Articles Posted in Failure To Diagnose

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stethoscope-hand-moneyAccording to a recent article out of the New York Times, shorter hospital stays are not because hospitalized patients are becoming younger and healthier.  In fact, by and large, today’s patients are actually older and sicker. Rather, shorter hospital stays may be attributed to hospital financing.

According to the New York Times, in 1980 the average hospital stay in the United States was 7.3 days, while today it is closer to 4.5 days. One reason attributed to this change came in the early 1980s when Medicare stopped paying hospitals for their claimed costs and phased in a payment system. This “prospective payment system” pays a predetermined rate tied to each patient’s diagnosis and shifts the financial burden of a patient’s hospitalization from Medicare to the hospitals. As a result, hospitals are economizing and one way to do this is to get patients out of their hospitals, sooner.

Almost as soon as this “prospective payment system” started, experts raised concerns that it would lead to a higher rate of readmission. Meaning, patients discharged too quickly may be prone to complications, necessitating their return to the hospital. According to the New York Times, evidence backs this logic.  And, with recent programs created by the federal government aimed to penalize hospitals for readmission rates, e.g., Medicare’s Hospital Readmissions Reduction Program, where hospitals lose up to 3 percent of their total Medicare payments for patients readmitted within 30 days of discharge, questions remain as to whether patients are getting the care they need.

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DrAccording to a paper published in the new issue of the Journal of the American Medical Association, more than one in four doctors in the early stages of their careers have signs of depression, and their patients – now and in the future – may suffer because of it.

The findings come from an investigation of 50 years’ worth of studies, published between January 1963 and September 2015, that looked for depression symptoms in more than 17,500 medical residents. Their analysis revealed that the percentage of residents with possible depression ranged from 20 to 43 percent, resulting in an average of 29% physicians-in-training with depression or depressive symptoms.  By way of comparison, in 2013 the National Institute of Mental Health reported that about 6.7% of all U.S. adults had at least one major depressive episode during the previous year.

According to Srijan Sen, M.D., Ph.D., senior author of the study and a member of the University of Michigan’s Depression Center, depression obviously negatively impacts the doctors-in-training themselves, but it also affects patient care, as mental health issues are linked to medical errors. Indeed, it could interfere with attention and focus, the development of the doctor-patient relationship, and result in a resident physician less engaged or interested in a patient’s care – inevitably resulting in errors. The prevalence of depressive symptomatology and disease in physicians-in-training is a significant and important indication of a system in need of change.

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A7GEAW_2378638bNovember is National Diabetes Awareness Month, so a recent report published in JAMA Pediatrics, revealing that pregnant woman with elevated blood sugar levels are more likely to have babies with congenital cardiovascular defects, even if their blood sugar is below the cut off for diabetes, could not come at a more appropriate time.

The study was conducted over four years out of the Stanford University Medical Center, where researchers examined blood samples taken from 277 California women during their second-trimester of pregnancy. Out of the 277 women, 180 were carrying infants without congenital heart disease, and the others had infants affected by one of two serious heart defects. Specifically, 55 had tetralogy of fallot, where a baby is getting too little oxygen, and 42 had dextrotransposition of the great arteries, where the position of the two main arteries leading form the hart are swamped, preventing oxygenated blood from the lungs to circulate throughout the body.

The women’s levels of glucose and insulin were measured and used to test the association between those levels and the odds of having a baby with a heart defect. The results revealed that women who had fetuses with tetralogy of fallot had higher average blood glucose levels, but there was no significant finding in the relationship between dextrotranspostition of the great arteries and glucose levels.

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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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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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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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“Even though stroke is the third leading cause of death in the United States, the signs and symptoms are often overlooked in the emergency room,” said Syracuse medical malpractice lawyer Michael A. Bottar, Esq., of Bottar Leone, PLLC.

“We are currently representing a man who actually asked emergency room staff is he was having a stroke. He was, but was diagnosed with a ‘headache” and some over-the-counter Tylenol. The neurological damage progressed and one side of his body no longer functions.” The failure to diagnose a stroke occurs when emergency room personnel, especially in small towns, are not familiar with what to look for in a patient. A headache with other symptoms like loss of coordination and slurred speech should prompt a thorough investigation, including diagnostic imaging.

A new smart phone application may make diagnosis easier — by enabling doctors to diagnose a stroke remotely. The application is called Resolution MD. The program allows physicians to view high-resolution three dimensional images of the brain on an iPhone, iPad or Android phone. According to a study of the software, it was 94-100% accurate.

Prompt diagnosis of a stroke is critical because damage increases with time. Depending upon the type of stroke, medication called tPA may be administered to relieve symptoms. Information about tPA can be found in our prior post entitled “What Is tPA And Is It Available In Central New York Emergency Rooms?” Most emergency rooms, especially New York certified stroke centers, should have tPA on hand.
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Severe sepsis affects more than 750,000 people every year. “Our New York medical malpractice lawyers often file lawsuits alleging that a doctor or hospital failed to diagnose sepsis before it was too late,” said Syracuse wrongful death lawyer Michael A. Bottar, Esq., an attorney presently prosecuting several sepsis-based lawsuits.

The failure to diagnose sepsis is a common error. Unfortunately, sepsis, which is also known as blood poisoning, can result in a wrongful death. More than 200,000 every year. “It is the leading cause of death in the non-coronary ICU,” Bottar added.

Fortunately, help may be on the way. A new credit-card sized device being tested in Germany may aid physicians in quickly diagnosis sepsis. The tool, called MinoLab, may enable a doctor to diagnose sepsis in as little as 1 hour. Presently, analysis can take as long as 48 hours.

Signs and symptoms of sepsis include a fever, chills, severe shaking, tachycardia (i.e., high heart rate), low blood pressure, confusion, a decrease in urine output, and painful joints. If sepsis is timely diagnosed, it can be treated with intravenous antibiotics, vasopressors and corticosteroids, as well as intravenous fluids and surgery if the source of the infection can be identified and removed. Sepsis is a medical emergency. One out of of every 3 patients who develop “severe” sepsis will die within 30 days.
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“Even though an appendicitis is a clinical emergency, it is commonly misdiagnosed,” said Syracuse pediatric malpractice lawyer Michael A. Bottar, Esq., of Bottar Leone, PLLC. As many as 1 out of every 5 cases of appendicitis is not diagnosed before the appendix perforates (i.e., ruptures), which can lead to serious health problems including a periappendiceal abscess, peritonitis, an intestinal blockage, sepsis and death.

An appendicitis, or inflammation of the appendix, is caused by an obstruction of the appendiceal lumen. Signs and symptoms of an appendicitis, which typically strikes between the ages of 2 and 30, include (1) diffuse abdominal pain developing over 4-48 hours, (2) nausea, (3) vomiting, and (4) loss of appetite. When acute (i.e., inflamed), it is a “surgical” disease, meaning that it is treated by surgery as opposed to antibiotics. Surgery to remove the appendix is known as an appendectomy.

New York has one of the highest densities of pediatricians in the United States, with more than 150 pediatricians for every 100,000 children (second only to Massachusetts). This is a reassuring statistic because, according to a recent Reuters Health article titled Fewer Pediatricians, More Ruptured Appendixes, children who live in areas adequately staffed with pediatricians are more like to be timely diagnosed with an appendicitis and, in turn, are at 12% lower risk for rupture. According to the study underlying the Reuters article, a child’s proximity to a hospital, emergency room doctor and/or surgeon did not decrease risk. Statistically, access to pediatricians seems to make all of the difference in avoiding complications from an appendicitis.
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The kidneys are an essential part of the urinary system. They act as a natural blood filter and, as part of that process, divert waste products to the bladder where they are excreted through urine.

According to New York medical malpractice lawyer Anthony S. Bottar, Esq., a Bottar Leone, PLLC attorney handling Syracuse kidney failure lawsuits, “medical advancements have enabled physicians to diagnose kidney disease and kidney failure sooner and sooner. In turn, kidney dialysis is bring initiated earlier than ever. This may not be a positive development.”

Guidelines released by the United States National Kidney Foundation provide that dialysis should not begin until a patient has been diagnosed with stage 5 kidney disease. A study recently published in the Canadian Medical Association Journal reported that the timing of dialysis bears directly on mortality (i.e., death). Approximately 25,000 patients were included in the study. Researchers followed whether each received “early” or “late” dialysis, based upon testing of the glomerular filtration rates. About 30% of the patients started “early,” with a GFR greater than 10.5. The balance started “late.” Surprisingly, those who started “early” had an 18% increased risk of death.

“It is well-known that the failure to diagnose advanced kidney disease is medical malpractice, this study suggests that a nephrologist may also be liable for the wrongful death of a patient by starting dialysis too soon.”
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