On The Fence About Medical Malpractice

[+ FreshFluff]

3 minutes ago, Unicorn said:

I don't know any more about the details of this case than you do, unless @Rudynatesent you a private message. I'm just curious why, with your limited knowledge of this case, do you think you know more than the three attorneys, who presumably actually looked at all of the records in this case, about whether his "medical team screwed up"??? It's easy to make quick judgments with limited facts. I prefer to reserve my judgment until all of the facts are laid out. 

Like I said, I’m not judging whether the original team committed malpractice. I’m simply taking Rudtnate’s  Stanford doctor at his word. Whether that doctor is correct or not, it’s incredibly frustrating to hear something like that. 

[Rudynate]

15 minutes ago, Unicorn said:

I don't know any more about the details of this case than you do, unless @Rudynatesent you a private message. I'm just curious why, with your limited knowledge of this case, do you think you know more than the three attorneys, who presumably actually looked at all of the records in this case, about whether his "medical team screwed up"??? It's easy to make quick judgments with limited facts. I prefer to reserve my judgment until all of the facts are laid out. 

I didn't say that I knew more than the attorneys.  I didn't like what they had to say, but I realized they were probably right when they said that, poor as it was, the care I received would meet the legal test for reasonable.  I reviewed my contract with my provider and saw, that it said, right in there, in so many words, that they agreed to provide "reasonable" care and treatment.  Based on what the attorneys said and my review of the contract, I could only agree with them that I had a weak case, and stopped looking for lawyers.    Once again Unicorn, your fatal attraction to speculation has bit you in the ass. 

Edited November 2, 2021 by Rudynate
typo

[Guest]

5 minutes ago, FreshFluff said:

Like I said, I’m not judging whether the original team committed malpractice. I’m simply taking Rudtnate’s  Stanford doctor at his word. Whether that doctor is correct or not, it’s incredibly frustrating to hear something like that. 

It's one thing to empathize with @Rudynate's situation (which I do). But you used the words "screwed up." I do agree with him that even if I had the medical records in front of me, which neither of us does, I probably do not have the expertise to know whether his original doctors "screwed up." All I know is that his team at Stanford apparently used some rather inflammatory language that riled him up. (I'm not sure that language was helpful, and that language might have been somewhat unprofessional). I would venture to guess that the three attorneys Rn consulted DID present the facts to vascular specialists, who all came to the same conclusion. Despite Rn's categorically false statements that I have "speculated" regarding the facts of this case, I make no judgment (nor have I ever made a judgment) as to whether his care was reasonable, or even if a "screw up" did or did not occur. I don't know the facts and that's not my specialty.

What I can say is that multiple professionals have looked at this matter, according to his own words, and seem to come to the conclusion that his care was reasonable given the circumstances. No reputable news organization would just talk to one  or two people and pronounce "Mr. X is a fraud," or "Dr. Z screwed up," and so on. A reputable news organization simply reports the facts. I'm strongly against making quick judgments based on limited facts or sound bites. One can sympathize with his unfortunate situation without speculating on how things might have turned out differently, or if there was someone at fault. I will give him credit for calming his obsession after 3 professionals gave him the same advice. I can think of people who don't always do that. 

[+ FreshFluff]

9 minutes ago, Unicorn said:

It's one thing to empathize with @Rudynate's situation (which I do). But you used the words "screwed up." I do agree with him that even if I had the medical records in front of me, which neither of us does, I probably do not have the expertise to know whether his original doctors "screwed up." All I know is that his team at Stanford apparently used some rather inflammatory language that riled him up. (I'm not sure that language was helpful, and that language might have been somewhat unprofessional). I would venture to guess that the three attorneys Rn consulted DID present the facts to vascular specialists, who all came to the same conclusion. Despite Rn's categorically false statements that I have "speculated" regarding the facts of this case, I make no judgment (nor have I ever made a judgment) as to whether his care was reasonable, or even if a "screw up" did or did not occur. I don't know the facts and that's not my specialty.

What I can say is that multiple professionals have looked at this matter, according to his own words, and seem to come to the conclusion that his care was reasonable given the circumstances. No reputable news organization would just talk to one  or two people and pronounce "Mr. X is a fraud," or "Dr. Z screwed up," and so on. A reputable news organization simply reports the facts. I'm strongly against making quick judgments based on limited facts or sound bites. One can sympathize with his unfortunate situation without speculating on how things might have turned out differently, or if there was someone at fault. I will give him credit for calming his obsession after 3 professionals gave him the same advice. I can think of people who don't always do that. 

Oh FFS. I was empathizing with him  Any patient would be frustrated after hearing what the Stanford doctor said, particularly if the untreated clot had lasting consequences on the function of his leg. 

Edited November 2, 2021 by FreshFluff

[Guest]

7 minutes ago, FreshFluff said:

Oh FFS. I was empathizing with him  Any patient would be frustrated after hearing what the Stanford doctor said, particularly if the untreated clot had lasting consequences on the function of his leg. 

Words matter, as do how you say things. No need to use profanity. It doesn't make you look clever.

Edited November 2, 2021 by Unicorn

[+ purplekow]

On 10/30/2021 at 2:56 PM, Lucky said:

So sorry to hear of your experience. I wish you well.

Wouldn't the opinions of lawyers be more helpful in this situation? If you did consult with a malpractice firm, they would likely tell you if you were wrong in pursuing malpractice against these docs.

The lawyers would tell him if his case was likely to produce enough money for them to take it on contingency.  Malpractice cases are either settled because it is economically right for both parties to do so irrespective of the actual act,  or they go to trial where the vast majority of decisions find in the doctor's favor.  

Would suggest if you contact a lawyer and if his eyeballs turn into dollar signs as they do in some cartoons, then you likely have a case that is winnable or able to be settled.   None of this of course would make your recovery any easier or get your life back any faster.  So if you are in the "someone has to pay for my bad outcome" state of mind, then see a malpractice lawyer.  If however, you want to know whether there was malpractice, go to a a physician who has expertise in vascular surgery or oncology and ask them to review the case for you for a fee.   

Your synopsis does not present enough information to determine whether there was negligent malpractice but it does sound as though you had a very rough time and I hope you have a complete recovery.  

[Rudynate]

7 hours ago, Unicorn said:

It's one thing to empathize with @Rudynate's situation (which I do). But you used the words "screwed up." I do agree with him that even if I had the medical records in front of me, which neither of us does, I probably do not have the expertise to know whether his original doctors "screwed up." All I know is that his team at Stanford apparently used some rather inflammatory language that riled him up. (I'm not sure that language was helpful, and that language might have been somewhat unprofessional). I would venture to guess that the three attorneys Rn consulted DID present the facts to vascular specialists, who all came to the same conclusion. Despite Rn's categorically false statements that I have "speculated" regarding the facts of this case, I make no judgment (nor have I ever made a judgment) as to whether his care was reasonable, or even if a "screw up" did or did not occur. I don't know the facts and that's not my specialty.

What I can say is that multiple professionals have looked at this matter, according to his own words, and seem to come to the conclusion that his care was reasonable given the circumstances. No reputable news organization would just talk to one  or two people and pronounce "Mr. X is a fraud," or "Dr. Z screwed up," and so on. A reputable news organization simply reports the facts. I'm strongly against making quick judgments based on limited facts or sound bites. One can sympathize with his unfortunate situation without speculating on how things might have turned out differently, or if there was someone at fault. I will give him credit for calming his obsession after 3 professionals gave him the same advice. I can think of people who don't always do that. 

But you choose to ignore the important fact that other doctors at the treating HMO agreed with the Stanford doctor.  One of them actually apologized that the treatment had been so inadequate.

[Rudynate]

1 minute ago, Rudynate said:

But you choose to ignore the important fact that other doctors at the treating HMO agreed with the Stanford doctor.  One of them actually apologized that the treatment had been so inadequate.

"What I can say is that multiple professionals have looked at this matter, according to his own words, and seem to come to the conclusion that his care was reasonable given the circumstances."

But I already stipulated to that.  Yer beating a dead horse.  What can be learned from this, is that you can have a horrible outcome from  a treatment and be left with no recourse against the treating physician if the treatment you received meets the low bar of having been "reasonable."   Fortunately, for people in backward states where they are still practicing medicine from the middle of the last century, a national standard is applied in determining reasonableness, rather than the local standard that used to be used.

[Rudynate]

7 hours ago, purplekow said:

The lawyers would tell him if his case was likely to produce enough money for them to take it on contingency.  Malpractice cases are either settled because it is economically right for both parties to do so irrespective of the actual act,  or they go to trial where the vast majority of decisions find in the doctor's favor.  

Would suggest if you contact a lawyer and if his eyeballs turn into dollar signs as they do in some cartoons, then you likely have a case that is winnable or able to be settled.   None of this of course would make your recovery any easier or get your life back any faster.  So if you are in the "someone has to pay for my bad outcome" state of mind, then see a malpractice lawyer.  If however, you want to know whether there was malpractice, go to a a physician who has expertise in vascular surgery or oncology and ask them to review the case for you for a fee.   

Your synopsis does not present enough information to determine whether there was negligent malpractice but it does sound as though you had a very rough time and I hope you have a complete recovery.  

There's no such thing as a complete recovery when the deep veins in your leg and your pelvis are permanently obstructed with webs of scar tissue that have reduced your venous outflow by 85%.

But I do appreciate your good wishes PK.

[Guest]

8 hours ago, Rudynate said:

There's no such thing as a complete recovery when the deep veins in your leg and your pelvis are permanently obstructed with webs of scar tissue that have reduced your venous outflow by 85%.

But I do appreciate your good wishes PK.

Well, I don't know about webs in the veins, but just the presence of the clots in the thighs seriously damages the valves which keep the blood flowing uphill in the thighs, and it doesn't necessarily follow that busting the clot repairs the damage done on those valves. I don't know if it'll make you feel better, but I took the trouble to look up the research on thrombolysis in lower extremity DVT's, and in fairly recent research, the role still seems experimental. The latest article I could find was from December 2020:

https://ashpublications.org/hematology/article/2020/1/612/474313/Thrombolytic-therapy-in-acute-venous

"Although anticoagulation remains the mainstay of treatment of acute venous thromboembolism (VTE), the use of thrombolytic agents or thrombectomy is required to immediately restore blood flow to thrombosed vessels. Nevertheless, systemic thrombolysis has not clearly been shown to improve outcomes in patients with large clot burdens in the lung or legs as compared with anticoagulation alone; this is in part due to the occurrence of intracranial hemorrhage in a small percentage of patients to whom therapeutic doses of a thrombolytic drug are administered...".

Their graph indicates either anticoagulation or catheter-directed approaches as acceptable alternatives, and specifically states "systemic thrombolysis is NOT recommended due to high bleeding risks."

The Wikipedia entry on post-thrombotic syndrome also states that thrombolysis is a "research direction":

https://en.wikipedia.org/wiki/Post-thrombotic_syndrome

Research directions[edit]

The field of PTS still holds many unanswered questions that are important targets for more research. Those include

• Fully defining the pathophysiology of PTS, including the role of inflammation and residual thrombus after completion of an appropriate duration of anticoagulant therapy
• Developing a PTS risk prediction model
• Role of thrombolytic ("clot-busting") drugs in PTS prevention
• Defining the true efficacy of elastic compression stockings for PTS prevention (and if effective, elucidating the minimum compression strength necessary and the optimal timing and duration of compression therapy)
• Whether PTS prevention methods are necessary for patients with asymptomatic or distal DVT
• Additional treatment options for PTS with demonstrated safety and efficacy (compression and pharmacologic therapies)

So for all of his bravado, the Stanford professor's suggested approach seems rather experimental, potentially dangerous, and, according to what I could find in my search, not a "standard of care." I could find zero evidence from the medical literature/scientific studies that your outcome was likely to be any better had you been offered thrombolysis. Did you come across any research which suggested otherwise?

If not, I hope that, even if you have to suffer the unfortunate consequences of post-thrombotic syndrome, you can at least assuage your anger in this matter. Maybe that will help some. 

[Rudynate]

2 minutes ago, Unicorn said:

Well, I don't know about webs in the veins, but just the presence of the clots in the thighs seriously damages the valves which keep the blood flowing uphill in the thighs, and it doesn't necessarily follow that busting the clot repairs the damage done on those valves. I don't know if it'll make you feel better, but I took the trouble to look up the research on thrombolysis in lower extremity DVT's, and in fairly recent research, the role still seems experimental. The latest article I could find was from December 2020:

https://ashpublications.org/hematology/article/2020/1/612/474313/Thrombolytic-therapy-in-acute-venous

"Although anticoagulation remains the mainstay of treatment of acute venous thromboembolism (VTE), the use of thrombolytic agents or thrombectomy is required to immediately restore blood flow to thrombosed vessels. Nevertheless, systemic thrombolysis has not clearly been shown to improve outcomes in patients with large clot burdens in the lung or legs as compared with anticoagulation alone; this is in part due to the occurrence of intracranial hemorrhage in a small percentage of patients to whom therapeutic doses of a thrombolytic drug are administered...".

Their graph indicates either anticoagulation or catheter-directed approaches as acceptable alternatives, and specifically states "systemic thrombolysis is NOT recommended due to high bleeding risks."

The Wikipedia entry on post-thrombotic syndrome also states that thrombolysis is a "research direction":

https://en.wikipedia.org/wiki/Post-thrombotic_syndrome

Research directions[edit]

The field of PTS still holds many unanswered questions that are important targets for more research. Those include

• Fully defining the pathophysiology of PTS, including the role of inflammation and residual thrombus after completion of an appropriate duration of anticoagulant therapy
• Developing a PTS risk prediction model
• Role of thrombolytic ("clot-busting") drugs in PTS prevention
• Defining the true efficacy of elastic compression stockings for PTS prevention (and if effective, elucidating the minimum compression strength necessary and the optimal timing and duration of compression therapy)
• Whether PTS prevention methods are necessary for patients with asymptomatic or distal DVT
• Additional treatment options for PTS with demonstrated safety and efficacy (compression and pharmacologic therapies)

So for all of his bravado, the Stanford professor's suggested approach seems rather experimental, potentially dangerous, and, according to what I could find in my search, not a "standard of care." I could find zero evidence from the medical literature/scientific studies that your outcome was likely to be any better had you been offered thrombolysis. Did you come across any research which suggested otherwise?

If not, I hope that, even if you have to suffer the unfortunate consequences of post-thrombotic syndrome, you can at least assuage your anger in this matter. Maybe that will help some. 

 

I certainly appreciate your effort, but systemic thrombolysis is usually used only in one of three scenarios - pulmonary embolism, massive stroke, and massive heart attack.  These are the only scenarios that justify the risk of intracranial hemorrhage that it entails.  VTE (venous thromboembolism) is treated every day in IR suites all over the world with catheter-directed thrombolysis and has been since the late 90's.    The risk of bleeding from catheter-directed thrombolysis is slightly greater than that from anti-coagulation.

I notice from your chart that one of the factors to be considered in diagnosing and treating  VTE is "severity of thrombosis."  A minor clot in the calf is a whole different thing from a massive unexplained ileo-caval clot.  The minor clot in the calf can be treated with six weeks of anticoagulation.   I had the massive unexplained ileo-caval clot - my entire leg looked like a salami.  The ER doc who admitted me and the hospitalist who wrote the transfer order both assumed that the treatment would be thrombolysis and they were gob-smacked when the receiving hospital refused the transfer request.

[Guest]

3 hours ago, Rudynate said:

 

...VTE (venous thromboembolism) is treated every day in IR suites all over the world with catheter-directed thrombolysis ...

I don't know whether you read through the whole article I referenced in my prior post or if you've independently look at the research supporting Catheter-Directed Thrombolysis (CDT). The original article said "Most importantly, current evidence supporting the use of CDT in acute PE is limited to a small RCT or single-arm studies focusing on short-term surrogate outcomes rather than clinical outcomes." The research on CDT has only shown a marginal advantage in short-term outcomes. Unless I've missed some hidden research, there is ZERO evidence that CDT has any benefit in preventing PTS. The only study I found in CDT in DVT's (as opposed to PE), was a small Canadian study:

https://ashpublications.org/blood/article/130/Supplement 1/4922/80919/Catheter-Directed-Thrombolysis-for-Acute-Deep-Vein?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Blood_TrendMD_0

This study (dated December 7, 2017), specifically states: 

"Catheter-directed thrombolysis appears to be a well-tolerated treatment option for iliofemoral DVT. Complications were seen in 53% of patients and were frequently mild and self-resolving. The results of our study suggest that patients under 45 years of age who receive prompt thrombolysis, within 7-14 days of DVT diagnosis, are most likely to derive benefit from CDT. The clinical characteristics of patients described here are largely in accordance with those recommended by the 2016 CHEST guidelines.

Due to the limited sample size in our study, it is unclear if CDT is beneficial in reducing rates of PTS. Additional studies are needed to clarify potential risks and benefits of this treatment approach."

So first of all, unless you were under 45 at the time of the DVT (with no bleeding risk, the only patients accepted in the Canadian study), CDT shouldn't have been entertained in the first place. Secondly, there seems to be zippo evidence that CDT lowers the risk of PTS. CDT may lower the risk of getting a pulmonary embolism, or other short-term complications (at a certain risk), in those under 45, but there really is no evidence that it would have lowered your risk of PTS. The damage was almost certainly already done when you developed that massive clot. 

I'm sorry the Stanford professor passed on spurious (and self-serving) information to you. Hopefully you can go to bed tonight a little calmer in the knowledge that CDT wouldn't have prevented the predicament you have found yourself in.

Edited November 3, 2021 by Unicorn

[Guest]

First, I’m sorry for your experience.  As to suing, my benchmark of determining whether you have a case or not is whether an attorney will take the case on contingency or not.  If not, you’re just trying to make an expensive point.