September 2011 Archives

During gestation, an unborn child's brain is vulnerable to a wide range of threats.  When a newborn baby is asphyxiated (a lack of oxygen to the baby) before or during birth, a condition called HIE, hypoxic-ischemic encephalopathy may occur.   As the HIE continues to occur over several hours, the lack of oxygen and even blood supply to the brain causes a series of events to begin as the body attempts to repair the problem.  If the HIE is mild, there shouldn't be a problem; however, if the HIE is more severe, the body may end up causing damage to the brain as it attempts to repair itself.

The HIE takes several hours before the damage is permanent.  If the baby's body temperature is slightly cooled, creating a mild hypothermia, there is a chance the baby will live a normal and healthy life.  By giving the baby a cool fluid filled blanket or a water cooled cap, the baby's temperature can drop by 3-4 degrees celcius for 72 hours after birth.  This helps the baby's body shut down dangerous reactions that would normally create additional brain damage under these conditions.  Creating a brain hypothermia by reducing the baby's temperature to 33 degrees celcius for 72 hours after birth appear to be the only medical treatment for a baby who was asphyxiated at birth.  After the 72 hours, the baby's are slowly warmed back up to normal body temperature for the next 6 hours.

In order for the brain cooling method to be successful, baby's who have experienced HIE must be subjected to brain cooling within 6 hours of birth.  The infant must have sustained brain damage and been gestated beyond 36 weeks.  With so many elements required in such a short amount of time, it is critical that the doctor's are careful and understand how to properly apply this procedure.  Failure to handle this procedure properly could result in additional brain injuries or even death to the baby.  Brain cooling may also be referred to as therapeutic hypothermia or neural rescue.

For more information, visit brain cooling

Medical negligence is the act or omission in treatment of a patient by a medical professional, which deviates from the accepted medical standard of care.  Medical malpractice can take the form of negligence, in which the doctor, nurse, medical professional, hospital, or medical facility did not take the proper action at the proper time.  Doctors take the Hippocratic Oath which is a promise to treat their patient's to the best of their ability and avoid causing them harm.  When a medical professional breaks this oath, they are negligent under the legal definition.

Medical negligence or medical malpractice lawsuits can be brought against surgeons, plastic surgeons, doctors, nurses, anesthesiologists, obstetricians, radiologists, hospitals, surgical centers, nursing homes, and medical clinics. 

Types of medical negligence or medical malpractice

Failure to diagnose a medical condition or failure to diagnose in a timely manner

Failure to diagnose a medical condition in a reasonable time may cause the condition to worsen.  In fact with many cancer cases, early detection is the key to preventing the cancer from spreading to the point where it is irreversible, ultimately leading to death.  Although certain cancers, including pancreatic cancer, ovarian cancer, and small-cell lung cancer have a low chance of recovery for the patient no matter when they are treated, other cancers, including breast cancer, colon cancer, and non-small cell cancers have a high chance of being treated if detected early.  This is where failure to diagnose a medical condition or failure to diagnose in a timely matter, such as failing to diagnose certain cancers, may be medical negligence.

Failure to follow up with the proper treatment

A doctor who fails to monitor a patient after prescribing treatment may be guilty of medical negligence.  This includes a doctor failing to adjust a patient's medication over time, switching a patient to a new medication, or terminating the medication if the medical condition requires such changes. 

Surgical error

Surgical errors include the surgeon accidentally cutting a vital organ, which may lead to foreign fluids entering and causing infections, such as urine or feces, entering the abdominal cavity, which may cause severe infections, possibly resulting in death.  Another example of a surgical error could result from the surgeon removing the wrong body part, such as the wrong organ from a patient; even leaving an instrument behind in a patient's body, would fall under the category of surgical error.

Anesthesia error

Anesthesia errors are quite common, including in non-hospital settings, such as medical centers or doctor's offices, involving elective plastic surgery.  In non-hospital environments, a mistake made post-surgery by an anesthetist, who is improperly trained, could lead to a catastrophic result for the patient.  The doctor's office may not have the proper emergency staff available to correct the problem in time and this could lead to severe brain injury or death for the patient.  Anesthesia errors occur in hospitals as well, including after a successful operation, whereby the anesthesiologist fails to properly revive the patient in the post anesthesia care unit.

Medication error

Medication errors occur frequently in medical facilities:
 

• The medical staff may not properly review the patient's background, including examining if the patient is already taking medication that may not be compatible with the new medication given. 
• The patient may be allergic to the medication and have an adverse reaction. 
• The patient may not be properly monitored for the reaction to the medication. 
• The patient may be given an overdose of the medication. 
• A pharmacist may also prescribe the wrong medication to a patient, including not reading the doctor's prescription correctly. 

Medical negligence and medical malpractice cases are very complicated.  If you or a loved one were the victim of medical negligence or medical malpractice, it is critical that you contact the best medical malpractice attorney that understands medicine.  Dr. Bruce Fagel is a leading medical malpractice attorney who is also a licensed medical doctor.  This experience gives Dr. Fagel the necessary skills to understand where medical negligence or medical malpractice took place, including understanding how to interpret medical records.

Many families will trust a nursing home or skilled nursing facility with their loved ones because they can no longer care for them at home in a practical or safe manner.  When these dependent adults are in a nursing home, they are at the mercy of the nurses, or the staff who have even lower level training than the nurses. 

Because of the alarming number of cases of nursing home negligence, many states have added statutes to provide additional protections for the elderly or dependent adults.  For example, in California, nursing home negligence or elder abuse cases that lead to the death of an elderly or dependent adult, allow a family to recover not only the non-economic damages for the loss of their loved one, but also allow for recovery of the pain and suffering their loved one went through before they died.  This is different than other types of wrongful death cases because the death of an individual normally ends any pain and suffering recovery for that individual and the family can only recover their loss for the effect of the decedent's loss or death.  But in a nursing home or elder abuse case the family can recover both their damages for the death of the individual as well as the pain and suffering their loved one went through before they died.

Since nursing homes and assisted living facilities are a for-profit business, the owner's and staff's top priority is often profit.  Nursing homes and assisted living facilities often subcontract various services, such as food preparation.  Nursing homes engaging in negligence will often hide behind this veil of subcontractors as a way to shield themselves from lawsuits.  Understanding the business model of a nursing home is important to pursing a negligence case.

Signs of elder abuse may include physical abuse and neglect including:

• Unexplained bruises, burns, cuts, sprains, or broken bones
• The lack of sanitary living conditions, clean clothes, or properly prepared food
• Soiled bedding, malnutrition, dehydration, or poor hygiene
• Bed sores, any medical needs not being taken care of, or unexplained weight loss

Family members may even fail to attribute these signs to possible elderly abuse or nursing home negligence, as they may instead blame it on the natural aging and deterioration process of their loved one.  If you suspect a loved one is experiencing elderly abuse or nursing home negligence, it is imperative that you retain the services of an experienced nursing home negligence attorney to protect your loved one and represent the best interests of your family.  Those who can't protect themselves because they are elderly, in poor mental or physical health, need the greatest protection of all. 

Gastric bypass surgery is rapidly becoming one of the most widely used surgical procedures in the country.  Primarily for people who are overweight, can't control their weight, or even fall into the classification of morbidly obese.  Sometimes people in these predicaments have no other option but to turn to surgery. Although these are elective surgical procedures, they are major surgeries requiring general anesthesia.  Patients may run into trouble and have major complications or die, during the surgery or after the surgery.  

The basic concept of a bypass surgery is to take a loop of bowel and bypass the major portion of the stomach, resulting in a small pouch that contains little more than 1 or 2 oz, so that when the patient eats, they feel full.  But this is still a major abdominal surgery, and when problems or complications occur, it's important that patients understand that they have rights and if there is negligence involved, they have the legal right to pursue the doctors involved with these kinds of procedures.  

As with any surgery, there are risks and a small percentage of people who have gastric bypass surgery experience major complications, even death; especially if medical negligence was involved.  Complications can include leaking from the stomach into the abdominal cavity, resulting in infection, an infection where the incision is made, or a potential blood clot.  Additional complications can develop over time including ulcers, anemia, nausea, or a hernia.

Anesthesia errors may also occur during an elective plastic surgery, such as gastric bypass, lap band, or stomach stapling.  Even lipo suction, face lifts, breast augmentation, or rhinoplasty "nose job" carry anesthesia risks from medical negligence.  Since many of these procedures may not be performed in a hospital, but rather in a doctor's office or other non-hospital environment, additional anesthesia risks may occur, including if the patient runs into complications with the anesthesia.  In these types of environments, the doctor's office probably does not have close access to trained hospital staff that may be able to prevent major complications from occurring during an anesthesia emergency.   

Visit gastric bypass surgery negligence to view a video about gastric bypass errors.

Anesthesia injuries, which can be catastrophic to patients, occur in hospitals as a result of things beyond a patient's control.  Very often when a patient goes into a hospital, especially for an elective surgery, even for a non-elective emergency surgery, he or she will at least have a chance to meet with the surgeon, discuss options, and understand what is happening with regard to the surgery.  But very often, patients never get to meet or talk to the anesthesiologist who is the most important person during any type of surgery.  Anesthesiologists not only provide the pain relief so the patient can undergo the surgery, but have to be able to monitor the patient during surgery and make sure they wake up appropriately following the surgery. 

We see a number of cases where patients have been injured during or following surgery as a result of improper anesthesia care from individuals who the patient has never met, never known, and knows nothing about.  Very often we find that these individuals are either poorly trained, inadequately trained, or may not even be anesthesiologists.  Many hospitals use certified register nurse anesthetists who may be capable in most circumstances, but not all circumstances, so there is a variety of different kinds of anesthesia problems that can have catastrophic outcomes for patients.

Anesthesia errors occur frequently during surgeries, however, most errors are corrected, so the patient rarely ever learns about them.  It is only after a catastrophic event occurs, such as a serious injury discovered following surgery, or even death, that a patient or the patients' family becomes aware of the anesthesia error.  Many patient's will seek multiple opinions from surgeon's, yet never think of the role an anesthesiologist plays during surgery and in the post operative recovery room.  Many patients will have a successful surgery, yet encounter problems in the post anesthesia recovery room.

Anesthesia errors not only occur in hospitals but cosmetic clinics, walk-in medical centers, medical spas, and dental offices.  Anesthesia malpractice is often linked to gastric bypass surgery, even cosmetic surgery.

If you or a loved one has suffered a serious injury due to an anesthesia error, you may have a medical malpractice or negligence claim.  Anesthesia medical malpractice attorneys such as Dr. Bruce G. Fagel, can help a patient determine if he or she was the victim of medical negligence or medical malpractice.

The emergency room in a hospital is often a busy and chaotic environment, where many people are left sitting and waiting for long periods of time. Patients may wait for hours to be seen, while their condition continues to gradually worsen.

In fact, emergency rooms have become much more crowded in recent years.  When Dr. Bruce Fagel practiced emergency medicine (he practiced for approximately 10 years in Illinois and California), emergency rooms were basically at that time the entrance point for patients to come into the hospital.  Many patients did not have doctors and came in with various types of problems.  Patients came in as walk-ins and from ambulances and were seen in a more timely fashion.  In more recent years, emergency rooms have become very overcrowded.  One of the biggest problems with emergency rooms at this point is the long waiting time. 

Patients wait a long amount of time to either be seen initially or after being seen by a physician, waiting for a bed in the hospital.  Medical negligence may occur because the patient's underlying medical problem may require immediate attention; unfortunately the emergency room or medical staff isn't capable of recognizing or meeting these demands.  Patients will deteriorate, conditions will get worse, right in front of doctors in the emergency room, simply because once they've been seen by the emergency room physician, evaluated and determined they need admission to the hospital, they are left waiting in the hallway, where they wait for a bed in the intensive care unit.  So we see a lot more problems these days in emergency rooms due specifically to the problem of overcrowding and that has created a tremendous strain on the hospitals.  It's also very difficult for patients who go to emergency rooms to get the kind of adequate treatment they deserve.

This type of overcrowding also causes ER doctors and nurses to become overworked.  Emergency rooms are often understaffed.  With these types of conditions in place, negligence becomes a fairly common occurrence in emergency rooms throughout this country.

Examples of emergency room negligence:

• A patient left waiting too long while a medical condition worsens

• Nursing or doctor errors

• Failure to diagnose the medical condition

• Misdiagnosis of the medical condition

• Medication errors

In some cases, ER medical negligence may lead to a catastrophic injury or even death for the patient.

Surgical malpractice, including plastic surgery medical malpractice is a terrifying occurrence that injures and kills thousands of Americans each year.  Elective plastic surgery procedures including breast augmentation, lipo suction, face lifts, rhinoplasty, gastric bypass, stomach stapling, and other types of procedures are being done in doctor's offices throughout the country.  When these procedures are done in a hospital, generally there is a board certified anesthesiologist and a staff of nurses, critical care nurses, and others who deliver the anesthesia, monitor the patient during the surgery, make sure the patient recovers properly after the surgery, and avoids surgical complications.   

When plastic surgeries are performed in a doctor's office or a surgery center, anesthesia may be given by nurse anesthetists without supervision by a physician anesthesiologist.  Under current law, a certified nurse anesthetist (CRNA) may provide anesthesia under supervision by a surgeon, who often has less knowledge about anesthesia than the CRNA.  If a problem occurs with anesthesia or post-anesthesia recovery, the surgeon may not be able to handle the situation.  This is where we see a lot of medical malpractice in plastic surgery cases these days, where the surgery is successful but the patient is severely injured or dies, because there are so many things that can go wrong during any kind of surgery.  It is important that patients understand the risks when having medical procedures performed outside of a hospital setting.

Anesthesia errors that may occur during a plastic surgery:

• Mistakes in communications between medical personnel

• Untrained or inexperienced personnel

• Failure of the medical personnel to thoroughly study the medical records regarding the patients' specific requirements, including allergies and medication sensitivities

Since the patient is generally unconscious during an operation, he or she is usually the last person to find out if negligence occurred.  Most often, medical mistakes can be corrected so that there are no permanent effects, however, some negligence, including post operation anesthesia errors do result in severe medical injuries and even death.

Although a patient in a hospital setting is usually safer than in a doctor's office or surgeon center because of the full hospital staff available during an emergency, medical negligence may still occur, and severe injury or death may still result in a hospital setting.

Visit plastic surgery negligence to view a video about plastic surgery errors.

Failure to diagnose cancer leads to terrible suffering and wrongful deaths for thousands of Americans each year. A failure to diagnose or misdiagnose cancer allows the cancer to progress through the body until the point where nothing can be done to save the patient's life.  When a doctor fails to properly diagnose or misdiagnoses the cancer, the patient suffers enormously from the wrong treatment, delayed treatment, or lack of receiving any treatment at all.

Cancer is not a single disease; it's a multitude of different types of problems involving different organ systems, so there is different statistics for different types of cancers.  When it comes to some types of cancers, such as certain types of brain cancers or pancreatic cancer, it almost doesn't make a lot of difference if there is a delay diagnosing them, because these types of cancers are difficult to treat no matter when they are detected.  Other types of cancers, such as non-small cell, lung cancer, colon cancer, and breast cancer, are effected by treatment time, because treatment delays do result in some differences in terms of the patient's outcome when there has been a significant delay.  Regardless of the type of cancer or location of the cancer, the earlier the diagnosis is made, and the sooner treatment begins, the better the chances for survival.

Regarding medical malpractice cases, we have to look at every type of patient or claim where a patient has had some type of delay in diagnosis in cancer, as an individual case, because each case is different based on the types of different cancers, time frames, and a number of different types of factors.  The law is also different for the statistics used for the types of cancer cases.  Therefore, every cancer case has to be looked at individually and we can't make generalizations.  But there are certainly a lot of patients who unnecessarily have a terminal prognosis given or die as a result in the delay of their diagnosis.

The following are examples of cancer misdiagnosis:

• Failure to investigate a patient's complaints to find out what is making them ill

• Failure to identify the type of cancer

• Failure to correctly identify a tumor or skin lesion as malignant

• Failure to send a patient to a specialist

• Failure to properly screen patients for lifestyle behaviors associated with cancers

• Failure to follow up with patients who do not respond to the treatment

If you believe you or someone you care about was not properly diagnosed for cancer or misdiagnosed, you may have grounds for a medical malpractice case.  Contact an experienced medical malpractice attorney today.  Dr. Bruce Fagel is a medical malpractice lawyer and a licensed medical doctor, so he understands exactly what it takes to pursue and win a case involving a delay in diagnosis or misdiagnosis of cancer.

The most common medical malpractice error that occurs in hospitals today is medication errors.  In fact it's so common that statistics show that every patient who enters a hospital can expect a medication error at least once during their hospitalization.  Fortunately most of these errors do not result in any serious injury or problem.  But sometimes they do.  We have had cases where patients have been given heparin, a blood thinner.  Only when it's given to the wrong patient under the wrong circumstances, can cause a devastating brain bleed and cause serious and permanent injury.  We have had other cases where a medication such as Demerol, a common narcotic pain medication used for after surgery, results in communication problems with doctors; meanwhile the Demerol builds up in the system of the patient and leads to a death.  

We handled a case involving a young individual 33 years old, who went in for a routine appendectomy and died because the doctors and nurses miscommunicated about which medications to give to the patient for his pain.  So when medication errors occur in hospitals, while sometimes they are documented, very often they are not.  We have to go painstakingly back through the autopsy report or medical records to find out where or how the medication error occurred.  But when we do, the hospital and, or doctors are responsible then for compensation for the injury or death.   

How do you know if a medication error occurred?

Many medication errors are only noted from a review of medical records after a patient is discharged from a hospital, or a nurse discovers the error before any significant injury occurs.  If a significant injury to a patient result from a medication error, the hospital is required to notify the patient or family about the error and what effect it may have on the patient.  Many doctors will downplay such an effect.  If a medication error occurs with a patient who is suffering from multiple medical conditions, the specific medication error may be even more difficult to identify.

This is where an experienced medical malpractice attorney, specializing in medication errors is vital to a victim of medical negligence.  Dr. Bruce G. Fagel is both a medical malpractice attorney and a licensed medical doctor.  This experience gives Dr. Fagel the knowledge to understand medical records and determine if a medication error occurred.

Wrongful death is the legal term used to describe a death that takes place as a direct result of the action or lack of action of another person.  A wrongful death action is brought to protect the surviving dependents of the victim by receiving compensation for the economic and non economic losses caused by the wrongful death.

The death of a loved one is never expected by any family.  But when that death is caused by medical negligence, the family has the right to know what happened and be compensated for their loss.  The first thing that we need to know when someone has died and medical malpractice is suspected is what was the cause of death.  An autopsy is usually required in most cases to show the death was due to medical negligence.  

When Dr. Fagel pursues a medical malpractice wrongful death claim, where someone has died as a result of negligence, he looks for evidence in the medical records which ties the doctors or nursing actions directly to the cause of death, based upon that autopsy report.  The wrongful death claim must be able to prove that there was medical or hospital negligence and this negligence caused the death of the patient.

Who are the plaintiffs in a wrongful death case?

The plaintiffs of a wrongful death case are the heirs to the descendent.  If the death involves a patient who was married, then the heirs are the spouse and any children.  If the death involves a child, then the parents are the heirs.  If the victim was not married, then the heirs would be the children, if the victim had any children, otherwise the victims' parents. If the victims' parents are not alive, then the heirs would be the victims' siblings.  Sometimes determination of the proper heirs can be very complicated.  Also, different states have different statute of limitations limiting the time available to file a wrongful death case.  

If a member of your family was the victim of a wrongful death due to medical malpractice, you may have a cause to bring a wrongful death lawsuit.  A highly experienced wrongful death attorney such as Dr. Bruce Fagel can help you get answers and help you be properly compensated for your loss.  Dr. Fagel has successfully helped many victim's families who have lost family members due to wrongful death from medical malpractice.

In obstetrical birth injury cases, we often have to explain to the jury the process of a normal labor and delivery and orient them to understand how things can go wrong.  In a delivery, the placenta which is usually located up inside the uterus is the blood supply and oxygen supply for the baby through the umbilical cord. When the placenta doesn't function properly, which can occur in some pregnancies, the baby can't receive enough oxygen or blood and there can be injuries to the brain.  Sometimes this occurs rather abruptly, such as when the placenta suddenly separates from the uterine wall before the baby is delivered or if the cord prolapses through the birth canal as the babies' head is coming down, it can get trapped against the head, kink and cut off the blood supply.  

There are other situations where a birth injury can occur, such as when the umbilical cord gets wrapped around the babies' neck or another body part.  When this happens, the cord can kink and cut off blood supply.  When this occurs in a very short and severe fashion, there is a particular type of injury that can occur to the brain in the midbrain area, as opposed to the cerebral cortex. When an injury occurs to the midbrain, it affects the motor center and coordination, and these babies come out with a true form of cerebral palsy, where often the cerebral cortex is spared, so they are mentally and cognitively normal, but because of an injury to a particular part of the brain where nerve signals have to be coordinated to come down to the spinal cord, they can have a fairly severe form of cerebral palsy.  

In a medical malpractice case, we have to relate all this back to the process of labor and delivery to show how the doctors actions or inactions, or the nurses inattention to the fetal monitor strip, which displays the babies heartbeat during labor, demonstrates that negligence caused the injury to the babies brain.   

There are several different types of injuries that can result to a baby at birth as a result of trauma. Normally the babies' head comes down through the birth canal and through the bones of the pelvis of the mother.  When the babies' head comes out, the rest of the body usually follows, because the head is usually the largest presenting part that has to come through the birth canal.

Sometimes doctors will use a vacuum which is a suction device attached to the head, to pull the babies' head out.  On occasion, if the baby is too big, the baby gets stuck.  When that occurs, the doctor has to twist and turn and maneuver the babies' head in relation to the body in order to get the body out.  Sometimes when that happens, the brachial plexus, which is a collection of nerves that exit the spinal cord in the neck, and supply the nerve impulses to the arms, gets damaged.   

These nerves can get stretched, pulled, and sometimes even avulsed, or actually pulled out of their sockets in the spinal cord.  When there is an injury to the brachial plexus, then the baby is born with what is called brachial plexus injury or erbs palsy.  A baby with brachial plexus can be identified, as the arm is immediately noticed to be limp and weak, and if it doesn't recover, the baby is left with a permanent injury, in which he or she can never move their hand or arm.  This can result in life-long injuries and disabilities to the child.  

When the Law Offices of Dr. Bruce G. Fagel & Associates presents a medical malpractice case to the jury, we have to explain the anatomy of a baby, the abnormalities that the doctor was faced with, and what the doctor did to actually cause the injury to the child.  If the jury understands how the injury occurred, they are more likely to understand why it was negligent.