Like a bartender who serves a drunk customer: The physician's liability for drug side-effects

David Sacca, 75, was a very sick man, with emphysema, high blood pressure, and metastatic lung cancer. He was taking oxycodone, Zaroxolyn, prednisone, Flomax, potassium, Paxil, oxazepam, and furosemide – some of which can cause drowsiness, dizziness, and fainting.

While driving in Spring 2002, David passed out and drove off the road, hitting and killing a ten-year-old boy, Kevin Coombes, who had been standing on the sidewalk with a friend.

Yesterday the Massachusetts Supreme Judicial Court ruled that David's doctor could be sued for failing to warn his patient about the side effects of the drugs and for failing to warn him of the danger of driving while under the drugs' influence.

In writing the court's lead opinion, Justice Roderick Ireland compared the doctor's liability to that of a bartender who serves a drunk customer.

Almost every drug has side effects. Drowsiness is a common side effect of many prescription drugs. This ruling greatly expands physicians' liability for the prescriptions they write every day.

Advice: Ask your doctor and pharmacist about the likely side effects of your drugs.

Browse for related stories in the index at the very bottom of this page, or read a story of the sad consequences of a different kind of expectable side effect, from Zyprexa.

Thanks to Liz Kowalczyk for the source article in today's Boston Globe.

Its third wrong-site surgery this year: Errors in brain surgery

The Rhode Island Department of Health reprimanded a Rhode Island hospital yesterday, and fined it $50,000, for its third wrong-site surgery this year. Doctors at the hospital had performed four wrong-site surgeries in six years, all involving brain surgery.

An 82-year-old man was in the neurosurgical intensive care unit (ICU) for brain surgery on Friday. A CT scan had shown bleeding on the left side of his brain. A resident (a physician in training) began drilling into the right side of the patient's head. The resident realized the mistake, closed the initial incision, and performed the procedure on the left side.

As a result of the latest incident, all intra-cranial neurosurgical procedures will have an attending physician present for the entire procedure, hospital officials said.

Advice for patients at teaching hospitals: Add and initial a note on your patient consent form that requires a real physician to accompany the resident throughout your surgical procedure.

Browse for related stories in the index at the very bottom of this page, or read another wrong site brain surgery story at the same hospital three months ago.

Thanks to Liz Kowalczyk for the source article in today's Boston Globe.

She walks nicely: Staph infection and payment for hospital errors

Virginia Harvey, age 47, broke two bones in her left ankle while stepping off a curb in Boston in 1996. She required two operations at Brigham and Women's Hospital. After the second surgery, her ankle became infected, in the hospital, she believes.

The staphylococcus infection ate away parts of her ankle and crept up her shin, requiring 26 additional surgeries, 15 of them at the Brigham. Eventually she switched to Beth Israel Deaconess Medical Center in Boston, where surgeons amputated her leg below the knee. The infection has caused other problems, for which she now takes medication.

Virginia testified last week on a bill now being considered by the Massachusetts Legislature (H.2226/S.1277), the Healthcare Transparency bill. She walks nicely, and you wouldn't guess that she wears a prosthetic leg and foot. That belies the suffering she has experienced over the years. In addition to her suffering are the bills: she has paid $18,000 so far out of her own pocket for the prostheses – which she will need to replace as she ages.

Insurance covered most of the cost of her care; the Brigham has not waived any of her bills. Insurers, of course, set their premiums so as to cover their payouts, so all Massachusetts residents are paying for the Brigham’s errors.

The vice president for clinical affairs for the Brigham's parent organization, Partners HealthCare, said he and his colleagues are now developing a policy on when to waive charges. Until then, he added, Partners' executives make decisions on a case-by-case basis.

Nationally, Medicare has recently formed a policy aimed at preventing hospitals from receiving payment for their errors, beginning in October 2008.

Advice to victims of medical error: Ask your state legislators if you can testify on bills to reduce medical errors. Tell your story there, and here.

Read about another patient's experience with a leg staph infection, or read more from Liz Kowalczyk's article in today's Boston Globe.