IL Governor Signs Med Mal Law

From Modern Physician

Illinois Gov. Rod Blagojevich has signed a medical malpractice law that caps noneconomic damages at $500,000 in cases against physicians and increases regulatory oversight of medical liability insurers in the state. The legislation includes a $1 million cap for hospitals, and allows physicians to apologize for errors without such statements being used against them in court.

The medical establishment, which has sought the changes for years, said the law will reduce the cost of liability insurance and stop the migration of doctors who may be leaving the state because of high costs. “Every patient and physician in Illinois should be happy to know that positive change is on the way,” said Craig Backs, president of the Illinois State Medical Society.

Previous attempts to impose a cap have been declared unconstitutional by the state Supreme Court, and lawyers are already mounting an effort to have the legislation overturned, saying it strictly limits the rights of plaintiffs in cases where doctors have made errors.

"No Wait" ER’s

I love the title on this one, excerpted from The Journal News.

“Hospitals figure patients don’t like to wait”

Hudson Valley is hoping that yesterday’s opening of its new “no-wait” emergency room will attract patients who dread waiting a long time to be treated in other crowded facilities.

The hospital’s emergency room overhaul is the first in a wave of emergency room expansions coming to Westchester that are designed to cope with a growing patient load and, if not actually eliminate emergency room waits, then at least reduce them and make them less stressful.

Among its improvements, the million-dollar redesign at Hudson Valley doubled the number of patient rooms and eliminated the need for patients to stop at a registration desk by introducing bedside registration on a wireless computer.

“Our patients have told us what they would appreciate most is eliminating the whole waiting period,” said John Federspiel, the hospital’s president.

State’s Malpractice Cap Applies to Award in Civil EMTALA Action

From BNA’s Health Care Daily (Volume 10 Number 164, Thursday, August 25, 2005, ISSN 1091-4021)

6th Circuit Says State’s Malpractice Cap Applies to Award in Civil EMTALA Action

Noneconomic damages awarded in a failure-to-stabilize claim brought under the Emergency Medical Treatment and Labor Act must be reduced in accordance with Michigan’s limitation on malpractice awards because the federal statute incorporates state law and the claim would be considered a medical malpractice action under state law, a federal court of appeals held Aug. 18 (Smith v. Botsford General Hospital, 6th Cir., No. 04-1436, 8/18/05).

In an issue of first impression for the U.S. Court of Appeals for the Sixth Circuit, Judge Deborah L. Cook reduced the $5 million district court jury award to less than $400,000, ruling that Michigan’s malpractice cap on noneconomic damages applied to Andrea Smith’s EMTALA claim.

Smith sued Botsford General Hospital under EMTALA’s civil enforcement provision, alleging the hospital failed to stabilize her husband, Kelly Smith, before transferring him to another hospital better equipped to deal with a man of his size. Kelly Smith, a 600 pound man whose suffered a broken left femur that pierced the skin of his thigh in an automobile accident, died from extensive blood loss while being transferred, according to Cook.

Cook affirmed the jury verdict in favor of Smith, but reduced the award pursuant to Michigan’s malpractice law.

EMTALA Incorporates State Law

EMTALA’s civil enforcement provision allows individuals harmed as a result of a hospital’s violation of the federal statute to recover personal injury damages “under the law of the State in which the hospital is located,” according to Cook, quoting 42 U.S.C. §1395dd(2)(A). The plain language of the statute therefore incorporates state law, Cook said.

The next step, Cook said, is to determine whether Smith’s claim would constitute a medical malpractice action under Michigan law. A claim sounds in malpractice if it relates to an action that occurred during the course of a professional relationship and involves a question of “medical judgment beyond the realm of common knowledge and experience,” Cook said, highlighting the test the Michigan Supreme Court set forth in Bryant v. Oakpointe Villa Nursing Center, 684 N.W. 2d 864 (Mich. 2004).

Smith’s claim met the definition on both counts, Cook said. There was no dispute that Botsford’s treatment and transfer of Smith occurred within the course of a professional medical relationship. Further, Cook concluded that Smith’s claim necessarily involved questions of medical judgment, even though an EMTALA action does not require a breach of the professional standard of care.

The statute’s stabilization requirement demands a medical judgment to determine “within a reasonable medical probability” whether a patient can be transferred without risking a deterioration in his or her condition, Cook said.

Cook also addressed Smith’s challenge that Michigan’s cap on damages violated the Seventh Amendment and her right to equal protection under the constitution.

Concluding there was no Seventh Amendment violation, Cook noted that the role of jury is to determine the extent of a plaintiff’s injuries, not the legal consequences of its factual findings. As to equal protection, Cook said Michigan’s choice to limit the amount of a plaintiff’s recovery did not violate a fundamental right and served the legitimate state interest in controlling health care costs.

Full text of the decision is available at

Wasp Stings in Wisconsin

Excerpted from the Milwaukee Journal- Sentinel

“Rash of wasp attacks stings area “

Medical and emergency response officials from Milwaukee-area counties confirmed Wednesday that wasp and bee stings are on the rise and expressed concern about the severity.

“Over the last three weeks, we’ve had a tremendous increase in incidents of bee stings, and occasionally some are becoming infected,” said Bill Haselow, an emergency medicine physician at Columbia St Mary’s, Ozaukee Campus in Mequon.

On some shifts, as many as seven patients have sought treatment for stings, he said.

“It’s definitely more than I’ve ever seen,” said Thomas Dietrich, an emergency medicine physician at St. Joseph’s Hospital near West Bend.

Woman Offended by Doctor’s Obesity Advice

From AOL News, excerpted below:

As doctors warn more patients that they should lose weight, the advice has backfired on one doctor with a woman filing a complaint with the state saying he was hurtful, not helpful.

Dr. Terry Bennett says he tells obese patients their weight is bad for their health and their love lives, but the lecture drove one patient to complain to the state.

“I told a fat woman she was obese,” Bennett says. “I tried to get her attention. I told her, ‘You need to get on a program, join a group of like-minded people and peel off the weight that is going to kill you.’ “

He says he wrote a letter of apology to the woman when he found out she was offended.

Her complaint, filed about a year ago, was initially investigated by a board subcommittee, which recommended that Bennett be sent a confidential letter of concern. The board rejected the suggestion in December and asked the attorney general’s office to investigate.

Bennett rejected that office’s proposal that he attend a medical education course and acknowledge that he made a mistake.

Top Ten Medical Devices We Miss

From Medgadget, excerpted from “Top Ten Medical Devices We Miss”

1. The Precordial Thump

It couldn’t be simpler, or more satisfying: take your fist and whack an unresponsive patient’s breastbone. And before people knew about cardiac contusions or commotio cordis, it was done quite a bit. The thump isn’t entirely gone — it’s still allowed by ACLS guidelines for witnessed arrest in the absence of a defibrillator. There’s some evidence that the energy of the strike can sometimes convert a ventricular tachycardia to a normal rhythm, and in the case of witnessed arrest, it’s worth the risk. Otherwise, it’s an artifact of a lively past.

New Efforts Begin to Improve CPR Effectiveness

Excerpted from Associated Press / AOL News

“New Efforts Begin to Improve CPR Effectiveness
Guidelines, New Machines Designed to Help People Do it Right”

Old-fashioned CPR is getting a makeover. Cardiopulmonary resuscitation is crucial when people collapse with cardiac arrest, but it’s hard to perform correctly.

Now major efforts are under way to improve how doctors, paramedics and average bystanders do the job: New CPR guidelines are due this fall, and high-tech machines that promise to help are already showing up in ambulances and offices.

Not yet proven is whether using technology – like a chest-squeezing gadget or sensors that coax rescuers to pound harder – to spice up the 40-year-old resuscitation technique really will save lives.

Emergency-care specialists agree that CPR today doesn’t save as many lives as it could.

“We’ve got our work cut out for us to make sure CPR is done better,” says Mary Fran Hazinski of the American Heart Association, which is finalizing new recommendations designed to do just that.

More than 300,000 Americans each year die of cardiac arrest, where the heart’s electrical system goes haywire and the heart abruptly stops beating.

Portable defibrillators can increase survival, delivering a jolt of electricity that stuns the heart, ending the abnormal rhythm and giving it a chance to resume a normal beat.

But the heart-zappers alone aren’t enough. Virtually all cardiac-arrest victims need CPR, too. It buys time until a defibrillator arrives. Often, it’s needed immediately after zapping, as the heart struggles to resume circulation.

Also, studies show that doing CPR first makes defibrillation more likely to work if cardiac arrest has lasted longer than three minutes. The longer someone goes without oxygen, the more their abnormal heart rhythm degrades until it’s unshockable.

But “it has to be good CPR. We don’t want to delay defibrillation for crummy CPR,” warns Dr. Lance Becker of the University of Chicago, co-author of one of a pair of surprising studies earlier this year that found even the best-trained rescuers – doctors, nurses and paramedics – too frequently give inadequate CPR.

The studies found long pauses in CPR; that rescuers often didn’t pound hard or fast enough on victims’ chests; and that they pumped too much air into the lungs (a mistake more prone to professionals using hand-held air bags instead of mouth-to-mouth breathing.)

Why? Good CPR is tough – you must compress the chest 1 1/2 to 2 inches deep – and rescuers tire or may pause to prepare the defibrillator or perform other tasks.

More on Rapid Response Teams

From Modern Physician

“Hospitals embrace rapid response teams to prevent deaths”

The number of Australian-theme Outback Steakhouse restaurants has grown to 898 from zero in 17 years. In healthcare, another inspiration from Down Under — hospital rapid response teams — has shown even more explosive growth, to roughly 1,400 U.S. hospitals today from no more than 50 two years ago, according to the Institute for Healthcare Improvement in Boston.

Australians are credited with developing the rapid response team concept, which focuses on identifying hospitalized patients as their conditions just start to decline and providing immediate, aggressive treatment. The typical team consists of a critical-care nurse, a respiratory therapist, and other support staff and physicians as needed.

Nurses are asked to call the team if they have a “gut feeling” a patient is in trouble or when physiological measures, such as sharp changes in blood pressure or heart rate, indicate there may be trouble.

Two factors influenced the rise of rapid response teams in the U.S., experts said. First, the federal Agency for Healthcare Research and Quality began using “failure to rescue” deaths — hospital patients who die of medical complications — as a quality measure. And the IHI began promoting rapid response teams in its “100,000 Lives” campaign.

The nearly year-old campaign seeks to avert 100,000 preventable patient deaths by encouraging hospitals to adopt rapid response teams, evidence-based care for heart attacks and various interventions to prevent adverse drug events, ventilator-associated pneumonia, and central-line and surgical-site infections.

The impact of the campaign on the growth of rapid response teams has been “absolutely huge,” said Terri Simmonds, a nurse who is an IHI faculty member and director.

So far, Centura Health in Denver has deployed rapid response teams at 10 hospitals and will expand to one more in December, said Terry O’Rourke, M.D., the system’s chief medical officer.

“We were talking about (rapid response teams), but our decision to participate in the IHI campaign certainly added some emphasis,” O’Rourke said. “Our projections show we have the potential to save 50 to 100 lives (systemwide) annually, and our experiences so far could support that kind of an outcome — or even better.”

O’Rourke said it’s too early for definitive data, but rapid response teams have been getting 10 to 15 calls a month in Centura’s larger hospitals and three to five a month in smaller facilities. The result, he said, has been fewer cardiac arrests.

Picture Archiving Communications System (PACS)

An interesting article about digital radiography, from the Gainsville Times, excerpted below:

“Film is a thing of the past at hospital”

The lighted box that doctors use to view X-rays fast is becoming a museum piece.

A growing number of hospitals are ditching film and converting to a computerized system for storing images.

Northeast Georgia Medical Center made the switch this spring, spending more than $11 million to implement its Picture Archiving Communications System (PACS).

The new technology, which includes X-ray, MRI, CT scans and cardiac imaging, was introduced at the Lanier Park campus in March, followed by the Imaging Center in April and the main campus in May.

David Kimball, chief of radiology at the hospital, said he and his colleagues are enthusiastic about the change.

“A lot of us used this type of system when we were in training, but it’s still found mostly at the academic hospitals,” he said. “This technology can improve the accuracy of diagnosis, because you can manipulate the image any way you want.

“And reading off a computer makes things so much faster,” he said. “You always have quick access to images. You don’t have to go hunting for them.”

Bulky film images created two major problems: getting them from one place to another and finding someplace to put them.

Rural Hospital Information Technology

From Iowa Senator Chuck Grassley, as published in the Iowa Hospital Association Friday Mailing “Newstand” supplement, excerpted below.

Information technology holds the promise of reducing health care disparities for those living in rural communities. We can measure our success in building an IT infrastructure by the provision of quality care in these communities challenged by long distances and scarce medical resources.

The Institute of Medicine (IOM), National Committee on Vital and Health Statistics, and numerous experts recommend information technology as a powerful tool for iincreasing quality and improving efficiency in health care. One of the best ways we can leverage IT is in the creation of a national health information infrastructure that supports improved decision-making and public health initiatives. I believe, however, that to develop a comprehensive IT infrastructure we must focus on rural America, which truly needs assistance in the adoption and use of health IT. Until information technology is integrated within health care delivery systems in Iowa, Montana, Alaska and other rural and frontier areas, the transition to an interoperable health IT system that links all providers nationwide is not possible.


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