DC Medical Malpractice & Patient Safety Blog

Doctors who aren't directly involved in patient safety issues often sail through their careers without much awareness of how commonly errors and malpractice infect hospitals, clinics and medical offices. Then they become patients, and suddenly their world is turned upside down.

Itzhak Brook, M.D., has been a doctor for more than 40 years. He is an infectious disease pediatrician at Georgetown University Hospital in Washington, D.C. Then he got throat cancer a few years ago.

His cancer was successfully removed, but then it came back. He had to have his voice box -- the larynx -- removed, and the throat was reconstructed.

It was then that the errors began to pile up, or, as he puts it, “mistakes occurred at all levels of my care.”

Dr. Brook recorded these incidents before, during and after his surgery:

* Surgeons had failed to timely diagnose the recurrence of his cancer. It was finally observed by an astute resident via a basic procedure that allowed visualization of the pyriform sinus, which was where his tumor was located. Had his experienced surgeons done the same basic procedure, his tumor most likely would have been observed and removed much earlier.

* Surgeons mistakenly removed scar tissue instead of the cancerous lesion. A week after the surgery, pathological studies revealed that the tumor was actually farther down in the pyriform sinus. This error could have been avoided if frozen sections of the lesion itself, not just its margins, had been analyzed in the operating room. As a result, he had to undergo additional surgery to remove the tumor, which was more difficult because of swelling and changes to the surgical site due to the original operation.

* While still in the ICU one day after surgery, he experienced an airway obstruction and couldn’t find his call button, which had fallen on the floor. Though he was only a few feet away from the nurses station, he was unable to get the attention of staff but was ignored. (He couldn’t call out because he no longer had a larynx).

* In what was probably the most serious error, he was fed soft food by mouth far too early, which, following laryngectomy with flap reconstruction, can lead to failure of integration by the flap. It took 16 hours before the feeding was stopped, and only after Dr. Brook brought this to the attention of a senior surgeon. The error occurred because the order to start feeding was in fact intended for another patient.

In addition, nurses and other staff:

Did not clean or wash their hands.

Did not use gloves.

Took oral temperature without placing the thermometer in a plastic sheath.

Used an inappropriately sized blood pressure cuff (which produced alarming readings).

Attempted to administer medications by mouth intended to be given by nasogastric tube.

Dissolved pills in hot water and fed them through the feeding tube (thus irritating the esophagus).

Delivered an incorrect dose of a medication.

Connected a suction machine directly to the port in the wall without a bottle of water.

Forgot to rinse the hydrogen peroxide used for cleaning the tracheal breathing tube (causing
severe irritation).

Did not write down verbal orders.

Fortunately, despite all these errors, Dr. Brook did not suffer any long-term consequences. Still, his experience made him realize that a hospital is the least safe place for patients, and that all hospitalized patients should have a dedicated patient advocate such as a family member or a friend at their bedside.

Dr. Brook writes extensively about his experiences as a throat cancer patient on his blog. He also lectures to medical groups to try to get doctors and nurses to understand the human costs of the epidemic of medical error.

You can also read Dr. Brook’s account of his hospital experiences in the Journal of Participatory Medicine.

Diabetes medication Avandia will be pulled from pharmacy shelves in November because it poses a major risk of heart attack, the Food and Drug Administration has announced.

Under a new program effective Nov. 18, 2011, only certified physicians will be allowed to prescribe the drug, and then only to patients who've been informed of the risks and who will fill their prescriptions by mail order through specific pharmacies.

The new FDA guidelines limit the drug to patients already successfully treated with it or to those for whom it's pretty much a last-ditch effort to control blood glucose medically. In addition, healthcare providers and patients have to enroll in the Avandia-Rosiglitazone Medicines Access Program to prescribe and receive rosiglitazone medicines.

The restrictions to access are so tough that virtually no one will be able to obtain the drug, says Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who has long advocated more restrictions on the use of rosiglitazone (Avandia's generic name).

Avandia is also sold as a component in the combination drugs Avandamet and Avandaryl. It was approved in 1999 to lower blood-sugar levels in patients with type 2 diabetes. In 2007, Nissen published an analysis showing that the drug increased heart attack risk by about 40% in people with type 2 diabetes, who are already much more prone to heart attacks than people without the disease.

Subsequent studies confirmed the greater heart attack risk. In June 2010, more than half of the members of an FDA advisory committee recommended pulling Avandia from the market or tightening restrictions on its use, and in September, the FDA decided to impose restrictions.

Source: TheHeart.org

You can read the FDA’s decision here.

Testimonials from satisfied customers sell products. Every marketer knows that. But testimonials from patients are the wrong way to decide if a drug deserves an endorsement worth billions in sales from the Food and Drug Administration.

Why? Because, as a Virginia cancer doctor explains in a new article, the testimonials from happy cancer patients mask the fact that many other patients were not helped, or worse, were killed by the drug.

The drug now being pushed to the FDA by the testimonial technique is called Avastin. It's been proven to help patients with some kinds of cancers: colon, brain, lung and kidney cancers which have spread beyond their first site of discovery. It doesn't cure the cancer, but it can strangle a tumor's blood supply and thus shrink a cancer.

Avastin was tried with advanced breast cancer, but rigorous studies found that it didn't help quality of life for patients with breast cancer, and it didn't extend their lives, even measured by months. Plus it comes with serious side effects, the most prominent being the potential to cause a hole to suddenly develop in the stomach or intestines, which can be fatal.

So the FDA said the manufacturer couldn't market it for breast cancer.

Now Genentech, the maker of Avastin, is taking another run at the FDA, using testimonials from patients and treating doctors to try to get the agency to change its mind.

Dr. Frederick C. Tucker Jr., an oncologist in Fredericksburg, Virginia, wrote an "op-ed" piece in the New York Times commenting on this stratagem by the drug company:

[A]necdote is not science. Such testimonials may represent the human voices behind the statistics, but the sad fact is that there are too many patients who have been treated with Avastin but are not here to tell their stories.

Avastin will not disappear because of the F.D.A. decision. It remains available for treating other cancers, and research to find its appropriate role in breast cancer treatment continues. In the meantime, the F.D.A., which is expected to make its decision in September, needs to resist Genentech’s attempt to have it ignore scientific evidence.

Serious progress in the treatment of cancer will not be the result of polemics, lobbying or marketing. Genentech’s money and efforts would be better spent on research for more meaningful treatments for breast cancer.

The Avastin website has photos of real patients who Genentech says have been helped by the drug. These photos tug at viewers powerfully. But they don't substitute for hard statistical analysis.

While evidence continues to mount of the high cost of preventable medical errors, and the failure of safety efforts to put much of a dent in the rising tide of injuries from health care, here's a curious new statistic: Malpractice lawsuit payments are at their lowest level in 20 years.

That figure comes from Public Citizen, which every year scours the official National Practitioner Data Bank for data on total payments. According to Public Citizen, the cumulative total of payouts in 2010 across the United States was its lowest since the data bank started in 1990, adjusted for inflation.

Public Citizen says the numbers give the lie to efforts by some Congressmen to blame rising health care costs on malpractice victims who sue for accountability. A bill which has advanced in the House of Representatives, the Help Efficient, Accessible, Low-cost, Timely Healthcare Act of 2011 (H.R. 5), would put an artificial "cap" on malpractice lawsuit damages (other than tangible items like lost wages and medical bills) of $250,000 even for the most catastrophic injuries and death. The cap would also apply to cases against drug and medical device manufacturers for defective products.

The decline in dollar payouts to malpractice victims may reflect the efforts of lawmakers in many states to make malpractice lawsuits more difficult and expensive to bring by putting lids on damages, shortening the time for filing a lawsuit, and other tactics. That legislative strategy is the same one behind the H.R. 5 bill in Congress, which would make "tort reform" uniform and applicable in every state.

“There is a crisis in medical malpractice, not lawsuits,” said Taylor Lincoln, research director for Public Citizen’s Congress Watch division and the author of the new study. “Trying to stop people from being compensated for catastrophic injuries is not the answer. We should instead concentrate on making hospitals safer and disciplining doctors who repeatedly commit malpractice.”

The Public Citizen analysis also found that:

• Between 2000 and 2010, health care spending rose 90 percent while medical malpractice payments fell 11.9 percent;

• Malpractice payments in 2010 amounted to only 0.13 percent of 1 percent of national health costs, the lowest percentage on record; and

• Total costs for malpractice litigation fell in 2009 to just 0.40 of 1 percent of health costs, the lowest level since the databank’s inception.

Meantime, medical journals continue to report that preventable injuries happen commonly in hospitals and other health care facilities. A recent study of North Carolina hospitals, published in the prestigious New England Journal of Medicine, found that 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."

Article first published as Malpractice Lawsuits Are Down While Injuries Are Up on Technorati.

Making physicians aware of the cost of regular lab tests cuts the daily bill for those tests by as much as 27%, according to a new study.

The study, published in the May issue of Archives of Surgery, first monitored the baseline daily per-patient cost for two common lab tests - complete blood count and total chemistry panel – among surgical patients at Rhode Island Hospital in Providence. Once the baseline was established, researchers made weekly scripted announcements to the physicians-in-training who order most of the tests and to their attending physicians about the cost of those tests, but doctors were never told when or when not to order a particular test.

When the program began, the daily cost per non-intensive care patient was $147.73. Over the 11 weeks of the study, that dipped as low as $108.11 in the eighth week. There were a couple of weeks where the cost of tests went up from the previous week, but those corresponded with a new influx of intern physicians who were hearing the announcement for the first time.

Over 11 weeks, the official total saved was $54,967. (In practice, of course, the true amount saved would be less, as the official savings is based on the sticker price of the tests, not the amounts actually paid by Medicare or negotiated with third-party insurers.)

Study co-author Elizabeth Stuebing says the results show what can happen merely by giving physicians information they don’t usually get. “We never see the dollar amount of anything," she says. "The first week I stood up and said that in the previous week we’d charged $30,000 of routine blood work and I could hear gasps from the audience.”

Source: The Wall Street Journal

You can read an abstract of the study here.

Ask any nurse for stories about dealing with doctors, and you will hear that American hospitals and other health care institutions have a long way to go before civility and teamwork rule the day. Why is that a malpractice prevention issue?

Nurses have a vital role as a check and balance to catch mistakes and oversights by doctors that could lead to tragic malpractice injuries. But a typical example, when a nurse quietly questions a doctor's order for a medication that the nurse doesn't think appropriate, is to hear the doctor say: "When you get an MD after your name, you can question what I order."

Stamping out the attitude of doctor superiority is important for everyone in the health care system, especially patients. That message came through loud and clear in letters to the editor of the New York Times responding to a nurse's frustrated column about being humiliated one too many times by a doctor in front of a patient.

The CEO of one of New York City's top hospitals: Herbert Pardes of New York-Presbyterian Hospital, wrote:

The best doctors I know consider themselves part of a team and use the team’s knowledge to the advantage of the patient. They think “patient first” and draw on the experience of nurses, laboratory technicians and other medical professionals. The patient receives the doctor’s best treatment advice based on the collective knowledge of the team.

Doctors who accept only their own counsel are putting ego before medicine, possibly at the expense of the patient. Hospital care should be based on collective wisdom to reach the best treatment plan. Nurses, doctors and all highly trained medical professionals each have a role to play, each of which is invaluable to the patient.

And another letter writer, Donna Nickitas, a nursing professor at Hunter College, said:

As a nurse, I would not want my family member or my nursing students in a hospital where physicians demean and insult their nurse colleagues, thus hampering their ability to care. A culture of civility and a climate of respect and dignity not only win the day but also ensure patient safety and quality care.

So when you're in a hospital and you see doctors acting arrogantly, know that it's not just a personality quirk, but something that could be bad for the health of any patient, including you and your loved ones.

Physicians, researchers, drug makers and regulators should pay more attention to patients’ first-hand reports of their symptoms while they take medicines because their information could uncover safety problems and guide treatment and research, a cancer researcher says.

In an article in the New England Journal of Medicine, Dr. Ethan Basch, an oncologist who treats men with prostate cancer at Memorial Sloan-Kettering Cancer Center in New York, writes that direct reports from patients are rarely used during drug approval or in clinical trials, and, when patients’ comments are sought at all, they are usually filtered through doctors and nurses, who write their own impressions of what the patients are feeling.

In addition, physicians and nurses “systematically downgrade the severity of patients’ symptoms” and sometimes miss side effects altogether. One result is “preventable adverse events” — for instance, suicidal thoughts in young people taking antidepressants, or severe constipation in people taking a drug for irritable bowel syndrome, both of which might have been detected earlier if symptoms had been systematically tracked.

Basch first studied people who receive chemotherapy, comparing symptom reports by patients with those from doctors and nurses and found that for every problem — fatigue, nausea, appetite loss, vomiting, diarrhea, constipation — patients reported it earlier and more often than did doctors and nurses.

The tendency to downplay symptoms may be based on the doctor’s knowledge that a patient is in the early stages of an illness and could be much worse. Or the doctor may be making mental comparisons with other patients who are sicker.

Sometimes, the downgrading may reflect wishful thinking by doctors, who may think that a certain drug will help patients and don’t want to take them off it.

Mistakes and distortions in reporting symptoms can be compounded in studies, where one researcher collects the information, another retrieves it from the chart and enters it into the study record, and still others evaluate it. The results can be like playing broken telephone.

He recommends that patient symptoms should be rated separately by patients and their physicians, particularly before and after new medications are approved and brought to market.

Source: The New York Times

You can read the original article in the New England Journal of Medicine here.

When you see a specialist, you expect to hear from an expert who will diagnose your condition and then recommend the appropriate treatment. But that may not be the case, especially if you’re dealing with gastroenterologists and your symptoms appear to resemble those of Barrett’s Esophagus, a condition in which the lining of the esophagus is damaged by stomach acid.

When gastroenterologists were asked in a survey to cite the criteria for diagnosing and managing Barrett’s, most gave answers that differed from published guidelines, suggesting overdiagnosis and an excessive burden on patients.

Barrett's can be a precursor to cancer of the esophagus. It happens with repeated episodes of reflux when stomach acid is expelled upward into the esophagus. Typically the lower part of the esophagus closer to the stomach becomes chronically inflamed. Heartburn is the usual symptom from these repeated episodes of reflux, or even difficulty swallowing.

Under a microscope, Barrett's is diagnosed when a biopsy from the esophagus shows that the normal cells have been transformed into "dysplastic" or precancerous cells. The cells look more like those seen in the colon than those that should be lining the upper part of the gastrointestinal system.

In the survey of 261 gastroenterologists presented last week at Digestive Disease Week in Chicago, 23% failed to name the only criterion for Barrett’s endorsed by the official American College of Gastroenterology (ACG) practice guideline, while more than half listed other criteria.

Furthermore, about a third said they perform follow-up exams in patients with non-dysplastic Barrett’s more frequently than the 3-year interval recommended by the ACG.

The ACG guideline defines Barrett's as a change in the lower lining of the esophagus of any length to a columnar-type mucosa, with biopsy confirmation as intestinal metaplasia. Although 77% of respondents correctly indicated that such a finding would be adequate for a diagnosis of Barrett’s, respondents could name multiple criteria and a substantial number endorsed one or more criteria not included in the ACG guideline including (1) irregular-appearing squamocolumnar junction with biopsy finding of intestinal metaplasia (47%); normal-appearing squamocolumnar junction with biopsy finding of intestinal metaplasia (22%); visible columnar-type mucosa above the gastroesophageal junction (17%) and irregular-appearing squamocolumnar junction without biopsy ( 3%).

The guideline also indicates that, for nondysplastic Barrett's esophagus, follow-up endoscopy should be performed every three years. This interval was seconded by 55% of respondents in the survey. Some 34% respondents indicated that they perform endoscopies in such cases every one or two years, while another 9% said their preferred follow-up interval varied, depending on the length of the dysplastic segment.

The survey also found that, compared with salaried physicians, those with "productivity-based incomes" were significantly more likely to perform endoscopies at 1- or 2-year intervals in nondysplastic patients.

Source: MedPage Today

Reference: “Poor compliance with guidelines in the diagnosis and management of Barrett's esophagus" DDW 2011; Abstract Sa1064.

As an increasing number of patients being tested for prostate cancer contract potentially lethal drug-resistant infections, some physicians are rethinking their approach to prostate cancer screening.

Several studies released in the past year reveal that infectious complications from biopsies have more than doubled in less than a decade, and a growing percentage of patients who undergo needle biopsy tests are becoming critically ill and dying from bacterial infections, including sepsis.

A tissue biopsy of the prostate to detect cancer typically entails sending an ultrasound-guided needle about a dozen times through the rectum to collect specimens from the walnut-sized gland that sits under the bladder. The test carries an infection risk because the needle can take bacteria from the bowel into the prostate, bladder and bloodstream.

If the bacteria is resistant to antibiotics given at the time of the biopsy, the routine, 15-minute procedure can turn into a dangerous situation.

More than 1 million transrectal prostate biopsies are done in the U.S. each year to diagnose cancers in men whose screening blood tests suggest they may have the disease, but no studies have examined the risk of sepsis globally. Instead doctors are trying to gauge the scope of the problem from studies beginning to emerge from North America, Europe and Asia.

For example, a research team at the Odette Cancer Center in Toronto uncovered the emerging infection risk last year after examining more than 75,000 electronic records of biopsy patients treated in Ontario between 1996 and 2005.

The team discovered that the chance of being hospitalized within a month of the procedure had increased fourfold in less than a decade, reaching 4.1%in 2005 from 1% in 1996; of these, 72% were diagnosed with infections.

Source: Bloomberg News

You see them walking around hospitals, and sometimes even on the street: health care workers wearing surgical "scrubs." It's something of a fashion statement, but also a potential carrier of infections, yet no one has really carefully studied the problem to know for sure.

The old adage among patient safety advocates that “you can’t improve what you don’t measure" describes what we know about infection rates in hospitals. As long as little or no data on infection rates are collected, the problem tends to be sidelined.

There is no data about a possible link between hospital scrubs worn outside the operating room and infection rates. Scrubs can carry harmful pathogens, and because the transmission modes of drug-resistant pathogens are more prevalent than previously thought and are no longer confined to hospitals, some patient safety advocates say it’s time hospitals addressed the issue.

One such group, the Empowered Patient Coalition, which works on patient education and empowerment issues, wants hospitals and other health care organizations to start by gathering data on scrubs in their facilities and by looking at the data about the types of pathogens that are found, and then developing policies to keep both their workers and the public safe.

But, the group says, for such a policy to be effective, a hospital would have to:

1-Promote a culture where the policy is the norm, not an additional burden.

2-Communicate the policy efficiently to staff using supervisors who believe in the action.

3-Ensure that ignoring the policy will have consequences and would be considered an employment standards issue.

Source: University of Southern California Reporting on Health

It's a new story but an old story too: For-profit spine surgery centers recruit patients with promises of relieving their long-standing back pain with tiny cuts and high-tech lasers. Then comes a string of malpractice lawsuits from patients crippled by the surgery. Then the journalists mount the evidence: Big profits, many operations, little scrutiny from state or federal health regulators, and no evidence the high-tech stuff even works.

Bloomberg News just published this expose of malpractice issues at the Laser Spine Institute, which has surgery centers in Philadelphia, Tampa, Scottsdale and Oklahoma City.

One problem for patients is that there's no FDA for surgeons. Unlike drug companies which have to show scientific evidence that their products work, surgeons can make promises to patients about minimally invasive surgery and show testimonials from satisfied customers that make it all sound irresistible, even with no real scientific proof that their high-tech stuff works any better than what other surgeons offer.

The laser part of the surgery merely substitutes the laser beam for what other surgeons would accomplish with an electrical current. In both cases, the idea is to burn off sensitive nerve endings between the vertebrae. The problem is that no matter what device does the burning, the pain relief tends to be short-lived as the nerve endings grow back.

The other part of the typical surgery at Laser Spine Institute involves removing some of the bones surrounding the spinal cord when those bones have become overgrown and the spinal canal is narrowed and painful. That is standard back surgery. It's different at the Laser Spine Institute only in the doctors operating through smaller holes and viewing the operative site through telescopes (endoscopes) rather than direct vision.

Since the surgery is done at a same-day surgery center, patients are sent home or to hotel rooms afterward, and that can be a huge issue if something goes awry. For example, it's not uncommon that patients start bleeding near the spinal cord after back surgery. This can create a collection of blood near the spine that compresses the nerves and can cause paralysis and damage to nerves controlling bowel and bladder function -- known as cauda equina syndrome.

The Bloomberg article also documents malpractice issues with other for-profit spine surgery outfits that compete with Laser Spine for patients. Those include the Bonati Institute in Hudson, Florida and North American Spine of Dallas.

Another big problem with the business model of these spine outfits, which are competing for an estimated $73 billion that Americans spend annually seeking relief from back pain, is that surgeons are offered a "piece of the action" as investors in the profitability of the surgery center. That means that the more patients they send to surgery, and the bigger and more elaborate the operations they do, the more profit they make.

Sure enough, University of Michigan researchers found that surgeons increased their recommendations for back surgery by 87 percent after they became part owners of surgery centers. Their findings were published in the journal Health Affairs last year.

Children at emergency departments in the U.S. had five times as many CT scans in 2008 as they did in 1995, according to a recent study, increasing not only risks associated with radiation exposure but also risk of “incidentalomas," the term physicians use for incidental findings that could be (but probably aren't) cancer.

In addition, the study, published in the journal Radiology, found that 6% of pediatric visits to the ER involved a CT scan, while an earlier study by the same research group, led by Dr. David Larson at Cincinnati Children's Hospital Medical Center, found an even greater rise in scanning during adult ER visits, with 25 percent of patients age 65 and older and 12 to 16 percent of younger adults getting a CT scan in 2007. CTs of the abdomen and pelvis were the most likely to turn up an incidental finding.

An earlier study published in the Archives of Internal Medicine found that nearly 40 percent of CT and MRI scans performed for research purposes at the Mayo Clinic from January through March 2004 turned up at least one incidental finding. In the 35 patients in whom doctors took further action (i.e. additional testing, specialist consultation, or surgery), only six were judged by researchers to have clearly benefited from an investigation, while in the rest there was no clear benefit or clear harm, such as complications from surgery for a benign tumor.

In response to growing concern about the rising numbers of incidentaloma, the American College of Radiology recently published detailed guidance for clinicians about how to approach such findings, and warns physicians that “subjecting a patient with an incidentaloma to unnecessary testing and treatment can result in a potentially injurious and expensive cascade of tests and procedures." The college advises physicians to carefully consider an individual patient's risk for cancer in deciding whether or not to recommend further evaluation.

It also advised patients who are told about an incidental finding to seek a second opinion to verify that the radiologist's interpretation of their scan is correct, to adopt a "healthy skepticism" about testing, and only to consent to scans absolutely necessary to establish a diagnosis or plan of action, rather than to those ordered “just to be sure.”

Source: U.S. News & World Report

Several Supreme Court justices strongly suggested recently during oral arguments that Vermont’s attempt to restrict the use of drug prescription records for marketing purposes violates corporate free-speech rights. Vermont’s law is aimed at so-called data miners, companies that buy prescription records from pharmacies — minus patient identifying information — and sell them to drug makers.

The drug companies use the information to target doctors to try to persuade them to order the companies' products. Vermont Assistant Attorney General Bridget C. Asay told the court that the state’s interest is to “allow doctors to decide whether this information that they’re compelled to provide to pharmacies may be used in marketing that is directed at them.”

But skeptical justices hurled a barrage of questions in return, asking whether the state’s goal was simply to make it harder for drug manufacturers to convince doctors that their drugs should be prescribed instead of cheaper generic drugs.

“The state is interested in promoting the sale of generic drugs and correspondingly to reduce the sale of brand-name drugs,” Justice Ruth Bader Ginsburg said. “And if that’s the purpose, why doesn’t that run up against what this court has said — that you can’t lower the decibel level of one speaker so that another speaker, in this case the generics, can be heard better?”

Asay insisted that drug manufacturers are still free to pitch any message they want, but that doctors don’t want their histories of prescriptions to be used to target them. The Vermont law lets individual doctors "opt out" of having their prescription histories sent to the drug manufacturers.

There’s no doubt that pharmaceutical companies have an easier time if they have such information, she said, but “they have no First Amendment right to demand it, just as they have no right to demand access to the doctor’s tax returns, his patient files, or to their competitors’ business records.”

The federal government and 35 states are siding with Vermont in the fight, which has split lower federal courts.

The case is Sorrell v. IMS.

Source: The New York Times

As reported in more detail on our child safety blog, New York state has created a new fund to pay medical expenses for infants who suffer brain and nerve damage because of medical malpractice and other medical errors.

The fund, which is due to go into effect on Oct. 1, 2011, allows medical costs to be provided on a yearly basis to injured children. Parents can still pursue medical malpractice actions on the basis of emotional distress and other harms.

Fortunately for the babies, a part of the proposal that would have put an arbitrary and low ceiling of $250,000 on the amount recoverable for intangible injuries was dropped from the final legislation.

Source: New York Law Journal

A pioneering new study of the popular liposuction surgery finds that the fat which a surgeon sucks out from one part of the body gets added back in elsewhere by Mother Nature.

The study published in the journal Obesity found that within a year, all the fat suctioned out in a liposuction was regained by the body -- not in the location of the liposuction but in other places such as the upper abdomen and shoulders.

Obesity researchers say that the body "defends" its fat, carefully regulating the total amount of fat in the body. So fat removed by surgery in this respect is no different from fat lost by dieting -- the body's natural mechanism tends toward putting that fact back on.

No one quite knows why liposuction fat doesn't come back in the same place, but researchers told the New York Times it may be due to the way that liposuction disrupts the fishnet structure under the skin where fat cells reside.

Since liposuction has been around since the 1970s, why hasn't a carefully controlled study like this been done before? It has a lot to do with surgeons who rely on anecdote to prove that their methods work, rather than careful statistical studies.