Perspective: Black, white or gray: Does post-hoc knowledge alter opinion of care quality?

May 30, 2011

May 30, 2011 By Charles A. Pilcher MD FACEP Medical malpractice is a field where opinion matters. That’s why attorneys hire experts. But how valid are those opinions? On what are they based? Does one’s opinion of the quality of care change when one knows the outcome of the case? This is the question asked […]

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Perspective: Door-to-needle times for tPA in stroke hard to meet

May 5, 2011

By Charles A. Pilcher MD FACEP September/October, 2011 Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke.  (“Last seen normal” […]

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Perspective: Emergency Department discharge instructions: “Sign right here and your good to go.”

May 5, 2011

By Charles A. Pilcher MD FACEP August, 2011 So you’re not having a heart attack like your wife thought. That’s the good news. But what is wrong, what did cause that pain, and what should you do from here on out? That’s the purpose of discharge instructions, and it’s not enough for the ED staff […]

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Medical Malpractice Bulletin – April, 2011

April 26, 2011

Proximate cause: No harm, no foul? By Charles A. Pilcher MD FACEP In the course of nearly 3 decades of reviewing medical records for both plaintiff and defense attorneys, I find the most challenging of the 4 elements necessary for a successful malpractice lawsuit to be “proximate cause” or “causation.” This is often the Achilles […]

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Proximate cause: No harm, no foul?

April 26, 2011

By Charles A. Pilcher MD FACEP In the course of nearly 3 decades of reviewing medical records for both plaintiff and defense attorneys, I find the most challenging of the 4 elements necessary for a successful malpractice lawsuit to be “proximate cause” or “causation.” This is often the Achilles heel of malpractice for the plaintiff […]

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Medical Malpractice Bulletin – February/March, 2011

February 27, 2011

Perspective: Practice guidelines always help your case – maybe not By Charles A. Pilcher MD FACEP David O’Dell MD JD has written a nice summary of the topic of guidelines and their value in medical malpractice cases in the January 10 edition of Medical Economics. This newsletter  discussed the value of “Guidelines” in an earlier […]

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Perspective: Practice guidelines, Part II – Who do “guidelines” actually guide?

February 27, 2011

By Charles A. Pilcher MD FACEP Related to this newsletter’s earlier “Perspectives” essay on the value of “Guidelines,” David O’Dell MD JD writes his own nice summary of the topic in Medical Economics, January 10 edition. He discusses the relationship between malpractice claims and “guidelines.” Dr. O’Dell agrees that most guidelines carry little weight in […]

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Medical Malpractice Bulletin – January, 2011

January 3, 2011

In this issue: Expert medical review services – 2011 rate increase Perspective: OOPS! Why do doctors make diagnostic errors? Surgical errors still occurring “far too often” despite protocols Washington state hospitals post surgical infection rates Patients trust a CT scan 4 times more than they trust the doctor “Handoffs:” Reducing the error of a high-risk […]

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Perspective: OOPS! Why do doctors make diagnostic errors?

January 3, 2011

By Charles A. Pilcher MD FACEP American Medical News published an informative essay by Kevin B. O’Reilly on December 13, 2010, about errors in diagnosis and why doctors make them. According to Gordon Schiff, MD, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital, “The problem of diagnostic […]

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Medical Malpractice Bulletin – November, 2010

November 14, 2010

In this issue: Perspective: Health reform & why we vote the way we do, by Leo Greenawalt, CEO, Washington State Hospital Association OK to delay surgery for appendicitis Dangerous jawbone condition rare side effect of Fosamax Death rate from strokes in US hospitals falls 26%… REALLY??? ABCD3-I Score May Improve Risk Stratification After Transient Ischemic […]

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Perspective – US Health Care: Quality? Availability? Price? [PICK 1]

November 13, 2010

Charles A. Pilcher MD FACEP, Editor Editor’s Note: This month’s guest“Perspective” comes from Leo Greenawalt, CEO of the Washington State Hospital Association, and appeared in a WSHA newsletter November 10. It is republished with his permission. For further reading, I recommend “The Healing of America” by TR Reid. The first two chapters claim that the […]

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Medical Malpractice Bulletin – October, 2010

October 13, 2010

Perspective: Medical Malpractice and Healthcare Reform By Charles A. Pilcher MD FACEP Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. At a recent Swedish Hospital 100th Birthday Symposium on “Innovation in the Age of Reform,” an array […]

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Perspective: Medical Malpractice and Healthcare Reform

October 13, 2010

By Charles A. Pilcher MD FACEP Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. Bottom line: There is no consensus what the future holds. There is no question that reform is necessary to avoid absolutely bankrupting the […]

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Medical Malpractice Bulletin – September, 2010

September 14, 2010

In this issue: Perspective: Should consent to life-saving procedures have a “sunset clause?” Neutral radiologists fail to detect x-ray abnormalities found by “experts” What specialty is a doctor practicing? Michigan Court of Appeals sides with plaintiff, says Urgent Care doctor was practicing Emergency Medicine Two rulings from New Jersey support arbitration agreements Disclosing errors reduces […]

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Perspective: Should consent to life-saving procedures have a “sunset clause?”

September 14, 2010

By Charles A. Pilcher MD FACEP Your 88 year old mother has just been admitted to the ER with a severe stroke. The doctor comes out of the resuscitation room, explains the gravity of the situation, and says that because of brain swelling, an endotracheal tube and artificial ventilation is needed. He asks for your […]

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Medical Malpractice Bulletin, July/August, 2010

July 27, 2010

In this issue: Perspective: Avandia – What’s the risk? Washington dumps notice for malpractice lawsuits Conflict of interest: Can a defense attorney’s former client testify as a plaintiff expert in a later case he is defending? Prostate cancer and PSA: If and when to test The “how” matters when gauging risk after suicide attempt Calling […]

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Perspective: Avandia – What's the risk?

July 27, 2010

Rosiglitazone (Avandia – GSK), an oral hypoglycemic agent (OHA) used in treating diabetes, has been in the news recently because of concern that it is associated with an excessive number of adverse events in users of the drug. After a week of media hype with headlines such as “Avandia users experience 30% more heart attacks,” […]

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Medical Malpractice Bulletin June, 2010

June 15, 2010

In this issue: Perspective: Is a ruptured appendix evidence of malpractice? Do you have issues? Suggest a topic for “Perspectives” Florida ruling jeopardizes EMS services nationwide Diagnostic or screening mammogram? Whose call is it? Is a plaintiff expert necessary? Kentucky Supreme Courts says “Yes” — but barely. X-Rays of hip and pelvis miss 1/3 of […]

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Is a ruptured appendix evidence of malpractice?

June 15, 2010

June, 2010 Charles A. Pilcher MD FACEP Appendicitis is the most common acute abdominal surgical condition in medicine, yet there is probably not a single physician in practice today who hasn’t missed the diagnosis at least once. Often that results in “simple” appendicitis becoming a “ruptured” or “perforated” appendix. I have reviewed several such cases […]

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Medical Malpractice Bulletin May, 2010

May 19, 2010

Perspective: Tell your expert the whole story Medical staff is not a separate entity from the hospital Can associate of plaintiff’s new physician testify for the defense? Court says “no.” Does improving patient safety reduce malpractice claims? Rand Corporation study says “yes.” Database on stroke treatments incomplete due to non-published trials tPA for stroke: Give […]

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Perspective: Tell your expert the whole story

May 18, 2010

Charles A. Pilcher MD FACEP A few years ago I was asked to review a case involving a death that occurred less than 24 hours after hospital discharge. In a phone call with the attorney, the case seemed to have merit. I agreed to take a look at the records and was sent a brief […]

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Medical Malpractice Bulletin April, 2010

April 9, 2010

Perspective: Strolling blissfully down the garden path… “What is an emergency physician’s duty?” Medical Economics: Plaintiff Attorney gives advice Autism lends itself to questionable medical practices VBAC (Vaginal Birth After Caesarean Section) is safe State Supreme Court Rules on Corporate Practice of Medicine Case Nurses cleared in whistleblowing case in TX Georgia Supreme Court: One […]

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Perspective: Strolling blissfully down the garden path…

April 9, 2010

“Always trust your first impression.” We’ve all heard it time and time again, but is it really true? Especially in medicine, should it ever be true? In my review of malpractice cases over the years, one of the most common errors seen is “falling in love with one’s first impression.” It’s called “anchoring,” and can […]

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Medical Malpractice Bulletin, February, 2010

February 22, 2010

In this issue: Perspective: The IME: Does time heal all wounds? FDA issues warning on long-acting asthma meds Texas nurse cleared of charges after reporting physician for unsafe practices. “Medical Mafia” case in Las Vegas coming to a close What are the chances? Explaining risk to patients Good Samaritan defense depends on the circumstances Emotional […]

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The IME: Does time heal all wounds?

February 22, 2010

By Charles A. Pilcher MD FACEP Wham!!! Jim’s head snapped back as the Hummer hit the back of his Subaru Forester, totaling the Forester but leaving little more than scratches on the Hummer’s sturdy bumper. Jim had no idea how fast the Hummer was traveling. All he knew was that he had just stopped quickly […]

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Medical Malpractice Bulletin – January, 2010

January 15, 2010

Perspective: Would “no fault” be a better way? By Charles A. Pilcher MD FACEP Last month I reported on the defense verdict in the case of a Bellingham woman left with brain damage as a result of a surgical complication. The case bothers me. The patient’s injuries were major and her family devastated. Future expenses […]

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Perspective: Would “No Fault” be a better way?

January 15, 2010

By Charles A. Pilcher MD FACEP January, 2010 Last month I reported on the defense verdict in the case of a Bellingham woman left with brain damage as a result of a surgical complication. The case bothers me, and for the past few weeks I’ve been asking myself “Isn’t there a better way?” Medicine is […]

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Medical Malpractice Bulletin for Nov/Dec, 2009

December 16, 2009

In this issue: Perspective: I got elected. Now what? Woman with DNR order given 20 mg IV morphine, dies. Family wins $3 million. Defense verdict in Bellingham brain injury trial Feedback to hospitals on performance fails to improve quality of cardiac care Plaintiff attorney may advertise for patients similar to his client. Georgia high court […]

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Perspective: I got elected. Now what?

December 16, 2009

It’s been a real honor working with the readers of this newsletter during the past few years. I look forward to continuing our relationship and wish all of you a happy and prosperous new year. As I mentioned in the last issue, I believe in community service. In June area leaders approached me to challenge […]

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Medical Malpractice Bulletin for October, 2009

October 26, 2009

In this issue: Perspective: Certificate of merit overturned. Now what? Health insurer can’t recover medical costs paid if settlement is only for pain and suffering. Law firm can’t read their own retainer agreement, sues own client – unsuccessfully. Do as I do, not as I say: Defense expert’s personal practice supports plaintiff’s claim Social Media: […]

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Perspective: Certificate of merit requirement overturned

October 26, 2009

By Charles A. Pilcher MD FACEP As most Malpractice Bulletin readers have undoubtedly heard by now, the requirement that a plaintiff must have a “certificate of merit” to file a malpractice lawsuit was overturned by the Washington State Supreme Court on September 17, 2009. The requirement was ruled to unfairly discriminate against a specific class […]

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Medical Malpractice Bulletin for August/September, 2009

September 13, 2009

Perspective: Service Service. My parents exemplified it and passed the value down to me. Since my first job delivering newspapers in Federal Way for the Seattle Times, I have enjoyed serving others. On rainy days it was important to me that the papers I delivered did not get wet. “Any job worth doing is a […]

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Perspective: Service

September 13, 2009

Service. My parents exemplified it and passed the value down to me. Since my first job delivering newspapers in Federal Way for the Seattle Times, I have enjoyed serving others. On rainy days it was important to me that the papers I delivered did not get wet. “Any job worth doing is a job worth […]

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Medical Malpractice Bulletin for July, 2009

June 18, 2009

Perspective: What did Obama tell the AMA about malpractice reform? On Monday, June 15, President Obama spoke to physicians assembled in Chicago for the annual AMA convention. His subject: health care reform. I listened to most of the speech on the radio and have read the reviews. What I heard and what I read seem […]

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Perspective: What did Obama tell the AMA about malpractice reform?

June 18, 2009

On Monday, June 15, President Obama spoke to physicians assembled in Chicago for the annual AMA convention. His subject: health care reform. I listened to most of the speech on the radio and have read the reviews. What I heard and what I read seem divergent. What I heard was a detailed, well-presented, thoughtful speech […]

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Medical Malpractice Bulletin for May, 2009

May 25, 2009

Perspective: “Guidelines” are of little value The Institute of Medicine has been an advocate for clinical guidelines for many years. Although the true value of guidelines has never been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past […]

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Perspective: "Guidelines" are of little value

May 24, 2009

The Institute of Medicine has been an advocate for clinical guidelines for many years. Although the value of guidelines has never really been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past few months and I review it […]

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Medical Malpractice Bulletin for April, 2009

April 18, 2009

Contents: Perspective: Good case/bad case Darvon and Darvocet: How much truth in the allegations? Still innocent till proven guilty: Ohio doctor cleared of criminal conduct for alleged over-prescribing of pain meds Woman loses arms and legs. Was there malpractice? AZ legislator reintroduces malpractice bill Waste is destroying the American health care system; reform needed U.S. […]

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Perspective: Good case/bad case

April 18, 2009

Whenever there is an initial allegation of malpractice, the goal of each party is different, but an honest opinion of the merits of a case is important to both. Plaintiff attorneys want to know if their client has a case. Defense attorneys want to know if their client is at risk. This requires an appraisal […]

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Medical Malpractice Bulletin for March, 2009

March 26, 2009

CONTENTS: Perspective: Money doesn’t buy health Wyeth v. Levine: FDA approval does not protect against lawsuits. Arizona Supreme Court allows legislature to define an “expert witness” “This is no more an expert report than my son’s tricycle is a Harley” Questions to ask. Questions you might be asked. Depends on which side you’re on. More […]

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Perspective: Money doesn't buy health

March 26, 2009

A recent report indicates that the cost-benefit of healthcare in the US falls behind our leading economic competitors. The Business Roundtable concludes that “America’s healthcare system has become a liability in a global economy.” Spending on healthcare per person is about 2 ½ times more than any other advanced country such as Canada, Japan, Germany, […]

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Medical Malpractice Bulletin for February, 2009

February 22, 2009

CONTENTS: Perspective: Stroke, Part III:  What is the standard of care? Radiologist can’t give films to defense expert without authorization. Another instance of “How to win a malpractice case even if you lose.” Gynecologist sued. Non-gynecologist expert’s testimony challenged. CMS “Never Events” Why can non-compliant patients still sue their practitioner? Enough fishy stuff here to […]

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Perspective: Strokes, Part III: What is the standard of care?

February 22, 2009

Despite two previous Perspective pieces on the topic of stroke last year [“Is thrombolytic therapy for stroke the standard of care?” and “Stroke/TIA evaluation and treatment both a medical and legal quagmire“], both patients and attorneys continue to have questions about treatment standards for this often devastating condition.  In an effort to make this as […]

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Medical Malpractice Bulletin for January, 2009

January 21, 2009

CONTENTS: Perspective: Futility Medicare wants its money back Must doctors also be prophets? Georgia Supreme Court to rule More on judgment and hindsight Flaps – check. Brakes – check. Airspeed – check. Can surgeons learn something from pilots? Unlike in church, confession doesn’t necessarily lead to absolution in the world of medicine. “Informal” consults can […]

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Perspective: Futility

January 21, 2009

It’s paradoxical that the idea of living a long life appeals to everyone, but the idea of getting old doesn’t appeal to anyone. Andy Rooney Health nuts are going to feel stupid someday, lying in a hospital dying of absolutely nothing. Redd Foxx I am prepared to meet my Maker. Whether my Maker is prepared […]

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Medical Malpractice Bulletin for December, 2008

December 12, 2008

CONTENTS: Perspective:  MRSA: What’s all the fuss about? There’s lots of recent hype about infections with MRSA (methicillin resistant staphylococcus aureus). The media uses that hype to sell ad space, but for the medical profession it’s old news. Here’s a reality check:  The problem is not so simple. Many of us are infected with MRSA […]

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Perspective: MRSA: What's all the fuss about?

December 12, 2008

There’s lots of recent hype about infections with MRSA (methicillin resistant staphylococcus aureus). The media uses that hype to sell ad space, but for the medical profession it’s old news. Here’s a reality check:  The problem is not so simple. Many of us are infected with MRSA already and don’t know it. Blame your friends, […]

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MEDICAL MALPRACTICE BULLETIN for November, 2008

November 23, 2008

Perspective: State Supreme Court Accepts Two Important Cases for Review in 2009 An article in the October 23, 2008, issue of the WSMA Bulletin explains WSMA’s concerns regarding two upcoming cases to be heard by the Washington State Supreme Court in 2009. The first, Columbia Physical Therapy, Inc., P.S. v. Benton Franklin Orthopedic Associates, P.L.L.C. […]

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State Supreme Court Accepts Two Important Cases for Review in 2009

November 23, 2008

This issue’s “Perspectives” is a news article that was first published in the October 23, 2008, issue of the WSMA Bulletin. It is reproduced here in its entirety. The Washington State Supreme Court has accepted review of two cases that the WSMA is engaged in on behalf of our members. The Court is expected to […]

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Medical Malpractice Bulletin for September, 2008

September 29, 2008

CONTENTS: Perspective: Stroke, Part 2: Stroke/TIA evaluation and treatment both a medical and legal quagmire PSA test is not the standard of care. Discussing it with patients is. Texas liability reforms spur plunge in premiums and lawsuits Can I please have my bullet back? Court request leads to lawsuit against physician Does a patient near […]

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Perspective: Stroke, Part 2: Stroke/TIA evaluation and treatment both a medical and legal quagmire

September 28, 2008

Stroke evaluation, diagnosis and treatment was briefly addressed in last issue’s “Perspective” titled “Is thrombolytic therapy for stroke the standard of care?” Recent articles highlight the need for more information for attorneys on this subject. Liability risk greatest for doctors not using tPA for stroke An August article by Liang and Zivin (Ann Emerg Med. […]

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MEDICAL MALPRACTICE BULLETIN for August, 2008

August 25, 2008

CONTENTS: Perspective: Certificate of Merit statute challenged by national trial lawyers Study finds settling is better than going to trial Choosing one’s battles: A PNW ER doc blogs about two recent malpractice settlements Medical Economics malpractice primer for physicians, Part III: Proximate Cause Some plaintiffs just don’t quit “Loss of chance” doctrine Malpractice claims frequency “mysteriously” […]

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Perspective: Certificate of Merit Statute Challenged by National Trial Lawyers

August 20, 2008

This month’s “Perspective” is a reprint of an article in WSMA Reports, July 31, 2008, from the WSMA Legal Resource Center, Tim Layton, Director. The Center for Constitutional Litigation, the law firm for the national trial lawyers association, has intervened in a case challenging the constitutionality of the state’s certificate of merit statute (RCW 7.70.150). […]

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MEDICAL MALPRACTICE BULLETIN for July, 2008

July 19, 2008

CONTENTS: Perspective: Is thrombolytic therapy for stroke the standard of care? Use of technology in the courtroom lags in med-mal cases Primer for physicians on necessary elements of a successful malpractice suit: Duty to treat “Primer on Medical Malpractice Lawsuits” for attorneys Lawsuit successful, but was the right doctor sued? Expert witness disqualified because legislature […]

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Perspective: Is thrombolytic therapy for stroke the standard of care?

July 19, 2008

The so-called “clot busting” drugs for treatment of heart attacks were heavily marketed and quite widely used for the past 10-20 years. They remain useful in circumstances where better options are not available. However, in the past 10 years evidence has mounted that the best option is percutaneous transluminal coronary angioplasty (PTCA), available only in […]

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MEDICAL MALPRACTICE BULLETIN for June, 2008

June 18, 2008

CONTENTS: Perspective: The high cost of medical care Nevada jury awards plaintiff nothing while finding defendant pathologist negligent: The downside of tort reform Georgia judge rules that tort reform unfairly favors wealthy patients Sanctity of peer review process upheld in US District Court rulings for JAMA and NEJM Lawyers must behave: Two courts find breaches […]

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Perspective: The high cost of medical care

June 18, 2008

Two recent articles contend that, compared to other nations, the United States gets too little value for the money spent on health care. One is by Dr. John Wennberg and colleagues from the Dartmouth Institute for Health Policy and Clinical Practice. The other is a June 18. 2008, JAMA “Commentary” by Ezekiel Emanuel and Victor […]

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MEDICAL MALPRACTICE BULLETIN for April, 2008

April 19, 2008

CONTENTS: Perspective: Rabies? Practicing defensive medicine leaves me sleep deprived Empty chair defense The expert who changed his opinion: follow-up Rapid strep tests The defamed witness “Do it yourself” malpractice law Physicians attempt to curtail frivolous lawsuits Funding your malpractice suit Hospitals won’t bill for medical errors Losing defendants pay plaintiff attorney fees Falsifying records […]

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Perspective: Rabies? Practicing defensive medicine leaves me sleep deprived

April 19, 2008

Normally I try to practice evidence based medicine, meaning that I try not to order unnecessary tests or prescribe unnecessary treatments. To do otherwise, more often than not, has just left me chasing down “false positives,” or unexpected results that mean nothing. I can’t think of many times that I have been truly surprised or […]

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Perspective: Template Charts and the EMR: The Good, The Bad And The Ugly

March 30, 2008

In January WSMA Reports contained an excellent article by Elizabeth Leedom, JD, on the risks and benefits of the electronic medical record (EMR). I hereby add my comments to the discussion. More and more emergency departments and physician offices are using template charts or electronic medical records (EMRs) to record patient encounters. They are being […]

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MEDICAL MALPRACTICE BULLETIN for Februrary, 2008

February 21, 2008

CONTENTS: What about small cases? Physicians report far fewer errors than actually occur When the plane crashes, where’s the NTSB? Another take on error reporting. Replace torts with contracts…in my lifetime??? Can a physician self-insure for malpractice? Possibly Can stupidity be regulated? Long Island medical malpractice cases spark call for ban on multi-dose vials Twin […]

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What About Small Cases?

February 21, 2008

How can patients without million dollar injuries find justice? Defense firms, presumably billing the deep pockets of insurance companies hourly, can drag a case on and wear down a plaintiff attorney, who is funding the case from his/her own pocket. Having watched these cases play out over years in most cases, it costs at least […]

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MEDICAL MALPRACTICE BULLETIN for January, 2008

January 8, 2008

CONTENTS: Who me? How I became an expert witness System errors and closed claims System errors: Can the hospital be held responsible? Oversight of expert witnesses Slimed? Checking the credentials of expert witnesses Is “hot-tubbing” an answer? Frivolous lawsuits? Who Me? How I Became an Expert Witness The author of this bulletin retraces his journey […]

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Who me? How I became an "expert" witness

January 8, 2008

By Charles A Pilcher, MD Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in […]

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