Missed Diagnosis Lawsuit and the Dynamics of Age Related to Risk
Years ago I had the opportunity to care for Mr Smith, a 101 year old man who presented to the hospital with chest pain and shortness of breath. Besides having 101 year old heart and lungs that tend to follow their own biological clock, this man also had a massive chest tumor filling 85% of one side of his thorax.
Whoah really? What does that mean in a 101 year old man? Most folks this age have exceeded the normal bell curve distribution of life and disease. When you reach 101 years old, there isn’t a lot of chronic anything you can catch with the expected time you have left on earth.
Every now and then, however, we find patients who are the exception to the rule, such as the 101 year old guy that present with a new cancer diagnosis. That’s where being an internist comes in handy. Read more »
*This blog post was originally published at The Happy Hospitalist*
In Dinah’s post “The Chapter I Wish We Had Written” an anonymous commenter wrote about his problems finding an expert witness for his or her employment discrimination case (since I don’t know if Anonymous is male or female I’m going to use a standard male pronoun in this post—apologies if I got this wrong). Anonymous asked his doctor to help with the case, but he refused. He explained to Anonymous that he would be a biased witness and Anonymous also understood that the doctor’s involvement might affect the therapeutic relationship. Anonymous’s doctor gave her a number of referrals to forensic psychiatrists, but since he was not working with an attorney no expert would take the case. Anonymous was understandably frustrated by this situation.
I wanted to write about this because this situation comes up fairly often and I get calls from friends, colleagues and former students asking how to handle it. I’ve already written about what to do when you get served with a subpoena in my post “When Lawyers Call.”
First of all, I think Anonymous’s doctor was particularly astute to recognize the dilemma that arises when trying to help patients in situations like this. Read more »
*This blog post was originally published at Shrink Rap*
A mother called the office today. Her daughter had breast implants placed by a surgeon in another state and the two ladies are not happy. They called for a second opinion.
It is dicey dealing with situation like this as a second opinion consultant. The first question is whether or not the first surgeon did anything wrong. A botched boob job is not any boob job that the patient or mother do not like. “Botched” indicates fault. Sometimes there is fault on the part of the surgeon and sometimes there is not. Sometimes patients ask for surgery on the cheap and decline breast lifting or other associated surgery that might have made things look better. Sometimes the patient choose a surgeon of limited skill or qualifications. Sometimes infection, cigarette smoking or scarring can distort an otherwise good procedure. It is not always clear.
The second question for a consultant is whether or not the patient wants him or her to fix things or just wants to return to the original surgeon. No smart consultant wants to end up embroiled in a patient’s lawsuit with the original doctor. It is a waste of time and time is money.
*This blog post was originally published at Truth in Cosmetic Surgery*
Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.
The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal regulations. However, the relevant regulation (45 CFR 164.514(b)(2)(ii)) also provides that this only works if “the covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information.” Thus, the problem with this approach is that, these days, nobody can disclaim knowledge of the fact that information de-identified by removing this cookbook list of 18 identifiers may be re-identified by cross-matching data with other publicly-available data sources. There are a number of reported instances of this sort of thing happening. The bottom line is that our collective technical prowess has outstripped the regulatory safe harbor.
Is this the basis of the lawsuit brought against Walgreens? An objection to trafficking in health information that should remain private? No. The plaintiff group of customers is suing to share in the profits realized by Walgreens from trading in the de-identified data. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
You may have heard about Andrew Wakefield who tried to find a link between MMR vaccines and autism. He has published several papers. Now it turns out he acted unethically in carrying out his research according to a medical regulator.
Doctor Andrew Wakefield’s 1998 study, published in the Lancet medical journal, said there might be a connection between the measles, mumps and rubella (MMR) injection and autism.
The suggestion horrified parents and led to a slump in the number of youngsters getting the jab, as well as triggering heated debate in medical circles.
In a ruling Thursday, the General Medical Council attacked Wakefield for “unethical” research methods and for showing a “callous disregard” for the youngsters as he carried out tests.
This included taking blood samples from children at his son’s birthday party for five-pound payments.
Why am I writing about it?
Because we all have to learn from this. Read more »
*This blog post was originally published at ScienceRoll*