One hospital consultant says hospitals in the Bergen-Passaic region of New Jersey and nationwide can play a big role in preventing injury to its patients while limiting their own costs and potential exposure to liability. While part of a hospital's mission is patient safety and quality care, this is not always met due to a wide range of factors.

Hospitals are responsible for their employees and ensuring they actually follow proper policies and standards. Effective hospitals are those that do the following:

• Conduct annual reviews to evaluate the efficacy of rules and regulations in-place
• Manage risk management programs for their physicians
• Hire a capable and experienced hospital administrator who can internally review and address how the hospital is doing
• Take an interest in every medical malpractice case
• Comply with credentialing procedures for physicians and other licensed independent practitioners
• Pay attention to and approve new equipment for use

Increasingly, hospitals are included in medical malpractice lawsuits because courts are finding corporate negligence to be a factor in many claims. If hospitals take more involvement in the day-to-day happenings of its employees, it may help to improve the care that patients receive and limit the amount of malpractice cases.

Medical malpractice lawsuits are necessary in our legal system to see that patients are adequately compensated for their injuries when they have been harmed by physician or hospital negligence. Medical negligence can happen many different ways like failing to diagnose a disease or condition, making an anesthesia or medication error, making a mistake in surgery or when delivering a baby, and more.

According to an article in philly.com, the study found that about $23,000 is the average cost to a doctor defending a malpractice claim, but that costs vary significantly among medical specialties. For example, the average paid claim for a cardiologist is more than $83,000 - but for an ophthalmologist almost $24,000.

These defense costs are relatively high even when plaintiffs do not recover anything in the suits.

However, even if malpractice suits increase medical costs overall, victims of medical negligence should not hesitate to discuss their potential legal claims with experienced medical practice attorneys. Defense costs should never deter malpractice victims from seeking justice.

Interestingly, the article describes an experimental program by the University of Michigan hospital wherein the facility timely notified patients of medical errors and offered compensation, driving down potential defense costs and shortening the time patients had to wait for recovery compared with traditional malpractice suits. It will be interesting to see if this approach picks up steam.

Source: philly.com, "Doctors Detail High Costs of Fighting Malpractice Claims," Mary Brophy Marcus, April 5, 2012

• There was a contract between the doctor and patient
• There is a history of the relationship and a physical exam was done
• The physician billed the patient for services
• The physician issued a medical opinion
• The physician discussed the patient's health issue in specific and not general terms.

Determining the Relationship Can Be Difficult

Not all doctor-patient encounters are as clear as the above examples; in these cases, it is more difficult to prove a doctor-patient relationship. For example, doctors are often asked by third parties such as insurance companies and employers to give an opinion about a patient's health. In such cases, there is not a doctor-patient relationship. However, if a serious of life-threatening condition is discovered during the exam, the doctor can be liable if he does not inform the patient of the condition.

In addition, with modern technology, it is more common now that doctors are called to give an opinion over the phone or by Internet. In general, a doctor-patient relationship is established if any of the above factors are established. However, if the doctor does not give a medical opinion, but merely suggests that the patient schedule an appointment for further examination, no relationship has been formed.

Finally, if a patient encounters a doctor in a supermarket or social gathering and asks him or her a medical question, generally no relationship is formed. However, a relationship is formed if the doctor asks about the person's medical history and gives a medical opinion.

A simple rule of thumb to determining the existence of a doctor-patient relationship is if the doctor took clear action to diagnose or treat the patent's specific condition, there is probably a relationship. Conversely, if the doctor merely discussed the patient's health in a hypothetical or general way, there is likely not a relationship. Establishing a doctor-patient relationship is the necessary first step in holding a negligent doctor liable for the harm he or she causes the patient.

Source: "Is This a Real Doctor-Patient Relationship?: Situations in Which You Won't Be Held Liable," Anthony Francis, Medscape.com, 3/1/12

Hospitals and medical schools are involved in heavy discussions about this problem, which has been nicknamed "distracted doctoring." University of Rochester Medical Center anesthesiologist and director of critical care Peter J. Papadakos says that what he sees is "not funny" when walking around a hospital. He says he has seen employees at all levels "glued" to their phones and other devices.

However, recent cases show doctors have not only been too focused on their screens instead of their patients, but sometimes are not even doing work on them. Some examples are:

• A nurse checking airfares in the middle of surgery
• Technicians texting during bypass machine procedures
• A neurosurgeon making calls during an operation
• Technicians talking on phones while in surgery

A particularly disturbing example is a recent case in Colorado, in which a man was left partially paralyzed after an operation where the neurosurgeon made around ten personal calls on his cell phone during the operation.

Hospitals are starting to limit the use of these devices in critical settings. Some doctors have also made their operating rooms "quiet zones" and banned any activity not focused on patient care. In addition, many schools are reminding their students that their first priority should be their patient. However, students find this difficult because the schools are also giving them more devices to use at the same time.

Since distracted doctoring is still a new problem, little research is available. However, doctors and nurses who engage in these activities while performing their duties are at risk of committing medical malpractice.

Payments for malpractice claims based on these three categories of error increased from $21.7 million in 1991 to $91 million in 2010.

The study suggested that the increases in medical malpractice claims based on failure to diagnose may be partly due to the fact that diagnostic testing capabilities are growing much faster than the medical system's notification processes can handle.

How Can Patients Help Protect Themselves?

Unfortunately, a late diagnosis can mean the difference between survival and death for too many patients.

As the study noted, many missed or delayed diagnoses are the result of poor communication between the laboratory, the physician and the patient. Patients can help improve this communication by being proactive in their discussions with healthcare providers. Make sure you thoroughly report all your symptoms. If you were supposed to hear back about a test result and you haven't, call the doctor's office to follow up.

If you think you might have a serious illness, don't wait to go to the doctor. Make an appointment to get evaluated as soon as possible.

Not every missed or delayed diagnosis is a result of medical malpractice, but many are. If you think you may be the victim of medical negligence, contact an experienced New Jersey medical malpractice attorney who can evaluate your claim and advise you of your options.

Source: The Clinical Advisor, "Better Diagnostic Test Reporting Needed to Avoid Malpractice Claims," Ann W. Latner, Nov. 14, 2011.

FDA Panels Convene to Discuss the Dangers of Bone Density Drugs

Medical experts have begun questioning the benefits of continued and prolonged use of bone building medication because of the medical side-effects due to prolonged use, which could potentially lead to medical malpractice claims against doctors who have overprescribed the drugs. Controversy has also arisen because of a debate over the type and language of that warning label that appears on the medication.

Recently, two Federal Drug Administration (FDA) panels met to discuss these issues. The panels discussed the injuries that have been linked to the medication. Several panelists commented that use of bone-building medications has only been shown to be effective for three to five years, but a small number of patients take the drug for longer. Beyond that time, patients have a higher risk of jaw disease or thigh fractures, according to recent reports. The panels considered whether to change the label to highlight the increased risks of long-term use, but the panel did not settle on specific language that must appear on the labels for leading bone-density drugs like Boniva, Fosamax and Actonel.

On August 1st, the reputable journal published findings from the CUMC team in which more than 21,000 Medicare beneficiaries' records were analyzed. Reviewing data from 1995 to 2005, study subjects consisted of patients who were aged 65 and older, diagnosed with either breast, lung or colon cancer, and had at least one erythropoiesis-stimulating agent (ESA) and chemotherapy benefits claim.

Of the patient records analyzed, 24 percent (5,099) received ESAs for one week or less, which constituted misuse of the drug therapy. Another 7.6 percent (1,601) were prescribed the therapy in excess of 14 weeks, which was longer than the recommended treatment period noted on product labeling. Another 13.6 percent (2,876) of the patients received the treatment in the absence of chemotherapy, which was also inconsistent with product labeling. The CUMC study findings highlighted a number of issues, including inappropriate use of ESA, physician propensities to prescribe off-label, patient safety, and resource waste.

Recently the United States Food and Drug Administration (FDA) announced new dosing guidelines for ESAs when prescribed to patients with chronic kidney disease. The change was prompted by findings that ESAs increased the risks of adverse cardiovascular incidents such as stroke, blood clots and heart attack in these patients, potentially leading to medical malpractice claims.

ESA use increased 340 percent in the United States from 2001 to 2006. Considering that the National Institutes of Health reported that cancer cost the American public an estimated $263.8 billion in medical costs and lost productivity in 2010, ESA therapy costing the Medicare system an estimated $1 billion dollars each year is significant.

Cancer impacts millions of lives and patients rely on their doctors to know the risks certain drug therapies have on their life and health. The CUMC study proves that doctors need to be better educated on treatment interventions or their patients will suffer the consequences.

Breast cancer screening guidelines have been a source of debate for some time. In 2009, the United States Preventive Services Task Force weighed in on the issue. The Task Force, reviewing and analyzing new data, suggested a different protocol. Instead of screening starting at age 40, the Task Force recommended biennial mammography screenings for women aged 50 to 74. However, a change in the screening process could lead to many doctors failing to diagnose and detect the cancer.

Groups such as the American Cancer Society and the American College of Radiology strongly disagreed with the Task Force's recommendation and announced that they would continue recommending annual screenings starting at age 40, which is consistent with the new ACOG guidelines.

Mammograms, according to some breast care experts, are imprecise and can lead to inaccurate results. These results have led to patient anxiety and unnecessary treatments and procedures. Still, mammograms are seen as a vital tool in reducing breast cancer mortality in the United States.

The Centers for Disease Control and Prevention (CDC) predict that 450 men and 39,520 women will die from breast cancer in 2011. The CDC also estimates that another 2,140 men and 230,480 women will be diagnosed with the condition this year. Early detection has been the key to saving lives. While the medical community debates proper treatment courses for patient, the real test is that doctors need to tailor patient care based on the individual's needs.

The main proponents, Dr. Anil Potti and Joseph R. Nevins, published their study in 2006, claiming that it had been a great success. The physicians started three clinical trials where some of their methods were put in place. The entire cancer community was increasingly excited about the potential the study offered.

However, when other physicians and organizations reviewed the study, several potential problems began to emerge. After a four-year period of scrutiny and review, the entire study was discredited due to unreliable data. Duke shut down the trials, and redacted the published research. Some of the study's participants died while receiving treatment proscribed by the Duke team, leading to several medical malpractice lawsuits against the university.

While initially offering great promise, gene research continues to try to find a way to accurately diagnose and treat different types of cancer. Those who have the disease are encouraged to speak to their physicians to learn about the best potential treatment options available. Do not be afraid to seek a second or third opinion, as often different doctors will have different ideas that may be helpful for you.

While the shifts may be physically demanding, it allowed student doctors to get an opportunity to see several different types of injuries and illnesses. Having had the chance to both participate and observe in the treatment plans for a wide range of conditions allowed student doctors to be ready when they faced these issues on their own.

The union previously had managed to impose limits that restricted a student doctor to a maximum shift length of 16 hours. Proponents of the change hope that these restrictions will reduce the number of mistakes that occur, which often lead to medical malpractice cases. Student doctors will no longer be forced to work past the point of exhaustion, and will have the time to learn more about medical conditions that may be affecting their patients.

However, the patients may be the ones who suffer the most due to these changes. When a student doctor's 16-hour shift is up, he or she leaves the hospital. This means that a new doctor will have to take over, which could lead to gaps in patient care. Additionally, when the doctor is practicing professionally, he or she will not have been exposed to as many issues as student doctors have in the past. As more doctors finish their residencies, the true impact of these changes on patient safety will become clearer.