This whole thing just proves how necessary it is to find a replacement or better way of delivering tPA, maybe magnetically directed nanoparticles, that would only require a small bolus. That would never do, to listen to a non-medical person suggestion. And objective diagnosis of stroke.
How silly of me to expect someone with some analytical brains to see all the problems in stroke care.
https://www.uic.edu/com/ferne/pdf/ieme_2006/tpa/tpa_weintraub_tpa_medicolegal_2006.pdf
Background and Purpose—Despite the success of the 1995 National Institutes of Neurological Disorders and Stroke
(NINDS) study using IV recombinant tissue plasminogen activator (tPA) within 3 hours in acute stroke and its
subsequent FDA approval, there has been a reluctance to use tPA because of safety and efficacy issues with high
incidence of intracerebral hemorrhage, and protocol violations.
Summary of Review—The following cases will illustrate the increased number of malpractice lawsuits generated by the
controversy of “standard of care” and illustrate and educate clinicians regarding specific issues and how to avoid: (A)
Failure to use tPA (loss of chance) or to transfer, Reed versus Granbury Hospital (Texas): acute stroke victim taken to
local hospital with tPA available only for cardiology. Wife subsequently transferred patient to nearby stroke center but
no tPA given. Defendant verdict; (B) Stroke misdiagnosis (failure to diagnose, loss of chance), Mei versus Kaiser
Permanente South (San Francisco, CA): acute stroke while driving with ambulance taking to local hospital. Symptoms
were misdiagnosed and neurologist did not see her for 6 hours. Plaintiff verdict; (C) Bleeding complications of
therapy/failure of informed consent, Harris versus Oak Valley Hospital (California): acute stroke and hypertension
treated with tPA with subsequent development of intracerebral hemorrhage. Patient alleged that tPA should not have
been given. Defense verdict; (D) Expert witness testimony, Wojcicki versus Caragher (Massachusetts): a prominent
neurologist gave “false and misleading testimony” and the Court found that the neurologist perpetrated a “fraud on the
Court” intentionally and deliberately misleading the Court and jury. Court sanctioned the neurologist $88 685; Ensink
versus Mecosta County General Hospital (Michigan): neurological testimony (plaintiff expert) regarding potential
benefit of using tPA during last available 1 hour of window was felt to be “speculative”. Defendant verdict.
Conclusions—Neurologists, emergency room physicians and hospitals are at increased liability risk if they use or do not
use tPA. Detailed documentation,
No comments:
Post a Comment