Georgia Overturns Malpractice Cap In A Case That Puts A Face On Why Limits Are Unjust

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Posted on 24th March 2010 by gjohnson in Uncategorized

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This one means something personal to me. Tommy Malone of Atlanta, Georgia is the best lawyer I know. He is a long time personal friend, a man who has mentored me, chuckled at some of my “out there” theories and co-counseled cases with me. His son, Adam Malone, may be the finest “young lawyer” in America. Adam has the combination of character, intelligence and sincerity that if he wanted to run for President, he would be a serious contender. He will someday have the position I now hold as Chair of the Traumatic Brain Injury Litigation Group.

I first saw the video of the catastrophic ruin a greedy doctor made of this woman’s face last summer at our national convention. My paralegal Jayne, who sat next to me while we watched, it has asked me about how the appeal has come out, a dozen times since.   Here the problem wasn’t that a jury wasn’t favorable to Adam’s client. The reason for the appeal was that the law, put in to assure that all doctors didn’t leave the State of Georgia (how ridiculous is that to even say) had limited her right to recover for this horrible disfigurement, drastically reducing the verdict.   The Georgia Supreme Court has said that was wrong and ruled the cap on damages unconstitutional.  In this case there may be the coming to justice that will forever put a stop to artificial restraints on what victims of malpractice and other wrongdoing can recover.

With this action, Georgia has become the latest state to throw out caps on awards in medical malpractice suits.  In this case,  Betty Nestlehutt, who is 75 now,    was horribly disfigured from a botched facelift. http://www.ajc.com/news/georgia-politics-elections/state-high-court-overturns-392119.html?printArticle=y

If you watch the video,  you will see the injustice on capping this wrongdoing. http://www.georgiawatch.org There is no way that Georgia’s $350,000 limit on noneconomic malpractice damages could be considered adequate payment for her ordeal.   It’s particularly heart-wrenching to watch Nestlehutt’s spouse try to carefully apply some kind of bandages to her wounds, as she flinches in pain.

In fact, a jury had found that she was entitled to $1.265 million in damages – a verdict that the George Supreme Court upheld, leading to the overturning of the state’s cap on malpractice awards.

Nestlehutt, who was in the real estate business with her husband in Marietta, Ga., decided to get a facelift in 2006. Her physician convinced her to get a long list of procedures, including the facelift. But after the surgery, Nestlehutt developed raw, open wounds on her face.

Nestlehutt’s face remained scarred, and the video says she is embarrassed to be seen now and doesn’t like to go out.

On Monday Georgia’s highest court ruled on Nestlehutt’s case, finding that the state’s $350,000 limit on noneconomic damages, such as a plaintiff’s pain and suffering, from malpractice was in violation of the Georgia constitution, which guarantees the right to a jury trial.

In the high court’s unanimous ruling, Georgia Chief Justice Carol Hunstein wrote that the state’s 2005 limit on damages “clearly nullifies the jury’s findings of fact regarding damages and thereby undermines the jury’s basic function…The very existence of the caps, in any amount, is violative of the right to a jury by trial.”

Last month the Illinois Supreme Court scrapped the state’s $500,000 cap on malpractice damages against doctors and $1 million cap for hospitals, saying that the limits were unconstitutional. Roughly two dozen state now have caps on malpractice damages.

Georgia was limiting malpractice damages to $350,000 against physicians and $1 million against health-care providers.

In Nestlehutt’s case, a jury awarded her $115,000 for past and future medical care; and $1.15 million to her and her husband for noneconomic damages, with $900,000 of that for the woman’s pain and suffering.

Plastic surgeon Dr. Harvey “Chip” Cole had appealed the jury verdict, based on the state’s malpractice cap.

The real credit in this case must go to Adam Malone.  Rather than declining this case because of the cap, he saw it as just the right case to prove in undeniable ways the injustice of the cap.  He advocated in a special way unique to who he is and changed the law of Georgia and perhaps the law of the land.

Adam, I am proud to know you.

Hospitals Look At Ways to Curb Errors, Help Staff That Make Mistakes

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Posted on 18th March 2010 by gjohnson in Uncategorized

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Hospitals Look At Ways to Curb Errors, Help Staff That Make Mistakes

The Wall Street Journal Tuesday offered an intriguing take on how hospitals are trying to deal with errors by staff – including consoling physicians and doctors who make mistakes. http://online.wsj.com/article/SB10001424052748704588404575123500096433436.html

The story, headlined “New Focus on Averting Errors: Hospital Culture,” leads off by noting that errors by medical staffs lead to the deaths of an estimated 44,000 to 98,000 people a year.

The piece by one of the Journal’s star reporters, Laura Landro, says that hospitals are not only addressing the problem of staff errors but are also “coming up with procedures for handling – and even consoling – staffers who make inadvertent mistakes.”

A government advisory board, the National Quality Forum, has crafted a Care of the Caregiver guide, which has hospitals treating “traumatized staffers” who made errors with patients as if they are patients, too. Those guides even suggest that such staffers take part in the investigation of the error as long as they are not believed to acted recklessly or intentionally.

Noting that sometimes hard to assign blame for an error, the story cites a case that happened at St. Mary’s Hospital in Madison, Wis., four years ago. A nurse, Julie Thao, mistakenly gave a 16-year-old teen, Jasmine Gant, about to give birth an IV with an filled with an epidural pain killer.

The baby was delivered through a Caesarian section, but the mother Gant died. Thao lost her job, and was prosecuted for criminal negligence.

St. Mary’s paid a $1.9 million settlement to dispose of the malpractice suit brought by Gant’s family.

A study on that case that will be published in the April issue of the Joint Commission Journal on Quality and Patient Safety. That study found that although Thao skirted some safety procedures, there were weak links in the safety guidelines that contributed to her error. That study was also critical of the way St. Mary’s fired Thao.

Eventually, Thao plead guilty to reduced charges of two misdemeanors, and her nursing license was suspended. But Thao, who once considered suicide, got work as a researcher with an official of the National Quality Forum.

Almost 50,000 A Year Are Killed By Infections They Pick Up While Hospitalized

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Posted on 26th February 2010 by gjohnson in Uncategorized

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Perhaps hospitals should post signs warning patients that they’re at risk of dying – from ailments they pick up while they’re being treated at those health-care facilities. Or so a new study says.

About 48,000 patients a year die from ailments – from pneumonia to blood poisoning – that they contract while hospitalized, according to a study by the Center for Disease Dynamics, Economics and Policy at Resources for the Future, a Washington think tank.

http://www.nydailynews.com/lifestyle/health/2010/02/23/2010-02-23_hospital_infections_killed_nearly_50000_in_a_year_says_a_new_study.html

The cases of patients getting an illness while hospitalized lead to 2.3 million extra patient days in hospitals, costing $8.1 billion in 2006, the study found.

Sepsis, a blood infection, killed 20 percent of the patients who got it after surgery, according to the study. Patients who contracted sepsis after surgery stayed hospitalized on average 10 days more, costing $32,900 per patient.

As one doctor lamented, a basically healthy person can come to a hospital for routine surgery, but then develop sepsis because of sloppy infection control and die.

Pneumonia was another deadly disease contracted by hospital patients. Those who got pneumonia had to stay an extra two weeks at the hospital, for an additional cost of $46,400. Over 11 percent of those who contracted pneumonia died, the study found.

Simple measures such as better hygiene, like mere handwashing, and screening patients as they check in can help decrease the number ailments that patients get while hospitalized. But enforcing those actions is difficult.

California Woman Gets $12 Million Malpractice Award After Sustaining Brain Damage From Gunshot Wound

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Posted on 16th February 2010 by gjohnson in Uncategorized

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Our reality sometimes runs squarely into irreconcilable medical facts. Our reality is that patients get lousy service in Emergency Rooms. Sometimes there is no margin for error. This story is one of those cases. One simply cannot wait your turn when you have an intracranial pressure event going on inside the brain. Any hospital that does not find a way to prioritize head injury in the Emergency Room deserves to pay the consequences.

A Southern California woman, now in vegetative state after being waiting hours in a hospital emergency room to have an air-rifle bullet removed from her brain, has been awarded $12 million by a jury, according to The Washington Post.
http://www.washingtonpost.com/wp-dyn/content/article/2010/02/12/AR2010021200089.html

The verdict in Pomona Superior Court was against Greater El Monte Community Hospital, which was found to be negligent in its treatment of Jessica Ramirez, 22. The malpractice suit was filed on behalf of Ramirez by her mother, Ofelia Reynaga.

While at a family member’s house, Ramirez was shot in the head with an air gun in September 2007. She walked into the emergency room of the greater El Monte hospital, but was left waiting for five hours.

Finally, she was taken by helicopter to Huntington Hospital in Pasadena, Calif., and underwent surgery.

But the pressure and bleeding that Ramirez sustained in the shooting caused permanent damage to her brain. She is now minimally conscious and has to have round-the-clock care.

The suit had named the hospital’s parent, AHMC Healthcare. The hospital plans to appeal the verdict.

“Despite the verdict, we strongly believe the evidence presented in this case shows that our emergency room staff provided compassionate, timely and clinically appropriate care to a patient who had suffered a catastrophic head injury,” Greater El Monte Community Hospital said in a statement.

The hospital’s insurance company had rejected a settlement that was much less than the jury verdict, according to The Post.

Woman’s Family Sues When She Sustains Brain Injury And Dies After Having Teeth Pulled

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Posted on 11th February 2010 by gjohnson in Uncategorized

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One of the greatest challenges in a career representing injured people is that it is almost always those with the greatest vulnerabilities, that have the worst results. This story about a woman who had a routine dental procedure which left her with a brain injury, which ultimately killed her, is a perfect example. Clearly this woman’s cerebral palsy made her more vulnerable to something bad happening. The medical and dental professionals involved in this case will likely argue that it was her cerebral palsy which was the problem. But for her cerebral palsy, she wouldn’t have needed the procedure at all. No defense lawyer should ever be allowed to persuade that a vulnerable person is less entitled to justice.

The survivors of a Bronx woman who suffered brain damage, and ultimately died, after having her teeth extracted have filed a wrongful death suit in the case, according to United Press International. http://www.justicenewsflash.com/2010/02/11/ny-woman-suffered-brain-damage-died-teeth-pulled_201002113316.html

The lawsuit was filed by the family of Felita Dowdy, 33, against dentist Dr. Bruce Lish and St. Luke’s Hospital in Manhattan. The case is in the Bronx Supreme Court.

Dowdy had cerebral palsy, and her teeth had rotted. She went to St. Luke’s last July 21 to have her teeth pulled.

But shortly after the extraction, the suit claims, Dowdy went into respiratory arrest and sustained brain damage as a result. She died Oct. 14. The lawsuit also alleges that the pain killers fentanyl contributed to Dowdy’s demise.

According to the story, St. Luke’s offered condolences to the Dowdy family but declined further comment. Lish’s father, dentist Dr. Jerome Lish, in the article said that his son has many disabled patients and wasn’t responsible for Dowdy’s death.

Illinois Supreme Court Strikes Down Malpractice-Damage Caps

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Posted on 5th February 2010 by gjohnson in Uncategorized

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In a controversial ruling that could have national ramifications, the Illinois Supreme Court Thursday overturned the state’s cap on damages for pain and suffering for medical malpractice, deeming the limit unconstitutional. http://www.state.il.us/court/OPINIONS/recent_supreme.asp

In the decision, which critics said will lead to higher damage awards, the high court voted 4-to-2 to throw out the limits on “non-economic” damages that can be recovered in malpractice suits. The Illinois cap had put a $500,000 maximum on damages that could be collected from physicians and $1 million from hospitals.

In its ruling, the court said that the 2005 law violated the Illinois constitution regarding separation of powers. The Court ruled that this law gave the lawmakers control of decisions that should be in the hands of judges and juries.

This marks the third time that the Illinois Supreme Court has overturned malpractice-award caps that lawmakers had enacted in the state.
http://www.chicagotribune.com/business/ct-biz-medical-malpractice-cap-feb04,0,348689.story

The test case that prompted the ruling is that of Abigaile Lebron, now 4, who sustained severe brain damage when she was born through a Caesarian section procedure in 2005. Her family sued a doctor and Gottlieb Memorial Hospital in Melrose Park, Ill., for medical negligence, charges that the physician and hospital deny.

The Wall Street Journal reported that the girl suffered from “cerebral palsy and other impairments.” http://online.wsj.com/article/SB10001424052748703357104575045624066646704.html?mod=googlenews_wsj
The young girl, Abigaile, is now wheelchair-bound.

In Thursday’s ruling, Illinois Chief Justice Thomas Fitzgerald wrote in the majority opinion that the court was not swayed by the fact that many states have imposed malpractice-award caps.

“That ‘everybody is doing it’ is hardly a litmus test for the constitutionality of the statute,” Fitzgerald wrote. http://www.chicagotribune.com/news/chi-ap-il-medicalmalpractic,0,4062339.story

But in a dissent, Justice Lloyd Karmeier wrote, “We have no business telling the General Assembly that it has exceeded its constitutional power if we must ignore the constitutional constraints on our own authority to do so.”

The Illinois high court’s decision drew fire from a variety of sources. The American Medical Association (AMA) immediately criticized the ruling.

“Today’s court decision threatens to undo all that Illinois patients and physicians have gained under the cap, including greater access to health care, lower medical liability rates and increased competition among medical liability insurers,” AMA President Dr. James Rohack said in a statement.

The New York Times noted that the Illinois decision “held a particular sting” for the AMA, since it is headquartered in Chicago. http://www.nytimes.com/2010/02/05/us/05malpractice.html


And The Chicago Tribune blasted the ruling in an editorial, warning, “This is a disastrous decision…Watch out for what happens now.” http://www.chicagotribune.com/news/opinion/editorials/ct-edit-medmal-20100204,0,5948924.story

“Malpractice costs were skyrocketing in Illinois because insurers were afraid to do business here,” The Tribune editorial said. “They were afraid of runaway jury verdicts…Malpractice premiums in Illinois were particularly egregious for doctors in riskier specialties such as obstetrics and neurosurgery. As a result, doctors were leaving, particularly doctors in rural areas. They couldn’t afford to practice in their communities. That made it more difficult for patients to find the care they needed. The 2005 law eased the crisis. Malpractice premiums declined. The exodus of doctors stopped.”

But opponents of malpractice-award caps, which are being considered by lawmakers in Washington, were jubilant.

The American Association for Justice, once called the Association of Trial Lawyers for America, said the Illinois ruling showed “why federal efforts to put arbitrary limits on the amount injured patients receive won’t pass muster or fix America’s broken health system,” The Times reported.

The Illinois Trial Lawyers Association also lauded the ruling.

“The Illinois Supreme Court has decided that the health-care crisis can not be solved by further hurting the patients who are victims of medical errors,” the lawyers’ group said in a statement.

The Illinois ruling could reverberate to the Capitol, where Republican lawmakers have called for federal caps on malpractice awards. The health-care reform House bill that Congress Democrats passed last year, and the Senate health-care bill, do not mandate any big change to malpractice rules, according to The Times.

Almost 30 states have set caps that put a maximum on non-economic damages, namely damages for pain and suffering, Reuters reported. http://www.reuters.com/article/idUSN0411041820100204
Those caps range from $250,000 to $700,000, according to the Robert Wood Johnson Foundation.

The AMA said that in 16 states courts have upheld the caps. In 11 states the limits have been thrown out.

Generally, these Caps have done little to lower rates. But whether rates are lowered or not is not the central issue. The issue is whether doctors should be given a free pass on killing and maiming those that suffer because of their mistakes. Despite the constant right wing hysteria over med mal awards, the reality is that only the most egregious conduct by doctors results in a lawsuit, and about 85-90% of even those lawsuits, result in verdicts for the doctors. A doctor has to do something truly outrageous to wind up losing a medical malpractice case.

What is violative of equal protection about a malpractice cap, is that it punishes those most severely hurt by the worst conduct of doctors. If a doctor say cuts off the wrong toe, the compensation cap of $250,000 might be adequate. But if the doctor’s wrongful conduct results in loss of the normal use of a brain, then $250,000 is not justice. Yet a cap imposes the worst injustice on those who have the worst harm. That is unfair and unjust.

Hospital told to pay damages for mistaking babies

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Posted on 20th July 2009 by gjohnson in Uncategorized

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Even under American law, this would be a tough case to determine damages. How does a couple effectively argue that they have been wronged for loving a child for 16 years, even if it is the wrong child? Similar issues have thwarted efforts to get compensation for botched birth control methods as well. But those issues notwithstanding, $55,793 for giving a couple the wrong child, seems a little on the light side.

What happened to the other child? Isn’t that a form of kidnapping?

And what about the other family?

Attorney Gordon Johnson
http://tbilaw.com
http://waiting.com
http://fishtail.tv

Date: 7/20/2009 7:08 AM

SEOUL, South Korea (AP) — A South Korean court has ordered a hospital to pay 70 million won ($55,793) in damages to a couple that raised the wrong daughter for 16 years because of a hospital mistake.

Seoul Central District court judge Kim Sung-soo said Monday the court made the ruling earlier this month. He did not give details.

Local media say the couple gave birth to a baby girl at the hospital in 1992. They began suspecting she may not be their daughter because her blood type A did not match theirs.

A DNA test confirmed their suspicions and the hospital acknowledged their mistake last year.

The hospital is refusing to disclose information on their biological daughter citing privacy.

Copyright 2009 The Associated Press.

TV ad war begins over health overhaul

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Posted on 6th July 2009 by gjohnson in Uncategorized

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Date: 7/6/2009 5:40 PM

EDITOR’S NOTE — An occasional look at political ads and what’s behind them.
By ALAN FRAM

Associated Press Writer

WASHINGTON (AP) — Staring at the camera, Canadian citizen Shona Holmes says a brain tumor would have killed her had she relied on her government-run health plan that would have provided treatment far too late. “Now, Washington wants to bring Canadian-style health care to the U.S.,” a narrator says darkly.

The television ad from a conservative group is dramatic — but deceptive.

In fact, President Barack Obama and Democrats pushing to overhaul health care want to create an optional, government-run plan to compete with private insurers, not replace them. As Obama told a health forum last week, “We’re not suddenly just going to completely upend the system. We want to build on what works about the system and fix what’s broken about the system.”

The ad is part of a handful of commercials that are expected to grow this summer in both numbers and criticism as detailed health bills emerge from Congress and dozens of interest groups, companies and labor unions tussle over influencing lawmakers.

Through June 27, $31 million has been spent for roughly 47,000 TV ads on health care this year, says Evan Tracey, president of the Campaign Media Analysis Group, a firm that tracks issue advertising. That’s double the roughly $14 million the insurance industry spent in 1993 and 1994 for the famous “Harry and Louise” ads credited with helping kill President Bill Clinton’s health care drive, but a fraction of the $250 million Tracey guesses will ultimately be spent this year.

Hoping to shape the early debate, the initial ads are “really being aimed at some people in the administration, some people on Capitol Hill, a whole bunch of reporters, a few bloggers,” Tracey said. As Congress’ direction becomes clearer and interest groups seek public support, “then I think you’re going to see the spending go on a hockey stick curve straight up,” he said.

So far, Tracey said about $15 million has been spent on ads favoring the Democrats’ push to revamp the health care system and $4 million to oppose it. Another $12 million has gone to ads generally favoring better health care — nearly all of it by the Pharmaceutical Research and Manufacturers of America, representing drug makers, which hopes its market will expand if more people have insurance.

These figures might be too low, with several groups reporting higher figures reflecting costs Tracey doesn’t track.

Ken Johnson, spokesman for the pharmaceutical group, says the association has spent tens of millions on television ads since late 2008, thanking lawmakers for supporting previous health initiatives or urging them to support a comprehensive effort this year.

“It’s conditioning the environment, it’s setting the table for the debate to come,” he said.

The ad with Shona Holmes — who says she borrowed and saved money for a crucial operation in the United States — exemplifies how groups are intent on bending the debate toward their agendas.

Its sponsor, Patients United Now, is an offshoot of the Americans for Prosperity Foundation, a privately funded, Washington-based conservative group that believes in limited government and cutting taxes. Among its directors are businessman and conservative activist Art Pope and James C. Miller, a top Reagan administration official.

The group says it has spent nearly $1.8 million running the ad in Washington, D.C., and 11 states with senators on committees writing health care bills or ones seen as wavering. Patients United spokeswoman Amy Menefee says the ad is fair because giving government more control over health care would be a slippery slope toward increasing the federal role, and because some Democrats still favor government-only insurance.

Dominating the spending among opponents is Conservatives for Patients Rights, led and largely financed by Rick Scott, who was ousted as chief of the Columbia/HCA health care company during a fraud probe that ultimately saw the firm plead guilty to overbilling charges. Spokesman Brian Burgess says the group has spent over $4.5 million on TV ads that have run hundreds of times this year, mostly criticizing public health coverage.

On the other side, progressive and labor groups have not been shy about using ads to assail Democrats viewed as insufficiently loyal in the struggle.

Health Care for America Now says it plans to spend $11 million on TV ads. The group is funded by labor, liberal groups and the progressive Atlantic Philanthropies, an international grant-making foundation whose president, Gara LaMarche, worked previously for billionaire Democratic donor George Soros.

Its latest ad: A $1.1 million campaign aimed at prodding senators of both parties from 10 states to support a public health insurance option. Targets include Sen. Ron Wyden, D-Ore., who HCAN says has not shown strong enough support for the government-run option.

“Tell Senator Wyden, it’s your health, it should be your choice,” the ad says.

MoveOn.org and other liberal groups began airing a 60-second ad on Friday in Louisiana criticizing Sen. Mary Landrieu, D-La., for not yet embracing a public insurance plan. They also dropped plans to run ads challenging Sen. Kay Hagan, D-N.C., after she expressed support for a bill containing a government insurance option.

Last Tuesday, the Laborers International Union of North America began airing ads in the home states of Sens. Max Baucus, D-Mont., and Kent Conrad, D-N.D., criticizing them for considering a tax on workers’ employer-provided medical benefits to help finance the overhaul.

Union spokesman Jacob Hay says the ads, which had been scheduled to run through Friday, were pulled after a request from Baucus aides. Baucus has agreed to meet with the union’s president, Terence O’Sullivan, to discuss the legislation.

“Ads really do get their attention quickly,” Hay said.

Copyright 2009 The Associated Press.

Coroner criticizes doctors over girl who starved

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Posted on 16th February 2009 by gjohnson in Uncategorized

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Date: 2/16/2009


LONDON (AP) — An 8-year-old girl starved herself to death because of an extreme dental phobia that doctors failed to diagnose properly, a British coroner said Monday.

Coroner Emma Carlyon said staff did not realize the severity of the condition afflicting Sophie Waller, who died in December 2005. Carlyon said this prevented the girl “from receiving the medical support that could have prevented her death.”

Witnesses at the inquest testified that Sophie had an extreme phobia of dentists and refused to eat, sleep or drink after her baby teeth became loose. Medical staff ultimately decided to pull out all her baby teeth under general anesthetic in November 2005.

She was sent home a few days later but would not eat and died three weeks after the operation.

Her parents said they contacted doctors and a psychologist but no one saw Sophie in person before she died.

The Royal Cornwall Hospital in Truro, 250 miles (400 kilometers) southwest of London, acknowledged there had been failures in Sophie’s care, and said it had made changes.

A coroner’s inquest is required in Britain to establish the facts when someone dies unexpectedly, violently or of unknown causes, but has no power to punish anyone.

Carlyon gave a narrative verdict, in which a coroner simply outlines the circumstances that led to the death or deaths.

She said the immediate cause of Sophie’s death was kidney failure due to dehydration and starvation.

Copyright 2009 The Associated Press.

Rapid rise seen in fatal medication errors at home

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Posted on 28th July 2008 by gjohnson in Uncategorized

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Date: 07/28/2008 04:04 PM

By CARLA K. JOHNSON
Associated Press Writer

CHICAGO (AP) _ Deaths from medication mistakes at home, like actor Heath Ledger’s accidental overdose, rose dramatically during the past two decades, an analysis of U.S. death certificates finds.

The authors blame soaring home use of prescription painkillers and other potent drugs, which 25 years ago were given mainly inside hospitals.

“The amount of medical supervision is going down and the amount of responsibility put on the patient’s shoulders is going up,” said lead author David P. Phillips of the University of California, San Diego.

The findings, based on nearly 50 million U.S. death certificates, are published in Monday’s Archives of Internal Medicine. Of those, more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs.

Deaths from medication mistakes at home increased from 1,132 deaths in 1983 to 12,426 in 2004. Adjusted for population growth, that amounts to an increase of more than 700 percent during that time.

In contrast, there was only a 5 percent increase in fatal medication errors away from home, including hospitals, and not involving alcohol or street drugs.

Abuse of prescription drugs plays a role, but it’s unclear how much. Valid prescriptions taken in error, especially narcotics such as methadone and oxycodone, account for a growing number of deaths, said experts who reviewed the study.

The increases coincided with changing attitudes about painkillers among doctors who now regard pain management as a key to healing. Multiple prescription drugs taken at once — like the sleeping pills, painkillers and anxiety drugs that killed “Dark Knight” star Ledger — also play a part, experts said.

“When we see overdoses, we’re seeing many more mixed drug overdoses,” said Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners and director of autopsies at the University of Michigan in Ann Arbor. Jentzen said autopsies are much more likely to include toxicology tests today than 25 years ago, which would contribute to finding more fatal medication errors as cause of death.

But Phillips said there were no significant increases in other poisonings like suicidal overdoses or homicides, so more testing doesn’t explain the huge increase. The analysis excluded suicides, homicides and deaths related to side effects.

The increase was steepest in death rates from mixing medicine with alcohol or street drugs at home; that death rate climbed from 0.04 per 100,000 people in 1983 to 1.29 per 100,000 people in 2004.

Many patients ignore the risk of mixing alcohol with prescriptions, said Cynthia Kuhn of Duke University Medical Center, who was not involved in the study.

“They think, ‘Oh, one drink won’t hurt.’ Then they have three or four,” Kuhn said.

The increase in deaths was highest among baby boomers, people in their 40s and 50s.

“We’re sort of drug happy,” said boomer Dr. J. Lyle Bootman, the University of Arizona’s pharmacy dean, who was not involved in the research. “We have this general attitude that drugs can fix everything.”

People share prescriptions at an alarming rate, Bootman said. One recent study found 23 percent of people say they have loaned their prescription medicine to someone else and 27 percent say they have borrowed someone else’s prescription drugs.

Kenneth Kolosh, a statistics expert at the National Safety Council, praised the study but said improved attention to coding location on death certificates may account, in part, for the huge increases the researchers found.

Phillips countered that home deaths from any cause increased relatively little during the time period, so better coding doesn’t explain the change.

Michael R. Cohen, president of the Institute for Safe Medication Practices, said more states should require pharmacists to teach patients about dangerous drugs and insurers should pay pharmacists to do so.

___

On the Net:

Archives of Internal Medicine: http://www.archinternmed.com

Copyright 2008 The Associated Press.