Medical Malpractice Cerebral Palsy

Posted on August 7, 2008 by Paula Strand

Medical Malpractice – Cerebral Palsy

Cerebral Palsy is a term used to describe a group of disorders caused by brain damage that affect body movement and muscle coordination. It is a non-progressive disorder which means it will not worsen over time, nor will it be cured. Brain damage that causes Cerebral Palsy can happen during pregnancy, the birth, or shortly after birth; and can be attributed to illness during pregnancy, pre-term birth, or a lack of oxygen to the baby during birth. In the early childhood years it can develop due to certain types of infection, a lack of oxygen to the brain, severe jaundice and other factors. Over 750,000 children and adults in the US suffer from some form or show one or more symptoms of Cerebral Palsy. About 8,000 babies are diagnosed with Cerebral Palsy every year. Cerebral Palsy patients are often diagnosed with the disorder before 18 months of age, usually after  parents notice infants have not reached certain developmental milestones such as crawling or rolling over.

Effects/Symptoms

Some of the effects of Cerebral Palsy are involuntary muscle spasms, awkward gait, poor balance, difficulty swallowing, sight or speech impairment, seizures, abnormal sensation and perception, or mental retardation. Additionally patients with Cerebral Palsy may experience difficulty with bladder and bowel control, difficulty eating, skin disorders, breathing problems because of poor posture, or learning disabilities.

Types of Cerebral Palsy

There are three main types of Cerebral Palsy: spastic, athetoid, or ataxic. Spastic cases, the most common, affect 70 to 80 percent of Cerebral Palsy patients, and are further broken down into three categories. Patients whose lower extremities are affected more so than upper are classified as spastic diplegia;  patients who experience difficulty with only one side of the body are classified as spastic hemiplegia; and patients whose whole body is affected are classified as spastic quadriplegia. Cases of athetoid Cerebral Palsy affect roughly 20 percent of Cerebral Palsy patients. Its characterized by involuntary motions, trouble holding a steady position, or slow, writhing movements. Such patients often have difficulty getting their hands to a certain spot or holding on to objects. Ataxic cases are far less common, affecting less than 10 percent of Cerebral Palsy patients. Affecting balance and depth perception, ataxic Cerebral Palsy patients have difficulty walking steadily or when trying to execute a swift movement. Basic motor skills may also present difficulty.

Diagnosis

Diagnosis is made through testing the infant’s motor skills and examining mother and infant’s medical history. Doctors will try a hand test. Most babies under 12 months do not favor one hand over the other and will reach for an object with the hand that is closer to it. Infants with spastic hemiplegia will often show a hand preference, using the hand that is unaffected and therefore stronger and more manageable. Doctors will rule out other conditions that may cause movement disorders and keep a watchful eye to make certain symptoms are not progressing or worsening. Certain tests that examine the brain, such as MRI, CT scan or ultrasonography may be used to check for abnormalities in brain tissue or structure. Lastly, doctors will most likely check for other conditions that Cerebral Palsy patients often exhibit, such as seizures or vision and hearing problems.

Treatment

Cerebral Palsy is not curable, but with proper treatment and management patients can learn to function and live more effectively. The earlier the disorder is treated the better the chance the child has to develop and overcome difficulties or to learn alternative methods to achieve the desired result. Physical therapy and stretching programs can help patients improve gait and strengthen muscles, and help limit contractures. Occupational therapy can help patients work within their limits and maximize their function. Speech therapy helps patients learn to communicate effectively by learning how to control mouth and jaw muscles. Massage therapy can help keep tense muscles relaxed, strengthen muscles and keep joint flexible.

Prevention

Cerebral Palsy can be prevented through a few precautionary measures. Immunization against measles for pregnant women who have not already been immunized is key. Proper treatment of jaundice if the newborn appears to be affected with it is helpful. Other measures are aimed at preventing premature birth, such as reducing the risk of exposure of pregnant women to virus's and bacterial infections, avoiding x-rays and certain medications, proper control of diabetes or nutritional deficiencies, and adequate prenatal care.

Medical Negligence

Often cerebral palsy can be attributed to the fetus not receiving enough oxygen during the birth.  If this is the case, a failure or a delay in performing a C-section can result in the brain damage that causes cerebral palsy. If the baby's heart rate or oxygen flow is not monitored properly, resulting Cerebral Palsy could be fault of the hospital staff. If Cerebral Palsy is the result of hospital staff not responding to birth complications appropriately they can also be held responsible.

 

To learn more about medical malpractice law issues, please view our  medical malpractice   To learn about our medical malpractice lawyer in Maryland, please read about our medical malpractice lawyer, John Sellinger.
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Doctor Study Reporting Errors?

Posted on January 16, 2008 by Jason Fernandez

Another study has been published about doctors failing to self-report mistakes, despite consensus that doctors should. The new study by the University of Iowa (Go Hawks!) surveyed 338 doctors at three unidentified teaching hospitals. 17% of respondents admitted failing to report “minor” errors (defined as mistakes that prolonge treatment or cause discomfort). 4% of respondents admitted failing to report mistakes that caused disability or death. Lead researcher Lauris Kaldjian was troubled that fewer than half of the respondents stated that they would report hypothetical errors. He said that doctors and other medical professionals should follow the airline industry, which encourages pilots to report every error to check for systemic flaws.

One continues to wonder why doctors would not report errors considering the favorable treatment they receive from politicians and legislatures. The Commonwealth of Virginia’s medical board has reprimanded 2 doctors for their handling of births that resulted in devastating, lifelong injuries to infants during delivery. Both of the affected families were blocked from suing the doctor and hospital because of the commonwealth's 20-year-old, no-fault Birth-related Neurological Injury Compensation Act. In addition, the public reprimands neither fine nor limit the doctors ability to practice medicine. There will, however, be a notation in their permanent records.

The doctors are: Dr. Evelyn Anna Ruelaz of Fairfax County and Dr. Regina Burton of Woodbridge.

To learn more about medical malpractice issues, please see our website at medical malpractice law.  To learn more about our medical malpractice lawyer, John Sellinger, please click medical malpractice lawyer maryland.

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Medical Malpractice Insurance Premiums

Posted on November 14, 2007 by Jason Fernandez

As the 2008 election cycle nears, the American public will undoubtedly begin hearing about the legal boogeyman – frivolous medical malpractice lawsuits. Texas Republicans famously (and deceitfully) distributed a press release in 2002 that claimed that 86% of all medical malpractice claims were frivolous. President Bush has declared the need for tort reform regarding medical malpractice claims in his State of the Union address. There is no reason to believe that in the current political climate, candidates will not again try to score points with voters by trumpeting reforms of the tort system. But, should voters listen to that tired old song?

The argument goes that frivolous lawsuits are increasing medical malpractice insurance premiums, which in turn makes the practice of medicine prohibitively high. This argument has two main parts: (1) that there are a lot of frivolous lawsuits; (2) increased pay-outs for claims (by settlement or court judgment) increase insurance premiums. Research has shown that both of these claims are false.

First, most claims are not frivolous. Hospitals self-report injuries that occur due to doctor malpractice. There is an extreme difference between the number of cases reported by hospitals and the number of claims actually filed (an estimated 1,000,000 injuries per year versus 85,000 lawsuits). This statistical gap leads to two conclusions. Most injured patients do not pursue a claim against the responsible doctor(s). Also, the system filters claims – preventing the frivolous from coming to court.

No doubt the greatest signal barrier to reducing the number of frivolous claims is the plaintiffs’ lawyer. Because plaintiffs’ lawyers frequently work under a contingency fee arrangement, there is a strong economic incentive to pursue only those claims that have a high likelihood of recovery and a high potential recovery value. Professor Herbert Kritzer of the University of Wisconsin surveyed plaintiffs’ attorneys in Wisconsin regarding acceptance rates of medical malpractice cases. Professor Kritzer found that 80% of all medical malpractice cases were declined at the initial contact with attorneys. Another study looked at how particular attorneys handled such inquiries. The lawyers’ office received calls from 730 people over 10 randomly selected days. Only 1 in 30 calls resulted in litigation – lawyers rejected 97% of potential plaintiffs. Greenberg & Bederman has accepted only 5% of medical malpractice inquiries in 2007. Additionally, cases that are initially accepted by lawyers are dropped because they turn out to be weak. In short, lawyers must screen potential cases because:

  • the contingency fee economic model requires that lawyers select only those cases that have a high likelihood of succeeding.
  • the costs of pursuing a claim are extremely high – court costs, discovery costs, expert fees, etc.

  • medical malpractice claims take longer to resolve than other types of civil cases.

  • provider-defendants win at least 73% of all cases taken to trial

These facts create an incentive system for lawyers to only select the most meritorious claims.

Second, there has not been an increase in the amount of medical malpractice pay-outs. As stated before, when insurance premiums spike the go-to explanation is an increase in claim pay-outs. A Texas study from 1988 to 2002 found that no sudden changes in the number or amount of pay-outs occurred during the period of dramatic premium spikes in late 1999. A Florida study from 1990 to 2003 found that pay-outs per 100 doctors dropped from 3.98 in 1990 to 3.33 in 2003. These studies (and others) have lead researchers to claim that "factors outside the medical malpractice system were responsible for the premium spikes." One can only speculate then as to what those outside factors might be. Personally, I favor two explanations:

  1. insurance companies are corporate entities and thus seek to maximize profits. Increasing premiums will effectuate this goal. The negative publicity this generates can be safely passed on as the work of legal boogeymen

  2. insurance companies need to compensate for poor corporate investment strategies (sub-prime markets, dot-coms, Enron, etc.)

Either way, doctors should not look to plaintiffs’ lawyers as the cause of premium increases. Instead, the AMA should require insurance providers to explain the need for premium increases based on actual statistics rather than rhetoric. And, voters should ask politicians to find real problems on which to base campaigns.

Citations:

Prof. Herb Kritzer's article is Risks, Reputations, and Rewards: Contingency Fee Legal Practice in the United States (Stanford University Press, 2004).

Suggested Reading:

David A. Hyman and Charles Silver, Medical Malpractice Litigation and Tort Reform: It's the Incentives, Stupid, 59 Vand. L. Rev. 1085 (May 2006).

Jason Fernandez

To learn more about medical malpractice issues, please see medical malpractice.  To learn more about our medical malpractice lawyer, John Sellinger, please click on medical malpractice lawyer maryland, and read his firm bio.
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