Personal Injury Law Update

Danger of Doctors ‘Practice Drift’ to Cosmetic Surgery

Increasingly, doctors are being tempted to add in-office or non-surgical cosmetic procedures to their practice - regardless of their specialty - a phenomenon known as “practice drift”. Surprised that a gastroenterologist could perform a tummy tuck? There are no laws in the United States that require doctors to practice medicine only within their fields.

How many doctors are practicing outside their specialty? No one knows: doctors are not required report “practice drift” to any medical authority. And doctors performing cosmetic procedures are not even required to report complications.

“There is a misconception among consumers that as long as a doctor is certified in a medical field that he or she is qualified to practice plastic surgery. This is absolutely wrong and it is dangerous for patients.” American Society of Plastic Surgeons

Physicians practicing medicine outside the specialties in which they're trained and board certified is usually prohibited by hospitals. However, outpatient surgical facilities used for cosmetic procedures are often unregulated, and expose patients to dangers from untrained staff, improperly sterilized equipment, and lax safety processes. 

If there are complications in the procedure, in-office facilities – in some cases, medical spas or tanning salons – may not have even the most basic emergency equipment. Only 21 states, among them Oregon and Washington, require outpatient surgical facilities to have life-saving emergency equipment and medication, as reported in a series about cosmetic surgery by USA Today.

There are patient risks in any cosmetic procedure – even non-surgical procedures like Botox. If you’re considering cosmetic surgery, make sure the facility is accredited in that field – and so is the doctor. 

Read the full article on state regulation in cosmetic surgery, including physician and facility accreditation.  

 

Trucking Group Opposes New Safety Regulations

The rest periods before professional truck drivers can start a new workweek, known as restarts, are under review by the Federal Motor Carrier Safety Administration (FMCSA).  A new rule, scheduled to go into effect in July 2013, mandates a 34-hour rest period before drivers can start a new week. The controversy in the trucking industry stems from the stipulation that the restart cycle must include two 1 a.m. to 5 a.m. stretches of rest.

Bill Graves, president of American Trucking Association, said requiring truckers to have 2 overnight rest periods will mean that thousands of semi-trucks will be getting on the road as commuters are heading to work, “creating additional and unnecessary congestion and putting motorists and those professional drivers at greater risk.”

Carriers expressed concerns about loss of efficiency, decreased productivity and added freight costs as a result of the proposed trucking rules, and worry about enforcing the new hours of service rules.

The FMCSA position is that restart changes are meant to limit driving to no more than 70 hours per week. Continuously driving long hours is associated with a higher risk of crashes, and serious chronic health problems for the truck drivers.

 “The rule follows through on the commitment that I’ve made over and over again — which is putting safety as our highest priority,” stated Anne Ferro, head of FMCSA, in an interview with Transport Topics.

I have previously expressed my support for new trucking safety rules: 3,675 people died in truck-related accidents in the United States in 2010. I urge you to support a transportation bill awaiting action in the U.S. Senate, The Commercial Motor Vehicle Safety Enhancement Act, which makes important improvements to federal truck safety standards.

 

Resources for Oregon’s Winter Weather

It isn’t often that a major storm brings Oregon snow, ice and rain – all in the same day. As a severe weather system heads in to the Northwest, be safe and be practical about the conditions.

• Monitor the weather forecast on local TV or radio stations, or see the weather.com interactive travel map. For up-to-date school closures and other emergency information, try OregonLive.com/closures.

• Check the road conditions on Oregon Department of Transportation’s TripCheck for travel conditions in Portland, Salem and throughout the state. See snow plow routes for any address at PublicAlerts.

• Make sure your vehicle is ready for potentially dangerous road conditions: tires should be properly inflated, fluids topped off, and the trunk stocked with roadside flares, jumper cables, extra blankets and water.

• Drive carefully: watch for ice (see Driving Tips for Icy Conditions), keep an extended distance from snowplows and trucks – and don’t forget to watch for pedestrians and bike commuters braving the snow and ice. 

Where do you go for weather information and safety tips?

 

New Devices Promise Faster Detection of Brain Injuries

Traumatic brain injuries affected more than 155,000 men and women in uniform in just the past decade. Brain trauma can be very hard to diagnose, since the victim may not exhibit external signs of injury, and detecting equipment like CT scanners are not always readily available.

ProPublica reports the advance of two potential solutions on the horizon: the InfraScanner, and prototype from the National Institute of Health. Both are small devices that would detect bleeding in the brain, and make diagnosing traumatic brain injury much faster and easier.

The InfraScanner model detects about 75 percent of all hematomas picked up by a CT scan, according to the initial Food and Drug Administration report, by using near-infrared light to detect differences in light absorption in the brain – indicating the presence of bleeding.

A device developed by the NIH, still in the prototype stage, is moved over the injured person’s head, and compares changes in blood volume:  a significant spike would indicate brain bleeding.  

It is encouraging to see advancing technology to detect brain injuries in the men and women of our armed forces: hopefully, better diagnostics will lead to a greater understanding of these injuries, and faster treatment for the victims.  But there is still a long way to go: often, brain injuries go undected, and many serious brain injuries don't show up on CT scans or MRIs. According to the Centers for Disease Control and Prevention, about 1.7 million people in the United States experience a traumatic brain injury every year.

Read the full ProPublica piece New Technologies in the Works to Detect Brain Injury.

 

 

Winter Safety Reminder: Share the Roads

As the temperature drops and the rainy season begins in earnest, the normally bike-friendly Northwest becomes a more dangerous place for cyclists.

Wet leaves, black ice, and frequent rain or snow don’t help driving conditions for cyclists OR motorists.

Drivers, remember:

• Cyclists have a right to be in the lane of traffic. They’re not riding there to annoy you, or slow down your commute. During winter months, they are probably avoiding the bike lane because of ice or piles of wet leaves.
• Use your turn signal so bicyclists – and other vehicles – know where you’re going. This should be second nature for safe drivers.  
• Leave them some room. Wet roads are more dangerous for bikes then for cars, and rain or snow extends the stopping distance for a bike as well as a car. Leave a little extra room when following or passing a cyclist.
• Remember they’re dealing with the same factors that affect how you drive – potholes, train tracks, cars that turn without signaling – but these things are much more dangerous when you’re on a bicycle. 
• Do not honk or yell at a bicyclist.  Cyclists are concentrating on their ride - honking can be very startling. If you need to alert someone to your presence, a light tap on the horn is sufficient.

The Bicycle Transportation Alliance has great tips for cyclists - like planning a longer stopping distance, lowering your tire pressure, and relying less on the front brake – or see Bicycle Safety tips here.  

For those of us operating automobiles, it's a great time of year to brush up on safe driving tips.

Image: Rawich / FreeDigitalPhotos.net

The Real Risks of Wisdom Tooth Removal

The recent death of a teenager during a common surgical procedure has prompted a national conversation about the removal of wisdom teeth (third molars).  Deaths like this - hypoxia from oxygen deprivation – are rare, but serious risks are inherent in any surgical procedure.

Ten million wisdom teeth are extracted in the U.S. each year. While wisdom tooth removal is undoubtedly necessary for some people, many oral surgeons advocate for the removal of the third molars to prevent potential future infections or tooth damage. Yet, studies suggest that less than 12% of wisdom tooth impactions lead to infections or damage to adjacent teeth.  For comparison, about 1 in 15 people will get appendicitis – but no medical associations recommend preventative appendectomies.

For most of us, wisdom tooth removal – regardless of its necessity – is a week or two of pain and discomfort. Many people believe that because getting one’s wisdom teeth out is common, it is safe.  In most cases, patients are given unsubstantiated information that might, in some circumstances, invalidate their informed consent of the potential risks of the surgery.  Dr. Jay Friedman wrote in the American Journal of Public Health:

"At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of [dentist-induced] injury that afflicts tens of thousands of people with lifelong discomfort and disability," See the full text of his article: The Prophylactic Extraction of Third Molars: A Public Health Hazard.

Dangers in wisdom tooth removal include:

• Risks and potential complications of anesthesia, including heart attack or stroke
• Infection in the extraction site or subsequent stitches
• Lingual nerve damage, which can result in permanent numbness, loss of taste, and other mouth  and tongue problems (read more about lingual nerve damage here)
• “Dry socket”, a painful inflammation in the extraction site
• Permanent loss of feeling in the lip, tongue, or cheek which never goes away, ranging from complete numbness to  “pins and needles” comparable to when your foot or hand falls asleep  
• Bone splinters or root fragments can be left behind in the gum tissue
• Jaw fracture can occur if the surgeon removes part of the bone to access the impacted tooth
• Damage to existing dental work or to the structures of adjacent teeth

If your doctor or dentist recommends wisdom tooth removal, make sure you educate yourself on the procedure, and learn about your Oregon dentist or oral surgeon’s experience and record for the surgery.

Prenatal Exposure to Valproate Increases Risk of Autism

Valproate is a a chemical compound used as an anticonvulsant in the treatment of epilepsy.

A presentation recently delivered at the annual meeting of the American Epilepsy Society advised that children born to mothers with epilepsy treated with valproate during pregnancy are at an increased risk for autism.

The study included 655,691 children born to 428,431 mothers between 1996 and 2006. Mothers with epilepsy, who redeemed a prescription for valproate medication between 30 days before the estimated conception day and the day of birth, were identified, as were their children with autism.

Researchers found that children exposed to valproate during pregnancy had more than double the relative risk of autism, compared with children not exposed to antiepileptic medication during pregnancy.

A second study found that the risk of autism was greater from valproate than other commonly prescribed anti-epileptic drugs: carbamazepine, lamotrigine, and phenytoin.

Traveling Safely

We are coming in to the most chaotic season of the year – which makes it one of the most dangerous times to travel. Here’s a quick checklist to keep your family safe – and keep your sanity – this holiday season.

• Stay off facebook and Twitter, or at least be smart about sharing your plans and photos. It’s not a good idea to post that you’re going out of town or you’ll be visiting someone. Remember, people other than your friends can easily see what you post.
• Do a home security check.  Are your doors and windows locked? Do you have a light timer set, or can you leave a couple of lights on? Have you stopped the mail and newspaper, or can you have a neighbor pick them up? Before you leave, do a walk-through to make sure no appliances are left on, and your electronics are unplugged.

Driving?

• Get your car checked. This is the most basic but often overlooked element to winter driving. Make sure your tires are winter ready and properly inflated, and that your fluids are topped off.  Take it to an auto shop if you need to, but don’t skip this step.
• Be prepared for a change in course. Do you know your route? It’s very easy to become reliant on a phone or GPS to guide you, but you can’t look at a map and the road at the same time. Also, if you run in to construction, road closings or traffic jams, you’ll be ready to drive an alternate route.
• Pack a winter safety kit for the car. Have the essentials for a safe road trip? The Red Cross has an emergency preparedness kit, but every vehicle should have these items.
  • Cell phone and car charger
  • Ice scraper
  • Jumper cables
  • Blanket, hat and gloves
  • Flashlight and extra batteries
  • Roadside flares and matches
  • First Aid kit
  • Water

 

• Remember the basics of driving in bad weather. Here in Oregon, drivers will have to contend with particularly rainy driving conditions or icy conditions. Spend a minute reviewing the basics to be a safer driver this year.   

Flying?

• Confirm your trip. There are fewer flights this year and they’re more expensive, so it may be harder to fly stand-by. Check in for your flight, and make sure your plane is on time before you leave for the airport.
• Keep a copy of your passport or driver’s license, plus your flight information, in a safe place in case the originals get lost. 
• Put address tags on your luggage - inside AND outside. Use your work address or covered tags on the exterior.
• Flying with kids? Put all essential items in your carry-on bag including food, medication, diapers, and safe toys (nothing sharp, heavy, or easily broken).  TSA has some modified security procedures for children, which should mean an easier experience at security.
• Pay attention to the flight attendants, the preflight briefing, and who is around you in the airport and on the plane.
• Wash your hands - a lot. Buses, trains and planes are incubators for germs, and flu season has started.

Whatever your plans, I wish you a safe and happy holiday season.

National Transportation Safety Board Urges Total Ban on Cellphone Use While Driving

Following a rash of deadly accidents caused by drivers distracted by texting and other cellphone use (like the August 2010 multi-truck and car pileup in Missouri that killed two people that investigators now attribute to texting), the National Transportation Safety Board (NTSB) has urged states to pass laws imposing a total ban on cellphone use while driving, including hands-free use.

As NTSB chairman Deborah Hersman aptly observed, while the recommendation would likely be unpopular with drivers accustomed to cellphone use behind the wheel, "[n]o email, no text, no update, no call is worth a human life."

While the NTSB's recommendation is not binding on the states, it carry significant weight.

A second recommendation issued by the NTSB urged states to aggressively enforce current bans on text messaging and the use of cellphones and other portable electronic devices while driving. Without enforcement, even the toughest laws have little effect. Proof of the positive impact of increased enforcement can be seen from pilot projects in Syracuse, NY, and Hartford CT, where stepped-up ticketing and public initiatives caused significant drops in hand-held cellphone use for texting or talking.

Deadly Truck Accident Highlights Dangers of Texting

Federal investigators announced today that a 19-year-old pickup truck driver involved in a deadly highway accident in Missouri in August 2010 sent or received 11 texts in the 11 minutes immediately before his truck crashed into the back of tractor trailer at 55 mph.

The driver sent six texts and received five texts, with the last text just before the crash. The crash began a chain collision when the pickup was rear-ended by a school bus, which in turn was rammed by a second school bus.

The pickup driver and a 15-year-old student on one of the school buses were killed, and 38 other people were injured.

This is just another tragic example of how texting dangerously distracts drivers of cars and trucks.