EPA-mandated diesel-engine governor shuts down ambulance carrying patient in cardiac arrest to emergency room. [WTTG; Washington, D.C.] The D.C. fire union says emissions-control engine governors, the result of an EPA mandate, have shut down rescue vehicles during missions at least three times since August. Following strenuous protests from rescue squads around the country, EPA last May waived the application of the rules for fire trucks and ambulances, but D.C. is apparently stuck with vehicles acquired before the waiver.
After all, what if something should go wrong? Following a resident’s death, a California senior facility defends its “protocol” of ordering nurses to stand by for rescue personnel rather than perform CPR themselves [L.A. Times]
More: Plenty of pushback from readers, including warnings that CPR is not necessarily an appropriate or desired intervention in the resident’s situation, even in an independent-living arrangement in the absence of a DNR (do not resuscitate) order. The resident’s family has expressed satisfaction with the senior facility’s actions and says it has no plans to sue. More: ABA Journal, White Coat.
“The family of a man shot and killed by his neighbor in Skagit County can proceed to trial on claims that the county’s emergency communications center mishandled its response to his panicked 911 call, Washington’s Supreme Court ruled.” According to his family, a 911 operator told William Munich that help was on the way but did not code the call as an emergency; a sheriff’s deputy showed up 18 minutes later, by which time Munich had been shot by the irate neighbor. “I am concerned the majority’s decision will put unwarranted pressure on every statement made by 911 operators, straining communications that depend on the free flow of information,” wrote dissenting Justice James Johnson. [KOMO; Munich (Gayle) v. Skagit Emergency Communications Center, holding, dissent (wrong link fixed now); background on Washington's unusual approach to sovereign immunity]
P.S. Another Washington sovereign liability case of interest: Robb v. City of Seattle, “Whether the city of Seattle may be liable in an action for wrongful death brought by the survivor of a murder victim based on the failure of police to confiscate ammunition while detaining the murderer for questioning just before the murder occurred.” [Temple of Justice]
The director of Orange County, N.C. emergency services had terminated the squad following complaints of unprofessionalism from other emergency responders, and it proceeded to sue. “The lawsuit, filed in federal court, claimed to be a class-action lawsuit for all the citizens of Orange County and those who transit through Orange County, but U.S. District Judge William J. Osteen Jr. wrote in his opinion that the rescue squad lacked standing to bring a class action lawsuit.” [Herald-Sun; background, Daily Tar Heel]
“Health and safety regulations which burden Britain and lead to good samaritans facing prosecution are to be swept away in a blitz on ‘compensation culture’”. Among the measures are rollbacks of liability for volunteers, emergency service responders and school recreation. “A coalition source said: ‘What we are determined to see is a great extension of personal freedom, at the same times as a rolling back both of the state and the power of the courts.’” [Telegraph]
“The parents of an 8-year-old boy who died after his grandfather fired a cannon that exploded at an outdoor Fourth of July celebration in 2007 have filed a wrongful-death lawsuit against Thurston County.” [The Olympian; KOMO; earlier]
It’s enough to exasperate WhiteCoatRants (Oct. 20):
…Utter the terms “chest pain” and “trouble breathing” in the same sentence and with some doctors you’re getting a chest CT. It doesn’t matter that you have a cough, runny nose, that the chest pain is burning and only occurs when you cough, or that half the people in town have influenza because they didn’t get their flu shots. Even if bronchitis is the clinical diagnosis, there is still a 0.0001% chance that you could have a pulmonary embolism along with your bronchitis and we don’t want to miss it, because if we do, it may cause you to die and result in a lawsuit against the physician. Some doctors aren’t willing to take even the 1 in 1,000,000 chance that they’ll be sued. …
If a doctor doesn’t get every conceivable test on a patient and there is a bad outcome, then the doctor gets smacked with a lawsuit because the doctor didn’t do enough. Unless something changes, more and more patients coming to the emergency department will get megaworkups so nothing gets “missed.”
Then I read that some pompous plaintiff’s attorney said somewhere that “defensive medicine” was a myth. His theory was that if doctors do an extra test that catches a disease while it’s still treatable, then it is “good medicine,” not “defensive medicine.” Either he doesn’t get it because he is ignorant or he doesn’t get it because that attitude helps him afford his chalet in the Swiss Alps.
Medicine will never be perfect.
While on the subject, prominent health economist Uwe Reinhardt has cited our medical liability system as an important reason costs are significantly higher in the U.S. than elsewhere (PoL, Nov. 16). And KevinMD’s excellent section on defensive medicine has numerous posts in recent months we still haven’t gotten around to linking, including: guest take by “Dr. SSS” on the “two most expensive words in medicine” (“Sometimes it is difficult for me to understand if I am really treating myself or the patient.”); background on the $210 billion estimate that has been bandied about; E.R. visit + chest pains = obligatory catheterization?; quote from PandaBearMD (“Why risk our own money when we can use somebody else’s to protect us, even if it costs millions?”; a British visitor’s view of immobilization collars; don’t put the doc’s name on the chart!; and more reader reactions (“even if a patient has a good relationship with a physician and is willing to forgo various diagnostic tests, the family can decide to sue later if there is a bad outcome. … it is far easier to just order the test”)
In Thurston County (Olympia), Washington, a cannon explosion during a backyard party fatally injured 8-year-old Devan Vyborny. “Now, more than 14 months later, the boy’s family is taking legal action, but not with anyone having to do with that cannon. Instead, the boy’s parents are blaming rescue crews and 911 dispatchers. … Despite the scathing allegations, the rescue crew’s actions had not been called into question until the claim was filed.” (Ray Lane, “Family of boy hit by shrapnel seeks $47 million”, KOMO, Sept. 23).
- “The accusatory legal document begins with several remarks defaming the skills, education, ability, integrity, and honesty of the physician being charged.” [Donald May, State Policy Blog] But hey, don’t take it personally, lawyers say [Mark Crane, Medical Economics] Good luck with that [Chiaramonte/Examiner, KevinMD, more]
- Law throwing open Florida doctors’ peer review to lawyers was bad enough, but now state high court has applied it retroactively to records created before law was enacted [KevinMD guest post; background at PoL here, here, and here]
- Even the New York Times hails as “sensible” laws encouraging medical apologies by making them inadmissible as evidence of wrongdoing [editorial]; but see counterexample to the usual reportage [Berlin/Am. Journal of Roentgenology via Buckeye Surgeon]
- A med-mal defense attorney says plaintiffs would win more often in proposed “health courts” than they do in the cases he handles [Medical Economics, more, and similarly]
- More evidence, this time from study of orthopedists, that docs rated as cold or callous attract far more than their proportionate share of suits [Orthopedics Today]
- EMTALA, the law forcing emergency rooms to take all comers, “has created the very conditions it sought to avoid” [Edwin Leap, M.D.O.D.] Watch for “free-standing” ERs that dodge mandate by refusing federal dollars [Scalpel or Sword?, Health Care BS] Semi-defense of law [Over My Med Body]
- Besieged state of dispersed emergency rooms and specialists is one reason for use of those risky helicopters that fly patients to the big city [Williams/Health Business Blog, M.D.O.D.]
- Docs should stand up to family members demanding futile or inappropriate end-of-life care [Musings of a Dinosaur] Relatedly, daughter on dying father: “if you give him any more morphine, I will sue you.” [Fat Doctor]
(Most links via the highly recommended one-stop shop for medical blogging, KevinMD
, e.g. this post
and this one
New Jersey: “An Essex County jury has ordered Newark to pay $4.1 million to the family of a murdered Seton Hall University student because of mistakes made by a police dispatcher and 911 operator during her abduction. The jury’s verdict came after the attorney for Sohayla Massachi’s family argued that prompt action by the Newark police may have prevented her murder after she was abducted by a jilted boyfriend in May 2000.” The jury attributed 25 percent of its $5.5 million award to Seton Hall and its security agency, Argenbright Security Inc., but those defendants had already settled. (William Kleinknecht, Newark Star-Ledger, May 16).