Posts Tagged ‘pregnancy’

New Study Reveals Significant Increase in Pregnancy-Related Strokes

Monday, August 8th, 2011

A new study published in the Journal of the American Heart Association this month reveals that pregnant women have a significantly high risk of developing a stroke. According to the lead author of the study,  Dr. Elena V. Kuklina (senior service fellow and epidemiologist at the Center for Disease Control and Prevention (CDC)), “the overall rate of women having strokes while they are expecting a baby and in the three months after birth went up 54% in the 12 years leading up to 2006-07.”

This is a significant finding! To put it in context, consider the following facts about stroke:

  • Stroke is the third leading cause of death in the United States. Over 143,579 people die each year from stroke in the United States.
  • Stroke is the leading cause of serious, long-term disability in the United States.
  • Each year, about 795,000 people suffer a stroke. About 600,000 of these are first attacks, and 185,000 are recurrent attacks.
  • Nearly three-quarters of all strokes occur in people over the age of 65. The risk of having a stroke more than doubles each decade after the age of 55.
  • Strokes can – and do – occur at ANY age. Nearly one quarter of strokes occur in people under the age of 65.
  • Stroke death rates are higher for African Americans than for whites, even at younger ages.
  • Among adults age 20 and older, the prevalence of stroke in 2005 was 6,500,000 (about 2,600,000 males and 3,900,000 females).
  • On average, every 40 seconds someone in the United States has a stroke.
  • Each year, about 55,000 more women than men have a stroke.

“A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a ‘brain attack.’” The following are well-recognized stroke risk factors: high blood pressures (hypertension), atrial fibrillation, diabetes, heart disease, high cholesterol, increasing age, and a family history of strokes.  Being pregnant is a risk factor in and of itself.

As part of the study, Dr. Kuklina and colleagues used information from 5 to 8 million discharge records from about 1000 hospitals. According to Dr. Kuklina, the increase in the stroke rate during pregnancy and in the 3 months after birth was mainly attributable to high blood pressure and obesity. The study enumerates these specific findings:

  • Pregnancy-related stroke hospitalizations went up by 54%, from 4,085 to 6,293 over the 12 years leading up to 2006- 07.
  • Strokes in pregnancy went up by 47% (from 0.15 to 0.22 per 1,000 deliveries).
  • Strokes recently after giving birth went up by 83% (from 0.12 to 0.22 per 1,000 deliveries).
  • Strokes during delivery did not change (they stayed at 0.27 per 1,000 deliveries).
  • In 2006-07, about 32% and 53% of women who were hospitalized after having strokes in pregnancy and shortly after giving birth respectively had either high blood pressure or heart disease.
  • Increased prevalence of these two conditions over the 12 years up to 2006-07 accounted for almost all the increase in stroke hospitalization after giving birth that occurred in the same period.

It appears that an increasingly larger number of women enter pregnancy with one or more stroke risk factors. This is particularly true with respect to hypertension and obesity. According to Dr. Kuklina, “[s]ince pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk.” For this reason, it is particularly important to enter pregnancy in relatively good cardiovascular health and to reduce other risk factors, if possible. If you are pregnant or plan on becoming pregnant, talk to your OB/GYN about your stroke risk factors. In collaboration with your physician, implement a plan to manage and reduce your stroke risks before, during, and after pregnancy.

Read these related blogs:

Stroke Warnings: Most People Who Experience Minor Strokes Do Not Recognize Its Symptoms

Strokes – Family History a Significant Risk Factor

Spinal Stroke: An atypical cause of back pain

Brother, will you help me? If you don’t this stroke might kill me.

Landmark NIH Clinical Trial Comparing Two Stroke Prevention Procedures Shows Surgery and Stenting Equally Safe and Effective

Parents – be aware and read this article: Children Don’t Have Strokes? Just Ask Jared About His, at Age 7 – NYTimes.com

To view our collection of educational videos about stroke, visit us at:

http://www.youtube.com/user/nashlawatty#g/c/BDCB5099E7C9F6C4

The death of a baby – the economic realities

Monday, June 6th, 2011

I recently wrote a blog about the grief that parents suffer when they lose an unborn child. At the risk of sounding crass, I want to now discuss the economics of lawsuits involving the death of an unborn child. For those contemplating taking legal action for the loss of their child, I hope this provides some useful information for you to consider.

Maryland courts have carved out specific rules for when an unborn child is considered a person capable of recovering damages in the event of death. The primary rule is that if a baby is actually born alive, no matter at what gestational age, that baby is considered a person with legal rights. So, if a 20-week baby is born alive and then dies one minute later, that baby is considered a “person,” and a lawsuit can be filed on behalf of the estate for that baby’s pain and suffering, otherwise known as a Survival Action.

(This leads to an interesting question – does a fetus feel pain? See Related Links below). The parents of the unborn child can also file what is known as a Wrongful Death action for their own economic and non-economic damages resulting from the death of their baby, primarily their grief and emotional loss over the death of their child. Survival actions and Wrongful Death actions are two separate claims, although they are usually pursued in the same lawsuit.

When a baby dies before birth, however, another question has to be asked: was the baby viable or not? Viability means that a baby is able to live outside the womb, even though he or she may require serious medical intervention. The current thinking is that babies are viable at around 22 weeks. The courts have made the rule that if an unborn child dies before the age of viability, that baby is not yet a “person” and has no legal rights. There can be no Survival Action and there can be no Wrongful Death action. If, however, the baby has reached the age of viability, then the baby is considered “a person” with legal rights, even if the baby was never born alive. Confusing? Yes it is.

The Maryland Courts were following the ruling in Roe v. Wade that a mother had a constitutional right to abort a non-viable baby. Therefore, a non-viable baby was not legally considered a person. If the baby was not a person, then no lawsuit could be filed on behalf of the estate of that baby, nor could the parents file a wrongful death action. So in order for a Survival Action or a Wrongful Death action to lie for an unborn baby, that baby has to have reached at least 22 weeks of gestation.

To make things even more confusing, the Maryland courts have carved out an exception to the above rules. Let’s consider the example of a non-viable baby (i.e., less than 22 weeks gestation) who dies before birth as a result of someone else’s negligence that injures the mother.

A common situation occurs when the mother (let’s say she’s 8 weeks pregnant) is injured in a car accident and suffers a miscarriage as a result. Looking at the above rules, one would think that no claim is allowed. However, the courts have said not so fast. In this circumstance, while the mother cannot recover for the grief of losing her child (because the child is non-viable and, therefore, not legally a person), she can recover for similar damages, including:

  • The depression, anguish, and grief caused by the termination of the pregnancy;
  • The manner in which the pregnancy was terminated;
  • Having to carry a baby which was killed by someone else’s tortious conduct; and
  • Having to witness the stillborn child or the fetal tissue that was to be her child.

I realize this itemization of damages sounds awfully close to the damages permitted in a Wrongful Death action – the very damages that are not allowed in the case of a non-viable baby. It is confusing, to say the least. The courts are trying to find a way to compensate a woman who is injured and loses her non-viable baby as a result of someone else’s negligence, while remaining true to prior precedent in this state that there is no Wrongful Death action allowed in the case of a non-viable baby.

Lastly, keep in mind that Maryland’s cap on non-economic damages applies to cases involving the death of an unborn baby. Economic damages (medical bills, lost wages) are usually very small in such cases. There are no lost wages because we’re talking about a baby, and the medical bills are usually small.

The value of these cases is in the emotional pain and suffering of the parents, and the physical pain and suffering of the baby (assuming a viable baby). Under Maryland law, the maximum allowable recovery for such a claim is $868,750 in a medical negligence action (assuming Mom and Dad both file a wrongful death action).

Under the hypothetical of the mother seeking recovery for the loss of a non-viable baby, the maximum allowable recovery is $695,000 if the allegation is medical negligence, and $755,000 if the allegation is non-medical negligence. (The Maryland Legislature has for some strange reason imposed different caps depending on whether the negligence is medical or non-medical, e.g., a car accident).

As for the question of whether an unborn child feels pain, please click on the link below for a blog by Brian Nash on this very issue.

Related Nash and Associates Links

Does a fetus feel pain

Hysteria over malpractice “crisis”

 

 

 

The Grief of Losing an Unborn Child

Wednesday, June 1st, 2011

Image from HopeforParents.org

Fetal Death In Utero. It sounds so clinical, so devoid of meaning. Maybe that is by design. Medical terms have a way of masking the real human suffering that is being described.

Adenocarcinoma instead of cancer. Cerebral hemorrhage instead of stroke…and “fetal death in utero” instead of “losing an unborn child.” The medical terms are necessary, but they don’t capture the essence of the diagnosis. As one woman told me, “I didn’t lose my fetus. I lost my baby.”

For any parent, the loss of a child is the most agonizing experience imaginable. As the father of two, I can’t even imagine being told that your child has died. I can’t imagine the life-long grief that follows. I almost decided not to write about this topic for that very reason – I didn’t know the pain of losing a child so who was I to write on it? But other times I’ve waded into topics despite a lack of personal involvement because the issue has touched those whom I care about. For example, I’m not a parent of a special needs child, but I’ve written on that topic because I am close to people who are raising special needs children. Their experiences deserve to be shared.  The same is true here.

For parents who have lost an unborn child, the sense of grief is no different than if the child had been born and then died. Unfortunately, our society seems less sympathetic to the loss because there is no infant that we have seen and gotten to know. We all recognize the agony of losing an older child. Even if we haven’t experienced it ourselves, we can at least try to understand how sickeningly awful it must be. We can then offer our support and love and condolences to those who have experienced it. With an unborn child, however, it’s different. We have a tendency to minimize the grief associated with losing an unborn child, as if the fact that the child wasn’t yet born makes him or her less real. Even medical providers are guilty of this. I’ve had women tell me that their doctors tend to treat miscarriage or stillbirth as a medical condition, not the loss of a loved one. For the parents of such children, however, the loss is deep and real and long-lasting.

Donnica Moore, M.D., an Ob/Gyn and the author of a book entitled “Women’s Health for Life,” summed it up well when interviewed by the New York Times:

Couples can feel there’s no socially accepted way to grieve. If you lose a family member, people know how to do that, they know how to support you and grieve with you. But this is new territory for a lot of us. It’s a tragedy for people who have gone through it that might not be on the radar of people who have not.

I’ve recently had the pleasure (strange word, I know, given the circumstances) of representing two wonderful families who lost children. One couple lost their 9-year-old son who died of a correctible heart condition that his pediatrician failed to detect, and the other couple lost their unborn daughter when the mother was 37 weeks pregnant after being sent home from the hospital where she had gone complaining of decreased fetal movement. It’s easy to see the grief for the first couple. One day they have a little boy going to school, playing, doing homework, and the next day he’s gone. With the second couple, it’s harder to see the grief, but it’s there. I’ll share their story briefly.

This was the first child for Michelle (not her real name) and her husband. They had already decorated the nursery and picked out a name. One evening (believe it or not, Michelle had just attended a baby shower earlier in the day) she felt that the baby wasn’t moving as much as usual and called her doctor’s office. They told her to go to the hospital, which she did. At the hospital, she and her baby were evaluated and told that everything was OK. She was told to go home and keep her regularly scheduled appointment the next day. When she went to her doctor the next morning, however, the doctor could not find a heartbeat. Her daughter, unfortunately, was gone. To make things even worse, Michelle then had to carry her deceased daughter inside her for another full day before she gave birth.

Michelle did her best to move on with her life. She continued to work. She and her husband had another child. But for the entire time I represented her (to its credit, the hospital approached us about resolving the case early on) there was not a single time I talked to her that she did not start to cry in discussing her first baby – the daughter who should now be three years old. She still grieves for the loss of her daughter, wonders why it happened, wonders what her daughter went through in those final moments. She asks herself whether she did anything wrong, whether she should have been more forceful that night in the hospital. These questions don’t go away for her. They’re the same questions that any mother would ask after losing her child – whether it was an unborn child or an older child.

We all need to do a better job of recognizing that the pain of losing an unborn child – whether by miscarriage or stillbirth – is deep and long-lasting. If you know someone who has lost an unborn child, don’t shy away from him or her. A simple and genuine “I’m sorry for your loss” is a good starter. Be there to offer support and talk just like you would if the child were older. Don’t expect it to go away in a matter of weeks, and don’t assume that a subsequent pregnancy somehow erases the pain of losing the previous child; it doesn’t. Also, try to avoid clichés, e.g., “everything happens for a reason,” “I’m sure you’ll be able to have more kids.” While such sayings are meant well, clichés tend to minimize the degree of loss. If you don’t know what to say, it’s perfectly fine to say, “I don’t know what to say.”

If you yourself have lost an unborn child, you need to treat this loss like you would the death of a loved one. It is a long, slow, painful process that not everyone will fully understand. That can add to the sense of loss because you may get the feeling that people are expecting you to be over it already. Don’t let their artificial time-tables dictate your own personal grieving. You may also experience feelings of guilt, asking yourself if you did something during your pregnancy that caused this (in almost every case, the answer to that question is a resounding no). You may feel resentful toward other parents or children, or find it difficult to be around children, especially those who are the same age as your child would be. You may wonder if you will be able to have another baby. All of these feelings are completely normal, but they will take time to resolve.

Additional Links

Here are some good links to learn more about the grieving process for unborn children.

National Share

AmericanPregnancy.org

Related Nash and Associates Links

Pregnancy-related gingivitis and prematurity

 

 

 

Budget Crisis Avoided, But What About the Babies? Can They Live With $504 Million Less in Funding?

Wednesday, April 20th, 2011

Let’s start here:  The Federal Government Shutdown has been avoided.  Federal workers and government contractors that depend on a functioning federal government can breathe a deep sigh of relief.  As the hysteria subsides and we return to business as usual, we should ask ourselves – “Are we really returning to business as usual?”  When it comes to your health and more specifically, the healthcare that you and your baby receive, the answer very well may be a resounding “NO.”

How It All Happened

I suppose I should set the stage for you, in case you missed the hand-wringing and other hysterics.  The two houses of Congress are divided.  As is par for the course, Democrats profess that one course of action is correct and Republicans declare that another course is more appropriate.  A budget needs to be in place for the government to function, yet the two political parties couldn’t come to an agreement.  A shutdown of the federal government was promised if a compromise was not reached.  The American public held its breath—or protested.  At the 11th hour, cuts were made, backroom deals were struck, and Washington spoke:  there will be $38 billion dollars trimmed from the federal budget.  On a positive note, federal agencies will remain operational until the end of September. Reason to cheer? Maybe. Before we break out the party hats and noise makers, let’s take a look at how healthcare fared.  The following areas are among those cut:

-         Special Supplemental Nutrition Program for Women, Infants and Children (WIC):  $504 million

-         Community Health Centers:  $600 million

-         Substantance Abuse & Mental Health Services Administration:  $45 million

-         Infectious Disease prevention:  $277 million

Total:  $1.426 Billion.  Yes, billion, with a “B”!

WIC, Babies, Community Health & Death

Women, Infants and Children, otherwise known as WIC, is a program that provides food for poor women and children up to the age of five.  WIC’s mission statement is “to safeguard the health of low-income women, infants, and children up to age 5, who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.” WIC gives targeted nutritional supplementation to help prevent birth defects and developmental problems caused by malnutrition.  It also provides information on healthy foods and referrals for medical care, according to the program’s website.

The WIC program gave out about $7 billion in food grants to states in 2010. There were nearly 8.9 million households receiving WIC benefits at the end of 2010, according to the Department of Agriculture. Locally, on an annual basis, Maryland WIC serves over 130,000 women, infants and children each month.  More than 151,000 pregnant and breastfeeding women, infants, and toddlers benefit from the program in Virginia.  Despite the number of women, infants and children assisted by the program, the recent budget compromise promises to slash $504 million in funding. The startling aspect is the number of women and children that are eligible but for one reason or another are not enrolled in the program. There is an estimated 43 percent of women and children, who are eligible for benefits but aren’t receiving them.  The cuts to funding will effectively foreclose their opportunity to receive benefits. At risk and in need, they will have to look elsewhere.  Sadly, many will not.

In addition to the significant cuts to WIC’s budget, the budget for community health centers would drop by about $600 million, affecting access to basic health services for approximately 5 million low-income Americans, according to the National Association for Community Health Centers. By 2015, according to NACHC, the reduction could undermine health centers’ capacity to provide services to 40 million people.

But what does it mean?

It is 2011.  My computer, cell phone and other gadgets all confirm that we are soundly within the confines of the 21st century. While we can certainly live with the fact that automobiles do not take flight a la The Jetsons, what is troubling is that we are continuing to battle fetal death in the United States.  Around 2.6 million babies are born with no signs of life after 28 weeks’ gestation – which defines a stillbirth. Undoubtedly, most of these stillbirths take place in developing countries.  Nonetheless, in the world’s wealthiest nations around 1 in every 300 babies are stillborn.  In 2005, data from the National Vital Statistics Report showed a US national average stillbirth rate of 6.2 per 1000 births. In fact, of the world’s most advanced economies, the United States has the highest infant mortality rate.  In Maryland, a preliminary report from the Department of Health and Mental Hygiene (DHMH) shows that Maryland’s infant mortality rate is 7.2 infant deaths per 1,000 live births.

The major causes of stillbirths—complications during labor, maternal infections, hypertension, diabetes, and fetal growth restriction—aren’t too different from the major causes of maternal or neonatal deaths. Among the most fundamental ways to prevent stillbirths and fetal death is to improve basic and comprehensive emergency obstetric care. Providing pregnant women folic acid supplements, preventing disease, and improved detection and management of infection during pregnancy are simple ways to ensure babies are born healthy.

According to WIC, numerous studies have shown that pregnant women who participate in WIC have longer pregnancies leading to fewer premature births; have fewer low birth-weight babies; experience fewer fetal and infant deaths; seek prenatal care earlier in pregnancy and consume more of such key nutrients as iron, protein, calcium and vitamin C. That being said, the budget negotiations resulted in drastic cuts to a program effective at reducing harm to the nation’s most vulnerable?  Oh, boy.

With the exception of a short stint as a student legislator in high school and college, I do not have meaningful experience in the political arena.  I will not pretend to have significant insight into what it takes to balance a federal budget.  As a lay person, what I can do is look at the statistics and read the reports.  The numbers and reports tell me that in the 21st century America, a scary number of its children are being harmed by the preventable.  On top of that, the funding—the lifeblood—that sustains the programs aimed at reducing the problem just took a devastating blow. Will the programs designed to help our most vulnerable continue to operate? We can only hope.   At least, for the sake of the children. So please excuse me if I don’t put on my party hat and celebrate the $38 billion in budget cuts. I haven’t found a cause for celebration just yet.

Agree or disagree? That’s why the comment section is below. Let me know if you have your party shoes on.

 

Makena: Drug to fight prematurity leads to major firestorm.

Thursday, April 7th, 2011

Last week, I started following a still emerging story about a drug that I had never heard of before called Makena. The medication is a synthetic form of progesterone that is used for women who have a high risk of prematurely delivering a baby based on having had a premature delivery in the past. The drug must be injected by these women weekly for 18-20 weeks of their pregnancy.

According to the Baltimore Sun, the controversy surrounding this drug began when the “…K-V Pharmaceutical Co. boosted the total cost of the drug during a pregnancy from about $400 to $30,000, igniting a firestorm of objections.” This was possible because originally the medication was created by a compounding pharmacy mixing it together for patient use. Then in February, the FDA granted K-V Pharmaceutical Co. the exclusive rights to manufacture the medication for seven years.

If raising the cost of the medication 75 times its original cost (from $10-20/dose to $1,500/dose) were not enough, the Baltimore Sun reports that the company then went on to “sen[d] letters to pharmacies threatening that the FDA would punish them if they compounded their own versions of the drug.”  However, the FDA, amid a loud outcry of complaints, has “…declared it would do no such thing.  In its statement, the FDA noted that the drug was important and K-V ‘received considerable assistance from the federal government in connection with the development of Makena by relying on research funded by the National Institutes of Health to demonstrate the drug’s effectiveness.’”

What has been so interesting are the implications of this story and the reactions to it. Clearly, the original decision by the pharmaceutical company to raise the cost of the drug 75 times the old cost is an attempt to make money from their exclusive rights. I can hardly imagine that there is any reason other than profit creation for this move given that they did not have costs associated with research and development or any other clearly identifiable costs. So, aside from my initial reaction of disgust that this might make it harder for women who need this medication to protect their children, I also thought about the bigger implications.

First of all, the cost issue is not so simple as it first appears.  As another article from the Baltimore Sun mentioned, “[t]he burden for many will fall on insurance companies, which may have to raise rates. The increase will also affect already strapped Medicaid programs.” The increased costs of drugs impact many Americans directly – those without insurance or those for whom even co-pays are a major budgetary struggle. However, the costs here also reach all of us. If the costs associated with the company’s increased profit are borne by the insurance companies and Medicaid, it also means that the costs are going to be felt by all of us who pay for health insurance or whose companies pay for health insurance and yes, by all of us, who pay taxes.

Secondly, for those women who do not realize that they could still go to a compounding pharmacy for this prescription and for whom it is not covered by insurance, the increased cost may mean that some woman will go without these injections. The Baltimore Sun article reports that:

About 500,000 U.S. infants are born prematurely each year. The March of Dimes estimates that about 10,000 of those premature births could be prevented if eligible women received Makena.

The implications here deal with both the health and safety of the unborn child who is now at risk of premature birth. But, unfortunately, they also have an associated monetary cost. The cost of a baby being born prematurely is also going to weigh on the insurance companies and is, therefore, going to be shared by all in the form of potentially increased premiums.

Given the intense criticism in the news, K-V Pharmaceutical Company moderately changed course in the last few days, according to Medical News Today and said they would bring the cost of Makena down to $690 per dose from the originally announced price of $1,500 per dose. While this is lower, this is hardly a significant adjustment given that the compounded version costs between $10-20 per dose. The March of Dimes, which originally backed FDA approval of the drug and was allowing the pharmaceutical company’s use of its name and logo, is apparently embarrassed by KV Pharmaceutical’s decisions. According to an article on the nonprofitquarterly.org, “…the March of Dimes is backing out of a sponsorship deal with the [pharmaceutical] company that sells [Makena]. Last Friday, the nation’s leading nonprofit focused on the health of pregnant women and babies said it would no longer allow St. Louis-based, KV Pharmaceutical Co. to use its name or logo in any of the drug company’s promotions.”

The response from the March of Dimes is not KV Pharmaceutical Co.’s only trouble as the Wall Street Journal is reporting that after the FDA announcement that it will not take action against pharmacies that compound the drug, and the company subsequently announced that it would cut the cost, the company’s shares fell 5.2%.  Reuter’s is reporting that this represents a drop of more than 20 percent.  Congress is also in an uproar about this issue.  The Reuter’s article says that elected officials are creating pressure for more to do be done on this issue.

What do you think should be done about KV Pharmaceutical Co.? Are they really any different from any of the other pharmaceutical companies? Is it relevant to consider that this is a so-called orphan drug and that the company has exclusive rights because of this? Do you think that allowing compounding pharmacies to create the drug for woman separate from the FDA approved drug is a sufficient solution? What about the bigger question of companies creating inflated prices for their products and having insurance (and all of us) foot the bill?

 

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.

 

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.

Pregnancy Gingivitis: Simple ways to avoid risk for you and your baby.

Friday, February 25th, 2011

I recently came across a website that offers a lot of really good advice for parents-to-be, and I’m happy to promote it on our blog. You may want to visit The Pregnancy Zone and bookmark it for future good reads. If you are a long-time reader of our blogs, you know by now we are really into sharing health and safety information with our readers. As we say on our Twitter page, we are lawyers trying to get the word out so you never need people like us

A recent post on The Pregnancy Zone brought to my attention a condition that, quite frankly, I was not all that familiar with - pregnancy gingivitis. Gingivitis is probably a condition that you are already familiar with. Simply put, it is a form of periodontal disease, which involves inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets. What I didn’t realize is that it has a real potential risk for moms-to-be and their babies. Watch this video by Dr. Jaimie Johnson for a better understanding of why it is important to not overlook this basic element of your prenatal care.

httpv://www.youtube.com/watch?v=c8Uip6hr3vM

So why is this so important? Premature delivery is the primary reason.

At least a couple of major studies have shown that there is a link between gum disease and premature birth. Researchers of one study who published their results in The Journal of the American Dental Association found that pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely (before gestational week 37) than mothers with healthy gums.

Mothers with the most severe periodontal disease delivered the most prematurely at 32 weeks. The researchers’ study did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question. Their main findings, however, support the results of another study that also showed that premature, underweight babies were born more often to mothers with gum disease.

Source: WebMD:

What also drew my attention to this topic was a story of a mom, who suffered a stillbirth at full term. The best cause for how this could have happened, according to her doctors, was that the bacteria from her dental condition had directly affected the placenta, leading to the death of her fetus in utero.

What is a bit disturbing about the WebMD post is the statement that the study “did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question.” Clearly, some blogs and videos on this topic indicate that there is a treatment-risk reduction benefit. It does seem to make common sense, doesn’t it?

Would love to know if you have any information to share about any other studies, ongoing research and the like on this topic. Sure seems that – at a minimum – getting good dental care during your pregnancy is sound advice and surely worth the effort in case there is a direct cause-effect-treatment relationship perhaps is the case.


Study: Screening Tools Accurately Identify Postpartum Depression – Focus Group: Urban Minority Moms

Saturday, February 20th, 2010

In a study led by the University of Rochester Medical Center and published online by the journal Pediatrics, researchers have determined that there is a high degree of accuracy in making the initial determination of postpartum depression (“baby blues”) in urban, minority women when using three depression screening tools.   This research was funded by the National Institute of Mental Health 

This study is reported in a recent article posted in Medical News Today.

Many women experience the so-called “baby blues.” When the feelings persist or worsen it may be clinical depression. The symptoms include insomnia, persistent sadness, lack of interest in nearly all activity, anxiety, change in appetite, persistent feelings of guilt, and thoughts of harming oneself or the baby. Postpartum depression affects up to 14 percent of new mothers in the United States, with higher rates among poor and minority women.

These screening tools have previously been evaluated but this is the first time they have been tested with a group for whom there is not much data – low-income women, especially African-American women, said Linda H. Chaudron, M.D., associate professor of Psychology, Pediatrics and of Obstetrics and Gynecology.

The three screening tools being evaluated were the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory II and the Postpartum Depression Screening Scale.  By clicking on any of the links we have supplied to these tests, the reader can readily see just how simple they are and how quickly they can be administered (as reported – 5 minutes or less).

These screening tests are just that – screening mechanisms.  Healthcare providers dealing with new mothers should be mindful of using these tools and thereby be in a position to help these mothers during this difficult time in their lives.  This is not something restricted to obstetricians  - it is for all healthcare providers who come in contact with any new moms, whom they suspect may be suffering from “baby blues.”  Don’t assume all is well on the home front – ask!  It won’t take much time, but it could provide much needed help for your patients.


News – text4baby – Expectant Moms, Heard About This One?

Saturday, February 6th, 2010

Social Networking, cell phones, tweets, blogs – you name it – are all the rage.  Now comes news of an interesting and useful (it seems) way for expectant moms to receive weekly text messages timed according to the ‘due date’  News – text4baby.

According to the article, there are approximately 500,000 premature births in the US every year.   This very worthwhile campaign is designed to lower that awful statistic.  As we are all aware, along with prematurity come many bad outcomes for these infants.

Who’s putting this helpful information out there to these moms-to-be?

The messages, which have been vetted by government and nonprofit health experts, deal with nutrition, immunization and birth defect prevention, among other topics. The messages will continue through the baby’s first birthday.

The program has some heavy-weight sponsors – among them: Johnson & Johnson, Pfizer, WellPoint and CareFirst BlueCross and Blue Shield.  It is also noteworthy that wireless carriers including AT&T, Verizon and Sprint are waiving all fees for receiving these texts.

Here’s a little more about the thinking behind this campaign:

Organizers hope the effort can curb premature births, which can be caused by poor nutrition, excessive stress, smoking and drinking alcohol. About 500,000 babies are born prematurely in the U.S. each year, and 28,000 infants die before their first birthday, according to the Healthy Mothers, Healthy Babies Coalition. The nonprofit is among the sponsors of the campaign.

The announcement of this campaign was to have occurred this past Thursday, February 4, 2010 and will be publicized by government officials in various and sundry ways in the days, weeks and months thereafter.

We thought we would do our little bit to get the word out there.