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Why insurance companies have contributed to this country’s health care crisis

Here are two additional must-read reports  (.pdf downloads) from the American Association of Justice’s research department. The first report I recommend is: Tricks of the Trade: How Insurance Companies Deny, Delay, Confuse and Refuse and the second  is: Five Myths About Medical Negligence.

What do you think about the findings from these reports? Be sure to create an account or sign in to WordPress on the upper-right hand corner of the blog’s dashboard and leave your comments below!

Posted in Updates.


Interesting KBR story in the news

Here’s an interesting story in the news from today’s Houston Chronicle about a lawsuit against US contractor KBR’s activities in Iraq. The story revolves around an incident in 2004, during which a military contractor truck convoy iwas ambushed by insurgents, leading to six civilian truck drivers being killed and others injured – and whether or not someone should have stepped in and proactively stopped the convoy.

According to the Chronicle, US District Judge Gray Miller previously ruled that the US Army had “control” over KBR’s activities, meaning that once the military made the decision to send the convoy out, the private contractor no longer had effective decision-making authority to stop the order. However, an appellate court subsuquentlu sent the case back for him to Miller, and that now, the “legal landscape may look different after months of pretrial information gathering.”

For example (quoting from the article):

Internal KBR e-mails from April 8 and 9 suggest many KBR supervisors did not believe they were constrained by military orders — a constraint that is central to KBR’s defense in the federal case. KBR declined to discuss individual e-mails for this story.

Some examples of e-mails on the question of who had the authority to decide whether convoys proceeded:

• “You, your team or any individual (as you have previously indicated to everyone in theater), have the right to say no to anything that is unsafe or where security is not available.”— T.J. Lopez, KBR senior vice president for government and infrastructure.

• “We need to work with the Army without a doubt relative to stopping convoys, but if we in management believe the Army is asking us to put our KBR employees in danger that we are not willing to accept then we will refuse to go . . . We cannot allow the Army to push us or to put our people in harm’s way …” — Tom Crum, KBR Middle East regional chief operating officer.

• “All — no KBR convoys will move tomorrow, 10th April 04. I will inform the military chain of command.” — KBR supervisor Craig Peterson to employees.

• “KBR will not execute convoys tomorrow, 10 April 04 . . . I appreciate the challenges that this decision causes your operation. We cannot continue to put these drivers at such great risk …” — Peterson to military commanders.

Read sure to read the rest of the article to hear KBR’s side of the story (i.e.: these internal emails don’t tell the entire story) and leave us a comment on what you think about the merits of the case.

Posted in Military, News Analysis, Updates.

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Some quick tips for using LinkedIn for building your legal network

I recently came across this short article by legal marketing expert Larry Bodine about how attorneys and law firms’ marketing departments can effectively utilize the LinkedIn web service to market their practice.

Some advice on using the professional networking tool for your firm’s business development include:

- If you want an introduction to make a sales call, inquire about job opportunities or make partner connections with another company, this is the way to do it. LinkedIn gives you instant credibility. Many executives use it and they realize it is a great networking tool. Remember in business development, it is not what you know but whom you know.

- To send a message to your connections, click on the Answers link at the top. Disregard the caption that says “ask a question,” and instead make a statement, tell some good news or send an announcement to your connections. Click on the Next button until you get to the “Share your question with your connections” box. You can send a message to up to 200 contacts.

- You can ask others in your network, former employers, clients, business colleagues, etc. to give you a recommendation. These show on your profile. Again these can provide you with a lot of credibility.

Do you or another personal injury attorney use LinkedIn for professional networking or business development? Have the results been positive, and if so, what is the best way to measure its Return-On-Investment relative to alternative marketing strategies (either online, or in the real world)?

Posted in Updates.


AMA’s own research contradicts myths about litigation costs

Despite public misconceptions, the supposedly rising costs associated with medical malpractice – which, in turn leading to higher insurance premiums – actually isn’t forcing doctors to quit their jobs or relocate their practices to different states.

This myth and other claims that litigation costs will destroy the health care industry that are repeated ad-nauseum by health care and insurance industry lobbyists simply aren’t supported by the data, the validity of which isn’t even contested by either side in the debate.

In fact, the data contradicts these red herrings.

Citing the findings of a GAO study (link to .pdf) which in turn analyzes the AMA’s own statistical data, AAJ notes that:

“Many of the reported provider actions taken in response to malpractice pressures were not substantiated or did not widely affect access to health care … some reports of physicians relocating to other states, retiring, or closing practices were not accurate or involved relatively few physicians.”i In fact, data from the AMA shows that physician numbers have been increasing across the board for many years.

The AAJ goes on to detail what is actually going on:

The number of doctors is increasing. The total number of physicians in the U.S. rose to yet another record high in 2007, the most recent year for which data is available. There were 941,304 physicians in the U.S. in 2007, nearly 20,000 more than the year before.

The number of doctors is increasing faster than population growth. The increase in physicians outpaced the increase in population once again. The number of physicians per 100,000 population is at an all-time high of 307. The increase of physician numbers compared to population growth has climbed steadily for decades. There are now twice as many physicians per 100,000 population as there were when the AMA began tracking figures in the 1960s.

The number of physicians is increasing across the states. Despite the cries of physicians fleeing multiple states, the number of physicians increased in every state in 2007. In addition, the increase in physicians either matched or outpaced population growth in every state over the last five years.

The ratio of doctors to population is higher in states without caps; the number of physicians per 100,000 population is 13% higher in those states that do not have caps

These facts on the actual economic impact medical malpractice litigation is having on doctors’ job security, check out AAJ’s excellent online resource on the subject here. And for some quick facts, download their comprehensive primer.

As the national debate on the future of health care and health insurance continues to boil over, it’s more important to know the actual facts instead of relying on the soundbites you hear from the media and the so-called “expert” punditry. Do your own fact-checking instead.

Update: Case in point, make sure to read this article from Bloomberg News reports on exactly the kind of lobbyist-induced misinformation that is in play.

Posted in Discussion, Industry Trends, Studies.

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Twitter Weekly Updates (10/15/09)

  • Must-Read: Hearst Newspapers’ report on the surprisingly high # of deaths in US due to preventable med. mistakes: http://bit.ly/RnXWL #

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Posted in Twitter.


Is the healthcare debate overlooking the impact of medical errors?

This article from the Friday edition of the Connecticut Post raises an extremely important point that has unfortunately managed to slide under the radar in the ongoing debate over health care and insurance reform policy.

Here is the key clip:

The entire issue of medical errors is avoided in the health care bills.   While some would rather focus on limiting the legal rights of injured patients, over 98,000 people die every year from preventable medical errors with countless more injured. Tort law changes would only save 0.5% of all health care costs, and leave injured patients with practically no legal recourse. But reducing medical errors means healthier patients and lower costs.

Be sure to read the entire story, which links to this investigative report on the number of deaths that occur as a result of medical malpractice and negligent care, by Hearst Newspapers, here.

Posted in Discussion, Legislation, Opinion, Studies, Updates.

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Still searching for “elusive” consensus on Health Insurance Reform

It’s certainly hasn’t taken even casual political observers by surprise, but it bears noting that the GOP is pulling out all of the stops in order to derail the Obama Administrations, and the Democratic-controlled Congress’ efforts at providing some badly-needed reform to the healthcare sector. This article filed by McClatchy’s does a good job of summarizing just how brazen and counter-productive their campaign to stonewall any progress really is.

Despite the Democratic Party recently receiving powerful mandates from the American public – with the party regaining control of both chambers of Congress in 2006 and Obama’s blowout victory last November – there appears to be little chance of any practical bi-partisan support being reached in the near-term.

Of course, divisions in policy exist not just between the Republican and Democratic parties, but squabbles within the Democratic party itself also pose a roadblock to reform taking place. Conservative, or “Blue Dog” Democratic members of Congress are in some cases as firmly against the Administration’s agenda (as articulated in a Presidential Memorandum released this week) as much as they are unsatisfied by the plan offered last week by Senate Finance Committee Chairman Max Baucus (D-MT).

Hopefully, some sort of agreement will be able to be reached across the political spectrum as the American public, especially the 40 million of those currently without health insurance, are the biggest losers in the current impasse. However, it is equally important that the Democratic party doesn’t compromise on its core principles and ignore the powerful mandate for domestic policy reform the previous elections have entrusted them with.

Also, be sure to check out this statement on the Administration’s Medical Liability Memo released on Thursday by the American Association for Justice (previously ATLA)

Posted in Discussion, Legislation, News Analysis, Pharma, Updates.

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Wyeth caught paying ghostwriters to pen favorable journal articles

From today’s New York Times, we learn that:

Newly unveiled court documents show that ghostwriters paid by a pharmaceutical company played a major role in producing 26 scientific papers backing the use of hormone replacement therapy in women, suggesting that the level of hidden industry influence on medical literature is broader than previously known.

The articles, published in medical journals between 1998 and 2005, emphasized the benefits and de-emphasized the risks of taking hormones to protect against maladies like aging skin, heart disease and dementia. That supposed medical consensus benefited Wyeth, the pharmaceutical company that paid a medical communications firm to draft the papers, as sales of its hormone drugs, called Premarin and Prempro, soared to nearly $2 billion in 2001.

But the seeming consensus fell apart in 2002 when a huge federal study on hormone therapy was stopped after researchers found that menopausal women who took certain hormones had an increased risk of invasive breast cancer, heart disease and stroke. A later study found that hormones increased the risk of dementia in older patients.

And:

The ghostwritten papers were typically review articles, in which an author weighs a large body of medical research and offers a bottom-line judgment about how to treat a particular ailment. The articles appeared in 18 medical journals, including The American Journal of Obstetrics and Gynecology and The International Journal of Cardiology.

The articles did not disclose Wyeth’s role in initiating and paying for the work. Elsevier, the publisher of some of the journals, said it was disturbed by the allegations of ghostwriting and would investigate.

Posted in News, Pharma.

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FOIA investigation exposes total breakdown of New York’s “NYPORTS” system

This article in today’s edition of the New York Daily News serves as a timely reminder that the Freedom of Information Act – and independent, investigative journalism in general – are essential in order to protect the public, and in particular by revealing to the public any evidence of wrongdoing that the perpetrators conspire to cover up.

The paper’s must-read expose reveals the concerted efforts of eleven different New York City-based hospitals to hide from public health regulators numerous incidents of serious mistakes made by its staff members, resulting in dozens of patients suffering serious injuries . . . without them even receiving any subsequent notifications mandated by law!

First, let’s provide a little perspective in terms of the scale of patients involved in the dozens of “botched operations, deadly accidents, malpractice and other medical mistakes” that have until this article was published earlier today had been systemically covered up: The story points out that as the busiest municipal system in the US,  New York City’s eleven acute-care hospital provided care for 1.3 million patients last year; of whom 450,000 had no health insurance coverage.

It’s important to note that the Daily News‘ months-long investigation, which made very good use of the Freedom of Information Act, which mandates that certain information be released to journalists or academic researchers upon the filing and acceptance of a request – when there is a “public interest” in such information being revealed (see here and here for further background).

The investigation uncovered some extremely troubling incidents of medical malpractice, “mistakes”, “accidents” and “screwups” occurring at these eleven hospitals on a shockingly-large scale. Records reveal that over the four-year time period covering 2004 to September 2008, New York State cited city hospitals 68 times for violating laws that require immediate reporting of so-called “adverse events.”

Specifically, the law requires all hospitals providing care in New York to “quickly report all serious medical mishaps to the state.

But according to Arthur Levin, the Director of The Center for Medical Consumers and an expert on this issue interviewed for the story: “There’s a tremendous lack of confidence in the reporting. It matters because it is a way to understand where the safety problems are. . . . this identifies what goes wrong and where.”

According to the story’s authors, “hidden incidents” uncovered by the investigation — and corroborated by dozens of interviews with doctors, patients, lawyers and the families of victims — bordered on what they deemed as”Medieval.”

Some incidents were simply not reported, while others were reported long after the fact, making an accurate and comprehensive investigation “impossible.”  Some of the records that were reviewed by the paper were in fact  either “incomplete or even fictional.”

Here are some specific examples of horrific medical malpractice committed (and not reported) at these eleven New York City hospitals:

  • A stroke victim’s leg had to be amputated after gangrene was left untreated. No report.
  • An ill infant died after sitting, unexamined by a doctor in an ER for 24 hours. Confronted for not having enough doctors on duty, they produce a “corrected” report saying there was – a month after the fact.
  • A mental patient hanged himself and, after several days, died. Though hospitals must report suicides, they report this one as an “unexpected death.”
  • Records were altered after medical students made mistakes and an infant died.
  • Logs for a respirator were changed after staff failed to notice it wasn’t turned on. The patient died.

It is also important to realize that many of these findings were revealed to the public an entire year after employees of Kings County Hospital tried to hide the death of 49-year-old Esmin Green. Hospital staff wrote in records that she was “fine”; this despite the fact that video shot at the time of her expiration the victim dead on the floor.

Yet as the investigation continued apace, the cover-up of this tragic incident was recognized as representing merely one small part of a much larger pattern found in thousands of pages of internal hospital records obtained under the Freedom of Information Act request.

Apart from the fact that the protocol for reporting such hospital mistakes and injuries to the proper channels – in this case a New York State-run oversight panel named the New York Patient Occurrence Reporting and Tracking System (NYPORTS) – there are other reasons why this scandal was allowed to remain obscured for such a long period of time.

“From 2002 through June [2009] – when there were hundreds of citations – there were only 12 enforcement actions brought against all 11 city-run hospitals. Fines totalled a paltry $235,000.”
We also find out that:

Five of the 11 hospitals faced zero enforcement actions and zero fines in that time period, though the five racked up hundreds of complaints. [While[ the state is supposed to track and analyze all medical incidents and implement improvements. The problem is this oversight system (NYPORTS) is a disaster.” (emphasis in original)

Since 1999, all New York hospitals have been required to self-report a long list of medical incidents to NYPORTS, which in turn analyzes the incidents and implements patient safety reform. . .  and the Statewide Council that oversees it hasn’t met in over two years. Though NYPORTS is supposed to release these “annual” reports, the last one filed is dated 2004.

Be sure to read this article in its entirety, as it is a powerful reminder that many “self-reporting” and other healthcare-related oversight systems (such as NYPORTS) are completely ineffective  as a result of their simply not being put into practice, and even if they are, these “self-policing” mechanisms involve little more than a figurative slap on the wrist.

Posted in Hospitals, News, News Analysis.

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Naval hospital settles in major med-mal suit

AP reports that the Jacksonville Naval Hospital has reached a settlement in a medical malpractice suit. The suit was brought by the parents of twin children delivered at the government medical facility, one of whom suffered major injures as a result of receiving insufficient oxygen during birth.

According to the parents’ attorney, the naval hospital’s staff was negligent in failing to prevent the oxygen deficiency, which led one of the twin children to be blind and with cerebral palsy. The child subsequently died last year at three years of age.

Posted in Military, News.

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