On Edward's and the "junk science" of the cereberal palsy cases

[underpants]

I read in a LTTE someone regurgitate this talking point and Hannity last night (as he has on his radio show) repeated stating the FACT that Edwards based his arguments on "junk science"-expect to hear that phrase often in the coming months.

What follows is the best I have been able to find so far.

Cybercast News Service "broke" this story in January

Dr. Murray Goldstein, a neurologist and the medical director of the United Cerebral Palsy Research and Educational Foundation, said it is conceivable for a doctor's incompetence to cause cerebral palsy in an infant. "There are some cases where the brain damage did occur at the time of delivery. But it's really unusual. It's really quite unusual," Goldstein said.

"The overwhelming majority of children that are born with developmental brain damage, the ob/gyn could not have done anything about it, could not have, not at this stage of what we know," Goldstein added.

Edwards responds to the CNS story

According to the Saturday's New York Times, "...Mr. Edwards did not dispute the contention...that few cases of cerebral palsy are caused by mishandled deliveries." Edwards did say that during his legal career, he represented only the few cases that were the exceptions to the rule.

Edwards now insists that the cerebral cases he represented were the exceptions.

"I took very seriously our responsibility to determine if our cases were merited," Edwards told the New York Times in an interview on Friday, just days after refusing to answer CNSNews.com's questions on the same topic.

"Before I ever accepted a brain-injured child case, we would spend months investigating it," Edwards added.

The Times also noted that between 1985 and 1995, "Edwards filed at least 20 similar lawsuits against doctors and hospitals in deliveries gone wrong, winning verdicts and settlements of more than $60 million, typically keeping about a third. "

Now I noticed that the two studies or their sources where not mention but I did find this.

The March of Dimes says:
What are the causes of cerebral palsy?
In about 70 percent of cases, cerebral palsy results from events occurring before birth that can disrupt normal development of the brain. Contrary to common belief, lack of oxygen reaching the fetus during labor and delivery contributes to only a small minority of cases of cerebral palsy, according to a 2003 report by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). A small number of babies also develop brain injuries in the first months or years of life that can result in cerebral palsy. In many cases, the cause of cerebral palsy in a child is not known.

about-cereberal-palsy.org says:

Why does your child have cerebral palsy? The simplest answer to this question is because your child has brain damage. This leads naturally into the second question: Why does your child have brain damage? There are many possible answers to this second question, because there are many reasons children can sustain brain damage. Your doctor must carefully review your child's health history and conduct a variety of medical and neurological tests to help determine the cause. Cerebral palsy is caused by an injury to the brain before, during, or shortly after birth. In many cases, no one knows for sure what caused the brain injury or what may have been done to prevent the injury. A large number of factors which can injure the developing brain may produce cerebral palsy. In general, however, there are two problems that can cause cerebral palsy:

failure of the brain to develop properly (developmental brain malformation)
neurological damage to the child's developing brain
Whatever the cause of your child's cerebral palsy, the severity of the brain damage generally depends on the type and timing of the injury. For example, in very premature babies, bleeding into the brain (intraventricular hemorrhage) can cause extensive damage. Also, the longer an unborn child goes without oxygen, the greater the extent of brain tissue damage.

Ten to fifteen percent of cerebral palsy is caused from a recognized brain injury, such as infection (like meningitis), bleeding into the brain, and damage caused by lack of oxygen. It is very important that you understand that a brain injury caused during delivery in many cases could have been prevented. Medical mistakes are responsible for thousands and thousands of cerebral palsy cases. It would be virtually impossible for a parent, on their own, to determine if a medical mistake caused their child's cerebral palsy or brain damage. It is only through the concerted efforts of a legal/medical team that can answer the question, "was my child's cerebral palsy preventable?"

[underpants]

1. Long read I know but

:kick:

[Bread and Circus]

2. As a doc who always tries to do my best I think....

people need to understand that most doctors are really
trying to do their best.

Some malpractice cases are warranted, conversely others are not.

Unwarranted cases, whether Lottery Handouts are awarded or not,
hurt society in many ways.

1.) The cost of the cases gets passed on through malpractice
premiums to the doctors and then on to the patients.
2.) 60 to 80 billion dollars of unneeded tests and c-sxns are
done just so doctors can "cover their asses".
3.) The climate of fear has driven a wedge between doctors and
patients.

I don't know what the solution is but malpractice is part of the
health care crisis whether you believe it or not.

[Bridget Burke]

4. Then stop malpractice.

A fairly small percentage of doctors are actually guilty. If they could be removed from practice, everybody would benefit. "Tort reform" has done nothing at all to help the health care crisis in Texas. But the insurance companies keep getting richer; our little governor is deeply indebted, just as his predecessor was.

All of Edwards' cases are a matter of public record. A detailed study of each of them would be more useful than generalities based on statistics.

[AP]

11. It's bad for the economy to leave damage from negligence uncompensated.

If the negligent actor doesn't pay for it (and that person's usually a for-profit individual or corporation) than it's the taxpayer who ends up covering the loss through the public benefits the government has to provide for people (and it's society's loss when the people we educate and raise can't earn to their full potential).

An accident is one thing. But negligence uncompensated is a huge social cost and a subsidy for further negligence.

[underpants]

5. Surely it plays a part but premiums don't seem to go up because of THEM

I am not arguing mind you but it appears that in a macro sense premiums have increased more than malpractice pay outs have and tort reform, even when passed, has done nothing to reduce premiums.

http://www.insurance-reform.org/StableLosses2003F.pdf

This new study makes two major findings:
 First, contrary to what the insurance and medical lobbies have alleged, the years 2001 and
2002 saw no “explosion” in medical malpractice insurer payouts or costs to justify
sudden rate hikes. In fact, rather than exploding, inflation-adjusted payouts per doctor
dropped from 2001 to 2002. Payouts (in constant dollars) have been essentially been flat
since the mid-1980s.
 Second, medical malpractice insurance premiums rose much faster in 2002 than was
justified by insurance payouts. The 2002 hike is similar to the rate hikes of the past,
which occurred in the mid-1980s and mid-1970s and were not connected to actual
payouts. Rather, they reflect a weakened economy and losses experienced by the
insurance industry’s market investments and their perception of how much they can earn
on the investment “float” (which occurs during the time between when premiums are
paid into the insurer and losses paid out by the insurer) that doctors’ premiums provide
them.

http://www.insurance-reform.org/pr/AIRCaps%20then%20Rate%20Hikes.pdf

Texas: During the 2003 campaign for a “tort reform” referendum, ads promised rate cuts if caps were
passed. After the referendum passed, major insurers requested rate hikes as high as 35 percent for
doctors and 65 percent for hospitals.1 Lawmakers who supported the cap are now expressing anger that
premiums have not gone down.2 In April 2004, after one insurer’s rate hike request was denied, it
announced it was using a legal loophole to avoid state regulation and increase premiums 10 percent
without approval.3
Florida: “When Gov. Jeb Bush and House Speaker Johnnie Byrd pushed through a sweeping medical
malpractice overhaul bill last August, the two Republican leaders vowed in a joint statement that the bill
would ‘reduce ever-increasing insurance premiums for Florida's physicians .��.��. and increase physicians'
access to affordable insurance coverage.’” But, insurers soon followed up with requests to increase
premiums by as much as 45%.4

[Bread and Circus]

7. I'm telling you I know for a damn fact that doctors order all

kinds of un-necessary tests and workups just to cover their asses.

I am probably no better or worse than most docs so I am trying to
be frank about it.

We don't do it because we are assholes or have weak morals, we
do it because if you don't, you get screwed. And even if you
don't get screwed, the fear of losing everything you have worked
for eats at you everyday and fucks with your mind.

This is reality. I live it. I see it and hear it from others.
I learned it in Med school, reinforced in residency and further
reinforced in private practice. Though not unique to America,
America, as in many other ways, has this problem particularly bad.

It's not like this in Europe (I have heard).

I am not carping on Edwards because I don't even know what his
cases were about. If they were frivolous or faulty suits, then
god help us. If not then great.

But overall, on balance, America is a sue happy place and it's one
of the things that makes America suck more.

[underpants]

8. I understand about the testing and from what I know I agree

What? I am going to argue with a doctor about this?

I stated that on a macro sense......... I don't know about the day to day as you do so I didn't comment on it.

Sue happy yes. Deflection of blame happy yes also.

[fob]

10. How much of that $60 to 80 billion in your assertion #2 is from Dr's

ordering tests/charges to get the billing up?

My insurance was billed over $1,600 for my son for one night in the hospital nursery. A lot of money, yeah. The problem is I refused to let him out of my sight and he stayed with us in Mom's room (also billed at $1,600) and NEVER even went NEAR the nursery! And before you say, well perhaps that was for services by the nursery ward or whatever, THOSE charges were there too!

How many of the c-sections are done to accomodate a Doctor's schedule?

Some malpractice cases are warranted, conversely others are not. - That's what a trial is for, don't prove your case, no money. What percentage are sent/settled in arbitration? What percentage are thrown out?

1.) The cost of the cases gets passed on through malpractice
premiums to the doctors and then on to the patients.

The BENEFITS of cases are also passed on, like a story that ran recently about instituting double and triple checking of what is to be done BEFORE surgeries take place for things like removing a limb/organ/etc. How many Doctors commit heinous acts and because it is so difficult to find out about these creeps, they just move on to the next town and their next victim?

I don't know what the solution is but malpractice is part of the
health care crisis whether you believe it or not.

Certainly not to the degree implied here.

[Bread and Circus]

15. I didn't come up with the 60 to 80 billion number....I heard it on NPR

And just so people know, if I order an MRI or CT scan,
I don't make a kickback on it.

Such kickbacks are illegal vis a vis the Stark II laws.

Same for referrals to other doctors.

People seem to think that doctors make money by ordering tests
and making referrals. That's only true if they themself do
the test. This happens but not to the extent that people think.

Some of my patients are shocked that this is the case.

Ultimately, when you talk about the benefits and drawbacks
of malpractice suit abuse, you have to look at the big picture.

I think the pendelum has swung far too in favor of trial lawyers
and people trying to get Lottery Sum awards at the expense
of the doctor patient relationship, nurse job satisfaction,
and increased expense to patients/employers/federal gov't.

The back of my phone book cover is a full page, full color ad by
a "slip and full" lawyer. An ad like that costs 10's of thousands
of dollars. Guess who subsidized that ad.

[fob]

16. Guess who subsidized that ad.

People who caused a lot of damage to innocent persons and who now want the tax dollars of those same people to save their asses.

Any chance of tracking down the NPR quote and link to support your assertion?

Who said anything about kickbaks? I made no such implication. Insurance fraud, yes, kickbacks, no. This is the main reason healthcare should not be a for-profit industry.

There are states that have adopted tort reform and limits on liability awards and they still have the same health care cost problems as states that don't. IIRC Texas is one of those states. Where is the proof that, trial lawyer = increased healthcare costs = need for tort reform?

Just so you know, I think the majority of people that go into the healthcare field do so for perfectly altruistic reasons and there are many more upstanding people than not. My point is that the same hold true for the legal profession and the neo-cons have succeeded in their divisive plan pitting good people against each other when they are for the most part on the same side as the average American, ie - the side opposite bushco*!!

[Bread and Circus]

17. It sounds like you a lot more enamored of a sue happy society

than I am.

This is one tenet of the "Left Wing" I just don't buy into.

I am sorry if you don't believe me but go to any ER in America
and say this: "I am having the worst headache of my life"

Even if you are perfectly well and have a perfectly normal exam,
you will be guaranteed a CT of your brain costing several hundred
dollars. Without any objective evidence of a problem, you will
get the test just to cover the medico-legal ass of the ER doctor
and the hospital.

This is reality and a tiny tiny tip of the iceberg.

Also, next time you are in a hospital and want the attention
of the nurse, go check out what they are doing....Paperwork.

You know why, it's to cover their ass and the big fat deep
pocketed ass of the hospital. Over 50% percent of a nurses
time is on CYA documentation. Ask any medical/surgical/ob nurse.

And guess what...the nurses hate it. So do doctors.

But as long as this is a cash cow for lawyers, why challenge
the system?

[fob]

18. "sue happy society" - Please provide evidence of this.

I support a society that does not give in to talkingpoints.

You know why, it's to cover their ass and the big fat deep
pocketed ass of the hospital. Over 50% percent of a nurses
time is on CYA documentation. Ask any medical/surgical/ob nurse.

Please provide documentation to connect that assertion with Trial Lawyers. If the nurses are spending 50% of their time on CYA paperwork, blame those that effed up, not the lawyers that defended them.

I am sorry if you don't believe me but go to any ER in America
and say this: "I am having the worst headache of my life"

Even if you are perfectly well and have a perfectly normal exam,
you will be guaranteed a CT of your brain costing several hundred
dollars. Without any objective evidence of a problem, you will
get the test just to cover the medico-legal ass of the ER doctor
and the hospital.

Your scenario doesn't make sense. You tell the Doc that you have "the worst headache of your life" and then you say "even if you are perectly well and have a perfectly normal exam". Did you mean to imply if you went to the ER and LIED, that you would get your head examined! I think that's probably warranted along with a recommendation to seek metal help. I mean the Doc has to take you seriously right? If the "acceptable tests" are "perfectly normal" you should just be sent home? If the first tests show nothing, doesn't it MAKE SENSE to try others? If you get the CT is it just for medico-legal ass-covering, or good medicine?

[Bread and Circus]

20. Yes, go to the ER and lie like I said and you will get a head CT.

That's my whole point.

[fob]

22. You're "point" is based on deliberately providing faalse information!

Any result you get from your scenario is worthless. If you actually carried the experiment out in real life, you may get sent for a CT, you may not, but given the information, supposed real symptoms which aren't detected with normal work-up, it's unsurprising that you would be sent for further tests.

I understand your point that there are instances of medical decisions for non-medical reasons. I'm just saying they're not exclusive to, "oh my god do that so the trial lawyers don't get us" type as you implied.

[Bread and Circus]

23. I'm not going to argue medicine with you.

It's not the point anyway.

What I find so surprising is the defense trial lawyers get
on this forum.

Pound for pound, when you reduce it down to the most basic
level - we could do without trial lawyers but not doctors and nurses.

There is a crisis, it is affecting doctors/nurses/patients, and
it is getting worse.

This thread seems to be based on links that show the connection
between cerebral palsy and birth hypoxemia has been way overstated.

Meanwhile, due to fear of litigation, more women than should
be get their bellies/uteri cut just to cover ass of the OB docs.

Any fuckin' ob worth their salt will tell you this.

[fob]

27. Right now an Al Franken Show he just read stats from bush* admin

report that malpractice costs represent less than 2% of healthcare costs. (Friday, July 16 9:55am - PST)

I didn't catch the title of the report, but I'd be willing to wager there are many other things that contribute to healthcare costs at a MUCH greater rate.

What I find so surprising is the defense trial lawyers get
on this forum.

With the veracity of your talkingpoint based scenarios, I again am unsurprised that you have encountered vigorous debate in defense of trial lawyers

Pound for pound, when you reduce it down to the most basic
level - we could do without trial lawyers but not doctors and nurses

In nirvana, neither would be needed. Here in reality, BOTH are necessary.


There is a crisis, it is affecting doctors/nurses/patients, and
it is getting worse

Here we agree.


This thread seems to be based on links that show the connection
between cerebral palsy and birth hypoxemia has been way overstated

From the original post:
Dr. Murray Goldstein, a neurologist and the medical director of the United Cerebral Palsy Research and Educational Foundation, said it is conceivable for a doctor's incompetence to cause cerebral palsy in an infant. "There are some cases where the brain damage did occur at the time of delivery. But it's really unusual. It's really quite unusual," Goldstein said.

"The overwhelming majority of children that are born with developmental brain damage, the ob/gyn could not have done anything about it, could not have, not at this stage of what we know," Goldstein added.
<end snip>

Let's take this guy at his word, first let's note that he AGREES that in "some cases" brain damage occurred at time of delivery, second he changes "some" to "really unusual" and thirdly to "really quite unusual" and finally I think comes back closer to the original "some" by saying "the overwhelming majority" are not ob/gyn caused.

I will handicap these qualifiers here;
Some = 10%
Really Unusual = 5%
Really Quite Unsual = 2%
Overwhelming Majority = 80% (Or for to campare with first three, we'll refer to this as an Overwhelming Minority = 20%)

Admittedly these are MY subjective calls, but I think pretty good calls.


<snip>
The March of Dimes says:
What are the causes of cerebral palsy?
In about 70 percent of cases, cerebral palsy results from events occurring before birth that can disrupt normal development of the brain. Contrary to common belief, lack of oxygen reaching the fetus during labor and delivery contributes to only a small minority of cases of cerebral palsy, according to a 2003 report by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). A small number of babies also develop brain injuries in the first months or years of life that can result in cerebral palsy. In many cases, the cause of cerebral palsy in a child is not known
<end snip>

I equate "small minority" with RQU above. The point here is that there is agreement that there ARE cases of CP caused at delivery. And that it's not clear that the connection has been "way overstated"

Meanwhile, due to fear of litigation, more women than should
be get their bellies/uteri cut just to cover ass of the OB docs.

Any fuckin' ob worth their salt will tell you this.

Here's where I will hold that it's not "fear of litigation" that is the driving force. IMO it's much more a result of the general state of the healthcare industry in America. It's for-profit and the move to HMO's and managed care have brought business decisions into the ER/Doctor's Office/Hospital. Under the pressure of turning profits, medical personnel have to make decisions NOT necessarily based on their medical training but whether or not it will add a "cost" to the hospital. Part of that means a CBA for certain procedures, maybe they DON'T send the guy with a headache but no discernable injury for a CT because it's too expensive and it turns out later that the CT would have shown the problem. That family hires a trial lawyer and sues. The hospital pays out a settlement and may/may not change their procedures. It depends on the settlement, it may be cheaper to take 1 lawsuit per 1000 mystery headache cases than order 1000 CT scans.

For-profit managed healthcare has fostered a situation that leaves medical professionals stuck between erring on the side of care(order the CT) or erring on the side of business (don't order CT) and the result is not a solomonic comprimise but a downward spiral of ALL aspects of healthcare.

Just my opinion

[AP]

21. That's why Edwards says lawyers who bring multiple frivolous suits should

no longer be able file med mal claims. You have to punish the lawyers who know the law and know their exploiting the legal system and their clients, and NOT their clients who generally have no idea what the four elements of a tort are and have no idea whether their cliams are reasonable or unreasonable (and since a tiny fraction of people with good claims sue, it's WAY more often the case that a victim of negligence DOESN'T sue when they should).

[Bread and Circus]

24. Good, because I am not bashing Edwards on this....if anything...

he should be able to do more to rectify the situation than
someone who hasn't seen the abuse.

A lotta folks here seem to think there isn't a problem when
there is a huge mother fucking problem.

[Bread and Circus]

25. I am not against Edwards on this...if anything he is more

able to help fix this problem because I am sure he is
aware of the abuse.

[CatWoman]

3. Colmes had to rescue Hannity last night

Hannity made a complete ass of himself.

He had this Judge on who had worked with Edwards, and Hannity tried in vain to get the judge to say something derogatory about Edwards, and to help him push the "junk science" line.

The judge wouldn't bite -- he fiercely and stauchly defended Ewards.

Hannity was reduced to asking the judge if the reason that he won't rag on Edwards was becuase the judge was an Edwards supporter.

That's when Colmes came to the rescue.

Hannity looked so stoopid :silly:

[underpants]

6. Yes that judge seemed like .....well a judge

calm and reasoned. I think most people would characterize him as a "sweet man" ( nice guy).

I actually watched that (stuck around to see it) and Hannity must have thought he was in his isolated little radio booth. The judge (Parker?) not only wouldn't back up his talking points he was smart enough, or it was his nature, to not get into a yelling match. When Hannity mentioned the "junk science" cases the Judge said he had never heard of them. That was part of the reason I researched on this.

Cybercast NEws Service? I noticed neither they nor WorldNetDaily (picked this ball up and ran with it) mentioned who did the two studies in 2003.

Google John Edwards cereberal palsy cases-WND is on the first page.

[gratuitous]

9. Golly, if only the doctor could have afforded a competent attorney!

You know, it's positively criminal the number of heueuege malpractice awards that get handed out all the time, every day, across this country. And you know who's to blame, don't you? That's right, trial lawyers. Say it now and say it proud: It's all the fault of the trial lawyers.

Not the ones on the plaintiff's side, mind you; I'm talking about the insurance defense lawyers, who are so freaking stupid they don't know to start squawking "junk science" or "legal lottery" every three or four seconds like those sharp legal minds Hannity and Carlson do! If they'd just do that, why, they'd win every time -- there's just no defense to the squawk of "junk science" or "legal lottery," you know! I mean, that's black letter, hornbook, first year law.

But no, those doggone defense lawyers are just too stoopid to use every defense at their disposal, and they just willingly lose case after case for their insurance company clients, all so that doctors whose patients get butchered (somehow, some way, but clearly not because of the doctor's negligence, incompetence or malpractice) will look bad.

[underpants]

13. Think of how good of lawyers they could afford with tort reform

Indeed those poor doctors just sit there while some hotshot lawyer takes all their money from them for doing nothing. Those doctors probably don't even know any lawyers as they have their own schools ya know and belong to those country clubs and such but if they did maybe the lawyers would tell them to just scream "junk science" like the have Tourette's syndrome.

Okay I will stop now. I can't come close to your post gratuitous

like those sharp legal minds Hannity and Carlson do!

LOL :thumbsup:

[AP]

12. The short story: one bad reading on a Fetal Heart Monitor usually has...

...little correlation with brain injury, yet many doctors order a C-section at the first sign of trouble, and some laywer will bring a suit when there was a single blip on the FHM of a brain damaged baby.

Juries USED to give awards in that case, but studies now convince jurors of the low correlation.

This is NOT what happened in Edward's case. In the FHM case in four trials, there was (1) a CONTINUOUSLY bad FHM reading, (2) the doctor did a cervical exam and found the umbilical cord wrapped around the baby's next, only he didn't realize that's what he was feeling until the trial revealed that to be the case, and (3) the nurse wanted to tell the doctor to order a c-section but felt her job would be in jeopardy if she contradicted him.

The jury felt that all that stuff was serious negligence (including the fact that the hospital didn't have a policy to protect nurses and they, in fact, had been fired in the past for questioning doctors, especially when they were right).

All hospitals in NC enacted policies protecting nurses after this trial.

[underpants]

14. Thanks for the details

I am planning on getting the book this weekend.

Doesn't sound frivolous to me....now.

[Ayesha]

19. A personal perspective

Wow - I had no idea that Edwards was involved in these cases. And I must say, I am INCENSED at the people who call this junk science. You see, I have cerebral palsy, caused by medical malpractice during my delivery. My parents sued the doctors and won. If they had not, and I did not have the award from that lawsuit, I wouldn't be where I am today - in graduate school, living independently in my own home, able to drive. I received a much smaller settlement that what Edwards' client did, and it's enough, but with the rising cost of medical care, I worry that someday it won't be. I am covered by insurance through a special program at my father's former company, but when he dies someday, I will lose that coverage. And who the hell is going to be willing to insure me? Plus, consider these expenses NOT covered by insurance:

Adapted van: $70,000
Personal Care Assistants: $20,000 per year (would be much more for someone who needs actual nursing care or 24hr/day assistance)
Condo in new building since older more affordable ones are not accessible to wheelchairs: $300,000 (even more now due to L.A. real estate market)
Extra costs for wheelchair adaptions not covered by insurance: $2-5000, every 5-10 years when new chair is needed.

I could go on, but you get the idea. These jury awards are not ridiculously high, they are fair considering the lifetime of care
someone with my disability is likely to need. Of course, if we had universal health care, that would make a huge difference, but it's still not going to cover most of the expenses I just listed.

Accidents do happen, but if a doctor is willfully negligent or should have known better, he/she should pay. Perhaps if docs had to risk their cushy mansions and Rolls Royces instead of insurance covering their asses, they'd be a bit more careful! We also need to regulate insurance rates, so that the companies can't jack them up higher than is justified.

[underpants]

26. Welcome to DU Ayesha

You offer a perspective (one of two very pertinent to this discussion see familydoctro above) that is extremely insightful.

:hi:

[Ayesha]

28. Thanks!

Thanks! I was hesitant to post so much personal info at first, but I realized how important it is to put a real face on cases like these. It's a lot harder to dismiss such lawsuits as frivolous when you see what a difference they can make to the life of someone who has been injured.