“Forced Rectal Exam” Lawsuit, Part 1

From the AP:

NEW YORK (AP) — A construction worker claimed in a lawsuit that when he went to a hospital after being hit on the forehead by a falling wooden beam, emergency room staffers forcibly gave him a rectal examination.

Brian Persaud, 38, says in court papers that after he denied a request by NewYork-Presbyterian Hospital emergency room employees to examine his rectum, he was “assaulted, battered and falsely imprisoned.”

His lawyer, Gerrard M. Marrone, said he and Persaud later learned the exam was one way of determining whether he had suffered spinal damage in the accident.

Marrone said his client got eight stitches for a cut over his eyebrow.

Then, Marrone said, emergency room staffers insisted on examining his rectum and held him down while he begged, “Please don’t do that.” He said Persaud hit a doctor while flailing around and staffers gave him an injection, which knocked him out, and performed the rectal exam.

Persaud woke up handcuffed to a bed and with an oxygen tube down his throat, the lawyer said, and spent three days in a detention center.

A request by the hospital to dismiss Persaud’s lawsuit was denied by Justice Alice Schlesinger, who ordered a trial to start March 31.

Waits Grow in Emergency Rooms

From the Wall Street Journal / WSJ Health Blog:

nullIf you felt like the wait to see a doctor was interminable the last time you were in the emergency room, you were right.

ER times dragged out 36% longer between 1997 and 2004, according to a Health Affairs study by a gaggle of Harvard docs out today. Researchers say there’s every reason to think the trend has worsened, thanks to the closing of some ERs and increased volume at the rest, the WSJ reports.

The headline numbers in the report are bad enough: The median wait for an adult visiting the ER to see a doctor was 30 minutes in 2004, up from 22 minutes in 1997. For heart attacks, the median wait was 20 minutes — up 150% from eight minutes in 1997.

But median figures only tell part of the story. Three-quarters of heart-attack patients were seen by a doctor within 20 minutes in 1997. That figure rose to 50 minutes in 2004—meaning a quarter of such patients didn’t see a doctor for nearly an hour. That’s particularly bad news because of the mounting evidence that shows early intervention can make all the difference in heart attack survival.

“Not only are they waiting longer and suffering while they wait, but potentially there could be long-term consequences to those waits as well,” says Andrew Wilper, lead author on the study and, like his coauthors, a doc at Cambridge Health Alliance.

First Responders Seek Best Treatment in Sudden Cardiac Arrest

From MedPage Today:

NEW YORK, Jan. 11 –Fire departments here and in London are embarked on a cooperative study to determine whether all patients in sudden cardiac arrest should get immediate defibrillation or whether some would benefit from a period of CPR before shock.

They are cooperating on a randomized study of nearly 1,000 cardiac arrest patients to try to resolve the question. It was first raised by a nonrandomized study in Norway that found that after a few minutes of ventricular fibrillation, delaying shock to give CPR produced better outcomes in patients than did immediate shock.

But a similar study in Australia revealed no difference in patient outcomes.

In the study by the first departments, first responders carry automated external defibrillators randomly assigned to possess either the standard AED technology or additional modified software designed to analyze the electrocardiogram waveform in cardiac arrest patients who present in ventricular fibrillation.

Millions of Young People Use Cough Medicines to Get High

From MedicineNet:

About 3.1 million Americans ages 12-25 (5 percent) used cough and cold medicines to get high last year, according to a federal Substance Abuse and Mental Health Services Administration report released Wednesday.

That’s about the same number of young people who used LSD and many more than the number who used methamphetamine, said the agency’s 2006 report on drug abuse and health.

More than 140 over-the-counter cough and cold medicines contain the cough suppressant DXM that, when taken in large amounts, can cause disorientation, slurred speech, blurred vision and vomiting, the Associated Press reported.

The rate of misuse of cough and cold medicines in the 12-25 age group was 2.1 percent among whites, 1.4 percent among Hispanics, and 0.6 percent among blacks.

“While increasing attention has been paid to the public health risk of prescription drug abuse, we also need to be aware of the growing dangers of misuse of the over-the-counter cough and cold medications, especially among young people,” said SAMHSA Administrator Terry Cline, the AP reported.

Manage Expectations, Manage Legal Liability

From Medical Economics

“This won’t hurt a bit.” We first heard that when we were very young and our pediatrician was about to give us a shot. Many of us have had a slight, but lingering, distrust of physicians ever since. Yet, it’s an example of how the natural inclination of doctors to comfort patients and relieve their anxiety might do medical professionals more harm than good.

Simple assurances like, “This is a straightforward procedure and you have absolutely nothing to worry about,” or “If you stay on this medication, everything will clear up in a couple of days,” don’t always yield the promised result. And when that happens, you’ll have an unhappy patient—or perhaps even a malpractice claim—on your hands.

CNN.com: “Should I Sue My Doctor?”

From the CNN.com “Empowered Patient” Series

When Christine had a hysterectomy in September, her doctor told her it would take about a week to recover from the laparoscopic procedure.

Medical complications are not always the result of negligence. Nearly every procedure involves some risk. 

Four months — and three additional surgeries later — she’s still recovering, and out thousands of dollars in medical bills and lost wages.

Christine has become caught in the cracks of America’s health care system, where there are no easy answers for patients who suffer a complication.

Many assume a lawsuit would be the obvious path.

Christine says she’s spent about $5,000 out of pocket to fix the complication, plus she lost thousands of dollars when she was too sick to work.

“The first question everyone I know asks is, ‘Are you suing?'” says Christine. “My mother, my sister-law-law, my husband. My husband is on a rampage — he’s on the lawsuit bandwagon.”

Christine, who’s a physician herself and didn’t want her last name used, was reluctant to sue. She didn’t want a black mark against her doctor. “He’s such a nice guy. He delivered my children,” she says.

Her friends and family weren’t moved. “They said, ‘I don’t know what’s wrong with you,'” she says.

So after weeks of pressure, Christine visited a malpractice attorney recommended by a friend. But he wouldn’t take the case. A different lawyer contact by CNN said he wouldn’t have either, partly because he wouldn’t make much money off it.

Physician-Owned Hospitals Faulted on Emergency Care

From the Washington Post

Most physician-owned specialty hospitals are poorly equipped to handle medical emergencies, federal investigators will report today, underscoring a long-standing concern about the rapid rise in the number of such hospitals.

The report found that 55 percent of 109 physician-owned hospitals reviewed had emergency departments — and that the majority of those had only one bed, wrote Inspector General Daniel R. Levinson at the Department of Health and Human Services.

Fewer than a third of the hospitals had physicians on site at all times, and 34 percent relied on dialing 911 to get emergency medical assistance for patients in trouble, according to the report.