Editore"s Note
Tilting at Windmills

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January 22, 2006
By: Kevin Drum

MALPRACTICE WATCH....Last month, in a review of Tom Baker's The Medical Malpractice Myth, I mentioned briefly that patients sometimes file malpractice suits simply to obtain information about their own treatment. They do this because hospitals routinely refuse to disclose information about their quality of care unless they are taken to court.

Some readers wondered if this could really be true. Check this out:

Claudia Mejia gave birth eight and a half months ago....Twelve days after giving birth at Orlando Regional South Seminole hospital, she was transported to Orlando Regional Medical Center where she became a quadruple amputee. Now she can not care for or hold her baby.

"Yeah, I want to pick him up. He wants me to pick him up. I can't. I want to, but I can't," she said. "Woke up from surgery and I had no arms and no legs. No one told me anything. My arms and legs were just gone."

....Her attorney, Judy Hyman wrote ORHS a letter saying, according to the Florida statute, "The Patients Right To Know About Adverse Medical Incidents Act," the hospital must give her the records....The hospital's lawyers wrote back, "Ms. Mejia's request may require legal resolution." In other words, according to their interpretation of the law, Mejia has to sue them to get information about herself.

Don't get me wrong. I don't think the doctors at Orlando Regional Medical Center just hacked off Mejia's arms and legs for no reason. She had contracted both a flesh eating bacteria and toxic shock syndrome, and amputation might very well have been the only option.

Still, if I woke up from surgery with no arms or legs, I'd want to know every last detail about what happened to me. Why should I have to file a lawsuit to get that?

Via QandO.

Kevin Drum 8:18 PM Permalink | Trackbacks | Comments (101)

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Comments

A little tangental, but with Florida being such a cesspool of Republicanism, how did they acquire the various progressive/liberal statutes that keep coming up? Like the sunshine law, now this about patient's rights.

Posted by: alan on January 22, 2006 at 8:31 PM | PERMALINK

That is just amazing. From the sound of it, they didn't tell her husband beforehand either. You would think amputation would require some kind of informed consent from the next-of-kin, at least, even if the patient was incapacitated.

Posted by: MJ Memphis on January 22, 2006 at 8:33 PM | PERMALINK

> Why should I have to file a lawsuit to get that?

The counterargument being "I had a tiny patch of flesh eating bacteria on my arm, but it was fully cured. Why should my medical records of that incident be disclosed to a 3rd party, and then presumably in open court, when I don't want them to? If I lose medical insurance or a future job as a result, who will compensate ME for that"? That is what HIPPA was designed to address.

So how so you split that baby?

Cranky

Posted by: Cranky Observer on January 22, 2006 at 8:36 PM | PERMALINK

this is a weird story ... the thing which could compound this even worse is if the docs accidentally left something inside of her in her initial delivery (if it was a c-sxn) or if the tampons they used after a vaginal delivery for residual bleeding caused the toxic shock.

this is a partial story ... hard to prognosticate. Unfortunately, the hospital's reluctnce may be speaking towards some ass-covering.

... on another note, pakistan is flatly denying and the US is backing away from claims that the bombmaker was killed in the civilian massacre last week. ... on CNN's website now.

Posted by: Nads on January 22, 2006 at 8:40 PM | PERMALINK

I think the hospital views her request as the usual preliminary to a lawsuit and so understandably their lawyers are the ones who have taken over this issue. By having an adversarial tort-based malpractice system in the first place, it encourages these sort of annoying obstructive tactics (common to any sort of civil lawsuit) and needless expenditure by both sides. Basically again we have a situation where precious health care resources are eaten up by a system which does not compensate victims (note the fact that most malpractice victims receive nothing and those who do receive a lot are not victims ie cerebral palsy patients), does not punish wrongdoers (most doctors who do commit malpractice are actually well liked by their patients and do not get sued while most who do get sued tend to be in certain fields where it is profitable to sue like ob gyn or neuro) and does not change medicine for the better (we have the same error rates as countries where malpractice suits are not permitted like NZ). The only beneficiaries of the current system are in fact malpractice lawyers and the democratic party which tends to receive the majority of their political contributions.

So thus, Kevin, I think your question shows a sincere lack of understanding about why ppl act the way they do in the health care system. You are also welcome to spend a day in my hospital and see just how much time and money is wasted in 'protecting' against lawsuits (futile attempts in my opinion) by doctors, nurses and the hospital administration. In no way am I saying this is the only or the most severe problem in our health care system but it is also one of the most easily fixed (see how Sweden for example handles this same issue) and those who want to oppose tort reform need to acknowledge that they do so for ideologic reasons and not practical ones.

Posted by: v on January 22, 2006 at 8:42 PM | PERMALINK

The counterargument being "I had a tiny patch of flesh eating bacteria on my arm, but it was fully cured. Why should my medical records of that incident be disclosed to a 3rd party, and then presumably in open court, when I don't want them to?

I'm sorry, I don't follow. Kevin writes about a patient having access to his or her own records. What does this have to do with 3d parties having acccess to those records over the objection of the patient?

Posted by: Don on January 22, 2006 at 8:42 PM | PERMALINK

I saw this report on CNN a couple of days ago and I was totally amazed that the hospital would not release the information to the patient about why this procedure seemed to be necessary. What we have is a young woman who I would presume to have had some degree of decent prenatal care which would require regular visits to her doctor. Where did this flesh eating bacteria come from and why did it appear so suddenly that such drastic measures were called for during something which should have been as simple as childbirth?

Seems to me there are many more questions begging for answers here.

Posted by: fred on January 22, 2006 at 8:43 PM | PERMALINK

The only beneficiaries of the current system are in fact malpractice lawyers and the democratic party which tends to receive the majority of their political contributions.

... and insurance companies. anyone who neglects to mention THAT clearly is doing so for ideological reasons.

Posted by: Nads on January 22, 2006 at 8:44 PM | PERMALINK

I don't think the doctors at Orlando Regional Medical Center just hacked off Mejia's arms and legs for no reason. She had contracted both a flesh eating bacteria and toxic shock syndrome, and amputation might very well have been the only option.

Perhaps, but there is such as thing as "informed consent". No one should have the right to hack off any limb without the patient having given their consent.

Posted by: Don on January 22, 2006 at 8:45 PM | PERMALINK

v, all of that information would come out in discovery anyway, so why not just be up front with it? Assume there's going to be a lawsuit and release the information. It will actually save them from lawsuits in the long run if everybody no longer has to sue to get the information they'd get by suing. I think your comment shows a basic lack of understanding of the legal system. An adversarial system is not the problem. It's time-honored and has served us well for a couple of centuries.

Transparency would avoid both lawsuits and prevent mistakes. If there are legitimate systemic problems causing mistakes (which I believe there are), sunlight is the best disinfectant.

Posted by: Michael Ditto on January 22, 2006 at 8:51 PM | PERMALINK


Posted by: Speachless & Appalled on January 22, 2006 at 8:52 PM | PERMALINK

V: If you clicked the link, you'd see that my original post on this subject also discusses some remedies that are similar (though not identical) to the ones you propose. I think we all understand the motivations of the various actors here pretty well.

Posted by: Kevin Drum on January 22, 2006 at 8:59 PM | PERMALINK

So what does this story have to do with the Malpratice Myth? Are you saying this is very common?

Posted by: Freedom Fighter on January 22, 2006 at 9:01 PM | PERMALINK

V, the reason I am opposed to "tort reform" is that Republican proposals are designed with the goal of reducing the income of lawyers as much as possible, regardless of the effect on the health of patients. Furthermore, I'll support tort reform if we get nationalized health care.

Posted by: marky on January 22, 2006 at 9:05 PM | PERMALINK

Nads on January 22, 2006 at 8:40 PM:

...on another note, pakistan is flatly denying and the US is backing away from claims that the bombmaker was killed in the civilian massacre last week...

Don't forget the link...Seems as if someone(s) were a little too eager to report some progress in the endless War on Terror...

Posted by: grape_crush on January 22, 2006 at 9:08 PM | PERMALINK

Her attorney, Judy Hyman wrote ORHS a letter saying, according to the Florida statute, "The Patients Right To Know About Adverse Medical Incidents Act," the hospital must give her the records....


This is not a malpractice case or anything like one. It's more like a FOIA request.

Posted by: Thinker on January 22, 2006 at 9:13 PM | PERMALINK

This story sounds inaccurate to me. I am a hospital-based physician with a personal interest in information systems. The HIPAA Act (Health Insurance Portability and Accountability Act) passed during the Clinton administration (1996 Kennedy-Kassebaum Act) states explicitly that patient's medical records are open to the patient. It is ILLEGAL for a doctor, hospital, clinic, etc. to deny a patient access to his/her medical record. That doesn't mean of course that the patient can remove their records or tamper with them (though they may be able to legally annotate them, but I am not sure why anyone would want to.) The flip side to the HIPPAA is that it also states who, besides the patient, may legally access the medical record. Only physicians and healthcare workers who are directly responsible for that patient's care can do so. This is a serious law which carries fines that range from $25,000 to $250,000 and 10 years jail time. It has also caused significant expense (and hassle) within the medical field. However, as a hospital based doctor, I can tell you that this is the current law and in wide effect. It is seriously taken, and followed strictly. I believe every hospital, clinic and private practice in America not only follows this law, but also has identified specific HIPAA coordinators to ensure that it is carried out.

If you're interested, here are some links:

http://www.hipaadvisory.com/regs/HIPAAprimer.htm
http://privacyruleandresearch.nih.gov/

Eric

Posted by: eric on January 22, 2006 at 9:19 PM | PERMALINK

V: If you work at a hospital, you must acknowledge that some of the best "doctoring" ocurrs to the medical records in order to practice "preventive medicine". There is a pervasive "Us" versus "them" mentality-- in which EVERY patient is viewed with disdain when it comes to any mishap. Moreover, any one who has studied the issue knows claims are DOWN, payouts have been generally static, and any so-called insurance crisis has been purely a function of reduced rate-of-return due to sub-par market investment returns. In doctors, the Repugnants have found a sympathetic tool in order to try to hit the pocketbook of one of the largest Dem supporters-- trial lawyers. So go ahead, be a tool...

Posted by: tjschill on January 22, 2006 at 9:22 PM | PERMALINK

"ORMC said Mejia is requesting information on if there were other patients or someone on her floor with the streptococcus. They said, if they release that to her, that would be a violation of other patients' rights."

This is the bit that's requiring legal resolution.
She's trying to get info on other patients.

On the permission for the surgery - I would question that she doesn't know. She's probably been coached by her lawyers not to lie, but selective memory that might help her case would not hurt.

Posted by: McA on January 22, 2006 at 9:29 PM | PERMALINK

Regarding informed consent, it seems more likely that the amputations were a desparate life-saving treatment--under those circumstances, the patient is not usually in a position to give informed consent. It would be prudent to attempt to contact husband, if time permits. Otherwise, life-saving measures can be undertaken without informed consent of the patient.

There is more to this story. It doesn't make sense that the patient was given no information. With all the health care providers involved in her recovery care, the odds are that at least some of them attempted to explain it to the best of their ability.

Posted by: Bad Shift on January 22, 2006 at 9:44 PM | PERMALINK

McA on January 22, 2006 at 9:29 PM:

This is the bit that's requiring legal resolution. She's trying to get info on other patients.

Or, as stated in the news item, information as to how "she caught streptococcus, during labor or after." The hospital doesn't have to release names, just incidents of exposure to unnamed patient(s) who had streptococcus...smells like the hospital is trying to cover something up...

On the permission for the surgery - I would question that she doesn't know.

Being the unsympathetic outsourced McAss that you are, I can see how you would question that.

She's probably been coached by her lawyers not to lie, but selective memory that might help her case would not hurt.

Nice attack on a quadruple amputee mother of two, McA...You are such a class act...

Posted by: grape_crush on January 22, 2006 at 9:52 PM | PERMALINK

On the permission for the surgery - I would question that she doesn't know. She's probably been coached by her lawyers not to lie, but selective memory that might help her case would not hurt.
Posted by: McA

no ... despite what right wingnuts call that, most people call that lying.

although there are other possibilities ... toxic shock is ... well ... shock. The rules for infomed consent (and informed refusal) are different between states. ... In a situation like this, a presumably otherwise normal patient in a life-threatening situation, the MDs may have figured that if she were competent (and not deleriously sick) she WOULD HAVE consented to the surgery, which they would have deemed emergent.

Not knowing much beyond what's been given, I would add that in a situation like this, the presumed caretaker (that's the husband for you schiavo fans) would have been notified and allowed to consent based on what he figures his wife would want. It is weird that people are claiming that NO ONE knew what had happened and why.

... and upon reading, I realize Bad Shift has made every point I had planned to make ... and more succinctly, I might add.

Posted by: Nads on January 22, 2006 at 9:54 PM | PERMALINK

o ... despite what right wingnuts call that, most people call that lying.

Posted by: Nads on January 22, 2006 at 9:54 PM | PERMALINK

Yup, but that bit is legally not prosecutable. Its impossible to prove someone in that circumstances has not forgotten she signed a document or something...

----------------------

just incidents of exposure to unnamed patient(s) who had streptococcus...smells like the hospital is trying to cover something up...

Posted by: grape_crush on January 22, 2006 at 9:52 PM | PERMALINK

Would you allow a former abortion receiver who feels she wasn't warned on her depression to get the records of every abortion in that clinic for a few years so she can see if they are trying to cover up other cases of post-abortion depression?


Posted by: McA on January 22, 2006 at 10:00 PM | PERMALINK

Bad Shift on January 22, 2006 at 9:44 PM:

It doesn't make sense that the patient was given no information. With all the health care providers involved in her recovery care, the odds are that at least some of them attempted to explain it to the best of their ability.

Unless they were:

A) Threatened with the loss of their jobs, and/or
B) The infection occurred at the Orlando Regional South Seminole hospital where she gave birth, with no/limited detail given to the Orlando Regional Medical Center, where her limbs were amputated...This would open up the possibility that the while the staff was able to tell Mejia why it was necessary to amputate her limbs, they could not tell her when or how she became infected.

But then again, the whole issue could be just about differering interpretations law and an emphasis on patient's rights...

Posted by: grape_crush on January 22, 2006 at 10:07 PM | PERMALINK

It doesn't make sense to me that "we" are arguing over an issue with a huge gaping hole where information should be. The gap being what exactly did she and her husband know/understand that the flesh eating bacteria was doing to her. The articles posted as links simply do not fill in enough information to even qualify us to comment on the informed consent issue. So far the comments posted are mostly conjecture with regard to this.

Having said that....yeah, it stinks that a new mother can't hold her baby or her husband ever again.

Our emotions shouldn't replace the facts that are not available. Sorry, I know it sounds cold, but the information gap is raising red flags in my brain.

Posted by: jcricket on January 22, 2006 at 10:09 PM | PERMALINK

Hate to break it to you little Drummer boy but you have no arms or legs as any sort of ' political animal'. Your a bit like that Knight in Monty Pythons ' The Holy Grail' movie threatening to anklebite the baddies. Have you thought about selling the masthead?

I see ' sex.com' just went off for 16 mill.

Stop embarresing yrself Kevin. Someone will take care of you when you retire - like ' Boxing Helena' we'll get Anne Coulter to nurse you. Hows that sound?

Posted by: professor-rat on January 22, 2006 at 10:22 PM | PERMALINK

More from the McAristotle collective:

McA on January 22, 2006 at 10:00 PM

Would you allow a former abortion receiver...blah blah blah... of post-abortion depression?

Apples to oranges, and a weak attempt at a distraction. Do try to focus, will you?

McAristotle on January 22, 2006 at 10:06 PM:

I'm not sympathetic whenever I see a media story trying to play the sympathy card.

So heartlessness is a characteristic of the McA collective, yes?

Because its written that way, being biased against the intent of the article helps me not miss little facts.

ROFL! 'You' and 'facts' go together like 'Dubya' and 'eloquent'...Mischaracterizations both...

Note the thing about finding out if their was other infections on her floor is right at the end..as if an editor put it in to cover someone's ass.

Or maybe to explain why the hospital is refusing to hand over Meija's information...Note to Rove: Another thousand or so will buy you smarter outsourced trolls...

I'd say the facts of this case depend on exactly what was requested of other patients.

Yeah, it would be helpful to know what was requested to fully understand the hospital's odd behavior...As usual, it's not enough info from a transcript of a 2-1/2min TV segment...

Its a great trap really. Make something look reasonable when the target can't comply then use media pressure.

The target could comply by simply stating whether or not Mejia was exposed to any patients with streptococcus infection...Either way, the central queston remains: How does a person under hospital care go into toxic shock and contract a flesh-eating bacteria?

Lots and lots of pressure - possible leading up to a quick big settlement.

If the hospital is at fault, then I have no problem with a 'quick big settlement'...

Lawyers on a fixed percentage make a lot more money from a quick settlement than a long fight.

And defendants often opt to settle early when they know they are at fault. Your point is?

The only thing protecting the client from their conflict of interest is their -koff- ethical code.

Kinda like Congressional Republicans deciding how to clean up their own corruption, eh?

Posted by: grape_crush on January 22, 2006 at 10:54 PM | PERMALINK

Waddya call a man with no arms and legs on your front porch?
Matt

Waddya call a man with no arms or legs hanging on the wall?
Art

Waddya call his dad?
Pop Art

Waddya call a baby whose mom has no arms or legs?
Bouncy!

Posted by: Matt on January 22, 2006 at 10:55 PM | PERMALINK

We saw a little bit of this problem when my mother got transferred from a small town hospital to the big town hospital. The new doctor wanted a complete record of the IV drugs she had been given (to assess the cause and remedy of certain long term side effects) and it was like pulling teeth.

Posted by: frodo on January 22, 2006 at 11:07 PM | PERMALINK

...and this thread started out with decency.

Okay then. See you all on a new thread soon. I am so out of here.

Oh, and....YEAH SEAHAWKS!!

(Really..it is about time. The 12th man has been really a patient -and now deserving- crowd.)

Posted by: jcricket on January 22, 2006 at 11:10 PM | PERMALINK

Whattya call a man with a rabbit up his ass?

Warren.

Posted by: floopmeister on January 22, 2006 at 11:17 PM | PERMALINK

http://www.cbc.ca/news/background/hospital-infections/mrsa.html

http://www.cbc.ca/story/canada/national/2005/03/21/infections-canada050321.html

Note that Canada is having quite a problem with it at present. Again proving the universal health care isn't a magic wand...

Posted by: McA on January 22, 2006 at 11:21 PM | PERMALINK

http://www.mdcoastdispatch.com/landonappeal100605.html

And here's a case of a doctor winning a case of this sort under appeal.

Posted by: McA on January 22, 2006 at 11:23 PM | PERMALINK

As said above, HIPAA prohibits the release of information that could be traceed to a patient. Given the limited number of patients on a floor, providing any other information about patients in response to the question could breach HIPAA. Furthermore, what her lawyers appear to be seeking is material from the hospital QA and risk management files, which historically has usually been kept inaccessible as attorney work-product,etc. However, Florida has passed a law which apparently overrides this privilege. But the hospital is contending that the law only applies when a law suit is filed (this is what I glean from the link, anyway).

The current legal system just doesn't provide much of an incentive for the health care providers to be forthcoming.

Posted by: sj on January 22, 2006 at 11:28 PM | PERMALINK

Note that Canada is having quite a problem with it at present. Again proving the universal health care isn't a magic wand...

And another freeper strawman bites the dust.

Posted by: floopmeister on January 22, 2006 at 11:42 PM | PERMALINK

What do you call a man with no arms or legs in your mailbox? Bill!

What do you call a man with no arms or legs in a hole in the ground? Phil!

What do you call a woman with no arms and legs who's propped up against a wall? Eileen!

What do you call a man with no arms or legs in a swimming pool? Bob!

What do you call a man with no arms or legs in a pot on the stove? Stew!

What do you call a man with no arms or legs on the president's desk? Vito!

What do you call a man with no arms or legs in a coffee urn? Joe!

What do you call a woman with no arms or legs buried in your garden with her head poking up? Daisy!

What do you call a woman with no arms or legs that someone stuffed into your car's gas tank? Ethel!

What do you call a man with no arms or legs grilling on your BBQ? Frank! What's his wife's name? Patty!

What do you call a man with no arms or legs in a probate court filing cabinet? Will!

What do you call a woman with no arms or legs squeezed into a cut-crystal decanter? Sherry!

What do you call a ... oh shit, nevermind.

Although none of these are anywhere near as funny as floopmeister's Warren :)

Bob

Posted by: rmck1 on January 22, 2006 at 11:50 PM | PERMALINK

The problem with tort reform is that it addresses a non-existent problem. Insurance companies, not attorney's and patient lawsuits, are the ones that set the malpractice insurance rates. And those rates are based, not on the losses they've suffered through claims, but on their own greed. They will continue to gouge doctors and hospitals for all they can get, then try to blame attorneys. In Hawaii, the number of malpractice claims is very low, but docs here have to pay rates just as high as those in other markets where there are a greater percentage of claims per patient population.

Oh yeah, almost forgot . . . GO SEAHAWKS, BEAT THE HELL OUT OF PITTSBURGH!!!

Posted by: DevilDog on January 22, 2006 at 11:51 PM | PERMALINK

Re just telling her if she was exposed from other patients, I doubt that HIPAA would allow that unless the hospital got permission from the other patient(s) who may have exposed her.

That might even be true even if they did not give her the name - I doubt the HIPAA rules on what kind of disclosures are allowed are particularly easy to apply to this fact case.

Posted by: Michael Friedman on January 23, 2006 at 12:12 AM | PERMALINK

rmck1, you're a real asshole.

Whatever else this story is, it is not funny.

Posted by: Michael Friedman on January 23, 2006 at 12:14 AM | PERMALINK

Oh, and same goes for Matt.

Posted by: Michael Friedman on January 23, 2006 at 12:15 AM | PERMALINK

grape_crush:

Don't forget the link...Seems as if someone(s) were a little too eager to report some progress in the endless War on Terror...

Don't forget, it was also Pakistan sources that were saying the terrorists had been killed. Pakistan has been all over the place on this, which is why it would be smart to wait for a DoD or other announcement on this.

Posted by: tbrosz on January 23, 2006 at 12:19 AM | PERMALINK

Mr Friedman: I think you're missing the point.

The "Whattya call a man..." jokes are actually off topic.

Posted by: floopmeister on January 23, 2006 at 12:22 AM | PERMALINK

Well...Sen. Frist has such a spotless record of long distance diagnostics...why not ask him?

Posted by: S Brennan on January 23, 2006 at 12:38 AM | PERMALINK

"flesh eating bacteria"

That is some scary shit.

Posted by: Boronx on January 23, 2006 at 12:48 AM | PERMALINK

Michael Friedman:

Did I say a word about the story?

My stupid one-liners may have been extremely lame and the product of momentary boredom -- but I beg to differ as a general principle:

Gallows humor can be quite funny, indeed.

Bob

Posted by: rmck1 on January 23, 2006 at 12:56 AM | PERMALINK

How can it be constitutional for the hospital to withold information about your own body?

Posted by: doug r on January 23, 2006 at 12:59 AM | PERMALINK

Boronx: yeah, but sometimes it's not as bad as the story makes it out to be. For instance, the bite of the much maligned White Tailed Spider in Australia was supposed to cause flesh rotting disease.

The little buggers are everywhere in Australia - in houses, under beds, etc:
"...because the spiders were usually encountered between bedclothes, towels or in clothing..."

They are nomadic hunters (no web). The thought that a bite could lead to amputation was pretty damn scary, let me tell you...

Turns out to have been a false alarm.

Posted by: floopmeister on January 23, 2006 at 1:05 AM | PERMALINK

Jumping rashly (pun intended) into the realm of metaphor, this story is the single best parabolic representation of how I've felt nearly every single morning waking up in the U.S. for the last 5 years.

Posted by: The Confidence Man on January 23, 2006 at 1:10 AM | PERMALINK

streptococcus -- isn't that strep throat?

A serious sore-throat-on-steroids that you had better take care of -- but I had never heard of it having flesh-eating consequences. Is this some new strain that has mutated into a superbug because of antibiotics?

Bob

Posted by: rmck1 on January 23, 2006 at 1:12 AM | PERMALINK

Okay, here's what I don't understand ...

I can understand if the hospital needs to protect the privacy rights of a patient who might have given this woman the strep infection.

But why in god's name can't the doctors *explain what happened to her* and simply omit the person's name? "You caught it from a patient here -- we can't tell you who."

I don't think her son is really interested in who made his mom sick -- the poor kid would just like to know what the flock happened to her..

Bob

Posted by: rmck1 on January 23, 2006 at 1:18 AM | PERMALINK

Is this some new strain that has mutated into a superbug because of antibiotics?

Bob

Posted by: rmck1 on January 23, 2006 at 1:12 AM | PERMALINK

Yes. Its a superbug. See the CDC link.

Posted by: McA on January 23, 2006 at 1:56 AM | PERMALINK

constitutional for the hospital to withold information about your own body?

Posted by: doug r on January 23, 2006 at 12:59 AM | PERMALINK

Again proving liberals can't read - and just act from the bleeding heart. Read the end of the linked article.

Other bodies are involved.

BTW - I'm cool with precedent being set for this that allows a single abortion complainee to get the statistical records for the entire clinic.

So a judge should go knee-jerk and release it all.

Its bad for inflation but it serves a greater good.

Posted by: McA on January 23, 2006 at 2:04 AM | PERMALINK

That is just amazing. From the sound of it, they didn't tell her husband beforehand either. You would think amputation would require some kind of informed consent from the next-of-kin, at least, even if the patient was incapacitated.

Posted by: MJ Memphis on January 23, 2006 at 3:07 AM | PERMALINK

McA:

Well, I looked up toxic shock syndrome and flesh-eating bacteria on WebMD. It makes a lot more sense now.

It doesn't necessarily need to be a superbug; a regular staph or strep infection can set it going. All a person needs is lack of immunities to that particular strain, and it can happen in a healthy person. And this sort of thing is definitely more common in healcare environment, where these bugs tend to hang around.

Toxic shock syndrome apparently leads directly to necrotizing tissue, and once that happens amputation is often necessary. When the tissue's dead, it's dead; no chance of it coming back to life. Gangrene.

I imagine the reason the hospital is not giving out information is because it could be used in a lawsuit to claim neglegence of some kind. Who knows how the original strep infection was passed along, whether some kind of carelessness was involved. It didn't say whether the strep was airborne-transmitted or not ....

Anyway -- that's my read of the situation.

Bob

Posted by: rmck1 on January 23, 2006 at 3:21 AM | PERMALINK

It didn't say whether the strep was airborne-transmitted or not ....
Anyway -- that's my read of the situation.
Bob
Posted by: rmck1

toxic shock isn't airborn ... it's a septic reaction to microorganisms in contact with mucous membranes ... like tampons, or nasal packing, or surgical sponges left inside a body.

Posted by: Nads on January 23, 2006 at 3:32 AM | PERMALINK

Nads:

What's your gut read as a doctor?

Do you think it's probable that negligence was involved -- or could this infection just have snuck up out of nowhere and took everyone by suprise?

Bob

Posted by: rmck1 on January 23, 2006 at 3:58 AM | PERMALINK

rmck1: I feel pretty hesitant to comment on this case, mostly because there is so little info. But actually, yeah ... my gut feeling on this is that there probably IS NOT anything negligent per se ... but enough people in hospital admin are acting shady that I wouldn't rule it out. what they are "covering up" may just be a worry that they didn't catch the disease, or contain the infection fast enough to prevent amputation. multiple amputations. ... which may or may not be negligence.

the most suspicious thing for me is the timeline. childbirth has risks (a lot riskier than ... say ... abortion), but this level of infectious complication is rare. and then there's the toxic shock ...

nec fasc (flesh eating bacteria) can literally come from anywhere ... fairly innocent-looking lesions or rashes end up having penetrated to the muscle layer, and requiring amputation.

but toxic shock historically were really frequently (50% of the time) associated with super-absorptive tampons ... less so now. even so, today toxic shock occurs mostly with foreign bodies (tampons) and as post-surgical complications.

If a post-surgical infection is the cause, then that is NOT malpractice. infection is a risk of surgery ... same with a tampon to stop vaginal bleeding ... this is the right treatment. If someone gets infected, then that's unfortunate, but not negligence. foreign body after surgery is a different matter, of course.

Posted by: Nads on January 23, 2006 at 4:22 AM | PERMALINK

That is some of the saddest and scariest situations I've read about in a while. The woman's life was saved, but my God, what a price.

How often is this happening?

Posted by: Tim B. on January 23, 2006 at 4:50 AM | PERMALINK

What the fuck are trolls doing on *this* thread? This is a psychotic degree of non-self awareness. You're flaming someone who lost all their limbs? Don't you disgust even yourself?

Posted by: Alex on January 23, 2006 at 5:24 AM | PERMALINK

The original story, and some of the even more shocking comments here, sends out a message to the world loud and clear - the United States is in the grip of a terminal psychosis, and should be avoided at all costs.

Posted by: Sanity Clause on January 23, 2006 at 6:27 AM | PERMALINK

What do you call a stinking turd with a keyboard?

McAristotle.

Posted by: ahem on January 23, 2006 at 8:29 AM | PERMALINK

Whoa, I wake up and see someone repeated my comment a few hours later. What gives with that?

Posted by: MJ Memphis on January 23, 2006 at 8:30 AM | PERMALINK

You're flaming someone who lost all their limbs? Don't you disgust even yourself?

Remember, Drumtrolls yuk-yucked at Ann Coulter and Mark 'Shit' Steyn's smearing of Max Cleland. I'd like to see them try that with amputees in Walter Reed.

Posted by: ahem on January 23, 2006 at 8:31 AM | PERMALINK

"Why should I have to file a lawsuit to get that?"

You shouldn't Kevin. Plain and simple.

Posted by: Lurker42 on January 23, 2006 at 9:37 AM | PERMALINK

Still, if I woke up from surgery with no arms or legs, I'd want to know every last detail about what happened to me. Why should I have to file a lawsuit to get that?

Sorry, sir, national security. It's need to know only, and you don't need to know.

Posted by: Adam Piontek on January 23, 2006 at 9:45 AM | PERMALINK

"ORMC said Mejia is requesting information on if there were other patients or someone on her floor with the streptococcus. They said, if they release that to her, that would be a violation of other patients' rights."

Doesn't this graph from the story really answer the question?

Posted by: anotherpawn on January 23, 2006 at 11:15 AM | PERMALINK

Doesn't this graph from the story really answer the question?

Posted by: anotherpawn on January 23, 2006 at 11:15 AM | PERMALINK

Yup. But its not about thinking if you are liberal. Its about making the world fit pre-set beliefs. Then venting and feeling good about how strongly you feel about those pre-set beliefs.

Posted by: McA on January 23, 2006 at 12:09 PM | PERMALINK

When you go to a hospital, you are giving the doctors an implicit permission to do whatever they think is appropriate to save your life. Clearly, then, any adverse outcome that results from the doctors' best efforts is something that you have no right to complain about. Cruel as it may sound, it's a simple case of people taking responsibility for their own actions.

Posted by: tbrosz on January 23, 2006 at 12:10 PM | PERMALINK

Then there's also the possibility that the doctor did everything possible, but the hospital staff did not catch warning signs soon enough.

There's really not enough information to go off here, but I am currently handling a professional negligence case against a hospital staff. The patient had a heart bypass and valve surgery. The surgeon did a wonderful job and the patient is happy as a clam in butter with the surgeon.

The day after the surgery, the patient went back in for a second surgery because there was internal bleeding. This is common with such a serious surgery, and the patient doesn't have any problems with that.

BUT, when they brought him back to the cardiac intensive care unit, they wrapped the lead for the EKG monitor around his bicep and left if like that for nearly 2 days. Patient was restrained and had a tube down his throat.

Remember tying a rubber band around your finger in grade school and watching it turn purple? Medically, that's what happened to him. A surgeon came in and operated on his forearm (an eight inch incision) and hand (four incisions) to drain the blood from his lower arm. BUT, he's going to have permanent impairment and a restricted use of his arm. It's too early to tell how much (hopefully, he'll regain *most* of the use of his arm).

He has absolutely no beef with the doctor. The heart surgery went great. The hospital staff should not have hooked his EKG up that way, and certainly should have noticed his arm swelling up before it was like that for 2 days.

So, while it is difficult to do anything other than guess in the case with the Mother (the post we're commenting on), there's also the possibility that the doctor did everything right, but the staff didn't catch or respond to the warning signs soon enough.

Posted by: Dave on January 23, 2006 at 12:13 PM | PERMALINK

but the hospital staff did not catch warning signs soon enough.

Posted by: Dave on January 23, 2006 at 12:13 PM | PERMALINK

That's possibly true. But how does a hospital run a 100% diagnosis rate. Even tests have false negatives. Unless you repeat every test and examination 2-3 times you don't get 0% error.

Posted by: McA on January 23, 2006 at 12:30 PM | PERMALINK

McA,

I have no idea. I don't know if the hospital did everything correctly or not. There's clearly not enough information to make any type of informed opinion. The only thing you can do is guess with the info provided.

I was only pointing out a potential possibility. The possibility being that the doctors did everything correctly, but the hospital staff didn't catch the warning signs (and I'm not saying tests and examinations, I'm talking warning signs).

In my case, the guys arm turned purple and swelled up like a stuck pig. That's a warning sign that something's not right with the arm. No tests needed. When you're on 24 hour watch in intensive care, that's something the hospital staff should have caught.

Again, we can't tell what happened. Just sometimes things go wrong and people other than the doctor screw up.

Posted by: Dave on January 23, 2006 at 12:47 PM | PERMALINK

I think McA's point that the lawyers are "ruthless" and that means he/she/they the McA borg can suspend normal rules of kindness, thoughtfullness, even common sympathy and courtesy is very signficant. YOu see, nothing in the text of the case as presented implies any level of "ruthlessness" on the part of the lawyers. In fact, I'd be hard pressed to know what that would mean. Are the lawyers going to inflict flesh eating bacteria on helpless hospital staff? Are they planning to cut off their arms and legs? Are they planning to hold personal information belonging to hospital staff hostage? Are they planning to picket hospital staff? Are they planning to shoot hospital staff "ruthlessly" as McA's strawman anti abortionists do? No? What on earth is so "ruthless" about a woman seeking information through the court system with the help of legal representation? The hospital itself insists she *must* sue to get the information and she is submitting herself to their dicta. That's not very ruthless at all.

So what in that story legitimates MCA's rapid descent (if, indeed, it began in any higher location) to brutal insults and contempt for this poor woman--accusations that she is lying, that her lawyers suborned perjury, that she is doing this all for a "big settlement" to which she is not entitled.

I'd submit that only the most depraved and sub human view of the human condition and one's fellow citizens could result in McA's postings.

As for the accusation that the woman is lying and that she excercised "informed consent" to the procedure having just taken my child to the ER three times in two months I can assure MCA that if the hospital excercised any kind of due diligence on informed consent they would have a signed document describing the procedure and its perils to show in court and to the media at a moment's notice. If they haven't already shown it? Logic argues that it doesn't exist and that, possibly with no real wrongdoing on the hospital's part, they failed to properly inform the patient of what was happening to her and why.

Hospitals and medical care are damned complex organisms and it is far, far more likely that the hospital was negligent in some way than that the lawyers, brought in after the fact, are guilty of "ruthlessness"--whatever on earth that means in a legal system like ours.

But you know that McA, like tom delay, trent lott and, of course, rush limbaugh will rush to avail himself of legal representation and even the help of the ruthless ACLU when he needs it. A libertarian/republican is only against lawyers until they need one.

aimai

Posted by: aimai on January 23, 2006 at 1:11 PM | PERMALINK

What I'm not sure I understand here is how NF resulted in a quadruple amputation. I'm admitedly largely unaware of how the condition works and haven't found many answers, but the notion of the infection attacking all 4 outer limbs admitedly seems unusual to my uninformed mind. I would have assumed an infection would radiate outward. Perhaps the feet could be infected simultanious, but 4 limbs at once still seems odd to me. Does this make more sense to those who know more? I know NF is an unusually aggressive condition, but its the geography of the infection here, which is puzzling me. I'd heard of amputations due to NF, but a quadruple amputation seems like a very different thing.

Posted by: BStu on January 23, 2006 at 1:13 PM | PERMALINK

Why would anone live in florida?

Posted by: Pechorin on January 23, 2006 at 1:18 PM | PERMALINK

Kevin: Why should I have to file a lawsuit to get that?

Because for all their posturing, the GOP really does want to encourage certain types of litigation because these types of litigation cost the middle class and poor (the usual plaintiffs) and divert their dollars to the rich - what they don't want is a litigation system that makes the rich pay their share of litigation costs and they certainly don't want a litigation system that results in financial benefit to the middle class and poor.

Conservatives are evil.

They are selfish.

They are self-centered.

They are self-righteous.

They are liars.

They are parasites.

What about that don't you understand?

Posted by: Advocate for God on January 23, 2006 at 1:29 PM | PERMALINK

Nads, post-surgical infection is not malpractice unless the physician did the procedure without wearing a mask, washing hands, wearing gloves, or using sterile tools--all occurrences that I have witnessed with my own eyes. Post-surgical infection is most certainly malpractice if the physician fails to take even the most basic steps to mitigate the risk, which a Duke University study showed happened up to 80% of the time in their own ICU.

A lot of physicians are not only under the impression that their s*** don't stink, but that it's completely germ-free. And if their arrogance leads to loss of life or limb, it's not inherent risk--it's malpractice.

Posted by: Michael Ditto on January 23, 2006 at 1:50 PM | PERMALINK

I'd submit that only the most depraved and sub human view of the human condition and one's fellow citizens could result in McA's postings.

Now he'll claim that it's all because of racism!

Every time someone reacts to something our resident troll from the Far East has to say, he plays the racism card.

His standard way of doing business is to leave a trail of smartass remarks, then wait for someone to call him out on it so he can fold up and cry racism.

This is how he gets his giggles.

Posted by: Pale Rider on January 23, 2006 at 2:29 PM | PERMALINK

Hi. Lemme clarify here regarding my rather tasteless one-liners last night.

I was not even *thinking* of that poor woman; I was reacting to Matt's original series of "no arms or legs" jokes. It was late at night, I was bored -- and being a Thomas Pynchon fan, I'm a sucker for stupid humor. If I offended anybody, I apologize.

MJ Memphis:

I've noticed that, too. You'll observe that in your re-post, one character in a word was highlighted in a link. If you click on it, it'll take you to a gambling site.

This is a new tactic of spam-bots which I noticed about two weeks ago. They'll quote posts (often completely out of context with arbitrarily truncated sentences) and link random words. The idea is to get you to think that they're real posters.

Bob

Posted by: rmck1 on January 23, 2006 at 2:37 PM | PERMALINK

I share BStu's question on this. The geography of the infection seems very strange; you would think that it would radiate outward, not attack four separate extremities at once. The limbs are also far removed from mucuous membranes. How does NF bacteria "choose" a site to nectrotize that's far removed from the site of the original infection (vagina, sponge left inside, etc.)?

Also, I think Michael Ditto's probably right on the money. It was probably as simple as neglecting to scrub or autoclave.

Bob

Posted by: rmck1 on January 23, 2006 at 2:53 PM | PERMALINK

nectcrotize = necrotize

Posted by: rmck1 on January 23, 2006 at 2:54 PM | PERMALINK

rmck1,

Rarely does anyone apologize around here. I was waiting for that sociopath McAristotle to come back with his usual line of bullcrap but instead you had posted your apology.

Listen, I'm as guilty as anyone of feeding these trolls and pushing the envelope of decorum, but when someone does apologize, it shouldn't be trivialized and it should be accepted for what it is.

Kudos to you.

Posted by: Pale Rider on January 23, 2006 at 2:55 PM | PERMALINK

"Conservatives are evil.

They are selfish.

They are self-centered.

They are self-righteous.

They are liars.

They are parasites.

What about that don't you understand?"
Posted by: Advocate for God


Wow AFG. You DO like to pick fights don't you?

"What about that don't you understand?"

Why you hate so. Sad. Such an unproductive waste of energy.

Posted by: Lurker42 on January 23, 2006 at 2:57 PM | PERMALINK

I read the issue as - the patient is asking if any other person on the same floor had streptococcus. The hospital answered - we can't tell you or we'd be invading other patients privacy.

I don't think it would invade anyone's privacy if the hospital disclosed that no one else on the floor had streptococcus.

... but it would only invade someone's privacy if someone else on the floor did have streptococcus...

Posted by: anotherpawn on January 23, 2006 at 3:01 PM | PERMALINK

Read this link:

http://www.orlandosentinel.com/news/local/orange/orl-flesh2106jan21,0,6625021.story?coll=orl-home-headlines

It implies she was told "amputate or die" - not that they did it without her consent. And it confirms she wants to find out if this sort of problem is common in the hospitial - in other words, if the hospitial has 'prior bad acts' so to speak.

Posted by: JohnN on January 23, 2006 at 3:14 PM | PERMALINK

Kevin made an excellent point in his article : how depraved is a system wherein a person can't even find out why they lost their limbs - except by suing? After giving birth?

And unfortunately, what do you read in the comments? Lots of "blame-the-victim" theories that seem to be tenously attached to the facts of the case?

?Implicit approval for amputation when you go into deliver a baby? You're not serious, are you?

? Post abortion depression? A right wing theory that's never been proven? And you're seriously suggesting it would play a role in how a women gets infected and loses limbs?

?Reflecting on national health care? Really, because those hospitals in Canada have to report on rates of infection?

Please guys, and I mean guys, this has got to be one of the most heart-rending stories that one can imagine, and we just spew out this type of stuff. Please think before posting.

Posted by: Samuel Knight on January 23, 2006 at 3:31 PM | PERMALINK

Kevin:

I'm moved to comment on this post because a) I'm a physician (and infectious disease specialist), and b) the one issue where I think most progressive commentators are off base is litigation reform; or, at least, medical malpractice litigation reform. The best comment upthread is probably from "V." If anyone hasn't read it, then skip mine and read his. Several others have made good observations. We have heard from some lawyers, pro and con. Some of the participants are also MD's, and if I gather correctly they are getting flamed pretty good, in spite of bending over backwards to be reasonable.

Sigh.

That's the problem with this debate. The darn victims always evoke so much sympathy that you start off desperately wanting to help them, but in the end somehow your good intentions get perverted by the system, so that only a small percentage of the malpractice premium dollar goes to compensate victims. Most of it goes into the pockets of lawyers and insurance companies, and the losers are patients and their doctors.

As others have noted, we don't have enough information to pass judgement on this case. That is no incidental things, either: it's important. The news article hasn't given you enough information to make a reasonable determination. Sound familiar? Can anybody else think of a few issues in the past five years when the news media didn't quite manage to give us enough of the truth for us to make informed decisions? This is pervasive problem, and it is no less evident when the media report on medical malpractice.

I'll try to make a few points succinctly:

# The reason the hospital refused to release information immediately was because they knew they were being set up for a malpractice suit. V is absolutely right about this. Whether one agrees with this decision or not, it was the hospital lawyers who advised them to stonewall.

# Yes, the patient has a legal right to see everything in her medical records. The hospital does have some recourse. They are allowed to drag their feet a little bit (it's been tested in court, and some extenuating circumstances are allowed) but ultimately they have to release the information.

# There is no valid reason for her lawyers to request information about other patients' infections, unless they are building a case for malpractice. This is known as "a fishing expedition." The hospital knows this.

# Necrotizing fasciitis can be caused by various combinations of bacteria, although when people refer to "flesh eating bacteria" they usually mean Group A streptococci, which are not commonly spread in hospitals at all.

# Toxic shock is a different entity, usually caused by Staph aureus (but sometimes Group A strep). It doesn't usually go along with necrotizing fasciitis, although theoretically it could. I once considered that possibility myself in a case of NF, which also evolved into a malpractice case (I was on the winning side), but the patient probably didn't have it. In a situation like this, toxic shock wouldn't probably have anything to do with a tampon or retained device (sorry).

# It is really odd for necrotizing fasciitis to attack all four extremities (good pick up!). I'd say it was damn odd, to the verge of impossible, so it probably didn't happen that way. I suspect her limbs were amputated due to hypoperfusion and peripheral tissue damage due to her shock and probably the "pressors" they used to sustain her blood pressure. These are drugs like epinephrine that clamp down peripheral blood vessels and increase cardiac output, which raises the blood pressure at the expense of peripheral blood flow. We use them in desperation. Sometimes, I think we overuse them. Other times, honestly, we have no choice.

# You don't need informed consent to perform a life-saving procedure in an emergency. Think about it.

# If at all possible, you should attempt to obtain informed consent from the patient (in this case, we know that she was unconcious, right?) or the family (we know nothing about their availability). There should have been time to do this, if her next of kin or health care surrogate had been identified. Sometimes, they can't be found.

# I don't think that the hospital is "acting suspiciously," and it is wrong to infer this. They are behaving quite normally for people forced to operate in this poisonous atmosphere of constant litigation.

# I would not assume that there is any malpractice involved (tampons, sponges, retained devices, failure to scrub, etc.) Shit happens.

# At the same time, I wouldn't assume that there was no malpractice. Shit happens.

# It is quite wrong to say that medical tort reform is an anwser to a problem that doesn't exist. The problem is very real. In my state, I cannot afford malpractice insurance. I practice without coverage. If I were forced to pay it, I couldn't pay my mortgage. How does that help anybody?

# Most opposition to tort reform is wrong-headed. Some states (California, Minnesota, Colorado) have passed reasonable limits on noneconomic damages, for example, and they still have affordable rates, while other states without such limits have seen rates spiral out of control. Real reform requires more than this, but it is one example.

# I agree with the commentor who said that he doesn't support tort reform because "all the Republicans want to do is reduce the income of lawyers." That's what derailed tort reform here in Florida last year: all Jeb Bush wanted to do was stick it to the trial attorneys. He didn't really want to fix the system. Now, I think that any successful fix for the system is going to reduce the income of trial attorneys -- it simply has to -- but that shouldn't be the primary goal or you risk missing the real target (which they did).

# Actually, I don't trust the Republicans on this issue at all. Well, to be honest, I don't trust about anything. Who would? Regarding tort reform, I think they are playing organized medicine for chumps, just like they do the Christian Right. They rely on doctors for political donations and votes, but they forget about us as soon as the election is over. They seduce doctors with fancy talk about "tort reform," but when they propose legislation it is always about indemnification of big business against product liability suits. That is ALL that they care about. Period. They don't give a damn about doctors and patients.

# If you want comprehensive reform, I would suggest you look at Florida's NICA fund for inspiration. It is a pool of money to compensate parents of brain-injured infants into which all doctors pay. The money is there for the asking. It is dispensed on a no-fault basis. All you have to do is apply for it. Payments are approved and dispensed by an impartial panel. How has it worked?

Well, nobody complains about it.

Patients seem to be adequately compensated, although it's possible that some people never find out that they're eligible and don't apply, because there are no big, State Lottery-sized judgments, and attorneys are not motivated to advertise and troll for patients. If someone wants to apply to the fund, they pay an attorney for a few hours of his time to fill out the application. There are no multi-million dollar paydays for the lawyers. The fund does not have to support an entire insurance industry and an entire malpractice litigation industry: all the money goes to compensate victims. The result is that money is piling up in the fund, unclaimed. It is massively over-funded. Apparently, lawyers can't be bothered to apply for the money. Touching, isn't it, how concerned they are for their clients?

Something like that could be implemented on a state by state basis, and it would probably solve the problem. I don't think it will happen, because the current system works too well for the people who run the system. Republicans don't care about doctors and patients, and the Democrats are in the pocket of the trial lawyers.

We are so screwed.

Posted by: Telllurian on January 23, 2006 at 6:06 PM | PERMALINK

I think most people who file malpractice claims against their doctors do so because, of a negative outcome from medical treatment, they are going to be penniless, and almost homeless. It would make more sense to eliminate malpratice as a concept and provide a real safety net for bad outcomes of medical care, even if the care was good.

I think that rather than have a tort system, we should have a workers compensation type system for bad medical outcomes. Economic damages should be capped at the median wage for the state where you had the treatment. If you earn above the median wage you should be offered the opportunity to purchase additional private insurance to cover yourself for additional economic losses based on your treatment you are going to undergo and who and what you are going to be treated for. This will pay for higher economic losses as an individual. Pain and suffering payment should be limited, but necessary medical care should be automatically covered.

There needs to be transparency in such a system, so providers, and instutions should have to make public their number of proceedures and the level risk represented, and the number of problems they have. A patient can hopefully make an informed choice on which provider, and institution should provide their care.

Of course such a system will make Lawyers, institutions, and doctors nervous. Bad and/or below average providers will face issues that they can not get patients to trust them with care because of their records, and Lawyers will not have a system which is designed for full employment of Lawyers. But the public and the average provider will be served because a tight system will insure that most unexpected outcomes are dealt with in a fair and orderly manner.

Posted by: dan on January 23, 2006 at 6:27 PM | PERMALINK

Tellurian:

Very interesting, sensible and well-balanced post.

So you think she lost her limbs because her blood pressure collapsed and they used drugs and/or physical proceedures to clamp down on the extremities to increase BP in her trunk -- and she developed infections and lost her limbs because there wasn't enough blood in them to pump away the toxins?

I dunno shit about physiology -- just thinkin' like Marcus Welby here ...

Bob

Posted by: rmck1 on January 23, 2006 at 6:33 PM | PERMALINK
I think that rather than have a tort system, we should have a workers compensation type system for bad medical outcomes.

I would be more supportive of such a concept, in general, if criminal remedies were more consistently applied where the conduct producing the bad outcome amounts to criminal battery and related offenses.

Posted by: cmdicely on January 23, 2006 at 6:56 PM | PERMALINK

Yep, leave it to the docs to fashion a remedy which takes away a trial by a "jury of peers"-- a constitutional right. A Workers comp-type system??? Are you kidding me!!!! Name me one state where work comp works!!!! Its the legislative playground of the business community, and the benefits suck... They should abolish work comp and allow the employee the right to sue his employer--that would clean up the cesspool... Anybody notice the rate of injury amongst day workers-- is over 20 percent!!! Why? Cause they're all considered "independent contractors" in most states and they're NOT entitled to work comp benefits... Safety flows directly from accountability and responsibility... Want to debate that point-- Anybody see a Ford Pinto around lately... didn't think so...

Posted by: tjschill on January 23, 2006 at 7:58 PM | PERMALINK

http://www.orlandosentinel.com/news/local/orange/orl-flesh2106jan21,0,6625021.story?coll=orl-home-headlines

It implies she was told "amputate or die" - not that they did it without her consent.

Posted by: JohnN on January 23, 2006 at 3:14 PM | PERMALINK

So after having the crap bashed out of me, I find out I'm right. There was consent.

Posted by: McA on January 23, 2006 at 10:19 PM | PERMALINK

The hospital is saying, "please sue us" - we'll be happy to give you the information once the court orders us to, but we can't voluntarily be giving out information about another patient (the one who brought the strep into the hospital).

Posted by: JR on January 24, 2006 at 12:25 AM | PERMALINK

Aren't US hospitals much dirtier than European hospitals?

Posted by: marky on January 24, 2006 at 4:10 AM | PERMALINK

Unfortunately, the hospital's reluctnce may be speaking towards some ass-covering.

"May be?" I guaran-damn-tee it is. The hospital fucked up, in a huge way.

I have trouble remaining neutral on this topic since my mother is hospitalized right now - she walked in there to spend a few days getting intravenous nutrition to strengthen her for surgery and a week and a half later was delirious with fever from from a (highly preventable in my opinion) infection she picked up in there. I've been furious about it, but after reading this story I suppose I should just be grateful she still has her arms and legs.

Jesus.

Posted by: kc on January 24, 2006 at 10:01 AM | PERMALINK

You are also welcome to spend a day in my hospital and see just how much time and money is wasted in 'protecting' against lawsuits (futile attempts in my opinion) by doctors, nurses and the hospital administration.

That's what your fucking problem is. Your industry spends too much time covering its ass and far too little time delivering competent care.

Posted by: kc on January 24, 2006 at 10:03 AM | PERMALINK

rmck1, the lady also could have developed disseminated intravascular coagulation (DIC) as a result of her infection. This is a condition which causes the blood-clotting mechanism to go out of whack, leading to excessive clotting or excessive bleeding. Multiple blood clots in her extremities stopping circulation and leading to gangrene would also be a reason to amputate all 4 limbs.

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Posted by: enlargement free penis pill sample on January 24, 2006 at 6:24 PM | PERMALINK

She's entitled to her own records, at some reasonable fee per page for copying, but she isn't entitled to anyone else's totally redacted records. This isn't FOIA stuff here. If the plaintiff can make a case that the hospital had an epidemic at the time that could be caused by poor infection control procedures at the hospital, well, present that to the judge and see how it flies. If the judge issues a subpoena for redacted records of all patients dying with infections of the plaintiff's species of organisms, then I assume HIPAA is overridden and redacted records can be released legally. (Redaction: no patient identifiers, ie, no date of birth, no age if over 90, no SSN, no hospital internal identifiers, etc)

Posted by: NancyP on January 24, 2006 at 6:40 PM | PERMALINK

She may also have had thrombotic thrombocytopenic purpura, which is classically seen in peripartum women (though still rare, and more often than not associated with neurologic damage). Overall, I'd vote for intractable shock, from whatever cause, and necessary but limb-destroying pressor use. Said shock may be due to bacterial toxin or other cause.

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