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SteelerEmpire
09-25-2010, 12:20 PM
WASHINGTON (AP) — President Obama's health care overhaul has divided the nation, and Republicans believe their call for repeal will help them win elections in November. But the picture's not that clear cut.

A new AP poll finds that Americans who think the law should have done more outnumber those who think the government should stay out of health care by 2-to-1... ..."Republican legislators' passion to repeal the legislation is understandable if they are paying attention to members of their own party," Krosnick added. "But if they want to be responsive to all Americans, there are more Democrats and independents than there are Republicans."

LINK: http://www.usatoday.com/news/washington/2010-09-25-health-care-poll_N.htm?loc=interstitialskip

Hindes204
09-25-2010, 01:05 PM
The latest Rasmussen Reports national telephone survey shows that 43% of Adults believe the private sector has the best chance of keeping health care costs down and the quality of care up, down slightly from November of last year (http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/november_2009/47_trust_private_sector_more_than_government_to_ke ep_health_care_costs_down_quality_up).
But 37% trust the federal government more in these areas. Another 20% are undecided.


http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/september_2010/americans_send_mixed_signals_over_best_way_to_cont rol_health_care_costs_quality



Its all in how the question is asked, I can play this poll game all day

SteelerEmpire
09-25-2010, 01:31 PM
The latest Rasmussen Reports national telephone survey shows that 43% of Adults believe the private sector has the best chance of keeping health care costs down and the quality of care up, down slightly from November of last year.
But 37% trust the federal government more in these areas. Another 20% are undecided.
http://www.rasmussenreports.com/publ..._costs_quality



Its all in how the question is asked, I can play this poll game all day
------------------------------------------

Actually competition within the private sector still remains with the over-haul, if not "expanded" as some states only had one insurer over the entire state. In addition, there will be no "government option". It still will be competition between current insurers, but with just "increased government regulations" to avoid past "for profit" abuses by insurers.
As far as the poll is concerned, in reality, "repealing" of the health care law passed is a dream being sold to those that listen to it... it will be next to impossible... Republicans would basically have to have control of all three branch's of government and at the levels that the Dems did/currently do for that to happen. With the demographics of the country changing 'not' in favor of the Republicans, I really don't see that happening...

Godfather
09-25-2010, 02:08 PM
With the demographics of the country changing 'not' in favor of the Republicans, I really don't see that happening...

It's not that far outside the realm of possibility. The R's should get to at least 48 seats this year. And the D's are BADLY exposed in 2012 and 2014.

If the GOP is really smart, they'll pass a bill that does the following:

- Repeals the individual mandate

- Allows HSA holders to spend their funds on any third party, not just spouses and dependents. (This would result in massive savings because it would make mutual aid socieities stronger, and medical providers would just need to track the payments coming in instead of needing an army of employees to fight with deadbeat insurers).

- Restores the allowable annual HSA contribution, undoing the Obamacare cuts

- Allows individuals to buy plans with lifetime limits or high annual deductibles

- Allows individuals to deduct premiums, so that people who don't get insurance at work can receive equal tax treatment

- Allows states to opt out of Obamacare

They could call it the "Restoring Patient Choice and Cost Control Act of 2011". Obama would veto it because he cares more about his ego than he does about the American people. That would be a real reform and would be highly popular, so blocking it would be political suicide for the Jackasses.

The irony of all this is that if they'd just passed Medicare for All and a tax credit for people wanting to opt out and buy private insurance, they'd be in a lot less trouble.

Craic
09-25-2010, 03:56 PM
Actually, the original article is quite misleading.

75% want "substantial" change in teh system. "Substantial change" does NOT mean change towards universal health coverage, or change towards the original Obama plan.

I WANT SUBSTANTIAL CHANGE. Yet, the substantial change I WANT has nothing to do with what this article is pushing as "change."

I want major lawsuit reform. I want the govt. medicare system to be scaled back and overhauled because it is driving price increases across the board. I want a complete change in govt. oversight of current insurance policies.

This article is quite one-sided.

JonM229
09-26-2010, 08:49 AM
Even if Republicans win every seat available this election, it won't be enough to override a Presidential veto if they pass a bill repealing the Health Care reforms.

GodfatherofSoul
09-26-2010, 11:23 AM
I've got the same problem with the health care bill. We all know what has to be done to reform the system, but Republicans want to stick with privatized health care. Since there wasn't a strong enough Democratic majority, we ended up with a weak compromise between doing nothing and real reform.

I'm real curious about how you think Medicare is driving up the cost of health care when it covers the neediest of customers and cost *less* than privatized health care. I'm also curious about how you think lawsuit reform will affect the cost of health care and if you know what percentage of health care spending is attributed to lawsuits. In your own words please, don't just post links.

Hindes204
09-26-2010, 11:41 AM
I'll take on the lawsuit reform question. To put it plainly, doctors are afraid to get sued so they continue to order unnecessary (and expensive) tests. It's called "defensive medicine". The last study I saw said that tort reform could save anywhere from 92 to 202 billion dollars. That's what would help reduce healthcare premiums

SCSTILLER
09-26-2010, 11:47 AM
I've got the same problem with the health care bill. We all know what has to be done to reform the system, but Republicans want to stick with privatized health care. Since there wasn't a strong enough Democratic majority, we ended up with a weak compromise between doing nothing and real reform.

I'm real curious about how you think Medicare is driving up the cost of health care when it covers the neediest of customers and cost *less* than privatized health care. I'm also curious about how you think lawsuit reform will affect the cost of health care and if you know what percentage of health care spending is attributed to lawsuits. In your own words please, don't just post links.

Don't have time to find the article/report that I read about this but soon as I can I will track it down. The reason Medicare is driving up the cost of healthcare is because it is cheaper than privatized health care. What I mean by this is that Medicare tells the doctors what it is going to pay them for procedures, and it is only around 70% of the actual cost of said procedure. Now, the doctors/hospitals/clinics have to make up the difference somehow, so they can either bill the actual customer for the remaining difference, knowing full well that they won't get their money, then also/either pass the loss off to the insurance companies of other patients and make it up that way. So, in essence, Medicare not paying the full share is the reason health care costs are going up because the doctors have to make up the difference somehow.

Also, like Hindes said, TORT reform needs to happen for any real healthcare costs to go down.

Mach1
09-26-2010, 12:11 PM
The reason Medicare is driving up the cost of healthcare is because it is cheaper than privatized health care. What I mean by this is that Medicare tells the doctors what it is going to pay them for procedures, and it is only around 70% of the actual cost of said procedure.

And thats the reason why a lot a doctors wont accept medicaid/medicare.

Craic
09-27-2010, 01:09 AM
I've got the same problem with the health care bill. We all know what has to be done to reform the system, but Republicans want to stick with privatized health care. Since there wasn't a strong enough Democratic majority, we ended up with a weak compromise between doing nothing and real reform.

I'm real curious about how you think Medicare is driving up the cost of health care when it covers the neediest of customers and cost *less* than privatized health care. I'm also curious about how you think lawsuit reform will affect the cost of health care and if you know what percentage of health care spending is attributed to lawsuits. In your own words please, don't just post links.

Im on my phone, so I'll make it short. 1. Tort reform. The threat of.a lawsuit must be covered with malpractice insurance. An ObGyn pays $500,000 a year IN PREMIUMS for coverage in some places. So, say 10 patients a day, three days a week, 50 weeks a year (docs need a couple days for educ., rounds, etc.) That is 1500 visits. To cover the insur. Prem. Alone, they have to charge $333. A visit. That doesn't count overhead, salaries of employees, etc. Etc. Tort reform can immed. fix that by dropping the overall bill by what? 50% maybe? Since prob. Half of every visit or MORE is going towards insur. From lawsuits.

Medicare. Too comp. To do on a phone. Basically, though, all prices get driven up to then negotiate w the govt. On medicare allowable rates. Because med. Pays so low, the other rates are driven much higher to show both disparity and to cover a losing proposition.

Vis
09-27-2010, 10:49 AM
Preach, what should happen when doctors screw up and devastate a patient's life?

Mach1
09-27-2010, 11:35 AM
Preach, what should happen when doctors screw up and devastate a patient's life?

What should happen when the govt(IRS) screws up your healthcare and devastates a patients/family's life(s).

BnG_Hevn
09-27-2010, 03:00 PM
What should happen when the govt(IRS) screws up your healthcare and devastates a patients/family's life(s).

I'm sure there are some military vets that can answer that question.

LLT
09-27-2010, 03:30 PM
Originally Posted by Vis
Preach, what should happen when doctors screw up and devastate a patient's life?



I'm sure there are some military vets that can answer that question.

Bingo...If you want to see government controlled healthcare. Go to a VA clinic and ask the Vets how they like it. IT SUCKS!!!!

7SteelGal43
09-27-2010, 05:02 PM
Many Wish Health Care Would Go Further


yeah....like right off a cliff. Please repeal this abomination !

Craic
09-27-2010, 05:43 PM
Preach, what should happen when doctors screw up and devastate a patient's life?

First, what do you mean by "doctors screw up and devastate a patient's life?" Is it that the Doctor has a choice between two legitimate paths of treatment, took one, and it didn't work? Sorry, that isn't lawsuit worthy IMO. Is it that the Doctor did something radical in surgery because an unforeseen circumstance came up... and he had to make a judgment call? Nope, not lawsuit worthy.

There is a major difference between "second guessing" and negligence. Most malpractice lawsuits, are for the former, and IMO, are frivolous. The latter, is a much tougher threshold. However, if it can be proved, then there is no problem with a payout large enough that it helps the person the rest of their life.

If the malpractice is malicious (such as the Dr. carving his initials on the person during surgery, which happend a few years ago), then since that is a much higher threshold, there should be no limit to the payout. Conversely, the insurance companies also would have the ability to limit their responsibilities to only the first two thresholds, thus limiting their exposure.

Heck, even Canada recognized the problem with lawsuits
Fees are lower than in the United States for a number of reasons. Two of these are that Canada’s highest courts have set limits on awards and the country’s liability laws make establishing professional negligence more difficult. Another is that the physicians’ insurance company defends lawsuits very vigorously. http://www.loc.gov/law/help/medical-malpractice-liability/canada.php

Matter of fact, if the fed. govt. wanted to set up a similar system to the Canadian system, then they would allow a national insurance organization for all American doctors and Hospitals, without regulations dealing with the states... then reimburse every doctor about 85% of their premiums.

Vis
09-28-2010, 04:21 AM
First, what do you mean by "doctors screw up and devastate a patient's life?" Is it that the Doctor has a choice between two legitimate paths of treatment, took one, and it didn't work? Sorry, that isn't lawsuit worthy IMO. Is it that the Doctor did something radical in surgery because an unforeseen circumstance came up... and he had to make a judgment call? Nope, not lawsuit worthy.

There is a major difference between "second guessing" and negligence. Most malpractice lawsuits, are for the former, and IMO, are frivolous. The latter, is a much tougher threshold. However, if it can be proved, then there is no problem with a payout large enough that it helps the person the rest of their life.

If the malpractice is malicious (such as the Dr. carving his initials on the person during surgery, which happend a few years ago), then since that is a much higher threshold, there should be no limit to the payout. Conversely, the insurance companies also would have the ability to limit their responsibilities to only the first two thresholds, thus limiting their exposure.

Heck, even Canada recognized the problem with lawsuits http://www.loc.gov/law/help/medical-malpractice-liability/canada.php

Matter of fact, if the fed. govt. wanted to set up a similar system to the Canadian system, then they would allow a national insurance organization for all American doctors and Hospitals, without regulations dealing with the states... then reimburse every doctor about 85% of their premiums.

The problem is you're wrong. You have a common misconception if you believe most are frivolous but common doesn't make it right. But lets say the negligence is real, Dr is drunk and takes out wrong part leading to a lifetime of medical bills. Then what? What tort reform stops truly frivolous suits but allows legitimate ones to go forward unencumbered?

Mach1
09-28-2010, 08:08 AM
Grasping at straws.

Vis
09-28-2010, 11:54 AM
Grasping at straws.

Any system put in place needs to filter the garbage cases and allow the real ones to go forward. Put on whatever thinking cap you might have and suggest a system that does both - different from what there is now (if you know what that is) or bow out of adult discussions.

X-Terminator
09-28-2010, 12:31 PM
The problem is you're wrong. You have a common misconception if you believe most are frivolous but common doesn't make it right. But lets say the negligence is real, Dr is drunk and takes out wrong part leading to a lifetime of medical bills. Then what? What tort reform stops truly frivolous suits but allows legitimate ones to go forward unencumbered?

We'd need to clearly define what is negligence and what is not. Problem is, it's difficult to do so because there's so much gray area. A surgeon can do everything by the book, no problems, mistakes, anything...but if the patient doesn't get relief or the problem isn't corrected, he can still sue the surgeon for negligence. I don't think that should be allowed. I also don't believe a surgeon or other doctor should lose everything he has if he does make a mistake that can be corrected with a follow-up treatment. Those cases should have caps on liability so that the patient is compensated for his inconvenience, yet the doctor receives "punishment" for his mistake. However, if it is gross negligence that results in a lifetime of problems for the patient, then those cases should be unencumbered.

Vis
09-28-2010, 02:18 PM
We'd need to clearly define what is negligence and what is not. Problem is, it's difficult to do so because there's so much gray area. A surgeon can do everything by the book, no problems, mistakes, anything...but if the patient doesn't get relief or the problem isn't corrected, he can still sue the surgeon for negligence. I don't think that should be allowed. I also don't believe a surgeon or other doctor should lose everything he has if he does make a mistake that can be corrected with a follow-up treatment. Those cases should have caps on liability so that the patient is compensated for his inconvenience, yet the doctor receives "punishment" for his mistake. However, if it is gross negligence that results in a lifetime of problems for the patient, then those cases should be unencumbered.

You are wrong. If a doctor follows the standard of care regardless of outcome there is no negl. Even negl doctors don't lose everything They usually don't lose anything because cases are settled with confidentiality agreements so the next patient has no way of knowing the dr is a frequent screw-up and the settlement isn't greater than the ins coverage. The dr pays nada. You buy into the sales pitch of the ins industry. Caps don't prevent frivolous suits, they limit the recovery of the worst cases. Frivolous suits get tossed on summary judgment in most cases. Med mal cases, in most states, require another dr swear that the standard of care was violated before suit can be brought.

Vis
09-28-2010, 02:27 PM
Here's SC law:

Medical malpractice lawsuits have specific requirements that must be satisfied in order for a genuine issue of material fact to exist. David, 367 S.C. at 247, 626 S.E.2d at 3. Specifically, a patient alleging medical malpractice must provide evidence, through expert testimony, showing (1) the generally recognized and accepted practices and procedures that would be followed by average, competent practitioners in the physician's field of medicine under the same or similar circumstances, [*16] and (2) that the physician departed from the recognized and generally accepted standards. Id. at 247, 626 S.E.2d at 4. Additionally, the plaintiff must show that the defendant's departure from such generally recognized practices and procedures was the proximate cause of his alleged injuries and damages. Id. at 248, 626 S.E.2d at 4.

Craic
09-28-2010, 02:32 PM
The problem is you're wrong. You have a common misconception if you believe most are frivolous but common doesn't make it right. But lets say the negligence is real, Dr is drunk and takes out wrong part leading to a lifetime of medical bills. Then what? What tort reform stops truly frivolous suits but allows legitimate ones to go forward unencumbered?

Actually, I am not wrong. I got most of that information from lawyers defending lawsuits against doctors.

For instance, 51.7% of lawsuits from ER visits are "Misdiagnosis, failure to diagnose, or delayed diagnose". Unless truly negligent, I am sorry, but that is simply frivolous. We have set a standard that says Doctors are supposed to be All-knowning, and then sue them when they are not.

That also runs counter to a underlying medical truism, "When you hear hoofbeats, look for a horse." Once in a while it is a Zebra, but unless you are in a Zoo, or in africa, WHY IN THE WORLD would you look for a Zebra? But today, Doctors are being sued because they didn't. Thus, they order tests that are completely unnecessary for 99 percent of the patients, so that when the 1 percent is caught, by pure luck mostly, they aren't sued.

As to the rest of your question, I already answered it my previous post.

Vis
09-28-2010, 02:33 PM
Actually, I am not wrong. I got most of that information from lawyers defending lawsuits against doctors.

For instance, 51.7% of lawsuits from ER visits are "Misdiagnosis, failure to diagnose, or delayed diagnose". Unless truly negligent, I am sorry, but that is simply frivolous. We have set a standard that says Doctors are supposed to be All-knowning, and then sue them when they are not.

That also runs counter to a underlying medical truism, "When you hear hoofbeats, look for a horse." Once in a while it is a Zebra, but unless you are in a Zoo, or in africa, WHY IN THE WORLD would you look for a Zebra? But today, Doctors are being sued because they didn't. Thus, they order tests that are completely unnecessary for 99 percent of the patients, so that when the 1 percent is caught, by pure luck mostly, they aren't sued.

As to the rest of your question, I already answered it my previous post.

I posted the law. Does it match your post in the slightest? I have handled med mal cases on both sides.

LLT
09-28-2010, 02:44 PM
I posted the law. Does it match your post in the slightest? I have handled med mal cases on both sides.

But lets be honest...it is a lawyers job to FIND the loophole. To PROVE that the doctor was listening for a horse instead of a zebra and to present it to a judge or jury in such a way as to convince the act as negligence.

Vis
09-28-2010, 02:44 PM
Here's the facts from an actual "failure to diagnose" case I once had. Patient presents with blisters on his arms, hands, legs, feet, and tongue. He was having an allergic reaction to penicillin. The triage nurse in the ER, as well as the ems people noted all the above but when the ER dr got there he didn't look at the file but merely asked what the patient did for a living - he washed dishes at a Shoneys. The Dr decided it was a chemical burn from the soap (how that got on feet and tongue he didn't explain since the dr never looked at them as his notes proved) Dr pumped him full of antibiatics - co-reactive with penicillin thereby making the situation worse (its called toxic epidermal necrolysis) and sent him home in an ambulance. The infected lesions on his hands made it impossible for the guy to wipe himself even if the dr had been right. Patient's brother found him rotting in his bed two days later. He was air-lifted to a burn-unit two states away where he dies eleven unimaginably painful days later as his skin burned off from the inside. That one would fit in your stat, wouldn't it?

Vis
09-28-2010, 02:49 PM
But lets be honest...it is a lawyers job to FIND the loophole. To PROVE that the doctor was listening for a horse instead of a zebra and to present it to a judge or jury in such a way as to convince the act as negligence.

And it's the other lawyers job to stop it. But here's the kicker - med mal cases are so expensive to prove with all the experts needed that lawyers don't take even legitimate ones unless the damages are huge. If we lose we get nothing and we don't get the tens of thousands we spend to get that far back

Craic
09-28-2010, 11:58 PM
Here's the facts from an actual "failure to diagnose" case I once had. Patient presents with blisters on his arms, hands, legs, feet, and tongue. He was having an allergic reaction to penicillin. The triage nurse in the ER, as well as the ems people noted all the above but when the ER dr got there he didn't look at the file but merely asked what the patient did for a living - he washed dishes at a Shoneys. The Dr decided it was a chemical burn from the soap (how that got on feet and tongue he didn't explain since the dr never looked at them as his notes proved) Dr pumped him full of antibiatics - co-reactive with penicillin thereby making the situation worse (its called toxic epidermal necrolysis) and sent him home in an ambulance. The infected lesions on his hands made it impossible for the guy to wipe himself even if the dr had been right. Patient's brother found him rotting in his bed two days later. He was air-lifted to a burn-unit two states away where he dies eleven unimaginably painful days later as his skin burned off from the inside. That one would fit in your stat, wouldn't it?

Now, I would want to know if the Doctors notes stated WHY he didn't look at the other blisters. And, on the tongue is easy to understand. Ever see someone pour soap and a dust cloud come up? Feet... just depends on what he was wearing.. or if water soaked through. Those are all the questions I would FIRST want to be answered if I was on the jury. Furthermore, was the Dr. told that the patient was on Penicillin? If not, then Horses before Zebras. That is the patients responsibility to inform the doctor of those things. My mother has a list of EVERY medicine she is taking, and when she goes to the ER, we MAKE SURE they ALL see it, because that is my responsibility. If he did, then the onus falls on the doctor to say why he didn't check it out.

If it came about that the doctor simply ignored protocol, then that is negligence. If it came out that the doctor knew of the sores on the feet and tongue, but, saw the blisters on the hands, wasn't presented with the facts that the guy was on Penicillin, and thus concluded that they did INDEED look like chemical burns... then it is the fault of the patient for not informing the Dr. of the medicine he was taking.

The suffering the patient endured thereafter again has no bearing on whether the Dr. was guilty. I believe the idea behind justice, is that emotion is left out. So however much I sympathize with the man's pain, it has no place in the decision making process. Yet, I have to ask, when the case was argued... was it argued on a factual level, an emotional level, or both? Were pictures of his sores on his hands presented, or were pictures of his entire body after 11 days presented, to sway the jury? For me, to do anything but present emotionless facts is to distort the system, and part of the entire problem not just with healthcare reform, but tort reform in general.

The key ingredient that is left out of the civil court system today, is PERSONAL RESPONSIBILITY. If this guy didn't share his meds, its his responsibility, not the Docs. I had a friend whose wife went to McDonalds and ordered Hot Chocolate. Yep, you guessed it. She gave it to her daughter, her daughter spilled it, burning herself, and they sued McDonalds. It was settled for 3-5 thousand dollars. The wife actually said to me, "It was so hot, I wouldn't even drink it". To which I practically was bleeding biting my tongue... because IMO she should have been countersued AND CPS CALLED for endangering a child. Personal Responsibility.

A woman I know was in a store looking at a mirror. She picked it up, then dropped it on her toe. She went to the manager, told him what happened, and demanded that they pay for her X-rays at the hospital, which they did. IMO, the manager should have asked her to show him the mirror. Then, if there was even a scratch, he should have CHARGED HER FOR THE DAMAGE and then kick her out of the store--why? Because she is too clumsy to hang on to a mirror. Personal Responsibility.

That, my friend, is the big issue here. I believe doctors need to take personal responsibility when something goes wrong. I believe the patient needs to take A WHOLE LOT MORE PERSONAL RESPONSIBILITY when they screw up the diagnosis by not giving the Doctor enough info, or acting like an idiot (or the family, as a lawsuit where a man's family requested no new X-rays be done, and instead transfer the man to another hospitale, and then when the Dr. did that, the guy dies, and the family sues the Dr. FOR UNSTABLE TRANSFER. Personal responsibility. The family made the wrong decision. Don't blame the doc.

Craic
09-29-2010, 12:21 AM
Here is another example of "Personal Responsibility"


Presentation
A 35-year-old woman came to a family practice clinic on July 31 with complaints of right arm and finger numbness and neck pain. She had a history of lumbar surgery six years ago and lumbar fusion five years ago. The patient also reported that she was seeing a psychiatrist for anxiety, depression, and mood swings. She was currently taking Paxil 40 mg and Thorazine 150 mg. The patient stated that her neck felt like her back did before the fusion.
Physician action
A physician’s assistant (PA) examined the patient and found that she was tender on palpation of the cervical vertebrae and shoulder with a tight trapezius muscle. She was noted to have decreased range of motion of the neck and decreased right arm strength. The initial assessment was neck pain, shoulder pain, neuropathy, and muscle weakness to the right arm. She was prescribed a Medrol dose pack, Darvocet for pain, and Soma for muscle spasms. The office scheduled an MRI of the cervical spine on August 5.
On August 1, the patient called the office complaining of pain. Another PA, with the approval of the supervising physician, called in a prescription for Lortab 10/500 #20 for the patient. The patient did not keep her appointment for the MRI that was scheduled on August 5. On August 6, the patient was
N
ot all medical liability suits filed against physicians are prompted by medical errors. Patients often cite interpersonal aspects of care, such as poor communication or feeling rushed, as central to the decision to initiate litigation. 1
“Patients do not necessarily file lawsuits because they believe they were harmed by a medical error. They sue because they believe they were harmed by a medical error and something else happened during their care,” says Jane Holeman, vice president of risk management at TMLT.
This publication will describe 10 common errors that can increase the risk of a malpractice suit, and offer risk management techniques to address these issues. Included with each error is a TMLT closed claim study that demonstrates how the error led to a lawsuit alleging medical liability.
4
prescribed Phenergan, Soma, and Lortab, but Family Physician A denied the request for Darvocet. The patient again called and obtained refills for Phenergan, Soma, and Lortab on August 9.
On August 12, the patient called for refills — Lortab, Soma, Restoril, and Paxil were prescribed with the understanding that no more medications would be prescribed until her MRI was completed. Office staff then contacted the patient’s psychiatrist to determine what medication he was prescribing for the patient. The psychiatrist would not respond to their call or fill out the medication form that was sent. The psychiatrist noted that the patient had signed a form that would not allow him to release any information about her care and treatment.
The patient failed to show for the MRI that was scheduled for August 19. When she called on August 23 seeking a refill for Soma, Family Physician B denied the request because the patient had not obtained the MRI.
On August 23, the MRI scan of the cervical spine showed a large right paramedian disc protrusion at C6-7 with a mild impression on the anterolateral aspect of the spinal cord. There was also a large paramedian disc protrusion at C5-6 producing mild neuroforamenal stenosis and pressing upon the right anterolateral aspect of the cord. The MRI results showed changes that would explain the patient’s pain. On August 26, Family Physician B called the pharmacy to approve another 5-day supply of Phenergan, Lortab, and Soma.
The patient called the office on August 28 stating that her pain medications were not strong enough. Family Physician B requested that she return to the clinic for a follow-up visit. The patient came that day and complained of neck pain and numbness in the right arm. Family Physician B performed a complete physical exam. He noted that her right arm was weaker than her left, and the right trapezius muscle was tender to palpation. The patient mentioned that Darvocet had not helped her in the past; but Oxycontin had provided relief. The physician diagnosed cervical disc disease, hypertension, and fatigue. He prescribed 40 mg of Oxycontin to be taken twice daily; one Soma every six to eight hours; and for her to keep a log of her blood pressure. Additionally, he noted that he would schedule an appointment with the neurosurgeon for September 26. He ordered a follow-up visit in two to three weeks for a blood pressure check.
At this visit, Family Physician B specifically remembered telling the patient not to take other medication when she took Oxycontin. He also remembered telling her to begin by taking only one pill per day though he wrote the prescription for two pills per day. He recalled providing specific patient education about the risks of Oxycontin.
On September 1, the patient called the clinic complaining of pain. The prescription for Darvocet was refilled to treat the patient’s breakthrough pain. The patient’s psychiatrist prescribed a 30-day supply of Restoril to the patient on September 2.
Today’s visit
Patient’s name _____________________________________________ Date of birth __________________
Main reason for today’s visit:
Other concerns I would like to discuss if there is time:
Please check all that apply:
_____ I have prescriptions to be refilled ______ I need the attached forms filled out
_____ I need a school or work excuse ______ I need a referral for my insurance company
This form can help prompt patients to state the reason for their visit.
5
The following day, the patient’s husband found his wife in the garage passed out and covered in urine. He explained that since he found her at 2 a.m., he thought her condition was a side effect of drowsiness. Neither the patient nor her husband notified any medical providers of this incident.
On September 5, the patient was found dead by her minor children on their return home from school. The medical examiner found that the cause of death was an accidental mixed-drug overdose from Oxycontin and Darvocet. The pathologist stated that he believed the patient consumed Oxycontin and Darvocet well in excess of the instructions in the prescription, and that this was not a case of accidentally taking an extra pill or two. He did not believe it was a suicide because the patient did not consume all the pills from the bottle or leave a note. The cause of death was also not a homicide or natural, so he was left with accident as the only choice when completing the death certificate. Based on the toxicology results, the patient took at least 8 to 10 Oxycontin and at least 6 to 8 Darvocet on the morning of her death.
Allegations
Lawsuits were filed against Family Physician A, Family Physician B, and their practice. The plaintiffs alleged that the physicians failed to realize that the patient was a drug abuser and should have taken steps to place the patient under long-term pain management care.
Lawsuits were also filed against the psychiatrist, the pharmacy and pharmacist who filled the patient’s prescriptions, and the physician’s assistant at the family practice clinic.
Legal implications Continued below

Craic
09-29-2010, 12:21 AM
Defense experts fully supported the actions of the family physicians in this case. The patient suffered from physiologic pain brought on by injuries to her cervical and lumbar nerves and her spinal cord. When faced with a patient with clear-cut MRI evidence of a lesion that is capable of causing severe pain, it was appropriate for the family physicians to rely on what the patient said would relieve her pain. The patient required strong pain medication, such as Oxycontin, because other medications failed to relieve her pain. The physicians made a good faith effort to treat the patient and did meet the standard of care in trying to manage a difficult situation.
Regarding causation, the defense argued that the patient took a huge dose of medication, well in excess of that prescribed by the defendants. If she had taken the drugs as prescribed, she would not have died.
During the investigation of this case, it was discovered that the patient had a history of prescription drug misuse dating back more than five years. Her medical records clearly showed that she would manipulate physicians into giving her pain medication and when they finally refused, she would go to another physician. About one month before the patient came to the defendants’ clinic, she was dismissed by a neurosurgeon for lying about medications and abusing her medications. Unfortunately, the family physician defendants did not know about the patient’s history because she purposefully failed to disclose her previous three treating physicians. She also told her psychiatrist that he could not disclose anything to other medical professionals.
The plaintiffs retained an expert in pain management who supported their allegations. He argued that the family physician defendants should have diagnosed the patient as an addict and initiated an involuntary commitment. However, he could not explain why involuntary commitment was warranted or point to any evidence that the family physicians should have been aware of her addiction. This expert also stated that the results from the MRI mandated an emergency referral to a neurosurgeon. Defense counsel pointed out that the radiologist who read the study did not describe her condition as an emergency or note spinal cord involvement.
The plaintiff’s pharmacology expert testified that his primary concern was not with the prescriptions that were given, but with the number of pills that the patient was allowed to receive. He stated that she should not have been permitted to obtain a 30-day supply of Oxycontin. This expert agreed that the patient’s early refill requests could easily be explained by “misuse” of the medication and not “abuse.” He conceded that the family physicians appropriately used the “carrot and stick” approach by denying the patient refills when she did not obtain the MRI and making sure refills were on time and not early. Further, he agreed that the patient’s conduct was noncompliant, unreasonable, and a component that caused her death.
Another weakness in the plaintiff’s case involved the actions of the patient’s husband (a plaintiff in the case) when he found the patient passed out in the garage. He did not take her to the emergency
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department or notify any of her treating physicians. The plaintiff’s own expert described this as negligence on the part of the husband and agreed that health care professionals would likely have intervened had this episode been brought to their attention.
Disposition
At the conclusion of the plaintiff’s presentation of evidence during the trial, the defense attorney made a motion for directed verdict. The judge granted the motion, concluding that the plaintiffs did not meet their burden of proof that malpractice occurred in this case. (A directed verdict is an order from the judge that one side or the other wins the case. After a directed verdict, there is no longer any need for the jury to decide the case. Motions for a directed verdict are rarely granted as judges tend to let the jury make the decision on whether or not the standard of care was violated.)
At the end of trial, defense counsel interviewed jury members. Those interviewed indicated that they felt the patient’s death was an unpredictable suicide and was not due to any fault of the defendants.Now, while this case was not won, it has STILL caused a number of problems. First, the doctors and pharmacists now have a malpractice lawsuit on their record for insurance. REGARDLESS of the outcome, the lawsuit puts them at higher risk, because the insurance company had to front probably 200 to 300,000 dollars on this lawsuit. That means if this happens some what often, their rates go up to cover their exposure--whether the lawsuit IS WON OR NOT. Thus, little johnny who now has the flu might not be able to see the doctor because Daddy had to take the lowest insurance option, since the insurance company had to raise rates to cover the new fees of the doctors, which were raised to cover the insurance higher fees... because of idiotic lawsuits like this one, and IMO, a lawyer who thought he could get a cheap buck, probably on a settlement. After all, it is much cheaper to settle these things out of court then to fight it, PERIOD. A 30,000 dollar settlement is much cheaper than a 300,000 dollar billing from the lawyer. And THAT... is why we need major Tort reform from the ground up in this country. ANd to start out with, All class action lawsuits should be restricted to a 5% payout TOPS for lawyers, plus DOCUMENTED costs after examination by a judge. Because ADS on TV BEGGING for clients to join a lawsuit against a drug company is crass at best, and ambulance chasing at average.

Vis
09-29-2010, 06:42 AM
The key ingredient that is left out of the civil court system today, is PERSONAL RESPONSIBILITY. If the Doctor lived up to his PERSONAL RESPONSIBILITY no suit would have been needed. He would have given everything he owned to the family of the man he killed and fallen on a sword. Lawsuits are there to force the cause of the loss to pay for the loss when they won't pay out of any sense of moral or civil obligation.

Craic
09-29-2010, 04:25 PM
If the Doctor lived up to his PERSONAL RESPONSIBILITY no suit would have been needed. He would have given everything he owned to the family of the man he killed and fallen on a sword. Lawsuits are there to force the cause of the loss to pay for the loss when they won't pay out of any sense of moral or civil obligation.

Why would he be obligated to pay for a patients screwup, if that is what it was?