Over Radiation In The Treatment Of Cancer

The use of radiation therapy for cancer treatment is designed to kill cancer cells and stop the cancer from spreading. It is a specific and exact therapy where an external beam  is directed to the site of the cancer by a machine called a linear accelerator. The beam is precise in terms of the amount of dose sent to specific areas on the human body for treatment.

Over radiation occurs when the patient gets more than the prescribed dose of radiation over a period of time. The results for over radiated patients  even in seemingly small doses  weakens and kills healthy tissue causing skin and organ damage.

In a remarkable article by Josh Goldstein of the Philadelphia Inquirer it was reported last week that the Hospital of the University of Pennsylvania (HUP) has publicly revealed  that on January 21, 2010 a man being treated  for prostate cancer received radioactive seeds, a similar therapy to that of a linear accelerator, which were incorrectly implanted outside of the intended target site. Similarly, the Department of Veterans Affairs in December 2009 apologized for a prostate-cancer program where veterans were over radiated for six years at its main Philadelphia  VA Hospital via the same method as in the HUP case.

These are not isolated events. In a lawsuit against the Melbourne Internal Medicine Associates, a cancer clinic in Melbourne, Florida, it is alleged that doctors put patients at risk through poor safety procedures as well as lack of oversight of technicians, and then tried to cover up their mistakes. Not only that, but the lawsuit further alleges that the clinic fraudulently over billed Medicare from 2003 through 2008 for the over use of the  high tech and highly reimbursed radiation treatments. The Florida suit was started by a "whistle blower,"  a Fred Fangman, the cancer center's former director of radiation oncology. Federal prosecutors joined in the suit.

Walt Bogdanich of the New York Times has been following this issue. His article dated January 26, 2010 entitled "The Radiation Boom-As Technology Surges, Radiation Safeguards Lag" reports the following.


In New Jersey, 36 cancer patients at a veterans hospital in East Orange were overradiated — and 20 more received substandard treatment — by a medical team that lacked experience in using a machine that generated high-powered beams of radiation. The mistakes, which have not been publicly reported, continued for months because the hospital had no system in place to catch the errors.

Lorraine Raymond, a radiation therapist, raised concerns about overradiation in the treatment of Frederick Stein at a Veterans Affairs hospital in New Jersey in 2006.
In Louisiana, Landreaux A. Donaldson received 38 straight overdoses of radiation, each nearly twice the prescribed amount, while undergoing treatment for prostate cancer. He was treated with a machine so new that the hospital made a miscalculation even with training instructors still on site.

In Texas, George Garst now wears two external bags — one for urine and one for fecal matter — because of severe radiation injuries he suffered after a medical physicist who said he was overworked failed to detect a mistake. The overdose was never reported to the authorities because rules did not require it.

These mistakes and the failure of hospitals to quickly identify them offer a rare look into the vulnerability of patient safeguards at a time when increasingly complex, computer-controlled devices are fundamentally changing medical radiation, delivering higher doses in less time with greater precision than ever before.

 

"No Government Bureaucrat Will Come Between You And Your Doctor" and Protection For Doctors From Malpractice Lawsuits

As the health care reform debate intensifies, it is apparent that malpractice reform is not a key part of the President's agenda. Though it certainly is not excluded from the debate. Will medical malpractice protection for health care providers be back doored into a final bill on health care? Are the two issues necessarily linked? What would happen to malpractice insurance premiums if malpractice standards were federalized? (I suggest malpractice insurance carriers would not be pleased because their ability to vary rates based upon specialty and region would be controlled. But that discussion has to be left to a subsequent post).

President Obama has repeatedly made the statement that "no government bureaucrat will come between you and your doctor." He stresses in TV talk shows,  town hall meetings  and in his June 2009 speech to the American Medical Association that "if you like your doctor, you keep your doctor, if you like your insurance company, you keep your insurance company."

Is the president suggesting connecting malpractice reforms to doctors and hospitals  who would follow government guidelines?  This is what he said in the speech:
Now, I recognize that it will be hard to make some of these changes if doctors feel like they're constantly looking over their shoulders for fear of lawsuits. I recognize that. (Applause.) Don't get too excited yet. Now, I understand some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue. (Applause.) Now, just hold on to your horses here, guys. (Laughter.) I want to be honest with you. I'm not advocating caps on malpractice awards -- (boos from some in audience) -- (laughter) -- which I personally believe can be unfair to people who've been wrongfully harmed. But I do think we need to explore a range of ideas about how to put patient safety first; how to let doctors focus on practicing medicine; how to encourage broader use of evidence-based guidelines.

Is he suggesting 1) complete preemption of malpractice lawsuits and 2) complete insulation from malpractice liability for a doctor that provides care which meets a government checklist?

It does not appear, yet, that is direction of the debate. One glaring reason? The doctors and hospitals that  provide care which does not adhere to the checklist, even for good reason, may expose themselves to liability. Maybe the checklist becomes outdated and an advancement in clinical diagnosis calls for test on a patient that isn't on the checklist. Is a doctor liable for a bad result by going beyond the checklist even if the checklist is not in the best interest of the patient?

"Evidence based guidelines" mandated by bureaucrats in Washington could end up being a double edged sword for doctors.

Why Doctors Practice Defensive Medicine

I can't say for sure because I'm a personal injury lawyer and not a doctor. But every time I've had an MRI of my knee, it's because the orthopod thought it was in my best interest to get another look inside the joint.

As fellow trial lawyer Ronald V. Miller Jr. has recently stated in his excellent blog post:

"Let us not pretend that there is no defensive medicine in this country. But we have to take out of the medical malpractice equation three kinds of defensive medicine: (1) tests and evaluation that are actually good for the patients, (2) additional treatment that is motivated, not by fear of lawsuits, but by fear of harm to the patient, and (3) patient induced defensive medicine (i.e. patient seeks tests doctor would not necessarily recommend)."

There is one more reason not mentioned in Mr. Miller's blog post which is also relevant.  The simple fact that medical testing equates to profits for doctors and hospitals is a real issue that we need to deal with when health-insurance reform is discussed. I'm not suggesting that doctors and hospitals shouldn't make money. They should.  And insurance companies are very stingy these days in reimbursing medical providers for the procedures that are billed. But more medical testing on  patients positively affects the bottom lines of medical providers and we, meaning consumers, politicians, and medical providers can't and shouldn't overlook that.

I have tremendous confidence in the orthopedic surgeon that repaired the ACL in my knee. All of the MRIs that I've had on my knee before and after the surgery were performed at a facility affiliated with his hospital.  It was convenient for me and profitable for the hospital that he works for.

 

 

Medical Malpractice Claims and the MCARE Fund

Last week Governor Rendell stated he will not be seeking to renew the state funded subsidy for medical malpractice premiums known as MCARE due to the fact that any "medical malpractice crisis"  is officially over. The Medical Care Availability and Reduction of Error Program, or MCARE provides $500,000 in liability insurance in addition to the $500,000 in coverage medical providers must buy from the private insurance market.

 

MCARE was designed to provide additional professional liability insurance to doctors and hospitals in Pennsylvania at subsidized, and therefore reduced, premium rates. 

 

Statewide, there has been a 41 per cent drop in malpractice lawsuits in the last decade. Judicial rule changes and new laws implemented in 2002 have been extraordinarily effective in abating and reducing the malpractice insurance premium rates, Rendell said at a news conference.

 

The statistics in the report published by the Adminstrative Office of the Pennsylvania Courts, and which Rendell relied upon, make clear that any argument that Pennsylvania is in a medical malpractice crises is simply no longer true. Premiums that doctors and hospitals pay for coverage have gone down. Moreover,today there are 57 carriers writing malpractice coverage in Pennsylvania as compared to 3 in 2002.