By: Judy Greenwood and Victoria Guituan
What is postpartum hemorrhage (PPH)?
update
Postpartum hemorrhage is defined as excessive blood loss quantified as 1,000 mL or greater with signs of hypovolemia within 24 hours of birth (Postpartum Hemorrhage, 2017). Signs of hypovolemia include cool, clammy skin, fatigue, pallor (pale skin), decreased level of consciousness, and generalized weakness (Hypovolemic Shock: MedlinePlus Medical Encyclopedia, 2024). Primary postpartum hemorrhage occurs within 24 hours of birth, while secondary postpartum hemorrhage can occur up to 12 weeks after birth (Postpartum Hemorrhage, 2017). Postpartum hemorrhage is one of the most common complications following childbirth and can lead to further complications if not treated rapidly.
How does it occur?
Postpartum hemorrhage is caused by the 4 T’s: tone (uterine tone), trauma (uterine trauma), tissue (retained placental tissue or clots), and thrombin (blood clotting deficiencies) (Wormer et al., 2024; Postpartum Hemorrhage (PPH): Causes, Risks & Treatment, 2023). The most common cause of PPH is generally due to the lack of uterine contractions after childbirth. This is essential because uterine contractions are responsible for expelling blood clots and returning the uterus to its normal size. After birth, the uterus should begin to feel firm, instead of boggy or soft.
Other causes may include blood loss during a cesarean section, delayed placental delivery after birth of the child, lacerations or ruptures, and previously diagnosed clotting disorders.
Signs and Symptoms of PPH
Signs and symptoms of PPH mirror hypovolemic shock. This may include feeling faint, cool or clammy skin, sweating, a decreased level of consciousness, a drastic drop in blood pressure, increased heart rate, and excessive and uncontrolled blood loss quantified as ≥ 1,000 mL of blood within 24 hours or up to 12 weeks after childbirth.
Treatment
Initial treatment of PPH generally includes a fundal massage and administration of Pitocin (oxytocin). Massaging the fundus of the uterus helps to expel clots and to help promote uterine contractions. Similarly, oxytocin is a naturally occurring hormone that plays a role in promoting uterine contractions. This can be administered in its synthetic form as Pitocin to help reduce hemorrhaging. The most important factor to consider when treating PPH is to determine the cause and to treat the source of bleeding directly.
To account for the large amount of blood loss, providers may initiate blood transfusions to help restore blood (Bienstock et al., 2021).
Severe Complications Associated with PPH/Timing in Treatment
If left untreated, PPH can result in serious complications. Other complications include infection, hypovolemic shock from immense blood loss, acute renal (kidney) failure, hepatic (liver) failure, excessive clotting, also known as disseminated intravascular coagulation (DIC), and death (Bienstock et al., 2021).
Timing in treatment and early recognition of risk factors are essential in reducing adverse outcomes, such as maternal mortality. Some risk factors that may increase the likelihood of PPH include anemia, cesarean section, multiparity (having multiple pregnancies), macrosomia (neonate that weighs more than 9 lbs at birth), and shoulder dystocia (shoulder of the neonate becoming stuck during childbirth) (UpToDate, 2025). Without adequate timing in treatment, excessive blood loss can cause other organ systems to shut down due to the lack of oxygen, which can ultimately result in death. Failure to identify alarming risk factors and to intervene is considered to be negligent, where one may face adverse outcomes if not treated accordingly.
Reduce hemorrhaging. The most important factor to consider when treating PPH is to determine the cause and to treat the source of bleeding directly. To account for the large amount of blood loss, providers may initiate blood transfusions to help restore blood (Bienstock et al., 2021).
Severe Complications Associated with PPH/Timing in Treatment If left untreated, PPH can result in serious complications. Other complications include infection, hypovolemic shock from immense blood loss, acute renal (kidney) failure, hepatic (liver) failure, excessive clotting, also known as disseminated intravascular coagulation (DIC), and death (Bienstock et al., 2021).
Timing in treatment and early recognition of risk factors are essential in reducing adverse outcomes, such as maternal mortality. Some risk factors that may increase the likelihood of PPH include anemia, cesarean section, multiparity (having multiple pregnancies), macrosomia (neonate that weighs more than 9 lbs at birth), and shoulder dystocia (shoulder of the neonate becoming stuck during childbirth) (UpToDate, 2025). Without adequate timing in treatment, excessive blood loss can cause other organ systems to shut down due to the lack of oxygen, which can ultimately result in death. Failure to identify alarming risk factors and to intervene is considered to be negligent, where one may face adverse outcomes if not treated accordingly.
By: Judy Greenwood, Esq and Stephen Ulan, Esq., Law Offices of Judy Greenwood, PC
Though we know this to be called a “Bedsore”, medically speaking we are talking about “pressure ulcers” or decubitus ulcers. These are localized injuries to the skin and the underlying tissues, typically over bony areas that protrude, which occur from prolonged pressure, sometimes in combination with friction or shear. Bedsores are most often seen in patients who have limited movement whether due to getting old, or from underlying medical conditions, and nutritional deficiencies. Pressure ulcers are commonly seen in nursing homes or in rehabilitation centers, but may occur in hospitals as well.
Statistically approximately 70% of all “pressure ulcers” have been reported to occur in patients who are over 65, which explains why these very often occur in nursing homes. These ulcers can develop rapidly, and can cause significant harm in patients who are elderly, immunocompromised or who suffer from underlying co-morbidities, leading to premature death.
Preventing “bedsores” from developing in the first place, is a key to avoiding the serious effects of a pressure sore. It is a key responsibility of nursing home staff, rehabilitation center staff, and nurses to take steps to prevent a pressure sore from developing. Key measures that can be taken include:
1. Regular skin assessments to identify any early signs of a pressure ulcer.
2. Implementing a turning schedule, for residents or patients to be turned once every 2 hours.
3. Using specialized mattresses (air mattresses) and cushions to provide additional support and re-distribute the pressure.
4. Hydration and nutritional support to help with skin integrity
5. Adequately trained nursing staff with knowledge regarding the prevention and management of pressure sores.
Once a pressure sore develops it is crucial that there be prompt and effective treatment. This may include wound care, with cleaning, debridement, dressings and other measures, to promote healing and avoid the worsening of the condition. Wound vacs and skin substitutes may also be used where appropriate.
Failure to prevent and/or promptly treat a bedsore can be viewed as negligence or neglect, and may serve as the basis for legal action against the hospital, nursing home, or rehabilitation center where the development of the bedsore occurred. It is best to be vigilant and prevent an issue, but if you or someone you know is in a nursing home, rehabilitation center, or a hospital and has suffered a “bedsore”, particularly one that was not promptly recognized and treated, you should call an attorney experienced in handling medical negligence and nursing home neglect cases, for a free consultation to discuss whether or not there is a basis for a claim.
By: Judy Greenwood, Esq. and Stephen P. Ulan, Esq., Law Offices of Judy Greenwood, PC
Have you been in an accident or been the subject of a surgery gone wrong causing you not only an injury but chronic pain that seems excessive for the injury you suffered? Sometimes the pain is so bad it becomes debilitating and keeps you from functioning? Because the "pain" cannot be seen are your complaints minimized or dismissed by those around you?
You may have a condition formerly referred to as "RSD" or reflex sympathetic dystrophy but now identified as "CRPS" or chronic regional pain syndrome, a very real condition that affects approximately 26.2 per 100,000 persons, with females being affected at least 3 times more often than males, according to one study. CRPS has been said to affect some 200,000 people each year in the United States. Once diagnosed many patients are referred to pain management specialists for pain relief and ongoing care.
Complex regional pain syndrome (CRPS) is a known chronic health problem that causes long-lasting pain. The pain is often excessive and prolonged and very often follows after an injury to or surgery on an extremity. CRPS is classified as one of the most painful chronic pain condition known, reaching 42 out of 50 on the McGill Pain Scale, higher than non-terminal cancer or amputation of a finger without anesthesia. Flares of CRPS can cause pain that is worse than childbirth The pain may be due to C-fiber-mediated neurogenic inflamation at the injury site, where the nerve is trying to repair itself.
There are 2 types of CRPS:
Symptoms of CRPS include:
The outcomes in CRPS can vary from person to person, and in some people can be quite severe. Physical therapy and exercise can be used to help improve blood flow and ease symptoms. It can also help improve the affected limb’s flexibility, strength and function. CRPS can cause emotional or psychological issues for those affected. People might have depression, anxiety, or post-traumatic stress disorder and can make the pain seem worse.
Some reports suggest that treatment is most effective when it started early in the course of the illness, but the benefits of treatment can vary irrespective of when the treatment occurs in the course of the condition. CRPS can be acute or a chronic, permanent disability, and there is no great understanding as to what causes it to be either acute or chronic, nor any way of accurately predicting if it will improve or go away over time in an individual patient. CRPS, may also progress to more-disabling signs and symptoms such as:
CRPS can be debilitating for the person affected. While the Social Security Administration recognizes CRPS as a potential cause of disability depending on its severity and impact on a person’s life, like all pain syndromes CRPS is often not well recognized or understood despite its’ actual adverse effect on the individual who suffers from this condition.
Some resources for learning about CRPS include the National Institute of Neurological Disorders and Stroke.
Complex Regional Pain Syndrome | National Institute of Neurological Disorders and Stroke
According to the American Cancer Society, 192,370 women in the United States will develop breast cancer this year. With routine self breast examination, yearly mammograms, and proper surveillance, we expect that if we develop breast cancer it will be detected at its earliest stage and with treatment, our chance for survival and cure will be excellent. But what happens when our mammograms are misread or our doctors make mistakes? During any given year a certain number of women find themselves in that very situation. The damage having been done, their only course of action may be litigation to compensate them for their harm and to prevent the catastrophe from occurring to other women.
To maintain a successful medical malpractice case, it will be necessary for the victim to prove that the doctor, nurse, or other healthcare provider who cared for you deviated from the accepted standards of medical care for his or her profession; in other words, that the doctor or other provider was negligent and/or careless. You must also prove that the doctor's negligence caused your resulting harm. Because the doctor did not give you the disease and your claim involves the delay in diagnosing your condition in a timely fashion, proving "causation" is usually the more difficult aspect of your case. The result of the negligent delay can be proven by showing the progression of the disease from one earlier stage to the next, and comparing the treatments necessary at each stage with the statistical survival rates from one stage to another. The damage claim you make is one that revolves around your "increased risks".
Your lawyer should hire medical experts in the same field as the physician or nurse involved in the care; these experts can offer opinions to a reasonable degree of certainty (the legal standard that applies to these types of cases) that the care was "substandard." Thus, for example, cancer specialists can give opinions regarding the harm caused by the diagnostic delay. Most of the trial time in this type of case is taken up with the testimony by the competing experts for the person suing and the person being sued, with a jury determining the outcome.
You will need all of your medical records. These must include the records of the doctor or other healthcare professionals who misdiagnosed your condition, as well as the records of the physicians who ultimately diagnosed your condition and provided you with care. Those records should be reviewed by an experienced medical malpractice lawyer, and experts who can opine about the quality of the care and the effect the substandard care had on your treatment and your chances of survival.
Doctors, hospitals and other healthcare providers aggressively defend against medical malpractice or medical negligence cases, and many of these cases do not settle and go to trial. You can expect that it will take a few years before your case is listed for trial. During that time, you will be asked to answer written questions regarding your personal history, your medical care, your work and family history, other lawsuits you may have been involved in, and other questions. You will be asked to sit for a deposition where you will be asked questions by the defendants' lawyers, and your testimony will be transcribed and/or recorded on videotape. There will be meetings with your attorney to prepare you for your deposition and for court. Photographs or videotapes of you, your treatment, and its effects may be necessary. You can expect that your family and significant others may be questioned as well.
A medical malpractice or medical negligence case is a civil action for money compensation. It is not a criminal case and does not typically involve punishment for wrongdoing. A money award to compensate for your harm is the only outcome of such a case. Neither the doctor's license nor his ability to practice is affected. Any settlement or verdict against a physician is, however, a reportable event under the National Practitioners Data Bank. While not open to the public, this data bank can be accessed by hospitals and health care providers when reviewing a physician's application for privileges or hire, and does remain on the physician's record.
You should consult an attorney who handles medical malpractice cases in the state where you received the negligent care. Because these cases require special expertise and experience, you should make sure you locate an attorney with the necessary experience in this area of the law. You will need to gather copies of your medical records so that they may be reviewed by expert physicians to determine if there was substandard care that caused you harm, and you must act quickly because there are statutes of limitations, which limit the time within Free Content Articles Distribution Directory and Search Engine for Ezines and Websites http://www.isnare.com/print.php?aid=381671[1/13/2010 5:26:50 PM] which you can make a legal claim (in many states, such as Pennsylvania, the statute is two years; in some it is only one year). Make sure you document your "damages" by keeping a record of your treatments and taking photographs of yourself in the hospital and at home following surgery, radiation, or chemotherapy treatments.
This handy Pennsylvania medical malpractice tip is provided by the Philadelphia medical malpractice law firm, The Law Offices of Judy Greenwood, P.C., at 1800 JFK Boulevard, Suite 1500A, Philadelphia, PA 19103, www.greenwoodlawoffice.com, email Ju***********@*ol.com.
About the author: Philadelphia medical malpractice attorney Judy Greenwood represents victims of medical negligence and catastrophic injuries with a concentration in medical negligence cases, and is located at 1800 JFK Blvd., Suite 1500A, Phila., PA 19103, http://www.greenwoodlawoffice.com, email Ju***********@*ol.com.
Article Source: www.isnare.com
If you are injured when receiving treatment in a hospital, can you sue the hospital for negligence or medical malpractice? Though hospitals are often on the hook for incompetent care provided by employees like paramedics, nurses, and medical technicians, they often are not responsible for a doctor’s medical malpractice.
Here’s a primer on when a hospital is, and is not, responsible for medical malpractice committed by its employees and staff doctors.
If someone is an employee of a hospital, the hospital is responsible (liable) if that employee hurts a patient by acting incompetently. In other words, if the employee is negligent (is not reasonably cautious when treating or dealing with a patient), the hospital is on the hook for any resulting injuries to the patient. (Keep in mind that not every mistake or unfortunate event that happens in a hospital rises to the level of negligence. )
Typically, nurses, medical technicians, and paramedics are hospital employees. As long as the employee was doing something job related when he or she injured the patient, the patient can sue the hospital. For example, if a paramedic employed by the hospital injects the wrong solution into the patient on the way to the hospital, particularly if the medical situation is not life threatening, then the hospital is liable for the paramedic’s mistake.
However, if a doctor makes a mistake and injures a patient while working in the hospital, the hospital will not be liable for the doctor's mistake unless the doctor is an employee (which is unlikely -- see below).
Also, if a hospital employee commits malpractice while under a doctor’s supervision, the patient can sue the doctor, but the hospital may be off the hook. Whether an employee is under the supervision of the doctor when the misdeed occurs depends on:
For example, a surgeon may be liable if an attending nurse miscounts the surgical sponges, leading the surgeon to leave a sponge in the patient.
Whether a doctor is a hospital employee depends on the nature of his or her relationship with the hospital. Though some doctors are hospital employees, most doctors are not. Non-employee doctors are independent contractors, which means that the hospital cannot be held responsible for the doctor’s medical malpractice, even if the malpractice happened in the hospital.
A doctor is more likely to be an employee (rather than an independent contractor) if:
Even if a hospital would generally not be liable for an independent contractor doctor's malpractice, a hospital may be held responsible in certain situations.Hospital Appeared to be the Doctor’s Employer
If the hospital does not make it clear to a patient that the doctor is not an employee, the patient can sue the hospital for the doctor’s malpractice. Hospitals attempt to avoid this problem by informing patients in the admission forms that the doctor is not a hospital employee.
The situation is different for patients injured in an emergency room. Usually, the hospital does not have an opportunity to inform emergency room patients that a doctor is not an employee. This means that ER patients can often sue the hospital for a doctor’s medical malpractice. There are also a few states that say a hospital can be sued for emergency room malpractice regardless of what the patient believed or was told.
A number of states hold the hospital responsible if it gives staff privileges to an incompetent or dangerous doctor, even if the doctor is an independent contractor. The hospital is also responsible if it should have known that a previously safe doctor had become incompetent or dangerous. For example, if a doctor becomes severely addicted to drugs and the hospital management knew about it, or it was so obvious they should have known about it, a patient injured by that doctor can sue the hospital.
Doctors must fully inform their patients about the risks involved in any proposed medical procedure or treatment. In both medical and legal terminology, this is called “informed consent.” If a doctor does not get informed consent from a patient, and the patient is injured, the patient may have grounds to sue the doctor for medical malpractice.
Here are the details of what constitutes informed consent, when it is required, and what exceptions can be made.
Most medical procedures or treatments involve some risk. It is the doctor’s responsibility to give the patient information about a particular treatment or procedure so the patient can decide whether to undergo the treatment, procedure, or test. This process of providing essential information to the patient and getting the patient’s agreement to a certain medical procedure or treatment is called informed consent.
Doctors typically require patients to sign a consent form detailing the risks of any given treatment or procedure. But signing a form alone does not necessarily prove that the patient gave informed consent. The doctor must actually discuss the procedure and risks with the patient. And the patient must understand, to the extent possible, the risks he or she faces.
Whether or not a patient gave his or her informed consent to a treatment is crucial in the law of medical malpractice. If a doctor does not get a patient’s informed consent, and the patient would not have opted for the treatment if he or she knew about the risks, the patient may be able to sue the doctor for medical malpractice.
A doctor doesn’t have to tell a patient about every possible thing that might happen as a result of a procedure or treatment, but only those risks that are important. But what is considered important? For the most part, states use one of two standards to determine this.
In states that use this first standard, an injured patient who is suing a doctor must hire a medical expert to testify that other competent doctors would have informed the patient of this risk. The doctor being sued will also hire an expert to testify that a competent doctor would not necessarily have disclosed the risk to the patient.
In the end, the crux of the argument is usually over whether the risk was statistically likely enough to make disclosure worthwhile. Simply because a particular bad result is a remote possibility does not mean it must be disclosed -- even if that bad result comes to pass.
In states using this second standard, courts ask whether a normal patient, with the same medical history and conditions as the plaintiff, would have changed his or her mind about the treatment if the risk was disclosed. Unlike states following the first standard, a doctor must also inform a patient of realistic alternative treatments, even if the doctor only recommends one treatment.
Medical expert testimony is not always required in states following this rule. But if the medical facts are complicated, an injured plaintiff might want to use an expert anyway.
There are several exceptions to the informed consent rule:
Emergencies. In an emergency, there is no time to describe the risks involved and a physician must act quickly to save a life. A patient cannot sue for lack of informed consent in this situation, even if he or she would not have allowed the treatment.
Emotionally fragile patients. If a doctor knows that the patient is so distressed that he or she will refuse needed treatment, the doctor may not be required to get the patient’s informed consent. For example, if a brain tumor is life threatening, but removal entails frightening risks like paralysis, it may be appropriate for the doctor to be vague in her description of the risks.
Also, if disclosing too much detail about a necessary procedure may make an already frail patient sick with anxiety, the doctor may be able to withhold some information. A doctor may decide how much to disclose based on the particularities of each patient, but he or she must be able to demonstrate a clear reason why the risks were not disclosed.
If the doctor performs procedure B after the patient has given informed consent for procedure A, the patient can sue the doctor based on lack of informed consent. This is true even if the procedure was successful. For example, if a doctor operates on the left leg to remove a growth that is on the right leg, the patient may be able to sue for, among other things, lack of informed consent.
A patient only has a claim, however, if the additional or different procedure was a mistake or clearly not necessary.
If a doctor fixes a serious medical problem that she finds while in the middle of another procedure, the patient probably does not have a claim for lack of informed consent. For example, if a patient consents to an operation in which the doctor will fix a heart valve, and in the midst of the operation the doctor finds another serious medical problem with the patient’s heart, the doctor can go ahead and fix the second problem without getting separate informed consent from the patient.
A patient injured by medical malpractice can recover a wide variety of damages -- from medical bills to the loss of enjoyment of life to future earnings losses. If the medical malpractice results in the patient’s death, the patient’s family and heirs can also recover damages.
This article covers the types of damages that patients and their families can recover in medical malpractice lawsuits, as well as some of the limits that states impose on the amounts that can be recovered.
To get a damage award, the patient must show that:
The three categories of damages available in medical malpractice cases are general, special, and punitive.
General damages. General damages refer to the patient’s cost of suffering that, although real, cannot by its nature have a definite price. The most common examples are:
Every case is different and there are no clear rules about how the exact amount of damages is determined. To arrive at a dollar value, the patient and others will give evidence about the patient’s pain and suffering, loss of enjoyment, and so on. An expert might testify (give evidence) about the usual consequences of the patient’s injury. If the patient is relatively young and will be impaired long term, expert testimony about how to estimate the value of lost earning capacity may be necessary.
Keep in mind that general damages aren’t available for an injury existing before the malpractice, or the pain and suffering that a pre-malpractice injury, by itself, will cause in the future.
Special damages. Special damages cover the more quantifiable expenses caused by the medical malpractice, including medical bills and past missed work. Although there is often some guesswork involved, particularly when it comes to future medical expenses, special damages are typically more exact than general damages. An expert may still be useful, but in some states simply submitting a certified copy of the medical bill is good enough, depending on the facts of the case.
Punitive damages. In some circumstances, the patient may be able to recover punitive damages. The rules on when a patient may get punitive damages vary from state to state, but the general requirement is this: The doctor must have known that he or she was behaving in a harmful manner.
Example: A doctor intentionally leaves a sponge in the patient during surgery in order to create a reason for a second surgery to remove the sponge. This behavior would warrant punitive damages.
The exact amount of punitive damages is up to the judge or jury, but typically cannot be more than several times the amount of the special and general damages.
Many states place a cap on the maximum amount of damages the patient can recover. Some states put a cap on all damages combined, saying a patient cannot recover more than, for example, $500,000. Others have a cap on general damages but not special damages.
Many states also have rules that reduce the damages the doctor must pay by the amount the injured patient received from other sources like insurance. Finally, many states also have statutes that limit the amount the patient’s attorney can charge for a malpractice case.
All states have laws determining what damages can be recovered if the medical malpractice results in the patient’s death. These are called survival statutes and wrongful death statutes.
Survival statutes. Survival statutes allow the deceased patient’s heirs or estate to recover damages that occurred during the time period from the initial medical malpractice to the death of the patient. These damages generally include everything allowed in a malpractice suit had the patient survived, except for damages relating to the future, like earning capacity. Some survival statutes also provide for recovery of funeral expenses, although this is usually part of the wrongful death statute.
Wrongful death statutes. Wrongful death statutes are designed to compensate the patient’s family for their future monetary loss. The calculation is more thorough than a simple projection of future salary -- it also considers factors like the patient’s spending, saving, and working habits. Compensation for the family’s loss of companionship or emotional harm is typically not allowed under the wrongful death statues, although recently some states have allowed that kind of recovery. Depending on the state, not all family members can recover. For example, a state may allow the patient's spouse and children to recover damages, but not the patient’s parents (at least in the case of an adult patient).
Medical malpractice occurs when a patient is harmed by a doctor (or other medical professional) who fails to competently perform his or her medical duties. The rules about medical malpractice -- from when you must bring your lawsuit to whether you must notify the doctor ahead of time -- vary from state to state. But there are some general principals and broad categories of rules that apply to most medical malpractice cases. Here’s an overview of the law and some of these special rules.
To prove that medical malpractice occurred, you must be able to show all of these things:
A doctor-patient relationship existed. You must show that you had a physician-patient relationship with the doctor you are suing -- this means you hired the doctor and the doctor agreed to be hired. For example, you can't sue a doctor you overheard giving advice at a cocktail party. If a doctor began seeing you and treating you, it is easy to prove a physician-patient relationship existed. Questions of whether or not the relationship exists most frequently arise where a consulting physician did not treat you directly.
The doctor was negligent. Just because you are unhappy with your treatment or results does not mean the doctor is liable for medical malpractice. The doctor must have been negligent -- not reasonably skillful and careful -- in your diagnosis or treatment. To sue for malpractice, you must be able to show that the doctor caused you harm in a way that a competent doctor, under the same circumstances, would not have. The doctor’s care is not required to be the best possible, but simply “reasonably skillful and careful.” Whether the doctor was reasonably skillful and careful is often at the heart of a medical malpractice claim. Almost all states require that the patient present a medical expert to discuss what standards of treatment are considered to be reasonably skillful and careful in a particular case.
The doctor’s negligence caused the injury. Because many malpractice cases involve patients that were already sick or injured, there is often a question of whether what the doctor did, negligent or not, actually caused the harm. For example, if a patient dies after treatment for lung cancer, and the doctor did do something negligent, it could be hard to prove that the doctor's negligence caused the death rather than the cancer. The patient must show that it is “more likely than not” that the doctor’s incompetence directly caused the injury. Usually, the patient must have a medical expert testify that the doctor's negligence caused the injury.
The injury led to specific damages . Even if it is clear that the doctor performed below the expected standards in his or her field, the patient can't sue for malpractice if the patient didn't suffer any harm. Here are examples of the types of harm patients can sue for:
A wide variety of situations can lead to a medical malpractice claim -- from a doctor leaving a sponge in a patient’s stomach during an operation to failing to tell a patient that a prescribed drug might cause heart failure. Most medical malpractice claims fall into one of these categories:
Failure to diagnose. If a competent doctor would have discovered the patient’s illness or made a different diagnosis, which in turn would have led to a better outcome than the one actually achieved, then the patient may have a viable medical malpractice claim.
Improper treatment. If a doctor treats the patient in a way that no other competent doctor would, the patient could have a medical malpractice claim. In a similar vein, it may also be malpractice if the doctor selects the appropriate treatment but administers it incompetently.
Failure to warn a patient of known risks. Doctors have a duty to warn patients of known risks of a procedure or course of treatment -- this is known as the duty of informed consent. If a patient, once properly informed of possible risks, would have elected not to go through with the procedure, the doctor may be liable for medical malpractice if the patient is injured by the procedure (in a way that the doctor should have warned could happen).
Many states have special rules and procedures for medical malpractice claims. It is important to know about these rules and follow them carefully.
Medical malpractice cases must be brought soon after the injury. In most states, you must bring a medical malpractice claim fairly quickly -- often between six months and two years, depending on the state. (The time period in which you must bring the lawsuit is called the “statute of limitations.”) If you don’t file the lawsuit within the specified period of time, the court will dismiss the case regardless of the facts.
When the time period starts ticking also depends on the state. In some states, the clock starts when the negligent act occurred; in others, it starts when the patient should have discovered the injury.
Special medical malpractice review panels. Many states require the patient to first submit the claim to a malpractice review panel. This panel of experts will hear arguments, review evidence and expert testimony, and then decide whether malpractice has occurred. The panel decision does not replace an actual medical malpractice lawsuit, and the panel cannot award damages, but it's a hoop the patient must jump through before getting to court. The findings of the review panel can be presented in court, and courts often rely on a review panel's finding of no medical malpractice to throw out a case before it goes to trial.
Special notice requirements. Some states require that the patient give the doctor notice of the malpractice claim, in the form of a basic description, before filing anything.
Expert testimony is required. Expert opinions are often a crucial feature of the patient’s case. A qualified expert is usually required at trial. (And often, expert testimony or an expert affidavit is required at the malpractice review panel proceedings prior to commencing trial.) State rules vary as to what makes somebody qualified to provide expert medical testimony, but generally it is someone with experience in the particular field at issue. In a very limited number of circumstances, expert testimony is not required, such as when a surgical towel is left inside the patient after a surgery.
Limits on damage awards. Many states cap the amount of money that can be awarded to a medical malpractice patient.
There are several conditions that mothers may develop during their pregnancy, all of which can adversely affect the health and well being of the mother or her baby if left undiagnosed and not properly treated. One of these conditions is called “pre-eclampsia” or “pregnancy induced high blood pressure or hypertension.” This condition, which has been said to affect between 5 to 8 percent of all pregnancies (by some authorities), if unrecognized and untreated, can result in serious consequences.
The signs that are classically associated with pregnancy induced hypertension, or pre-eclampsia, are (1) high blood pressure and (2) protein in the urine. Other symptoms may include (1) scotoma or visual issues, (2) reduced urine output, (3) nausea, (4) vomiting, (5) abdominal pain, or (5) headache. The presentations by the patients to the doctors vary, and some women may only have a very few of these symptoms. Atypical presentations may be more difficult to diagnose and can require an experienced physician’s review. Once diagnosed, the treatment for pre-eclampsia may include delivery of the baby and/or medication with magnesium sulfate.
While treatment for this condition reduces the risk of an adverse outcome, if left untreated, pre-eclampsia can result in the mother having a seizure, a condition commonly referred to as eclampsia. Pre-eclampsia can also place the mother at risk for stroke, impaired kidney or liver function, fluid on the lungs and even death. Because of its effect on the placenta and its blood flow, pre-eclampsia may impact the health of the baby as well as the mother. It can result in a premature delivery, cause a lack of oxygen to the baby’s brain, or result in the infant’s death.
Proper pre-natal care can prevent this condition from having devastating consequences. Pre-natal visits should include a blood pressure check and a urine test to see if there is evidence of protein. If pre-eclampsia develops late in the pregnancy the baby can be delivered thereby controlling the pregnancy induced high blood pressure. If pre-eclampsia develops early in the pregnancy, the mother may be placed on bed rest while efforts are made to reduce the mother’s blood pressure through other means.
While pre-eclampsia will often develop gradually it can, in some cases, appear suddenly. While usually appearing during the third trimester of the pregnancy, it can develop earlier in the pregnancy and in some cases in the hours after delivery.
The failure to appreciate the signs of this condition in the patient, and to act to protect the mother and baby from its potentially devastating effects may constitute negligent care/medical malpractice. Physicians, residents, obstetrical nursing staff, and all others who provide care to the pregnant mother should be vigilant in monitoring for both the subtle and not so subtle signs of this disease and be prepared to take swift action.
If you or someone close to you has suffered an eclamptic seizure or had a child who was born with problems that may be related to pre-eclampsia, you may want to have the medical records of your care reviewed by an attorney who specializes in medical negligence and/or birth injury cases. These attorneys are familiar with the symptoms, proper care, and work with experts, including physicians, who can help evaluate whether the patient received sub-standard care or the medical provider committed malpractice.
About the author: Philadelphia medical malpractice attorneys Judy Greenwood & Stephen Ulan have represented victims of medical negligence and catastrophic injuries for 25 years. Their office is located at 1800 JFK Blvd., Suite 1500A, Phila., PA 19103, http://www.greenwoodlawoffice.com, email Ju***********@*ol.com.
Article Source: www.isnare.com
Until you have been involved in a medical negligence suit, you probably will not appreciate how time consuming, expensive, and difficult they usually are. This is intended only as the most general overview of what these suits entail and is based generally on the laws and procedures in Pennsylvania, where the authors practice law.
In Part I, we discussed pre-suit matters and pleadings. In Part II, we discussed discovery and trial. In this, the final Part, we will discuss post-trial matters.
Post trial proceedings
After trial, the parties are allowed to file various motions challenging the result on legal grounds, in other words, that there has been some legal error during trial. These are called post-trial motions, and if they are not filed, then a party is generally prevented from filing an appeal. It is most unusual for a motion challenging the factual findings of the judge or jury to be granted unless there is simply no evidence to support the factual basis of the verdict.
There may also be a motion necessary to add interest to the verdict if plaintiff has prevailed. This interest, sometimes called delay damages, is calculated in Pennsylvania based upon Rule of Civil Procedure 238.
Only after final decision of all such motions may a party displeased with the result file an appeal to the next level of court. Those appeals do not retry the facts of the case, but are based upon legal issues some of those issues may contest the admissibility of certain evidence, but almost never successfully challenge a jury’s finding if based upon admissible evidence. It is not the role of the court, either appellate or trial court, to substitute its evaluation of the evidence for that of the jury so long as there is some admissible evidence upon which the jury relied. As a result, challenges that only question the evidence, rather than legal issues relating to the evidence, are generally unsuccessful.
And finally, usually years after the litigation process began, itself usually one to two years after the injury was suffered, the case is over. Of course, with appeals, cases can take a very long time. In Philadelphia County, it can take two years after a case is filed for a medical malpractice case to go to trial. If there is an appeal, that can take one or more years. If the appeal is successful, there may be a new trial, etc.
Keep in mind this is a very general overview. Each jurisdiction has its own body of court rules dictating procedures, and its own body of statutes and court decisions controlling the substance of medical malpractice law. This article is based on Pennsylvania procedures (generally), in particular, Philadelphia County Because of this, what is permissible procedure in one state may not be in another. What is good law some places may not apply elsewhere. Some states put a cap on pain and suffering damages and others do not. Some states recognize certain liability theories that others do not. Because of this, it is most important that parties be represented only by attorneys with experience in this field of law in the locale in which it is to be tried.
About the author: Philadelphia medical malpractice attorneys Judy Greenwood & Stephen Ulan have represented victims of medical negligence and catastrophic injuries for 25 years. Their office is located at 1800 JFK Blvd., Suite 1500A, Phila., PA 19103, http://www.greenwoodlawoffice.com, email Ju***********@*ol.com.
Article Source: www.isnare.com
Stroke in the United States
There are 795,000 new or recurrent strokes per year in the United States. Stroke is the fourth leading cause of death in this country. Stroke occurs when the flow of blood carrying oxygen and nutrients to healthy brain cells is disrupted, due either to a vessel bleed or a blockage within the blood vessel. If the blood supply is not quickly restored it would lead to death of the brain cells (an infarction) that are supplied by the affected vessels.
Ischemic and Hemorrhagic
Strokes The two major types of stroke are identified as hemorrhagic (due to a bleed), and ischemic (due to a blockage). The large majority of strokes are due to ischemia resulting from a blockage in the vessel and can be treated by dissolving or removing the blood clot or thrombus and restoring blood flow. Time is of the essence when relieving the blockage, which is why stroke centers coined the phrase “time is brain” when referring to stroke treatment. Most legal cases arise when the stroke is not promptly diagnosed or treated in the emergency room, costing the patient a significant opportunity for a good outcome. If one can relieve the blockage before permanent damage occurs, significant disability can be avoided.
Treatment of Ischemic Strokes
The standard treatment to relieve a clot or a thrombus is the administration of a “clot-busting drug” known as tissue plasminogen activator or “tPA” which can be administered intravenously for 3 to up to 4.5 hours after symptom onset. If the patient arrives to the emergency room more than 3 to 4.5 hours after symptom onset, there may be advanced treatment options that are available to dissolve and/or remove the clot including: 1) The administration of the clot busting drug “tPA” through a catheter directly to the clot; 2) The use of mechanical devices to remove the clot; or 3) A combination of these treatment approaches. The accepted time windows for these advanced treatment options range from 6-8 to up to 24 hours after symptom onset, depending on the location of the blockage and other factors. With all of these treatments, the earlier the treatment is administered, the better the chance of avoiding significant disability.
Treatment of Hemorrhagic
Strokes This type of stroke, accounts for perhaps only fifteen to twenty percent of the strokes, but can be similarly devastating as brain tissue is deprived of blood supply due to the “rupture” of the artery carrying blood to the affected region. Once a rupture occurs, timely diagnosis and emergent intervention by a well trained and experienced neurosurgeon or interventional neuro-radiologist, is needed. At times, depending upon the circumstances, techniques less invasive than open surgery can be successfully used to treat. At times, these strokes are preceded by a complaint of the onset of “the worst headache of my life,” and an expansion of the wall of the artery can be discovered radiologically before rupture allowing, at times, for treatment to be offered before bleeding occurs.
Failure to Treat Signs and Symptoms of Stroke On a Timely Basis
Most medical negligence claims involving stroke revolve around the failure to diagnose and/or treat the signs and symptoms of a stroke on a timely basis. Over the past several years more and more hospitals have applied for certification to become either a “primary” or “comprehensive stroke center”, requiring that the hospital follow the guidelines of the American Heart Association and the American Stroke Association (AHA/ASA) for treating stroke. Failure of a hospital certified as a stroke center and its stroke team to work up and treat its patient in accordance with the AHA/ASA guidelines may form the basis for a claim of negligence and the breach of standards. Even at hospitals that are not certified as stroke centers, certain standards must be met in recognizing the signs and symptoms of stroke and acting promptly to work up and either treat the eligible patient or arrange for transfer to another hospital that can provide the necessary treatment under accepted medical standards. Not only can the doctors involved in the stroke care be held responsible, but the hospital itself can be held to account for its failure in having the necessary facilities, equipment, policies, and staffing in place to assure prompt and proper stroke care. With the availability of telemedicine and interactive video access to specialists at “comprehensive” centers capable of providing the most advanced stroke treatments, there is little basis for failing to offer patients potentially life-altering stroke care to eligible patients at least by transfer to another hospital.
Proving a Causal Connection in the Stroke Case
As with all medical negligence cases, proving substandard or negligent care is only half of the battle. What must also be proved in each malpractice case is the causal connection between the claimed negligence and the harm. It is the person bringing the case who must prove this causal connection in each case. Where the underlying condition (that is, the clot or blockage which precipitated the stroke) pre-exists the negligent care, one must show that proper diagnosis and timely treatment would likely have resulted in a significantly better result. Given the risks associated with treatment, and the fact that treatment will result in a good outcome in only a certain percentage of cases, establishing the likelihood of a good or significantly better outcome from what is a serious medical condition is the most difficult part of proving the stroke case in court. As treatment methods for relieving clots or blockages improve and the success rates from treatment become higher, the ability to establish the causal connection may become easier in the future.
Case Evaluation
Whether you do or do not have a good medical negligence case is very fact specific and requires a thorough evaluation by an experienced medical negligence attorney in consultation with experts in stroke care after a review of the medical records. Only then can you know if there is a strong enough basis for proceeding with such a claim. Visit the American Stroke Association website at www.strokeassociation.org.
There is nothing more devastating than having a child born with a hypoxic brain injury. The mere fact that your child has a devastating injury or defect does not, however, mean that a doctor or nurse did something wrong. Separating the instances of unpreventable, unfortunate outcomes from true medical malpractice typically requires the assistance of an experienced birth injury lawyer. Most lawyers, once provided with the medical records, will undertake to evaluate your circumstance at no charge to you, and with the help of medical consultants will determine whether there is a provable claim. In Part I of this article, we we will discuss the information needed to evaluate a medical malpractice binrth injury claim.
a. Mother’s Prenatal Records Before the Birth of the Baby
Typically, the mothers have had prenatal care, and have been seen by an OB/GYN, either privately or through a clinic, and have had ultrasounds or other imaging performed during their pregnancy. These records must be reviewed and analyzed for signs of problems during the pregnancy that may not have been properly addressed, or for evidence of a genetic condition which may have caused the poor outcome. Whether you have been properly screened for gestational diabetes, pre-eclampsia (high blood pressure associated with pregnancies) or other conditions which might have affected the birth will be apparent in the prenatal record. These records will also identify the baby’s due date and whether the baby was overdue or pre-mature.
b. Mother’s Hospital Records
Hospital records of the labor and delivery will document when the doctors and nurses saw you and what they did to evaluate your baby immediately before and during the delivery. These records will show your status as well as the baby’s during the course of your labor. Whether your labor was progressing normally or abnormally, whether the baby was descending at an acceptable rate, whether there were signs that the baby was having difficulty getting through the birth canal, whether the power or frequency of the contractions were appropriate and whether medications such as Pitocin were being properly given, are issues to be reviewed in these records.
c. Electronic Fetal Heart Tracings
Typically, you and your baby will have been monitored through an electronic fetal heart monitor which records the baby’s heart rate, your contractions and vital signs. The electronic fetal monitor is intended to serve as an early warning system for potential problems with you or your baby. An expert can review these tracings to determine if there were signs of potential problems which went undetected and/or unresolved. The monitor tracings may reveal whether your contractions were occurring too close together, whether the baby was exhibiting signs of fetal distress and the extent to which nurses or physicians involved in the care were properly monitoring you and your baby and responding to any signs of danger. A hard copy of these monitoring strips are typically maintained by the hospital with the medical chart, and may contain hand written notations by the nursing staff with regard to what, if anything, was being done. These tracings can be the most significant evidence of negligence in a legal case.
d. The Baby’s Records
The baby’s records will document the baby’s APGAR scores which assess the status of the baby at one and five minutes after birth, as well as the pH and oxygenation levels of the baby’s blood. They will reveal when and if your baby suffered seizures consistent with a hypoxic injury, during the post-partum period.
e. Imaging Studies
Ultrasounds, CT scans, and MRIs of the baby’s brain taken after the birth may reveal the presence of an anoxic brain injury and whether the damage was an acute event. These studies may provide a basis for determining the window of time within which your baby’s injury occurred. Pediatric neurologists are typically consulted to review these studies.
CONCLUSION
Proving malpractice as a cause of a birth defect or injury is a difficult matter. The process of evaluating whether or not negligence occurred can be a long one. A thorough analysis of the records by an experienced birth injury lawyer working with medical experts is necessary to determine whether or not the claim can be proved. While an evaluation may not find that there was negligence, an evaluation by the professionals can at least give you some answers, as to why,the injury occurred.
This handy Pennsylvania medical malpractice tip is provided by the Philadelphia medical malpractice law firm, The Law Offices of Judy Greenwood, P.C., at 1800 JFK Boulevard, Suite 1500A, Philadelphia, PA 19103, www.greenwoodlawoffice.com, email Ju***********@*ol.com.
About the author: Philadelphia medical malpractice attorneys Judy Greenwood & Stephen Ulan have represented victims of medical negligence and catastrophic injuries for 25 years. Their office is located at 1800 JFK Blvd., Suite 1500A, Phila., PA 19103, http://www.greenwoodlawoffice.com, email Ju***********@*ol.com.
Article Source: www.isnare.com
Nothing is more devastating than having a child born with a brain injury. Discovering that the birth injury could have been prevented, or was the result of a doctor’s or hospital’s or other medical provider’s malpractice, however, only compounds the tragedy. In Part I of this article, we discussed the information needed to review a claim; in this article, we will discuss who needs to review the records for a medical malpractice birth injury claim, and other important factors, such as the statute of limitations that applies to these cases.
Typically experts from several medical specialties will be involved to assess the circumstances of the birth. An obstetrician/gynecologist will need to review the records to determine if the obstetrical care was substandard and provide an opinion on this issue. Nursing experts may need to review the records to evaluate whether or not the nurses, who have an independent duty to the patient separate from that of the doctor, complied with nursing standards of care.
A pediatric neurologist and a neuroradiologist will likely be retained to evaluate whether or not negligence caused the baby’s condition to occur. There must be proof of negligence or substandard care and proof that the negligent care caused your baby’s harm. Without proof of a cause and effect relationship between some conduct or misconduct by medical personnel and the condition of the baby, a legal case cannot be proved.
RULING OUT NON-NEGLIGENCE CAUSES
It will be important for the experts to rule out other non-negligent causes for your baby’s injury. Since it is your burden to prove that it was substandard care that caused your child’s problems, the non-negligent causes for his or her condition will have to be discounted and ruled out in order to properly establish the case.
STATUTE OF LIMITATIONS
Each state has different laws which govern how much time you have to bring a claim on behalf of your injured child. You need to check with a local lawyer to find out what the time frame is for pursuing a claim on behalf of a minor in your state. Parents typically have much shorter periods of time to pursue any claims they may have in connection with the birth of an injured child. In some states, minors have until two years past their age of majority to bring a claim creating a long window for investigating and pursuing a case on behalf of your minor child.
DAMAGES
The damages to your child can be catastrophic, impacting upon all aspects of his/her life. Life care planners will serve to evaluate your child’s long term needs and what the cost of that care will be over your child’s lifetime as part of an assessment of what the damages are that have resulted from the negligence. The non-economic damages of disability, physical pain and suffering, and loss of life’s pleasures are items that will need to be demonstrated through expert testimony, and are typically left to be quantified by a jury if negligence is proved.
CONCLUSION
It is never easy to prove that a doctor’s medical malpractice was the cause of a birth defect or injury. In addition, the process that medical malpractice attorneys use to evaluate these types of negligence cases can be time-consuming. However, without a thorough analysis of the records by an experienced birth injury lawyer, malpractice may be overlooked. That is why attorneys who handle medical negligence cases work with medical experts to verify whether or not the claim can be proved.
While an evaluation does not always determine that the doctor or hospital or other medical provided negligent, the conclusions reached may provide some answers why the injury occurred.
About the author: Philadelphia medical malpractice attorneys Judy Greenwood & Stephen Ulan have represented victims of medical negligence and catastrophic injuries for 25 years. Their office is located at 1800 JFK Blvd., Suite 1500A, Phila., PA 19103, http://www.greenwoodlawoffice.com, email Ju***********@*ol.com.
Article Source: www.isnare.com
When people think of skin cancers, they do not think of a condition that can be devastating or result in death. However, these cancers include conditions that if not properly and promptly diagnosed and treated can result in death. There are two general categories of skin cancers; melanomas and non-melanomas.
The most common types of non-melanoma skin cancers include basal cell carcinoma and squamous cell carcinoma. Basal cell cancer is perhaps the most commonly occurring type of skin cancer, and tends to grow more slowly and have a smaller chance of spreading to other
areas of the body. Basal cell cancers develop from the basal membrane of the skin. Squamous cell cancer usually develop from the outer layer of the skin. This type of skin cancer is more likely to grow into the deeper layers of the skin than basal cell cancers and has a greater capacity for spread than the basal cell lesion.
A separate category of skin cancer is the melanoma. Melanomas develop from the pigment making cells of the skin, and can arise in moles found on the skin. Unlike squamous and basal cell cancers, melanomas have a much greater capacity to spread to other parts of the body and are generally considered far more dangerous because of that tendency.
Each of these skin cancers is, however, curable in the early stages of the disease. Early detection is key to a good outcome regardless of the type of skin cancer. Moles, blemishes, or birthmarks that change in size, shape, or color or a new skin growth that did not appear before should be treated with suspicion and seen by a physician. Diagnosis of skin cancer is made by taking a biopsy of the skin lesion and having it examined under the microscope to see if it contains cancer cells and to identify the type of cancer cells present.
It is the failure to perform a biopsy, the misreading of the pathology specimen or the pathology report, and/or the failure to adequately treat and/or remove the cancer once diagnosed that will most often form the basis of a legal claim. The failure to inform the patient of the risks of the condition or the failure to take appropriate steps to ensure ongoing surveillance may also form the basis for a claim, under the right circumstances. Most often the claim is made against the dermatologist for his or her failing to perform the necessary work-up; for failing to properly communicate the results of a biopsy; for failing to fully remove a skin cancer; or failing to closely monitor the patient following the detection of a cancer. Because these cancers have signs that can be visible on the skin, once a law suit is instituted the patient is often blamed for failing to see a doctor earlier, or for failing to follow recommendations for skin surveillance or follow up care. The contemporaneous medical record often serves as the key to resolving factual disputes about what the physician did or did not do and/or what the patient was or was not told.
It is the person who is bringing the claim who has the burden of proving that the physician departed from accepted standards of medical care, and was medically negligent in the treatment provided. In most states proving medical negligence requires analysis and opinion by another medical expert in the same or similar field of practice as the physician involved. Once medical negligence is established, there must then be proof that the failure to provide proper or timely care resulted in or was a substantial contributing cause of the harm. Proving that the physician’s conduct or failure to act was a factual cause of the spread of the disease and/or resulted in the harm is a key aspect of proving any claim of medical negligence.
It is important to recognize that every case of a failure to diagnose or treat a skin cancer is different. Whether or not you have a provable legal case is dependent upon the specific facts. Each potential case requires a thorough analysis of what happened and whether that constitutes substandard care, as well as proof that the medical negligence caused significant harm. An evaluation of the facts is best performed by a lawyer experienced in medical malpractice cases, acting in concert with medical experts in the field.
Judy Greenwood and Stephen Ulan practice personal injury law with a concentration in medical malpractice cases in Pennsylvania at the Law Offices of Judy Greenwood, P.C., 1800 JFK Boulevard, Suite 1500A, Philadelphia PA. Their website is www.greenwoodlawoffice.com.
Until you have been involved in a medical negligence suit, you probably will not appreciate how time consuming, expensive, and difficult they usually are. This article is intended only as the most general overview of what these suits entail.
Pre-suit
First of all, one must have suffered significant harm (either a direct measurable harm or, in many states, an increased risk of harm or a loss of chance of recovery) as a result of substandard medical care. A claim of provable negligence or carelessness without harm or harm without a negligent cause both will lead nowhere. Further, even with negligence and related harm, in light of the expense and risk inherent in these suits, the damages must be substantial. No attorney will willingly risk $50,000 or more in advanced costs, a fairly typical investment in mostly expert fees and deposition expenses, and perhaps hundreds of work hours, if the predicted recovery will not be sufficient to carry these costs and fairly compensate the injured client. An attorney with experience in this field, before committing to litigate, will broadly and deeply investigate the claim and damages with the assistance of medical experts. To do less is to do a disservice to the client by getting him or her involved in a suit with little chance of success and exposing the client to what for many is an emotional roller coaster ride.
Commencement of suit
Once that threshold is met, suit is commenced with the papers mandated by the jurisdiction in which it is brought. In many, if not most, locations the plaintiff is required early in the life of the litigation to file of record some sort of documentation attesting that the matter has been reviewed by competent physician expert(s) who believes that based upon the information available, there was negligence which caused harm. The failure to file this document, where required, may lead to the suit being thrown out of court. While this device may eliminate many of the suits that defendants label “frivolous,” it also makes it incredibly difficult to pursue claims based upon faulty or absent hospital policies or oversight when the documentation needed to prove such claims, and support the certificate of merit, cannot be obtained in advance of suit so that a certificate may be filed. Such matters usually will not be revealed in the patient’s medical records, typically the only documents a patient can obtain pre-suit.
Pleading
Next in the “pleading” stage is the defendant’s response to the complaint. Depending upon the jurisdiction, the defendant might be able to attack the complaint on legal grounds such as not being sufficiently factually specific, improper form, or even that the allegations, even if true, fail to make out a recognized claim of malpractice. Alternatively, the defendant may directly answer the complaint with direct responses to what plaintiff has alleged and further, stating affirmative defenses (like, for instance, someone else, or even plaintiff, was responsible for the harm alleged, or too much time has passed since the occurrence in violation of the statute of limitations), The plaintiff, or course, may then reply to the affirmative defenses stated by the defendant. In some situations, the defendant, when blaming another party not yet involved in the lawsuit, will join new parties who then have the right to file pleadings such as an answer. The pleadings set limits on the theories of liability that may be asserted at trial, and the theories of defense which may be used.
In Part II, we will discuss discovery and trial.
Keep in mind this is a very general overview. Each jurisdiction has its own body of court rules dictating procedures, and its own body of statutes and court decisions controlling the substance of medical malpractice law. Because of this, what is permissible procedure in one state may not be in another. What is good law some places may not apply elsewhere. Some states put a cap on pain and suffering damages and others do not. Some states recognize certain liability theories that others do not. Because of this, it is most important that parties be represented only by attorneys with experience in this field of law in the locale in which it is to be tried.
About the author: Philadelphia medical malpractice attorneys Judy Greenwood & Stephen Ulan have represented victims of medical negligence and catastrophic injuries for 25 years. Their office is located at 1800 JFK Blvd., Suite 1500A, Phila., PA 19103, http://www.greenwoodlawoffice.com, email Ju***********@*ol.com.
Article Source: www.isnare.com
Until you have been involved in a medical negligence suit, you probably will not appreciate how time consuming, expensive, and difficult they usually are. This is intended only as the most general overview of what these suits entail and is based generally on the laws and procedures in Pennsylvania, where the authors practice.
In Part I, we discussed pre-suit matters and pleadings.
Discovery
The “discovery” stage is then underway. The three primary discovery (investigatory) methods are requests for documents, interrogatories (written questions requiring written responses under oath), and depositions (oral questions offered by the parties’ attorneys before a court reporter). The first and last are probably the most important. Full and complete records lay the groundwork for a case, and depositions often are not fully prepared for by the deponent and allow best for “truth testing.”
The law recognizes limitations on discovery, and a party, rather than answer, may object, usually claiming either that the requested information is not relevant to the case, or is protected by some privilege. At that point, if the parties cannot reach agreement, and rarely can they, the dispute must go to a judge for resolution. This investigation may make or break a case.
As that portion of discovery winds down, the parties will have to exchange expert information. Some jurisdictions require reports and resumes, and others permit expert depositions. Since the claim relates to medical negligence, the law requires that plaintiff’s case be supported by expert medical testimony in all but an infinitesimally small number of cases. This is because in medical science, only a medical practitioner can establish what was the appropriate care to be provided under the facts of the claim at the time of the events, and only a doctor is trained on the issue of what can be caused by inappropriate care.
Just as the pleadings limit the scope of the case, typically at trial an expert may not wander from the theories of liability or defense that have been set out in the report or deposition. The attempt to insert new liability or defense theories from the witness stand at trial will be shot down upon objections. The opposing party simply will not have had an opportunity to prepare for this in advance and should not be surprised at trial.
Prior to trial it is common for the defense to file a motion for summary judgment setting forth legal reasons that the court should throw out some or all of plaintiff’s case. The court’s approach is to accept as true all factual allegations of the plaintiff so long as they are supported by some evidence adduced during the discovery process, to accept plaintiff’s expert opinions so long as they fall within the scope of that which was pleaded, and then decide if there is no way a jury could find in plaintiff’s favor, or if it is clear that the plaintiff has failed to assert a claim recognized at law. For instance, the evidence made available during discovery may show a named defendant was not responsible for some asserted error, and that defendant would prevail in a motion for summary judgment.
Trial
Trial of a “short” and less complicated medical negligence case will usually take a few days. Very commonly, these case take a week or two in part because often scheduling numerous experts’ testimony is difficult. Plaintiff puts on its evidence and witnesses first. The defense initially has no burden of proof. If plaintiff’s evidence in legally insufficient to make out a case against a particular defendant, upon the close of plaintiff’s case that defendant might be dismissed from the case upon appropriate motion. The defense then puts on its evidence contradicting plaintiff’s version and in support of its own “affirmative” defenses. Once the defendants rest their cases, the plaintiff may introduce rebuttal evidence which is limited to responding to the claims of the affirmative defenses.
The jury (or judge) will have to decide who, if anyone, was negligent, whether the negligence caused any harm and to what degree the negligence of each careless defendant (or careless plaintiff) contributed to the harm, and the amount of damages to be awarded. This certainly is not an easy task as the jury will have to review days and days of testimony, much of it technical medicine and therefore both unfamiliar and at times contradictory, determine which witnesses are telling the truth or have better memory, and what weight to assign to evidence. Where the case involves multiple defendants, this can be very difficult.
Keep in mind this is a very general overview. Each jurisdiction has its own body of court rules dictating procedures, and its own body of statutes and court decisions controlling the substance of medical malpractice law. Because of this, what is permissible procedure in one state may not be in another. What is good law some places may not apply elsewhere. Some states put a cap on pain and suffering damages and others do not. Some states recognize certain liability theories that others do not. Because of this, it is most important that parties be represented only by attorneys with experience in this field of law in the locale in which it is to be tried. Free Content Articles Distribution Directory and Search Engine for Ezines and Websites
About the author: Philadelphia medical malpractice attorneys Judy Greenwood & Stephen Ulan have represented victims of medical negligence and catastrophic injuries for 25 years. Their office is located at 1800 JFK Blvd., Suite 1500A, Phila., PA 19103, http://www.greenwoodlawoffice.com, email Ju***********@*ol.com.
Article Source: www.isnare.com
