DC Medical Malpractice & Patient Safety Blog

Or ... let them run through your body first, and then into the toilet. Either way, taking mega-doses of vitamins and other supplements just doesn't do much for people, other than enriching the vitamin content of their toilet water.

Latest proof: High doses of Vitamin D and calcium do nothing for most people, because the body gets plenty out of a normal healthy diet and from normal sun exposure (for making Vitamin D).

Worse, although less conclusive: Vitamin D can actually be harmful in large doses.

Here's a discussion of the latest evidence.

And what just is a vitamin, anyway? Here's an excerpt from an article on the subject at the website of the American Council on Science and Health, a debunker of health myths of all sorts:

Vitamyths

By Josh Bloom, Ph.D.

If you ask 100 people what a vitamin is, at least 100 of them will get it wrong. They will have some vague ideas: everyone should take them, they are derived from natural sources and the more you take, the healthier you will be. All of this is wrong.

The definition is actually rather simple: vitamins are nutrients required in very small amounts to promote many of the thousands of chemical reactions that make life possible. Most vitamins function as catalysts — substances typically used in miniscule quantities to promote these reactions that would otherwise not take place or would do so millions of times more slowly. Vitamins must be consumed because (with few exceptions) they are not produced within the body.

The quantity of vitamins actually needed is unexpectedly small. If you add up the total weight of all vitamins in the Recommended Daily Allowance (RDA) you come up with 150 milligrams, roughly equivalent to 5 grains of uncooked rice. This tiny amount is sufficient to support a wide-ranging array of biochemical reactions that generate energy, synthesize proteins and regulate hormone levels, just to mention a few.

Surprisingly, nearly all vitamin supplements come from synthetic rather than natural sources. The two forms are chemically identical and your body cannot tell them apart, so the source is immaterial. Even vitamin C, which could easily be extracted from fruits or vegetables, is man-made in vitamin pills.

More surprisingly, large doses of vitamins can be harmful and even fatal. [Emphasis added by protectpatientblog.] Vitamins are divided into two classes: water-soluble and fat-soluble. Each group behaves differently when taken in large quantities. Water-soluble (B and C) vitamins are less toxic, since they are rapidly excreted in the urine, where they nourish the life forms in your sewer at the expense of your wallet. By contrast, fat-soluble vitamins (A, D, E, and K) are stored in body fat, and they are eliminated much more slowly, making them more dangerous. Indeed, numerous studies have shown that large doses of vitamin E are associated with cardiotoxicity and early death. Excess vitamin A causes liver toxicity, anemia and hair loss, and is especially dangerous for the fetuses of pregnant women. It is chemically related to the acne drug Retin A, which can cause serious birth defects.

Read more here:

A Louisiana neurosurgeon may face multiple lawsuits after the fund that normally handles malpractice claims in the state said it might not cover the cases.

Dr. Ravish Patwardhan already has had to surrender his surgical privileges in September over concerns about the speed of his surgeries, the number of surgeries he performed annually and the amount of followup care he provided. Now the state’s compensation fund says that if it decides Patwardhan intentionally caused harm to patients, he’s on his own.

In Louisiana, malpractice claims involving negligence or lack of medical skill are not filed against physicians directly. Instead, they are filed against the Louisiana Patients Compensation Fund, which physicians pay into in return for malpractice coverage. Such claims are capped at $500,000. However, the fund won’t cover cases if it determines that the physician intentionally harmed the patient. A panel of experts will review the claims made against Patwardhan, a process that could take as long as 2 years.

The case is unusual because usually people can sue only after a panel finishes its work. However, John Hammons, the attorney who is handling about 100 potential malpractice claims against Patwardhan, sued both Patwardhan and the fund directly after being notified that the claims might not be covered under Louisiana malpractice law.

Earlier this year, Hammons reported his concerns about Patwardhan to the Louisiana State Board of Medical Examiners, triggering an investigation that led to the board suspending Dr. Patwardhan's right to practice surgery.

Source: The Shreveport Times

A study of ten hospitals in North Carolina finds a one-in-four chance of being hurt by medical care, a rate that hasn't improved in the ten years since a landmark study said that 100,000 Americans were killed by malpractice and medical error each year.

The new study, published in the nation's leading medical journal, the New England Journal of Medicine, looked at 2,300 randomly chosen admissions in the ten hospitals. North Carolina was chosen for the study because it has a high rate of participation in hospital safety efforts.

But the results were discouraging. One in four hospital admissions included harm to the patient due to medical care, and two out of three of those harms were judged to be preventable.

The researchers wrote: "[W]e found that harms remain common, with little evidence of widespread improvement."

What needs to be done? Patient safety experts know that provable techniques to reduce harm to patients haven't penetrated as well as they should into routine hospital practice. Among the techniques identified in this study:

* Computerized order entry systems, to prevent errors in medications.

* Hand washing by doctors and nurses to prevent infection spread.

* Reducing excessive hours by doctors in training and nurses.

* Mandatory, rather than voluntary, error reporting systems.

You can read the whole study here.

Patient safety advocates and brand-name drug makers lined up against companies that make generic drugs over just how flexible the standards should be for the clinical testing of biosimilars.

These drugs, also known as biogenerics, follow-on biologics and subsequent entry biologics, are officially approved subsequent versions of biopharmaceutical products following patent and exclusivity expiration on the original product. Until now, only a handful of biosimilars have been approved in the U.S., but that is about to change.

At the hearing, patient safety advocates argued that the only way to be sure that a drug is safe is through extensive clinical trials, while generic biosimilar manufacturers and distributors maintained that dangerous and expensive clinical tests are not required because they will be based on drugs that are already proven safe.

But are they? Biosimilars exhibit high molecular complexity and may be sensitive to manufacturing process changes. In addition, the biosimilar manufacturer doesn’t have access to any of the information or substances (e.g. molecular clone or cell bank) that the originator used to create the drug. As a result, patient safety advocates worry that biosimilars might perform differently than the branded versions, and could have potentially serious health implications.

Amgen, a brand-name biopharmaceutical manufacturer, called for biosimilars to undergo rigorous testing and recommended that the FDA:

1. Use well-designed clinical trials to establish biosimilarity

2. Ensure the product manufacturer and lot number is known for all administered biologics

3. Set scientific and practical criteria for interchangeability.

Critics of a rigorous clinical testing standard say that in addition to the expense, there are ethical questions involved in repeating potentially dangerous trials in humans. To avoid repeating human trials, U.S. Senator Bernie Sanders has proposed require generics makers to pay a fee for access to clinical data used in the manufacture of the brand name biologic.

Source: Wall Street Journal blogs

You can get more information about the FDA hearing and view video of the proceedings here.

X-rays in the dental chair carry a small but cumulative risk of causing cancer, and there are simple ways to reduce the risk.

One is to ask the dentist if he or she is using "fast" X-ray film, which allows a smaller X-ray exposure to get the same quality image.

The majority of dental offices still use the slow "D-speed" film, which the American Dental Association says should not be used. Better is to use E-speed or F-Speed, which can cut X-ray exposure by 60 percent.

Even better than film is digital imaging detectors which further cut radiation dose.

This and other tips are found in a New York Times article on high-dose radiation risks in dentistry, which are even greater with a new technology called cone-beam CT scanning, which creates 3-D images of the entire teeth and facial bones.

More questions to ask your dentist about radiation can be found in this list prepared by the Times reporters.

Read the whole report in the Times here.

An orthopedic surgeon who performed the wrong operation on a patient now says he no longer sees any burden in The Joint Commission’s (TJC) Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. And he's gone on the record in a prominent medical journal to confess error and try to help other surgeons do it right.

TJC’s universal protocol recommends that surgeons:

1. Conduct a pre-procedure verification process.

2. Mark the procedure site before the procedure is performed.

3. Perform a time out.

The surgeon, David C. Ring, M.D., was treating a 65-year-old woman whom he had diagnosed 3 months earlier with trigger finger, a common disorder in late adulthood in which a finger or thumb snaps or locks before unlocking (like a trigger), caused by a swollen flexor tendon.

According to Dr. Ring’s own account, the correct arm had been marked at the wrist by the nurse but the planned incision site on the hand was not marked. Dr. Ring performed three other carpal tunnel procedures that day, one of which was performed on a patient who became extremely agitated before and after the procedure, causing the surgeon to vow that the next procedure would be the best carpal tunnel release he’d ever performed. In addition, the patient was moved to another operating room, resulting in a change of personnel which meant the nurse who had had performed the preoperative assessment would not be in the room during the procedure.

About 15 minutes after performing the carpal tunnel procedure, Dr. Ring realized he had performed the wrong surgery. After informing staff, he told the patient about the error, apologized and offered to perform the correct procedure. The patient agreed, and the trigger finger release was performed. Later, the patient’s son informed Dr. Ring that the patient had lost faith in him and would not return for followup care. A financial settlement was negotiated shortly after the event.

Dr. Ring asked that the case be published in the Case Records of the Massachusetts General Hospital to encourage the development and following of procedures that would minimize the risk of such events occurring again.

Source: New England Journal of Medicine

You can view and download a poster of the Universal Protocol here.

A new study from the Office of Inspector General of the US Health and Human Services Department estimates that one in seven Medicare patients in hospitals -- or some 134,000 patients per month -- are hurt by "adverse events" in hospitals.

Nearly half of those events are preventable, based on reviews by doctors, the report says.

Read the summary of the report here.

And here is a USA Today story about the report.

Any lingering doubts about the positive effects of comprehensive surgical checklist intervention should vanish following the release of a study conducted in the Netherlands and published in the New England Journal of Medicine.

The Dutch study evaluated the effects of a comprehensive surgical checklist intervention in six regional and tertiary care centers in the Netherlands and involved 11 distinct checklists applied
during different phases of preoperative, intraoperative, and postoperative care completed by
surgeons, anesthesiologists, nurses and other staff.

The checklists included nearly 100 items that address the availability of imaging information, equipment and materials, patient and operative site verification, communication of postoperative instructions between caregivers and discharge instructions. Outcomes improved substantially as a result of this intervention. The proportion of patients with one or more complications fell from 15.4 to 10.6%, while mortality dropped from 1.5 to 0.8%.

A large international study supported by the World Health Organization (WHO) released last year reported similar results, showing that checklists cut surgical morbidity and mortality almost in half. However, not everybody was convinced by the findings of the WHO study, because:

1. The pre-intervention/post-intervention study failed to control for confounding factors, such as the the “surgical Hawthorne effect,” which states that outcomes tend to improve rapidly when surgeons know they are being evaluated.

2. The study’s operating room checklist consisted primarily of common-sense items and processes of care that seemed unrelated to the most common serious complications of surgery, making it implausible for some that improved compliance with these practices could lead to such drastic reductions in morbidity and mortality.

3. Compliance of the eight study hospitals with the checklists had no bearing on the extent of improvement in outcomes. Overall compliance with processes of care on the checklists improved negligibly even in the two hospitals with the greatest reductions in morbidity and mortality, while conversely, the two hospitals with the greatest increase in compliance showed no change in outcomes.

The Dutch study avoided these pitfalls by including hospitals that had already been tracking their surgical outcomes with the same detailed registry for many years, so the results cannot be attributed to the effects of performance feedback.

It also documented a strongly positive relationship between checklist compliance and outcomes, in that patients with incomplete checklists had significantly more complications than those for whom checklists were more fully completed.

Finally, the study included a control group. At five similar hospitals that did not implement the checklist intervention, morbidity and mortality were unchanged during the study period.

An editorial published with the article concluded that surgery checklists now have advanced from a good idea to "standard of care."

Source: New England Journal of Medicine

You can view an abstract of the Dutch study here.

You can view an abstract of an editorial about the Dutch study here.

A lesson in the safety and efficacy of new drugs is very simple: small studies are bad, big studies are good. This lesson has been proven all over again with a big trial of a heart failure drug called Natrecor (generic name: nesiritide).

Small studies made the drug look worrisome for some bad side effects. Now a big study has found those worries misplaced -- but it also found the drug doesn't work all that well for its main purpose of preventing fluid accumulation in the lungs of heart failure patients -- symptoms that give them a terrible feeling of near drowning.

As quoted in the New York Times, a leader of the study of nesiritide, Dr. Robert M. Califf, a Duke cardiologist, said:

“Once again, small studies give us the wrong answers. There was no safety issue at all. To me, the really important message is that the drug got very widely used for reasons that are incorrect, and then it got bashed for reasons that are incorrect. Unless we do these kinds of large clinical trials we are engaged in a comedy of errors.”

And more from Dr. Califf, talking about both nesiritide and another heart drug -- Zetia -- now under a big study:

“F.D.A. by mandate could require studies, but that wouldn’t be necessary if clinical trialists and academic medical centers stuck to their guns and demanded the evidence before they used the drugs on a wide scale. Huge amounts are spent on marketing that could have been spent on a clinical trial."

Listen up, Big Pharma.

ProPublica, the investigative reporting group, is publishing a series on the quality of care the nation's 400,000 dialysis patients get, and it's not pretty. The basic conclusion:

"Taxpayers spend more than $20 billion a year to care for those on dialysis -- about $77,000 per patient, more, by some accounts, than any other nation. Yet the United States continues to have one of the industrialized world's highest mortality rates for dialysis care. ...

"At clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care. Regulators have few tools and little will to enforce quality standards. Industry consolidation has left patients with fewer choices of provider. The government has withheld critical data about clinics' performance from patients, the very people who need it most. Meanwhile, the two corporate chains that dominate the dialysis-care system are consistently profitable, together making about $2 billion in operating profits a year."

The ProPublica reporters go on to say that: "One reason the system's problems have evolved out of the health care spotlight is that kidney failure disproportionately afflicts minorities and the dispossessed."

Read more about this emerging malpractice and safety scandal here.

And here is part 2 of the series, which opens with a horrifying story about a woman who lost a quarter of her blood because the dialysis tube delivering the cleansed blood back to her body became dislodged and the technicians didn't notice until it was too late.

Here is one more piece of it, an important footnote about how the ProPublica reporters got the hard data on patient deaths that the government keeps hidden from the public.

St. Joseph Medical Center in Towson, Maryland will pay $22 million to the federal government to settle claims that it engaged in a decade-long, illegal kickback scheme with the cardiology group MidAtlantic Cardiovascular Associates, which was co-founded by Mark G. Midei - the cardiologist accused of performing hundreds of unnecessary heart procedures.

More than 100 patients have filed malpractice lawsuits against the hospital and Midei. He was taken off duty in May 2009 under suspicion that he had falsified patient records to justify unneeded stent procedures.

Dr. Midei filed a suit against St. Joseph last month in which he said that officials there ruined his reputation by warning nearly 600 patients about his work. He denies all allegations against him.

Read more in the Washington Post article here.

The headline is not exactly shocking, so the real news may be why the issue of how long work days can cause doctors to make errors is so rarely studied.

For nurses and residents (doctors in training), plenty of studies have found that when work days stretch beyond twelve hours, more mistakes are made, and patients become vulnerable to malpractice and even smaller errors.

But a new study of radiologists is one of the first to examine the effect of long work days on the performance of attending level physicians. The researchers gave a set of bone X-rays to radiologists at the beginning of their work day, and again at the end. Then they measured their accuracy at finding fractures. By the end of the day, the radiologists were making around one in twenty more errors -- both missing fractures and seeing ones that weren't there -- than at the start of the day. It's a small but significant difference.

The study in the radiology journal concluded:

"After a day of clinical reading, radiologists have reduced ability to focus, increased symptoms of fatigue and oculomotor strain, and reduced ability to detect fractures."

Dr. Bob Wachter, a UCSF patient safety guru, has a thoughtful piece on this in his own blog, which he titled: Tugging on Superman's Cape. Read it here.

Dr. Wachter riffed off a story he heard about legendary heart surgeon Michael Debakey performing sixteen open heart surgeries in a single day, even in his eighties. While the Baylor staffer who told Wachter this story was awestruck at Debakey's stamina, Wachter wondered what it would be like to be patient No. 16.

For the rest of us, there's a lesson when facing elective surgery. Surgeons love to stack up patients back to back and operate from the early morning to late in the day. If we have any choice, we should opt for a place early in the queue. Why tempt the gods of fatigue?

Article first published as Fatigue Wears at Doctors' Work Performance Too on Technorati.

The Food and Drug Administration has issued Class I recalls of Hospira Symbiq One- and Two-Channel infusers and Medtronic Octopus Nuvo tissue stabilizers.

Class 1 recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of these products will cause serious adverse health consequences or death.

The FDA is recalling Hospira’s infusion pump products due to motor encoder failures in the pumping mechanism that causes the infuser to cease operation. Delay or interruption of therapy may result in serious injury or death in: patients receiving critical therapy, pediatric patients, and neonates. The company mailed an “urgent device field correction” to affected customers and issued a recall notification in February 2010. All the affected units were distributed from Dec. 23, 2006 to January 22, 2010.

Medtronic’s Octopus Nuvo tissue stabilizers were manufactured from February 19, 2010 through August 28, 2010 and distributed from March 8, 2010 through September 7, 2010. The device stabilizes and minimizes the motion of selected areas of the beating heart during minimally invasive cardiac procedures while directly visualizing the heart through a small cut in the chest cavity. The FDA ordered the recall because of the possibility that a component of the device could fracture during use and fragments could fall into the patient’s chest cavity and/or damage the heart tissue, causing serious injury or death. Fortunately, no action from patients is required, since any adverse event related to the device would occur at the time of surgery.

Medtronic sent an “urgent medical device recall notice” to its customers on September 14, requesting that they discontinue use of the device, quarantine all unused devices and return unused devices.

Hospira recall source: Bioscience Technology

To view the FDA ruling on Hospira, click here.

Medtronic recall source: Operating Theatre Journal

To view the FDA ruling on Medtronic, click here.

Tired of reading doctor report cards and not knowing which ones to believe? Now there's an organization that reviews the plethora of health care report cards available online in order to provide you with clear choices about the sites that really do provide accurate and useful information.

The Informed Patient Institute provides detailed analysis of online health report cards – covering nursing homes and physicians for now and other health areas in the future – to show consumers where they can find the best information.

An independent, non-profit organization funded by foundations and individual donors, IPI provides guidance to other consumer-focused organizations, such as Consumers Union, to “facilitate access to credible online information about health care quality and patient safety,” but not by rating individual health facilities or professionals. Instead, IPI evaluates the usefulness of the wealth of online report cards and advocates making more -- and more useful -- health care quality information available to consumers.

Among the best features of IPI's system:

1. It uses a clear rating system. Organizations can receive an A through F grade, with explanations for what each means. IPI always tells you “what we like” and “what we don’t like.” For example, the New York State Health Department’s Nursing Home Profile received one of the few A grades. IPI praises the site for providing a “wide range of information including state survey results, complaints and quality of care provided,” but also notes that it doesn’t “have information on costs, nursing home staffing, or resident or family satisfaction with the home.”

2. It allows for exceptions to the rules. If a site has “unique content” but doesn’t quite make the grade in other criteria, IPI gives the site a “U.”

3. It simplifies users’ options. If you click on a state like Alabama, you will see that the only option for you to click is “Physicians” because there is no nursing home content related to Alabama. California, by contrast has sites that cover both. All the areas that IPI hopes to cover in the future are included in the drop-down menu, but only the topics that have content are clickable.

4. It provides good context. For each state, on the right side of the screen, you will see a Top 10 ranking of the sites IPI has reviewed that contain content about that state.

Source: Reportingonhealth.org

To visit the Informed Patient Institute web site, click here.

The news about a major government study that found 20 percent fewer deaths in a group of heavy smokers who got annual CT scan screening for lung cancer has a few more statistics that are sobering for the rest of us who pay the price as a society for this screening.

The study enrolled 50,000 smokers and gave half of them CT scans and half regular chest X-rays, every year for three years.

All enrollees had to have had at least a thirty pack year history of smoking (that's the same as one pack a day times thirty years, or two packs a day times fifteen years).

After three rounds of screening -- a total of 75,000 CT scans in 25,000 patients -- they found a total of 18,000 suspicious findings that needed follow-up -- biopsies with long needles or some other kind of surgery. That was about a one-in-four incidence of suspicious findings per screen.

In those 25,000 people, eighty-eight lives were saved from lung cancer death. (The lung cancer deaths totaled 354 people in the CT group versus 442 in the control group of another 25,000 patients who got chest X-ray only for comparison.) That's where the 20 percent number came from for the headlines.

So, bottom line: take 25,000 people, give them 75,000 CT scans, do further testing and surgery and more followup on 18,000, and save 88 lives.

Now, those are 88 very hideous deaths prevented. Lung cancer is one of the worst. But the delicate problem is that it's also self-induced by smoking most of the time.

So who should pay for all this testing? That's the kind of thing we need to have a national conversation over -- not hysterical shouting about so-called "death panels" -- but what can we really afford?

You can read the data from the government agency here.

And to see how the news media handle the story, contrast the AP story "CT scans modestly cut lung cancer deaths," with the Washington Post ("significantly cut..."). Which is more accurate? It depends on how you focus your microscope. My vote is with the AP's writer.

As many as 180 medications are in short supply so far this year, according to data from the the Drug Information Service (DIS) at University of Utah Health Care, which has tracked drug shortages for a decade. DIS calls the number of shortages this year “unprecedented.”

Across the United States, life-saving or medically necessary drugs are in short supply, endangering care and increasing the odds of medication mistakes for a broad swath of patients. Health officials say drug shortages pose a growing public health crisis, fueled in large part by financial motives of pharmaceutical companies concerned about falling profits due to competition from low-cost generic products.

According to figures compiled by DIS, there has been a significant increase in the number of drug shortages since 2005, when 74 drug shortages were recorded across the U.S. By 2009, the number had more than doubled to 166. And as of Sept. 10 this year, it had logged 150 new shortages – in addition to 30 drug shortages still unresolved and more being reported every week.

This year, shortages have been reported for commonly used drugs such as morphine for pain relief, propofol for sedation and Bactrim injections for infections. The problem has reached such a peak that four leading groups representing cancer doctors, anesthesiologists, pharmacists and safety advocates have convened an invitation-only meeting in Bethesda, Md., on Nov. 5 and have asked pharmaceutical companies and supply-chain representatives to join them in efforts to solve the shortage problems.

According to Valerie Jensen, associate director of the Food and Drug Administration’s drug shortage program, about 40% of the shortages are caused by manufacturing problems, including safety issues, 20% are caused by firms ceasing production of a drug and another 20% are due to production delays. Shortages also may arise due to raw material shortages, increased demand, site issues and problems with parts such as syringes or vials.

The FDA can’t force drug manufacturers to address the problem because it lacks authority to compel them to continue producing a certain drug, or to require them to make a drug that’s in short supply. Nor are companies required to inform the FDA about impending shortages unless there is no alternative for the drug in question, and even then, there are no sanctions for not informing the FDA.

Source: MSNBC

For FDA information about drug shortages, go here.

Victims of hospital malpractice hunger to be treated with respect as human beings by the hospitals who have destroyed or damaged their lives. A simple "we're sorry" is a good first step, but only a first step. Some forward-looking hospitals are learning that implementing patient safety changes as part of the healing process makes good business sense in addition to helping the patients and their families.

The online magazine, Hospitals and Health Networks, has a good article in its current issue on this. An excerpt:

When Sandra Coletta took the helm as president and CEO of Kent Hospital in Warwick, R.I., in October 2008, she received a trial-by-fire course in the management of medical error. Two years earlier, in July 2006, a high-profile medical error had occurred in Kent's emergency department when heart monitoring that a doctor ordered for a patient never happened, and the patient died hours after seeking help in the ED. When Coletta began her post at Kent, the legal case was still pending.

"No one from the hospital had talked to the family," Coletta says. "They had only been contacted by lawyers." The hospital had taken a causality defense, its initial position being that the patient's death could not be proven to be a result of its failure to monitor.

For Coletta, it was black and white. The hospital had made an error and was not owning up to it. The family was not getting answers they deserved, and no one was healing, including the caregivers involved in the error.

"There are many pressures from all fronts not to get involved, especially from a legal or public relations perspective," says Coletta. Instead, knowing it would be the only way for everyone involved to begin the healing process, Coletta chose to sit down with the family and do the unthinkable in a medical lawsuit—apologize.

Read more about this different approach to defending hospital malpractice lawsuits here.

An Illinois Supreme Court judge who earlier this year voted to throw out a 2005 law that placed caps on the amount patients could receive in medical malpractice cases has raised $2.5 million for his retention campaign. Opponents of Tom Kilbride, who is running as an independent, have raised $650,000 to campaign against his retention.

Combined, the $3 million+ raised make this contentious race the most expensive Supreme Court retention campaign the state has ever seen, according to the Illinois Campaign for Political Reform.

Under the 2005 law, jury awards for pain and suffering had been capped at $500,000 for doctors and $1 million for hospitals. Kilbride, along with three other judges, voted to overturn those caps as violating the state's constitution.

The Kilbride campaign has received the majority ($1.4 million) of its money from the Illinois Democratic Party. The Illinois Federation of Teachers have also pitched in hundreds of thousands of dollars. His opponents believe these large donations show Kilbride is not the independent he claims to be.

“He claims in his commercials that he’s independent. That is pure hogwash,” said Ed Murnane, president of the Illinois Civil Justice League, which is heading the campaign opposing Kilbride’s retention. The league has been rallying support from national tort reformers and business interests because of the malpractice decision.The Kilbride campaign accuses its opponents of running a “smear campaign” and distorting Kilbride’s record.

The race has also drawn interest because the court is split along party lines. Kilbride is one of four Democrats on the court, while the other three justices are Republicans. It is feasible that a Republican could replace him on the court if he is not retained. However, an Illinois Supreme Court justice has never lost a retention race.

Source: The Galesburg Register-Mail
To read the malpractice decision at the heart of the campaign against Judge Kilbride, go here.

"Why didn't they check?" That was the front-page headline in a Bundaberg, Australia newspaper about Dr. Jayant Patel, asking why the local hospital had hired Dr. Patel when he had already been the subject of medical discipline for patient deaths and injuries in Portland, Oregon.

But tragically, the question wasn't asked until Dr. Patel had been working in the Australian city for three years and until he had been the subject of several confidential complaints to the licensing authorities from nurses who saw frequent complications with his surgical patients.

Once the newspaper put a reporter on the case, he found the old information from Oregon with a simple Google search.

Now the surgeon has been convicted of manslaughter for the deaths of three patients.

Read more here from CNN International.