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There appears to be a correlation between antidepressant drugs (selective serotonin reuptake inhibitors or SSSIs) and falling injuries in nursing home patients who have dementia. The British Journal of Clinical Pharmacology released the results of a study that should make people take pause when approving certain medication for their loved ones who have dementia.

SSRIs are mostly used to treat clinical depression. There is a lot of debate over whether they are even effective—some studies show them to be no more reliable than placebos. (I think they probably work for some, but probably a minority, of patients.) SSRI antidepressants include:

  • Paxil
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Tragic story here about a lieutenant from a Sheriff’s Department who was severely incapacitated after he underwent bariatric surgery in 2007. The details of his care and treatment are appalling.

After being told that a weight-loss surgery would be “less risky” than continuing to live in his physical state (he was 6’1″ and 375 lbs), a once active and contributing member of society now remains confined to a wheelchair, brain-damaged and blind, but completely aware of what he once was and what he is now.

How could this happen you might ask? Well, when your surgeon is unaccredited and has performed less than half of the required number of surgeries to become accredited, you find yourself with a major case of malpractice. Furthermore, the surgeon was required to have at least twenty hours of bariatric education courses, yet he had only taken one.

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Suit was recently filed in the Superior Court in Hartford, Connecticut, alleging that a pediatrician failed to diagnose bacterial meningitis, leading the loss of a young boy’s eyesight.

The details here are so sad. The lawsuit claims that the doctor dismissed the boy’s severe headache, instead of sending him to the emergency room where a spinal tap would have been done and the meningitis would have been diagnosed. Tragically, the boy fell into a month-long coma, suffering severe brain damage along with the blindness, the suit claims.

These kinds of failure to diagnose claims are so sad because the illness could have been so easily prevented had the proper diagnostic tests been done. Instead, the boy’s complaints were disregarded and quickly brushed off. Too often, the severity of injury in meningitis cases is the result of medical malpractice. These claims usually involve an infection from a delay in diagnosis or failure to properly treat the meningitis to stop the infection. Too many doctors chalk up meningitis as simply a headache or a simple fever. Misdiagnosis or delay in diagnosis of bacterial meningitis is of great concern as early diagnosis of bacterial meningitis and treatment is key to prevent permanent damage such as brain damage, hearing loss, seizures, intracranial pressure, decreased intelligence, kidney damage, amputation, or death.

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The Pop Tort rages about the certificate of merit requirement that many states have in medical malpractice cases, citing a particularly onerous Connecticut merit requirement. The Pop Tort cites a news article of an awful injustice done to a woman who had her medical malpractice lawsuit dismissed.

After a long ride to the end of the article, we find out what the grave injustice was. The plaintiff sued her doctors for alleged breach of contract and infliction of emotional distress — not malpractice – and the court decided she needs a certificate of merit.

Personally, I’m fine with this. I think certificates of merit are actually a good thing. There is a knee jerk reaction: the certificate of merit makes it hard for plaintiffs and their lawyers to bring lawsuits. But not all things that are made harder are bad things. I know that there are some meritorious cases that don’t make the cut because discovery is needed to get the information for the certificate of merit in the first place. But good lawyering can find a way around that problem, at least in Maryland.

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One frequent emergency room complaint is abdominal pain of unknown origin. The challenge for the ER doctor is to diagnose the source of the problem, or at least narrow the problem, and rule out life-threatening aliments. Three big potentials for problems are appendicitis, volvulus, and ruptured abdominal aortic aneurysm and intussusception – all can lead to misdiagnosis and wrongful death malpractice lawsuits. Today, we will look at appendicitis misdiagnosis claims.

Failure to diagnose an appendicitis is a common failure. It is critical to immediately remove an inflamed appendix before it ruptures. If a patient walks in with an inflamed appendix and walks out before getting the proper treatment – usually removal – they are put at risk of death. Particularly at risk for an appendicitis and a missed diagnosis is our youngest and oldest. The classical appendicitis presentation includes patients with low-grade fevers with crampy, intermittent abdominal pain that gets worse with movement that migrates to the right lower quadrant of the stomach within 12–24 hours of the onset of symptoms.

Some emergency room doctors miss even the obvious diagnosis in patients most at risk. There are medical malpractice cases where the patient could just have well come in the emergency room with an “I have an inflamed appendix” shirt and the ER doctor still blows it. But the standard of care also requires ER doctors to catch more than just the fly balls. For moderate-risk patients that have some, but not all of the classic appendicitis symptoms, doctors really do need to order more follow-up diagnostic testing. Call it defensive medicine, call it whatever you want, but if it looks like it could be an appendix problem, it’s worth getting a CT scan.

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  • The family of a man who died at Massachusetts General Hospital has settled its case against the hospital for $850,000. The man died after nurses failed to respond to alarms on his cardiac monitor. This death has shed national attention on the dangers of “alarm fatigue’’ among hospital staff.
  • A few New York courts are taking a new approach to handling the 4,000 medical malpractice suits filed each year. The approach…settling cases early. The pilot program will be using a $3 million grant to train more judges in medical issues, and has been shown to cut court backlogs and save money, while also proving to be a cost savings to hospitals and directly impacting the indemnity insurance of doctors. One of the new rules approved for the medical malpractice cases, in order to expedite things – scheduling Settlement Conferences 45 days after court papers are filed.
  • The Tennessee Court of Appeals issued an opinion on its relatively new certificate of merit rule in Crawford v. Kavanaugh. Maryland has a similar rule and this opinion is a cautionary tale for both Tennessee and Maryland malpractice lawyers. The lesson: don’t take a malpractice case unless you know how to handle it.
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The Tennessee Court of Appeals issued an opinion on its relatively new certificate of merit rule in Crawford v. Kavanaugh. Maryland has a similar rule and this opinion is a cautionary tale for both Tennessee and Maryland malpractice lawyers. The lesson: don’t take a malpractice case unless you know how to handle it.

In Crawford, the defendant doctor performed a cystoscopy, retrograde pyelogram, and a brush biopsy on a woman’s ureter. The purpose of this procedure is typically to diagnose transitional cell carcinoma, a cancer of the urinary system. The doctor believed the woman had atypical urothelial cells. To combat this, the doctor performed a uretectomy and ureteroneocystostomy. The woman had an infection and other complications. Another doctor treating the woman noticed she had a bowel obstruction. The woman had to undergo another surgery.

Clearly, this is an awful thing in human terms but not a major injury in the medical malpractice milieu. The woman needed “many additional weeks” in the hospital and “many months of recuperation and rehabilitation.” Again, I don’t want to minimize her suffering. This is a tragedy if it happens to someone I care about. But that does not mean it is a good malpractice case. What is my point? This is the kind of case taken by maybe an otherwise good lawyer who does not regularly handle malpractice cases. Typically, experienced malpractice lawyers don’t take a case like this and won’t make these mistakes.

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A wrongful death lawsuit has been filed in Texas after a nursing home resident fell from her bed and suffered severe and eventually fatal neurological injuries.

The facts are awful. A woman was found on the floor, next to her bed, yelling for help. She was neurologically alert and coherent, but bleeding from head trauma, and in severe pain. According to the lawsuit, the woman was placed back in bed, where she was later discovered nonresponsive, taken to the hospital, and died from her injuries.

Plaintiff’s lawsuit alleges that contrary to the doctor’s orders, the woman’s bed was not in a low position, and floor mats and a bed alarm were not being used. Though she was a high fall risk resident, a care plan and nursing interventions (to prevent a fall) weren’t followed. The lawsuit further claims that the nursing home’s nurses were not adequately trained or apprised of the resident’s care plan.

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A new study, published in the Annals of Surgery, has determined that elderly nursing home residents may suffer more complications from major operations than other people their age.

nursinghomeBased on more than 70,000 nursing home residents, and 1 million non-institutionalized Medicare enrollees 65 years and older, it is being reported that the elderly “are frail and often have advanced medical problems, which puts them at higher risk of dying after surgery.” An example cited states that 12 out of 100 nursing home residents who had their appendix removed died within a month of the procedure, as compared to 2 out of 100 elderly people living on their own.

The study revealed that the death rates were consistently higher among people in nursing homes. Why is this? Researchers have said that we may be too aggressive with surgery in nursing home residents, that they are frail and often have advanced medical problems. This puts them at a higher risk of dying after surgery.

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You suffer an injury and need surgery. You have to rely on your surgeon to play it straight with you. Besides a second opinion, never a bad idea, what else can you do? Far down on your list of fears: not getting the surgery the doctor tells you that you are getting.

But, in massive numbers, that seems to have happened in New York. There are currently dozens of new lawsuits, alleging medical malpractice, pending against a New York based orthopedic surgeon, with about another 100 cases being discussed.

Ten of the current lawsuits filed allege that the doctor performed surgery, but intentionally did not treat, or improperly treated, his patients’ injuries. While those complaints stem from a surgery performed, there are yet other complaints that allege a surgery was never performed. In one particular case, a patient went to the surgeon because of shoulder problems. A “shoulder reconstruction” was performed, but when the patient’s pain and problems continued, she sought a second opinion from another doctor. After a battery of x-rays, it was determined that there was no evidence whatsoever that the surgeon performed a shoulder reconstruction, such as screws, anchors, or a fixation device. That patient further claims that the doctor injured her nerves during the surgery, and as a result, she now has permanent hand numbness, and problems grasping things.

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