Archives 2021

In 2000, the Institute of Medicine (IOM) published a book titled, To Err Is Human: Building a Safer Health System.  Alarming statistics were revealed within this text, referencing that an estimated 98,000 people die annually in the U.S. from medical errors occurring in hospitals.  Medical errors were referenced as the third leading cause of death in the U.S.  Within the text, the IOM outlined a national agenda for reducing medical errors and improving patient safety through the design of a safer health system.  The IOM made broad range recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and the development of effective systems at the level of direct patient care. The text reinforced that the problem is not bad people in health care, rather good people working in bad systems that need to be made safer.

In 2016, Johns Hopkins patient safety experts calculated that more than 250,000 deaths annually were due to medical error in the U.S.

The U.S. DOH and Human Services, along with the Agency for Health Care Research and Quality (AHRQ) published a November, 2021 U.S. DOH report referencing strategies to reduce medical errors.

In response to the increase in medical errors, the U.S. DOH and Human Services, along with AHRQ, have proposed the following defense strategies:

• Monitor risk by using analytical approaches to patient safety research, measurement, and practice improvement.
• Monitor patient safety problems by increasing the use of research methodologies
• Implement evidence-based practice in real-world settings supported by useful tools and infrastructure.
• Utilization of patient safety strategies outlined in the National Action Plan by the National Steering Committee for Patient Safety.

Key Highlights:

• The report referenced the importance of developing learning health systems as such healthcare systems are better able to support the integration of the most current evidence to improve care.
• The report referenced the importance of analyzing healthcare data, specific to procedures and patient outcomes to evaluate safe practices and opportunities for improvement.
• The development of a learning healthcare system requires a culture of safety and a shared mental model to drive improvement in clinical practice that is outcomes based. 

To view full report, see the AHRQ.gov link below:

AHRQ.gov: https://psnet.ahrq.gov/issue/strategies-improve-patient-safety-final-report-congress-required-patient-safety-and-quality

HealthcareITnews.com: https://www.healthcareitnews.com/news/feds-point-learning-health-system-key-patient-safety

Institute of Medicine. 2000. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press.https://doi.org/10.17226/9728.

John Hopkins Medicine: https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

In this blog, I’ll be identifying case types Barber Medical Legal Nurse Consulting, LLC can review where health, injury, or illness is an issue.

Examples of these case types include:

• Family law (custody battles)
• Probate (when competency is an issue)
• School health (sexual assault by a teacher)
• Americans with Disabilities Act (ADA)
• Employer-employee relationships (wrongful dismissal from employment)
• Sexual harassment
• Right to die
• Social security benefit issues
• Medicare benefit issues
• Physician facility relationship (physician was dropped from an HMO)
• Insurance Issues (reasonableness of a medical bill, relationship of the medical bill to alleged injuries or damages)
• Family Medical Leave Act (FMLA), Paid Family Leave (PFL)
• Healthcare professional board disciplinary actions

Barber Medical Legal Nurse Consulting, LLC screens the medical related issues of the above cases, and identifies if the cases are meritorious.

In this blog, I’ll be sharing another case type Barber Medical Legal Nurse Consulting, LLC has the expertise to review.  Workers’ compensation cases involve job related injuries that arise out of, or in the course of employment.  In workers’ compensation cases, compensation can be obtained secondary to the damages and hardship acquired. 

The claimant (employee) must be able to show that he, or she suffered impairment or incapacity resulting in an inability to earn wages he or she was being paid when the injury was sustained in the same or other employment.

Examples of workers’ compensation cases include: auto accidents, back injuries, injuries involving objects striking workers, cumulative trauma disorders, as well as equipment and machinery related injuries.

In these types of cases, Barber Medical Legal Nurse Consulting, LLC assesses the alleged damages or injuries.  The extent of injuries, damages, and hardship is assessed, as well as the presence of underlying medical conditions that could influence causation.  Factors that caused or contributed to the alleged damages or injuries are identified. 

The 21 years of experience specific to medical record review, allows Barber Medical Legal Nurse Consulting, LLC to efficiently, and thoroughly organize, tab, and paginate medical records.  We identify and review relevant medical records.  Following an objective review of the medical records, Barber Medical Legal Nurse Consulting, LLC summarizes, translates and interprets the medical records.   Strategic literature searches are performed and the literature is integrated into the case analysis.  Upon client request, Barber Medical Legal Nurse Consulting, LLC can be involved in interviewing claimants, consulting with healthcare providers, as well as coordinating and attending independent medical examinations (IME’s).

P.S. Comment and share what has been the most challenging aspect of representing worker’s compensation cases, medically, and/or legally.

In this blog I’ll be reviewing criminal cases, and the role Barber Medical Legal Nurse Consulting, LLC has in leveraging a successful outcome.

It is important to understand what is legally considered a crime.  A crime is any act that society considers contrary to the public good.  To be considered a crime, the act must cause harm to society.

Secondly, it is important to understand the differences between civil and criminal cases.

Civil cases involve actions that are personal in nature, causing individual harm, personal injury or property damage, and result in monetary damages.  Civil cases require proof by a preponderance of evidence. A civil verdict requires a majority of the jury to agree.

Criminal cases involve actions against society as a whole, violating the peace of the community.  This could involve homicide, assault, rape, or abuse among other things.  Criminal cases require proof beyond a reasonable doubt. A criminal verdict must be unanimous. 

Some actions can be both civil and criminal in nature. 

When Barber Medical Legal Nurse Consulting, LLC teams with a legal firm on a criminal case, we consider the elements of a crime in developing our report.  For example, the act committed, and the criminal intent.  We evaluate causation – did the act cause harm? We assess the extent of injuries, presence of any pre-existing conditions, the long-term prognosis, and develop a life care plan if needed.

Examples of criminal cases Barber Medical Legal Nurse Consulting, LLC evaluates: DWI and DUI, sexual and physical assault, child, spouse, or elderly abuse, criminal cases against individual providers and facilities, criminal environmental, any case involving a victim of a violent crime, psychiatric defenses, psychiatric issues, Medicaid, and Medicare fraud and abuse, possession of narcotics, and excessive use of force by law enforcement.

P.S. Comment and share your experience with criminal cases.  How has the element of causation influenced your case outcomes?

In this blog I’ll be reviewing another type of case Barber Medical Legal Nurse Consulting, LLC has the expertise to assist with.  Product Liability is a claim brought for personal injury, death, or property damage caused by the manufacture, construction, design, formulation, preparation, assembly, installation, testing, warnings, instructions, marketing, packaging, or labeling of any product.

3 major types of product liability claims:

1. Manufacturing defect: occurs in manufacturing and usually involves poor-quality materials or workmanship;
2. Design defect: occurs when the product design is inherently dangerous, and fails expectations on what is a safe product, whereby its risks outweigh its benefits; and
3. Failure-to-warn (marketing) defect: occurs in products that carry inherent non-obvious dangers which could be mitigated through adequate warnings to the user, and these dangers are present regardless of how well it is manufactured.

In the event a company fails to disclose warnings about the possible health hazards or when it tries to minimize the dangers, public health can be in jeopardy from defective materials.

Examples of medical devices and drug related products liability cases include:
Celebrex ^®, hormone therapy, birth control pills, Vioxx ^®, Ephedrine, Oxycontin ^®, Botox ^®, Fosamax ^®, hip implants (all metal), implantable defibrillators, and ventilators.

Examples of non-medical device products liability cases include: Machinery and equipment, children’s toys, cigarettes and lighters, motor vehicles, automobiles, and automobile parts, food, household products, and personal care products.

What is the role of Barber Medical Legal Nurse Consulting, LLC in a product liability case?

• Case screening / assess case for merit
• Assess injuries, damages, and prognosis / life care planning
• Evaluate causation
• Summarize and translate authoritative literature to attorney, and legal team
• Educate attorney, and legal team
• Evaluate validity, and reliability of research from opposing side
• Report writing
• Develop chronological timeline
• Development of evidence to assist with deposition and/or trial
• Identify and review tangible items
• Interview client witnesses
• Identify and locate testifying experts

P.S. Comment and respond if you have experience with product liability cases

In this blog, I’ll be addressing personal injury cases, specifically motor vehicle accidents, one of the seven types of cases Barber Medical Legal Nurse Consulting, LLC can review. In the event of a personal injury case involving a motor vehicle accident (MVA), the plaintiff has a history of ankylosing spondylitis (AS). The plaintiff has a 5-year history of low back and bilateral hip pain.  Status post MVA, the plaintiff reports worsening mid to low back and left hip pain with a new onset of left leg pain radiating down the full length of extremity associated with numbness and tingling making it difficult to stand or walk for long periods of time.

 Is this a non-meritorious case secondary to a pre-existing medical condition?  Or, is this a meritorious case secondary to exacerbation of a pre-existing medical condition as a result of the MVA?

Per Patient Safety in Surgery, cited in Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis, (AS) is:

• A chronic system wide inflammatory rheumatic disorder primarily affecting the axial skeleton (sacroiliac joints and spine)
• Characterized by remissions (reduction in severity of disease symptoms), and exacerbation (acute increase in severity of disease symptoms).  Exacerbation’s can be triggered by traumatic incidences, such as an MVA.  Exacerbation’s should be distinguished from traumatic lesions which have been reported to occur in rigid AS spines (which usually resolve within two weeks.) 

>The defense is likely to argue that the damages were unavoidable and were due to a pre-existing condition of AS.

The below links are useful resources specific to AS with a great case study in the first link provided:

Handle with care: the dangers of cervical spine fracture in patients with ankylosing spondylitis. (Cases in Point). https://link.gale.com/apps/doc/A97295577/HRCA?u=nysl_ca_sal&sid=bookmark-HRCA&xid=f46a940f   

Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis. https://link.gale.com/apps/doc/A181172821/HRCA?u=nysl_ca_sal&sid=bookmark-HRCA&xid=35390642

P.S. Comment and share what your thoughts are about the merits of the case based on the limited information provided

P.P.S. Comment and share if you have experience with a personal injury case involving a plaintiff with a history of AS. How did this medical history impact the outcome of the case?

In this blog, I’ll be discussing toxic tort, one of the seven types of cases Barber Medical Legal Nurse Consulting, LLC can assist plaintiff and defense attorneys with.  The medical knowledge, combined with the ability to review large volumes of records and integrate learned knowledge into case analysis, assists clients with successful outcomes.

MOVE TO FEDERALLY REGULATE PFAS (“FOREVER CHEMICALS”)

On October 18, 2021 the Washington Post published an article announcing that the Biden administration will be moving to Federally regulate PFAS (“forever chemicals”).  These long-lasting, human-made chemicals pose many environmental and health risks.  These “forever chemicals” remain unregulated by the federal government.

The State of New Jersey was the first state to publish drinking water standards for Perfluorooctanoic acid (PFOA) and Perfluorooctane sulfonic acid (PFOS) (both collectively known as PFASs) in 2020 in the absence of federal regulations.  The State of New York adopted drinking water standards that went into effect in 2019. 

APPLICATION AND HEALTH CONSEQUENCES 

“Forever chemicals,” continue to be used in an array of products such as cosmetics, dental floss, food packaging, clothing and cleaning supplies.

According to the U.S. Department of Health and Human Services, Toxicological Profile for Perfluoroalkyls, PFAS has a long half-life in the human body causing bio-accumulation.  PFOA and PFAS are resistant to degradation by natural processes such as metabolism and are persistent in the environment because of their durability.  Over a period of time, the chemicals make their way into soil, water, food and even blood, potentially harming public health.   

Multiple peer reviewed studies demonstrate that exposure to PFAS at certain levels can lead to infertility risks, thyroid disease, certain types of cancers, gestational hypertension, and developmental problems in children.

CONSEQUENCES OF FEDERAL REGULATION

 Once mandatory Federal standards come into effect, it is believed that local water utilities will face penalties if they fail to meet them.  Additionally, if the Environmental Protection Agency (EPA) classifies some of the PFAS chemicals as hazardous, this would strengthen the ability to hold polluters accountable.

Click on the link below to view the article from the Washington Post:

https://www.washingtonpost.com/climate-environment/2021/10/18/epa-regulate-forever-chemicals-pfas/

Click on the link below to view content from the U.S. Dept. of Health and Human Services, Toxicological Profile for Perfluoroalkyls:

https://www.atsdr.cdc.gov/toxprofiles/tp200.pdf

P.S. Comment and Share your experience with toxic tort cases, or PFAS

In this blog I’ll be reviewing the NYS maternal mortality statistics as well what type of lawsuit would support maternal mortality cases. Additionally, I will be briefly addressing the new 2020 Joint Commission Maternal Safety Standards.

The NYS maternal mortality rate is 18.9 deaths/100,000 live births. This is 1.7 times the Healthy People 2020 target of 11.4/100,000 live births. Of the pregnancy-related deaths the CDC reviewed, 27.2% were considered preventable.

The NYS Maternal Mortality Review Report identified 33 pregnancy-related deaths in 2014.
The leading causes of pregnancy-related deaths were:
Infection: (21.2%)
Hemorrhage: (15.2%)
Cardiomyopathy, embolism, pulmonary problems: (12.1%)

According to the CDC, nine cases (27.2%) among the pregnancy-related deaths were considered preventable based on the reviewer’s determination that there was at least some chance of death being averted by changes to patient, family, provider, facility, system and/or community factors.

To address maternal morbidity, as of July 1, 2020 there are new Joint Commission (JC) Maternal Safety Standards required of JC accredited hospitals.

Medical malpractice, and wrongful death are types of lawsuits that can be filed to support maternal death cases. Recovery involves compensation for economic and non-economic damages. Having an understanding of current statistics, current standards of care, Joint Commission standards, available sources of evidence, and an awareness of how to interpret the medical records will help to ensure that your clients achieve the greatest possible outcome with the support of their legal team.

I welcome you to collaborate with Barber Medical Legal Nurse Consulting, LLC to learn more about the new Joint Commission Maternal Safety Standards.

To learn more about the NYS Maternal Mortality Review Report, visit link below: https://health.ny.gov/community/adults/women/docs/maternal_mortality_review_2014.pdf

In this blog, I’ll be referring to one of the seven types of cases a CLNC® has the expertise to analyze. Additionally, I’ll be providing an ongoing environmental issue that exists in the U.S. that is grounds for filing this particular type of lawsuit.

There are 7 types of cases a CLNC® has the expertise to review. Toxic tort, or environmental exposures is one of them. This type of claim is a specific type of personal injury lawsuit in which the plaintiff claims that exposure to a dangerous substance, or chemical, caused the plaintiff’s injury or disease.

Did you know that paraquat is one of the only two herbicides still being used in the U.S.? Paraquat has been banned in Switzerland and the European Union countries secondary to its high toxicity.

Breathing in paraquat can cause long term, irreversible lung damage and can lead to a disease called paraquat lung. Long-term exposure to paraquat may cause scarring of the lungs called pulmonary fibrosis. This makes it hard to breathe.

If paraquat touches the lining of the mouth, stomach, or intestines, it can cause damage to the body. Paraquat may also damage the kidneys, liver, and esophagus (the tube that food goes down from your mouth to your stomach).

If paraquat is swallowed, death can quickly occur. Death may occur from a hole in the esophagus, or from severe inflammation of the area that surrounds the major blood vessels.

To learn more about the long-term damages associated with paraquat, visit the U.S. National Library of Medicine, Medline Plus and the Centers for Disease Control and Prevention at the below links.

https://medlineplus.gov/ency/article/001085.htm

https://emergency.cdc.gov/agent/paraquat/basics/facts.asp

I look forward to learning about your experience with toxic tort cases. If you have been involved, or are involved in a medical case specific to paraquat, please respond, “yes.”

Breast cancer is the most commonly diagnosed cancer in women in the United States and the second leading cause of cancer death in American women.

Breast cancer mortality can be reduced through screening performed in accordance to current standards of care.

There are 12 million medical misdiagnoses each year, half of those being cancer-related. A quarter of all malpractice lawsuits are related to either a misdiagnosis or a missed diagnosis in the US. As many as 1 in 70 patients are diagnosed with cancer when they do not actually have cancer, leading to unnecessary treatment, and/or surgery. Many are misdiagnosed when they do in fact have cancer. This can lead to delays in treatment, and increased mortality rates.

It’s crucial to be aware of best practice recommendations specific to breast cancer screening, while remaining current with new screening modalities.
Breast cancer screening guidelines come from ACOG, U.S. Preventive Services Task Force, American Cancer Society, and the National Comprehensive Cancer Network.
Recommendations refer to breast cancer risk assessment, self and clinical breast examination, mammography, and MRI.

Historically, the screening recommendations have not considered racial differences in breast cancer epidemiology, treatment, and survival. According to a study published in the October Annals of Internal Medicine, in Black versus White women, initiating biennial screening 10 years earlier (at age 40) reduced Black-White mortality disparities by 57 percent.

To learn more about the study specific to reduction in racial disparities surrounding breast cancer screening, view the below link:
https://www.acpjournals.org/doi/10.7326/M20-6506

P.S. comment and share if you have experience in missed diagnosis or misdiagnosis cases