Medical Malpractice Attorneys
  • Toll Free 1-800-529-9120
  1. Malignant Melanoma and Medical Malpractice

    Posted by Dr. Larry Leichter on April 15, 2018.

    Each year, approximately 69,000 people in the United States will be diagnosed with malignant melanoma of the skin. As a disease that commonly affects young patients, malignant melanoma causes more lost life expectancy per death than almost every other cancer.  When diagnosed at an early stage, the prognosis for melanoma is quite good.  According to the Joint Committee on Cancer, when the lesion is deeper than 4 millimeters, or nearby lymph nodes are enlarged due to the melanoma, the prognosis for survival is  significantly diminished, especially when the outer layer of skin is ulcerated.

    iStock_000005950192Large-1.jpg

    Allegations in a melanoma malpractice case may include a clinician’s failure to adequately biopsy a suspicious mole and/or improper interpretation of the biopsy by the pathologist.  Errors by the clinician include a biopsy of inadequate size (as is sometimes seen with shave and punch biopsies), a biopsy that has crush artifact, or the chosen  biopsy site does not adequately represent the lesion.  The ideal biopsy (if clinically practical) is when there is complete excision of the lesion surrounded by 2-3 millimeter margins of adjacent normal skin.  Errors by the pathologist include mishandling of the biopsy specimen and/or misinterpretation of the study.  Pathology reports that imply certainty on suboptimal biopsies may result in an unfortunate and deadly delay in diagnosis.

    Communication of the patient’s history to the pathologist is sometimes essential to avoid a wrongful diagnosis in the lab.  It is not uncommon for an experienced clinician (knowing the history of a patient’s suspicious mole) to request step level analysis of the biopsy to make sure that deeper tissue levels are  studied for melanoma.  Another excellent practice is when a pathologist obtains an additional opinion or a second signature on the pathology report in an attempt to reach a proper diagnosis.

    For additional facts, statistics, events and support groups related to melanoma, please see the American Melanoma Foundation.


  2. Deep Venous Thrombosis and Medical Malpractice

    Posted by Dr. Jack Sacks, Esq.on March 28, 2016

    Deep venous thrombosis is the development of a blood clot in the large, deep veins of the lower leg and thigh. Thrombi can cause tissue injury due to vascular occlusion or distal embolization. However, venous obstruction can be offset by collateral blood vessels. Thrombi can also cause local pain and edema due to the blockage of blood flow. If the clot breaks off and travels through the blood, it is referred to as an embolism. An embolism can become trapped in the brain, lungs, or heart leading to major injury. Pulmonary embolus (PE) is a common complication and life threatening if not treated quickly with anticoagulants. PE presents with shortness of breath, chest pain, and cough with blood in sputum.

    iStock_000012053156XSmall.jpgDVT can occur with stasis or in hypercoaguable states. It is commonly seen following trauma, surgery, or burns, which contribute to decreased physical activity, damage to vessels, and release of procoagulant substances from tissues. Reduced physical activity causes a decline in the milking action of lower leg muscles and slows venous return. Risk factors for DVT include advanced age, bed rest, immobilization, smoking, birth control pills, family history of blood clots, fractures in the pelvis or legs, giving birth within the last 6 months, heart failure, and obesity.  To prevent DVT, patients should move their legs during long flights or when they are immobile for long periods of time.

    Although many DVTs are asymptomatic, they can recur. Some individuals suffer from post-phlebitic syndrome, which involves chronic pain and swelling in the leg. The major symptoms of DVT include changes in a patient’s leg such as redness, increased temperature, pain, and tenderness. Diagnosis is based on the physical exam, which should demonstrate a red, swollen leg. Diagnostic tests include a D-dimer blood test along with other blood tests to check for hypercoagulability such as activated protein C resistance, anti-thrombin III levels, antiphospholipid antibodies, and genetic testing for mutations with a predisposition towards blood clots. Imaging studies of the legs include Doppler ultrasound, plethysmography, and radiography.

    The primary treatment for DVT is anti-coagulants, also known as blood thinners. They prevent the formation of new clots and the growth of old clots. However, they cannot dissolve existing clots. Patients are more likely to bleed on these medications. Heparin is an IV administered anticoagulant given in a hospital setting.  Warfarin (Coumadin) is an oral anticoagulant that takes several days to work; thus, Heparin cannot be stopped until Warfarin is functioning at an effective dose for a minimum of two days. Many patients wear pressure stockings on their legs to improve blood flow and decrease their risk of DVT.  When medications are ineffective, patients may need to undergo surgery. A filter can be placed in the body’s largest vein to prevent thrombi from migrating to the lungs. Also, surgery may be necessary to remove large thrombi.


  3. Meningitis and Medical Malpractice

    Posted by Dr. Jack Sacks, Esq.on March 28, 2016

    Meningitis is inflammation of the meninges, the membranes that cover the brain and spinal cord. It is commonly caused by infection, but other causes include chemical irritants, drug allergies, fungi, and tumors. Based on the clinical evolution of the illness and the type of inflammatory exudate present in the cerebral spinal fluid (CSF), infectious meningitis is categorized into acute pyogenic (usually bacterial), aseptic (usually viral), and chronic (usually tuberculosis, spirochetal, cryptococcal).

    iStock_000003651637XSmall.jpg

    Early diagnosis is essential for bacterial meningitis because it can result in death or brain damage if left untreated. In bacterial meningitis, a correlation exists between bacterial organism and age. The most likely organism in neonates may be Escherichia Coli or group B Streptococci. In the elderly, it may be Streptococcus Pneumonia or Listeria Monocytogenes. In young adults, it may be Neisseria Meningitides. In contrast, most viral infections are due to enteroviruses but only a small number of people who develop enteroviral infections present with meningitis. Other viral infections that can cause meningitis include mumps, herpes virus, measles, and influenza. Chronic meningitis can be caused by pathogens such as mycobacteria and spirochetes. Thus, medical attention is necessary to differentiate between bacterial, viral, and chronic meningitis.

    Risk factors include individuals over the age of 60 or below the age of 5, diabetes mellitus, renal or adrenal insufficiency, hypoparathyroidism, cystic fibrosis, immunosuppression, HIV, crowding (military recruits and college residents), recent exposure to those with meningitis, etc. The symptoms have a rapid onset and include fever, chills, mental status changes, nausea, vomiting, photophobia, severe headache, and meningismus (stiff neck). Additional symptoms include agitation, bulging fontanelles, decreased consciousness, tachypnea, poor feeding or irritability in children, and opisthotonos (unusual posture, with head and neck arched backwards).

    To confirm a diagnosis, a lumbar puncture (spinal tap) should generally be performed on anyone suspected of meningitis to sample and culture the CSF for abnormal cell counts, glucose, and protein. Other diagnostic tests include blood culture, chest x-ray, and MRI or CT scan of the head. The underlying cause of the meningitis needs to be determined to administer proper treatment and define the severity of each case. Unlike bacterial meningitis, viral meningitis usually does not involve treatment and patients generally recover within two weeks; however, in certain instances (such as with the herpes simplex virus) antiviral medications may be indicated.

    Antibiotic treatment for bacterial meningitis is dependent on the underlying bacterium. By treating the most common types, the risk of dying is reduced to below 15%. Symptoms such as brain swelling, shock, and seizures are treated with other medications and intravenous fluids. Possible complications of meningitis include brain damage, subdural effusion, hearing loss, hydrocephalus, and seizures. To prevent contraction of meningitis, the meningococcal vaccination is recommended for populations at risk.


  4. Oral Cancer and Medical Malpractice

    Posted by Dr. Jack Sacks, Esq.on March 26, 2016

    Oral cancer is the uncontrollable growth of cells that invade and inflict damage in areas involving the lips, tongue, cheek lining, floor of the mouth, gingiva, and palate. Men are twice as likely to have oral cancer, specifically men over the age of 40. Risk factors include smoking/tobacco use; heavy alcohol use; chronic irritation from rough teeth, dentures, or fillings; human papilloma virus infection; family history; excessive sun exposure; taking immunosuppressants that weaken the immune system; and poor oral hygiene. Oral cancer can present with a sore, lump, or ulcer in the mouth that initially is painless; however, as the cancer progresses it may evolve into a burning sensation or pain. The area may appear pale colored or it can be dark and discolored. Other symptoms include dysphagia (difficulty swallowing), odynophagia (painful swallowing), chewing problems, speech difficulties, lymphadenopathy (swollen lymph nodes), and weight loss.

    iStock_000018882292XSmall.jpg

    To diagnose oral cancer, your physician or dentist will examine your oral cavity and if a suspicious lesion is identified then an oral brush biopsy may be performed. The test is painless and involves isolating and analyzing a small sample of tissue for abnormal cells. However, if the lesion is more concerning then a scapel biopsy is recommended to determine whether the area is malignant or benign. X-rays and CT scans may be utilized to determine if the cancer has metastasized. Other tests that may be conducted include endoscopy, barium swallow, or PET scan. 90% of oral cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that line the lips and oral cavity. Squamous cell carcinoma often develops in areas of leukoplakia, white patches of cells that do not rub off. Other types of oral cancer include adenocarcinoma, lymphoma, melanoma, or teratoma.

    If oral cancer is not diagnosed early, it can be life threatening. Treatment is dependent on the stage of the cancer which is determines by tumor size, lymph node involvement, and metastatsis. Surgery is recommended if the tumor is small enough and has not spread to the lymph nodes. Complications of surgery include disfigurement of the face, head, and neck. Often surgery is combined with radiation. Complications of radiation include dry mouth and dysphagia. When dealing with larger tumors, chemotherapy is recommended. Speech therapy is also essential to improve and retain movement, chewing, swallowing, and speech.

    Depending on the presentation of the oral cancer, approximately 50% of individuals with oral cancer may survive greater than 5 years following diagnosis and treatment. If the cancer is identified early before significant metastasis, then the cure rate may be almost 90%; nevertheless, the majority of oral cancers have metastasized prior to diagnosis. One in four individuals with oral cancer will die due to delayed diagnosis and treatment. To prevent oral cancer, individuals should avoid smoking/tobacco, moderate or avoid alcohol use, and practice good oral hygiene.


  5. Advanced Diagnostic Imaging for Acquired Brain Injury

    Posted by Dr. Jack Sacks, Esq.on March 22, 2016

    One of the first steps in evaluating brain injury is diagnostic imaging. Imaging refers to various methods of viewing the structures and processes residing in the brain. Some of the more familiar modalities are CT (or CAT) scans, which use X-rays to evaluate intracranial structures. MRI, Magnetic Resonance Imaging, uses magnetic fields to illustrate the brain. However, in cases of traumatic brain injury (TBI), more advanced methods may be needed for proper diagnosis.

    iStock_000000113655XSmall.jpg

    An MRI machine can use special software to perform a brain scan called Diffusion Tensor Imaging (DTI). This scan detects the diffusion of water across brain cells and highlights certain areas that may be associated with injury. These injuries may not be apparent on conventional MRI’s.

    PET scan (Positron Emission Tomography) measures uptake and metabolism of glucose from a small radioactive “tagged” sample injected into the patient.  The scanner monitors this sample as the brain utilizes it. The metabolic uptake and usage may differ in patients who have suffered a brain injury. This helps define the extent and type of injury.

    In SPECT (Single Photon Emission Computed Tomography), the tagged sample is not absorbed or utilized in the brain cells. Instead, it remains in the blood stream and demonstrates the blood movement or perfusion through the brain. Areas of brain injury or damage may not have normal blood flow so the SPECT scan helps define these areas.

    Brain injuries can result from medical malpractice. A baby may suffer birth trauma during labor and delivery. A child may have a concussion or sports injury misdiagnosed or improperly evaluated by a physician. An individual injured in a car accident may not have the indicated testing done by the emergency room. Although scientific progress in imaging studies has improved the ability to diagnose and evaluate brain injuries, these tests need to be utilized in the appropriate situations so patient results and outcomes can improve.


  6. Pulmonary Embolism and Medical Malpractice

    Posted by Dr. Jack Sacks, Esq.on March 20, 2016

    Pulmonary embolism (PE) is a life threatening condition that affects over 600,000 people per year in the United States. Through the use of modern diagnostic tools such as multislice spiral CT and advancements in treatment, the mortality rate of PE has been reduced in recent years.

    iStock_000000529518XSmall.jpg

    PE involves a blockage of an artery in the lungs from a clot that has traveled through the bloodstream from another part of the body. Usually the clot begins in the deep veins of the legs where it is referred to as deep vein thrombosis or DVT. The risk of PE increases during periods of immobilization such as long plane flights, surgery, pregnancy, and with conditions such as cancer and obesity. Additionally, estrogen based hormonal contraception (birth control) may increase the risk of PE.

    Signs and symptoms of PE may include chest pain, shortness of breath, abnormal EKG (such as inverted T-waves), rapid heart rate, and increased respirations. PE may be preceded by leg pain due to DVT. A low grade fever may be present as well as a cough or hemoptysis (coughing up blood). If PE is suspected, a D-dimer blood test should be performed which measures the level of specific clotting related protein fragments in the blood.  The D-dimer test can help rule out PE if the blood test comes back within normal limits. However, If the D-dimer blood test comes back elevated for suspected PE, then radiographic imaging is indicated.

    When available for imaging, the multi-slice spiral CT is favorable because it is non-invasive and is highly predictive of PE. If the patient has leg pain or other signs of DVT, then a ultrasound (doppler) of the veins in the legs may be performed as there is a high correlation between DVT and PE. But a negative leg doppler does not rule out PE. Other studies to help diagnose PE include include ventilation perfusion scanning and CTPA (CT Pulmonary Angiography-with contrast).

    Treatment for PE depends on the severity or size of the blockage. For severe cases that are emergent, thrombolysis may be the preferred treatment- this involves the administration of clot busting medication such as tPA. In specific situations of severe emergent PE, surgery (embolectomy) may be an option to remove the clot. In most cases of PE, anticoagulants such as heparin and warfarin are started early as possible and used to treat the condition. Heparin or LMWH (low molecular weight heparin) are typically given initially followed by warfarin.  When indicated, an IVC filter may be placed in the patient to help prevent further clots from forming in the arteries of the lungs.


  7. Shoulder Dystocia May Cause Erb’s Palsy or Brachial Plexus Injury

    Posted by Dr. Jack Sacks, Esq.on March 15, 2016

    In the typical birth of an infant, the baby arrives head first, followed by the shoulders and the rest of the body. However, in certain circumstances, the head delivers but the shoulders cannot fit through easily. This is called “shoulder dystocia” and can be an obstetrical emergency. The umblilical cord may be compressed inside the birth canal which can have grave consequences for the baby if this situation is not quickly remedied.

    iStock_000014328103XSmall.jpg

    One risk factor for shoulder dystocia is macrosomia, or large size of the baby. There are several well recognized risk factors for this. Maternal obesity may play a role. Moms with diabetes also have a higher incidence of having large babies.  In order to help minimize the incidence of these conditions special attention should be paid to mothers with these risk factors during prenatal care. Diabetes screening and management should be carefully monitored. Sonograms and fetal measurements can help with estimates of the baby’s weight. If a shoulder dystocia develops during labor, there are special steps that can be taken at that critical time to try to deliver the baby in the least traumatic fashion.

    Sometimes nerve injuries can occur in infants who have suffered a shoulder dystocia, one such unfortunate condition is called “Erb’s palsy.” In this condition, the baby has a paralysis of the arm and/or hand due to nerve damage to the brachial plexus of nerves. While some infants may improve or recover without additional treatment, many may need special procedures and even surgery to recover some function.

    Medical malpractice can arise in situations where the mother has not been properly screened for gestational diabetes, or the diabetes was not properly managed. There are situations where test results may have indicated an excessively large baby but a C-Section was not done or offered. Also, the proper precautions or techniques may not have been used during labor with a shoulder dystocia and nerve damage or Erb’s palsy may have resulted.


  8. Brain Injuries and Birth

    Posted by Dr. Jack Sacks, Esq.on March 01, 2016

    The brain is responsible for higher motor and sensory functions. It requires a constant source of oxygen in order to continue its vital functions. When the flow of oxygen is interrupted, the consequences can be devastating.  Severe injury can occur when the brain lacks the oxygen needed to continue functioning. A total lack of oxygen can be referred to as “anoxic” injury whereas a partial lack of flow can be referred to as “hypoxic” injury.

    Brain injury can occur in an unborn baby if the flow of oxygen from the mother’s circulation to the baby’s is interrupted. This can happen from a number of causes. For example, the placenta can become partially detached from the wall of the uterus (placental abruption), which can interrupt the flow of oxygen to the baby. This complication can arise in pregnant patients with untreated or inadequately treated high blood pressure. Close monitoring of mother and baby, along with timely delivery and/or C-Section when needed can prevent these complications.

    iStock_000000195410Large.jpg

    Excessive contractions of the uterus (sometimes called “uterine hyperstimulation” or “tetanic contractions”) from labor, or from medicines used to accelerate labor, like pitocin, can cause problems with the baby’s oxygen supply. The rapid, powerful contractions of the uterus can prevent maternal oxygen from reaching the baby. If the flow of oxygen to the baby is interrupted, hypoxic or anoxic brain injury can occur. The consequences of this can be severe and may include seizures, brain damage, developmental delay, cerebral palsy, and other problems with motor or cognitive functions. Use of medications like pitocin must be closely monitored by dosage and effect on the mother and baby. If contractions are too strong or too frequent, the dosage may need to be decreased, the medicine may need to be stopped entirely, or special medication to reverse the effects may be given.

    Brain injuries may occur in infants, children, and adults. Stroke, cardiac arrest, or choking can all interrupt the flow of oxygen to the brain. Patients who are undergoing surgery, or are in an intensive care unit in a hospital often have their oxygen levels monitored to be sure they are getting a sufficient supply. If they are not properly monitored or complications occur, hypoxic or anoxic brain injuries may result.

    Medical malpractice that results in brain injury is devastating for the victim as well as families and loved ones. The extent of disability from hypoxic or anoxic brain injury varies greatly, but many people require extensive care and rehabilitation to regain function and improve their quality of life.