics related to health, medicine, child safety, medical technology and patient safety. We started the week off with a piece by Brian Nash on some key facts women need to be aware of when having an epidural for labor, delivery and post-partum pain relief.

Epidurals

There can be no doubt that thousands of epidurals are administered to women every day throughout this country. This form of analgesia (pain relief) has become probably the most popular form of anesthetic management and apparently is generally believed to be essentially risk free. As this week’s piece, Having an epidural when you have your baby? 3 questions to ask the doctor, reports, some literature gives the figure of complications from epidurals as high as 23% - ranging in severity from minor inconveniences, to life-long major disabilities and even death.

This particular piece was written as a result of several cases in which we have been involved when women, who had undergone an epidural, became essentially paralyzed from the waist down. We raise some questions for women to ask the doctor and suggest they just might want to ask those questions before they find themselves in the process of labor or when they are going through the recovery phase of having given birth to their baby. We believe it’s an important piece for women – and frankly for all – to read so that they have a much better idea of what they should expect with an epidural and what the risks and benefits are of this wonderful yet potentially life-altering anesthetic technique.

Shaken-Baby-Syndrome

On Wednesday, Jon Stefanuca again brought to the public’s attention a problem that is probably as old as childbirth. Everyone who has had the experience of taking care of a child – particularly a baby – knows that along with the joy of parenting comes the physical and emotional toll on parents and care-givers. The human condition makes us all susceptible to being less than completely tolerant, forgiving and gentle with little ones when we are under stress, frustrated or just plain exhausted. The response to the persistent crying can simply not be “a good shake.”

Medicine and science (and unfortunately the courtroom) have given a name to a syndrome of injury babies can suffer when that “just a good shake” approach is used. While a parent or care-giver may think it unimaginable to strike a child, they may not realize just now much harm they can do with “just a good shake.” Jon brings this information and some expert tips and tricks on how to deal with these difficult times parents and care-givers face in their everyday lives in his piece Shaken Baby Syndrome – What we all should know to prevent child abuse.

Makena: New Anti-Prematurity Drug

Thursday, Sarah Keogh reported on a relatively new drug called Makena, which has been found to help pregnant women, who have previously had a premature infant. I say “relatively” since according to Sarah’s piece, a compounding pharmacy could and was making this medication prior to the FDA giving K-V Pharmaceutical Company the exclusive rights to manufacture this drug for a period of 7 years.

Read Sarah’s piece, Makena: Drug to fight prematurity leads to major firestorm, and see what the controversy is all about. How could people possible be upset with a drug that can fight premature birth? Prematurity is one of the major causes of significant childbirth injuries such as cerebral palsy. Sarah’s blog makes it all too clear why people are upset and why the March of Dimes withdrew its sponsorship for Makena.

Medical Technology and Patient Safety

The week ended with Part II of my series on medical technology and whether all the new toys, bells and whistles of our modern healthcare system are truly advancing safe, efficient and effective delivery of healthcare. The week’s piece focuses on perhaps one of the largest advances in the healthcare industry – electronic medical records (EMR).

The blog, Medical Technology and Patient Safety – Part II – EMR’s (electronic medical records), brings a lawyer’s perspective to this topic. Much has already been written – and frankly will continue to be written – about EMR’s by the medical profession. Controversy has filed the pages of journals and at times probably slowed traffic on the internet (okay – maybe that’s a bit of an exaggeration) since this new marvelous technological advance was rolled-out in our medical institutions.  Those writing and fighting about it have been the end-users themselves – the medical professionals, who have to deal with the issues and flaws that have surfaced with this wonderful new technology. I thought it was about time to tell you how this plays out by another end-user – the lawyer who now deals with EMR’s. This piece is also intended as the foundation for what we as lawyer have seen play-out in terms of patient safety and health as a result of EMR implementation.

Sneak Peak of the Week Ahead

I anticipate that next week we’ll be seeing Jason Penn with his first blog on a recent report about numerous safety violations by hospitals in our practice jurisdictions – Maryland and Washington, D.C. Mike Sanders will be bringing to our readers aN old but back-in-the-news report on super infections, which still seem to be – unfortunately – thriving in our nation’s hospitals. We’ll start off this coming week with a piece by Theresa Neumann, our highly acclaimed in-house physician’s assistant expert, on spinal stroke. We all know about strokes that can damage the brain. Theresa will be sharing her insights on an equally devastating stroke of the spinal cord. I also suspect – shhh – that we’ll be reading more from Sarah Keogh this coming week. If the practice of law doesn’t get too much in the way, I am also hoping to share with you some real life examples – from a lawyer’s perspective – of just how EMR’s may not be advancing the causes of patient safety and health.

As with all our blogs, we sincerely invite you to not only read our thoughts and comments but to also share yours with us and our readers. Our latest stats show that around 10,000 pages are viewed by our readers and visitors every month! We sincerely thank all of you, who have taken the time out of your busy lives to read our offerings in The Eye Opener – Views and Opinions from the Nash Community. We invite you to share our posts with your friends and colleagues. Don’t forget to sign-up for easy delivery to your email inbox. Last – but certainly not least – come join our social media communities on Facebook and Twitter.

The Week in Review: did you miss last week’s posts on health, safety, medicine, law and healthcare? A sneak preview of the week ahead.

Saturday, March 26th, 2011

Eye Opener - Nash & Associates Blog

This week we are starting a weekly posting of our blogs of this past week, some key blogs of interest to our more than 6,500 monthly readers, and a sneak preview of what’s coming next week. We would really like for you to join our community of readers, so don’t forget to hit the RSS Feedburner button or subscribe to our blog, Eye Opener. We share with you our thoughts, insights and analysis of what’s new in the law, the world of law and medicine, health, patient and consumer safety as well as a host of other topics that we deal with as lawyers on a daily basis in trying to serve the needs of our clients.

For those of you on Twitter, Facebook and LinkedIn, we have a vibrant presence on those social networks as well. Hit the icon(s) of your choice and become part of our ever-growing social network community. Share your thoughts, share our posts, give us your feedback on what YOU would like to hear about.

This Past Week

Birth Defect Updates: Warnings About Opioid Use Before and During Pregnancy In this post, Sarah Keogh, explored a new report which is vital information for women who are pregnant or thinking about becoming pregnant. Opiods, narcotic pain killers such as morphine, codeine, hydrocodone and oxycodone, are a valuable part of a physician’s drug armamentarium, but they can have significant implications for a fetus if taken during pregnancy or even just before a woman become pregnant. Read Sarah’s important piece, be informed and learn why you should discuss the use of any such drugs with your obstetrician/gynecologist before taking them.

 

Doctors Disciplined by Their Own Hospitals Escape Actions by Licensing Boards. Who’s at Fault? Brian Nash, founder of the firm, writes about a serious problem with this country’s medical licensing boards, who have failed, at an alarming rate, to take disciplinary action against physicians, who have had their hospital privileges revoked, suspended or curtailed for issues such as sub-standard care, moral transgressions and the like. Public Citizen brought this story to light; we analyze the issue and share our thoughts on this serious patient health and safety issue.

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding A mom herself and an advocate for public health childhood obesityand safety throughout her legal career, Sarah Keogh reports on a recent study covered by the Baltimore Sun about the long-term benefits of breastfeeding for at least six months. The issue for many, however, is – how can a family of two income earners afford to do this? Does our society and the workplace really lend itself to this practice? Read Sarah’s compelling piece and share your experience and thoughts.

The Week Ahead

Sneak preview of what’s ahead during the week of March 28, 2011:

medical technology

Brian Nash begins a series on the issue of medical technology and patient health/safety. Is the medical community being properly trained in the proper and safe use of all the new medical devices that are hitting our hospitals, clinics and medical offices? Is the rush to have the newest, shiniest and “best” new medical device really advancing the safe and effective delivery of healthcare in our country? Here’s a sneak preview…

Dr. Roper and so many other dedicated healthcare professionals are faced daily with the same issue – “…challenged by the task of putting lofty ideas into practice at the local level. I remain very committed to the effort, but we are daily challenged to put the best ideas into practice.” Put another way – at least for me – taking public healthcare policy and practices and making a much better widget.

As these lofty concepts were debated, published and analyzed, technology streaked along with its new bells and whistles at what some might call an amazing – almost mystifying – pace. Did you really envision yourself 25 years ago sitting with your iPhone or iPad and scouring the world’s news, chatting with your friends and followers on the other side of the planet, watching the latest streaming video of March Madness or sharing every random thought you have on Twitter or Facebook?

Some top posts you may have missed

What happens when your surgeon has been up all night and you are being wheeled into the operating room to be his or her next surgical case? We looked at an article from The New England Journal of Medicine that addressed this patient safety issue and made recommendations for change.  See our posting entitled A Surgeon’s Sleep Deprivation and Elective Surgery-Not a good (or safe) combination.

Dr. Kevin Pho, who is the well known editor and contributor of KevinMD.com, wrote a piece in which he espoused his belief that medical malpractice cases really do not improve patient safety. Having read this piece and finding that this was just too much to digest, Brian Nash wrote a counter-piece entitled Malpractice System Doesn’t Improve Patient Safety – Oh Really? What this led to was cross-posting by Dr. Kevin Pho on our blog, Eye Opener, and our posting on his blog. Our blog post (as best I can tell) led to one of the all-time highest postings of comments by readers of KevinMD. One thing all participants in the “debate” learned – we are both passionate about our positions. Read what led to this firestorm.

 

Doctors Disciplined by Their Own Hospitals Escape Action by Licensing Boards. Who’s at Fault?

Thursday, March 24th, 2011

Public Citizen logo

Public Citizen recently posted a report that revealed an extremely disturbing failure by licensing boards and/or hospitals to take appropriate disciplinary action against physicians, who have had their hospital privileges revoked, suspended or restricted.

At the heart of this revelation is the fact that when a physician does have action taken against his/her hospital privileges, the hospital is required to report such negative, adverse action to the jurisdiction’s medical licensing board. Nevertheless, as Public Citizen reports, during the time period being analyzed by Public Citizen (1990 to 2009), almost 6,000 such physicians have escaped any disciplinary action by state medical boards.

Of 10,672 physicians listed in the NPDB (National Practitioner Data Bank) for having clinical privileges revoked or restricted by hospitals, just 45 percent of them also had one or more licensing actions taken against them by state medical boards. That means 55 percent of them – 5,887 doctors – escaped any licensing action by the state. The study examined the NPDB’s Public Use File from its inception in 1990 to 2009.

For anyone familiar with how hospitals operate, it usually takes some egregious conduct for a hospital to take action against one of its privileged physicians. Threats of lawsuits by the physician against the institution are many times the first defense taken by a physician causing many hospitals to back-down from taking any disciplinary action. Often, those called upon to review the conduct of their fellow physicians are hesitant to discipline their peers too harshly for a multitude of reasons – not the least of which is the concept of “there but for the grace of God go I.”

That being said, how is it that when such an extraordinary step such as revocation, suspension or curtailment of hospital privileges does take place, these physicians escape being disciplined by their state medical boards?

Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group and overseer of the study, offers these thoughts:

One of two things is happening, and either is alarming. Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all. Something is broken and needs to be fixed.

While I personally don’t purport to know the “reporting requirements” for all medical licensing boards throughout the United States, let me share with you the reporting requirements and legislative mandate of two jurisdictions with which I am familiar.

In Maryland, one need only look at the Maryland Board of Physicians (this state’s regulatory body) “responsible for licensing and disciplining physicians, physician assistants, respiratory care practitioners, licensed radiation therapists, radiographers, nuclear medicine technologists, radiologist assistants, and polysomnographic technologists” Hospital Reporting Requirements FAQ to get the answer as to whether or not such hospital actions are a “reportable event.”

By law, hospitals must report to the Board – within 10 days of action – any action taken that immediately affects the privileges of a practitioner or any other health professional regulated by the Board, based on any of the grounds listed in Sections 14-404 (Physicians), 14-5A-17 (Respiratory Care), 14-5B-14 (Radiation Therapists, Radiographers, Nuclear Medicine Technologists, and Radiologist Assistants), 15-314 (Physician Assistants), and 14-5C-17 (Polysomnographic Technologists) of the Medical Practice Act. These matters generally relate to questions of competence, performance, unprofessional practices and unethical practices.

In the District of Columbia, once you work your way through the maze of online links, you eventually find that it is the Board of Medicine, “a division within the DC Department of Health, Health Regulation and Licensing Administration (HRLA), that “has the responsibility to regulate the practice of medicine in the District of Columbia.

What is interesting is that on its website, the D.C. Board of Medicine takes pride in the fact that in 2010, Public Citizen, the very source of criticism of the various licensing agencies in the most recent 2011 report being discussed here, listed D.C. as No. 16 in the nation in “living up to their obligations to protect patients from doctors who are practicing substandard medicine.” A review of the 2010 report by Public Citizen reveals that D.C. had previously been ranked No. 42 in terms of “meeting its obligations” to “protect patients from doctors…practicing substandard medicine.”

So exactly where is the proverbial ball being dropped? Is it the hospital that is failing to report its adverse action to the medical board? Is it the medical board, having been told of the adverse action, that sweeps the sins of the offending physician under the rug? Whichever it is – and it’s most likely a combination of the two to some extent but more likely the latter – those who suffer in the final analysis are patients, who unknowingly come under the care of these questionable physicians.

We are not talking here about a physician, who is otherwise a competent, skilled practitioner in his or her area of specialty, but who has a “bad day” and renders substandard care to a patient. Unfortunately, that happens with some degree of regularity across the nation every day. For a hospital to go to the point of bringing one of its own up on disciplinary charges and taking adverse action against that physician is a major step – one reflecting by necessity such a level of incompetency, a pattern of unsafe, bad care, outrageous conduct and the like that it must call into question the overall competency, integrity and character of that physician. Then, if that is the case – which it clearly must be – why are such physicians allowed to simply pull-up stakes and move on elsewhere to practice their trade? How is this in the interest of patient safety, which is precisely one of the main reasons for the very existence of medical licensing boards?

Public Citizen didn’t just report the findings of its analysis; it did something about it.

Public Citizen today sent the report to Kathleen Sebelius, Secretary of the Department of Health and Human Services, urging the agency’s Office of Inspector General to reinstitute investigations of state medical boards, something it has not done since 1993. Public Citizen also is notifying the 33 medical boards that have had the worst records in disciplining these doctors.

We commend Public Citizen for its investigation and report. While it is no doubt important that this problem comes to light, it is even more important that it be corrected – and soon. Will Secretary Sebelius take action? Will the licensing boards clean-up their act now that their misdeeds have been brought to the public’s attention? If hospitals are, in fact, not reporting their adverse actions, will there be repercussions for this failure? When will medical boards do what they are constituted to do – protect the safety and well-being of patientsnot when they feel like it, but when they are mandated to do it?

Smoking and Secondhand Smoke Increase Risk for Birth Defects and Stillbirth – Even before pregancy

Thursday, March 17th, 2011

Photo courtesy of Impact Lab

Recently, I came across several news articles regarding risks that can lead to birth defects.  While it has long been known that smoking during pregnancy is not healthy for the mom or her developing baby, a new study is showing that a mom who smokes during pregnancy creates a huge risk of heart defects in her baby.  A Reuters article explains that the potential for harm caused by smoking during the first trimester of pregnancy, a time when many women may not even realize they are pregnant, is significant:

Specifically, women who smoked early in pregnancy were 30 percent more likely to give birth to babies with obstructions in the flow of blood from the heart to the lungs, and nearly 40 percent more likely to have babies with openings in the upper chambers of their hearts.

While smoking later in pregnancy can also cause birth defects, it is the critical period in early pregnancy when organ development occurs that causes the risk to be so significant at that time.

The Reuters article goes on to explain that the new study, in the journal Pediatrics, does not explain precisely why smoking so dramatically increases the risk of heart defects. However, given the risk, women not smoking before or during early pregnancy could decrease the number of children born with these defects.

A news release from the CDC adds that this study and other research suggest that if women quit smoking before or very early in pregnancy, they could avoid as many as 100 cases of the obstruction type of heart defect and 700 cases of abnormal openings in the upper heart chambers each year in the United States.

This is yet another great reason for woman to quit smoking as soon as possible and certainly before trying to get pregnant.

Secondhand Smoke Risks to Your Baby

We cannot let spouses, partners or other people in the mothers’ lives off the hook when it comes to smoking cessation.  A blog article on The Chart from CNN discusses a new study, also from the journal Pediatrics, which gives a convincing argument why woman must avoid secondhand smoke during and even before pregnancy.  The “[r]esearchers found exposure to secondhand smoke increased a non-smoking pregnant woman’s [chances] of having a stillborn by 23 percent, and increased the risk of delivering a baby with birth defects by 13 percent.”  The article went on to explain that the risk of having a stillborn or delivering a baby with birth defects is almost as large for a woman who does not smoke but is exposed to secondhand smoke as for a woman who smoked herself.  The risks of having a stillborn are increased 20-34% when the mother herself is the smoker and the risks of birth defects are increased by 10-34%.

Aren’t these compelling reasons to continue to work hard as a society on prevention and smoking cessation for the young?  It is too late to wait until child-bearing age when women may already be causing unnecessary harm to their unborn children before they know they are pregnant or by sharing their lives with individuals, who are not able to quit smoking fast enough to prevent harm before conception or during early pregnancy.

Nationwide Push to Curb Elective Early Deliveries

Wednesday, March 16th, 2011

Image by SoulPrintsPhotography

I recently overheard a mother talking about her child’s upcoming birth.  She was pregnant with her fourth child and was a few days away from her due date.  Another mother was asking her about whether she was concerned about when she would go into labor.  The pregnant mother explained that she was scheduled to have a planned caesarean section, since for medical reasons her prior three children had already been born via caesarean section.  What was interesting and surprising about this conversation was that the mother went on to explain that she was scheduled to give birth to the baby a week later, four days after her due date.

The mother clearly stated that she specifically requested a delivery date after her due date.  I was surprised and impressed by this mother’s decision and the explanation that she gave to the other mother about her choice.  She said that her first child was born by unscheduled caesarean section following an attempted induction two weeks after her due date.  She then had each of her subsequent children by planned caesareans – the next on the due date, the third a few days after the due date and this one planned for 4 days after the due date.  She explained that she liked to wait as long as possible before having the caesarean sections for each of her children.  I don’t know if this mom was up to date on the recent research in this area or if she had other reasons that she chose to delay delivery.  However, her choices seem very sound based on current research that shows that too many moms are having elective deliveries before their due dates.  These deliveries before a baby is full term can increase the risk of complications to mother and baby and lead to longer hospital stays.

A recent article on a Wall Street Journal Health Blog discusses the current nationwide push to inform mothers about the risks of elective delivery before 39 weeks of gestation.  Another Wall Street Journal article highlights what a large number of births this might impact as “’early term’ elective inductions…[now] account for about a quarter of births, up from less than 10% in 1990.”  The number of elective deliveries is large and so are the complications:

Now, a growing body of medical evidence indicates that gestation even a few days short of a full 39 weeks can lead to short- and long-term health risks. Public health officials, safety advocates, private insurers and employer groups are stepping up pressure to sharply reduce early term deliveries. The practice drives up costs of neonatal intensive care and leads to a higher rate of caesarean sections. C-sections are more expensive than natural deliveries and result in longer hospital stays and more risks for the mother, including infection. A study last year estimated that reducing early term births to 1.7% could save close to $1 billion annually.

The current research, including a study published in the Journal of Reproductive Medicine, is influencing a campaign to stop doctors and hospitals from allowing elective deliveries before 39 weeks to better protect mothers and babies, as well as to cut unnecessary costs.

What do you think?  I can certainly sympathize with mothers who are uncomfortable at the end of a pregnancy and are ready for delivery.  However, I cannot imagine that many mothers, faced with the information about risks to themselves and their babies, would not be willing to stay pregnant for another week or two.  I wonder if a clear and widespread public education campaign targeted at mothers would not dramatically decrease the number of elective early deliveries?

 

IEP’s: Stand Up for Your Child’s Rights – Be Their Best Advocate

Monday, March 14th, 2011

IEP File Folder from KnowledgePoints.com

Recently I wrote a blog about the general difficulties facing parents who are raising a disabled child. This week I want to address one of those specific guidelines – ensuring a quality and appropriate education for your child. For many children with disabilities, they cannot meet the traditional school criteria because of either mental, physical or other special needs. For such children, an Individualized Education Program, or IEP, is a crucial step. What is an IEP? As the name implies, it is a written education plan that is specifically tailored to your individual child rather than a general plan used for all children. Keep in mind that an IEP is not something that your disabled child may be entitled to. The Individuals with Disabilities Education Act (IDEA) requires that IEP’s be developed for all students with disabilities.

Who creates an IEP? For every child, there is an IEP team which generally consists of the following people – the parents, the child’s teacher, the child’s special education provider, a public agency representative and perhaps other providers such as physical therapists. Depending on the age of the child and the specific disability, the child may also be part of the team. I want to emphasize that while the IEP team is filled with so-called experts in education and disability, the most important person on the team is the parent. There are two key points to keep in mind:  1) you, as the parent, are the best advocate for your child; and 2) never be afraid to stand up to the experts.

On the first point, I encourage you to read as much as possible and become informed on the subject, e.g., what new laws are coming out, what new technologies may be available. Only that way can you truly become an advocate for your child. There are a number of excellent sites on the Internet that give a wealth of information (see links below).

Parents of disabled children tell me that they have learned the hard way that there is only one person who truly cares what happens to their child – and that is the parent (or parents as the case may be). It is easy to go into an IEP meeting thinking that the administrators and teachers have your child’s best interest at heart. That’s not necessarily the case. While these people may be caring and decent people, they have other interests to consider – budgets, time constraints, other students, etc. You are the only one who is truly devoted to getting what is best for your child. Also, you are the one who knows your child best.  Just like when you go into a pediatrician’s office and describe your child’s symptoms and behavior, the same is true when attending an IEP meeting. You have interacted with your child more than anyone else. You see changes, skills, abilities (and disabilities) more than the folks who only see your child at school.  Share your knowledge and make sure the IEP team gets the benefit of your expertise as a parent.

On the second point, it can be difficult as a layperson to question those whom we see as experts. We have all been trained to defer to those with more experience. Unfortunately, some “experts” have been trained to talk down to others. A small personal story — years ago I took my grandmother to the doctor for a small skin rash. The doctor said it was psoriasis. I asked him how he knew it was psoriasis and not eczema, a similar skin condition. I will never forget his answer. “Because,” he said, “I’m a doctor.” He may as well have said, “Shut up and don’t question my expertise.” If someone on your IEP team ever adopts such an attitude with you, stand up to that person and demand answers. It is your child whose future is at issue, not the teacher’s.

As for resources, the rise in awareness of disability and IEP’s has created an entire field of special education law. Not that you need an attorney to obtain an IEP, but you should be aware of your child’s legal rights. One excellent resource that comes highly recommended from parents is Wrightslaw.com, which contains a wealth of information on disability law and special education.

No doubt a number of you have had to deal with IEP issues for your child. What has been effective for you in terms of getting the best plan for your child? What hasn’t worked? What legal entanglements have you run into? What advise do you have so that others may benefit?

Some Source References:

For general information on IEP’s (and one with a special focus on Maryland), I would recommend the following sites:

Maryland State Department of Education

National Center for Learning Disabilities

Education.com

Schaffer v Weast (a summary of the Supreme Court’s decision on burden of proof in IEP matters)