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Medical Malpractice Suits Easy But Poor Scapegoat for Rising Cost of Healthcare

David Mittleman — Tue, 21 May 2013 10:17:50 GMT

When it comes to talking about methods to lower the cost of healthcare, the discussion always seems to come around to reducing medical malpractice lawsuits and how this would be the "magical cure" that would solve all of our healthcare woes. However, a recent study conducted by researchers at Johns Hopkins debunks this delusion and instead found that the expenditures on medical malpractice payouts amounted to less than 1% of national medical expenditures.

The study leader, Dr. Marty Makary, associate professor of surgery and health policy at Johns Hopkins University School of Medicine, says:

The notion that frivolous claims are routinely resulting in $100 million payouts is not true. The real problem is that far too many tests and procedures are being performed in the name of defensive medicine, as physicians fear they could be sued if they don’t order them. That costs upward of $60 billion a year. It is not the payouts that are bankrupting the system – it’s the fear of them.

In fact, the researchers looked at the National Practitioner Databank, an electronic repository of medical malpractice claims for Nationwide. They looked at claims from 2004 to 2010, and found that during that time period 77,621 claims were made and 7.9% of those were "catastrophic claims". Catastrophic claims are those that result in payouts of over $1 million and occur when a patient under the age of 1 is severely injured as a result of medical malpratice, develops quadraplegia, requires lifelong care, sustains brain damage or when a claim results from errors in anesthesia use.

Overall, the study researchers concluded that efforts to reduce medical malpractice claims should be focused on preventing the type of errors that cause catastrophic claims, which would lead to better patient safety, instead of focusing on capping payouts. It's about time that we take studies such as these into serious consideration and stop looking for the scapegoat (you can read more about the myths and facts behind medical malpractice lawsuits here).

Originally posted at The Legal Examiner by David Mittleman

Despite Feeling Better, It's Important to Keep Taking Medication When Faced With Mental Illness

David Mittleman — Mon, 20 May 2013 10:41:17 GMT

Yesterday I wrote about a controversial new diagnosis for teenagers afflicted with mood swings. In that blog I wrote about the rising number of teenagers diagnosed with Bipolar Disorder, and how the DSM-5 has issued a new diagnosis in its place to stem the number of young people taking anti-psychotic medications. Some psychiatric experts say that anti-psychotic drugs used to treat Bipolar Disorder can be hard on teens, and lead to a number of health problems. However, I thought it also extremely important to note the significance of continuing to take medications if faced with a diagnosis of serious mental illness such as Bipolar Disorder.

One example I gave in my blog yesterday was the movie Silver Linings Playbook. In that movie, the main character is diagnosed with Bipolar Disorder and refuses to take his medication. His older parents are plagued with his delusional outbursts at all hours of the night, and his refusal to see that his marriage with his estranged wife is over. A recent NYT blog highlights the real "silver lining" in the movie plot: the main character's decision to start taking his medication and his life's sudden turn-around. In the process of uncovering the truth behind the plot of the movie, NYT blogger Tana Wojczuk details her own history with Bipolar Disorder and the difficult decision to take her medication.

Wojczuk tells the story of a life plagued by tumultuous relationships and frequent periods of mania that prevented her from enjoying life and the relationships she was attempting to build. Finally, after meeting Xander, a man whom she later married, Wojczuk decides that medication might not be such a bad idea afterall. It has been several years since she started taking Lithium, but Wojczuk says that her life is better. It was difficult for her at first, since the medication made her aware of others' feelings for the first time, among other new sensations. She still struggles with thoughts of abruptly stopping her medication regimen, but her story exemplifies the importance of continuing to take medication when faced with a serious mental illness--even after feeling better for some time.

Originally posted at The Legal Examiner by David Mittleman

Controversial Diagnosis in DSM-5 Over Teen Bipolar Disorder

David Mittleman — Sun, 19 May 2013 14:11:26 GMT

I just watched Silver Linings Playbook, and without giving away too much, the main character has Bipolar Disorder. If you aren't familiar, Bipolar Disorder is characterized by chaotic and unpredictable mood swings that do not follow a set pattern. A person afflicted by Bipolar Disorder can experience the same mood for weeks, months, or even years and then suddenly experience the opposite mood without warning. The moods also vary by intensity and severity depending on the individual.

However, the DSM-5 (I know, same initials as mine--but not named after me) has addressed the controversial topic of diagnosing Bipolar Disorder in teenagers. Prone to chaotic and sudden mood swings, when should mental health professionals label a teen Bipolar? The DSM-5 apparently claims never, and instead has come up with a new diagnosis of Disruptive Mood Disregulation Disorder (DMDD). Teens affected by DMDD are described as experiencing frequent angry outburts several times a week for more than a year. These temper tantrums are not your typical ones either, instead they are out of proportion explosions that occur at least three times a week, are not typical for the developmental stage of the child, and began happening before 10 years old. However, the DSM stresses that children under the age of 6 should not be diagnosed with DMDD.

The point of adding the new diagnosis is to prevent over-medication, says the chair of the DSM-5 task force, David Kupfer. Currently, the number of teens diagnosed with Bipolar Disorder is skyrocketing and resulting in improper treatment including over-medication. Over-medication can lead to severe weight gain and even medical conditions such as Diabetes. For parents facing severely emotional teens, some are grateful for the new diagnosis with the hope that it will lead to better and more effective treatment without the harsh side-effects of the anti-psychotic medications given for Bipolar.

Originally posted at The Legal Examiner by David Mittleman

Depression Linked to Double Risk of Stroke in Middle Aged Women

David Mittleman — Sat, 18 May 2013 12:23:50 GMT

Depression is a debilitating mental illness, as you probably already know. However, it was surprising to me to learn that middle-aged women who suffer from depression are also more likely to suffer a stroke. In fact, the risk of stroke was nearly double for this group.

The study, conducted by Australian researchers, focused on women ages 47 to 52. The researchers noted that the absolute risk of stroke is low in this group, but that depression may be a stronger risk factor. Overall, the researchers looked at data from over 10,000 women, none of whom had a history of stroke. Over the course of twelve years, 24% of the women reported suffering depression and 117 of those same women had a stroke. After analyzing the data, the researchers found that women who suffered from depression were 2.4 times more likely to have a stroke than those who didn't experience depression. These results held even after controlling for other common factors attributed to stroke including high blood pressure, obesity, socioeconomic status, age, heart disease, and other lifestyle choices such as smoking. The researchers warn that the results do not imply that depression causes stroke; rather stroke is linked to stroke.

A stroke occurs when a damaged artery deprives the brain of oxygenated blood, which causes brain cells to die and toxic chemicals to rise. Strokes are the third leading cause of death in the U.S., which 117,000 affected annually. May is National Stroke Awareness month and you can help to prevent death from stroke by spotting the warning signs early in those around you. The handy acronym "F.A.S.T." can be used to help you do so: F stands for face dropping, A stands for arm weakness, S stands for speech difficulty and T stands for time to call for help (if the person exhibits any of these symptoms).

Originally posted at The Legal Examiner by David Mittleman

CDC Says 58% of Public Pools Contain Poop

David Mittleman — Fri, 17 May 2013 11:45:02 GMT

It's that time of year again when many of us will be enjoying swimming pools, some of them public. But maybe you want to read a recent Centers for Disease Control report that says that more than half of public pools are basically toilets. In fact, more than half of public pools that the CDC tested contained E. Coli, the bacteria most commonly associated with fecal matter.

For the current study, the CDC took samples of pool water from filters from 161 public swimming pools. Of those samples, 58% showed signs of E. Coli. Although the researchers could not say with complete certainty that the bacteria was from human waste, they argue that it nevertheless "signifies that swimmers introduced fecal matter into the water".

So who is to blame for bringing the poop into the pool? For one, babies and other children that aren't yet potty trained can easily bring fecal matter into the pool. However, adults are also to blame; many adults fail to adequately shower before entering the pool (that means with SOAP and WATER). Just in case you think it's okay to pee in the pool (no harm, no foul, right?) the CDC's report also says that additional contaminants like human sweat and urine make it harder for chlorine to do its job on the poop traces. So we can assume that public pools are pretty gross, but they probably aren't hazardous to our health since the CDC has yet to conclude that any illnesses were related to pools.

Originally posted at The Legal Examiner by David Mittleman

Brain Injuries Potentially Linked to Suicide Among Military Personnel

David Mittleman — Thu, 16 May 2013 11:05:19 GMT

Just the other day, I saw a commercial about military personnel who have lost a limb while in combat and the struggles that they face as they adjust to prostheses. However, one overlooked area for military personnel is the rate of mental health issues that go unrecognized and unaddressed. Partially this is attributable to the overwhelming refusal and even confusion over what to do about mental health problems created by the atrocities of war. But the fact is that suicide is a major problem in the military: the annual rate of military personnel taking their own lives has doubled to about 20 in 100,000, or 324 suicides in the Army in the last year.

I came across an interesting article today that offered a speculation for the high rate of suicide among our military personnel, multiple concussions. It is true that roadside bombs have caused thousands of troops' mild traumatic brain injuries. Several studies are beginning to suggest that these MBIs are at least partially to blame for the high rate of suicide. One pertinent article controlled for the other important factors linked to suicide among military personnel, primarily PTSD and depression, and found that military personnel in Iraq who suffered multiple MBIs were far more likely to experience suicidal thoughts compared to those who experienced one brain injury or none.

Although the new study can't make a definitive link between MBIs and suicide, mild brain injuries are shown to impair problem-solving skills and the ability to be social. Researchers believe that these deficits could lead someone facing stress to consider suicide compared to those who aren't impaired in these areas. Another interesting possibility is the trait of impulsiveness, which can make some individuals more prone to suicide. However, troops that are injured by roadside bombs could also be more impulsive to begin with, since they are placing themselves in a potentially deadly situation. Overall, it is clear that the researchers have more work to do to disentangle the various psychological factors from the physical injuries that troops sustain. However, what is clear is that 20% of troops will be injured by a roadside bomb and suffer an MBI, making this type of research timely and crucial.

Originally posted at The Legal Examiner by David Mittleman

Student at University of Washington Forced to Drop Out Over Severe Peanut Allergy

David Mittleman — Tue, 14 May 2013 11:54:13 GMT

Peanuts are no laughing matter for Kelsey Hough, a college student at the University of Washington, Tacoma. Her first year in college, the university took her allergy very seriously and posted signs on classroom doors warning of her severe allergy to peanuts, including her throat potentially closing up and losing the ability to breathe. However, by her second year, all of the signs were removed and Kelsey was asked to write a letter that the school distributed to her classmates asking for their cooperation.

Nevertheless, Kelsey knew that the letter wouldn't be enough and that she wouldn't be safe at school. Ultimately, she was forced to drop out of college. The school claims that the signs were "unenforceable" and that it would be impossible for them to keep her safe, although she is a good student. She acknowledges that while she wasn't "forced" out of school, the school's response did make it nearly impossible for her to stay.

Compared to the prompt and perhaps extreme reaction of a high school to a student's apparent allergy to Axe Deoderant spray, you would think that the University of Washington, Tacoma could've done a bit more to help Kelsey. In fact, students with severe allergies can qualify under the Americans With Disabilities Act for special services, according to the vice president of the Allergy and Asthma Foundation of America. The Justice Department also recently reached a settlement with Lesley University in Cambridge, MA, requiring the school to make reasonable accomodations for a student with severe Celiac disease. As for the University of Washington Tacoma, they say that they hope that they can reach a compromise with Kelsey that would allow her to come back to school, but that they cannot guarantee her safety all over campus.

Originally posted at The Legal Examiner by David Mittleman

Daughter Saves Mother's Life With Kidney Donation

David Mittleman — Mon, 13 May 2013 11:08:55 GMT

One mother received a gift greater than a bouquet of flowers and a card for Mother's Day. Mindy Lam, a 45-year-old jewelry designer from Rockville, Maryland received the gift of life when her 19-year-old daughter, Kelly Sia, donated a kidney to save her mother's life.

Three years ago, Mindy was rushed to the emergeny room and nearly died. She was diagnosed with hypertensive nephropathy, or untreated high blood pressure that damaged her kidneys beyond repair. Mindy was stunned to learn of her diagnosis as she had no symptoms of high blood pressure, but doctors say that nearly 36 million Americans don't have their condition under control. She was given to options to save her life: undergo a kidney transplant or be put on dialysis. Unfortunately, the kidney donor list consists of over 102,000 Americans, so Mindy chose peritoneal dialysis which required her to be hooked up to a machine up to five times a day.

At the time, Kelly wanted to donate a kidney to her mother, but was too young at age 16. Mindy also suffered from dialysis-related complications, including catheter infections that were so severe they landed her in the ICU several times. Finally, when Kellly turned 18, she told her mom that she wanted to go through with kidney donation. On February 15, 2013, the two women checked into the hospital and the surgery was a success for both of them. Both women have recovered completely since the transplant surgery and share matching scars underneath their belly buttons. Kelly says that she wears her like a badge of honor, knowing that she saved her mother's life, who has already given her so much.

Originally posted at The Legal Examiner by David Mittleman

Wrong Kidney Removed from Patient at Mt. Sinai Medical Center

David Mittleman — Sun, 12 May 2013 10:48:00 GMT

In a terrible hospital error, the wrong kidney was removed from a patient at Mt. Sinai Medical Center. The prestigous hospital is under scrutiny after admitting that one of its surgeons removed the wrong kidney from a patient. Other patients were clearly shocked and upset when interviewed, and could not understand how such a grievous and obvious error occurred.

Nevertheless, officials at Mt. Sinai Medical Center say that the reason the error occurred was because the 76-year-old patient had two bad kidneys, making it difficult for the surgeon to know the right one to remove. Unfortunately, these so-called "never events" (meaning they are so easy to avoid that they should "never" happen) occur more frequently than any patient would care to know--in fact, they happen more than 4,000 times a year, according to a Johns Hopkins study.

The same Johns Hopkins study revealed that surgeons perform the wrong procedure 20 times per week and that doctors operate on the wrong body part 20 times per week as well. The kidney patient at Mt. Sinai had the second kidney removed and is now on dialysis. The hospital also tried to block cameras from filming outside the hospital on Friday and say that the surgeon has been relieved of his clinical and administrative duties until further review.

Originally posted at The Legal Examiner by David Mittleman

Physicians Fined for Sanitizing Gynecological Equipment Using Dishwasher

David Mittleman — Sat, 11 May 2013 14:13:44 GMT

Of course, it's important to have sterile hospital equipment, but definitely not the way that three gynecologists decided to "clean" their equipment. According to recent report, three gynecologists from Lewisville Physicians in Salem, VA were fined $1,000 each by the Virginia Board of Medicine after it was discovered that they had used a consumer dishwater to sanitize gynecological equipment.

In response, Lewisville replied that the “physicians felt they were in compliance since they were using a generally accepted practice recommended by their medical residency program and by other medical school experts for disinfecting medical instruments.” The physicians allege that they also scrubbed and sprayed the equipment with medical grade disinfectant.

Some others who have commented on the story argue that consumer dishwashers do reach temperatures high enough to sanitize instruments. Interestingly, it's been mainly men who have deemed it "appropriate" for the Lewisville physicians to use a consumer dishwasher to sanitize equipment that's likely never going anywhere near their nether regions.

Originally posted at The Legal Examiner by David Mittleman