Halifax Medical Malpractice Lawyer Blog

The recent series of C-Difficile infections in Cape Breton hospitals has brought some media attention to the problem of Hospital Acquired Infections.

I was doing some research on a case and came across information of a new antibiotic resistant "Superbug" that is being found in hospitals.

Carbapenem-Resistant Klebsiella pneumonia or CRKP is an antibiotic-resistant organism that can cause infections in health care settings like hospitals and nursing homes. The bacteria is often associated with pneumonia, bloodstream infections, wound or surgical site infections, and meningitis.

High Mortality

Patients infected with the bacteria have a very high risk of mortality (death). Previous outbreaks have had a mortality rate of up to 35%.

Limited Treatment Options

The CRKP pathogen is an enterobacteria, in the same family of bacteria as E. coli which als has a high mortality rate. CRKP is usually treated with the antibiotic colistin, or a similar drug. However colistin is so strong it is often toxic to patients.

So far CRKP has only been found in healthcare facilities. Unlike C-Difficile and MRSA and other superbugs, the organism has not spread into the community in general.

What Can You Do To Protect Yourself?

Take a look at my previous post for tips on protecting yourself from Hospital Acquired Infections like CRKP, C-Difficile, and MRSA.

C- Difficile Infections kill 4 in Cape Breton Hospitals

Biggest Hurdle?

The biggest challenge a plaintiff in a medical malpractice case usually faces is proving, on the balance of probabilities, that the defendant’s actions (or inaction) caused the plaintiff’s injuries.

Biological vs. Legal Cause

A recent case from the House of Lords in the United Kingdom examines the issue of causation in a wrongful death case and discusses the difference between the “biological cause" of death or injury and “cause in law”.

Although the decision is not binding on the courts here in Canada, the reasoning in the case is helpful for anyone who has to deal with the issue of causation in medical malpractice cases.

In Sienkiewicz v. Greif the court had to consider whether exposure to asbestos caused the death of Enid Costello.

Lord Phillips stated at paragraph 6:

“Methods of Proving Causation

Most claims for death or personal injury result from accidents. In such cases the cause of death or personal injury will seldom be in issue. A body of knowledge which I shall call “medical science” will enable a witness, expert in that science, to describe the precise mechanism by which the accident brought about the death or injury. I shall describe this as the “biological cause” of death or injury. It is sometimes referred to by the more general description of the “cause in fact”. In some cases, however, medical science will not yet have identified the precise mechanism by which an injury gives rise to a particular physical consequence. In such cases it may be possible to deduce that there was a causative link between the two by evidence of what usually happens. Epidemiological evidence that a particular injury or disease usually follows a particular type of bodily insult may enable a court to conclude in a particular case, on balance of probability, that the former was caused by the latter. “Post hoc ergo propter hoc”. A finding of causation based on such evidence is sometimes described as “the cause in law”.”

Lord Phillips’ decision examines the rule of epidemiological evidence in wrongful death cases and discusses whether proof that the defendant’s actions “doubled the risk” of death is the same as proving on the balance of probabilities that the defendant’s actions caused the plaintiff’s death.

Doubling the Risks

The court explained the "doubles the risk" test as follows:

“The “doubles the risk” test is one that applies epidemiological data to determining causation on balance of probabilities in circumstances where medical science does not permit determination with certainty of how and when an injury was caused. The reasoning goes as follows. If statistical evidence indicates that the intervention of a wrongdoer more than doubled the risk that the victim would suffer the injury, then it follows that it is more likely than not that the wrongdoer caused the injury.”

Lord Phillips concluded that:

“Where there are competing alternative, rather than cumulative, potential causes of a disease or injury … I can see no reason in principle why epidemiological evidence should not be used to show that one of the causes was more than twice as likely as all the others put together to have caused the disease or injury.”

Epidemiological Evidence and Causation

The court eventually went on to reject the epidemiological evidence with respect to causation in the plaintiff's case. However, the case does provide helpful direction to plaintiff medical malpractice lawyers who want to use epidemiological evidence to prove causation in medical malpractice claims.

Cape Breton District Health Authority has stated that 21 patients in two Cape Breton Hospitals have tested positive for the bacteria C. difficile. Four people have died as a result of the infections.

Hospital Acquired Infections a Deadly Problem

Nosocomial infections (Hospital acquired infections) are the fourth largest killer in Canada.

This isn't a new problem. Ontario's Auditor General released a study three years highlighting the concerns about the increasing frequency and dangers of hospital acquired infections.

Thousands of Canadian Patients Die Each Year

Each year, 220,000 - 250,000 hospital acquired infections result in 8,000-12,000 deaths.

The two most common types of Hospital acquired infections are MRSA, short for methicillin-resistant Staphylococcus aureus and C. Difficile.

C. Difficile Infections

C. Difficile is a bacteria spread by touching a surface or skin that is contaminated with fecal matter.

It appears the recent deaths are due to a new more virulent strain that has been found in Canadian hospitals over the last two years.

Hospital Infections are Preventable

The Centers for Disease and Prevention Control (CDC) estimates that over 2 million hospital acquired infections occur annually in the United States and are responsible for 90,000 deaths.

Not all these infections are the resut of negligence. But , Betsy McCaughy, the founder and chair of the non-profit patient safety organization Committee to Reduce Infection Deaths, says that "the evidence is overwhelming that nearly all infections are preventable."

The most shocking (or saddest fact) is that according to CUPE (the largest nurses union in Canada) thirty to fifty per cent of these hospital-acquired infections are preventable!

Hospital Infections Lead to Malpractice Claims

I am currently representing the family of a young man who died from an infection he developed after he was admitted to hospital. In the course of researching this case I learned that every year approximately seven percent of Canadian hospital admissions—an estimated 222,000 Canad­ians—pick up an infection while in hospital. About 8,000 of them die.

"How Can I Protect Myself?"

There are 3 things you can do to protect yourself Hospital Acquired Infections

1. Ask hospital staff to disinfect their hands before touching you. Keep an alcohol-based sanitizer in your room to make it easy for them. They are supposed to do this automatically, but studies have shown that only 40 per cent of health-care providers in Canada properly washing their hands.

3. Ask for hospital tubes to be removed shortly after surgery, or avoid having them when it's possible. because they are invasive, I.V.'s or feeding tubes are a major source of infections.

4. Leave hospital as soon as you can to go home. Unfortunately, hospitals are dangerous places.

Continue reading " Nova Scotia Medical Errors: C- difficile Infections kill 4 in Cape Breton Hospitals " »

My colleague, Ches Crosbie recently posted about an American Journal of Obstetrics and Gynecology report that studied medical charts for more than two millions births in California over a 14 year period. According to the study children born between the hours of 10 PM and 4 AM were 22% more likely to develop cerebral palsy.

Ches suggested:

Hospitals already have issues with staff shortages and fatigued workers, so it makes sense to me that these problems might be worse during the "graveyard shift".

I couldn't agree more. See for example Distractions & Interruptions Lead to Nursing Errors.

Ches's link reminded me of an article I posted about last year:
Beware the July Effect:Hospital Deaths Spike in Summertime

Teaching hospitals experience higher rates of medical errors and deaths in the summertime, when medical students start their hospital training.

Night time or summertime; when medical or nursing staff are tired, over worked or inexperienced, it can only lead to more medical errors.

In 2001 Spencer Sullivan had elective surgery for neck and back pain at the University of California San Francisco Medical Centre. The surgery went well and there were no complications.

Negligent Nursing Care

But while Sullivan was in the hospital recuperating his nurse, Rose McKenzie, gave him two different types of pain medication without checking with the doctors who were in charge of Sullivan’s care. McKenzie then failed to monitor Sullivan throughout the night.

Severe Brain Injury

The next morning Sullivan was unresponsive and suffered a severe brain injury and quadriplegia. Sullivan’s family sued McKenzie and the hospital and in 2005 settled out of court for $6 Million.

Nursing License Revoked

In 2008 the State of California revoked McKenzie’s nursing license for gross negligence.

Working in Canada

But since 2002 McKenzie has been working as a nurse in Ontario at Oakville Trafalgar Memorial Hospital. Until recently she was in good standing with the College of Nurses of Ontario.

Communication Critical

In Canada, doctors are regulated by their provincial College of Physicians and Surgeons. If a provincial College makes a disciplinary finding that affects the license of a doctor, the College notifies all regulatory bodies in Canada and the United States.

Nursing Organizations Don't Talk to Each Other

Incredibly, the regulatory bodies that license nurses in North America do not have any standard practice for sharing information regarding disciplinary offences against nurses!

In Canada nurses are required to self report to their provincial licensing body if they are being investigated for professional negligence or misconduct.

They are also expected to report any findings against them.

But there does not appear to be any system in place to check to make sure that nurses actually tell the College of Nurses when they have been disciplined.

The various provincial nursing bodies also don’t have a system in place to communicate with one another when a nurse transfers from one jurisdiction to another.

So a negligent nurse like Rose McKenzie can nearly kill someone, leave them paralyzed, lose her license to practice...and then just move to Canada and carry on treating patients.

Continue reading " Negligent Nurse Who Lost License Still Working in Canada " »

There is an old saying that a lawyer who represents himself has a fool for a client.

But what do you call a patient who diagnoses himself? "Dangerous." At least according to Dr. Ross Upshur, a University of Toronto scientist and Canada Research Chair in primary-care research.

Self Diagnosis Dangerous
More and more patients are turning to Google and the internet to diagnose, and even treat, their injuries and illnesses. Doctors are warning people about the dangers of relying on unproven or inaccurate information that can be found while surfing the web.

I couldn't agree more. Doctors are highly trained, well educated professionals. But even with their years of training, sometimes doctors make mistakes. Sometimes those mistakes can have catastrophic, even fatal, consequences.

Why in the world would someone without a medical degree think that they can diagnose themselves by typing a few search terms into Google?

Patient Safety Starts With the Patient

When it comes to patient safety, the first step is making sure you get proper medical advice. That is something you can only get from a doctor (and watching Dr. Oz doesn't count).

Please make sure you get regular medical check ups. If you have concerns about your health, call your doctor, don't turn on your laptop.