No one ever wants to spend time in a hospital. It can be overwhelming, scary and difficult to navigate a complex system that includes doctors, nurses, technicians, laboratory testing and many other complexities. Once discharged and back home, it oftentimes only becomes more confusing once the hospitals and doctors bill for services. The reason for this is because although a patient may have all of their care performed at one hospital, every doctor seen may bill separately for the care provided. And while the hospital may take the patient’s insurance, there is no guarantee that each doctor covers the same plan. This post attempts to explain how to avoid being a victim of “surprise billing.” Continue reading
Modern medicine can literally rebuild a patient’s body. Like a car needing new parts, doctors can replace hips, joints and even limbs in people with critical and serious injuries. In fact, one of the most common surgeries in hospitals are artificial knee replacements. As the Chicago Tribune reported earlier this month, “rates of the surgery doubled from 1999 to 2008, with 3.5 million procedures a year expected by 2030.” But as the Tribune article also makes clear, these knee replacements are not a guaranteed cure.
Recent studies show that two thirds of knee replacement recipients still deal with chronic pain and one out of every five are dissatisfied with the outcome of their surgery. A study by the BMJ medical journal found that patients with osteoarthritis who received a knee replacement felt that the surgery “had minimal effects on quality of life.” Coupled with the fact that numerous artificial knee products are under medical recall should leave patients questioning the surgery and electing to proceed as an absolute last resort. Continue reading
Perhaps it seemed of little consequence to the doctor at the time. A simple lunch to learn about the latest prescription pain killer medication on the market. Later it was a fee to speak at a conference about the use of that drug at the doctor’s practice. Six months later it was an all-expenses paid trip to a conference put on by the drug manufacturer to further market the medication. These situations have become common place in medicine and these payments are a major component of drug companies marketing agendas. So common, in fact, that the Washington Post highlights a new study that “found 434,754 payments totaling $39.7 million to 67,507 physicians — about one in every 12 doctors.” Alarmingly, a subset of this study found that “one in every five family physicians had received this kind of marketing.”
The payments have consequences. A recent, first of its kind study from doctors and researchers at Boston Medical Center and New York University School of Medicine, found a direct correlation between drug company payments to doctors and overdose deaths associated with the opioid epidemic. Michael Barnett, a professor at the Harvard School of Public Health who concentrates his research on the correlation between physicians and the opioid epidemic told the Post that these findings are “deeply concerning for the raging [opioid] crisis that we’re all quite aware of.” Continue reading
In 2007, the Carlyle Group, one of the wealthiest private equity firms in the world, purchased ManorCare, the second largest nursing home chain in the country. A recent investigation by the Washington Post details how the purchase made ManorCare a for-profit business that prioritized financial return for investors at the expense ManorCare’s 25,000 patients. The results were devastating. As the Post investigation revealed, in the years following the purchase, health code violations rose by 26 percent. Serious violations, which can be categorized as issues placing a patient in “immediate jeopardy” increased by 29%. The nursing homes were chronically understaffed by nurses. This past March, ManorCare filed for bankruptcy.
Behind each of these violations is a human being with a real story. The Post investigation details several and each are heartbreaking. They include stories of patients left unclothed with visible bedsores and infections; limited mobility patients forced to walk unaided due to lack of staff who would fall and suffer fractures or brain hemorrhages; and patients who “were so poorly staffed that some residents regularly soiled themselves while waiting for help to the bathroom.” We all have loved ones who currently or in the future may require, skilled nursing care. It is vital for family members to have faith and trust in the care providers. The unacceptable situation at ManorCare highlights a scary trend where regulations failed, and actual harm resulted. Continue reading
At Leopold & Associates, almost all of our cases deal with fighting insurance companies. Insurance companies are paid premiums to provide coverage, reimbursement and protection to people when things go wrong. We all know mistakes happen and we all also hope to be covered by insurance to help guard against the unforeseeable. Sometimes that can be reimbursement for medical expenses after a car accident or coverage for future medical care if a doctor makes a mistake. At its most basic, we carry health insurance to guard against catastrophic medical expenses such as a serious injury or cancer diagnosis. We count on the insurance that we, or an employer, pays for to cover those expenses. When an insurance company denies you coverage, trying to fight for your benefits you are entitled to while battling an injury or illness, can feel like fighting the weight of the world.
Last week, in a story similar tof John Grisham’s fictional book, and later movie, The Rainmaker, Aetna, one of the largest health insurance companies in the country was hit with a $25.5 million dollar verdict for denying lifesaving cancer treatment to an Oklahoma woman. As CNN reported, in 2014 Orrana Cunningham, was diagnosed with stage 4 nasopharyngeal cancer near her brain stem. Doctors wanted to treat the cancer with proton beam therapy, a common form of radiation. Aetna denied the claim arguing that this treatment was “experimental.” Orrana died of complications from the cancer in 2015 at the age of 54. Continue reading
One area of law that we often get many questions about is the quality of care a loved one receives in a nursing home or rehabilitation center. The concerns appear to be valid. As the New York Times recently reported, since 2013 federal records reveal that nearly 40% of nursing homes have been cited for serious violations of patient care. The Times article notes that “common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.” Sadly, the article also concludes that the government is not doing its part to appropriately monitor and enforce safety guidelines designed to protect patients. Continue reading
Yesterday, the House of Representatives passed major legislation repealing many important reforms created by the Affordable Care Act, commonly referred to as Obamacare. This new bill, was passed before many legislators had an opportunity to read the text, and before receiving any cost and coverage analysis by the non-partisan Congressional Budget Office (“CBO”). The bill fundamentally alters America’s health insurance system. The new law will impact approximately one-sixth of the nation’s economy and early projections from the scoring of previous bills estimate that as many as 24 million Americans could lose health insurance coverage. The law also affects other popular Obamacare regulations such as a ban on insurance companies placing lifetime caps on an insured’s care or denying of coverage for pre-existing conditions.
The attorneys at Leopold & Associates find many of these changes unconscionable. The impact on many residents in our Chicago community could literally be the difference between life and death. In addition to these concerns, we are also worried about proposals being floated within the new law that will substantially affect patient’s ability to seek justice when doctors or hospitals violate basic safety rules that seriously impact the patient’s life and the lives of their families. We are concerned about the effect on quality of care, quality of safety measures and the ability for a patient to seek fairness and justice against a medical corporation. But, as the saying goes, you don’t have to take our word for it. Recently, the highly respected New England Journal of Medicine published an editorial from doctors at Stanford University and Boston’s Brigham and Women’s Hospital highly critical of these proposed “malpractice reforms.” Continue reading
Our practice focuses on medical errors and their impact on our client’s lives and the lives of their families. Oftentimes, these cases stem from care received at a hospital or a doctor’s office. However, medical errors can happen in all branches of medicine. Today, we examine that quite literally by looking at medicine and the pharmaceutical industry. While we often take for granted prescriptions we receive from our local pharmacy, it seems as though there has been a recent increase in pharmaceutical errors that can sometimes lead to life-threatening problems.
This morning’s New York Times focused on one shocking tragedy; the trial of Barry J. Cadden. Mr. Cadden is the owner and head pharmacist of the New England Compounding Center. The trial stems from what the Times describes as “one of the worst public health crises in the nation’s history.” In 2012, a number of medications manufactured by the New England Compounding Center became tainted leading to an outbreak of meningitis and other serious infections. The outbreak affected more than 700 people and sadly killed 64 people. Hundreds of other patients now live with constant, terminal pain that affects many aspects of their everyday life. Continue reading
Whenever you go to the hospital, every doctor, nurse, therapist or other medical professional that is involved in your care generates a large number of medical records. These records are a vital part of any medical malpractice lawsuit and often total thousands of pages. Medical records serve as a window into the minute details that are often crucial in explaining why a medical procedure may have gone wrong. For example, when a patient is hooked up to monitor, every blood pressure reading, heart fluctuation or oxygen level is recorded, often on a minute-by-minute basis. This allows for the ability to track causes and their effects and pinpoint the precise moment that something may have changed. If a patient’s heart rate unexpectedly drops, it is very important to look at the portion of the medical records surrounding the decreasing heart rate to figure out exactly what may have happened to explain the change.
With all of that said, medical records are very private documents. They often contain information and medical history that is personal and therefore should only be seen by a doctor, the patient or a representative authorized by the patient to view their records. In order to protect this patient privacy, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. The HIPAA law regulates the use of protected health information by ensuring that this information remains private and is not shared with third parties. Protected health information is broadly defined as any portion of a patient’s medical record or billing information. Continue reading
Last week, NBC Nightly News reported on a shocking study by the National Academy of Medicine regarding medical errors in the United States. According to the report “most Americans will get a wrong or late diagnosis in their lifetimes… often with devastating effects.” Dr. John Ball, chairman of the Committee on Diagnostic Error in Medicine and an author of the study put it more bluntly by stating “everyone will experience one meaningful diagnostic error in their lifetime.”
The statistics are shocking. For example, the study analyzes that “diagnostic errors contribute to 10 percent of patient deaths” and a staggering “6 to 17 percent of adverse events in hospitals.” However, patients often never know these high and unacceptable numbers. The report explains that the lack of a uniform medical system in the United States contributes to keeping these numbers “under the radar” making it very difficult to quantify how many people are seriously injured by medical errors. The report calls this situation both an under-represented and understudied issue area in medicine. Continue reading