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It's Not Just Healthcare That's Bankrupt - It's Our Legal System, Too
Submitted by Charles Hugh-Smith of OfTwoMinds blog,
Yes, there is malpractice, but our current system is insane.
What can you say about a "healthcare" system in which 99% of all physicians will face a malpractice claim in their careers? According to Malpractice Risk According to Physician Specialty (The New England Journal of Medicine), "It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties."
Longtime correspondent Ishabaka (M.D.) provides some context:
"A little legal education is necessary to understand malpractice:For a malpractice suit to be successful, there are five necessary things:1. A duty to treat - there has to be an established doctor - patient relationship. A typical example would be someone who corners me at a party and asks me what I think is causing their abdominal pain. I give them my card, ask them to make an appointment for a check-up, they never do, and the pain turns out to be fatal cancer - in that case I had no duty to treat.2. Failure to practice the standard of care - note - this does not mean the BEST care in the world - it means the average, or median standard of care.3. A physician in the same specialty willing to testify that the doctor practiced below the standard of care - all States require this.4. Causation - the substandard care has to have caused the patient's problem - again, this requires expert physician testimony.5. Damages - if the substandard care causes no damage, there is no basis for a suit.Now, I ask you - how can 99% of obstetrician gynecologists, neurosurgeons, emergency physicians, neonatologists (pediatricians who take care of premature babies in the neonatal intensive care unit), and other high-risk specialists practice worse medicine than average? It's mathematically impossible.By the way, in the back of law journals are ads for medical expert companies that promise they will get a doctor to testify to anything the lawyer wants.Yes, there is malpractice, but our current system is insane."
I am not an attorney or a doctor, but it seems self-evident that our legal system enables "fishing expeditions" in search of a settlement by keeping the cost of "fishing" very low, the rewards high and no penalties for abuse of the law, by which I mean issuing unsubstantiated or fraudulent accusations in the hopes of triggering a nuisance settlement, i.e. it's cheaper and less stressful for the accused to pay the accuser a substantial sum to make him go away.
This practice is not unique to medicine. Anecdotally, I have heard from insiders in the insurance industry that there are people who make a good living claiming they were injured in department stores and retail outlets. The claims are bogus, but the grifters know our legal system encourages paying bribes to accusers to avoid the outrageous expense of a court trial.
Give me $10,000 and I'll go away. Do this ten times a year and it's a tidy income.
How can we defend a system where people are rewarded for spewing claims of damages in the hope that a few may stick or the falsely accused will pony up cash to avoid the horrendous expenses of defending oneself against baseless accusations in court?
Ishabaka (M.D.) has practiced medicine in both Canada and the U.S., and he reports that Canada's system for monitoring and dealing with malpractice is more effective at actually limiting incompetence in the system, and it does so without accusing essentially every physician of malpractice in an absurd "line up everyone for target practice" abuse of the legal system.
I do not have the expertise to validate this, and no doubt there are countless complexities to consider, but I find it difficult to believe that "ours is the best possible system," a blanket excuse issued in defense of both sickcare and our equally broken legal system.
I can anticipate that some within the legal profession will say that the low cost of making claims and accusations is worth the corrosive cost and stress of dealing with bogus claims and baseless accusations because it enables the poor and powerless to seek redress.
I find this argument mostly meritless based on two points:
1. How can anyone defend a system as fair, just and cost-effective when 99% of all physicians dealing with serious cases end up being accused of malpractice? It would take about 30 seconds to come up with a lower-cost, more just and effective system than what passes for "justice" in America.2. The vast majority of poor people don't end up having their day in court because that day in court is as absurdly expensive as sickcare. "Justice" in America goes more or less to the highest bidder, outside of propaganda-type Hollywood films.Legal services are extremely expensive and mostly paid in cash, so only the wealthy can afford legal representation or advice.
We would be remiss not to mention the other factor in malpractice, which is unrealistic expectations of medical science and practitioners. Yes, there are some incompetent doctors who should no longer be allowed to practice medicine. But there are many other factors to consider, for example, those doctors who take on the most hopeless, difficult cases are the ones whose "track record" will appear less than stellar.
Yes, there are legitimate cases of malpractice, and legitimate claims that end up being argued in court. But any system that accuses 99% of its practitioners of gross incompetence is deeply flawed, rife with injustice and bloated by needless waste and stress.
It's not just our healthcare system that is bankrupt--so is our legal system.
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I can tell you, from working for a large "non-profit" healthcare provider for many years, that healthcare system is not bankrupt. In fact, it is awash in money. Hospitals popping up, at $100M+, all over the place. You just have to be on the right side of the equation, to benefit. Employees of these companies are usually not the beneficiaries. They can build a $300M hospital, but can't provide an IT Analyst with a $300 laptop (in my case). Upper management and unionized employees are the large beneficiaries. Physicians can be beneficiaries, if they join one of these massive conglomerates as an employee and not an independently practicing entity. It also provides them shielding from malpractice lawsuits.
And, on the business side, these companies are rife with incompetence. it is an absolute miracle that anything gets done.
As a lawyer, med malpractice attorneys can be the worst ambulance chasers, but even the price of malpractice insurance is usually built into the cost of operating a medical practice already. Usually that takes care of most of the frivolous claims which get dismissed early in the pretrial stage.
All this to say, I could think of probably 25 different things that are more messed up in the legal system.
We need a mandatory loser-pays system for lawsuits, and we need it now.
Yes, because we don't already have enough central/central government in our lives... In case you hadn't guessed, this issue is up to the individual states to decide.
Fuck that. Frivolous cases get dismissed quickly via summary judgment (and defendant can already can request terms). Every other case, by definition, has merit, win or lose.
The whole point of adjudication is to settle differences of opinion regarding obligations/fault.
"Loser pays" just fucks the little guy who doesn't have the money to keep an army of attorneys on retainer.
THe the foul part of the story is that it's caused by boomer irresponsibility. Doctors lie yes. But the boomers let them.
The drugs are made cheap in India and Big pharma gets a nice profit with retained earnings used to bribe legislators with. Here's an example and lengthy description of their congame and how it violates the AMA Code of Ethics.
pcossurvivor.blogspot.com/2011/03/metformin-lie-and-pcos.html
In Japan’s SOCIALIST health care system, JAPAN’SCULTURALLY ENFORCED CONCEPT OF PERSONAL RESPONSIBILITY IS THE INVISIBLE HAND THAT ENFORCES QUALITY CONTROL WITH THEIR HEALTH CARE SECTOR. THEY EAT *REAL FOOD* MADE FRESH, THEY ARE ACTIVE, THEY DON’T USE ORAL CONTRACEPTIVES. Some of the oldest living Japanese citizens were smokers.THEIR HEALTH CARE SECTOR IS NOT THE MONEY MAKER SO THESE CORPORATIONS CAN’T LOBBY THE GOVERNMENT AGAINST THE WELFARE OF IT’S CITIZENS.
Look at it this way.
The U.S. boomer majority society totally failed at quality control. Americans in the U.S. are the geniuses that consume chemical cocktail concoctions prepared by homicidal maniacs WITH NO QUALITY CONTROL, then turn around and whine about Monsanto.Look, where would Monsanto get the bright idea that U.S. citizens would ingest, literally anything? Where would food makers get the idea that we love mystery gluten that comes from another country (China) in our carbs? The law states that the food producers need to require the country that the food was prepared/processed in, but they don’t have to disclose where the food processor got their ingredients. Where would big pharma get the bright idea that U.S. citizens again, would dump poisons at their own bodies? U.S. citizens got hooked on Meth without pushing for a non-addictive substance that would cause them to feel good. Duhmericans snort baby laxatives and possum dewormers in their cocaine and probably crack with money the government stole from innocent victims. Duhmerican white racists LOVE meth. And you want to know where Lamberto Andreotti gets the bright idea that people loved having the shits? Bristol Myers Squibb specializes in shitmaker Metformin to specifically cater to market demand! Bristol Myers Squibb's Hepatitis C medication causes psychosis. Where did Lamberto ANdreotti get the bright idea that Duhmericans love psychosis? From ALL of the tweaker trash running rampant and spreading Nazi propoganda throughout the state of California!
The government subsidizes tweaker and crackhead lifestyles, we're forced to pay them rent in this economy- then robs innocent people for their medicare, "medical" marajuana", disability and social security while they antagonize, harrass, intimidate and physically assault us. Yes this is really happening. Drug lords have more money than Mark Zuckerberg. Lamberto Andreotti "only" takes home $20 million/year.
The Justice Department pushings things like "Operation Choke Point." Rule of law is withering at all levels and branches of government.
# # # #
"WTF? Operation Choke Point: Obama Whitehouse Abusing Power Of State Against Legal Businesses Considered Objectionable"
http://thenewsdoctors.com/?p=195522
"A little legal education is necessary to understand malpractice:For a malpractice suit to be successful, there are five necessary things:
This is all off the mark.
What is necessary is for an attorney to call and make a claim. If we are going to discuss this then it needs to be in the proper context. What the good doctor is outlining here is technical details that matter only if a case goes to trial. The vast majority of claims do not go to trial.
If the doctors had their say all claims would go to trial and insurance premiums would be much higher because settlements would be much higher. There is good reason that med mal is out of the doctors hands once a claim is made.
On occasion I have seen a doctor have a say in how things proceed and it is usually disastrous and they can never get their emotions and self-righteousness out of the way. They push for a trial and lose because no experienced PI attorney is going to take a lame duck.
Personally I think the doc has had a recent case that angers him and that is understandable but has nothing to do with much. The reality is once a claim comes the doctor has no say in how things proceed. From there it is all about the insurance carrier, claims manager, and attorneys.
Unless a doctor has a history of big losses that get the attention of an actuary then they have nothing to be concerned with. All docs have claims and it is just part of the territory. It is the docs with substantial losses over many claims that should not be practicing and more likely than not they will be relegated to the fringes anyways. Shitty jobs like prison docs and stuff like that.
The system basically works by eventually filtering out the truly bad doctors by making it too expensive to employ them. Some lose their license.
Neither those who provide, nor those who partake, negotiate the performance or price.
Wrong. Those who provide a service or product determine the final price they will accept, regardless of the price offered. That is the law of contracts - commercial law.
As for performance, it it REALLY negotiable at all? For both those who provide and those who partake, isn't it a matter of expectation and hope?
Four incidents: Medical malpractice or not?
OK, let's stop all the bullshit !!!
As a former physician (orthopedic surgeon) claims were filed against only twice (which I consider "magical"), with quick settlements in both cases (at the insistence of my insurance provider). I never once went to trial. However, I was not in clinical practice for many years, I slowly steered my career toward research. Of course I was greatly relieved that I no longer had to pay for “medical malpractice insurance”, which had been an enormous expense. For the infrequent times later on in which I was in surgery, I was now covered by a policy paid for by the hospital. I also got to teach, not only residents, but also medical students and nurses. I also was no longer required to spend endless hours, during the days, nights and weekends, at the hospital. I was free to engage in the research of my choice and was paid a regular salary – no more haggling with insurance companies. Later I was able to easily transition between various careers and consequently my "work" was, in fact, always a pleasure
That being said, in my medical school class (at a very prestigious university) were a number of students (about 10%) to whom I would never let work on my neighbor's dog. And I hate my neighbor's dog! By the first year of full-time clinical work (the 3rd year of medical school) the divide between the competent and incompetent became apparent.
In post-graduate training (internship and residency) I must admit that most of my fellow residents seemed very competent. However, this particular post-grad training program was difficult to get into, so my colleagues were obviously NOT a "representative sample" of all physicians in post-graduate training.
However, from medical school through residency and into clinical practice, I personally witnessed a number of incidents of what could only be called "medical malpractice", if not "total incompetence". However, I will present 4 cases in which the “verdict”(so to speak) can be argued both ways. It is up to others to decide for themselves.
1.) One patient was in a medical ICU (intensive care unit) for repeated bleeding esophageal varices (enlarged veins in one's esophagus - the "tube" down which food travels from the mouth to the stomach). Another resident and I, along with several nurses, were his primary caregivers, but his physician of record was a well-connected professor of medicine and the head the newly-completed Medical ICU. I should add that he was both an superb physician and an excellent teacher. We managed to control the bleeding by a variety of methods, but felt that this patient needed surgical intervention. (My colleague and I were technically part of the Surgery Department and were merely temporarily "rotating" through the medical ICU.) We requested a consultation by a professor of surgery under whom we worked; his conclusion was that surgery was necessary to save this patient's life. (As an aside, it is understood in medical circles that physicians prefer to keep patients within their specialties, rather transfer to another service.) When we presented the recommendations to the head of the ICU, he became furious. How dare WE question his judgment? After all, we were mere surgical residents with little experience in such cases - all of which was true. He reminded us the HE was this patient’s physician-of-record and bore the responsibility. However, it was his next statement the substance of which I will never forget: Didn't we understand that because the medical ICU was new and needed to generate income to justify itself, we needed to retain as many patients as possible on the medical ICU, to "keep up its census". That last phrase in the sentence I explicitly recall: "to keep up its census." Two days later the patient developed another massive hemorrhage (bleeding) which we could not control. Even with massive blood transfusions, etc, he died there in his hospital bed. Another staff physician must have noticed how upset and angry I was, so he asked me to take one last blood sample to measure the patient's hematocrit (percentage by volume of clotted red blood cells compared to the combined volume of the clotted blood cells and serum) on a specialized centrifuge in another room just down the hallway. It was a useless task, since the man was dead - but I realized that this other doctor was simply trying to remove me from the scene. Now, whether this patient would have survived if surgery had been performed is unknowable. And given that we had managed to control (but not completely stop) the bleeding for several days gave credibility to the medical ICU director's claims. However, I always felt that the question of whether to maintain his treatment within the medical ICU or transfer him to surgery should have been the decision of the patient alone, based on all the information we could provide him.
2.) The second case I will present here was rather straightforward. I was rotating through a private OB-GYN (obstetrics and gynecology) hospital affiliated with our university, which also contained perhaps the finest neo-natal intensive care unit and staff I ever saw. The three non-medical related memories I have of this hospital were: 1.) the private dining room reserved for physicians, residents and medical students, with a huge dining table, real-silver cutlery, real china plates and its numerous waiters; 2.) the waiting room for physicians (usually those on-call at night) which always had unlimited fresh coffee and the most delicious pastries - for free; and 3.) the hospital’s fenced-in, gated and guarded parking lot which contained the largest number of Rolls-Royce automobiles that I have ever seen. The medical incident was simple enough: the GYN surgeon was operating on a young woman (for reasons I do not recall) when he suddenly announced that he had discovered a large tumor and was going to surgically remove it. My colleague and I were puzzled, so my colleague pointed out that the tumor was, in fact, the woman's urinary bladder. And one could clearly see the ureters (tubes for urine flow) running from each kidney into the bladder. The surgeon simply stopped his work, placed a wet towel over the surgical wound and telephoned for a general surgeon to come and assist him. Everything eventually worked out fine and the patients recovered fully - no harm done. But I always wondered, "What if . . . "
3.) The third was of a patient in his early 60's who had suffered a blood clot near the tip of the small toe on one foot. He was an insulin-dependent diabetic and diminished blood flow to one's extremities was a frequent complication. However, this particular clot was not caused by his diabetes. Rather, it was caused by a special x-ray procedure called "arteriography" or “angiography” in which a dye (opaque to x-rays) is injected into to an artery, then a series of x-rays is taken to determine blood flow to the various branches of that artery. What occurred was a not uncommon accident: a tiny bit of tissue (probably fat tissue) has become attached to the injection needle and was injected into the artery with the dye. The piece was small enough that it lodged near the tip of one small toe, totally blocking all blood flow to the farthest tip of that toe. The decision was made the by the "chief surgical resident" within the hospital that no surgery was needed; that the tip of that toe would wither by itself and simply fall off – a process called “auto-amputation”.
At that time, as a first-year resident I was near the “bottom of the totem pole.” Large university hospitals often have a rigid “chain of command” – or “caste system” as I used to call it. At the bottom were medical students. Second were interns and first-years residents. Above them were the nurses, then (for surgical residents) the 2nd to 4th year residents, at the pinnacle was the “chief surgical resident”. Technically, the full-time staff physicians outranked the “chief surgical resident”, but for the most part such senior staff physicians acted more like consultants for extremely difficult cases. I rarely saw a senior staff physician enter a patient’s room, much less examine a patient. And except for a very few staff surgeons who were actually thrilled by the challenge of an extremely difficult and “risky” case (as in, a case with high probability of being sued should the outcome not please the patient or his family), Except for a few notable exceptions, I seldom saw a full-time staff physician within a major university hospital perform an actual surgery.
Given my lowly status at the time, I agreed with the “chief resident’s” decision – not that it mattered! A “chief surgical resident” in a large university hospital setting is the closest thing to God. He performs surgery on ANY case he chooses; and he assigns the other cases to the other residents. A third-year surgical resident supervised me and another first-year resident; and each of us supervised two medical students. We two first-years residents performed most of the “floor work”: checking on patients pre and post-op, assisted by our students who did an amazing amount of the “grunt work”. We were extremely lucky: our third-year resident watched over us very carefully and was an excellent teacher. If we had any question about the status of a patient, he would check on that patient immediately and explain in detail what he was doing and why. (We later become good friends, primarily because we lived within a mile of each other and had long discussions; and also because I helped him rebuild a long stairway from his parents house to their dock on a lake. His father was at that time a U.S Congressman, but I did not learn that until a number of years later.) He even allowed us to assist him in his surgeries (sometimes allowing us to perform the most of the surgery, with his hand always at the ready to prevent any mistakes). Even the medical students were allowed to perform minor surgical tasks.
Anyway, this patient’s toe seemed to be healing well. However, a few days later redness and swelling appeared, soon followed by an “oozing” of yellowish material. I took several samples for “C&S” (bacterial culture and sensitivity testing using variety of antibiotics embedded within tiny cotton disks. The lab results came back revealing a bacterial infection susceptible to a very common antibiotic. My resident ordered additional cultures over the next 2 days which yielded the same results. Our conclusion was to “debride” (clean out) the infected tissue, then administer the antibiotics. The fact that the patient had insulin-dependent diabetes and greatly decreased blood flow to that area (which usually results in very slow or poor wound healing) reinforced our decision. After debridement and 2 days of antibiotics, the wound was healing well with no sign of infection. We continued the antibiotics.
A few days later during the daily afternoon “rounds” with the “chief surgical resident”, the first-year residents discussed each patient in the briefest manner possible. To this “chief resident” any report longer than 2 sentences was a waste of his time. I admit that I disliked this particular individual. He was rude, impatient, and not once did I ever see him enter a patient’s room to examine a patient or simply talk with a patient. He never referred to patients by their names; instead he spoke of the :gall bladder”, the “appendix” or the [fill in the name of the condition]. Since he filled out all the evaluations for every resident and student, it was obvious that everyone was afraid of him, as an adverse evaluation could jeopardize a resident’s or student’s professional career. (Residents work on a yearly contract basis and dismissals - “failure to renew” - from major medical centers are not uncommon. Students worried about their grades and written evaluations, since a failing grade or extremely poor evaluation could result in repeating that clinical rotation (thereby delaying graduation for a full year) or even outright dismissal from medical school. The only people working on the ward who were NOT afraid of the “chief resident” or apparently anyone else, were the nurses. They were, for the most part, very experienced, extremely competent and, when confronted by someone with whom they disagreed –even the chief resident - about patient care, were quick to say “You don’t know what the Hell you’re talking about.”
On this particular day when the chief resident asked about the “auto-amputation”, I replied that all was fine and that the infection had been controlled. One of my medical students chimed in that the antibiotics had worked surprisingly well. I can still recall the wince on the face of my third-year resident, as if he had been hit on the head with a brick. The chief resident was furious, demanding to know why he had not been informed and that in his opinion antibiotics were certainly not necessary. The third-year resident attempted to explain, even showing him the C&S results. The chief resident would hear nothing more. He ordered the antibiotics be stopped immediately.
To make the ending of this extremely long story short, the patient’s toe became re-infected and required a full surgical amputation of that toe. However, the infection had spread beyond the toe and was now spread throughout his entire foot and lower leg, which were surgically amputated the next morning. He was placed back on antibiotics and by the time my rotation on that unit was completed, he was doing just fine. However, about a year later I met him and his wife (both of whom became friends and even invited me over for Thanksgiving dinners for the next several years). They told me that after I left the unit, he had suffered some kind of “incident”, which left him blind in both eyes. He walked with a below-the-knee prosthesis, but with a cane due to his blindness. Soon after I explained the events of his hospital stay in some detail. I even offered to testify on his behalf if he should decide to file a civil suit. To my great surprise, he was not angry in the least and said he would never consider a law suit. He said in essence, “Mistakes may have been made, but they often are. I survived World War 2; I can survive this.”
4.) The last incident I will describe involved a man about 45-years of age. I was then a third-year orthopedic surgery resident doing another general surgery rotation. The patient was an immensely obese man, with an abdomen (stomach area) of a size I had seldom seen before. He had re-entered the hospital one day before I started my rotation on that unit. He had undergone surgery there several months earlier for reasons I forget. As a result of that prior surgery, he had a long, vertical scar down the center of his abdomen. However, incision had not healed properly and has partially separated, through which part of his intestines were now protruding. This condition is called an “incisional hernia” – a herniation (protrusion) of a part of the intestine through a previous surgical incision. It is an extremely dangerous condition, since the blood flow to the intestine protruding through the abdominal wall may be compromised, resulting in the death of that part of the intestine, severe infection and death. The next morning the chief resident operated on the man. It required the removal of all the tissue on both sides of the previous incision. When an abdominal incision is closed, there are several distinct layers of different types of tissue that need to be sutured, proceeding from the inner-most layers to the outer-most layer, and finally the skin. Most tissues do NOT heal by the re-growth of that same tissue in the affected area. Instead, they heal by forming “connective tissue” (also called “scar tissue”) and this “scar tissue” is actually very inelastic and very weak. The huge abdomen on this man evidently had exerted so much pressure on this scar tissue during the healing process that parts of it simply gave way.
After the dead scar tissue along the original incision was removed, it was decided that the interior layers of tissue were viable and required only additional sutures. As the final layers of tissue (subdermal and dermal layers) were being sutured, it became obvious that his intestines (covered with immense areas of fatty tissue) were far too large to fit into his abdomen. A discussion ensued. Should a section of his intestines be removed? Maybe, but this involved a great deal of additional and potentially dangerous surgery. In addition, each section of the large and small intestines serves specific functions vital to survival. (The intestines, unlike in TV commercials for various medicines, are not simply a long tube.) Each section has a very specific function, especially in the absorption of various nutrients.) Which sections should be removed and how much of those sections? What would be the consequences in terms of nutrition, intestinal motility (movement of the contents within the intestines), necessary oral medications and perhaps even intra-venous injections or intra-muscular injections of various vitamins and minerals. It was a complex issue, with apparently no one present who was qualified to provide the answers. In one respect the chief resident was correct: the longer any surgical wound is exposed to air, even under the most sterile conditions, the chances of subsequent infection increase exponentially,
The chief resident decided that the best solution, at least for now, was simply to close the new incision. If a subsequent operation was necessary, then some more qualified than those present could answer the previous questions. I objected to this decision. As the third-year resident this man’s post-op care would be under my direction; he would henceforth be my responsibility. If the original incision had been split apart by the size of the patient’s intestines, how could this new incision, which left far less volume within his abdomen, possibly heal properly and not also rupture? Further, his intestines would need to be so tightly packed within his abdomen that they would probably exert immense pressure against his diaphragm (the layer of muscle that needs to expand and contract in order for us to breathe? I was over-ruled, of course. And so the final closure of the outer layers of tissue began, To say it was not an easy task in a gross understatement. Instead of running sutures or individual sutures tied off one at a time, we found that the entire vertical incision in his abdomen had to have a series of heavy silk sutures in place, then two assistants pushed the man’s intestines down into the abdomen, while four other people pulled on all the silk sutures at the same time, with the chief resident tying them off one by one. The surgery was complete. Now the patient was in my hands.
I ordered him to be placed into the surgical ICU (intensive care unit) with special precautions, especially regarding his breathing, respiratory rate, and especially frequent arterial blood gas samples, along with the usual heart rate and rhythm, blood pressure, etc. monitorings. I was clearly worried, but had other patients to see. Since my first-year resident needed to check up on and do chart “write-ups” on all of our patients, I instructed my medical students to forget their other duties for now and make frequent visits throughout the day to check up on the status of this patient. That evening one of the students came running and informed me that the patient was having a great deal of trouble breathing. Worse his latest blood gases revealed very high carbon dioxide levels and low oxygen levels, meaning that he was not exchanging the air in his lungs properly and was developing a very high acid level in his blood (low Ph level). The obvious answer was to administer sodium bicarbonate intravenously, BUT the catch was that unless a person is able to breath out the excess carbon dioxide from is lungs, the bicarbonate does nothing of value. He also stunned me by stating that the nurses, fearing a rupture of his sutures, had wrapped him very tightly in something resembling a “straight-jacket”, further compressing his abdomen and chest and thereby interfering with his breathing even more. We ran down to the ICU where we immediately removed that “straight-jacket”. His breathing improved somewhat, but his blood gases revealed very poor ventilation of his lungs. I summoned the chief resident and chief resident in respiratory medicine, but they had no answers.
He was next placed on a respirator, including additional oxygen, which can be set to ensure that a specific VOLUME of air enters the lungs, rather than stopping inhalation when a certain AIR PRESSURE is reached within the lungs, thereby trying to ensure adequate oxygen delivery and carbon dioxide removal from the lungs. This type of ventilation is very dangerous, but at that point I saw few options. In short, he was suffocating to death – despite all we had tried, We simply could not get a sufficient VOLUME of air in and out of his lungs. His intestines, pushing with such great pressure against his diaphragm, simply would not allow the normal expansion of his lungs. His blood carbon dioxide and Ph levels were frightening. I thought that respiratory and heart failure would occur very soon. Short of re-opening his chest incision, thereby allowing him to at least attempt to breathe normally assisted by the ventilator, was a “last-ditch” option, but the chief surgical resident vetoed that idea. The patient was no so weak that he would probably die before the start of such a procedure The man died a few minutes later.
My question is: were these incidents, related in as much detail as I can now recall (and probably far more than you wished to read!), instances of “medical malpractice”? Were they any instances of “breach of care”, that is, care considered below the normal standards of medical care? There was certainly no failure in the “duty to treat”, since once a patient checks into a hospital, the hospital and his doctors assume full liability.
Were incorrect decisions made? In a few of the above cases, my opinion was and remains a definite “yes”. However, even in instances where I disagreed with the other physicians present, had my preferences been followed, would the outcomes have been different? I purposely chose cases in which physicians with far greater experience and knowledge were involved. But, as anyone with any common sense knows, even the most experienced and knowledgeable people makes mistakes. And often those “mistakes” are viewed upon hindsight; a choice between equally logical options in which the option chosen produced an undesirable outcome.
Hell, I read somewhere that even a lawyer once made a mistake!!!
John-Henry Hill, M.D.
retired physician
http://JohnHenryHill.Wordpress.com
why not treat Med Malpractice like Workmens comp. Remove the fault and just make it
is the issue " Likely to have been a negative outcome of treatment", then tie the damages
to a schedule of payments and compensate for lost wages.
then just have the fees and costs tied to a Medical comp program. Simple easy, and reserve
punitive for gross negligence or malice.
"our legal system encourages paying bribes to accusers to avoid the outrageous expense of a court trial."
Our legal system was modeled by our political system - it too encourages paying of bribes to candidates to avoid outrageous regulation, or to buy outrageous regulation for your competition.