Perspective: Physicians are learning nothing from med mal lawsuits. Time for a change.
By Charles A. Pilcher MD FACEP
I am upset that physicians (other than defendants) are learning nothing from medical malpractice lawsuits. In this month’s “Perspective” I share my strong feelings on this issue and describe a project that I have begun to change that and improve patient safety. The publication shares the results of verdicts and settlements and provides key “Takeaways” for physicians to avoid making similar mistakes. This one may be controversial. I expect differences of opinion and am interested in your thoughts. Read it here ->
Washington Supreme Court supports verdict agains a “team” of caregivers: Grove v. PeaceHealth
After experiencing complications of an aortic valve replacement, a plaintiff, Grove, won a jury verdict in a negligence lawsuit against a “team” of caregivers at PeaceHealth. However, the judge overturned the verdict because no single caregiver who had acted negligently had been named. The plaintiff appealed, and the judge’s ruling was sustained. On appeal to the Supreme Court however, the jury’s verdict was reinstated and a settlement paid. A successful lawsuit for negligent “team-based care” is a first in the State of Washington, to the dismay of Physicians Insurance, WSMA and WSHA. They had argued in an amicus brief that Washington’s medical malpractice statute requires plaintiffs to prove that an individual physician acted negligently, even when the plaintiff received treatment from a group of doctors working as a team. The Supreme Court indicated that the law still requires a plaintiff to establish a “link of a specific breach of the standard of care to an individual provider,” so did not re-write the statute but attributed that link to an apparently unknown member of the team. This does not fully allay concerns that the decision could open entire practices to claims lacking a specific identifiable provider.
Below is a summary of the evidence for the evaluation and management of adults with thoracic aortic dissection, as published in Annals of Emergency Medicine, January, 2015, by Diercks et al.
1. Are there clinical decision rules that identify a group of patients at very low risk for the diagnosis of TAD?
No. Do not use existing clinical decision rules alone. The decision to pursue further workup for TAD should be at the discretion of the treating physician. (Evidence Level C)
2. Is a negative serum D-dimer sufficient to identify a group of patients at very low risk for the diagnosis of TAD?
No. Do not rely on D-dimer alone to exclude the diagnosis of TAD. (Evidence Level C)
3. Is the diagnostic accuracy of CT angiography (CTA) at least equivalent to trans-esophageal echocardiography (TEE) or magnetic resonance angiography (MRA) to exclude the diagnosis of TAD?
Yes. Emergency physicians may use CTA to exclude TAD because it has accuracy similar to that of TEE and MRA. (Evidence Level B)
4. Does an abnormal bedside trans-thoracic echocardiogram (TTE) establish the diagnosis of TAD?
No. Do not rely on an abnormal bedside TTE result to definitively establish the diagnosis of TAD. (Evidence Level B)
Maybe. Immediate surgical consultation or transfer to a higher level of care should be considered if a TTE is suggestive of TAD. (Evidence Level C – Consensus recommendation)
5. Does targeted heart rate and blood pressure lowering reduce morbidity or mortality?
Yes, but… Decrease blood pressure and pulse if elevated. However, there are no specific targets that have demonstrated a reduction in morbidity and mortality. (Evidence Level C)
Source: Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection http://www.annemergmed.com/article/S0196-0644(14)01478-4/abstract
Cartoons Kill: Animated characters at high-risk for critical illness & death
According to a study published in BMJ in December, animated characters in children’s films face a higher risk for death when compared to characters in adult dramas. From Snow White to Bambi to last year’s Frozen, 2/3 of the children’s films highlighted an on-screen death of a key character compared to only half of adult films. The characters died from drowning, animal attacks, weapons and super-natural causes. While many were implied and not dramatized, the point seems to be that children are exposed to death at a very early age. For example, the mother of both Bambi and Nemo die early in the films, leaving the protagonist adrift. Dr. John Greenwood’s review cautions thus: “Should animated characters present to your ED, they should be aggressively resuscitated and strongly considered for admission or transfer to a higher level of care, as they appear to be at high-risk for death and rapid decompensation.”