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Author: Dan Frith

Dan Frith has over 25 years of experience representing individuals and families in cases of medical malpractice throughout Virginia. He has been named "Best Medical Malpractice Attorney" by Roanoker Magazine and is a member of the Million Dollar Advocates Forum. To speak with Dan, contact him by email at dfrith@frithlawfirm.com.

Screening Colonoscopies: Are there Risks?

July 12, 2018

No American between 40 and 80 is unaware of the recommendation for screening colonoscopies.  The American Cancer Society recommends that people at “average risk” of colorectal cancer start regular screening at age 45. This can be done either with a test that looks for signs of cancer in a person’s stool, or with an exam that looks at the colon and rectum (a visual exam or colonoscopy).  I have had two screening colonoscopies in my life and am fortunate to report both were normal and no complications were encountered…but not everyone avoids potential complications.

The Yale Center for Outcomes Research and Evaluation (CORE) decided it wanted to quantify the frequency and severity of harm from this common cancer screening, performed in roughly 14 million people each year.  What they found might surprise many: 1.6% of 325,000 otherwise low-risk healthy patients who had a colonoscopy in the year 2010 experienced a complication serious enough to send them to a hospital or emergency department within 7 days.  

A lot of things can go wrong even after colonoscopy in an outpatient setting or an ambulatory surgery center.  Perforations or lacerations to the colon can cause bleeding and hemorrhage or even infections that don’t show up for a day or more; sedative drugs can cause reactions resulting in hypoxia, aspiration pneumonia, and cardiac arrhythmias. 

My Take:  The type and frequency of risks associated with screening colonoscopies does not mean you should avoid following the American Cancer Society’s recommendations.  Colon cancer is easily diagnosed and, if not timely diagnosed, can lead to premature death.  My advice is that if you experience any post colonoscopy abdominal pain or blood in your stool, get to a hospital emergency department promptly.  Tell the doctors about your recent colonoscopy and your concern that your colon may have been perforated or that you are experiencing symptoms from some other complication from the colonoscopy.  An abdominal CT, with contrast, can typically determine if you have a serious problem.  

My last advice relates to the experience of the physician performing your colonoscopy and those who assist in the procedure.  Go to a gastroenterologist – a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver.  Gastroenterologists are specialists who receive training in endoscopy (upper endoscopy, sigmoidoscopy, and colonoscopy) by expert instructors. In rural Virginia, I see many general surgeons performing screening colonoscopies.  I prefer to have a doctor who has specialized training in the procedure and who performs colonoscopies with great frequency…not a general surgeon who might take out an appendix today, a gall bladder tomorrow, repair varicose veins two days later, and perform one colonoscopy a month.  Also, if you are having your colonoscopy outside of the hospital setting (like an ambulatory care center), make sure there is an anesthesiologist present at the facility and do not settle for a nurse anesthetist, who is not a medical doctor. If complications from anesthesia occur, you don’t want your life to depend on just how quickly you can be transferred to a nearby hospital with anesthesiologists on staff.

We have previously discussed the risks associated with colonoscopies in multiple posts:

  1. “Routine Procedure” anything but routine

  2. MORE THINKING ABOUT SCREENING COLONOSCOPIES

  3. COLONOSCOPIES ARE NOT WITHOUT RISKS

 

Late Diagnosis of Lung Cancer

July 12, 2018

I want to share with you the facts of a very sad case recently reported in a legal journal.  A 58 year old male smoker underwent a routine physical, which included a chest x-ray.  The x-ray was interpreted as normal by a reviewing radiologist.  Three years later, the patient was diagnosed with metastatic lung cancer.  Despite chemotherapy, radiation and other therapies, he died 20 months after his diagnosis.  

The patient’s wife sued the radiologist for failing to identify a suspicious 1.5 centimeter mass in the left lung which was visible on the x-ray.  The lawsuit alleged that had the mass been identified an appropriate follow up CT scan would have resulted in a prompt diagnosis of the cancer, and surgery to remove the mass would have had a 70 percent chance of cure.  No surprisingly, the trial resulted in a substantial verdict for the patient’s widow.

My Take:  Radiologists sit in darkened rooms looking at hundreds if not thousands of images every day.  Images of bones, kidneys, lungs, pancreases, brains, livers, and more.  Some of those radiologists are not working in the hospital radiology department but may be in their house sitting in their pajamas interpreting the images via a process known as “teleradiology”…not very reassuring to me.  We have written extensively on medical malpractice by radiologists and the problems with teleradiology:

  1. DEBATE ON TELERADIOLOGY – DOES IT MATTER WHERE THE RADIOLOGIST IS?

  2. ERRORS IN RADIOLOGY

  3. TELERADIOLOGY: WHAT IS IT AND HOW COULD IT AFFECT YOU?

  4. CASE REPORT: THE DANGERS OF TELERADIOLOGY

 

 

How to Find a Good Doctor (in Virginia)

April 10, 2018

I am sometimes amazed how people find and choose their doctors.  You do want a good and competent doctor don’t you?  Sometimes you have no options…you are admitted to the hospital with stomach pain, diagnosed with appendicitis and need emergency surgery.  In those cases you agree to take whichever general surgeon is offered by the hospital.  But what about those cases where you have time to consider and select a doctor?  How do you go about finding the surgeon to fix your hiatal hernia…perform elective back surgery…or replace your hip or knee?

This article will provide information sources and comments which will help you become an informed patient and find a “good doctor.”

     1.  Search for your doctor on the Virginia Department of Health Professions.  This site provides a wealth of information.  First, it tells you whether your doctor is licensed to practice in Virginia.  Second, it discloses where your potential doctor went to medical school, post-medical school residency, and fellowships. If your American born doctor went to medical school in Aruba, Grenada, or Belize, I suggest they were unsuccessful in gaining admission to any medical school in the United States…not impressive.  As a general rule, do not select those doctors.  Third, this site discloses whether the physician you are considering has ever had an adverse action taken against his/her medical license by the Commonwealth of Virginia.  Adverse actions can be anything between failing to keep accurate patient records to situations where the doctor has an alcohol or drug addiction which negatively impacted patient care.  Finally, this site may tell you if the doctor you are considering has ever been successfully sued for medical malpractice.  However, this section of the site contains information “self- reported” by the physician so it is not always accurate…more on lawsuits against your potential doctor later.

     2.  Age and Experience.  The older we get the younger all of the healthcare professionals look.  This truism aside, age matters…on both ends of the spectrum of life and a medical career.  You don’t want a doctor who graduated medical school 5 years ago if you can help it because that doctor doesn’t have the necessary “on-the-job” experience to deal with complicated medical issues.  Likewise, you don’t want a 70 year old doctor fusing the vertebrae in your low back as it is unlikely that doctor has kept up with modern surgical techniques.  General medical experience is important but so is experience with the specific surgery or condition for which you are searching for a doctor.  If I need a doctor who is removing a brain tumor or a mass pressing on my spinal cord, I want a doctor who has performed that same procedure many, many, many times.  I also want to know the success rate my potential doctor has had with the surgery…not what the national averages are for the success of the surgery but my potential doctor’s success rate.  If he/she will not answer that question I suggest moving to another doctor.

     3.  Membership in professional organizations for their specialty.  In short, you want to select a doctor who keeps up on the literature and developments in his/her area of practice.  Here is a list of medical associations based in the United States.  Many of these associations have a web site listing their members by name and location of practice.  Also, many doctors will gladly provide you with a list of the professional associations for which they are members.

     4.  Lawsuits.  I promised (above) to provide more information on previous medical malpractice lawsuits against doctors you may be considering to be your doctor.  Just because a doctor has been sued (successfully or unsuccessfully) does not necessarily mean they are incompetent or bad doctors.  There are certain “high risk” medical specialties which simply leads to lawsuits. The high risk specialties include neurosurgery, general surgery, orthopedic surgery, obstetrics and gynecology, among others.  With my concession that a previous lawsuit against the doctor you are considering should not rule out the doctor, there are easy ways to check on whether the doctor has been sued and, if so, how many times.  Almost all of the Circuit Courts in Virginia are online and can be searched by the public to see if the doctor you are considering has been sued.  Here are the easy and fast steps to follow:         

           a.)    Go to the Virginia Judicial System web site

          b.)    Click on Case Status and Information

          c.)    Under Circuit Court, click on case information

         d.)    Hit the drop down key and pick which jurisdiction (court) you would like to search & hit begin.  You want the city or        town where the doctor’s office is located or the location of the hospital at which the doctor has privileges.

         e.)    You will be at the main menu.  Check Civil and type in the doctor’s name (last name, first name) and hit search by name

          f.)    You will just need to scroll through the names (names are in alphabetical order).

My TakeDo your research and find a good competent doctor…your life just might depend on it.

Leapfrog Report Cards for Local Hospitals

November 3, 2017

On Wednesday I shared a summary of Leapfrog’s report cards on several hospitals in the Roanoke and New River Valleys.  Here are the report cards published by the Leapfrog Group for two additional hospitals in our area of Virginia:

1.  Memorial Hospital of Martinsville received a “C.” Infection problems included higher than average instances of MRSA and C. diff infections.  Surgical problems included collapsed lungs.  Poor communication about medicines to be given to patients and discharge orders were also below average.

2.  LewisGale Hospital-Pulaski also received a “C.”  The higher than average infection problems included urinary tract and C. diff infections.  Surgical problems included collapsed lungs.  Poor patient – doctor communications, patient falls, and a below average number of specially trained doctors stand out as problems.

3.  Danville Regional Medical Center received a “C.” A higher than average rate of MRSA infections and below average surgical scores for death from serious but treatable complications, collapsed lungs, serious breathing problems, dangerous blood clots, and accidental cuts and tears accounted for this hospital’s grade.

Read the details of each hospital’s report here.

My Take:  Folks who live in the cities of Martinsville, Bassett, Collinsville, Chatham, Gretna, and Danville, or the surrounding counties of Henry and Pittsylvania are not getting the medical care they deserve.  Who wants “average” medical care?  Not me.

How Safe are the New River and Roanoke Valley Hospitals? Leapfrog’s Study

November 1, 2017

We all want to know just how safe our local hospitals are don’t we?The Leapfrog Group is a nonprofit watchdog organization that serves as a voice for health care purchasers.  Leapfrog is the nation’s premier advocate of hospital transparency—collecting, analyzing and disseminating hospital data to inform patients (and others) about the quality of care they can expect.  Leapfrog just released the results of its 2017 Hospital Safety Scores.  Let’s take a look at how our area hospitals did:

1.  Carilion Roanoke Memorial Hospital received a “C.”  Infection problems noted included infections in the blood when patients were in the ICU, and urinary tract infections. Surgical problems included death from serious but treatable complications, breathing problems, and accidental cuts and tears.

2.  LewisGale Medical Center (Salem VA) received a “A.”  Despite this high grade, infection problems included C. diff infections, urinary tract infections, and surgical site infections after colon surgery.  Surgical problems also included death from serious but treatable complications.

3.  LewisGale Hospital-Montgomery (Blacksburg VA) received a “B.” This hospital also encountered above average problems with blood infections during stays in the ICU, urinary tract infections.  Reported surgical problems included death from serious but treatable complications and accidental cuts and tears.

4.  Carilion New River Valley Medical Center (Radford VA) received an “A.”  Experienced problems similar to Carilion Roanoke Memorial Hospital but at a much lower rate.

Read the details of each hospital’s report card here.

My Take:  The highest profile and “flagship” hospital in Western Virginia, Carilion Roanoke Memorial Hospital, has some work to do to justify its top billing and Level 1 Trauma Center designation.

Medical Malpractice Damage Caps and What the “Protecting Access to Care Act” (H.R. 1215) Will Do to You

September 6, 2017

The U.S. House of Representatives has already passed HR 1215, misleadingly titled, Protecting Access to Care Act.” The law awaits action in the Senate and, if passed, will have many negative impacts on those who are the victims of medical negligence including the following:  

  1. An across-the-board $250,000 “cap” on compensation for “non-economic” injuries (like paralysis, trauma, reproductive harm), which would be mandated in states even where such caps are unconstitutional.
  2. A repeal of state collateral source rules, meaning a wrongdoer can reduce their obligation to compensate a patient by the amount of disability, workers compensation or other insurance received, to which a patient has a right.
  3. A prohibition against a severely-injured patient receiving a full jury award in a lump sum, leaving the patient vulnerable and under compensated while the insurance company gets to sit on the money and pocket the interest.

You can read a more exhaustive list of the punitive effects of the proposed law at the Center for Justice and Democracy website.

I thought about sharing a story or two or three about how this law would hurt residents of Southside and Southwest Virginia but decided to let an article from The Hill ( a non-partisan political newspaper published in DC) shine the light on this outrageous proposed legislation.  You can read the article here.

 

US News & World Reports Hospital Surveys: Johnston Memorial Hospital

August 13, 2017

I have already shared with our readers the U.S. News 2017 – 2108 Hospital Survey ratings for Carilion Roanoke Memorial HospitalLewis-Gale Medical Center, and Memorial Hospital of Martinsville, and Danville Regional Medical Center.  Today, I will share the results of the survey for Johnston Memorial Hospital in Abingdon, Virginia.  

Johnston Memorial Hospital (JMH) is a general medical and surgical hospital with 116 beds. Survey data for the latest year available shows that 41,308 patients visited the hospital’s emergency room. The hospital had a total of 9,009 admissions. Its physicians performed 1,468 inpatient and 5,265 outpatient surgeries.

I will summarize JMH’s ratings in the following high volume medical specialties:

1.  Orthopedics – rated 32 out of 100, unranked in the United States, and not high performing.

2.  Gastroenterology and Gastrointestinal Surgery – rated 39 out of 100, unranked in the United States, and not high performing.

3.  Urology – rated 39 out of 100, unranked in the United States, and not high performing.

4.  Geriatrics – rated 35 out of 100, unranked in the United States, and not high performing. 

JMH did not have one medical specialty or department recognized as high performing.  Read the report here.

My Take:  Be an informed healthcare consumer and know the capabilities and limitations of the hospital you chose.  Your life may depend on your decision.

US News & World Reports Hospital Surveys: Danville Regional Medical Center

August 12, 2017

I have already shared with our readers the U.S. News 2017 – 2108 Hospital Survey ratings for Carilion Roanoke Memorial Hospital, Lewis-Gale Medical Center, and Memorial Hospital of Martinsville.  Today, I will share the results of the survey for Danville Regional Medical Center in Danville, Virginia.

Danville Regional Medical Center (DRMC) is a general medical and surgical hospital with 250 beds. Survey data for the latest year available shows that 25,434 patients visited the hospital’s emergency room. The hospital had a total of 8,748 admissions. Its physicians performed 1,836 inpatient and 3,564 outpatient surgeries.

I will summarize DRMC’s ratings in the following high volume medical specialties:

1.  Nephrology (disease and treatment of the kidneys)- rated 16 out of 100, unranked in the United States, and not high performing.

2.  Gastroenterology and Gastrointestinal Surgery – rated 25 out of 100, unranked in the United States, and not high performing.

3.  Urology – rated 15 out of 100, unranked in the United States, and not high performing.

4.  Diabetes and Endocrinology – rated 29 out of 100, unranked in the United States, and not high performing. 

DRMC did not have one medical specialty or department recognized as high performing.  Read the report here.

My Take: With all of the caveats previously expressed, Danville Regional Hospital may take the award for the worst survey scores in Western Virginia.

 

US News & World Reports Hospital Surveys: Martinsville Memorial Hospital

August 11, 2017

My last blog shared the U.S. News 2017 – 2018 Hospital Survey results for Carilion Roanoke Memorial Hospital and Lewis-Gale Medical Center, both in the Roanoke Valley.  Today, I will share the results of the survey for Memorial Hospital (MMH) in Martinsville, Virginia.

Memorial Hospital is a general medical and surgical hospital with 150 beds. Survey data for the latest year available shows that 41,455 patients visited the hospital’s emergency room. The hospital had a total of 5,440 admissions. Its physicians performed 1,054 inpatient and 5,056 outpatient surgeries.

 I will summarize MMH’s ratings in the following high volume medical specialties:

1.  Nephrology (disease and treatment of the kidneys)- rated 36 out of 100, unranked in the United States, and not high performing.

2.  Gastroenterology and Gastrointestinal Surgery – rated 45 out of 100, unranked in the United States, and not high performing.

3.  Pulmonary – rated 45 out of 100, unranked in the United States, and not high performing.

4.  Diabetes and Endocrinology – rated 37 out of 100, unranked in the United States, and not high performing. 

MMH did not have one medical specialty or department recognized as high performing.  Read the report here.

My Take:  These are not impressive ratings.    

US News & World Reports Hospital Surveys: An Update on Carilion Roanoke Memorial Hospital

August 10, 2017

I recently shared some of the ratings for Carilion Roanoke Memorial Hospital (CRMH) as reported by the U.S News 2017 – 2018 hospital survey.  You can read that blog post here.

My local newspaper, the Roanoke Times, ran an article today on those same survey results titled, “
Roanoke Memorial Ranked No. 3 in State.”  The title is correct and kudos to CRMH.  

My problem with the Roanoke Times article is that it failed to report how poorly the hospital did in the areas of neurology, neurosurgery, gynecology, and cancer treatment.  I think these are pretty important medical specialties. Another important omission in the newspaper’s glowing article is that CRMH is unranked for a large number of pediatric specialties including: cancer, gastroenterology/gastrointestinal surgery, neurology/neurosurgery, orthopedics, and pulmonary.  Why is CRMH unranked for these very important pediatric areas of practice?  Why did the newspaper article fail to mention the areas of medical specialty in which the hospital did not excel?