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According to a study published this week in the Journal of Pediatrics titled “Prescription Opioid Epidemic and Infant Outcomes,” the use of prescription narcotic painkillers during pregnancy increases the risk that a baby will be born small or early, as well as the risk of drug withdrawal known as neonatal abstinence syndrome.

The study included the analysis of medical records for more than 112,000 women in the Tennessee Medicaid program between 2009 and 2011. Of those women, approximately 28% filled a prescription for at least one narcotic painkiller — mostly short acting medications such as hydrocodone or oxycodone.  According to the authors, prescription narcotic painkillers are “commonly prescribed in pregnancy.”

Babies born small or early are at greater risk for labor and delivery complications, as well as neonatal complications, including:

  • respiratory distress,
  • infection,
  • jaundice,
  • intraventricular hemorrhage,
  • inability to maintain body heat,
  • gastrointestinal issues,
  • anemia,
  • patent ductus arteriosus,
  • retinopathy of prematurity, and
  • sepsis.

The study provides healthcare providers, including obstetricians, with important information about the dangers associated with the prescription of narcotics to women for pregnancy-related conditions such as pubic symphysis diastasis. “Studies like this are important to patient safety, because the warnings issued help inform and shape the standard of care,” said Michael A. Bottar, a Syracuse medical malpractice lawyer.

Bottar Leone, PLLC has decades of experience investigating and pursuing claims for injured patients, workers, motorists, and consumers.  To speak with us about a potential medical malpractice or birth injury claim, please contact the Firm by telephone, email, or click here to submit an online contact form.

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According to a study published in the journal Rheumatology titled “Non-Steroidal Anti-Inflammatory Drugs and Risk of Venous Thromboembolism: A Systematic Review and Meta-Analysis,” there is an increased risk of venous thromboembolism (VTE) among users of non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs include drugs such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and celecoxib (Celebrex).

VTE is a disease that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It is the third most common cardiovascular illness, after coronary syndrome and stroke, and can result in permanent disability or death if untimely diagnosed by a healthcare provider.

Data from the Ungprasert study, which compared NSAID users to non-users, provides that NSAID users demonstrated a 1.80-fold increase in risk for VTE. Until now, evidence supporting a between between NSAIDs and VTW was scant. The study has broad public health implications given the prevalence of NSAID use in the general population. As the report warns physicians to be aware of the association between VTE and NSAIDs, especially in patients already at a higher risk of VTE, this report may influence the standard of care with regard to NSAID use in various patients.
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World Cerebral Palsy Day is a global innovation project created to improve quality of life for people living with cerebral families, and their families. The project is led by a group of non-profit cerebral palsy charities, and supported by organizations in over 45 countries.

Cerebral palsy is a neurological disorder caused by abnormalities in parts of the brain that control muscle movements, hearing, vision and cognition. It is the most common physical disability in childhood. The majority of children with cerebral palsy were born with it, although the diagnosis may not be made until a child reaches three years of age. According to, at least two thirds of children with cerebral palsy will have movement difficulties affecting one or both arms, 1 in 4 children with cerebral palsy cannot talk, 1 in 3 cannot walk, 1 in 2 have an intellectual disability, and 1 in 4 have epilepsy. In the most severe cases, children born with cerebral palsy will live their lives dependent upon others for every aspect of daily living.

Causes of cerebral palsy include hypoxia or ischemia during childbirth, genetic disorders, stroke, infection and trauma. Where cerebral palsy is caused by a preventable medical error during labor and delivery, the child and his or her family may have a claim for medical malpractice.
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According to the Centers for Medicare and Medicaid Services (“CMS”), between October of 2008 and June of 2010, more than 11,000 Medicare-eligible patients received care and treatment at Crouse Hospital in Syracuse, New York.

During that time period, at least two patients experienced a 100% preventable surgical complication known as a gossypiboma or textiloma, which is when an object like a sponge, pad, or gauze are accidentally left inside a patient after the incision is closed. For this adverse incident category, Crouse’s rate per discharge of 0.609 was more than six times the national rate per discharge of 0.09.

“CMS’ report is significant because it lifts the veil of secrecy surrounding medical mistakes at area hospitals,” said Syracuse medical malpractice lawyer Michael A. Bottar, of Bottar Leone, LLC. “These statistics do not include errors affecting non-Medicare-eligible patients.”

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According to, a study published by The Project on Government Oversight suggests that Syracuse’s Veterans Administration Medical Center, also known as the Syracuse VA, has very few medical malpractice claims filed against it.

There may be a number of reasons for the low volume and size of claims against the Syracuse VA for medical malpractice. One explanation is that many veterans are not inclined to file a lawsuit against an entity that is providing ‘free’ medical care to them. Second, many veterans do not know that they have been injured by malpractice because they are advanced in age and/or are suffering from a constellation of disabilities stemming from their military service. Finally, claims against the Syracuse VA for medical malpractice are complicated because they are governed by the Federal Tort Claims Act (FTCA). Many personal injury lawyers do not prosecute FTCA cases because they are not familiar with the administrative claims process or the technical requirements of a lawsuit in federal district court.

“We like the complexity of FTCA cases,” said Michael A. Bottar, a Syracuse-based attorney handling a number of VA medical malpractice lawsuits, as well as claims against the the Department of Health and Human Services. “In addition, many agencies, including the VA, do a pretty good job of resolving claims during the administrative review process. Sometimes a lawsuit is unnecessary.” This, of course, assumes that the attorney handling the FTCA claim knows what information must be submitted to the agency, how to submit it, where it should go, and when. “The FTCA can be a mine field for the uninitiated, as there are short deadlines,” Bottar added.

Contact us for a copy of “A Desktop Guide To Federal Tort Claims Within the United States Court of Appeals for the Second Circuit,” or to learn more about claims against the federal government for negligence, malpractice and wrongful death.

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According to a study conducted by Dr. Ramon Jimenez entitled “Do Poor People Sue Doctors More Frequently?“, poor patients are less likely to sue their doctors for medical malpractice. The study has been published in the February 25, 2012 edition of Clinical Orthopaedics and Related Research.

The results of this study run counter to the notion, or misconception, that poor patients are more likely to pursue medical negligence lawsuits to obtain the proverbial “payday.” It appears, instead, that poor patients file claims less because they have less access to legal counsel and often lack the finances necessary to prosecute a case.

The study also touched on an “unconscious bias” held by some physicians who refuse to treat low income patients — that bias being that the doctor will not be paid for rendering services. The decision not to treat patients who may be hard to collect payment from may be eased, or justified, by accepting the assumption that poor patients are more likely to sue.

Bottar Leone, PLLC is a Syracuse personal injury law firm that has, for nearly three decades, represented patients from all walks of life. “We have clients who are homeless, as well as clients who are very successful. We even have physician clients.” Contact us to discuss your case or concerns with one of our New York medical malpractice lawyers.

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Do you know you statistical risk for a heart attack?

The American Heart Association wants you to know so that you can control your risk factors and avoid or delay the onset of heart disease and complications like a myocardial infarction (MI). The AHA heart attack risk calculator can be found here.

Computer-based risk calculators take a number of variables into consideration, such as a person’s age, gender, cholesterol levels, lifestyle, activity level, body habitus, blood pressure, and history of heart disease and diabetes. With this information, a heart attack risk calculator can estimate your chances of a problem over the next 5-10 years. “If calculators like these are available to doctors throughout the State of New York, we may see a decrease in the number of missed opportunities to intervene and save a life,” said Syracuse medical malpractice lawyer Michael A. Bottar, of Bottar Leone, PLLC.

When patients report to their physician or an emergency room with complaints of chest pain, shortness of breath, jaw pain, sweating, and/or left arm pain, the heath care provider should analyze these variables and arrive at a differential diagnosis that includes the possibility of a heart attack. When doctors fail to consider and/or rule out a heart attack as a potential cause of a patient’s complaints and, instead, make a diagnosis of, e.g., shoulder strain or heart burn, and the failure to diagnose a heart attack causes damage to the heart muscle (i.e., diminished ejection fraction), the patient may have a cause of action against the doctor for medical malpractice. If the patient dies following premature discharge from a hospital, the patient’s family may have a cause of action for wrongful death.
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More than 140,000 people die every year from a stroke. As strokes are the number three cause of death in the United States, health care providers should consider a stroke when a patient presents to an emergency room with complaints of a severe headache, face droop, arm drift, and/or slurred speech.

“As many as 800,000 people suffer a stroke each year,” said Syracuse medical malpractice lawyer Michael A. Bottar, of Bottar Leone, PLLC, a law firm representing injured patients throughout the State of New York. “Unfortunately, strokes are frequently misdiagnosed in the emergency room and patients are sent home without appropriate therapy.” Stroke therapy may include the administration of antiplatelets, anticogaulants, statins, and/or blood pressure medications. t-PA may also be administered. Depending upon the type of stoke, surgery may be necessary.

Recently, medicine took a major step forward toward treating acute ischemic strokes. On trial now in Florida is a device called Trevo. Trevo is a minimally invasive catheter system that can retrieve clots in order to return blood flow to the affected portions of the brain before there is brain death. Trevo is a hybrid of current catheter-guided thrombolysis technology. “If the Florida trial goes well we may see Trevo in New York and, in turn, stroke-related permament disabilities may decline,” said Bottar.
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Preeclampsia, also known as toxemia, is a condition that complicates as many as 10% of pregnancies. Typical symptoms during pregnancy and the immediate post-partum period include high blood pressure, protein in the urine (i.e., proteinuria), foot, leg and hand swelling (i.e., edema), nausea, severe headaches and abdominal pain.

A dangerous variant of preeclampsia is known as H.E.L.L.P. syndrome. A woman with H.E.L.L.P. syndrome may have a low platelet count and elevated liver enzymes. Women who suffer from H.E.L.L.P. syndrome may not exhibit the primary indicators for preeclampsia, such as high blood pressure and proteinuria. Because a pregnant woman with H.E.L.L.P. may not have symptoms that doctors typically look for, a woman suffering from preeclampsia may be misdiagnosed with the flu and treatment may be delayed.

Preeclampsia affects pregnant women everywhere, including in central New York. According to, in the weeks before she gave birth by cesarean section on August 1, 2011, Cato resident Kristie Rubino experienced several preeclampsia symptoms. She presented to St. Joseph’s Hospital Health Center on July 28, 2011, but was discharged. Days later, she underwent an abdominal delivery performed under general anesthesia. Shortly thereafter, her blood pressure escalated and she passed away.

A failure to diagnose preeclampsia early can lead to life-threatening complications for a pregnant mother and her unborn baby. “The misdiagnosis of H.E.L.L.P. syndrome can be even more dangerous, because it has a 25% mortality rate,” said Michael A. Bottar, Esq., a Syracuse medical malpractice lawyer. Significant labor and delivery complications include premature birth and, while rare, maternal death from problems such as seizures, cerebral hemorrhaging and stroke. The only “cure” for preeclampsia is delivery. While there is no “cure,” preeclampsia can be treated by monitoring maternal fluid intake and through the administration of magnesium for seizures and anti-hypertensive medication for elevated blood pressure.

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According to the American Heart Association, patients with stroke symptoms who are admitted to a hospital over a weekend have a higher risk of death than those admitted on a weekday. The risk is more than 17% higher. “This known as the weekend effect,” said Syracuse medical malpractice lawyer Michael A. Bottar, Esq., of Bottar Leone, PLLC, a law firm prosecuting New York stroke misdiagnosis lawsuits.

“Generally, there is decreased staffing at hospitals over weekends and, in turn, the quality of care can decrease.” However, the “weekend effect” appears not to occur at comprehensive stroke centers where brain imaging and acute stroke teams are available around-the-clock.

Designated stroke centers in central New York include Crouse Hospital and Upstate University Hospital. A list of the 116 other designated New York stroke centers can be found here.

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