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The CMG Voice

A Few Doctors Account For A Large Percentage Of Malpractice Claims

Posted Thursday, March 9, 2017 by Gene Moen

In a recent article in Journal of Patient Safety, it was reported that fewer than 2% of physicians were accountable for more than 50% of all settlements made in medical malpractice cases. The analysis used data from the National Practitioner Data Bank, a federal law that requires that all medical malpractice settlements, of any amount, have to be reported to the Data Bank.

It was set up so that doctors would not be able to move from state to state and avoid scrutiny of their malpractice histories. Any hospital to which a doctor applies for admitting privileges has to contact the Data Bank in order to find out about the doctor’s claims history. It is not open for inquiries from the public, however.

The article pointed out that only a small percentage of the physicians whose reported claim payouts were recorded in the Data Bank lost clinical privileges or were subject to licensing board action. In another study a year ago, it was found that 1% of doctors were responsible for 32% of paid claims. The conclusion: even with easy access to date showing that a few physicians are harming patients at a much higher rate that others physicians, our state medical disciplinary boards are doing little to protect those patients.

With the new Republican administration, it is unlikely that situation will change. Tom Price, M.D., the new Secretary of Health and Human Services, has frequently lambasted what he calls “lawsuit abuse,” and vows to enact laws that would prevent hospitals from reporting a claim to the Data Bank unless there have been hearings to protect the doctor.

He also will push laws to require “higher standards of evidence” for malpractice claims. This would make it even more difficult for such claims to be brought. At it is, of medical malpractice cases going to trial, fewer than 10% result in verdicts for the claimant. The health care providers win more than 90% of the lawsuits that are brought. Because of the high risk and cost of going to trial, attorneys in this area of law practice consider only a few claims to pursue.

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Google Glass promises to help doctors keep complete medical records and saves money!

Posted Monday, March 6, 2017 by Tyler Goldberg-Hoss

If you’ve been to an ER or hospital and had a doctor see you, you may have seen another person follow the doctor into the room. That person may have been a scribe, whose job it is to write down what is said so that the doctor can go back and create an accurate medical chart note reflecting the encounter.

However, a new model of charting has popped up, one in which the doctors are wearing Google Glasses and the scribes aren’t next to them in the room, but remote.

The company who designed the model, Augmedix, argues that its remote scribe model makes the whole process better. First it cuts down on costs: it’s 25-50% cheaper than the in-person model. Second, it saves a doctor time at the end of the day creating the chart note, since the remote scribe will create the substance of the note, and the doctor needs only review and sign off on it. Third, the scribe can actually provide the doctor information about the patient, including what medications the patient is taking, what recent lab results were, and the like. That information is displayed on the Google Glass instead of the doctor having to turn his or her back on the patient and look at a computer screen in the room. This allows the doctor to remain engaged with the patient.

In person scribes also have the typical problems associated with any worker: they call in sick, they aren’t available during the hours that are needed, and they take up physical space. With this more centralized model, Augmedix argues the scribe service is more consistent.

At least one study has shown that cardiologists who tried the model saw slightly more patients (9.6%) than those who used the traditional in-person scribe model. There have been no studies to see whether the patients’ experience is better, or that patient outcomes improve.

You can read an article on this subject from Medscape here:

Electronic Record Keeping With Google Glass and Helpers

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Why Most Firms Do Not Handle Medical Products Or Drug Litigation

Posted Monday, February 27, 2017 by Gene Moen

Like most medical malpractice firms, we get occasional referrals of cases involving drugs or medical devices that have caused harm in a medical setting. And like most firms, we ordinarily do not handle them. The reasons are simple: in mass tort cases (i.e., case in which there are many claimants around the country) a firm can only handle such cases if it has a large number of clients and is willing to pay the very large costs associated with the litigation. Representing only a few such clients with regard to a particular drug or device is difficult at best.

When a major drug company or device manufacturer faces many lawsuits around the country, they will spend huge amounts of money to defend the cases that first go to trial. The reason is that the outcome of those trials will impact the settlement value of the other claims. The same goes for the plaintiffs’ firms. If they have a hundred similar cases, they will spend large amounts on the first ones going to trial, because if they prevail the “value” of the other claims will increase dramatically. Thus, a case with a verdict potential of $1,000,000 may justify spending twice that amount because of that impact on the rest of the firm’s similar cases.

When many cases are filed in various federal courts around the country, one specific district court judge will usually be designated to handle the cases. This is done under a statute dealing with “multi-district litigation” (MDL) so that there are not contradictory rulings while the litigation proceeds. That then means that the cases filed around the country are all transferred to the MDL judge.

In MDLs, the court will usually designate a committee made up on the plaintiffs’ attorneys to handle discovery. The drug company or device manufacturer will then be ordered to designate the company representatives to be deposed by a member of the plaintiffs’ committee, or other specific discovery to be conducted. This then avoids the possibility of scores of attorneys all wanting to depose the same company employees about facts relating to the case. Sometimes, too, the MDL judge will order that other attorneys who want access to the depositions or other discovery materials pay some part of the costs of obtaining the evidence, sometimes as a percentage of the fees that are earned in settlement. .

Mass tort cases are usually very complex and difficult, for the reasons set out here. Many firms will advertise nationally for clients so that they have enough claims to justify going forward with claims. If you have a potential claim involving a drug or medical device, if you type in the name of the product and the word “attorney” on a search engine like Google, it is likely you will see many websites of such national firms. You may also see advertisements on TV seeking claimants. Handling such claims is a big business, and many firms that represent individual patient who have been injured because of their health care (medical malpractice cases) will not be able to take on cases involving medical products or unsafe drugs.

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Off-Label Use Of Drugs Can Be Beneficial

Posted Thursday, February 23, 2017 by Gene Moen

Most people don’t realize that, once the FDA approves a drug for a particular use, it can then be prescribed by a physician for an entirely different medical condition. Many of those “off-label” uses start through word-of-mouth information about how a particular drug seemed to help treat different conditions. Sometimes published studies have indicated usefulness of the drug for a condition not studied in the original FDA approval.

Some researchers think there should be a concerted effort to test existing drugs to find those that may help in treating different conditions. As a recent article pointed out, developing new drugs is an expensive and lengthy process, and often the side-effects that are found during the testing will block approval of the drug. But “finding new targets for drugs already in use to treat other disease, in other words repurposing, is an emerging area in developing anti-cancer therapies.” The “old” drugs have already been tested thoroughly for side-effects.

A recent study has found that calcium channel blockers — commonly prescribed for hypertension — can effectively stop cancer metastasis (spread of cancer cells from the original site of the cancer to other tissues or organs). The mechanism by which it does this is related to a very complicated process by which some aggressively spreading cancer cells express a protein called “Myosin-10” which increased the cancer cell motility or movement.

These cancers have a large number of structures that are like sticky “fingers” that allow the cells to sense their environment and to navigate through adjacent tissue. One researcher said it is like a blind spider finding its way through touch. The research found that the calcium channel blockers targeted those “fingers,” making them ineffective and blocking the cell movement.

Much more research is needed to determine which cancers can effectively be treated through using calcium channel blockers. Currently the research is centered on breast and pancreatic cancer. But the findings of the study reaffirm the concept that “repurposing” existing drugs may be a faster and more efficient way of developing new treatments of diseases and conditions.

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Medical Apologies Mean More Than Simply Saying “I’m Sorry”

Posted Monday, February 20, 2017 by Gene Moen

A recent blog post discussed a study that showed that the “apology” statutes did not mean a reduction in malpractice claims. The laws were passed to encourage doctors to disclose errors and apologize for them, by not allowing the apologies to be admissible at trial.

The pioneer in the “apology movement” is Dr. Lucian L. Leape. In an article in Frontiers of Health Services Management in 2013, Dr Leape discussed the concept in detail. He states that simply telling the patient or family that the doctor is “sorry” for a bad outcome is not enough. The apology has to make clear that the health care provider is accepting “ownership” of the mistake and accepts responsibility for the consequences. Following are some of the takeaways from Dr. Leape’s article:

“Apology conveys respect, mutual suffering, and responsibility. Meaningful apology requires that the patient’s physician and the institution both take responsibility, show remorse, and make amends.”

“Restoring the balance — acknowledging “we’re both hurting” — begins to restore the relationship, which is important to both parties.”

“If we are to make progress in preventing errors, it is essential that we learn from our mistakes, analyze the failures, and identify the systems changes that will prevent them in the future.”

“Even if communication is flawless and apologies are forthcoming when indicated, patients often require a long time to recover, lose their fear, and re-establish trust.”

“As custodian of the systems, the hospital has primary responsibility both for the mishap and for preventing it in the future. Hospital leaders must step up and take that responsibility.”

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