Medical Malpractice, what's that?The threat of medical malpractice is a healthy element in health care and can make us better medical providers. When there is truly malpractice, patients get very little of what doctors actually pay the insurance companies. The insurance industry has some of the best lawyers whose mission is not to give a "damaged" child the money he deserves. Medical malpractice should be "no-fault" whereby an ethical committee gives the injured patient the money he's due from a single trust fund. Were doctors to pay to a single fund, malpractice insurance would be very inexpensive. Half of all malpractice committed in the United States is by a handful of doctors, 5%. The doctors at the bottom 5% shouldn't be allowed to practice.Systems like Kaiser are protected against malpractice by law, i.e., BINDING ARBITRATION. Were Kaiser not to be protected through an arbitrary law (politically provided), it would quickly go out of the "medical business" given its rate of known medical malpractice and negligence. We can get rid of "binding arbitration" through political effort and by excluding an employer from any liability (the latter would be fair). Binding arbitration in healthcare is 'unfair and undemocratic.'Inadvertently, patients often make terrible and deadly decisions based on the "specialist syndrome." A mother once took her child to "The Giant Retail Store" for eyeglasses. The mother had erroneously ascribed her child's headaches to poor vision and took her to the store's optometrist. The mother took the child back because the glasses didn't seem to work. The child's visual changes and headache were due to brain swelling that could easily be seen through the pupil. The optic disk readily revealed papilledema (swelling of the optic disk). I quickly administered Dexamethasone Phosphate IM and referred her to Loma Linda Medical Center where she was successfully treated for a brain tumor. Given his training, the optometrist should have readily detected the swelling of the optic disk. Since I saved the child before any permanent injury occurred, there was no malpractice. If the child had died before seeing me (a high probability), it would still have been difficult to sue the optometrist for malpractice. The only expert that could testify against the doctor would have to be a willing optometrist (an unlikely scenario) and based on the standard of practice (the lowest denominator). An ophthalmologist or medical doctor would not qualify under the law to testify against the optometrist.A patient once saw a private doctor for his sore throat, fever, headache and vomiting. Though the doctor diagnosed him as having Pharyngitis, the doctor was clearly concerned about this patient's symptoms and administered Penicillin G-Procaine 1 million units IM, Ceftin® (a cephalosporin) tabs orally and Vicodin® for the pain. The l million units of penicillin translate to a miniscule total dose of 625 mg (1 mg is about 1600 units) absorbed over 2-4 days. This patient then went to an urgent care for continued symptoms. His CSF rhinorrhea (cerebrospinal fluid runny nose) was confused with a cold. This patient had bacterial meningitis with brain swelling and associated vomiting. The vomiting caused him dehydration and throat pain due to chemical irritation (gastric acid). This patient moaned for days as he lay in bed dying. Eventually he was taken to the public hospital where he died after his brain herniated through the foramen magnum. Before the case was taken to trial, the insurance company offered the family $5,000 to settle the case. The family received no money since the suit was later dismissed in favor of the treating doctors.In order to improve the standard of care, I am informing the public in regard to Promethazine DM. This is often erroneously given to asthmatics. If a child dies after taking Promethazine DM, it will still be hard to sue the involved doctor since most doctors prescribe this drug to children (the standard of care). Though Wyeth® wrote to all doctors in the United States, February 15, 2005, stating "respiratory depression, apnea, sometimes associated with death, are strongly associated with Promethazine products," a doctor may still prescribe it and it may difficult to sue him for malpractice since it is common practice in the community. If you inform your doctor about the risks associated with Promethazine but he still chooses to prescribe it for your child, then he would have less of a legal defense. I provide my patients with a legal note stating my presumptive diagnosis when I refer them to an emergency room. In this manner, the family may have a legal malpractice argument in case the patient is refused care and dies.Luis Lomeli MD/Beta

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