Massachusetts Teaching Hospitals May Commit More Medication Errors In July

According to a recent article published in the Journal Of General Internal Medicine, fatal medication errors spike by ten percent during the month of July, part of the so-called “July effect.”
The journal article, which drew upon data from 1979-2006, finds a statistically significant increase in the number of fatal medication errors during the month of July. What is the culprit for the so-called July effect?
The study’s authors suggest that it may be that July is the month when new doctors begin their residencies. Younger, more inexperienced residents may be more likely to commit medical errors.
The article attempts to rule out some alternative hypotheses. For example, one might think that the number of medication deaths would naturally spike during the summer because more people are consuming alcohol during the summer and alcohol has a number of adverse interactions with prescription drugs.
However, the study’s authors discount this hypothesis because the July effect does not extend to the summer month of August. It holds true only in July – the month when new residents begin their training.
What can be done to reduce medication errors? I’ve previously blogged about a journal article showing how the implementation of checklists reduced medication errors by nurses. Following such medication checklists could also be beneficial for residents and doctors.
Teaching hospitals can also do a better job of supervising their residents during their first month on the job. And patients can be aware of the fact that the residents they encounter in July may be new to the job.

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Supreme Lawyers? Supreme Judges?

Supreme-Court.jpgOne of my favorite recurring features on Eric Turkewitz’ New York Personal Injury Law Blog is his vetting of Supreme Court nominees. During the underwhelming Sotomayor nomination, he sniffed out some ethical issues about the billing of her firm as “Sotomayor & Associates,” when there were, in fact, no associates. (You’ve got to wonder what Congressional aides are doing when Eric, while running a private practice, manages to run through Sotomayor’s questionnaire and issue-spot the problem areas before you hear anything from Capitol Hill about it).
Anyways, this week came his vetting of Supreme Court nominee Elena Kagan. What jumped out at me were two sentences from Eric’s summary of Kagan’s response to the Senate Judiciary Committee’s lengthy questionnaire: “She concedes never having tried a case to verdict. That wouldn’t be so bad, of course, if the high court had other individuals who had done so for private individuals.”
It may come as a surprise to most non-lawyers, but a good deal of your appellate court judges have never tried a case. That wasn’t news to me but I was a little taken aback by the fact that none of our current Supreme Court has ever tried a case for an individual client.
Going back in my mind, the most recently appointed justice whom I know to have tried a case is Lewis Powell, who was nominated in 1971. (The political backstory to Powell’s nomination is told in Bob Woodward’s indispensable The Brethren).
In April, law professor Orin Kerr penned this very funny post about “Obama’s Diverse Shortlist” of Supreme Court nominees. As Kerr noted:
No matter who he chooses, Obama will continue to break new ground, or at least help bolster some of the low numbers of people of certain arguably underrepresented backgrounds on the current Court. For example, Elena Kagan would become only the second former Harvard professor presently on the Court (joining Justice Breyer). Either Kagan or Wood would be only the second Chicago professor (joining Justice Scalia). Further, Merrick Garland would be only the second Justice on the Court who went to Harvard College; then Harvard Law School; then clerked for Henry Friendly; then clerked at the Supreme Court; and then worked at DOJ and was a partner at a big DC law firm before serving on the DC Circuit (joining Chief Justice Roberts).
Elena Kagan would also bring notable educational diversity to the Court. Kagan would be the very first Justice ever to have attended Princeton and then Harvard Law. Obviously, that would be a major break after two consecutive nominees who had attended Princeton and then Yale Law (Justices Alito and Sotomayor). Whoever Obama picks, I think it’s clear that Obama faces a major choice and that his selection will be a historic occasion.

The lack of diversity in Supreme Court nominees’ legal credentials can, at times, be funny, but it’s also a serious issue. Appeals court judges apply a variety of legal doctrines to avoid having to reach the merits of arguments that are before them. For example, they’ll say that an appealing party waived the right to make an argument on appeal by not sufficiently objecting at the trial court level, or by failing to renew the objection at the proper time.
Sometimes these legal rules make sense. After all, if you could raise any new argument on appeal, trial lawyers would be incentivized to go with their strongest argument and to keep other arguments as “fallbacks” to raise on appeal if they lose at trial. No one would want that inefficient system.
But….enforcing these doctrines requires a certain bit of empathy and a certain bit of discretion. And if the appellate judge has never stood in a trial lawyer’s shoes and known the chaos, the distractions of trying a case to a jury, that understanding may be lacking.
Kagan deserves to be confirmed because she is the President’s choice and she is a capable legal mind within the legal mainstream. But someday perhaps we might benefit from a re-envisioning of the qualifications for the Supreme Court.

More Intellectual Dishonesty (And Callousness) From The Tort Reform Crowd

I’ve blogged previously about how misleading some of the blog posts on tort reform websites are – how their synopses of cases get it all wrong. This is doubly true when you see a link roundup of cases on one of these websites – one sentence summaries of cases followed by links.
The latest instance of this sort of dishonesty that I’ve come across was in a Point Of Law roundup post of May 17. The post contains the following precis of a case: “$28 million in punitive damages for bedsore in Sacramento.” Really, Point of Law? You’re better than that. Or at least you should be.
Having read The Pop Tort‘s coverage of the nursing home verdict a few days earlier and followed Point of Law‘s post through to its links, it’s obvious that this $28 million dollar punitive award was not for the bedsore: it was for a wrongful death. So far as the news reports tell it, the case concerned a seventy-nine year old woman who fell and fractured her hip in a nursing home operated by a company that had previously been cited for understaffing and patient neglect. The woman then developed an untreated bedsore that became infected and resulted in her death.
Hmmm….so is it $28 million for a bedsore or $28 million for a corporation’s killing an elderly woman through its “malicious, fraudulent and oppressive” business practices?

New Research Shows More Children Are Swallowing Tiny “Button Batteries”

lithium_button_battery_danger.JPGTwo new research articles published in the research journal Pediatrics are drawing attention to an unintended consequence of advances in battery technology: more children are swallowing the batteries as the batteries grow smaller. The journal articles published in Pediatrics reveal a sevenfold increase in the number of children who ingested batteries between 1985 and 2009.
One of the most worrisome aspects of this phenomenon is that, unless the parent sees the child swallow the battery, the health problems related to swallowing the battery may go misdiagnosed. One infant who swallowed a button battery was initially diagnosed with an upper respiratory infection. Eventually, an x-ray administered to check for pneumonia turned up the button battery. Surgeons removed the button battery from the child’s esophagus and the child was discharged. However, the chemicals in the battery had burned through the child’s esophagus, causing a fatal aortic rupture shortly thereafter.
While small batteries are here to stay, one of the most outrageous aspects of this danger is how manufacturers have not taken steps to child-proof the batteries. One thirteen month old apparently had the manual dexterity required to remove a button battery from the remote control for her parents’ iPod docking station. Hopefully, products liability litigation will lead to a redesign of either these small batteries or (more probably) the shells of the devices that contain them. When an infant not capable of neither walking nor talking can extract a twenty-millimeter battery from a remote control, there is a serious design defect with that product.

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