Healthcare Safety Index – January 2016

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

The Centers for Disease Control and Prevention issued a recommendation that men with a pregnant partner should abstain from sex or use a condom if they live in or visited an area where mosquitos are spreading the Zika virus. Additionally, the CDC also recommended that pregnant women who have visited countries and territories plagued by the virus, mostly in Latin America, should be tested even if they do not exhibit symptoms of infection.

The Centers for Disease Control and Prevention recommended that hospitalized patients, patients with severe, complicated or progressive illness and patients at high risk for complications due to influenza be treated with antiviral medication irrespective of the outcome of rapid influenza diagnostic test results. The reasons for this are that (a) there have been reports of severe influenza with some deaths and (b) RIDT results have a high potential for false negatives.

A study published in Pediatrics found that exposure to beta-2 adrenergic agonists during pregnancy (used in asthma drugs) may increase the risk for autism spectrum disorders in children.

The American College of Physicians and the Centers for Disease Control and Prevention released a new clinical guideline on antibiotic use in adults with acute respiratory tract infections.Except for confirmed bacterial infections like streptococcal pharyngitis or acute bacterial sinusitis, antibiotics should not routinely be used.

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.