Posts Tagged ‘medical’

Coaching medical witnesses

An instruction sheet for doctors providing defense-side “independent” medical exams in injury cases reads in part as follows:

# Point out whatever findings or claims are not related [to the sued-over incident]. Otherwise be silent on causal relationship.

# If prognosis appears good, then state that – otherwise be silent

# If you can state that plaintiff can participate in all normal activities, do so. If not, be silent

Eric Turkewitz, who brings this story to public attention (Feb. 12), wonders what ethical questions might be posed for both lawyers and doctors when expert witnesses are coached in this way to give partial and incomplete (to say no more) testimony. I don’t know what New York legal and medical authorities would do, but in the mother of all witness-coaching scandals in recent years — the inadvertent release of Baron & Budd’s “Preparing for Your Deposition” memo in asbestos litigation in Texas — nothing at all wound up being done by established authorities to discipline or punish the plaintiff’s lawyers involved. In fact, even more incredible, Baron & Budd succeeded in hiring more than one well-known academic ethics specialist to sign affidavits attesting that the coaching practices were in no way objectionable — details here and here (see pp. 161 et seq. of Brickman’s Pepperdine article). So if Integrated Risk Services, Inc., of Long Island, New York, which bills itself suggestively as a firm providing “Attorney Managed Independent Medical Consultation Services”, finds itself in hot water, perhaps it should give Prof. Silver in Austin a ring.

P.S. Jane Genova at Law and More doubts it works well before juries — though of course persuasiveness to a jury might not be the only objective for those who engage in coaching.

Flu shots in supermarkets

The mayor of Boston is against ’em: “allowing retailers to make money off of sick people is wrong.” (David Gratzer, “Health care innovation, and its enemies”, Examiner.com, Feb. 7). More views: Gene Pinkham, “Is the flu on your shopping list?”, Malden (Mass.) Observer, Jan. 18 (sick people might start visiting supermarkets and we can’t have that); Paul Howard (Manhattan Institute), “Competition won’t ail you”, Boston Herald, Feb. 9. More: Bainbridge.

Online prescribing

Despite promising potential advantages for patient care as well as cost savings, the medical profession has not been quick to embrace technologies that enable online linkage of prescribing doctors with pharmacies. One reason, according to an article in Medical Economics: fear of liability. The feedback flow of information from online prescribing tends to bring to a doctor’s attention that some patients have been failing to pick up or renew their prescriptions and are thus presumptively noncompliant. Once doctors know that, however, they’re open to being sued later on the theory that they knew of a patient’s noncompliance but failed to pursue him aggressively enough to come in for more counseling, etc. Apparently it’s safer not to know in the first place (Ken Terry, “E-prescribing: The rewards and risks”, Medical Economics, Jan. 4)(via KevinMD).

Big teaching-hospital cuts after Oregon high court ruling

But they told us the malpractice crisis was just a myth dept. (Associated Press):

Oregon Health & Science University plans to cut at least 200 jobs and raise tuition by at least 10 percent to free the money needed for higher insurance costs following an Oregon Supreme Court ruling.

The December ruling cleared the way for the family of a brain-damaged child to pursue malpractice damages from the university. It effectively eliminated a liability cap of $200,000 designed to protect state agencies from major damage awards.

The cutbacks, expected to be announced Friday, were first reported by The Oregonian newspaper. Besides trimming jobs and hiking tuition, OHSU expects to restructure or close clinical, research and education programs, and scale back construction on Portland’s South Waterfront.

OHSU said the court ruling will add $30 million a year in insurance and administrative expenses. Though that’s only 2 percent of OHSU’s annual operating budget of about $1.5 billion, it amounts to more than 60 percent of its annual support from the state’s general fund. …

OHSU is Portland’s largest private employer with about 12,000 staff.

More: Victoria Taft (cross-posted from Point of Law).

Catholic hospital won’t perform transgender-related surgery

In order to enhance diversity, it was necessary to suppress it dept.: “She feels as if she’s been treated as if she has no rights,” said the attorney for m-to-f transgender San Francisco resident Charlene Hastings, who’s suing Daughters of Charity/Seton in Daly City alleging harassment and discrimination because it’s not among the many Bay Area hospitals that would be happy to assist in Hastings’s breast augmentation procedure. (Melissa Underwood, “Transgender Woman Sues Catholic Hospital for Refusing Breast Augmentation Surgery”, FoxNews.com, Jan. 18; Barbara Feder Ostrov, “Transgender woman sues Seton hospital”, San Mateo County Times/InsideBayArea.com, Jan. 6). [Title edited after commenter pointed out inaccuracy]

Banning health clinics

Thanks to Glenn Reynolds for pointing out this story at the Boston Globe. Apparently there’s talk of banning the new clinics housed inside various Walmarts and CVS stores in Boston. As Glenn ponders, why would the lawmakers there want to eliminate affordable health care operated by the private sector? Also, Glenn links to this post which highlights how these clinics are doing things right.

Florida Mulls Lawsuit Over Antipsychotic Programs

That’s the title of a post by Ed Silverman over at Pharalot. The issue is the use if atypical antipsychotics in children:

Florida Medicaid records show the number of children – some just months old – who were prescribed the drugs went from 9,364 seven years ago to 18,137 in 2006. No records for privately insured patients are available.

As I mentioned earlier this week, putting the blame on the pharmaceutical industry is an oversimplistic reaction to how psychiatry, psychology,and our culture have transformed childhood into a diagnostic checklist. As mentioned in Ed’s post, the litigation in Florida appears to be the recommendation by agencies receiving Medicaid funds to use these drugs in children with ADHD who also had tics. While none of the atypical antipsychotics, to my knowledge, are FDA approved for this condition, it is common knowledge among mental health professionals that the most effective treatment for tics are dopaminergic antagonists such as atypical antipsychotics. True, the recent National Institute of Health’s CATIE study demonstrated that most of the atypicals were no better than the older ones. But that doesn’t mean that the newer atypicals aren’t effective or an appropriate treatment. Perhaps, our current social construction of adolescence is partly to blame for the boom in mental health diagnosis in our children.

Even more on autism and thimerosal

Ronald Bailey at Reason’s blog Hit & Run discusses a recent article by Stephanie Desmon in the Baltimore Sun on the topic. Ron rightly mentions the end result of all the fuss over thimerosal in vaccines: worried parents, unvaccinated kids and more expensive vaccines. As I mentioned earlier this week, a recent study in the Archives of General Psychiatry also cast doubt on the supposed link.