So what history was taken by the doctor before he agreed to implant eight embryos into Nadya Suleman?  He knew that she already had six kids since he was responsible for implanting those embryos earlier which as we know resulted in successful pregnancy and birth.  While the Medical Board of California has charged that he exceeded the limit in implanting eight embryos and the American Society of Reproductive Medicine agrees that implanting over two embryos exceeds the accepted limit, we wonder what responsibility, if any, should this doctor be held to for the moral and mental ability of a single parent being able to handle 14 kids with special needs?  Furthermore, what responsibility should the doctor owe society for burdening the social system with this unprecedented family unit.  Surely, Suleman will never earn enough money in a lifetime to support all 14 kids and quite frankly public perception doesn’t hold favorably for a “Jon & Kate plus 8″ show in America.  That leaves the care for the near bankrupt State of California to provide for this litter of kids. 

Dr. Kamrava may be ”devastated” but he should use this opportunity to self reflect and understand the moral, physical, and mental implications that his choice has created.  He may have been following his patient’s wish but he is the doctor and his job is to consider all factors before taking a patient’s money in exchange for granting her wish.  One would wonder that if a patient were to ask Dr. Kamrava for assistance with suicide would he likewise oblige that patient request?

We invite your opinions on the issue.

http://tinyurl.com/y87ydyr

In North Carolina, 77-year-old Dr. Sunderhaus, an eye doctor was treating a patient who complained that the doctor treated her beyond the bounds of decency when he told her that she was irresponsible for being unemployed, on Medicaid, and for relying on taxpayer money to pay for her pregnancy since she had given birth the year before.  Beyond that, and what apparently caused the Medical Board complaint, the patient reported that the doctor poked her in the thigh and said she was “fat”. 

Next, the plain-spoken doctor, began a letter campaign to defend himself.  He wrote to members of the Medical Board as well as the Governor to explain his actions.  In explaining the poke in the thigh, the doctor explained that Diabetes is the leading cause of blindness in America and that as a physician he needs to advise his patients of possible health issues.  However, his blunt delivery of the point, that “thick glasses wouldn’t make her go blind but that Diabetes and thick thighs would” are the point of contention. 

http://www.newsobserver.com/news/local_state/story/201354.html

The worst that could happen is that the doctor could lose his license over this.  More realistically he will get a public reprimand if the Board decides to do anything at all.  What do you think should happen to Dr. Sunderhaus?  Should he lose his license?  Should the Medical Board penalize him in some way?  Should the Medical Board be investigating this case of apparent blunt discussion and hurt feelings?  Let us know what you think.

~DocbLawg

http://tinyurl.com/yj6rvkc

This is the most difficult of decisions that anyone can make.  While the experts fought over the capabilities and qualities of this child to give the judge the evidence he needed to make an informed decision, the parents were split over the best course for this child.  In the end, it was better that the parents agreed on the course for thier child rather than having an outsider make such a difficult decision. 

DocbLawg

Up until today, we believed that Baby RB had a poor prognosis and would soon die whether or not removed from life support.  However, an article posted today from fellow CMS sufferers causes reflection into the issue.  Some of the CMS “survivors” were also given a “death sentence” through a poor prognosis but they have achieved life and have outlived their life projections.  How does one know that Baby RB won’t outlive all his “critics”? 

To read about the survivors:  http://business.timesonline.co.uk/tol/business/law/article6908060.ece

One thing is certain, while one judge will decide the fate of Baby RB, it will surely not end at this judicial level.  It is likely that the decision will be appealed and while the legal arguments continue, Baby RB will likely decide his own fate.

This fight is going on in Britain where the father of a one-year-old is literally fighting for the life of his son.  The baby, “RB”, has a genetic condition called myasthenic syndrome which causes a disconnect between the nerves and the muscles; this affects the baby’s limbs and breathing.  The baby has been in the hospital since birth and has been on a ventilator.  Unfortunately, the mother and father are separated and they are not united in the fight to keep their son alive.  The mother sides with the hospital who want to remove the life support from the baby. 

According to the father, the child’s mental capacity isn’t diminished.  The baby can see, hear, feel, recognize his parents and play with toys.  The father believes that his son has life quality despite the fact that the hospital says that he doesn’t.  If the court should rule with the hospital and the mother, it will be the first time that the court has gone against the wishes of a parent in deciding life or death. 

What an extremely difficult situation.  Who would you side with father or mother and hospital?  Are outside forces influencing the wishes of the hospital such as the socialized medicine regimen enjoyed by Britain vs. the cost of keeping this baby on a ventilator?  We would like your comments.  

Thanks to AOL for bringing us this important story: http://tinyurl.com/yzc88yk.  AOL is running a poll on the topic which might be of interest to you. 

DocbLawg Comment:  With the memory of Terry Schiavo still in some minds and the rumblings of rationed care proposed by the Government healthcare plan one cannot help but think that this story provides glimpses of what may be in the future of US healthcare.  Some patients will always too expensive to treat; will this lead us down the road of rationed care and futility in medicine?

It seems that this case reflects a financial decision more than a moral decision.  If a moral decision prevailed, the biological father should be able to keep his son alive.  However, should he be able to keep his son alive despite the opposition of the mother and the system?  While the outcome for patients afflicted with myasthenic syndrome is poor, shouldn’t this baby be allowed to die on his own terms.  After all a medical decision was made to put him on a ventilator at birth so that he would have a chance at life.  Now it seems irrational and unreasonable that they intend to remove it, especially since this baby is seemingly aware of life?  Maybe medicine shouldn’t have intervened and allowed him to be put on life support in the first place. 

Many thanks to www.bigworldcentral.wordpress.com for blogging this story.

In particular is the recent sanction by the AAOS (American Association of Orthopedic Surgeons) as against its member Steven R. Graboff, M.D. who is self-described as a “renowned orthopaedic expert witness with over five hundred attorney clients”.  Apparently, Dr. Graboff served as an expert for Plaintiff against Philadelphia orthopedic surgeon Dr. Menachem Meller, a surgeon whom Dr. Graboff had previously criticized and which resulted in a $4 million verdict against him.  The subject case involved care that resulted in the amputation of a patient’s leg.  Dr. Meller filed a complaint against Dr. Graboff regarding his expert testimony.

At issue in the Association’s case against Dr. Graboff was the fact that a preliminary report was used to settle the case when Dr. Graboff had not yet reviewed all the relevant materials.  The attorney admitted to taking Dr. Graboff’s preliminary report, redacted the word “draft” and presented the report as if the final version in order to extract settlement.  Dr. Graboff would not have reached the same conclusions had he reviewed all the materials. 

The story and Dr. Graboff’s response can be found here:    http://tinyurl.com/yk8bro9

DocbLawg Comment - The circumstances of the Graboff case seems to be of the variety that is not usually seen; that the attorney actually admits to the malfeasance.  I was faced with a similar situation years ago when defending a neurosurgical spine case.  The Plaintiffs’ expert had been suspended from the Neurosurgical Association for testifying two different ways in two very similar cases to the extent that his testimony in one case impeached his testimony in the other case.  Unfortunately, the Plaintiffs’ attorney did not know about the suspension until the expert’s deposition.  At that point the expert tried to downplay the entire issue but I was ready with the Associations’ attorney who was more than willing to impeach the testimony of the expert.  That case dismissed (no money being paid in settlement) 1 week before trial and after litigation costs had exceeded $250K.  Attorneys need to be careful when selecting experts because you never know what might be hidden in the closet.

Now, an orthopedic surgeon in Texas has been faced with similar restrictions imposed by the Government.  Apparently, as a surgeon, you cannot refuse service to a patient with HIV or AIDS.  In this case, the doctor referred the patient to another doctor who was 200 miles away which imposed a burden on the patient who needed treatment.  This was apparently due to the patient’s HIV positive status.  Would the same restriction would be imposed if the patient was referred to an alternative doctor who was just 1 mile away?  Doctors cannot choose their patients.  They have a moral and ethical duty to treat anything that comes through the door so long as their training is compatible with the care being sought. 

While I do feel for patients with limited access to specialists, physicians should be entitled to some choice in whom he/she treats.  Now I am not convinced it was appropriate to refer the patient 200 miles out of town; there must have been another medicare orthopedic surgeon in Austin who could have cared for this patient.  However, I believe that some latitude and free choice should be given to any professional to select his or her patients, clients, customers, etc. 

~ DOCBLAWG

http://tinyurl.com/yk7kyh6

Now you might think that I made this one up but unfortunately it is true.  The plaintiff, an angry, unattractive, obese female went to an OB/GYN for a gynecological issue.  Unfortunately for the Doc, the plaintiff needed an endometrial biopsy due to her past history and complaints.  As the doctor performed the biopsy the plaintiff went crazy, she stood on top of the table screaming with the tools of the trade still inserted.  The doctor was able to get the plaintiff calm enough to remove the goods but it was the beginning of a set of very weird circumstances.

After the “incident” the plaintiff started a campaign of harassment of the doctor and the office staff.  She claimed that the doctor stole her parts during the procedure and that she wanted them back.  She would call first asking and then screaming for the return of her parts.  Then she started drawing 3-D depictions of the parts that she thought were stolen.  She believed the doctor had saved the parts in a glass jar and was deliberately keeping them from her. 

Our office became involved when the plaintiff filed her own lawsuit against the doctor.  At that point the plaintiff started calling and harassing our office.  She was leaving threatening messages on our voice mail.  She would send the 3-D pictures to us and would call pretending to be our client or her office staff.  She would show up unannounced and would threaten our staff.  We finally got law enforcement involved and, believe it or not, the officer’s name was Jose Quervo. 

Through the discovery process we learned that our Plaintiff was known to law enforcement and other hospitals.  At one point she left a hospital ER after becoming dissatisfied with the care and walked down the street wearing nothing but her cardiac electrodes.  Good thing it was the middle fo the night.  She was placed on a mental health hold for that stunt. 

We deposed other physicians who had examined her and found that everything was in order; they even tried to show the Plaintiff that she was okay but she still did not believe them.  Some of them referred her to special plastic surgeons for consult on “reconstructing” her private concerns.  It was never shown that she went to any of the referred doctors.  All and all it was never proven that anything was amiss. 

Like many of these types of cases, it was ultimately dismissed by the court.  Of course she attempted to appeal but that was thrown out as well.  She faded into the sunset. 

Recently I learned that she was suing yet another group of doctors for some other negligent treatment.  When we litigated the case we left a plethora of information in the court file, the threats, samples of her writings, etc., all of which are public record.  Hopefully, the  new group of doctors being sued have attorneys who will pull our file and review exactly what they are dealing with.  Good luck.

DOCBLAWG

The parents contend that the patient, Kerrie Wooltorton, was depressed and was infirm and could not make a reasonable decision.  Apparently, Ms. Wooltorton suffered from depression believed to be linked to a disease that made her infertile.  However, the coroner conducting an inquest into the death did not agree.  He ruled that Ms. Wooltorton was of “sound mind” and that any attempt to disregard her wishes by the physicians would have been unlawful. 

While the parents have said that no amount of money will bring back their daughter, they hope to save other families the grief they have suffered by getting the law changed concerning living wills or advanced directives.  The law provides for seriously ill patients to opt out of receiving treatment and instead receive only comfort care.  This was the first time that the law was used by a suicidal patient. 

http://tinyurl.com/ydkyntp

DOCBLAWG COMMENT:  A very interesting case and twist on the Hippocratic oath.  When does a physician draw the line in listening to the wishes of a patient?  While the wishes of Ms. Wooltorton were seemingly appropriate she obviously had some mental issues with her repeated suicide attempts and inpatient mental health care within a year of her death.  It is a very sad case indeed.