We’ve already aired much dissent from the medical profession about whether or not top-notch hospital care can in fact prevent all instances of patient falls, decubitus pressure ulcers (bedsores), hypoglycemia, deep vein thrombosis, delirium, suicide attempts, c. difficile infection, or iatrogenic pneumothorax. Nonetheless, Medicare has adopted its proposal to deny hospitals reimbursement for the cost of treating such events and complications, with likely consequences both for hospital behavior (refusal to admit some patients at high risk of never events), for private insurer behavior and for the climate of medical malpractice litigation. (Kevin Sack, “Medicare Won’t Pay for Medical Errors”, New York Times, Sept. 30). White Coat Rants, who has blogged extensively on the issue in past months, has some predictions (Oct. 1) of things we can now expect to see more of: more patient transfers between hospitals (since Medicare will not punish the second hospital for the first’s “never event”; underdiagnosis of certain conditions and overdiagnosis of others; and, more remotely but no less alarmingly, pressure on some families to serve as ultimate bearers of risk for supposed never events affecting the frailest and most elderly:

Say hello to the Advance Beneficiary Notices. Medicare won’t cover preventative care, so you are going to have to pay for it out of your pocket. If you’re prone to falls or bedsores, you’ll have to pay for a personal nurse to wait on you hand and foot so you don’t develop these never events. If you don’t pay for a personal nurse 24 hours around the clock to keep a never event from happening, you’re personally responsible for paying the costs of treatment if the “never events” occur. You had the opportunity to prevent the events but you were just too cheap to pay for it. I think that ABNs are less likely to catch on, but eventually I think they will become commonplace.

In bedsores; hospitals; Medicare; never events; suicide

One assumes that in the U.S., the First Amendment would restrain the government from regulating this variety of online content. Not so in Britain, where parliamentarians frankly avow their intent to shut down websites that morbidly encourage notions of self-destruction. “I would recommend that publishers who moderate all comments on their forums or chat rooms should silence discussions that encourage suicide, and sites that rely on others to complain about material before they review it should take down such discussions if complaints are received,” said technology lawyer Struan Robertson. What would have happened to Goethe’s Sorrows of Young Werther? (Out-Law News, Sept. 18, via @lawtweets).

“The family of a 26-year-old man who died two years ago after an off-duty firefighter tried to rescue him from the edge of a roof will receive a financial settlement from The City, after claiming the firefighter was at fault.” Fire Lt. Victor Wyrsch tried to grab the suicidal Nick Torrico from the roof, but Torrico tore himself loose and fell to his death, and now the city’s taxpayers will pay Torrico’s family based on their contention that Wyrsch should have held back. (Beth Winegarner, “San Francisco pays up for failed rescue”, San Francisco Examiner, Aug. 26).

In Longview, east Texas, the Patterson Nissan dealership held a contest awarding prizes to the participants who could hold their hands on a car the longest. One contestant dropped out, ran to a nearby store where he broke a gun out of its case, and shot himself. The dealership has now settled the lawsuit by Richard Thomas Vega II’s widow claiming that the stress and sleep deprivation of the event amounted to “brainwashing” and that the sponsors failed to make allowances for temporary loss of sanity. (AP/FoxNews.com, Aug. 17).

On November 14, 1999, high-school dropout Rolando Domingo Montez, celebrating his 19th birthday, was arrested for public intoxication and trespass after the owner of the boat on which he and his friends were sitting complained. Police placed him in Cell No. 1 of the Port Isabel City Jail. The next morning, Montez was permitted to make some collect calls from his jail cell to seek bail money from his mother, Pearl Iris Garza. Mom, complaining that Montez was in jail again, refused. But she generously came to pick up Montez on the 16th when he was released on his own recognizance. Unfortunately, while Garza was waiting in the lobby, and while police were responding to a call for assistance regarding a suspicious vehicle, Montez hung himself with the 19-inch phone cord from the phone he had used to make the calls.

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• New FASB regulation may provide fodder for trial lawyers: publicly disclose your internal analysis of liability (thus giving away crucial settlement information and attracting more lawsuits), and/or face lawsuits when your disclosure turns out to be incorrect. [CFO.com; CFO.com; NLJ/law.com ($); FASB RFC]
• NBC settles a “You-made-me-commit-suicide-by-exposing-my-pedophilia” lawsuit. [LA Times; WSJ Law Blog; Conradt v. NBC Universal]
• A victim of overwarning? 17-year-old loses hat on Six Flags Batman roller-coaster ride, ignores multiple warning signs to jump multiple fences into unauthorized area, retrieves hat, loses head. [FoxNews/AP; Atlanta Journal-Constitution; TortsProf]
• Lots of Ninth Circuit reversals this term, as per usual. [The Recorder/law.com]
• A no-Twinkie defense doesn’t fly in a maid-beating case. [CNN/AP via ATL]
• The Chinese government demonstrates that it can enforce laws against IP piracy when it wants to [Marginal Revolution]
• “Justice Scalia said he thought that the United States was ‘over-lawed,’ leading to too many lawyers in the country. ‘I don’t think our legal system should be that complex. I think that any system that requires that many of the country’s best minds, and they are the best minds, is too complex. If you look at the figures, where does the top of the class in college go to? It goes into law. They don’t go into teaching. Now I love the law, there is nothing I would rather do but it doesn’t produce anything.’” [Telegraph]
• Above the Law commenters decidedly unimpressed by my looks. Looking forward to feminists rushing to my defense against “silencing insults.” [Above the Law]

41-year-old South Texas personal injury solo practitioner Hermes Villarreal was admitted to a McAllen hospital on April 16, 2005, reporting that his heart was racing. The hospital put him on a 24-hour EKG. Villarreal reported being under stress, but refused a psychiatric consultation or the recommended medication. At 5 a.m. on April 19, 2005, the day of his scheduled discharge, “Villarreal summoned the nurse on duty and requested a razor, saying that he wanted to take a shower and shave his chest, because the EKG monitor leads attached to his chest were bothering him.” The nurse complied with his wishes, and Villarreal locked himself in the bathroom and committed suicide with the razor.

This was, said Villareal’s family, the hospital’s fault; since it’s South Texas, a Hildalgo County jury, after a three-week trial, awarded $9 million in March (which looks to be reduced at least to $1.64 million under Texas law capping damages). Ironically, the opening line of the Texas Lawyer story says “It was a suicide no one saw coming,” but doesn’t question the resulting jury verdict.

Somehow, the trial lawyer, Raymond L. Thomas, a close friend of Villarreal’s, interjected himself into the closing argument, telling an emotional story of a Rolex Villarreal had given him as a gift that left the jury in tears; the press coverage doesn’t acknowledge the blatant violation of ethical rules (see also Texas Rule 3.04(c)(3)), much less indicate whether he got away with it because of the failure of the defense to object or a judge’s failure to oversee her courtroom. (Jenny B. Davis, “Attorney, Interrupted: Seeking Meaning, Recovery for a Legal Life Lost,” May 5 via ABA Journal).

…or the universal adoption of round-the-clock patient guards or restraint devices, it’s hard to go along with the notion that hospital falls should be so-called “never events”. (Happy Hospitalist, Jan. 15, Feb. 20). Nor is the concept much more useful when it comes to patient suicide attempts or hypoglycemia, among other misadventures (White Coat Rants, Feb. 5)(via KevinMD). Related: letters section, 2004 (pressure wounds/bedsores).

• Remember those class actions against tech manufacturers for allegedly misstating the capacity of hard drives? Another one just settled, with buyers in for coupons and discounts, lawyers for $1.78 million [The Register, Cho v. Seagate Technologies settlement website]
• Watch what you say about lawyers, cont’d: Erie, Pa. paper thus far has fended off libel suit by Pittsburgh attorney over coverage of his run-ins with authorities over client treatment [Post-Gazette via Ambrogi]
• New at Point of Law: suicide risk of anticonvulsants?; Ohio AG Dann rebuked on foreclosure activism; simultaneous asbestosis and silicosis happens all the time at some law firms; Bush nominates an ATLA/AAJ member to a federal judgeship; and much more.
• Has a prominent investor with close ties to President Bush set up shop as an East Texas patent troll? [Troll Tracker, The Recorder]
• Embattled Tom Lakin and Lakin Law Firm, once high on the Madison County heap, fight to overturn $3.7 million legal-malpractice judgment [MC Record]
• Brent Coon suing former colleagues at Beaumont’s Provost Umphrey over division of billions in tobacco-fee booty [Texas Lawyer]
• UK judge criticizes “barking mad” human rights rules after prisoner refuses to leave his “comfy” jail cell to attend hearing [Times Online, Telegraph]
• “Six years after Enron, executives face greater risks—but investors are no safer.” [Gelinas/City Journal]
• United Farm Workers union threatens to sue over unflattering coverage [two years ago on Overlawyered]

I’d like to thank Walter Olson for inviting me to contribute to one of my favorite blogs, Overlawyered. As an attorney and psychologist, I’ve worked in a number of different hospitals across the country. Health care institutions are unique places to work for in many respects because the decisions made there can directly lead to serious or even fatal outcomes. Of course this is obvious, as should be the fact that despite the best intentions of everyone involved in a patient’s care, bad outcomes occur.

Alison Cowan has this article in last Friday’s New York Times highlighting a recent case involving the suicide of Ruth Farrell. By all accounts Farrell had been quite depressed for a very long time. As is the case with some people who struggle with chronic depression, Ms. Ferrell was admitted to the hospital for care and observation related to her depression and suicidal ideation. Sadly, Ms. Farell hanged herself with her own pants between the standard 15 minute “checks” performed by staff on psychiatric wards. In turn, her estate sued her doctors and the hospital claiming improper care.

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• More fen-phen scandals: Possible smoking-gun email in Kentucky case (see Walter’s post today) came from Chesley firm computer; Vicksburg lawyer first attorney convicted in Mississippi fen-phen scam. [Courier-Journal via Lattman; Clarion-Ledger (h/t S.B.)] (Updated with correct Courier-Journal link.)
• Allegheny College found not liable by jury for student’s suicide; school raised issue of student privacy concerns. Earlier on OL: May 30; Dec. 7, 2004. [WSJ]
• Update on the tempered glass versus laminated issue earlier discussed in Overlawyered (Feb. 15, 2006; May 16, 2005; May 13, 2005, etc.) [LA Times]
• Massachusetts court rejects quack sudden acceleration theory. (See also Dec. 20, Aug. 7, etc.) [Prince]
• California bill would bar carpenters from school campuses. [Overcriminalized]
• New book: Antitrust Consent Decrees in Theory and Practice [Richard Epstein @ AEI]
• To be fair, I went to school with “young Mr Sussman, the boyish charmer”, and I don’t know how to pronounce “calumnies” either—it’s one of those words I’ve only seen written, and never heard spoken [Steyn; MSNBC]

More woes in British crime and punishment: “Compensation payments to prisoners have doubled in the last year to more than £4 million, while the total legal bill to the Prison Service has reached £20 million a year, The Times has learnt.” (Richard Ford, The Times (London), May 19). A couple of recent prisoner-suicide suits in the U.S.: Apr. 17, Apr. 28.

Ronnie Joe Neal, who got to Texas’s Death Row by committing a particularly heinous sex murder, says Bexar County jailers didn’t act speedily enough to save him after he attempted suicide by downing 50 prescription tablets. So he wants $35 million in his civil rights lawsuit, in which he’s represented by attorney James Myart. (Ken Rodriguez, “Alamo Heights teacher’s killer wants $35 million worth of ‘justice’”, San Antonio Express-News, Apr. 21). Similar: Apr. 17.

Illinois: “The mother of a Granville man who shot himself last year at the Spring Valley Jail has filed a wrongful death suit against the city, the police chief and a former police officer.” Robert “Steve” McFadin, placed in a holding cell after being charged with violating an order of protection against his estranged wife, wrested away the gun of former Spring Valley police officer Thomas Quartucci and beat him. When Quartucci fled the cell, McFadin used the gun to shoot himself. Quartucci, who was admitted to intensive care after the beating and remained on workers’ comp until retirement, is among the defendants in the suit, which “was filed on [Lori] Hafley’s behalf by Miskell Law Center of Ottawa and the Berkland Law Office of Marseilles. The suit alleges Quartucci violated procedure when he did not secure his loaded weapon before entering the cell. The suit also alleges actions taken by the officers at Spring Valley led to McFadin’s death.” (Erinn Deshinsky, “Mother of suicide victim sues police”, Peoria Journal-Star, Apr. 7). The suit seeks $15 million (John Thompson, “Mother sues Spring Valley, police”, La Salle News Tribune, Apr. 5; Dan Churney, “Police officers named in suicide suit”, Ottawa Times, Apr. 13).

Walter’s entry below on the Dick Schaap verdict misses a fascinating part of the case. While Schaap’s family lawyer at trial blamed three doctors for failing to diagnose lung damage from use of the medicine amiodarone (and the jury mysteriously held one doctor negligent while exonerating the other two), just two years earlier, the Schaap family and its lawyer had a different story to tell. Then, the family announced, Dick Schaap was killed because of an infection caused by the hospital’s lack of adequate hygiene standards. Unfortunately for the Schaaps, the theory didn’t stand up and the hospital was dismissed from the case, but not before ABC Primetime Live credulously reported in 2003 the supposed scandal of the hospital’s failure to prevent a “velociraptor”-like infection.

It was a case study of what can go wrong in American health care today, said the family’s lawyer, Tom Moore.

“If you ever speak to a surgeon, ‘Doc, what can I expect with my hip replacement?’ — at the top of the list is infection, post-operative infection,” he said.

(The CBS Early Show repeated the story a few days later: ask yourself if you could predict from that news coverage that the hospital would be vindicated before trial.) Without being able to tell the jury about germs that act like deadly dinosaurs, Moore invented a new theory and settled for putting Billy Crystal on the stand to wow the jury with tales of Schaap’s generosity and talent. The defense lawyer, Mark Aaronson, seems to have put his finger on the matter:

“Is everybody who dies in a hospital the victim of medical negligence?” he asked rhetorically. “So ultimately, a theory had to be concocted in front of a jury in order for a claim of damages to be made.”

(Andrew Jacobs, “Jury Deliberates Lawsuit Over Death of Dick Schaap”, NY Times, Jun. 23).

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Such suits are sufficiently common (e.g., Oct. 8, May 20, Jan. 31, 2003) that we can almost retire the category. Lawyers for Christopher Foster, a male prostitute who, while imprisoned, attempted to hang himself but only managed to self-inflict severe brain damage, argue that the mix-up in paperwork that resulted in his being put in a conventional cell instead of on suicide watch was a constitutional violation. While it’s perhaps too much to ask that suicides only blame themselves, most federal courts recognize that the standard for a constitutional violation is “deliberate indifference” rather than negligence. This case somehow got to trial and the City of Philadelphia is on the hook for $3.5 million (7% of the $50M Foster asked for) after a settlement. Foster won’t be conscious of the marginal difference in life-long nursing care (which one suspects is being shifted from one government expense account to another), but his lawyers, from the firm Kline & Specter (Jan. 24, 2003), will sure appreciate their seven-digit cut from taxpayers. (Joseph A. Slobodzian, “City abruptly settles suicide-prevention suit for $3.5 million”, Philadelphia Inquirer, Nov. 23; Jim Smith, “City to pay $3.5M in jail hanging case”, Philadelphia Daily News, Nov. 23).

“The mother of accused serial killer Maury Travis, whose bizarre hanging death in the St. Louis County Justice Center was ruled a suicide, filed a suit Friday against the county, the architects who designed the jail and the contractors who built it.” Authorities believe Travis committed as many as twenty murders; he hanged himself in his prison cell after leaving a note. (Peter Shinkle, “Mother of accused serial killer sues over death in jail”, St. Louis Post-Dispatch, May 15)(via Brian Noggle)(& letter to the editor, Jun. 22).