The Tucson-based group, founded in 1943, bills itself promisingly as “the only national organization consistently supporting the principles of the free market in medical practice”. It’s published material favorable to liability reform in its Journal of American Physicians and Surgeons (formerly Medical Sentinel). Before citing to AAPS publications as one might cite to JAMA or The Lancet, however, it would be wise to read this and learn more about the group’s indulgence for anti-vaccine, anti-fluoridation and anti-gay crankery, as well as what one of its contributors regards as the superiority of “the creation religion of Jehovah” over the “religion of evolutionary humanism”. On the vaccine issue, at least, “the Journal of American Physicians and Surgeons [has been] transformed into one of the primary media allies of litigators and plaintiffs seeking to review medical care after the fact, and find legal fault with physicians, vaccine developers and public health authorities who exercised accepted standards of care prevalent at the time they made their decisions.” (Kathleen Seidel, Mar. 12).
Posts Tagged ‘medical’
Defensive medicine — no big deal?
That’s what some bloggers (like these two) seem to think. Emergency room physician “Shadowfax” (Feb. 10) finds this point of view a “little maddening”, given that it conflicts with the experience of “every day of my working life, every patient I see, every diagnostic/therapeutic decision I make”. (via KevinMD).
Ohio high court OKs wrongful-birth cases
By a 4-3 margin, the Ohio Supreme Court has approved (PDF) a “wrongful birth” suit against doctors by parents who say they would have aborted their child had they not been given inaccurate genetic counseling. The court did reject the views of Justices Paul Pfeifer and Alice Resnick (as well as that of a lower court judge) who thought the damages payable should include the cost of raising the child through adulthood, plus pain and suffering. (Andrew Welsh-Huggins, “Supreme Court allows lawsuits over missed genetic disorders”, AP/Akron Beacon Journal, Mar. 3). However, some Ohio legislators are proposing to enact a law precluding wrongful-birth lawsuits; a bill to that effect passed the state senate this past week, but has not yet been considered by the house (Jim Provence, “Bill would protect doctors from ‘wrongful birth’ suits”, Toledo Blade, Mar. 1). More on wrongful-birth suits: Sept. 16, 2004 and links from there; May 1 (Australia) and Jun. 14, 2005. More: WizBang takes an extremely dim view of the parents in the case (Mar. 3).
Defensive echocardiograms
Defensive pediatrics
“Flea”, who practices as a pediatrician in the Northeast, gets a letter from his professional liability insurer instructing him “to maintain a high index of suspicion for the worst possibility” when patients present themselves, “even when the clinical presentation does not automatically lead one to [the] conclusion [that their lives or long-term health are in jeopardy]”. His response (Feb. 13):
I’m sorry, ProMutual, I cannot practice medicine this way. Let me give the most trivial of examples.
The worst that a child with a fever could have is sepsis or leukemia. I simply cannot maintain a high index of suspicion and do appropriate testing to rule out sepsis and leukemia (i.e., draw a complete blood count and blood culture) on every one of my patients with fever, without regard to the patient’s clinical appearance.
My Favorite Lawsuit
As my guestblogging stint winds down here at Overlawyered, I wanted to reflect a moment on lawsuits I see around me every day. My company runs an outdoor recreation business, mainly running campgrounds on public lands. As a public contact business, we get people trying to make all kinds of strange claims against us.
For example, we have had at least two different people who needed an operation that they couldn’t afford come into our facility and fake an injury to try to get us to pay for the operation. Fortunately, in both cases, the individual involved lived locally and had tried the same stunt at several other local businesses, and we were able to get them to move their efforts on to some other business (we used to have the same philosophy about fire ants in Texas — you can’t get rid of them, you can only chase them onto your neighbor’s yard). We have also had several people try the same thing, but as employees, turning down office work and begging us to give them lots of physical labor, only to be hit with a workers comp claim within weeks.
Every year, we have hundreds more job applications than we have positions to fill, so we have to turn down a lot of qualified people for employment. It is often the case that when one of these people we turn down for employment considers themselves in a “protected” group, they call me threatening to sue. Several folks who were over 65 have threatened to sue me for age discrimination, which always makes me laugh, since the vast majority of the 500 people I employ are over 65 — many are over 80 and a few are even over 90! We have also had at least one person who interviewed in a wheelchair threaten to sue for discrimination against the handicapped, right up until we saw him playing football at the beach in our campground (and despite the fact that over 10% of my work force is disabled in some way).
We always have issues with employees who honestly believe that the courts are supposed to act as a grievance and appeals board for job terminations. I can’t even describe the large percentage of employees we terminate for cause who call me and tell me they are going to sue. Even when they don’t sue (and few do, since lawyers working on contingency need to see some hope of winning) they still cost me a ton of time, because I feel the need to personally investigate every one to make sure my managers are treating people the way they should. In many cases, we probably wouldn’t have hired the person involved in the first place because they have a history of poor performance and quick terminations, but it’s hard to find this out anymore since lawsuits have dissuaded many companies from responding honestly to reference checks.
Despite all of these, my favorite suit actually was against the company from who we bought most of our assets. One day, a male visitor was near the campground in bare feet, and claims to have stepped on a nail. The nail caused a small puncture wound on the bottom of his foot. Employees offered to get the man to the emergency room to treat the puncture and to get at tetanus shot, but the customer turned down care. Months passed, and the case was mostly forgotten. Until one day the company was given notice that the man was filing suit for sexual dysfunction. Apparently based on some medical logic I never understood, perhaps some strange acupuncture effect, the man claimed he was unable to perform sexually based on stepping on that nail. In a sane world, this would have been dismissed out of hand. However, years later, the suit lumbers on, continuing to generate legal bills and settlement pressure.
Update: No cameras in the delivery room
We had the story about lawsuit-averse obstetrics wards Oct. 18, 2000 and Apr. 9, 2005, and Newsweek has it this week (Karen Springen, “Hospitals: No Candid Camera”, Feb. 20).
“Not for diagnostic purposes”
That’s a legally-driven warning formula, of course, intended to repel the specter of liability lawsuits if a diagnosis goes wrong and the lawyers begin casting around for parties to sue. GruntDoc notices it being used on an item that plainly is for diagnostic purposes (Feb. 6).
Pain management — at the doc’s own risk
“Doctors want to provide relief, but they also want to keep people safe and stay out of trouble themselves — since doctors have been sued for undertreating pain and jailed for overtreating it.” (Lois M. Collins and Elaine Jarvik, “Doctors walk narrow line in treating pain”, Deseret Morning News/Casper Star Tribune, Jan. 5). Commenters at Kevin Pho’s (Jan. 6) get specific about some of the legal headaches that an emergency room doctor may face when a chronic pain patient shows up claiming to need immediate relief: calling other local practitioners to check on whether the patient is known for “drug-seeking activity” is now a violation of the federal HIPAA health-privacy law, while giving a day or two’s worth of medication to tide them over risks litigation from family members accusing the doctor of enabling their relative’s narcotic habit.
CYA in the ER
Overcautious emergency care, and what one doctor did when he saw it happening (“Specter of medical liability creates enormous cost”, no byline given, The Olympian, Nov. 28)(via, in order, Common Good MedWatch, Dr. Rangel, and KevinMD).