The Perfect Storm: Reducing Waiting Times in Emergency Departments and Diagnosing Heart Attacks by Jean M. Klingenberger, RN

Heart_attack     Thanks to Guest Blogger, Legal Nurse Consultant Jean M. Klingenberger, MBA/MHA, BSN, RN, who took the time to write the following article.  Legal Nurse Consultants (LNC) play an important role in personal injury and medical malpractice cases by reviewing and analyzing the client/patient's medical records. Due to their extensive educational background and great practical experience in hospital and medical settings, LNC's are able to review records and put together a comprehensive medical picture of the client's case.  This picture helps the lawyer deal with the medical issues and interact effectively with treating doctors, expert medical witnesses and the opinions of the medical witnesses hired by the opposing side.

The Perfect Storm: 

Reducing Waiting Times in Emergency Departments and Diagnosing Heart Attacks

by Jean M. Klingenberger, MBA/MHA, BSN, RN of Aurora Nurse Consulting, PLLC

More than 1 million people per year in the US have heart attacks.  Heart disease is the leading cause of death in both American men and women.  Heart attacks, or myocardial infarctions, cause permanent damage to the heart muscle.  “Myo” means muscle, “cardial” refers to the heart, and “infarction” means death of tissue caused by lack of blood supply.  If the heart damage is extensive, one’s health and quality of life can be severely impaired since the heart pumps blood to the rest of the body.  

The heart has a network of arteries in the heart wall that supplies blood and oxygen to the heart muscle, allowing the heart to continue to pump effectively.  Build-up of plaque and other blood products, such as clots, can severely narrow or completely clog a coronary artery, cutting off the supply of blood to that area of the heart muscle.  Without restoring the blood flow to that area, the affected heart muscle will die.  


Medical treatment for acute myocardial infarctions (AMI) is aimed at returning this flow of blood by using medications and/or medical procedures.  Time is critical in restoring this blood flow.  The American College of Cardiology and the American Heart Association joint guidelines for AMI care state that the goal for treatment is 90 minutes from time of patient presentation (to emergency department) to the medical procedure (angioplasty).  For health care organizations using “clot-busting” medication, that time is narrowed to 30 minutes from time of patient presentation to giving the clot-busting medication.  

Recent estimates are that between 2 and 8% of AMI patients are erroneously sent home from emergency departments.  How does this happen?  One probable cause is that patients may not exhibit the classic symptoms of a heart attack.  Typical symptoms of AMI include:

  • Heart.Attack Any abnormal sensation such as squeezing, pressure, burning, or pain in the center of the chest, which sometimes moves or radiates to the shoulder(s), neck, jaw, arms, or upper back;
  • Shortness of breath;
  • Sweating;
  • Palpitations (fluttering in chest);
  • Fatigue.

However, a moderate percentage of people experience non-typical or “atypical” symptoms with or without the usual ones listed above.  These atypical symptoms include:

  • Faintness or lightheadedness;
  • Nausea and vomiting;
  • Abdominal pain.

It is people who present with these atypical symptoms that pose the highest risk of not being correctly diagnosed as having an AMI.  Women under the age of 55, nonwhite persons, and those who reported shortness of breath as their main symptom were most likely to be discharged from an emergency department prior to the correct diagnosis of AMI.


Another possible cause may be emergency department sensitivity drift.  Of all of the patients coming into emergency departments complaining of chest pain, only about 15% of them are actually having an AMI.  This leads to a skepticism shown to patients presenting with chest pain, since roughly 85% are not having AMIs.  Emergency department personnel are much more likely to drop everything and run for a gunshot wound patient than for a chest pain patient, even though the consequences of responding slowly in either case could be devastating.   

Heart attack emergency 500 Emergency departments have been pressured over the past few years to improve patient satisfaction and reduce waiting time.  This has led to a tremendous amount of work being done across the country’s emergency departments to improve processes to move patients through in shorter periods of time.  When factoring the complexity of diagnosing patients with atypical symptoms and efforts to improve work flow processes within emergency departments to reduce time, the result is missing the diagnosis of AMI.  


Time gained for emergency department process improvement goals can result in some people dropping through the cracks and not receiving timely medical care to prevent losing heart muscle function.  Loss of good heart pumping leads to less blood nourishment of all the organs in the body.  Not only can this affect the way we feel physically, but can reduce our ability to perform our activities of daily living.  This loss of ability can affect our families, jobs, and emotional well-being.  Financially, the costs of impaired heart function can be substantial to pay for physicians, tests, and medications.  

How do we weather this perfect storm?  The best way is to know all of the typical and atypical symptoms of an AMI.  Know that tests such as electrocardiograms (EKGs) and blood tests should be performed at least twice and compared to each other for change, indicating possible heart damage.  This time frame should be no shorter than 4 or 5 hours.  Insist on being heard by the emergency department staff.  Patients often know when “something is not right,” and communicate that clearly.  Being informed and being heard are keys to accurate diagnosis and effective care during a heart attack.  

You can contact Ms. Klingenberger at jean@aurora-lnc.com

If you, or someone you know, has been injured in an accident, please contact me immediately at

(323) 852-1100

lowell@steigerlaw.com

Skype (with or without video): Lowell_Steiger

"Treated With the Respect That You Deserve"


Jury Awards Truck Driver $9.5 Million for Permanent Damage from Erectile Dysfunction Treatment

Ed sad

    This absolutely fascinating story comes out of Georgia where plaintiff John Henry Howard (a Georgia truck driver) sued defendant Boston Men's Health Center, Inc. for damages suffered after treatment for erectile dysfunction (ED).  A Dekalb State Court Jury of his peers awarded Howard $750,000 in compensatory damages. However, the jury also found that the defendant acted with an intent to cause harm and further awarded Howard $8.5 Million in punitive damages.  Howard was brilliantly represented by attorney W. Fred Orr II, who himself received bear hugs from 10 of the 12 jury members after the trial was over.

Viagra pills

    Howard went to the clinic in an effort to resolve his ED.  The waiting room was filled with literature warning about the dangers of Viagra and Cialis, ED medications which are administered orally (i.e., the little blue pills).  The clinic staff advised Howard that their therapy was painless and based on a proprietary formula.

    They injected medication, whose primary ingredient was papaverine, directly into his penis. Papaverine was the treatment of choice until the introduction of Viagra in 1998.  Since that time, the Food and Drug Administration has warned that papaverine should not be used to treat ED.

    A macho man, Howard did not run scared when faced with the injection. However, he testified that "Not a man on the face of the earth would go into one of these places if they knew what they were going to do to them."   True, how painfully true.

    Not surprisingly, the injection gave him immediate results and Howard shelled out $1,200 for a six-month supply of the clinic's medication.  He was instructed to inject it into himself in the same location. He did and had "the best erection he's ever had in his life."  Unfortunately, that best erection lasted for a couple of days.  It had become painful, so he visited the clinic.  

    The staff removed blood from his penis in order to provide relief but that didn't work.  He wound up in the emergency room.  Eventually, he discovered that the medicine caused fibrosis and scar tissue to form.    

    Read the complete story from Law.com.

If you, or someone you know, has been similarly injured, 

please contact me immediately at

(323) 852-1100

lowell@steigerlaw.com

Skype (with or without video): Lowell_Steiger

"Treated With the Respect That You Deserve" 

State Farm Sued for Sham “Independent” Medical Exams

New York Personal Injury Lawyer Eric Turkewitz Reports The Following in his Blog:

State Farm Hit With Civil RICO Claim Over Sham Medical Exams

State Farm has been sued for racketeering in New York with a claim that it conspired with "Independent Medical Exam" companies and medical practitioners to produce fraudulent and sham medical reports. The suit, filed January 30th in the Eastern District of New York, is brought under the Racketeer Influenced Corrupt Organization Act (RICO). (This story has not been previously reported.)

State Farm acted in concert with "IME" companies and doctors to furnish fraudulent and boilerplate reports, according to the suit. The objective was to procure "scientifically dishonest reports in order to terminate benefits." The Complaint is here: McGee-v-StateFarm-RICO-Complaint.pdf

Of particular interest is that the plaintiff is not an injured accident victim that was wrongfully deprived of insurance benefits, but John McGee, a physician practicing rehabilitative medicine. The physiatrist asserts that claims submitted to State Farm are being wrongfully denied, thus depriving him of the revenue he should be receiving for the treatment he rendered. He alleges that "sham" examinations were done by the defendants to procure false findings so as to cut off the benefits, resulting in the claims he submitted being denied.

The Complaint alleges that State Farm and the other defendants communicated that the evaluations and reports must deny that its insureds needed future treatment and that there was a lack of medical necessity for prior treatment. The Complaint goes on to state that State Farm engaged the other defendants with the expectation that reports received would be favorable to the insurance carrier, and to the detriment of the insured.

McGee states that "State Farm made it known to the other defendants that if they did not provide sufficient denials within the evaluation reports then State Farm would not use their IME services."

The defendant "IME" companies are Independent Physical Exam Referrals, Inc., and Metro Medical Services, LLC.

According to the website of Independent, they play no role in the production of the report:

We have addressed the "independent" part of the examinations by requiring all reports to be independently processed by the medical provider, typed and forwarded on their own stationary. IPER does not participate in the production of the reports, thus ensuring an arms length transaction for our clients. IPER reviews all reports by a registered nurse only to ensure that essential components of the report are present and that your questions are answered. The medical opinions rendered are those of the examining physician and based upon his/her clinical assessment and review of medical records.

This description, however, is directly at odds with the allegations of the complaint, which states that "boilerplate medical evaluation reports" are used. That may be an easy thing to prove if identical language is used in many different reports.

Whether these companies are like Integrated Risk Services Inc. — a company I wrote about Tuesday that specifically states it doesn’t want information favorable to the plaintiff included — remains to be seen. (See: How to Fool a Jury (Is It Insurance Fraud?))

Another part of the Complaint alleges that State Farm pays an excessive fee to the IME company for the doctor’s services, and that the money is then shared with the IME company or a kick-back is given to non-medical personnel. The complaint sets forth (in paragraph 19) that felonies have been committed with respect to the sharing of medical fees with non-medical personnel.

Thanks to my anonymous tipster for the heads up.

The plaintiff is represented by Bruce Rosenberg of Bellmore, New York.

****************************************************************************************************************

Related Links:

Chicago Personal Injury Lawyer Gary McCallister’s Injuryboard discusses this and other related issues

Tipsheet: Independent Medical Exam

Wikipedia: Independent Medical Examination

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

Ed Heads: Where You Are The Virtual Surgeon!

Edheadsorg_2 EdHeads.org.  What an incredible site! You are the surgeon as you perform a virtual hip replacement, hip resurfacing or knee surgery.  You are the crash investigator at an accident scene.  Try it out.  It gives us all an appreciation for the role of a professional in these intense circumstances.  Hipsurg_2 Having handled many accident cases wherein my clients have had to have hip and/or knee surgeries, this website was of great interest to me. 

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

Videos of Surgical Procedures: Not for the Faint Hearted

Operating_room  Medline Plus provides links to literally hundreds of surgical procedures ranging from heart surgery to brain surgery to orthopaedic surgeries to name a few.  Here are links to just a few:

Minimally Invasive Repair of the Thoracic Aortic Aneurysm

Robot Assisted Heart Bypass Surgery

Heart Transplant

Hip Replacement

Total Knee Replacement

Penile Implant

Birth by Cesarean Section

and more, much, much more.

This fascinating site is not for the faint-at-heart.

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

Eli Lilly settles Claims over Zyprexa

Zyprexa  IndyStar.Com, Indiana’s Number 1 Local Media Site, reports the following:  INDIANAPOLIS — Eli Lilly and Co. has settled another 900 personal-injury claims against its antipscyhotic drug Zyprexa, including five set to go to court next month, thus avoiding what would have been the first trial in the U.S. The Indianapolis drug maker confirmed the settlement Wednesday but declined to reveal the amount. With the latest agreements, Lilly has settled more than 25,000 claims, leaving about 1,100 unsettled. Many of the plaintiffs have claimed Lilly underplayed the drug’s side effects, including weight gain and elevated blood sugar. Lilly has set aside $1.2 billion to pay claims. (Star report)

A google search on Zyprexa Litigation will refer you to a plethora of relevant links.

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

American Academy of Physical Medicine & Rehabilitation and Other Pain Management Sites

Physiatrist The American Academy of Physical Medicine and Rehabilitation is the national medical society representing more than 7,000 physicians who are specialists in the field of physical medicine and rehabilitation. They are called physiatrists (fizz ee at’ trists).

Physiatrists focus on restoring function. They care for patients with acute and chronic pain, and musculoskeletal problems like back and neck pain, tendonitis, pinched nerves and fibromyalgia. They also treat people who have experienced catastrophic events resulting in paraplegia, quadriplegia, or traumatic brain injury; and individuals who have had strokes, orthopedic injuries, or neurologic disorders such as multiple sclerosis, polio, or ALS.

Other links to information in Physiatrists

Association of Academic Physiatrists

Wikipedia on Physiatrists and Physical Medicine

Spine Universe has a wonderful article which describes the medical training and types of injuries treated by a physiatrist

Ohio State University College of Medicine

The Law Office of Lowell Steiger Represents Injured Victims

If you have suffered a Personal Injury, Call for a Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100

or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com 

Dr. Barry Carlin on Living Pain Free After an Auto Accident

Barry_carlin_2 YOU ACTUALLY CAN LEAD A LIFE

FREE OF PAIN AND DISCOMFORT AFTER A  CAR ACCIDENT

HERE IS HOW YOU CAN DO IT!

               

                                                   

Dr. Barry Carlin practices in

West Los Angeles

If you have any questions he can be reached at  310-478-1234 or barry@bestperformancesystems.com

When you are in an auto accident, there are a number of unique aspects of the injury that make it impact more on your life than the average sports, work or lifting injury; and frequently cause the injuries to become a chronic problem that effects your quality of life for years, sometimes forever.

Why is it that so many of you live with discomfort and sometimes limitations in sports, social and work activities after a car accident? Should not modern medicine be able to fix these aches and pains?

Due to the tremendous forces applied to your body, generated by two vehicles colliding, you do not have an injury. You have thousands of small injuries that not only cause pain, but cause instability in the soft tissue stabilizing structures in your body.

That is why you hurt so much, your symptoms flare so easily while performing normal activities, it takes so long to get better, and you often then have chronic or recurring problems for years or forever.

You are told you have to live with the pain. Worse yet, some of you have been told you probably will develop arthritis, and have worse problems in the future.

Click here to read the rest of Dr. Carlin’s informative article in Adobe Acrobat Format.  If you do not have the free Adobe Acrobat Reader, click on the link to the left to download the Reader for free.

The Law Office of Lowell Steiger Represents Injured Victims

Free Consultation

Contact Attorney Lowell Steiger at (323) 852-1100 or via e-mail at lowell@steigerlaw.com

"Treated With the Respect That You Deserve"

www.steigerlaw.com

Link of the Day – Medical Illustrations

Brain Karolinska Institutet has literally 1000’s of images, stills and movies/videos, in almost every conceivable medical area.  Fascinating to say the least.

Photograph Sources and Collections Listed with Links Cover These Topical
Areas:

General
Anatomy and Orthopedics
The Visible Human Project
Cardiovascular system
Dentistry and Oral Health
Dermatology
Endocrinology
Eye, ENT (Ear-Nose-Throat) and Respiratory System
Gastroenterology
Gynecology & Obstetrics
Hematology
Histology
Microbiology, Infectious Diseases
Neurology
Oncology
Pathology
Pediatrics
Radiology/-graphy, Nuclear Medicine & Ultrasonography
Surgery/Anesthesiology
Urogenital

lowell@steigerlaw.com

www.steigerlaw.com