Healthcare Safety Index December 2015

Here are noteworthy healthcare issues that have appeared in the news and medical journals throughout the last 30 days or so:

An article appearing in Pediatric Infectious Diseases concluded that it is reasonable to allow children treated with amoxicillin by 5:00 pm to attend school the next morning after diagnosed with streptococcal pharyngitis. Heretofore, a 24 hour wait-time following antibiotic treatment was the standard protocol.

New guidelines for the pharmacologic treatment of rheumatoid arthritis have been issued by the American College of Rheumatology which update and expand recommendations published in 2012.

The American Heart Association published updated guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

The US Preventive Services Task Force issued new recommendations for diabetes screening. Previously, the USPSTF recommended screening for diabetes in adults with hypertension, but now screening is recommended as part of a patient’s cardiovascular risk assessment in patients between 40 and 70 years old who have a body mass index (BMI) ≥25 kg/m.

Healthcare Index October 2015

Here are noteworthy healthcare issues that have appeared in the news and medical journals throughout the last 30 days or so:

Issac Itzkoff, of the New York Times, reported that comedian Robin Williams was battling Lewy body dementia at the time of his suicide. Lewy body dementia causes an Alzheimer’s-like slippage in memory and thinking as well as stiffness and movement problems such as the kind seen in Parkinson’s disease. It can also cause hallucinations which often involve seeing animals, children or miniature people. The condition results in steady decline, an average of 10% or more a year and there is no cure.  

A study appearing in the American Journal of Psychiatry demonstrated that schizophrenia may be caused by inflammation in the brain which can be discovered through PET scans which measure the levels of activity of immune cells in the brain. The authors suggest that the next step is to determine whether anti-inflammatory treatment in patients who are predisposed to the disease can prevent the disorder.

An article published in Trends in Pharmacological Sciences surveyed advances in “exercise pills” which seek to mimic the effects produced by physical exercise.

An article published in Science discussed the development of artificial skin that acts as a mechanoreceptor in conjunction with an organic transistor circuit that can simulate the sensation of touch. The hope is that this technology will aid in the design of large area organic electronic skin with neural integrated touch feedback for replacement limbs.

Health Care Safety Index July 2015

A study published in the American Journal of Clinical Nutrition concluded that people who consumed more fruits and vegetables had a 13% lower risk of heart disease.

The CDC reported that people with health insurance are up to three times more likely to obtain recommended preventative care. Preventive services are available for nine of the ten leading causes of death in the United States.


An article published in Neurology concluded that the risk of stroke in patients diagnosed with endocarditis is longer than previously thought. According to the authors of the study, the risk of stroke usually begins 4 months before a diagnosis of infective endocarditis, peaks in the month after the diagnosis, and then normalizes by 5 months afterward.


The FDA issued a safety communication regarding 45 patient deaths and other adverse events related to the use of SentreHEART devices used for left atrial appendage closure.


An article published in Osteoporosis International suggested a link between ischemic heart disease and osteoporosis. The authors concluded that bone health should be considered in patients diagnosed with ischemic heart disease.


The FDA amended the warnings related to NSAID use and the increased risk of strokes and heart attacks.   

The American Thoracic Society, European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association published new guidelines for the care of Idiopathic Pulmonary Fibrosis.
Updated guidelines for the treatment of Hepatitis C were published in Hepatology by The American Association for the Study of Liver Diseases.

An article published in Emerging Infectious Diseases (and approved by the CDC) revealed the continuing and significant expansion of Lyme disease. In counties throughout the United States between 1993 and 1997, there were 69 counties with high incidence of Lyme disease; this number climbed to 130 counties for the period from 1998 to 2002, 197 counties in 2003 to 2007 and 260 counties in 2008 to 2012. The news is bleaker for northeastern states who saw a 320% jump in counties with high incidence, from 43 counties in the first period to 182 in the last survey.


The CDC published a report indicating that the United States in in the midst of a heroin epidemic with usage rates climbing from 63% between 2002 and 2013. The biggest increases in use were seen in women and people with higher incomes.


Pauline Anderson, of MedScape News, reported on oral presentations at the Alzheimer's Association International Conference which demonstrated that physical activity reduces cognitive decline and improves neuropsychiatric symptoms in patients with dementia and may reduce Alzheimer's disease  biomarkers.     


A study appearing in Pediatrics raised the question of whether antibiotic use increased the risk of juvenile arthritis.

An article published in PLOS Medicine disclosed that Glitazones taken by patients for Type 2 Diabetes (including Avandia and Actos) might have the unintended but beneficial effect of decreasing the risk of Parkinson’s disease.                                                     

Damages and how we Approach Valuing Medical Malpractice Cases

What is my Medical Malpractice Case Worth?

When a prospective client first calls to discuss whether he has a medical malpractice case I have to make a preliminary decision about the potential value of the case. Obviously, questions about the value of a malpractice case also come up at the tail end of a litigation, when we reach the resolution phase of a matter and begin negotiating. At the outset, when I estimate the potential value of a case I am simply guestimating whether a successful outcome will likely justify the time and expense investments required to prosecute the file. When estimating the value of the case at the end of a litigation for clients, I am trying to come to a reasoned assessment about a case’s true value.  I have the benefit of much more information at the end of a litigation than I do when a client first calls me on the telephone, so I am in a better position to reach conclusions and give clients more guidance about the value of a case at that point. Nevertheless, at best case valuation is a process that involves judgment and reasonable minds can differ about issues involving judgment. Also, different clients have different objectives, money means different things to different people and individuals differ in their tolerance for risk. All of these things have to be taken into consideration when discussing how best to resolve a malpractice case.

Healthcare Safety Index June 2015

Here are patient safety issues that have appeared in the news and medical journals throughout the last 30 days or so:

An article published in the June 16, 2015 edition of JAMA concluded that antibiotic treatment of patients with uncomplicated appendicitis may be as effective as an appendectomy.

A study published online on PLOS One on June 10, 2015 concluded that proton pump inhibitor usage increases the risk of heart attacks.

U.S. News & World Report published its annual list of Best Children’s Hospitals.  Nationwide top finishers in their respective categories included: Cancer – Dana-Farber Boston Children’s Cancer and Blood Disorders Center;Cardiology & Heart Surgery – Boston Children’s Hospital; Diabetes & Endocrinology – Boston Children’s Hospital;Gastroenterology & GI Surgery –  Boston Children’s Hospital;  Neonatology - Children’s Hospital of Philadelphia;Nephrology - Boston Children’s Hospital; Neurology and Neurosurgery – Boston Children’s Hospital; Orthopedics – Children’s Hospital of Philadelphia; Pulmonology – Cincinnati Children’s Hospital Medical Center; Urology – Boston Children’s Hospital.

Top finishers in proximity to New Jersey include:   Cancer – Children’s Hospital of Philadelphia (3); New York-Presbyterian Morgan Stanley-Komansky Children’s Hospital (17); Memorial Sloan-Kettering Cancer Center (21); Children’s Hospital of Pittsburgh of UPMC (22); Penn State Hershey Children’s Hospital (24); and Children’s

Confidential Settlement on Behalf of Bloomfield, New Jersey Woman Who Suffered From Pressure Sore While a Recovering From Spinal Surgery

The plaintiff underwent multi-level spinal surgery in June 2011. She was admitted to a rehabilitation hospital and after six weeks she was diagnosed with a pressure ulcer on her sacrum and bilateral pressure ulcers on her heels. She was then discharged from that facility to a long term care nursing home. The plaintiffs contended that a lack of continuity of care resulted in an exacerbation of the pressure sore, so that it went from a Stage II pressure sore to a Stage IV pressure sore.

The plaintiffs further alleged that the pressure sore developed because appropriate pressure relief measures were not undertaken at either healthcare facility. Additionally, there was evidence that the plaintiff was malnourished and this contributed to the development of the pressure sores and their inability to heal. After appropriate pressure relief measures were undertaken, supplemental nutrition was employed and the plaintiff underwent multiple debridement surgeries, her pressure sores eventually healed. Nevertheless, the skin breakdown resulted in a prolonged stay at the nursing facility and some measure of out-of-pocket expenses to the plaintiffs.

The case settled at a mediation hearing prior to the scheduling of a trial date.

Health Care Safety Index May 2015

A study published in JAMA demonstrated that 57.7 percent of reported concussions in high school players and 57.6 percent of concussions in college players occurred during practice. The high incidence of concussions in practice is troubling because players and coaches have much more ability to control the kinds of impacts that result in these injuries during practice, as opposed to games.  

A study in JAMA Internal Medicine established that atypical antipsychotic medications like Seroquel, Risperdal and Zyprexa increase the risk of falls for elderly patients.

The FDA issued a warning indicating that some drugs used to treat Type 2 Diabetes including Invokana, Jardiance, Invokamet, Xigduo XR and Glyxambi, can sometimes lead to ketoacidosis.

An article appearing in the International Journal for Quality in Health Care demonstrated that prescribing errors with the potential to cause harm frequently go undetected and the incidence of medication errors reported do not accurately reflect the profile of medication errors which occur in hospitals.

The US Preventive Services Task Force  issued new draft recommendations regarding who should undergo mammogram screening and how often. Mammograms were recommended for women between 50 and 74 every 2 years.

A study published in the New England Journal of Medicine concluded that Clindamycin and Trimethoprim-Sulfamethoxazole were equally effective in treating uncomplicated soft-tissue infections.

A study published in the BMC Medicine concluded that following a healthy lifestyle meeting dietary and weight and exercise recommendations helps (a) prevent colorectal cancer and (b) people diagnosed with colorectal cancer live longer.

An article published in Science determined that measles causes children to become immunocompromised for up to 3-5 years.

A study published in JAMA demonstrated that a medication regimen that included Daclatasvir, Asunaprevir and Beclabuvir resulted in a sustained virologic response after 12 weeks of treatment in 91.3% of patients diagnosed with hepatitis C.

A study published in Obstetrics and Gynecology concluded that there was up to a 41% chance that maternal deaths during pregnancy could be avoided with better maternal safety programs.

An article appearing in the Annals of Cardiothoracic Surgery detailed the successful minimally invasive aortic valve surgery program at the Cleveland Clinic.

A study published in Pain Management Nursing demonstrated that the presence of dogs can reduce pain and distress in children who undergo venipuncture.

A study published in the International Journal of Impotency Research concluded that there was no increased risk of mortality associated with long term testosterone therapy. 

Health Care Safety Index April 2015

Here are patient safety issues that have appeared in the news and medical journals throughout the last 30 days or so:

Toni Clarke, for Reuters, reported that AstraZeneca's diabetes drug, Onglyza, may be associated with an increased risk of death due to heart failure.

A study published in Circulation demonstrated that sudden cardiac arrest during sports activity occur most frequently in middle age, but the outcomes following such events are usually better. This is because the events are usually witnessed by others and followed by cardiopulmonary resuscitation.

Research undertaken by the American Orthopaedic Society for Sports Medicine demonstrated that one in three children who undergo ACL surgery experience a re-injury to the same ligament.

An article published in Annals of Internal Medicine discussed the 2015 American Diabetes Associations’ Standards of Medical Care in Diabetes which recommended lowering the floor body mass index of Asian-Americans which should prompt investigation into diabetes from 25 to 23, tailoring plans for blood glucose control to individual patients by considering age, other co-morbid medical conditions, life expectancy and the patient’s motivation and preferences. Finally, statins are now recommended for all diabetes patients older than 40.

Patient Safety in the News February through March 2015

The editors at medGadget discussed a study appearing in the journal Inorganic Chemistry regarding research at Bielefeld University in Germany which demonstrated a new method of disrupting the spread of cancer using molecules that bind to DNA.

Sarah Knapton, with The Telegraph, discussed research published in JAMA about a new stem cell treatment which is reversing the symptoms of multiple sclerosis.

Robert Preidt, for Health Day, discussed a study performed by Cancer Research UK, which demonstrated that obesity raises the risk of cancer in women 40%. 

Jane Brody, for the NYT, reported on a study appearing in The Lancet which described a constellation of symptoms which appear to foretell a diagnosis of Parkinson's disease, including tremors, balance problems, constipation, low blood pressure, dizziness, erectile and urinary dysfunction, fatigue, depression and anxiety.

Patient Safety in the News January 2015

Rachael Zimlich, for Modern Medicine Network, reported that the U.S. Health Resources and Services Administration is predicting a 340,000 nurse surplus by 2025.

Amy Norton, for HealthDay, reported on a study appearing in Cell, Host & Microbe which concluded that a change in stomach bacteria in young children can precede a diagnosis of Type 1 diabetes by a year, aiding in diagnosing this condition.

Suzanne Russell, with My Central Jersey.com, reported that Dr. Anthony DelPiano, a physician practicing in Jersey City, plead guilty to accepting bribes in exchange for test referrals to Biodiagnostic Laboratory Services LLC of Parsippany.

Steven Reinberg, for HealthDay, discussed a report from the American Cancer Society which revealed lung cancer has replaced breast cancer as the leading cause of cancer-related mortality among women in developed countries.

Michael Fleeman and Dan Whitcomb, for Reuters, reported on the introduction of legislation by California lawmakers seeking to end the right of parents in the state to exempt their children from school vaccinations based on personal beliefs.