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How can women avoid becoming victims of medical malpractice?

"An educated woman is the best consumer Of medical care.... It is impossible to ask too many questions about one's health care."

Injuries caused by bad medical care are an enormous problem in the US. According to a Harvard Medical School study, 3.7% of hospitalizations result in adverse events, almost 30% of which stem from negligence. The Harvard study analyzed cases in New York and estimated that, in one year alone, 27,179 patients were injured, 6,895 died, and 877 became permanently disabled as a result of negligent medical care. On a national basis, the number of unnecessary injuries and deaths is staggering.

Women victims of medical malpractice have special problems due to both the peculiar nature of the damage that they sustain and their difficulty in receiving compensation for those injuries. Women consumers of health care must learn to educate themselves to ask probing and thorough questions before agreeing to surgery or other health care procedures. Many of the injuries caused to female patients as a result of medical negligence can be traced to nonessential procedures, which an educated patient/consumer can prevent.

Unnecessary surgery, including hysterectomy, is rampant. "Of the estimated 35,000,000 operations a year at least 15%, or 5,000,000 are unnecessary. Hysterectomies, dilation and curettage and caesarean section are the most over-performed procedures," according to Charles Inlander's book, Medicine on Trial. The unnecessary hysterectomy is perhaps the most prevalent abuse of women by the health care system. This is particularly true in cases where women "already" have had their children, and therefore no longer "need" the uterus or ovaries. The decision to perform a hysterectomy frequently is made without taking into consideration the impact of such an operation on patient well-being.

The National Institute for Health has reported that 22% of the 750,000 hysterectomies performed in the U.S. each year are unnecessary. Hysterectomy is radical, life-altering surgery, exposing females to premature menopause; increased cardiac risk, placing women into categories approximating those of men, as a result of the loss of naturally produced estrogen; sexual dysfunction, including pain during intercourse; and osteoporosis. Accordingly, before agreeing to so radical a procedure, the patient must satisfy herself that all less severe remedies have been attempted.

Other surgical procedures on women also are abused. Operations that should be routine frequently result in unnecessary injury and death. As pointed out by James L. Breen, president of the American College of Obstetrics and Gynecology: "In addition to the lack of adequate surgical training among obstetricians/gynecologists doing surgery, the number of gynecologic surgery procedures done each year is staggering." Their frequency is correlated statistically to the amount of negligent surgery. According to one study, five of the 10 most frequently performed surgeries are gynecologic: dilation and curettage (D&C), second; caesarean section, third; hysterectomy, fifth; bilateral tubal ligation, sixth; and oophorectomy and salpingo-oophorectomy (removal of tubes and ovaries), ninth.

Many methods of contraception available today may result in some type of injury, including oral contraceptives, intrauterine devices (IUDs), diaphragms, condoms, foams and creams, and tubal ligation. Each has the potential of harm. It is rare for patients to be informed fully about the risks of the various methods, and side effects are not looked out for with sufficient vigor.

The clearest example is the failed tubal ligation. Many women assume that the operation is a risk-free, fail-safe procedure. It is neither. Medical literature is replete with reports of tubes "heating" themselves, even when the ligation has been performed properly. It is a fact of nature that the human body will try to heal itself. Unwanted, unplanned for, and potentially deadly pregnancy can result. This is especially true where pregnancy medically is contraindicated.

Birth control pills have been shown to increase the risk of breast cancer. Additionally, according to the Women's Health Alert, millions receive and take pills with too high a dosage of estrogen, further increasing the chance of complications.

Another area of frequent medically caused injury in women involves those with cancer. They may be undiagnosed or misdiagnosed, and their cancer - be it breast, uterine, or cervical - improperly treated. One study found a large incidence of failure to detect breast masses. According to Inlander, "During a test, 80 doctors could find only half the lumps hidden in silicone models of female breasts. Might this 50% error rate have something to do with the fact that even though they knew they were being tested and observed and were told to treat the models as though they were real in a real examining situation, the doctors spent a mean time of less than two minutes examining these |breasts' for cancerous signs before coming up with their misdiagnoses? Had they been real breasts, the untreated breast cancer implications are enormous. Meanwhile, this information dovetails with that of earlier and concurrent studies showing that breast cancer is the source of a very large number of malpractice suits against primary care physicians specializing in family practice, obstetrics/gynecology, general surgery, and internal medicine - suits based not on faulty or catastrophic courses of treatment but rather based on delayed diagnoses or misdiagnosis."

A number of the areas of diagnostic error leading to these suits had to do with physicians accepting a negative mammogram as the only evidence they felt was needed to rule out cancer. In fact, mammography is not fail-safe. The doctors should have known this, but instead relied too heavily on technology and, by doing so, delayed performing potentially life-saving biopsies. On the other hand, injuries occurred because of physicians not following up on detected breast irregularities, including those shown in a positive mammogram. Doctors also inadequately evaluated nipple discharges and ignored patients' repeated breast complaints.

In such cases, should the patient decide to sue, she has a very difficult case ahead of her. To be successful, she must show some likelihood or chance of cure with timely diagnosis - something even the experts find difficult to predict. It is very hard to backtrack from a short delay to a measurable change in outcome. However, a delay, as sometimes happens, of six, eight, 10, or more months often can form the basis for successful proof of a measurable deterioration in outcome. In a few instances, a mammogram may have been done and misread. A competent radiologist, testifying as an expert, can provide the needed evidence that the tumor was there, yet missed. Marginal mammograms should be repeated, to ensure that no tumor is present.

Cervical cancer is still another area where poor medical care causes harm to women. These cancers most often are diagnosed as a result of an abnormal Pap smear. There is a large body of medical literature revealing that many pathology labs performing routine Papanicolaou (Pap) tests are sloppy and inaccurate. Test results are lost or switched, samples are misplaced or misidentified, etc. Consequently, patients receiving abnormal Pap results, or successive "normal" Pap results in the face of abnormal symptoms, would be well advised to obtain second or third lab tests and analyses. Additionally, abnormal Pap results frequently are missed on return to the gynecologist's office, leading to the death of many women.

Obstetric malpractice can result in harm to the mother as well as the baby. Frequently, the physical injuries sustained by mothers during pregnancy or delivery are written off as unavoidable or "normal." Many, in fact, are preventable.

Pre-eclampsia, sometimes called pregnancy-induced hypertension (PIH), is a condition that affects some women, usually in the later months. Symptoms include abnormally high blood pressure, protein in the urine, and edema (swelling of the feet, legs, hands, arms, or face), occurring after the 20th week of gestation. Without appropriate intervention, eclampsia can follow pre-eclampsia, and is characterized by the presence of convulsions. It also may produce coma, cerebral hemorrhage, pulmonary edema, renal failure, congestive heart disease, and/or ruptured liver. Symptoms include blood pressure of 160/110 or greater, protein in the urine, scanty urination, visual disturbances (i.e., spots before the eyes), pain in the abdomen, difficulty breathing, and/or excessive weight gain caused by retention of fluid.

If the unborn baby is developed sufficiently, the best treatment for pregnancy-induced hypertension and pre-eclampsia is delivery, which normally will prevent the onset of eclampsia. There is a risk for up to 24 hours after delivery, however, and appropriate medications and close monitoring of the mother should still be prescribed. If it is determined that the fetus is too immature to deliver, treatment includes bed rest and anti-convulsant and anti-hypertensive drugs. Failure to follow these steps can result in the serious complications listed above, up to and including death.

Another frequent area of poor medical care involves unnecessary caesarean sections, which account for 21.1% of the 3,700,000 annual deliveries in the US. "The bottom line, I think, is that a caesarean section is often much easier for [obstetricians], as they don't have to stay up all night waiting," indicates Steven A. Myers, a physician at Mt. Sinai Hospital, Chicago.

Consumer movements such as the CPM-VBAC (Caesarean Prevention Movement - Vaginal Birth After Caesarean) have become active in reducing this excess surgical technique. They provide a ready source of information to educate patients about physical and psychological aspects of unnecessary caesareans.

There is perhaps no greater area of questionable medicine today than in the diagnosis and treatment of infertility. Anxious parents, desperate to conceive, have been convinced to undergo wrenching, costly procedures, often to no avail. In this situation, perhaps more than in any other, women must avail themselves of second and even third opinions, particularly before submitting to surgery. They also should be sure their doctor is board certified in obstetrics and gynecology and has some special training or competence in the infertility field. Medical schools, county medical societies, and physician referrals are the best sources of information.

Cosmetic surgery risks

Most cosmetic surgery is performed on women. It is important to recognize that, legally, a physician need not be a plastic surgeon to perform cosmetic surgery. Patients, therefore, must assure themselves of the training and experience of their surgeon before going under the knife.

Whether the procedure is augmentation, reduction, or lift, breast surgery carries with it certain inherent risks. These include shifting or hardening implants; rupture of implants; and circulatory compromise, resulting in poor healing, wound reopening, tissue death, scarring, and poor appearance. Over 2,000,000 women have had breast implants. Up to 40% eventually will suffer painful hardening of their breasts, sometimes requiring repeat surgery, according to the Women's Health Alert. In addition to the known risks, other more ominous problems are being discovered. Mysterious auto-immune diseases including arthritic conditions, swollen joints, and other evidence of tissue rejection have been identified.

The gel implants frequently leak or ooze silicone even without an actual perforation in the "skin" of this type of implant. Microscopic amounts of silicone are carried throughout the body, causing tissue reactions, lymph node inflammation, and other toxic effects. Further, silicone gel has been found to cause cancer in laboratory animals. A final serious consequence of the implants is that they interfere with X-ray detection of tumors in the breast.

Other plastic surgery procedures that injure women include the "tummy tuck" or abdominoplasty. The risks of unsuccessful abdominoplasty are similar to those when circulation is impaired as a result of breast surgery. Compromised circulation can result in delayed healing, tissue death, and massive scarring.

As with most cosmetic surgeries, facial procedures have been almost uniquely the province of female patients. Whether face lift (rhytidectomy), eye lift (blepharoplasty), neck lift (submental lipectomy), or nose alteration (rhinoplasty), numerous instances of surgical misadventure occur. Additionally, because many of these are done as in-office procedures, there are frequent complications brought on by the use of untrained or undertrained anesthetist personnel, or by the physician opting to manage the anesthesia simultaneously with performing surgery. Here, the patient must inquire as to both surgical and anesthesia experience and training. She must satisfy herself that her surgeon is board certified in plastic surgery and that he has adequate anesthesia coverage. She should inquire as to the back-up available should an anesthesia complication develop.

Suction lipectomy involves insertion of a long tube or probe under the skin to suction out fatty deposits. There can be numerous complications, the most frequent of which is unsatisfactory appearance. More seriously, there have been numerous cases where patients have developed massive infection, become septic, and had other untoward major complications as a result of improper technique, including inadequate sterile assurance. Two women in Houston died as a result of uncontrollable infection brought on when their lipectomies, performed not by a plastic surgeon, but by a gynecologist, were done without proper safeguards against contamination. Their post-operative infections were diagnosed improperly and, because of the delay, treatment came too late to save their lives.

Finally, unwanted or inappropriate sexual contact between doctor and patient is virtually unique to the male physician/ female patient scenario. Modern medical authorities are unanimous in condemnation of sex between physician, therapist, or other health care provider and the patient. It is below accepted standards of medical practice for the physician to permit such behavior. The consumer must be aware that such conduct is not "treatment" and never is acceptable. These acts will delay recovery, if not prevent it. She must report such conduct to her local medical society to prevent injury to other patients.

In some cases where the health care provider is a psychiatrist, psychologist, or other psychotherapist, a particularly high risk exists because of transference - the patient transferring feelings of affection, respect, devotion, etc. to the person providing psychotherapy. These emotions frequently can be misinterpreted as genuine and healthy love. The psychotherapist continuously must be on guard to avoid therapy degenerating into sexual contact.

An educated woman is the best consumer of medical care. Years of experience in working with medical negligence victims supports one contention: It is impossible to ask too many questions about one's health care. The patient must maintain control of the care she is being given and have the final word about whether to accept or reject treatment and the course of her own health care. Too much injury and death occurs as a result of poor health care for patients who passively permit medical decisions to be made for them without their input. Competent, caring, dedicated health professionals support patients in seeking necessary health care information and willingly give it. A health care provider who refuses to answer basic and proper questions should be rejected and more appropriate treatment obtained.
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Author:Sweeney, Paula
Publication:USA Today (Magazine)
Date:Sep 1, 1993
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