DC Medical Malpractice & Patient Safety Blog

August 22, 2019

Do health care’s perverse incentives lure MDs into deliberate misdiagnosis for profit?

When doctors become medical outliers, shouldn’t hospitals, colleagues, insurers, and the rest of us ask how and why an individual practitioner diverges so much from the way others provide care?

Olga Khazan details for the Atlantic magazine the disturbing charges involving Yasser Awaad, a pediatric neurologist at a hospital in Dearborn, Mich. As she describes him, for a decade he racked up hundreds of cases in which he is accused by patients of “intentionally misreading their EEGs and misdiagnosing them with epilepsy in childhood, all to increase his pay.” Khazan says his case “shines a light on the grim world of health-care fraud—specifically, the growing number of doctors who are accused of performing unnecessary procedures, sometimes for their own personal gain.”

In the malpractice cases that are unfolding against him, Awaad’s pay has become a central issue, with evidence showing his hospital contract rewarded him for boosting the number of screenings he ordered and diagnoses he made. Jurors have been told that Awaad, whose salary increased from 1997 to 2007 from $185,000 annually to $300,000, “turned that EEG machine into an ATM.” He earned bonuses exceeding $200,000, if he hit billing targets.

August 21, 2019

Glimmers of hope in new therapies to battle killer Ebola and lethal TB strain

by Patrick A. Malone

Rare good news on destructive infections is emerging from Africa: Medical scientists, Good Samaritans, and public health officials are hailing the successes of powerful new therapies in treating a deadly and extremely drug-resistant strain of tuberculosis and Ebola, a killer viral hemorrhagic fever that spreads like wildfire.

Americans may skip over dispatches about these “foreign” news developments. They would be wise not to do so, because they have heightened importance these days, domestically, including in providing key lessons to be learned about how to safeguard the public health.

The TB care that is winning great attention overseas requires patients to take three drugs in a regimen in which they take five pills a day for six months. That already is a boon compared with other, now common therapies in which they might need 40 pills a day for as long as two years, or daily antibiotics shots with bad side effects like deafness, kidney failure, and psychosis.

August 20, 2019

As NFL talks up lesser head harms, study shows repeated slams injure brains

by Patrick A. Malone

Although commentators and pro football itself have argued that rule changes by the National Football League have notably reduced possible head harms, new evidence from college athletes shows that even knocks that aren’t severe enough to be deemed concussions may injure young brains.

Those findings come from a University of Rochester study based on brain scans and helmet data from members of the school’s Division III football team (shown above), the New York Times reported.

Researchers scanned the athletes’ mid-brain area twice, once before the season kicked off and at its end. They did so because that region would most likely show the effects of impacts, including those that might be tougher to gauge in other areas of the brain. They also compiled data from special equipment on players’ helmets, registering the number and intensity of every impact — not just from player collisions but also when athletes hit the ground.

August 15, 2019

Safety concerns more than skin deep with consumer products like sunscreens

by Patrick A. Malone

It probably should not have come as such a shock. But consumers are learning the hard way — notably through lawsuits in the civil justice system — that substances they slather on their skin don’t just stay there. They can move deeper into the body, causing bad things to happen.

Judges and juries have accepted the argument that this occurs with baby powder, with asbestos-tainted talc contributing over long periods of frequent application to claimants’ genital cancers. Plaintiffs have won sizable judgments, asserting their cancers were tied to extensive, sustained exposure to the chemical used in the weed killing product Roundup.

August 14, 2019

For patients’ sake, U.S. must slap down Big Pharma chiseling on tests, trials

by Patrick A. Malone

Big Pharma is testing crucial boundaries in the way that the nation determines the safety and effectiveness of prescription medications. And regulators, for patients’ sake, need to shove back — hard.

The concerning incidents involve “pay to play” clinical trials and “manipulated” data submitted to the federal Food and Drug Administration by maker Novartis as part of the approval process for a gene therapy drug with a sky-high price.

Neither instance, officials insist, had immediate effects in endangering patients. But both show extreme practices and conduct that regulators should slam to a halt.

August 13, 2019

Would workers really be sad if health insurers didn’t grab a third of their pay?

by Patrick A. Malone

With the 2020 presidential campaign obsessing early about health insurance rather than costly health care overall, voters may wish to reframe their thinking about coverage and candidates’ views on making it affordable. Their chief query may need to be this: Just how much of the vig should the bagman take?

That may be a blunt a way to put it, but is the vernacular of the criminal “protection” racket all that out of place here? Michael Hiltzik, a financial columnist for the Los Angeles Times, makes pretty much the same argument, that the bagman’s share ought to be zero. Why not get rid of health insurers, he asks in a bit of evidence-based hyperbole? He finds the companies don’t fulfill much of a public mission, save, as a former insurance executive describes it, to make themselves money and to persuade all of us that they are essential. Indeed, as Hiltzik sees it, insurers are not just a rip-off but a failure in their own terms:

“Let’s start by examining what the insurers say are their positive contributions to healthcare. They claim to promote ‘consumer choice,’ simplify ‘the health care experience for individuals and families,’ address ‘the burden of chronic disease,’ and harness ‘data and technology to drive quality, efficiency, and consumer satisfaction.’ (These claims all come from the website of the industry’s lobbying organization, America’s Health Insurance Plans (AHIP). They’ve achieved none of these goals. The increasingly prevalent mode of health coverage in the group and individual markets is the narrow network, which shrinks the roster of doctors and hospitals available to enrollees without heavy surcharges. The hoops that customers and providers often must jump through to get claims paid impose costly complexity on the system, not simplicity. Programs to manage chronic diseases remain rare, and the real threat to patients with those conditions was lack of access to insurance (until the Affordable Care Act made such exclusion illegal). Private insurers don’t do nearly as well as Medicare in holding down costs, in part because the more they pay hospitals and doctors, the more they can charge in premiums and the more money flows to their bottom lines. They haven’t shown notable skill in managing chronic diseases or bringing pro-consumer innovations to the table.”

August 12, 2019

Gun violence is a public health crisis. Research and treatment are needed now.

by Patrick A. Malone

With back-to-back-to-back incidents of mass gun violence killing almost three dozen children, women, and men, can this nation muster the political courage to treat this lethal scourge as a public health menace?

Can it, finally, green light and fund rigorous research that could inform public policies that both could protect Americans’ Second Amendment rights while also reducing the estimated 40,000 or so firearm deaths that occurred in 2018 alone?

For what it is worth, there is considerable and (what should be) convincing evidence that:

August 9, 2019

Another abuse scandal may change ‘The Talk’ with college-bound students

by Patrick A. Malone

It’s that time of year when parents send their kids off to schools and opportunities near or far away. While this should be a mostly welcome happening, sadly grownups may want to have The Talk with their young adults before they go to college or university.

No, they won’t be discussing just the birds and the bees. They may be talking about an ugly necessity — how young people must know appropriate boundaries and acceptable conduct by adults with responsibilities for their care, specifically athletic coaches and health providers at colleges and universities. This is an issue of rising concern for young women and men.

Yet another sexual abuse scandal has erupted involving dozens of young men in track and field programs, spanning the globe for decades, ESPN reported. The tawdry incidents focus on Conrad Montgomery Avondale Mainwaring, now 67 and hobbled by hip problems.

August 7, 2019

Loneliness, debilitation, and depression blamed for seniors’ rising suicides

by Patrick A. Malone

The nation’s rising suicide crisis torments seniors, too, with just under one out of five such deaths in 2017 occurring with individuals 65 and older. Men 65-plus, experts say, face the highest suicide risk, while seniors 85 and older, men and women, rank No. 2 in groups most likely to die by taking their own lives.

As the nation grays — 10,000 baby boomers a day turn 65, in a trend that will persist until 2029 — the already high concern about suicide, especially among seniors, is rising, National Public Radio reported.

NPR, noting that suicide already is the 10^th leading cause of death among all Americans, said that experts see loneliness, bereavement, grief, and depression as key factors in cases in which older individuals kill themselves. They find themselves isolated, overwhelmed, and with unending sadness when spouses and friends die. Their children, grandchildren, and other family members often live far away. They also struggle with their lives due to age’s increasing debilitation. As NPR reported:

August 6, 2019

$14k to treat iron-poor blood? That’s rich. As is politicians’ health care frenzy.

by Patrick A. Malone

Iron poor blood? For many of a certain age, mere mention of that phrase conjures the major advertising campaigns of yore for a popular, over-the-counter nostrum called Geritol. The tonic is still around and sells for less than what a first-run movie ticket costs.

Which leads to a different question that may burn many patients: Why are doctors and hospitals peddling Injectafer, a new and hot treatment for iron deficiency that happens to cost $14,000 per vial? The drug also must be given intravenously by trained medical personnel at additional cost in a doctor’s office, a clinic, or hospital.

Shefali Leuthra reported for the Kaiser Health News Service and NPR that doctors are ordering Injectafer and other pricey prescription drugs like Feraheme for big numbers of patients, particularly seniors because they suffer a common condition: