DC Medical Malpractice & Patient Safety Blog

A new research study gives hope that some patients who seem to be in a coma, or persistent vegetative state, may actually be aware of their surroundings and can communicate on a rudimentary level.

The even better news is that misdiagnosis of these patients, which studies suggest may be common, can be corrected by use of a simple, cheap and widely available brain wave test called the EEG, electroencephalogram.

The study was reported in the online edition of the prestigious British medical journal The Lancet.

Many patients who seem to be completely unaware of their surroundings after a brain injury do not show any response to this new kind of testing. But of the 16 patients tested in the new study, three patients did show a response, indicating that they had been misdiagnosed and should be reclassified as "minimally conscious."

The researchers gave the seemingly vegetative patients two simple tasks: imagine moving a right finger, and then imagine moving a right toe. The patients who passed the test were able to generate specific, repeatable brain wave responses in the same area of the brain, the pre-motor cortex, as normal healthy control patients could do with the same testing.

Other researchers have found that putting patients like this into MRI machines for functional MRI (f-MRI) testing also can show results that indicate the apparently unresponsive patient actually has a response deep within the brain. The brains of some of these patients light up in specific places on the f-MRI test when they are asked to imagine some specific athletic activity like playing tennis.

The problem with f-MRI testing is it's expensive and requires the patient to be transported to a radiology center.

Here is the conclusion of the authors of the EEG study:

Despite rigorous clinical assessment, many patients in the vegetative state are misdiagnosed. The EEG method that we developed is cheap, portable, widely available, and objective. It could allow the widespread use of this bedside technique for the rediagnosis of patients who behaviourally seem to be entirely vegetative, but who might have residual cognitive function and conscious awareness.

Brain scientists are excited that if these results hold up, we may have a way to communicate with some of the 25,000 Americans who lie in beds seemingly unaware but actually with something going on inside.

Article first published as New Hope for Communicating with Patients in a "Vegetative State" on Technorati.

Common sense says that putting stents into blocked arteries in the brain should help prevent strokes, just like propping open heart arteries cuts heart attacks.

But Medicare asked for a scientific study before it started paying for widespread use of the brain stents. So doctors tested stents versus medical therapy in high-risk patients. After one month, a dramatic answer: in one group, 6 in 100 patients got a stroke, but in the other group, 15 in 100 had strokes.

Problem is that the stent group was the one that had more than double the strokes of the medical treatment group.

The result was so big that doctors pulled the plug on the study, as they could no longer ethically put patients into the stent group.

This is yet another example of how therapies that seem like they should work, based on our knowledge of the body and medicine, turn out not to work. We have a lot left to learn.

In the case of brain arteries, bypass surgery to put in a new artery to go around blockages, also similar to what's done in the heart, also has failed to prove out in scientific studies.

You can read the new stent study in the New England Journal of Medicine.

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

Juries in Erie, Pa., last week returned substantial - and in the first case, record - verdicts on consecutive days in favor of the plaintiffs in two malpractices cases. One day after a jury gave $21.6 million - the largest malpractice verdict in the county’s history - to an Erie mother and her son over his botched delivery in 2006, another jury at the same courthouse returned a $1.8 million verdict in favor of the estate of a woman who died of lung cancer at age 66 in April 2005.

The first case began in 2006, when a mother went to the then Hamot Medical Center to have fraternal twins. The daughter was born normal but the son had severe brain damage. The jury agreed with the boy’s mother that the hospital's nursing staff was unprepared for complications arising from a breach birth and didn't do enough to prevent oxygen deprivation that left the boy unable to speak and requiring feeding through a tube.

The verdict includes $19.6 million to provide for the boy's future medical expenses. The rest covers past medical expenses and the boy's lost lifetime earning capacity. The hospital's attorney declined to comment on the verdict or whether the hospital will appeal.

The next day, a second jury determined that physicians treating Carolyn Champlin failed to properly diagnose and treat her lung cancer and returned a $1.8 million verdict. Champlin died in April 2005.

Her estate maintained that physicians in Erie and Kane failed to properly diagnose and treat the cancer. Champlin had received chest X-rays at Hamot and two other hospitals between 1998 and 2003. One of the plaintiff’s lawyers said after the verdict that the evidence showed Champlin had cancer in 2000, but was not properly diagnosed for 3 years. During that time, the lung cancer went from operable and curable to inoperable and incurable.

The jury agreed and found the two physicians negligent - her longtime primary-care doctor and a thoracic surgeon to whom she was referred. The estate settled with the surgeon before the trial ended. As a result, the jury verdict of $1,821,529 was reduced by 40% (the amount of the negligence attributed to the surgeon).
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Source: Erie Times-News and WICU-12

The following is a guest blog submitted by the Hawaii injury law firm of Davis Levin Livingston.

As reported by USA Today, there is a large treatment gap for brain injury victims in the United States. Despite the fact that programs like Medicare and Medicaid, and even most insurers, cover medical costs related to brain surgery and intensive care needed to save traumatic brain injury patients, many insurers simply don’t provide adequate funds for rehabilitation.

These rehab programs may cost anywhere from $600 to $8,000 a day, depending on the nature and extent of the services provided, according to Susan Connors, president of the Brain Injury Association of America.

Tragically, this lack of coverage for brain injury rehabilitation translates into thousands of TBI patients being discharged every from hospitals to nursing homes or to languish in their beds. Since it is in the early months following injury when their brains are most receptive to healing, many patients who might have otherwise have more successful recoveries simply miss their window according to data from the National Institute for Disability and Rehabilitation Research. As many as two-thirds of patients discharged from rehabilitation hospitals following 16 days of general treatment receive no further treatment.

Unfortunately, this means that countless brain-trauma patients, who but for the lack of treatment, may never regain full use of their limbs, their ability to use language, their emotional balance or their power to think clearly.

The views, opinions and positions expressed within this guest post are those of the author alone and do not represent those of Patrick Malone & Associates, PC. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations.

Attorney Mark Davis has been recognized as one of the top trial lawyers in Hawaii and in the United States. The Hawaii injury lawyers at Davis Levin Livingston are able to handle complex and costly litigation through a combination of common experience and expertise and individual achievement.

The views, opinions and positions expressed within this guest post are those of the author alone and do not represent those of Patrick Malone & Associates, PC. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations.