Medical Quiz #11 – Brain Matters
Test your knowledge of the brain.
Fact or Myth?
1. Brain size is associated with intelligence.
2. Listening to classical music can make you smarter.
3. Alcohol kills brain cells.
4. Talking to yourself is a sign of mental disturbance.
5. People use only about 10% of their brain.
Check back next week for the answers.
One question that often arises when caring for minors is whether there is a legal option for a healthcare provider to override a parents’ decision to withhold treatment from their child based on the parents’ sincerely held religious beliefs.
A Houston children’s hospital encountered that issue last week. Parents of a two-month-old in need of life-saving cardiac surgery refused to consent to the surgery. The parents, who are Jehovah’s Witnesses, refused consent because the surgery potentially would require a blood transfusion, which goes against their beliefs.
The hospital filed an Application to Provide Life-Saving Treatment on May 9, 2012. In the Application, the hospital cited the infant’s surgeon’s opinion that without the surgery, the infant would suffer either permanent harm or death. The hospital explained that blood products might be needed both during surgery and in recovery. The hospital specifically requested that the court enter an order allowing the healthcare providers to administer blood products, should the infant’s condition require them.
On that same day, a Harris County judge entered an order permitting the hospital to provide life-saving treatment to the infant, including administration of blood products. The order also allowed the parents to request modification or reconsideration of the order. As of the date of this post, the parents have not done so.
In these situations, time is usually of the essence. The hospital took a few steps to make the process as fast as possible. First, it does not appear the hospital requested that a guardian ad litem be appointed to represent infant. Instead, the hospital cited Texas law that allows a court to be a temporary managing conservator of a minor to give consent to medical treatment refused by the minor’s parents. Second, the hospital had the infant’s surgeon available at the hearing to testify regarding the necessity of the surgery, which allowed the court or the parents to ask any questions about the surgery as well as its risks, benefits, and alternatives, including the potential necessity of a blood transfusion.
More information regarding this court decision can be found here.
Medical Quiz #10 – Answers
Which kills or injures more people each year:
1. Sharks or cows? 
Sharks may be fearsome creatures that get the media coverage, but cows and bulls kill 20 times more people than sharks, even excluding food-borne illness caused by tainted beef. On average, one person per year dies in the U.S. from a shark attack, making the lifetime odds 1 in over 3.7 million.
2. Stairs or elevators?
Surprisingly, stairs are less safe than elevators, with approximately 2,000 people killed by falling down them every year.
3. Bicycles or planes?
About 900 people, mostly adults, are involved in fatal bicycle accidents annually, and in 90% of those, motorists are at fault. Far fewer people die or are injured in plane crashes.
4. Snakes or insects?
Insects are more dangerous. Although 7,000 to 8,000 people in the U.S. are bitten by venomous snakes each year, the mortality rate is less than 1%. More people die from stinging insects such as bees, hornets, and wasps.
5. Golf or ice hockey?
Among those aged 35-54, more visits to emergency rooms are made for golf-related injuries.
6. Ladders or chain saws? 
In 2010, persons treated in emergency rooms due to ladders or stools outnumbered chain saw mishaps by more than 10 to 1, according to the National Electronic Injury Surveillance System (NEISS), which tracks data from hospital emergency departments. See: http://www.cpsc.gov/library/neiss.html
7. Coal mines or nuclear power plants?
Coal mines have killed more people than the initial Chernobyl blast. No one was injured or killed by the Three Mile Island disaster, a nuclear meltdown that occurred at a Pennsylvania plant in 1979.
Edward J. Kroger, MD, JD and E. Dale Burrus, JD, LLM have been identified by Martindale-Hubbell as two of Texas’ 2012 Top Rated Lawyers. Dale Burrus was selected in the area of Medical Malpractice. Edward Kroger was recognized in the area of Health Law. Both attorneys are rated AV Preeminent by Martindale-Hubbell.
Which kills or injures more people each year:
- Sharks or cows?
- Stairs or elevators?
- Bicycles or planes?
- Snakes or insects?
- Golf or ice hockey?
- Ladders or chainsaws?
- Coal mines or nuclear power plants?
Check back next week for the answers.
Litigation and Intelligent Design
Why should litigators worry about design? Experienced trial attorneys know that perception and usability is critical. A client’s perception of your abilities, in person and on the web. The usability of your blog or website. A judge’s perception of your legal acuity via a carefully designed brief or oral argument. A jury’s perception of the story you tell when you present a case to them. Design focuses on the dialogue between people, things and contexts – which is also a good job description of a trial lawyer.
A good starting point is Universal Principles of Design, by William Lidwell, et al. The book takes the reader through a highly understandable description of 125 fundamental design concepts. An attorney reading the book will begin thinking about the contents of his jury arguments, the layout of his office, the appearance of his website…and on and on.
Here is a good example. The listing for “stickiness” describes a method for “dramatically increasing the recognition, recall, and unsolicited sharing of an idea.” Think opening argument. The elements of stickiness include:
- Simplicity – expressing succinctly and simply without sacrificing depth
- Surprise – it grabs your attention
- Concreteness – specific ideas using plain language or imagery
- Credibility – it must be believable, coming from a trusted source, or appealing to common sense
- Emotion – it must stimulate a reaction
- Story – expressing as a story dramatically increases memorability
The entry concludes with a reminder of the strength of presenting evidence and letting people draw their own conclusions.
Thinking about your next jury argument?
Beginning at 12:00 p.m. CST today, Memorial Hermann Hospital is live-tweeting a colonoscopy, complete with photographs, videos, and commentary as well as the opportunity to ask a gastroenterologist and an internist any questions about it. You can log onto Twitter to watch the procedure: www.twitter.com/@houstonhospital. For those who do not wish to watch this procedure during lunch, it will be archived on the hospital’s website.
In February, Memorial Hermann Hospital live-tweeted an open heart surgery via Twitter, complete with photographs, videos, and commentary. It was the first live-tweeted heart surgery in the country. A slideshow of that procedure is available here.
Social media is rapidly increasing patient access to health care information. Formerly, the only opportunity to watch a surgical procedure was to watch it from a gallery above an operating room. This opportunity is generally invitation-only, and these invitations are limited, so a member of the general public would rarely be able to watch a procedure from this vantage point. In addition, the distance from the gallery to the operating table does not allow the observers to appreciate any small moves the surgeon made within the body cavity. These tweeted procedures, however, allow the general public to watch a procedure as if they were scrubbed into it just like one of the health care providers involved.
If your physician recommends a surgical procedure for you or your family, would the opportunity to watch the procedure via Twitter (or another social media avenue) play into your decision to consent to the procedure? Please let us know in the comment section below.
Yesterday, in a brief one-page ruling, Judge Rodney Gilstrap of the Eastern District of Texas upheld the noneconomic damages cap implemented by the Texas Legislature in 2003 as part of its tort reform law. The cap was affirmed by Texas voters later that year.
The suit was brought by 10 plaintiffs in 2008. The plaintiffs challenged the constitutionality of the noneconomic damages cap, which limits such damages as pain and suffering and mental anguish to $250,000 to $750,000, depending on the type of defendants. They claimed the cap violated the U.S. Constitution by improperly taking private property and barring access to the courts.
Health care providers see the ruling as a victory, citing decreases in malpractice insurance rates post-tort reform and an increased number of physicians who have moved to the state, including to underserved counties.
There is no word on whether the plaintiffs will appeal the ruling.
More information is available here and here.
From Mechanic to Male Nurse?
Can a blue-collar working man find his niche in a female-dominated profession?
The answer is apparently affirmative, as greater numbers of men, laid off from their jobs in auto manufacturing plants, warehouses, and factories are choosing to retrain and redefine themselves as nurses.
Motivated by job security as demand for nurses expands amidst the nationwide shortage, men are taking another look at a career they may have dismissed as “women’s work”, where men remain a definite minority. Only about 7% of registered nurses are male and, until recently, their numbers had remained stagnant for years. Now, with improved opportunity and faded stigma attached to male nurses (Ben Stiller’s Meet the Parents character aside), the percentage of men in nursing has increased during the past decade, and is expected to grow as more men view nursing as a viable alternative to their previously stable jobs, and undoubtedly, view “women’s work” from a whole new perspective. We welcome them.
http://www.nurseweek.com/news/features/01-05/men.html
Kroger | Burrus is pleased to announce the selection of three of its younger lawyers as 2012 Texas Rising Stars. Lawyers who are 40 years old or younger are eligible for nomination by their peers. The selection process includes a review of credentials and experience. Ultimately, less than 2.5% of the lawyers in the state are recognized for this award.
Leah A. Greene, JD, LLM is a graduate of Texas A&M University, Texas Tech University School of Law and the University of Houston Law Center.
Pei-Chih Lee, JD, MPH is a graduate of Rice University, the University of Houston Law Center and the University of Texas.
Lauren M. Nelson, JD is a graduate of Baylor University and South Texas College of Law.
All three women practice in the areas of medical malpractice defense and health law, representing health care institutions and individual practitioners across Texas.
Congratulations to all three attorneys!
Edward J. Kroger, Leah A. Greene, Pei-Chih Lee, Lauren M. Nelson, E. Dale Burrus
Answers to last week’s Weird Medicine quiz:
1. Learning to surf can paralyze you, and not from falling off the board.
True. Surfer’s myelopathy is a non-traumatic spinal cord injury which occurs only in novice surfers, and can result in permanent paraplegia. The mechanism of injury is ischemic in nature, caused by lack of blood flow to the spinal cord from hyperextension of the back while lying prone on the surfboard for extended time periods, in conjunction with repetitive flexion-extension of the back while trying to balance upright. The condition is so rare, however, that surfers are probably more at risk for shark bite.
2. A stroke can leave you with a foreign accent.
True. Foreign Accent Syndrome is the result of injury, such as a stroke, to the speech area of the brain. Only about 100 cases have been reported since the 1940s. One afflicted person is Karen Butler, an Oregon resident who awoke from general anesthesia for dental surgery with an English/Irish accent. Born and raised in the U.S., Ms. Butler had never even been to Europe, yet sounds like a native of the British Isles. Although intensive speech therapy may reverse the syndrome, she declined because she prefers her new accent.
3. A woman forgot she was married following a car accident.
True. A current-release film, The Vow, is based on the story of real-life couple Kim and Krickett Carpenter who, shortly after their marriage, were involved in a car accident in which Mrs. Carpenter suffered a head injury with coma. When she awoke, she could recall neither her wedding nor her husband. There have also been reports of persons with “fugue states” who forget their own identity, and without any known physical cause.
4. Too much salt can shrink your brain.
True. The condition known as hypernatremic encephalopathy can cause mental changes, severe neurological damage, and death due to an abnormally high level of sodium (salt) in the blood. The brain cells literally shrink from water loss, with consequent hemorrhage. Hypernatremic encephalopathy can be caused by dehydration from failing to drink enough water, as seen in long-distance runners.
5. A man survived, without brain damage, an arrow shot through his skull.
True. In 1992, Arthur Ekvall, a 29-year-old San Diego man, awoke with a headache to find his roommate reloading a crossbow near his bed. The man had just shot him in the head with an arrow, which entered in the lower posterior skull and nearly exited above the left eye. Mr. Ekvall disarmed the rampaging roommate and ran for help. He was then taken to the hospital for surgical removal of the arrow and lived to tell the miraculous tale. The former roommate received a life sentence for attempted murder.
6. A woman was rendered brain-dead after being tasered by police.
True. A 20-year-old woman in Florida, who had been arrested on suspicion of a hit-and-run incident, ran out of the police station while handcuffed. Pursuing police tasered the woman. She fell backward, striking her head on the pavement and sustaining a traumatic brain injury that left her in a vegetative state.
7. Medication to grow eyelashes can turn your blue eyes brown.
True. Darkening of eye color is a potential side effect of Latisse. The drug, originally used to treat glaucoma, was found incidentally to affect eyelash pigment, making eyelashes grow darker and more luxuriant. But it can also affect the pigment of the eye’s iris, turning light-colored eyes brown, as shown in animal studies. No human user has thus far reported such a side effect, however.
Medical Quiz #9 – Weird Medicine
True or false:
- Learning to surf can paralyze you, and not from falling off the board.
- A stroke can leave you with a foreign accent.
- A woman forgot she was married following a car accident.
- Too much salt can shrink your brain.
- A man survived, without brain damage, an arrow shot through his skull.
- A woman was rendered brain-dead after being tasered by police.
- Medication to grow eyelashes can turn your blue eyes brown.
Check back next week for the answers.
GHSHRM’s 26th Annual Education Day
The Greater Houston Society for Healthcare Risk Management is holding its 26th Annual Education Day on March 8th and 9th. Kroger Burrus is a proud supporter of this conference, which in recent years has rivaled national meetings with the quality of the speakers and presentations.
If you are interested in attending Education Day 2012 – The Beat Goes On: Healthcare Risk Management Conflicts, Challenges and Changes, visit GHSHRM’s website or click here to register.
Risk management professionals should be familiar with the ECRI Institute (“ECRI”) http://en.wikipedia.org/wiki/ECRI_Institute, a nonprofit organization that uses applied scientific research to assist in establishing best practices to improve patient care. ECRI collaborates with the World Health Organization, the U.S. Agency for Healthcare Research and Quality, and the U.S. Department of Health and Human Services.
ECRI recently published “Top 10 Technology Hazards for 2012”, a brilliantly written practical guide to identifying technology risks at health care facilities. The guide is available as a free download upon on request here.
The guide addresses ten medical technologies that most frequently lead to patient injuries (and in our experience, malpractice lawsuits):
- Alarm hazards
- Exposure hazards from radiation therapy and CT
- Medication administration errors using infusion pumps
- Cross-contamination from flexible endoscopes
- Inattention to change management for medical device connectivity
- Enteral feeding misconnections
- Surgical fires
- Needlesticks and other sharps injuries
- Anesthesia hazards due to incomplete pre-use inspection
- Poor usability of home-use medical devices
Included in the guide are steps for assessing and addressing risks at your facility, including key references. We would recommend it as an excellent starting point for identifying and prioritizing technology risks at your facilities.
A client assignment recently led me to concisely describe what a litigation firm does – the purpose of a trial firm is the successful and efficient management of information.
A client has an issue or event giving rise to litigation. A litigation firm is then tasked with: 1) discovering information about the event; 2) evaluating that information; 3) transmitting information to the client; and 4) using the information to successfully resolve the litigation. Put another way, a trial firm collects the raw data surrounding an incident and organizes and presents it accurately to the client and persuasively to the opposing party and jury.
Clients should evaluate their litigation firms on their ability to carry out these four information-related tasks:
- Did the law firm accurately develop the key information surrounding the event? There should not be facts known to the opposing side which were not timely known by your litigation firm.
- Was the developed information evaluated by the firm correctly? Was the factual information organized and comprehended in a way that proved effective in resolving the case, whether through dismissal, settlement or trial?
- Did the firm deliver to the client a useful description of the case and accurately forecast the outcome? Clients use the case information not only to make decisions on how to proceed but also to make changes in their organization to prevent additional litigation. Most importantly, the client needs to know with a high degree of precision the likelihood of prevailing at trial and the probable jury award. There should be few surprises at the courthouse.
- Was the firm able to use the collected information persuasively with opposing counsel, the judge or a jury to reach the best result? Was the firm able to effectively use the law and the facts of the case to tell a story that was compelling to others?
The information management must meet two additional criteria: it must be timely, and it must be accomplished at a cost acceptable to the client. Good information acquired or developed too late is valueless. Information obtained at excessive cost may not have been worth obtaining.
Whether a litigation firm can excel at the above depends primarily on the quality of the individual attorneys handling the litigation.
