Losing My Leg to a Medical Error

LAST Fourth of July, during a day at the beach, I experienced a sudden pain in my left calf. Two months later, I required an above-the-knee amputation. Compounding my distress was the fact that my doctors had no explanation for why the blood flow to that leg had been cut off. I had none of the usual risk factors for atherosclerosis, the hardening of the arteries. I had low cholesterol and no evidence of diabetes, and I had never smoked. No blood vessels were blocked elsewhere in my body.

It took some further detective work to reveal what must have been the cause. Seventeen years earlier, in 1995, I had surgery on my left Achilles’ tendon. To prevent bleeding during the procedure, a pressurized cuff was placed above my left knee to block the blood flow. Apparently, the cuff was left on too long, injuring the arteries. In the years since, the vessels progressively scarred and calcified, which eventually blocked all blood flow to my lower leg.

I lost my leg because of a preventable error. The loss of a limb is traumatic, and I experience waves of sorrow and regret. I struggle with continual pain in my residual limb, and am trying to learn how to walk with my prosthesis. My work as a physician has been put on hold.

For the past two decades I have been studying how to prevent errors in health care, and the irony of my present predicament strengthens my motivation to continue the quest. No one should ever have to experience such preventable harm.

And yet many people do. Exactly how many, we can’t say, because there is no national registry for injuries or deaths caused by medical errors. Over a decade ago, in the best study of its kind, the Institute of Medicine estimated that there were 44,000 to 98,000 deaths per year because of preventable errors in the American health system. For every death there are likely to be at least 10 serious injuries, so we can assume that roughly a million patients are seriously injured each year.

Despite calls to action by patient advocates and the adoption of safety programs, there is no sign that the numbers of errors, injuries and deaths have improved. Why? Because those responsible for the delivery of health care have been unable to change how they do things.

They could help themselves by embracing the lessons of great manufacturing companies to improve quality and efficiency. Automatic alarm systems and shut-off switches can be designed to make it nearly impossible for caregivers to do the wrong thing. Checklists and specific protocols based on best practices for each procedure can also help.

In my case, if an alarm had alerted the doctor to how long the cuff had been in place, if the cuff had automatically deflated after a period of time, or if a checklist had reminded the doctor to remove it, my leg might never have been injured. Better yet, if the doctors had not used the cuff, which evidence has shown can be dangerous to patients, I would still be walking on that leg today.

Most of all, perhaps, we need better coordination and communication among caregivers. Consider what happened to Mary, my former wife and the mother of our two children. In 1988, she was lying in an intensive care unit with less than a 10 percent chance of survival. Her first symptom, a pain in the sole of her right foot, had seemed so innocent. A neurologist said she had most likely injured a nerve during aerobic dance and the doctor ignored our requests for further tests. But when Mary’s leg began to swell, we sought the help of an internist. She diagnosed thrombophlebitis, inflammation from blood clots. Mary was then admitted to the hospital for a blood thinner, but the medical team gave her too small a dosage. Her clots extended into her lungs. Next she suffered a heart attack, respiratory failure, renal failure and shock.

In desperation we transferred her care to another physician, who finally began treating her with corticosteroids for inflammation of the blood vessels. Over the next 24 hours, Mary’s symptoms reversed and she fully recovered. But we nearly lost her as a consequence of delayed decision-making, poorly coordinated care and a medication error.

Eliminating errors has the added dividend of reducing costs. The cost for treating Mary’s thrombophlebitis should have been $16,000; the complications pushed the cost nearly six times higher. The hospital bill for my leg amputation was approximately $150,000, my prosthesis cost more than $50,000, and I have lost months of work.

The Affordable Care Act has recognized this reality and is creating new reimbursement systems that reward the quality rather than the quantity of care. The act has also empowered an expert panel to create evidence-based treatment recommendations.

I wish I could go back in time and implement these changes before my surgery. But there is no way to turn back the clock. My life will never be the same, nor will the lives of roughly a million other patients who suffer similar preventable injuries each year. But we can make sure that future patients don’t suffer the same life-changing harm.

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Source: The New York Times (Southwick, 2/19)

Despite Counsel, Victim Is Hindered by Tort Laws

SAN ANTONIO — When Connie Spears arrived at a Christus Santa Rosa hospital emergency room in 2010 with severe leg pain, she told medical staff members about her history of blood clots. Doctors sent her home with a far less serious diagnosis.

Ms. Spears in a pre-surgery photograph. She has run into problems with the state’s expert-witness rule and its time frame.

Days later, swollen and delusional, Ms. Spears was taken by ambulance to another hospital where doctors found a severe clot and extensive tissue damage. With her life on the line, they amputated both of her legs above the knee.

Nearly three years later, Ms. Spears contends that she is a victim not only of a medical mistake but also of Texas’ tort reform laws.

The huge tort reform package that Texas lawmakers approved in 2003 capped noneconomic damages that a plaintiff could receive for medical malpractice at $250,000 and set a “willful and wanton” negligence standard — interpreted as intentionally harming the patient — for emergency care. It also required plaintiffs to find a practicing or teaching physician in the same specialty as the defendant to serve as an expert witness and to demonstrate evidence of negligence before a trial. Under the strengthened rules, if plaintiffs fail to produce adequate expert reports within 120 days of filing their cases, they are liable for defendants’ legal fees.

Ms. Spears said the laws obstructed her ability to find a malpractice lawyer and forced a judge to order her to pay thousands of dollars to cover some defendants’ legal bills. Her lawyers plan to file a motion that challenges the laws’ constitutionality.

“How can that law be?” Ms. Spears asked. “Maybe the law was too loose before, but they went way too far the other way.”

Tort reform proponents say that such restrictions are the only way to curb frivolous lawsuits against health care providers and that they have drawn more medical professionals to a state with exploding population growth.

“Our purpose had never been to have a procedural hurdle,” said Mike Hull, a lawyer for the pro-tort-reform Texas Alliance for Patient Access. “It had been to have the plaintiffs really get the case reviewed.”

For two years, Ms. Spears struggled to obtain legal representation, because several lawyers said they feared her case did not meet Texas’ new negligence standards. Justin Williams, a Corpus Christi lawyer who eventually took the case, said, “Her life has basically been ruined by all of this, and there was just no way I could turn her down.”

But the case fell apart under the new expert-witness rules. After the first attempt at an expert-witness report failed to identify the proper defendants, Mr. Williams said, he was unable to find another expert witness in a time frame that would satisfy Texas’ requirements.

Tina York, a lawyer for Christus Santa Rosa, said it was unusual for a case to be dismissed because of problems with an expert-witness report. The rules are in the statute, she said, to weed out plaintiffs who “can’t legally support their claim” from the beginning. (Christus Health is a corporate sponsor of The Texas Tribune.)

Ms. York said Christus Santa Rosa did not pursue compensation for its legal fees out of sympathy for Ms. Spears. But Ms. Spears said other defendants in the case had. With her retirement savings tapped and her husband out of work, she is afraid they will lose their home.

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Source: The New York Times (Aaronson, 1/24)

5 tips to survive emergencies on the road

Here are some potentially catastrophic driving situations that can be turned into quickly forgotten incidents with simple, but effective, action. For most, passengers can save the day. PM contributor Mac Demere, a former racing driver and driving instructor, offers a few simple tips to keep you alive out there.

Keep calm and drive on

Most fatal single-vehicle crashes involve the vehicle running off the road. Here's what happens in many of them: An inattentive or distracted driver allows the car's right tires to drop off the pavement or onto Interstate rumble strips. The loud noise suddenly alerts the driver that he's drifting to the right, causing him to yank left on the steering wheel. The wayward front tire regains grip while one or both rear tires are in the loose stuff. With little or no rear traction, the vehicle spins out and leaves the highway—and could even flip.

The way to avoid this fate is to stay calm and not overreact. If you find yourself drifting off the road, let off the gas and allow the car to slow down, and gently ease back on the road. Do not depress the brake unless you see an obstacle approaching and need to get back in your lane faster. Whatever you do, be smooth with the steering; a little goes a long way at high speeds.

Put It in Neutral

A stuck throttle is an automotive mugging: It's unexpected, petrifying, and what you do in the next few seconds may change your life forever. The solution is easy: Slap the shift lever into neutral. In the vast majority of cars, the passenger can do this as easily as the driver. Almost all modern cars have physical or electronic devices that prevent the transmission from going into reverse or park while you're driving down the road, as well as electronic limiters to preclude engine damage, so you don't have to worry about hurting the car by putting it in neutral. A manual transmission car might take a little bit more force to put into the neutral gate, but it'll go as well.

I've experienced stuck accelerators caused by faulty cables, misplaced floor mats, and panicked driving-event students who mistakenly mash the throttle pedal rather than brake. I've always quickly cured the problem by bumping the shifter into neutral or, when driving a manual-transmission car, depressing the clutch.

Get a spotter

Every car has blind spots. And today's cars increasingly have thick, airbag-filled A-pillars (the vertical post that connects roof and body) that can hide cars around you. If you're riding with a passenger, then, employ him or her as your spotter. I ask my passengers to say, "clear right" or "traffic right," when I'm trying to turn left. I'm also happy to have them point out things I might have missed, such as "bicyclist ahead." Stay away from saying "no" and "go." (At ages 6 and 8, my kids said, "clear, high!" when I passed a car on a two-lane. The things that happen when you're a race driver...)

This might take some getting used to. Most of us don't like back-seat (or front-seat) drivers, nor are we accustomed to offering advice or watching the road with care when we're not driving. But having a little help from the passenger seat will make everybody's ride a little safer.

I can't see clearly now

"I can't see," the driver shouted at me. As he ineffectively batted at the suddenly fogged windshield, I switched the heating system from "recirculation" to "fresh air" and engaged the air conditioner. Within seconds the windshield was clear, except for the smudgy patch left by his fingerprints.

Engaging the air conditioner (regardless of the temperature setting) and allowing the system to suck in fresh air lowers the humidity inside the car. Many vehicles now automatically engage the air conditioner and disengage recirculation when you select the defroster to avoid a fogged-up windshield.

Speaking of poor visibility, there's probably been a time in your life that you've forgotten to change your wiper blades soon enough and have been caught out in a rainstorm with blades that did more smearing than clearing. You might be able to revive them for one last storm with a quick cleaning. Rub the wiper blade with the sponge side of a gas-station squeegee (or the sponge from the office coffee room) and a clean, dry towel. Get the windshield, inside and out, while you're at it. Don't procrastinate about buying new blades the next day.

Make a plan B. And C. And D...

Recently I was following someone who was driving while texting who almost ran off the left side of a two-lane, as a car approached from ahead. Watching this unfold just in front of me, I had to figure out how to avoid it. Plan A was to pound the brakes. Plan B, backing up, was not a great option because I couldn't see far enough around the previous curve of this heavily traveled road to know whether other cars were coming. I crossed out Plan C, escape routes, because of earthen banks on both sides of the road. Plan D was to employ Plan B and go into reverse if the oncoming driver veered around the errant driver and into my lane.

Fortunately, the texter completed his text and returned to his lane, while the oncoming driver stopped. The moral of the story: Don't text and drive, but also work through possible options before an emergency happens. Then if it does, you'll be better prepared and able to think your way out of it.

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Source: Yahoo News (AP, 1/30)

General Motors Recalls Large Vans for Potential Roll-Away Problem

General Motors Co. is recalling certain Chevrolet Express and GMC Savana full-size vans from the 2013 model year because of problems with their ignition lock systems that could lead to the vehicles rolling away while unattended.

In a document filed with the National Highway Traffic Safety Administration, the car maker said the possible flaw affects 980 vans. The recall includes Express vans built from Nov. 1 through Dec. 21, 2012; and GMC Savana vehicles built from Nov. 14 through November 20, 2012.

In these vehicles it may be possible to remove the ignition key from its slot while the engine is running or when the transmission is not in the “park” position. The interlocking mechanism between the ignition and transmission, which is a standard safety feature throughout the U.S. auto industry, is supposed to keep the key from being removed unless the vehicle is in park and the engine is off.

Under the recall GM will notify owners about the recall and dealers will replace the ignition lock cylinder and keys, free of charge. The recall is expected to begin on Jan. 23, 2013. For more information, GMC owners may call 866-996-9463 and Chevrolet owners may call 800-630-2438.

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Source: The Wall Street Journal (AP, 1/18)