A sad personal tale of medical malpractice that ironically might have been prevented with an EMR, the legal malpractice that followed, as well as a comment on how the legal profession disciplines it members:
In this document from the National Association of Personal Injury Lawyers are the specifics of the events that led my father to miss being at the 2000 malpractice suit he initiated in 1995 for a two-year failure to diagnose bilateral renal cell adenocarcinoma and medical abandonment.
A dozen retrograde pyelograms in the O.R., performed from 1992-1994 didn't show his problem, as they wouldn't. They did not visualize the renal parenchyma, and despite repeated bouts of severe renal colic and GU bleeding with suspicious CT/MRI's, nothing else was done besides prescribing percocet.
This was despite a history of prior successful treatement with nitrogen mustard and other carcinogens two decades prior for mycosis fungoides, a lymphoma. The diagnosis was always "a kinked ureter" and a stent was placed, which the doctor accused my father of "knocking loose" by picking up heavy packages, etc.
In late 1994 when I became aware of a GU bleed so severe that it dropped my father's hematocrit several points, I demanded a renal arteriogram. At first the medical team refused, but then gave in when I basically threatened legal action (I was faculty at Yale School of Medicine at the time). According to my father, the radiologists said during the arteriogram: "ooops." The result: bilateral golfball-sized renal carcinomas. A "special file" was opened by the hospital.
We were then told the problem was inoperable; but the doctor did not order medical or oncology consults despite my asking him to do so directly. My direct requests to the Department of Medicine to intervene were refused on the basis of "can't get involved in this mess." I then transferred my father to the hospital where I did my residency just as he became septic from obstruction, and after some time in the ICU to clear up his septic shock his cancers, perfectly operable via partial nephrectomies, were removed. There were fortunately no metastases.
The urologic surgeon who did the surgery informed us there were no ureteral "kinks."
He lived without pain, and without bleeding, and without dialysis until 2000. In July 2000, he died of septic shock as a complication of dialysis for the renal failure that set in earlier that year. His battered kidneys, that had been subjected to repeated obstructions and hydronephrosis while the tumors were growing over a several-year period, finally gave out. My intervention in his case had given him six extra good years.
He filed suit for medical malpractice and abandonment in early 1995.
My father was not at the trial that did not take place until late 2000 (CHARGE VIII, Item 131: The Silverstein Matter) because the trial had been cancelled, and he died before the trial could be reinstated (itself a near precedent in Pennsylvania law). My father's case along with multiple other major injury/malpractice cases had been dropped by the court due to malpractice attorney Thomas W. Smith's secret problems.
My father did, however, attend the trial posthumously in the form of a videotape made under court-acceptable conditions, at my demand, since I felt my father might die before the case reinstatement matter was resolved.
My father won the case, posthumously.
At the trial, the defense had an "expert witness" (a urologic surgeon from another hospital) try to make the case that in elderly people (my father was 68 at the time the problems began) , renal cancers should be "left alone." Of course, this did not take into account the repeated bouts of renal colic, obstruction, bleeding and pain and was, I thought, an odd defense.
Presented as evidence in this regard was an article from the American Journal of Urology that had non-operation of renal cancers in the 'elderly' as its thesis.
Unfortunately for the defendants, the article's conclusion stated that such a course was experimental and that the standard of care was indeed surgery. When this 'expert witness' was asked by my parents' attorney to read the article's conclusion to the jury, he realized his error, and stammered and came out with such literal nonsense and 'spin' to try to explain away this little discrepancy, that I thought I was in an alternate universe. Everything I'd learned about medicine - the need to be cautious and honorable, the value of expertise, the respect for the patient - seemed to be just meaningless window dressing. (I paid for a transcript of that testimony just because I wanted to make sure I was not hallucinating at the time.)
Rubbing salt into the wounds, Medicare then put a lien on a portion of the winnings, to recover for the expense of "unnecessary procedures", including the dozen retrograde renal studies. An amount of money was put in an escrow account. It did not matter that the patient is not the person responsible for the tests being ordered, and in Pennsylvania the jury was not permitted to be informed that Medicare could recoup some of the expense of unnecessary medical procedures. Talk about screwed up. I fought this on the basis of it being unfair, based on a technicality in the language of the act that allows such recovery, and just a few weeks ago, in 2005, Medicare released the escrow and the amounts were given to my mother. I think this was done more due to the voluminous length of my father's records and the shortage of Medicare resources and personnel time to adjudicate my complaint, more than anything else.
My father and mother, as well as nearly a dozen other plaintiffs in numerous severe malpractice cases, suffered twice. Once, as a result of medical malpractice and then again, as a result of the legal malpractice that the National Association of Personal Injury Lawyers report linked above described as "both serious and grave in nature," with "eleven separate instances of major case neglect and multiple instances of misrepresentations [i.e., lies] about the status of the cases on seven separate dates."
The penalty, imposed in 2003?
Suspension from the practice of law for a period of four years, retroactive to December 13, 1998.
As to the physician involved, that's another matter. He received a promotion to Chief of Staff. I don't think he's practicing law.
Did I mention the physician was attending law school at the same time he was treating my father, while also running several urologic surgery practices? We found this out only several years ago.
Dad, it's a screwed-up world. Rest in peace.
-- SS
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