Prostate Cancer: Delay in Diagnosis, Failed Follow Up Strategy

in

Attorneys are often consulted by patients who feel that they have not been properly followed after cancer had been treated and that a recurrence could have been diagnosed earlier but was missed. Different cancers have different follow-up recommendations. For prostate cancer, PSA is the mainstay of the follow-up strategy.

One consequence of the routine adoption of PSA monitoring after treatment of early-stage prostate cancer is the identification of men with a PSA-only recurrence. In this situation, increases in serum PSA over the pretreatment baseline are often not accompanied by signs or symptoms of progressive disease. When PSA rises, the physician is often faced with a quandary. The longer one waits to perform an imaging study, the greater the chance that a recurrence can be confirmed and treatment started.

Read more

Cancer Pain Management Negligence

in

Safe and effective chronic opioid therapy for chronic cancer-related pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic non-cancer pain, several guidelines provide recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.

Generally, narcotics are not the only modality that can be used to treat pain. Adjuvant therapies together with narcotics can be very helpful. For example, steroids and non-steroidal anti-inflammatory drugs, such as ibuprofen(Advil) can reduce the inflammation associated with tumors pressing on tissues, and certain anti-depressants and anti-seizure drugs can modify how the brain perceived pain and lessen it. There are also procedures, such as nerve blocks, that can be helpful when pain is localized.

Read more

Life Care Planner: A Roadmap For Care

in

A Life Care Plan is a roadmap for care, describing anticipated medical and non-medical needs, with associated costs, of a person with a catastrophic injury or chronic illness over an estimated lifespan. It is based on standards of practice, comprehensive assessment, collaboration with all medical professionals, and analysis of medical records.

Life Care Planner’s help patients who have suffered catastrophic injuries and illnesses, advocate for them and plan out their care. Nurse Life Care Planners work with a patient’s family, insurance company, attorneys, and others to develop a life care plan, determining the future needs, services, and costs of care for the patient over their lifetime. Many Nurse Life Care Planners work independently from the hospital system, acting as a consultant for businesses, families, or courts of law. Because of life care plans, patients’ caregivers know how often they need to schedule appointments, what to expect in terms of rehabilitation, and what the course of medical care will look like.

Read more

Dog Bite Cases & Childhood PTSD

in

Dog bites can have very serious repercussions in a child’s life and can change their behavior, functioning, personality, self-esteem, impact a child’s educational progress as well as anxiety and years of counseling. For example, this patient is a seven-year-old white female, experienced a severe dog bite on her face. This was the result of a neighbor not keeping his Pit Bull on a leash. The neighbor was subsequently arrested and charged with Child Endangerment. The patient is now left with some significant scarring on her face. She is teased about this at school and her self-esteem has become quite low. Prior to the dog bite, she was a normal little girl and did well in all aspects of her life. Since the dog bite, she has had a deterioration in functioning.

Read more

Toxicity and The Risks of Environmental Lead Exposure

in

Lead is a naturally occurring element and does not break down. This means that lead will change chemically over time which influences its exposure but it will still be recognizable as lead. Lead used hundreds of years ago is still potentially available as a toxic chemical. Current regulations published by the USEPA are not eliminating all of the potential exposures to lead. Lead waste piles from mines and smelters dating back to the late 1800’s have been found to still present a lead exposure hazard. Lead-containing water service lines can be found in large older cities and water passing through the lines can present hazards to residents. Lead is still present in air from open combustion. Lead-based paint although now eliminated from use still has presents problems, especially for young children. Renovation work for remediation of lead-based paint must be done using the regulatory requirements of the EPA otherwise residential exposure to lead dust can result. Lead can be present in foods. All of these sources contribute to the total body burden.

Read more

Involve Your Medical Experts Early For Optimum Case Outcomes

in

“I Probably Should Have Contacted You Sooner…”

This opening line, on the phone or in office, strikes apprehension in your medical experts—or any expert, for that matter. Involving your experts as early as possible can quickly identify non-meritorious cases, save time, streamline case issues, improve case outcomes and the attorneys’ bottom line.

I recall a medical malpractice case several years ago involving a malfunctioning piece of life support equipment and multiple medical and nursing professionals, as well as falsified medical documentation.  By the time the attorney contacted me late in the process as a Nurse Expert, the medical equipment company had been excluded from the case, and it was too late to include several of the medical and nursing professionals responsible for significant breaches in the standard of care.  

Read more

Breast Implant Surgery Gone Wrong

in

Breast surgery that utilizes breast implants is very common and includes surgery for both cosmetic and reconstructive diagnoses.  As in all procedures, informed consent is a very important component in preparing the patient for surgery.  Lack of sufficient informed consent before a procedure that uses breast implants can reach the level of malpractice.

A patient consulted with her Plastic Surgeon about having a breast augmentation.  As a 4’ 11” person who weighed 96 lbs., she told the doctor that she currently wore a 32 a bra and wanted to be augmented so she could wear a 36 D bra.  She was very concerned about the possibility of implant rupture; she did not want to face the extra expense this would cost her.  Her doctor assured her that he could surgically place implants that would give her the size she wanted and told her that, although he had never seen a patient with ruptured implants, if the implants did rupture, her insurance company would cover those costs.   She had the surgery performed but was very unhappy because her bra size was only 34B, much smaller than her desired size.  Also, 5 years later one of the implants ruptured, requiring removal and replacement.  Her insurance company did not cover the costs of that surgery and she had to pay for this surgery out of pocket.

Read more

Dialysis Unit Communication: Real Time or Real Problem

in

Dialysis Unit Communication: At present, there are more than 6500 dialysis centers in the United States that provide life-saving care for patients with end-stage renal disease (ESRD) requiring renal replacement therapy.  This often thrice-weekly form of treatment has become commonplace in virtually every major city and suburb in the US.  Dialysis care is almost universally provided by Nephrologists (physicians specializing in the diagnosis and treatment of kidney diseases) in close collaboration with a team of health care providers that includes specially trained dialysis nurses technicians, social workers, and dieticians.  Dialysis care is now considered sufficiently routine that the Nephrologists need not be present during each treatment.

Potential Consequences of Dialysis: As with any procedure, hemodialysis carrels a small but significant risk of complication including infection, low blood pressure, and bleeding.  The risk of choric blood loss is real, even under ideal conditions; however, blood loss may also be acute, especially in patients with plastic dialysis catheters that are susceptible to accidental disconnection during or after the dialysis procedure.

Read more

Mild Hyponatremia: New Risk of Memory Changes, Gait Disturbances and Death

in

Hyponatremia is defined as a lower than normal serum sodium concentration using routine laboratory testing of serum electrolytes.  Although chronic hyponatremia below 120 mEq almost universally prompts medical investigation, milder forms are usually overlooked or disregarded as being of little clinical significance. Recently, mild-moderate hyponatremia (i.e., a serum sodium concentration >125-135 mEq/L) has been associated with distinct symptoms as well as with increased mortality after hospitalization.

What causes hyponatremia? Many conditions are associated with chronic hyponatremia, the single most common electrolyte abnormality.  These include inflammation in the brain or lung, cancers, thyroid disease, kidney disease, heart failure, and several categories of medications such as oral hypoglycemics (used in patients with diabetes mellitus), narcotics, diuretics, and antidepressants, particularly those agents referred to as selective serotonin receptor inhibitors (SSRI agents).

Read more

Saving Your Malpractice Case

in

The Fact Pattern

A 62-year-old male, Mr. Block, was in good health and had been a patient of Doctor Byrnes for many years. The patient had a history of rectal polyps which were removed in the operating room on several different occasions. The polyps continuously recurred despite adequate resection by Doctor Byrnes. The patient was compliant in every way and had a good relationship with Doctor Byrnes.

During a routine yearly visit, Doctor Byrnes found another rectal polyp. It looked suspicious and worrisome for a possible malignancy. Doctor Byrnes felt that a wider, more extensive local resection would be necessary. He told this to the patient, and the patient understood and agreed. Doctor Byrnes told Mr. Block that he (Doctor Byrnes) was now referring his operative patients to his younger associate, Doctor Madding. Doctor Madding examined Mr. Block. Doctor Madding concurred with the diagnosis and the proposed treatment plan. He established a rapport with the patient, explained the treatment plan and discussed potential complications with Mr. Block. In fact, Doctor Madding met twice with Mr. Block and did his best to explain the upcoming operation and tried to put Mr. Block at ease.

Read more