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According to the Boston Globe, between 2005 and 2010, more than 200 hospital patients died nationally from an improper response to “patient monitors.” Patient monitors are those machines that keep track of heart function, respiratory rate and other vital signs. Typically, nurses are responsible for watching monitors.

“Alarm fatigue,” a phenomenon where nurses become desensitized to frequent monitor beeping and constant false alarms, may contribute to instances of nursing negligence. A study at Johns Hopkins Hospital in Baltimore revealed 942 critical alarms on one floor, in one day. “That’s one alarm every 91 seconds,” said New York hospital negligence lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC, a Syracuse based law firm representing patients injured due to hospital mistakes and errors.

“The alarms become background noise,” Bottar said. In one case, a patient who was wheeled into an intensive care unit and connected to a cardiac heart monitor. The leads slipped off and the machine sounded an alarm, but nursing staff did not respond. The patient stopped breathing and died without anyone noticing. At a different hospital, a patient’s heart monitor displayed a flat line for more than two hours because the battery was low. Even though they were checking on the patient, the nurses did not change the battery. The patient suffered a heart attack without anyone knowing, and died.

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At the forefront of the current New York State budget debate is whether or not non-economic damages in New York medical malpractice lawsuits should be capped at $250,000.00. Non-economic damages are those damages awarded by a jury for pain and suffering and loss of enjoyment of life.

According to hospitals and doctors around the State, medical malpractice lawsuits are universally “frivolous.” In response, we ask New York doctors to comment on what just happened to 2 year old Malyia Jeffers. Specifically, we welcome their thoughts on whether this is a case of emergency room malpractice.

A short time ago, Malyia woke up with a fever. When the fever began to rise and Malyia began to show bruising on her cheeks, her parents rushed her to Sacramento’s Methodist Hospital emergency room. According to a CNN report entitled “Harmed In The Hospital? Should You Sue?”, Malyia sat in the emergency room for nearly five (5) hours before she was examined by a physician. By the time emergency room personnel diagnosed her with sepsis (i.e., a blood infection), it was too late. The infection was advanced and, to save her life, doctors had to amputate her left hand, most of her right hand, and both of her legs. Sepsis is typically treated with intravenous antibiotics. “And time matters,” said Michael A. Bottar, of Bottar Law, PLLC. “It is well known that for every hour of delay in the administration of antibiotic therapy for sepsis, there is an associated 7% rise in mortality.”

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Group B streptococcus (GBS) is a bacteria that can cause life-threatening infections in newborns, as well as disease in a pregnant mother during or after delivery. It affects about 18,000 people every year. “As many as 30% of women carry GBS. It’s usually harmless, unless it finds its way to the bloodstream,” said Michael A. Bottar, Esq., a Syracuse medical malpractice lawyer representing newborns injured by a failure to diagnose group B strep or GBS misdiagnosis.

An OB/GYN should test a pregnant woman for GBS during her third trimester. “That is the standard of care,” Bottar added. “If a woman is found to be ‘colonized,’ then antibiotics should be administered – usually by IV.” Antibiotic treatment for GBS is indicated to prevent transmission of the bacteria from mother to baby during childbirth. GBS causes sepsis (in mother and baby) and meningitis in newborns. Both sepsis and meningitis can lead to serious complications, including lifelong disabilities such as speech impairment, blindness and hearing loss.

Certain women are at high risk for delivering a baby with GBS, including those who develop a fever during labor, are colonized late in pregnancy, have a UTI due to GBS, have ruptured membranes more than 18 hours before delivery, and those who go into labor before 37 weeks.

According to a ScienceDaily article titled “Third Trimester Group B Streptococcus Test Doesn’t Accurately Predict Presence During Labor,” a study recently presented at the annual meeting for the Society for Maternal-Fetal Medicine has called into question the accuracy of the 3rd trimester GBS test. Apparently, many women who test negative for GBS at 37 weeks test positive at the time of delivery. The study suggests implementation of a rapid GBS test immediately before delivery as a way to avoid a GBS misdiagnosis.
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“A sponge was left inside our client for nearly one year,” said Syracuse medical malpractice lawyer Michael A. Bottar, Esq., an attorney representing the patient and his family. “We believe it was a laparotomy sponge measuring nearly 12 inches by 18 inches. That’s the size of a kitchen dish towel. And it had a radio-opaque strip woven into the fabric so it should have been identified on a post-operative xray — had a study been ordered. The surgical team forgot that too. This was a complete comedy of errors.”

A retained surgical sponge is an avoidable mistake. To leave a sponge behind is either the result of surgical malpractice or nursing negligence. This is because surgeons and operating room nurses are supposed to know exactly how many sponges are used during a procedure and should not close until the sponge count is correct. “Ten in, ten out,” Bottar added.

Surgeons have an independent duty to check the abdominal cavity for sponges, even if advised by the nursing staff that that all sponges have been counted. This is because sponges and pads are known to stick together so a nurse, thinking that one sponge has been handed to a surgeon has actually handed over two. When one sponge is counted at the end of the procedure, it appears that the count is correct.

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“Stroke is the number three cause of death in the United States,” said NY medical malpractice attorney Michael A. Bottar, of Bottar Law, PLLC, a Syracuse-based law firm prosecuting New York stroke misdiagnosis lawsuits.

On top of the ‘usual’ stroke risk is the increased risk of a cerebral vein thrombosis (CVT) during pregnancy. A CVT is the occlusion, or blockage, of a venous sinus which may extend to veins draining into the sinus. It can lead to regional ischemia and infarction in the cerebral cortex.

In a recent report titled Diagnosis and Management of Cerebral Vein Thrombosis: A Statement for Healthcare Professionals from the American Heart Association / American Stroke Association, the AHA articulated a number of evidence-based standards for the timely diagnosis of a CVT and recommendations for treatment during pregnancy and the post-partum period.

Unlike a conventional arterial stroke, the signs and symptoms of a CVT are more variable and typically take weeks to develop. This increases the risk of CVT misdiagnosis. Most patients suffer from a headache, paresis, seizure (generalized or focal) and mental status disorders.

Research behind the AHA study revealed that women a highest risk for a CVT are those who are pregnant, or taking oral contraceptives, and people under age 45. 73% of CVTs strike during the post-partum period (the +/- 4 weeks after giving birth). Recommendations for clinical diagnosis include: a comprehensive history for risk factors, blood testing, and magnetic resonance imaging (MRI). Treatment modalities include anticoagulant medications and, in some cases, endovascular treatment or surgery.
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Cerebral palsy is a term used to cover a group of brain and nervous system disorders affecting 10,000 babies annually. About 50% of all cerebral palsy cases involve full-term or near full-term infants. According to the American Medical Association, there are ways to prevent cerebral palsy in full-term and premature infants.

One way to prevent CP in a full-term infant is to prevent chorioamnionitis. Chorioamnionitis is an inflammation or infection in the amnion and/or chorion, the membranes that surround and protect a fetus before birth. It affects 1-10% of term births and is often associated with prolonged labor.

Risk factors for chorioamnionitis include: prolonged labor, maternal age (less than 21 years old), prolonged rupture of membranes, first pregnancy, and multiple vaginal examinations during labor. If it is timely diagnosed (typically after a mother exhibits a fever, increased heart rate, uterine tenderness and/or foul smelling amniotic fluid), chorioamnionitis can be treated with intravenous antibiotics (usually ampicillin or clindamycin, plus gentamicin). Undiagnosed chorioamnionitis, which may be the result of medical malpractice, can lead to serious complications including bacteremia, meningitis and respiratory distress syndrome which, depending upon the severity, can restrict fetal oxygenation and lead to cerebral palsy.

In preterm infants, administering a drug called magnesium sulfate 24 hours before delivery may also reduce the risk of cerebral palsy. Studies suggest that “mag sulfate” has a neuroprotective effect.
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“Bottar Law, PLLC is presently handling several New York birth injury cases involving permanent disabilities caused by new york obstetrical malpractice and labor and delivery nurses errors made during a nighttime labor and delivery,” said Syracuse birth injury attorney Michael A. Bottar, Esq. “Certainly, the outcome of a birth is linked to the time of day a baby is born.”

An article published in the Journal of Obstetrics and Gynecology entitled “The Night—A Dangerous Time To Be Born?,” reported that babies were twice as likely to sustain a birth injury if born during the night (between 7:00 p.m. and 6:59 a.m.), as compared to a daytime birth (between 7:00 a.m. and 6:59 p.m.). A Queensland study
entitled “The Impact of Time of Delivery On Perinatal Outcomes,” reported additional troubling statistics. That is, that fetal death rates were highest between 1:00 a.m. and 2:59 a.m. Of note, was that the rate of fetal death was lowest between 11:00 a.m. and 12:59 p.m., and the rate of neonatal death was lowest between 5:00 p.m. and 6:59 p.m.

A German study reported in 2003 linked nighttime delivery dangers to the delivery of substandard medical care, also known as obstetrical medical malpractice and labor and delivery mistakes.According to The March of Dimes, low birth weight babies are at high risk for respiratory distress syndrome (i.e., RSD), intraventricular hemorrhaging (i.e., bleeding in the brain), patent ductus arteriosus (i.e., PDA), necrotizing enterocolitis (i.e., NEC), and retinopathy of prematurity (i.e., ROP).
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“Because of confidentiality agreements that insurance companies insist upon following a New York medical malpractice settlement, the public does not know about the number and severity of medical errors. They are common and can be deadly,” said Syracuse hospital negligence lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC.

The statistics are alarming. According to a study recently released by the Office of the Inspector General (OIG), 1 in 7 Medicare patients were harmed by the medical care they received while hospitalized. “14% ?!” Bottar remarked. “We often file claims on behalf of families who suffer a loss due to New York hospital negligence, but we had no idea mistakes were this prevalent.”

The OIG study reported that as many as 180,000 patients are harmed annually, with a price tag of $4,400,000,000.00. The study was based on doctors sampling and reviewing medical records of just under 1,000 Medicare patients in 2008. For advice about how to stay safe during a hospital stay, patients should review the Consumer Reports on Health’s Staying Safe in the Hospital.

The most common hospital errors include prescription medication dosing errors (receiving too much or too little medication), improperly combining medications, infections, bed sores, equipment malfunction, falls and poor wound care. Wrong site and wrong side surgical errors also occur. Statistics suggest that nearly 50% of hospital mistakes were/are preventable.
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According to a 2010 study, more than 225,000 Americans die every year due to medical mistakes. “Medical malpractice is not a myth,” said Syracuse medical mistake lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC. “That being said, most medical negligence is confined to a very small number of physicians. The majority of physicians will practice for 20-30 years without being the subject of a medical malpractice lawsuit. Of course, they won’t say that publicly because it does not help advance tort reform to prevent negligence lawsuits altogether.”

Following the NPR series titled “Doctors Behaving Badly,” our team of medical negligence attorneys formulated the following list of ways that New York could better protect patients seeking medical care in this State:

Number One: Before licensing a physician in New York, the State should communicate with the licensing bodies of other states. There is no reason for New York not to know why a physician lost his or her license in Florida. It should not be up to physicians seeking licensure in New York to interpret and self-report the actions of another state’s administrative agency.

Number Two: Search the National Practitioner Data Bank to determine whether a doctor seeking licensure in New York has a disciplinary history and, if so, the details of the history. According to reports, states seldom query the registry. Why not?

Number Three: Interact with local and state agencies to be in a position to learn about publicly available information, such as when a physician is arrested. It should not be up to physicians to self-report their indiscretions.

Number Four: While much of medicine is an art not a science, there are aspects of medicine that have absolute standards of care. Why not codify the standards and force physicians to follow them or face civil liability?

Number Five: Create a process whereby the worst physicians cannot continue to practice, similar to three-strikes-and-you’re-out. After a specific number of mistakes, or perhaps after a single egregious error, a physician’s license to practice medicine should be in jeopardy. Many successful physicians are not concerned about medical malpractice lawsuits because they can afford to pay insurance premiums and, beyond that, it is almost impossible for them to lose their license.

Number Six: Doctors in need of help, such as rehabilitation or therapy, should have access to necessary services. Inpatient and outpatient treatment should be readily available to ensure that good doctors sidelined by personal issues are not exiled and can return to the field quickly once rehabilitated.

Number Seven: Physician disciplinary histories should be word-searchable and easy to find. It should be easy for patients and boards to find out about a doctor by way of a Google search.

Number Eight: A doctor’s track record should be publicly available forever so that a board and/or potential patient can decide if a transgression in the doctor’s past is something to be concerned with. There is no reason for disciplinary records to be purged after, e.g., 5 or 7 years. A mistake 8 or 9 years ago may be relevant to someone’s decision making process.

Number Nine: If there is too much information to mine and process, then help should be recruited.

Number Ten: Patients should be provided a centralized venue to share their views about a doctor, subject to review by a moderator to prevent abuse. Often, patients have the best information about whether a doctor is a great healthcare provider or otherwise. All doctors to reply to patient comments. The dialogue should make its way into board decision-making.
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“Bottar Law, PLLC is presently prosecuting several New York medical malpractice lawsuits concerning the wrongful death of an infant from Group B streptococcus,” said Michael A. Bottar, Esq., a Syracuse birth injury lawyer. “Even though GBS is the leading cause of infectious death in infants, it often goes untreated. Many pregnant mothers do not receive Penicillin when they should and the delayed diagnosis of GBS can be deadly.

In an effort to decrease the number of GBS infections, the Centers of Disease Control and Prevention released guidelines in 2002 which required that all women undergo vaginal-rectal screening for GBS colonization between 35 and 37 weeks of gestation. Recently, the CDC released the 2010 Group B strep guidelines which modified the manner in which women presenting in preterm labor are to be treated. Under the 2010 guidelines, doctors are required to obtain a GBS culture when the woman presents to the hospital and start an antibiotic regimen. If the woman progresses into full labor, the antibiotics should continue through delivery. If, after observation, medical staff determine that the woman is not in labor, then the antibiotics should be discontinued. No longer should antibiotics be continued for 48 hours.

An abdominal delivery (i.e., a cesarean section) does not eliminate the risk of GBS transmission. Group B strep can be passed from mother to baby even through intact membranes and in the absence of labor (although the risk is low). This is why antibiotics should be administered at least 4 hours before delivery.

If you were never tested for GBS, or tested positive for GBS but were not treated with antibiotics, and your baby was born with signs and symptoms of early onset GBS (e.g., breathing problems, blood pressure instability, heart rate instability, kidney problems, sepsis, or meningitis), you may benefit from speaking with a New York attorney with a practice limited to medical malpractice and birth injury claims.
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