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Severe sepsis affects more than 750,000 people every year. “Our New York medical malpractice lawyers often file lawsuits alleging that a doctor or hospital failed to diagnose sepsis before it was too late,” said Syracuse wrongful death lawyer Michael A. Bottar, Esq., an attorney presently prosecuting several sepsis-based lawsuits.

The failure to diagnose sepsis is a common error. Unfortunately, sepsis, which is also known as blood poisoning, can result in a wrongful death. More than 200,000 every year. “It is the leading cause of death in the non-coronary ICU,” Bottar added.

Fortunately, help may be on the way. A new credit-card sized device being tested in Germany may aid physicians in quickly diagnosis sepsis. The tool, called MinoLab, may enable a doctor to diagnose sepsis in as little as 1 hour. Presently, analysis can take as long as 48 hours.

Signs and symptoms of sepsis include a fever, chills, severe shaking, tachycardia (i.e., high heart rate), low blood pressure, confusion, a decrease in urine output, and painful joints. If sepsis is timely diagnosed, it can be treated with intravenous antibiotics, vasopressors and corticosteroids, as well as intravenous fluids and surgery if the source of the infection can be identified and removed. Sepsis is a medical emergency. One out of of every 3 patients who develop “severe” sepsis will die within 30 days.
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“Even though an appendicitis is a clinical emergency, it is commonly misdiagnosed,” said Syracuse pediatric malpractice lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC. As many as 1 out of every 5 cases of appendicitis is not diagnosed before the appendix perforates (i.e., ruptures), which can lead to serious health problems including a periappendiceal abscess, peritonitis, an intestinal blockage, sepsis and death.

An appendicitis, or inflammation of the appendix, is caused by an obstruction of the appendiceal lumen. Signs and symptoms of an appendicitis, which typically strikes between the ages of 2 and 30, include (1) diffuse abdominal pain developing over 4-48 hours, (2) nausea, (3) vomiting, and (4) loss of appetite. When acute (i.e., inflamed), it is a “surgical” disease, meaning that it is treated by surgery as opposed to antibiotics. Surgery to remove the appendix is known as an appendectomy.

New York has one of the highest densities of pediatricians in the United States, with more than 150 pediatricians for every 100,000 children (second only to Massachusetts). This is a reassuring statistic because, according to a recent Reuters Health article titled Fewer Pediatricians, More Ruptured Appendixes, children who live in areas adequately staffed with pediatricians are more like to be timely diagnosed with an appendicitis and, in turn, are at 12% lower risk for rupture. According to the study underlying the Reuters article, a child’s proximity to a hospital, emergency room doctor and/or surgeon did not decrease risk. Statistically, access to pediatricians seems to make all of the difference in avoiding complications from an appendicitis.
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Jaundice, which is the clinical manifestation of hyperbilirubinemia (too much bilirubin in the blood), occurs in about one-half of term newborns as well as most premature babies (85%). Elevated bilirubin levels are also associated with low birth weight babies, sepsis, delivery requiring instrumentation, and history of maternal diabetes.

“Hyperbilirubinemia is also associated with epidural anesthesia and Oxtyocin,” said Syracuse birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC. “Epidural anesthesia is the most popular mode of pain relief during labor and, while it is widely believed that regional anesthetics present little if any risk to an unborn baby, this is not true in all cases.” Epidural anesthesia is associated with fetal respiratory depression, decreased fetal heart rate, fetal malpresentation, and difficulty breastfeeding after birth. Likewise, Oxytocin (i.e., Pitocin) may also cause hyperbilirubinemia.

Where a pregnant mother receives an epidural, or where labor is augmented by Oxytocin to stimulate contractions, the obstetrician and labor and delivery nurses should be on alert for newborn hyperbilirubinemia Neonatologists and pediatricians should also conduct appropriate surveillance by testing serum bilirubin levels.

While too much bilirubin in a baby’s blood is easily treated by phototherapy (or an exchange transfusion in severe cases), it can lead to permanent brain damage if the diagnosis is not made early. Baby brain damage caused by exposure to too much bilirubin is known as kernicterus. Kernicterus can cause cerebral palsy and other permanent disabilities such as long-term hearing loss, behavioral problems, and bilirubin induced neurological dysfunction (BIND).
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The kidneys are an essential part of the urinary system. They act as a natural blood filter and, as part of that process, divert waste products to the bladder where they are excreted through urine.

According to New York medical malpractice lawyer Anthony S. Bottar, Esq., a Bottar Law, PLLC attorney handling Syracuse kidney failure lawsuits, “medical advancements have enabled physicians to diagnose kidney disease and kidney failure sooner and sooner. In turn, kidney dialysis is bring initiated earlier than ever. This may not be a positive development.”

Guidelines released by the United States National Kidney Foundation provide that dialysis should not begin until a patient has been diagnosed with stage 5 kidney disease. A study recently published in the Canadian Medical Association Journal reported that the timing of dialysis bears directly on mortality (i.e., death). Approximately 25,000 patients were included in the study. Researchers followed whether each received “early” or “late” dialysis, based upon testing of the glomerular filtration rates. About 30% of the patients started “early,” with a GFR greater than 10.5. The balance started “late.” Surprisingly, those who started “early” had an 18% increased risk of death.

“It is well-known that the failure to diagnose advanced kidney disease is medical malpractice, this study suggests that a nephrologist may also be liable for the wrongful death of a patient by starting dialysis too soon.”
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“The failure to diagnose gestational diabetes during pregnancy is a big problem,” said Syracuse birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC, a legal team representing the catastrophically injured throughout the State of New York.

4-12% of pregnancies are complicated by gestational diabetes. A recent study of 900,000 American women published in Obstetrics and Gynecology reports that as many as 1 in 3 pregnant women are not receiving a simple laboratory test to check for diabetes mellitus, also known as gestational diabetes. The failure to test for and the failure to diagnose gestational diabetes is obstetrical malpractice that places a pregnant mother and her baby at risk for complications, including preeclampsia, premature birth, macrosomic babies and neonatal hypoglycemia. Where timely diagnosed, gestational diabetes can be treated by controlling glucose by diet, as well as exercise and insulin.

The study titled Gaps In Diabetes Screening During Pregnancy and Postpartum also revealed that as many as 1 in 5 pregnant women who developed gestational diabetes while pregnant were screened for diabetes within 6 months after pregnancy. This means that many pregnant mothers developed diabetes that had gone undiagnosed and untreated for a significant period of time after birth. This is well below the standard of care, as current medical guidelines require that women with gestational diabetes be tested for diabetes 6 to 12 weeks after delivery.

The study also revealed that obese women, who have the highest risk for developing gestational diabetes, were the least likely to be tested. Women weighing more than 275 pounds were 12% less likely to receive testing, but were 348% more likely to have gestational diabetes. Women weighing more than 300 pounds were 6% less likely to receive testing, but were 300% more likely to have gestational diabetes.
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“Recent reports suggest that cesarean section rates are on the rise because women are asking for surgery, as opposed to delivering vaginally. This appears incorrect,” said Syracuse birth injury lawyer Anthony S. Bottar, of Bottar Law, PLLC, a law firm with decades of experience handling birth injury lawsuits throughout he state of New York, including those concerning fetal brain damage due to a delayed c-section.

According to Reuters Health, a recent study of nearly 20,000 women around the world revealed that c-section rates are rising even though women are not asking for abdominal deliveries. Only sixteen percent (16%) of the women in the study indicated that they would prefer a cesarean section to vaginal delivery. This means than roughly 84% of pregnant mothers prefer vaginal delivery. Among women who had a c-section previously, approximately twenty-nine percent (29%) said that they would like their next delivery to be by cesarean section. Seventy-one percent (71%) said that they wanted a vaginal birth after cesarean section (VBAC).

According to a study discussed in our blog post titled “Study Will Make Central New York VBACs More Available Despite Risk of Uterine Rupture and Baby Brain Damage,” a vaginal birth after cesarean section may not be as dangerous as doctor’s once believed. “We disagree,, especially if labor is augmented” Syracuse VBAC lawyer Michael A. Bottar said. “We have clients who experienced uterine rupture during a trial of labor encouraged by an obstetrician or midwife. VBAC is not right for everyone.”
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“The failure to diagnose cancer is one of the most common types of New York medical malpractice lawsuits,” said Syracuse lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC.

A new blood test developed by several Boston scientists will be brought to the market in the very near future through a partnership with Johnson & Johnson. Unlike currently available tests that can find tumor cells in blood, the new test dubbed a “liquid biopsy” will be able to capture whole cells that doctors can analyze. The new test can find one cancer cell in a billion or more healthy cells by using a microchip covered with 78,000 tiny posts that are coated with antibodies that bind with tumor cells when found. When blood cells are run over the hair-like posts, healthy cells “bounce off” and cancer cells “stick.”

“Metastatic disease and death due late diagnosis of cancer should decrease,” Bottar added. Historically, doctors administer a drug or therapy and have to wait months to perform imaging (e.g., a CT scan) to determine if the tumor has decreased in size. Many patients do not live long enough for oncologists to find a drug or therapy that works. The new test is promising because doctors will be able to determine, within a day or two, whether a particular cancer treatment is working.
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In the State of New York, children with developmental delays following birth are referred to the New York State Department of Health “Early Intervention” Program.

To be eligible for services, a child must be less than three years old and have a “confirmed disability” or “established development delay” that is (1) physical, (2) cognitive, (3) communicative, (4) social-emotional, and/or (5) adaptive.
Following an evaluation and development of an individualized family service plan (IFSP) services begin almost immediately. Typically within days.

“Many of our clients receive services from Early Intervention,” said New York cerebral palsy lawyer Michael A. Bottar, Esq., of Syracuse-based Bottar Law, PLLC. “EI does a great job providing physical, occupational and speech therapy to children diagnosed with cerebral palsy, Erb’s palsy, Down syndrome and other physical/cognitive deficits including blindness, deafness, and poor muscle tone or feeding. It is comforting to know that children, many of whom have disabilities because of something that went wrong during childbirth, have a safety net.”

In addition to therapy, EI provides family education and counseling, parent support groups, audiology, psychological services, nursing services, nutrition services, vision services, social work services and assistive technology devices and services. Additional detail about EI can be found in The Parent’s Guide to Early Intervention (pdf).
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“If your baby has been diagnosed with hypoxic ischemic encephalopathy after birth, then s/he has brain damage because of inadequate oxygen during delivery,” said Syracuse New York birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC. “HIE is a birth injury that can be prevented.”

Babies diagnosed with HIE after birth may show a decreased level of consciousness, altered spontaneous activity and abnormal posture. This is because a period of low oxygen has injured the brain, causing cerebral edema (i.e., swelling) that may lead to learning disabilities, mental retardation, epilepsy, poor motor control and spastic quadriplegic cerebral palsy. 80% of babies who survive HIE have a permanent cognitive or physiological impairment. HIE can also lead to death (50% mortality).

Therapeutic hypothermia is now available to decrease the damage caused by an HIE birth injury. TH involves cooling the baby (on a mattress) to a body temperature of 92.3 degrees for approximately 72 hours. The cooling slows down the metabolic process and decreases the damage caused by swelling. TH must start within 6 hours of birth to be effective.

HIE may be the result of medical malpractice if an obstetrician failed to appropriately respond to fetal distress marked by a non-reassuring increase or decrease in fetal heart rate. An appropriate response includes repositioning, oxygen and, if the heart rate does not improve, delivery by cesarean section as discussed in our prior post titled New York C-Section Lawyer Review of Rising Surgery Rate To Prevent Syracuse Birth Injury.
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The umbilical cord connects an unborn fetus to the placenta. It typically contains two arteries and one vein, encased in a durable substance known as Wharton’s Jelly. Most umbilical cords measure 20 inches in length, nearly 1 inch thick and may have as many as 380 helices (i.e., coils).

“The primary purpose of the umbilical cord is to deliver oxygen-rich blood and nutrients to the fetus, and to remove waste,” said Syracuse birth injury lawyer Michael A. Bottar, Esq., of Bottar Law, PLLC. Where there is umbilical cord compression during labor and delivery, an unborn baby may receive inadequate oxygen (hypoxia) or no oxygen (asphyxia). Hypoxia and asphyxia are associated with birth injuries such as cerebral palsy, blindness and deafness.

Umbilical cord compression is very common. It occurs in 10% of deliveries when, in most cases, the cord is compressed between a baby’s head and the mother’s pelvic bone. The umbilical cord may also be compressed if it becomes wrapped around a baby’s neck, as discussed in a prior blog post titled Umbilical Cord Around Baby’s Neck Is A Common Cause of Syracuse New York Birth Injury. This is known as a nuchal cord.

Fortunately, umbilical cord compression can be identified by review of fetal heart monitor tracings. In the usual case, periods of low fetal oxygenation will be marked by an increase (accelerations) or decrease (decelerations) in the fetal heart rate. Obstetricians and labor and delivery nurses can then take steps to remedy the problem by, e.g., repositioning the mother or administering oxygen. Where a baby experiences prolonged hypoxia s/he may be born depressed, with low APGAR scores discussed in a prior post titled Low APGAR Scores and Medical Malpractice In Syracuse New York. A baby born with low APGAR scores is at risk for developmental delays.
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