#Anesthesiologist Disability Insurance

[nochiquinn]

this is the partner I never shut up about. his name is David. (that's Hancock the kitten on his chest.)

on 11/17, he was diagnosed with detached retinas in both eyes. this is likely due to a form of neuropathy known as diabetic retinopathy. he's having surgery on 11/22, and will require at least 3-4 weeks recovery.

this makes us effectively a one-income household until after the new year. the cost of the procedure will come later, after fist-fighting the insurance company and the anesthesiologists and everyone else. what we're looking at directly is the loss of David's wages. while the lost wages still very much are an issue, as it turns out the out-of-pocket payment is $4000. we'll be able to make it in $150 monthly payments, with interest. this is another monthly payment in a time where our household income is cut in half. short-term disability is still pending approval, and even then will only be about 60% of what he usually makes. we have to make up that shortfall somehow.

if you are feeling at all generous:

gofundme ko-fi: nochiquinn (I'll be posting WIP art and writing and little snippets of contextless writing that fall out of my brain, accessible to supporters) (there's also already a couple handfuls of free-to-use mobile wallpapers and some pokemon art in the gallery) paypal: nochisan venmo: nochiquinn redbubble teepublic

and as always there's tipping on both blog-level and individual posts. this year has kicked the absolute crap out of us and y'all's generosity has honestly been what kept us afloat. thank you, thank you, thank you.

[alwaysabeautifullife]

i know you've probably had enough about Dental Discourse but im still reeling over the idea that brushing your teeth, a preventative measure, can... reverse tooth decay?? apparently?? so we can all forget about trying to make dental care more accessible and just hand out free toothbrushes??

The sad part was people claiming that diet doesn’t decay your teeth which...is literally what decays teeth Lmaooo. Like for 15 mins after you take a sip of anything but water, your teeth are being destroyed for that 15 mins. This is why dentists constantly warn parents to not give their children anything but water after they are done nursing/bottle feeding.

In my mind I was thinking about situations that people cannot control, as well. Like for an example when buggy was born, for some reason her top front teeth came in and I watched myself the enamel of her teeth come of like a hard candy shell. It happened within about two weeks of her getting each tooth in. She was in absolute agony, and her teeth immediately started to decay. This was when she was about 2. I went to several dentists and they explained she had a genetic disorder, one similar to the disease you can get that makes your bones brittle. He suggested as soon as the other two top tooth come in, to get them pulled. The bad news is, while the insurance covered part of the procedure, it did not cover any of the anesthesia, we had to come up with 7 thousand dollars or our daughter would suffer in agony with 4 teeth all sensitive enough she cried constantly. The other tooth popped out pretty quickly, we were able to come up with the money, we paid it in cash to the anesthesiologist, and she had her teeth pulled in surgery and had caps put on some of her top molars. The dentist does not believe it will affect her adult teeth.

I just...remember Portia crying in pain because of it for that last month waiting for the little baby tooth to come in so we can pull it. I can’t imagine if we would have been in a place we couldn’t pay the 7 thousand dollars. My baby would have to suffer. And we even struggled then, because only my husband worked. Most of their arguments were “poor people can fully control their situation”.

And in my experience, no one does. No one controls medical conditions, deaths, disabilities, etc. My dad didn’t control the fact he was fired because the company told him he was a “liability” after he broke his neck, fully recovered but had some minor hand paralization, my daddy Allen didn’t control the fact that although he was a wealthy buisness man, he would die when I was 7, and my mother, brother, and me would be shoved out like we were piles of trash. I remember Christmas that year, my mom bought me and my brother play dough, glitter play dough, for Christmas, and she spent all day making jewelry and things with us. She used to call powdered evaporated milk “magic milk” because all you need to do is add water and poof! Milk!!

People in poverty are not stupid, drug addicts, who abuse their families and don’t know how to budget. They are smart. They know how to cook for a family on 3 dollars a meal. They know how to keep their feet warm and dry in cold temperatures with out boots (you put plastic bags over your socks before you put your foot in the shoe), they are resilient, and they are good, and they are hardworking. All of them. Most importantly, they are people, and I just want other people to look at them as people.

[penningtonbrokerage-blog]

                                            Disability insurance

When it comes to Cardiologist Disability Insurance policy then we provide excellent options those meet your entire criteria. We provide review rates from over 240 name-brand disability insurance companies. We also satisfy queries pertaining to varied policies and their benefits. So come, compare plans and get the best insurance rates! Secure your future now! Visit Us Now:- http://www.penningtondisabilityinsurance.com/

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We offer disability insurance quotes. Compare plans and get the best insurance  rates.

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[debofskylaw]

Can My Disability Benefits Be Terminated Even If My Medical Condition Has Not Improved?

Navigating the disability benefit claim process can be overwhelming, and the challenges don’t necessarily end once your initial disability claim is approved. Understanding when and why an insurer can terminate your disability benefits can be confusing. Learning the most common ways an insurance company can use to terminate your claim, can make this process easier.

When and How an Insurer Could Terminate Disability Benefits

1. Can Your Disability Benefits Be Taken Away?

The short answer is “Yes.” An approval of long-term or short-term disability benefits is not a guarantee of continued payments under the policy. Disability insurers can use a multitude of reasons to terminate disability benefits after approval. That is why it is so important to read your disability policy, and timely answer any request for information the insurer may send; including, updated medical records, claim forms, and any other requests that align with your policy.

2. How Insurers Decide to Terminate Your Disability Benefits?

Insurers periodically review every claim for disability benefits in order to determine if the claimant continues to meet the definition of disability under the policy. These reviews may occur on a monthly, semi-monthly, or yearly basis. During their review, the insurer may request updated medical records, updated claim forms, a status of your social security disability claim (if applicable), or any other documents required under the policy. Providing the insurer with as much information as possible that establishes your continued disability will help the insurance company review your claim and provide enough evidence to receive continued benefits. However, sometimes no matter what you provide to the insurance company, they may still terminate your disability benefits. That is why it is so important to continue to receive medical treatment and document your symptoms.

Unlike the Social Security Administration, which is prohibited by statute from terminating Social Security disability benefits in the absence of medical improvement, disability insurance companies operate under no similar constraint. However, courts may consider the previous payment of benefits in deciding whether the denial of benefits was reasonable. Recently, in Roehr v. Sun Life Assur. Co. of Canada, the Eighth Circuit Court of Appeals overturned a denial of benefits to an anesthesiologist suffering from tremors, ruling that Sun Life abused its discretion when it terminated the doctor’s claim after 10 years of payments without first establishing that his condition had improved. Roehr v. Sun Life Assur. Co. of Canada, 21 F.4th 519 (8th Cir. 2021). The Roehr decision relied heavily on an earlier Eighth Circuit case, McOsker v. Paul Revere Life Insurance Company, which held that although an insurer is not bound by its initial decision to approve benefits, insurers must significantly consider the previous decision when reviewing a claimant’s continued disability. 279 F.3d 586, 589 (8th Cir. 2002); see also Leger v. Tribune Company Long Term Disability Benefit Plan, 557 F.3d 823, 833 (7th Cir. 2009) (“[T]he previous payment of benefits is just one ‘circumstance,’ i.e., factor, to be considered in the court’s review process; it does not create a presumptive burden for the plan to overcome.”).

The biggest take away for claimants from the rulings in the Appellate Court is to keep documenting the signs and symptoms of your ongoing disability, even after an approval of benefits have been obtained.

3. Reasons for Terminating Long-Term Disability Insurance Payments

Insurance companies can use a variety of reasons to stop payment of your disability benefits Some of the most common reasons for termination of disability benefits include:

1. BENEFIT LIMITATIONS FOR CERTAIN CONDITIONS.

Most policies impose limits on how long the insurer will have to pay benefits for certain conditions, including mental, nervous or psychological conditions, alcohol or drug addiction, or conditions with self-reported symptoms such as chronic fatigue syndrome or migraines. These limitations can be as short as 24 months or as long as 5 years, depending on your policy. Check your policy to verify how long the insurer will pay disability benefits for certain conditions.

2. NOT RECEIVING PROPER MEDICAL CARE OR TREATMENT FOR YOUR DISABLING CONDITION.

Insurers can stop your short-term or long-term disability payments if you fail to receive regular medical treatments as required under the policy. In many circumstances the insurer will send forms for your physician to complete certifying your disability and inability to return to work.

3. CONDUCTING MEDICAL REVIEWS OF YOUR CLAIM.

Insurers typically have nurses and physicians on staff that will review your medical records to determine if your disabling conditions continues to be supported by “objective” medical evidence. It is also common for the insurer to send your file out for an “independent” peer review. During this process the insurer will send out your medical file to a service that employs medical doctors or nurses to review the records and provide an opinion on your physical capacity to return to work. The physicians or nurses reviewing your file, rely on the medical records and updated claim forms to determine your capacity to return to work. Therefore, it is very important to provide the insurer with any medical records and documentation that continues to support your disabling condition.

Depending on your policy, the insurer may also be able to send you for an “independent medical examination.” The insurer will find a doctor (ideally someone that is familiar with your disabling condition) and send you for a medical examination, at the insurers expense. The information contained in the medical report form this physician is reviewed in order to determine if you continue to meet the definition of disability under your policy.

4. PARTICIPATING IN ACTIVITIES THAT ARE CONTRARY TO CONTINUED DISABILITY.

Insurers can conduct surveillance of your activities in order to determine if you continue to meet the definition of disability under your policy. Surveillance can include monitoring your social media accounts looking for posts of vacations, volunteer efforts, or other activities that are contrary to your stated disability. While we recommend limiting or canceling your social media accounts, or at the very least setting the highest possible security settings on your accounts. Surveillance can also include sending out a private investigator to record your activities. This may include taking pictures or video of you driving a car, gardening, or carrying groceries. Depending on your disabling condition, the insurer may use the private investigators report as evidence that you have the capacity to return to work.

5. REACHING THE END OF THE “OWN OCCUPATION” DEFINITION OF DISABILITY.

Many polices definition of disability will change after, generally, 24 months of benefits. When your claim is initially approved, the insurer has agreed that you can not work in your “own” or “regular” occupation. However, after the 24-month period the definition of disability may change from “own” occupation to “any” occupation. Therefore, if the insurer determines that you are able to return to work in a different occupation that aligns with your education, background, and a percentage of your previous income, the insurer can terminate your benefits. Check your policy to determine how long the “own” occupation period definition of disability applies.

What to Do if Your Disability Benefits Are Terminated and Your Condition Has Not Improved?

Act fast. Many disability insurance policies include procedures that a claimant must follow to appeal a denial or termination of disability benefits. If your policy is governed by the Employment Retirement Income Security Act of 1974 (ERISA), you may be limited to filing an administrative appeal with the insurance company within 180-days of the date on the denial letter. Many policies will require the claimant file an administrative appeal prior to filing suit in Federal Court.

A consultation with an experience an ERISA or disability attorney at on our team can help you navigate this very complex process. We can help you understand the reasons the insurer has terminated your short-term or long-term disability claim, and your options for filing an appeal.

Navigating the disability benefit claim process can be overwhelming and doesn’t end with an approval of your benefits. Understanding the best way to navigate the process and protect yourself in case of a denial can help.

[davidslepkow]

(via Rhode Island Wrongful Death Lawyer | Slepkow Law (est. 1932))

Rhode Island Wrongful Death Lawyer | Slepkow Law (est. 1932)

When an individual loses their life by the misconduct, negligence or intentional actions of another, the surviving family members have the legal right to file a lawsuit for the “wrongful death” The victim’s loved ones should retain a top RI wrongful death lawyer. Because of the fatal injury, the victim’s family can file a claim or lawsuit against all parties at fault for the death as a measure of accountability and a way to seek financial compensation for all damages and losses sustained by the wrongful death.

Wrongful death lawyer RI

Rhode Island Wrongful Death Lawyer

The Spouse or Family member is not entitled to file a wrongful death claim on their own in Providence Superior Court. In fact, only the duly appointed executor or administrator of the deceased who died in the fatal wreck may file a wrongful death cause of action utilizing a RI wrongful death lawyer. The executor must retain a top wrongful death lawyer in RI to litigate the deadly crash and seek compensation for the statutory determined beneficiaries.

How are wrongful death damages apportioned under RI law?

RI law states ““…one-half (1/2) shall go to the husband or widow, and one-half (1/2) shall go to the children of the deceased, and if there are no children, the whole shall go to the husband or widow, and, if there is no husband or widow, to the next of kin, in the proportion provided by law in relation to the distribution of personal property left by persons dying intestate…”  Law server

The surviving family members of a wrongful death victim often face horrific financial burden by the untimely death. By filing a suit Providence or Newport Superior Court, the family can receive economic damages AND non-economic damages as a result of the fatal collision or fall.

The most common causes in cases handled by Rhode Island wrongful death lawyers:

Every motorist has a legal responsibility to drive in a safe and conscientious manner to protect themselves and all others sharing the road. Unfortunately, more than 30,000 individuals die every year in motor vehicle accidents or car accidents where some type of negligence or reckless action caused injuries and death.

Often the automobile (auto) driver disobeyed traffic laws, failed to account for hazardous road conditions, drove recklessly in congested traffic or neglected obvious hazards/dangers that required an adjustment in their driving behavior.

Most deadly motor vehicle accidents and car accidents are usually trucking collisions involving Semi Trucks, Tractor Trailers, Big Rigs and 18 wheelers. If your loved one was killed in a tractor trailer crash in Rhode Island then you need to contact a RI truck accident lawyer who is also a Rhode Island wrongful death attorney. A RI wrongful death attorney will have experience litigating fatal trucking mishaps.

Motor Vehicle Accident in RI

Motorcycle accidents are also some of the most often deadly types of vehicular accidents in Rhode Island and Providence Plantations. If a spouse, child or family member is killed in a RI motorcycle accident by a car or other motor vehicle then you need to retain a Rhode Island motorcycle accident lawyer. A garden variety rear end car accident in RI can become fatal if a car or suv rear-ends a motorcycle.

Medical Malpractice

Mistakes, errors and failure to act professionally are the causes of many medical malpractice cases where the patient dies unexpectedly. Health care professionals and medical doctors are legally bound to provide treatment and optimal care by following acceptable standards of practice. Unfortunately, medical malpractice in Rhode Island happens when a medical professional is negligent in delivering appropriate medical care to individuals who consequently lose their lives.

Family members of the deceased patient can file a wrongful death claim against the facility and all medical professionals involved in the case including doctors, nurses, surgeons, psychologists, anesthesiologists and other health care providers who are legally responsible to provide care.

Nursing Home Neglect and abuse

Elderly, disabled and seriously ill individuals are among the most vulnerable in our society. When nursing staff and nursing facilities act negligently or abusively, the victim can easily succumb to their injuries. Nursing home neglect and abuse are common problems at facilities nationwide.

Sadly, many cases of nursing home neglect go unnoticed, undetected and unreported until it is too late. This is often because the victim feels too scared to tell others that their caregiver is being abusive or neglectful of their health and hygiene requirements. Neglect in a nursing facility often leads to bedsores (pressure sores; pressure ulcers; decubitus ulcers) that when left untreated can cause life-threatening open wounds and infections of the bone (osteomyelitis) or sepsis (blood poisoning).

Workplace Accident Death

Safety standards are set forth by OSHA (Occupational Safety and Health Administration) that must be followed by employers to ensure the safety of every employee. Even so, workplace accidents are one of the leading causes of wrongful death cases in the United States. While a workplace accident can occur anywhere, the most common locations are construction sites, logging sites and mines. However, truck drivers, metalworkers, electricians and those working in the fishing industry are also considered to be in a high-risk occupation that has a greater potential of a work-related death than most jobs.

Sadly many wrongful death claims in Providence involve construction site accidents. In the event of a construction accident in Rhode Island then you should retain a RI construction accident lawyer. Not every Rhode Island personal injury attorney has expertise going to the mat, so to speak, with insurance adjusters in Rhode Island construction accident death causes of action. A Rhode Island workers compensation lawyer can also seek death benefits against an employer for a work related accident under the workers compensation statute.

Product Liability fatalities

The manufacturer, distributor or retailer of all products are legally accountable for items sold to the public. Unfortunately, faulty product designs and defective manufacturing processes lead to the death of many consumers. Sometimes, the manufacturer and retailer know that the product is dangerous but fail to provide adequate warning of any potential risk of injury or death directly associated with its use. Any failure to properly advise or warn the consumer can be the basis of a wrongful death lawsuit seeking financial compensation.

If you have lost a loved one through a wrongful death, you likely have a legal opportunity to file a suit or claim for compensation. Skilled Rhode Island wrongful death attorneys or a Rhode Island wrongful death lawyer  will accept these types of cases on contingency and provide a free, initial consultation to determine the value of your case. A Rhode Island wrongful death lawyer will help the family of the deceased get the compensation they deserve and to seek justice on behalf of the innocent victim.

Citation

“Total fatalities in crashes with young drivers has decreased steadily over the 10-year period from 2005 to 2014, resulting in a 48-percent decrease in fatalities during that time, as seen in Table 1. Fatalities among young drivers, the passengers of young drivers, and occupants of other vehicles all declined by approximately half (51%, 54%, and 44%, respectively). However, nonoccupant fatalties in young driver-related crashes decreased by only 28 percent during the same 10-year period.” NHTSA National Highway Traffic Safety Administration, Traffic Safety Facts 2014 Data 1200 New Jersey Avenue SE. Washington, DC 20590 May 2016 DOT HS 812 278

Hold the individual or company responsible for the death legally accountable

The unexpected loss of a loved one is a devastating experience where the grieving process lasts for many years. Because of the overwhelming despair, many families never consider taking legal action to hold the individual or company responsible for the death legally accountable for their negligence, recklessness or intentional act. In most incidences, the unexpected death will place a huge financial burden on the surviving spouse who is left behind to support the family and provide emotional support to others, all while grieving. A Rhode Island wrongful death attorney will help the victim’s spouse, family and children get the justice they deserve and the compensation they need!

Rhode Island wrongful death attorney

While no amount of compensation can return the loved one, the grieving family should never have to pay for funeral expenses, hospital bills or the loss of financial support caused by a wrongful death. A Rhode Island wrongful death attorney can assist families who need to seek justice and obtain financial compensation for their damages. A reputable RI personal injury attorney or Rhode Island wrongful wrongful death lawyer can help determine whether survivors have a case and do all the legwork such as:

• File a claim • Gather evidence • Reconstruct the accident or incident • Speak to eyewitnesses • Negotiate an out-of-court settlement • Build a case for trial when necessary • Present evidence in front of a judge and jury

Under Rhode Island law any funds received as a result of the fatal RI car accident claim are to be split as follows: “…one-half (1/2) shall go to the husband or widow, and one-half (1/2) shall go to the children of the deceased, and if there are no children, the whole shall go to the husband or widow, and, if there is no husband or widow, to the next of kin, in the proportion provided by law in relation to the distribution of personal property left by persons dying intestate…” Law server

Defining Wrongful Death in Rhode Island

Wrongful death is a legal term used in civil court that refers to any death caused by another person or entity through a negligent, intentional or reckless act. Common types of wrongful death cases involve medical malpractice, vehicle accidents, defective pharmaceuticals (bad drugs), community pool drowning, nursing home abuse and premises liability accidents along with serious intentional actions including physical assault that leads to death.

State and federal tort laws provide surviving family members the opportunity to file a claim or lawsuit against all parties responsible for the death of a loved one.  In Rhode Island, only the executor or administrator of an estate can file a wrongful death lawsuit on behalf of the statutory beneficiaries.  Wrongful death lawsuits and claims for compensation hold others responsible for their negligence, recklessness or intentional actions causing the fatal car, truck or motorcycle accident.

Proving a Case for Wrongful Death in Providence Superior Court

To be successful in a Rhode Island wrongful death car or motor vehicle cause of action, it is the responsibility of the estate’s Providence personal injury attorneys or Rhode Island Island wrongful death attorney, to prove four specific elements in the case by showing:

1. The wrongful death case was filed because a person died; 2. The death was caused by the negligence, recklessness or intentional actions of another; 3. The tortfeasor owed a duty of due care to the person killed in the RI automobile wreck or RI car crash

What are the most common types of accidents leading to fatalities in Rhode Island

The following types of collisions or mishaps are often deadly:

motorcycle accidents,

bicycle accidents,

truck and tractor trailer collisions,

construction accidents and

car accidents in RI.

Wrongful Death Damages  in RI and Providence Plantations

The wrongful death attorney in Rhode Island will build a case on a financial or pecuniary injury to the surviving family members of the decedent killed by the actions of others. In a civil court action, a pecuniary injury can involve a loss of support, loss of inheritance, loss of services, funeral and medical expenses and others. In most cases, the law awards damages for a wrongful death at a compensation level that is fair and just in equal proportion to the value lost by the decedent’s death.

In most cases, the amount sought in a claim will cover medical bills, funeral expenses, recompense for grief and the total value of lost financial support along with attorney fees, court fees, and all other expenses directly associated with the case. Under RI  law the statutory beneficiaries may be entitled to: prospective income / earnings, value of homemaker’s services, punitive damages, hospital and medical expenses prior to death and Pain and suffering prior to death. RI car accident  

Hiring a Providence Car Accident Attorney or Rhode Island wrongful death attorney

Hiring a Rhode Island wrongful death lawyer is a sure way that surviving family members can obtain a successful resolution to their claim for compensation. A reputable  East providence personal injury attorney will use successful theories of law to build a strong case for compensation. Most of these types of cases are handled through a contingency fee agreement. This means all of the attorney fees are paid only after the law firm negotiates an acceptable out of court settlement or wins a jury award in a lawsuit trial.

Rhode Island car accident lawyer

Selecting an experienced, strong Rhode Island wrongful death attorney to represent the estate of a loved one allows the family to remain focused on mourning the unexpected death of a loved one. The RI fatal motorcycle accident lawyer  or Rhode island truck accident attorney can ensure all the families rights are protected while they seek justice to hold all parties at fault for the death legally and financially accountable for their actions.

Massachusetts wrongful death

Massachusetts wrongful death attorneys

Can someone proceed with a wrongful death case under Massachusetts Law when they were not executor or administrator of the deceased estate at the time of the presentment of the case?  Can someone proceed with a Mass. Wrongful death case when the MA Superior Court complaint was not brought by the administrator or executor of the estate?

Massachusetts wrongful death lawyer

The Massachusetts Appeals Court sitting in Middlesex County MA emphatically answered these 2 questions ‘NO’! affirming the lower Court dismissal.(It is unclear whether there is an appeal pending to the Supreme Judicial court)   Pursuant to Massachusetts wrongful death law, before a lawsuit can be filed there must be a probate of the estate and “obtain the appointment of the executor or administrator necessary to file a wrongful death claim…” In the Estate of Gavin case, “The judge did not err in concluding that the presentment was improper because the claimant lacked the legal capacity to make a presentment for wrongful death. Apart from the failure of presentment, the complaint for wrongful death also could not properly be maintained and was subject to dismissal because it had not been brought by the duly authorized executor or administrator on behalf of the heirs at law and next of kin as required by statute.” As a result, the court affirmed he dismissal of the lawsuit. ESTATE OF GAVIN v. TEWKSBURY STATE HOSPITAL

(Editor Note: Sadly a man died in a tragic accident and the heirs of the estate will not be compensated unless the  Massachusetts wrongful death lawyer committed legal malpractice by improperly presenting the case. There is not enough public info to determine whether there was malpractice in this case. In the event of legal malpractice, the claimants would need to file a legal malpractice case against their Massachusetts wrongful death attorneys alleging the  mA medical malpractice lawyers botched the case.)

Death from a “bacterial infection allegedly due to the improper re insertion of a feeding tube…”

In August 2008, Mr. Gavin died from a “bacterial infection allegedly due to the improper re insertion of a feeding tube and improper monitoring by physicians and staff at Tewksbury State Hospital.” Id.

He had a will when he died naming his parents as executors of the estate.

“In July 2010 (approximately 20 days prior to the two year presentment requirement required by Massachusetts law) an attorney for the Plaintiff sent a demand letter to the hospital; and the Attorney general seeking damages on account of a wrongful death.” Id.

“The presentment letter set forth in detail the basis of the claim of wrongful death. At the time of the presentment, no Probate and Family Court filings had occurred, and no executor or administrator of Gavin’s estate had been appointed.” Id.

A motion to dismiss was filed by the defendants.

The plaintiff scrambled to get their case in order.

“The plaintiff promptly opposed the motion and made some preliminary attempts to address the fact that there was no duly appointed personal representative empowered to bring the wrongful death action. On May 10, 2011, Thomas and Mary were appointed temporary coexecutors of Gavin’s estate. As well, on May 13, 2011, the plaintiff moved to amend the complaint, bringing it in the name of “James T. Gavin and Mary Gavin, as Coexecutors of the Estate of Steven Gavin.” Id.

A MA Superior Court judge dismissed the cause of action finding that the Plaintiff lacked “legal capacity to make a valid presentment” because the claimant who made the presentment was not the “executor or administrator with the capacity to commence suit or settle the wrongful death claim” Id.

Read more about Wrongful Death in MA here

The Appeal Co0urt reasoned that presentment was not meaningless and there was strong public policy behind the presentment requirement. “Establishing presentment as a mandatory prerequisite to suit reflects a legislative choice to permit the public employer to investigate any claim in full and to negotiate, arbitrate, compromise, or settle any such claim as it sees fit. Id. See Weaver v. Commonwealth, 387 Mass. 43, 47–48, 438 N.E.2d 831 (1982); Holahan v. Medford, 394 Mass. 186, 189, 474 N.E.2d 1117 (1985)”

The Appeals Court also ruled that “The failure of an authorized claimant to make a presentment within the two-year period prescribed by G.L. c. 258, § 4, was a fundamental obstacle to suit under the Act.” Furthermore the action was dismissed because the “complaint for wrongful death was not brought by the duly authorized executor or administrator on behalf of the heirs at law and next of kin.” Id.

Massachusetts medical malpractice lawyers

(Editors note: the plaintiff appeared to be in a quagmire because the case according to the Appeals Court was not presented properly as required by Mass law. Plaintiff also filed the case based on the same faulty presentment. Plaintiffs tried to cover their tracks by filing a probate case to be named executors but then the two years had expired and it was too late to make a proper presentment. To make matters worse, the Plaintiff was denied a request to change the name of the Plaintiff in the lawsuit to the proper name. It appears doubtful that it would have made any difference if the motion to amend the complaint was granted since the initial presentment was deficient and the two year wrongful death lawsuit deadline expired for proper presentment of the claim. What a mess! )

(Editors note: Did the MA wrongful death lawyers rush this claim to meet the 2 year presentment requirement deadline required by MA law? The presentment was only approximately 20 days prior to the two year deadline. A Probate case had not been opened and an executor had not been appointed and therefore the presentment was not in the name of the executor of the estate.)

It is unclear whether the MA medical malpractice lawyer was hired at last minute or the wrongful death attorney made a tragic mistake by waiting until the last minute and then not filing an estate and bringing the presentment by the executor or some other mistake was made. At the end of the day: what is clear- is that someone dropped the ball big time and a mistake was made. As a result the victim’s estate will not be compensated for this tragic death. (There is not enough information here to explain what went wrong.)

Legal Notice per Rules of Professional Responsibility: The Rhode Island Supreme Court licenses all lawyers and attorneys in the general practice of law, but does not license or certify any lawyer / attorney as an expert or specialist in any field of practice. While this firm maintains joint responsibility, most cases of this type are referred to other attorneys for principle responsibility.

[folsomclass]

ATLANTIC ANESTHESIA, INC.  PRACTICE

If you love helping people, then the Atlantic Anesthesia group is the group for you!  

When it comes to your medical needs the Atlantic Anesthesia group has you covered with a highly skilled Anesthesia care team. This team is comprised of some of the best anesthesiologists, nurse practitioners and post-operative nurses that will attend to any of your medical and anesthesia needs from pre to post-operative procedures.

What does the Atlantic Anesthesia group do?  

Services include brief sedation, anesthesia for complex surgical cases, pain relief for childbirth, acute and chronic pain management and consultations. Among all facilities, the total case load per year is around 60,000 procedures and 6,000 deliveries. Other services include general trauma, orthopedic, vascular, neurosurgery, ophthalmology, obstetric, and others.  

What are some benefits of working for the Atlantic Anesthesia group?  

There are a few different options when it comes to making your schedule. You are allowed to work either 8, 10 or 12-hour shifts. There are financial incentives for anybody working between 5 and 7 pm. CRNA’s are not required to work overtime unless they choose to do so. The average work week is around 36-40 hours. Other benefits include health insurance, life insurance, disability insurance, and 401k/Profit Sharing. Starting pay is 170,000$ with a 20,000$ sign-on bonus, including 5 plus weeks of vacation.  

Through innovative programs and practices, this group delivers consistent, high quality health care, which translates into excellent results for the patients, surgeons and hospitals we serve. If you like helping others then this is the group for you!

HOW TO APPLY

If you are interested, give the Administrator, Stephen Cyrus a call at (757) 473-0055 or email your resume to them at admin@atlanticanesthesia.com

Jacob Stobart

[biogenericpublishers]

Anesthesia Articles in JBGSR

Malpractice in the Intensive Care Unit by Evangelia Michail Michailidou* in Open Access Journal of Biogeneric Science and Research (JBGSR)

Abstract

Error in the Intensive Care Unit (ICU) is a welldocumented and frequent problem. This is understandable as one looks at the complexities of serious disease along with the number of invasive and potentially harmful procedures that are commonly used there. Until recently, allegations of medical malpractice resulting from suspected mismanagement in the ICU were unusual, but there has been a rise the last years.

It is difficult to determine whether the increase in lawsuits is due to a real increase in adverse incidents or to a shift in media perception. There is no question that the aggressive cover-up by law companies dealing in personal injury lawsuits offering to initiate claims on a contingency fee basis has become more common. The Medical Protection Society is experiencing an increasing number of claims generally, and the value of damages awarded is skyrocketing [1].

This includes the insufficient number of ICU beds in the public sector and the acute lack of appropriate nurses in both the public and private sectors. More troubling are the obstacles faced by nurses to apply for critical care and the limited number of critical care nurses graduating. Coupled with a high rate of turnover due to burn-out and greater work openings in other industries and overseas, this leads to a situation where even private ICUs fail to staff their units and retain standards. The mixture of high bed occupancy, chronically ill patients and novice nurses provides the ideal atmosphere for errors and incidents that can lead to lawsuits for damages. The condition is not any different on the medical side. The quality of treatment is that critically ill patients should be treated in ICUs by a team of health providers headed by critical care practitioners with specialty in Intensive Care. Not only surgeons, internists or anesthesiologists without specialization in Intensive Care, which they close holes in the gaps of the health system and do not have the proper education. We are all accustomed to thinking in terms of our primary specialty but this carries many risks. Intensive care training offers the skill to treat the patient comprehensively and systematically, something very important in patients of ICU. Although, we have to mention that there were few unexpected variations in malpractice claims occurring in ICU because of specific medical specialty. Preventive efforts should concentrate on procedures, regardless of the medical specialty, including: 1. Retaining procedural skills, 2. Well-framing of procedural hazards, and 3. Adequately describing post-procedural complications. Skills that are either innate or can be developed through ICU specialization training.

While critically ill patients in the private sector are frequently handled by separate and not suitable always, physicians, these doctors prefer to see the patient at different times of the day, give contradictory orders, and make their own private records. There is no team work usually. Also, under the best of conditions, ICU management often – one would say eventually – results in 'iatrogenic' disorders. John Marshall pointed out that critical disease is potentially iatrogenic and it only exists in people who have survived a life-threatening medical procedure. In addition, the entire structure of serious illness is focused on the effects of original resuscitation attempts or the outcomes of procedures that are regularly conducted in the ICU. It is

Introduction

The plants are part of a rich ecosystem in the soil [1], where bacteria generally colonize the plant rhizosphere and, sometimes, the endosphere. Some beneficial effects for plants may include assistance in getting nutrients and promoting plant growth by modulating growth-related hormones [2]. Other benefits include the reduction of damage caused by phytopathogen [3]. Filamentous plant pathogens can severely attack plants, and in agriculture, this could lead to high economic annual losses [4]. The suppressive soils support soil microorganisms as the first defense against soilborne pathogens. General suppressive soils have a high total microbial biomass, resulting in low protection against multiple pathogens. This strategy is dependent on the quality and quantity of soil organic matter and cover crops that enhance populations of beneficial microbes intended to antagonize associated crop pathogens primarily by occupying plant infection sites [5]. However, specific suppressive soils have a high concentration of specific microbial species and result in high protection against specific pathogens [6].

Cultural practices in agriculture have a strong influence on soil health through physicochemical characteristics and soil microbial communities. Beneficial cultural practices are used to improve soil health and can, in some cases, increase soil disease suppression [7]. According to Schlatter et al. [6], the relationship between soil properties and soil suppressiveness has not been deeply studied. Many different abiotic or biotic soil characteristics have been used to describe suppressiveness, but there is a lack of reliable descriptors.

The plant protection of certain bacteria against pathogens includes a wide range of mechanisms: antibiosis, competition for colonization sites, nutrients and minerals, parasitism, and cell lysis [8]. The protection can be caused by direct action due to antibiotic compounds or indirectly by promoting plant defense as induced systemic resistance [9]. The biological activity is also related to secondary metabolites production, low molecular mass products not essential for bacteria survival produced by secondary metabolism during the late growth phase (idiophase) [10]. These compounds are generally involved in the antibiosis or perform synergism with other inhibitors [11].

This mini-review focuses on some conditions needed to maintain a suppressive soil and the antibiotic compounds produced by the most studied bacteria groups. Because of these molecules' wide diversity, the classification is complex, and several criteria could be taken [12]. In this overview, the work description considers the bioactive metabolites as volatile compounds and non-ribosomal peptides in an integrated and general way difficult to determine the limits between cause and effect and between acceptable complications and preventable negligence [2-5].

Patients who survive a lengthy stay in the ICU are rarely left with life-long complications as a result. Prolonged muscle fatigue, neurological disabilities, and post-traumatic stress disorder involving both the patient and the family are usually described. Who can blame the patient for his anger?

Patients are most frequently admitted to intensive care as a result of an iatrogenic case. Researches showing that more than 21 per cent of admissions had a previous iatrogenic case, the most common being adverse drug disorders, postoperative illnesses and complications of surgical procedures. Personal injury attorneys extend the net extensively and ICU workers may be accused, particularly if the long-term condition is not specifically linked to the initial injury [6].

How do we defend ourselves from legal action that can be both socially and psychologically crippling, not to mention financially catastrophic, if one is not insured? Guidelines and protocols are not always solutions. Hospital managers appreciate directives because they transfer the responsibility to either the writer or the person who failed to obey [7].

The instructions have a position, but are of no value if they are out of date, so impractical that they cannot be complied with or agreed by the workers. There will never be a rule for any case, and there can be no formula for intensive care. By all means have basic rules, but they must be practical, versatile, approved and revised on a regular basis. The most critical thing is to uphold high professional expectations. This means ensuring that all medical professionals and nurses who treat chronically ill patients are critical care experts. In addition, they need to remain up to date with the constantly evolving field of critical care medicine. A multidisciplinary in-house academic curriculum is a positive start [8].

Second, intensive care administration should be focused on a team. The ICU team includes nurses, surgeons, dieticians, physiotherapists and others who contribute to patient care on a regular basis [9]. The team needs a leader, preferably an intensivist, who supports a 'flat hierarchy' and a transparent and efficient contact mechanism. This includes a joint management round where the different practitioners will offer feedback and remind, criticize and help each other [10].

Even a supreme chief cannot defeat a team when it comes to decision-making. Harmonious teaming often ensures that the patient and the family do not get mixed reports about the patient’s success and anticipated results. Holding good notes is necessary, not only as the most effective defensive tool in the (no doubt unlikely) case of a legal problem, but also as part of the contact on patient management. Notes should not only document clinical observations and incidents, but also the explanation why decisions have been taken. It is advisable to retain a copy of one's own reports and share them with colleagues in the patient's hospital folder [11-13].

Finally, maintaining a positive relationship with the patient's family is incredibly necessary, not only to get them navigate emotionally tough times, but also because they are the patient's proxy decision makers. Families need details, but the mistake of overwhelming them with medical care should be avoided. It is more important to give them time to pose questions. It is not generally possible to build a connection with the patient when they are seriously ill, so a follow-up visit after they have left the ICU is an important way to link with them at a personal level and at the same time give them an explanation of what has happened and what the potential effects are. In the case of patients who have died in the ICU, the interpersonal relationship that has developed with their relatives throughout their hospitalization [14].

We ought to have in our mind that most of malpractice cases are brought not out of malpractice or even because of concerns about the quality of medical treatment, but as an indication of frustration about any aspect of patient-doctor or doctor-relatives relations and contact. Intensivists who consider and will react adequately to the emotional needs of their patients are less likely to be sued [15,16]. This can also be transformed into a more accomplished practice of medicine by those doctors who are most mindful of the importance of a positive relationship. For more articles in JBGSR Click on https://biogenericpublishers.com/

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4 Easy Facts About Medical Malpractice Lawyers In The San Diego Area Shown

An experienced attorney can assess the differences with you and also explain the stamina of your instance. At the Law Offices of Brent A. Duque, we supply expert lawful support as well as highly professional lawful depiction in intricate injury lawsuits. We truly think that medical professionals, other doctor and health centers should be held liable when their oversight results in injury or death.

We use our comprehensive expertise, experience as well as sources, along with the most effective medical professionals, offered to get rid of the complex medical negligence litigation procedure to acquire fair as well as just settlement for sufferers as well as their family members. At the San Diego Region Legislation Workplaces of Brent A. Duque, we maintain a personnel of an extremely professional, educated, aggressive and effective medical malpractice attorneys that stand for injured individuals through our workplaces that extend throughout Southern California.

Get In Touch With the San Diego Region legislation office of Brent A. Duque at 877-241-9554 for a totally free examination and also situation analysis. You can also utilize our on the internet call form, as well as we'll respond to you quickly.

In any type of lawful case you may have, choosing the best attorney to aid you is seriously important. A poor attorney can make or break your instance. Picking the best attorney can be specifically vital if you have a medical negligence situation. Clinical negligence situations can be extremely intricate, as well as the risks can be high.

Some typical examples of clinical malpractice consist of the failure to identify a disease or condition, a misdiagnosis, a surgical error, a mistake throughout giving birth that leads to harm to the youngster or the mother, drug mistakes, as well as anesthetic mistakes. If your medical professional dedicates one of these errors or a similar error, you must call a medical negligence lawyer.

You ought to seek a person that is very ranked by clients and the state's bar association, as well as that has a lot of experience in clinical negligence instances. Find out what percent of situations the company manages are clinical negligence situations. Fees are also really essential. Your clinical negligence lawyer will certainly probably take your instance on a contingency fee basis, which indicates he or she receives a portion of any type of settlement.

When you meet https://en.search.wordpress.com/?src=organic&q=medical malpractice lawsuit an attorney, discover just how much of the work will be done by that attorney as well as just how much will certainly be handed off to others. Last but not the very least, discover a person whose personality you work with. You might potentially be spending a great deal of time with this individual.

If you are in San Diego, call me, Conal Doyle, San Diego clinical malpractice attorney at 310-385-0567. I have experience in dealing with big medical malpractice instances as well as can aid. Call today for more information.

The San Diego clinical malpractice lawyers at Cohen & Marzban Regulation Corporation are dedicated to representing customers who have actually experienced major injuries as the outcome of clinical malpractice. If you or a loved one has been harmed as a result of clinical malpractice or medical negligence in The golden state, please call our company today for a complimentary appointment with a knowledgeable lawful specialist.

In one of the most severe medical malpractice instances, clients might pass away as the result of the malpractice, making them the sufferer of a wrongful fatality. There are several instances which are taken into consideration clinical malpractice, some of which are provided below: Surgical error-- Malpractice which occurs when a doctor, anesthesiologist, medical citizen, or nursing personnel creates a mistake that results in an injury.

Oftentimes, the baby may be the victim of long-term serious disabilities, such as Spastic paralysis. Cancer cells misdiagnosis-- A severe sort of negligence in which an individual is not detected with cancer in a timely way, or is incorrectly identified with cancer that they do not have.

As a matter of fact there are close to 100,000 clinical negligences declares filed each year by damaged patients versus doctors, clinical experts, nurses, health centers, as well as other health care companies. If you have experienced injuries as a result of clinical malpractice or clinical oversight in California, please call our proficient San Diego medical malpractice lawyers to review your case.

Free initial examinations · Versatile office hours C a l l T o d a y 310-405-7111call 24 hours 7 days a week.

If you've been a target of clinical malpractice of your enjoyed one has, devastating or not, it is an unjustified accident that requires an expert medical malpractice lawyer. The Peck Regulation Group, a trusted law practice and component in California works with sufferers and families that have endured medical malpractice and also neglect.

Unfortunately, clinical malpractice as well as straight-out carelessness can damage an individual's life, income, their household and financial repercussions so serious, they lose every little thing. By working with an excellent attorney with extensive knowledge in med mal, a target as well as, or their enjoyed ones has the ideal chance at recouping problems. Some experts fail their people by producing treatment plans that trigger more harm than good.

Misdiagnoses as well as mistreatment of a disease. Diagnoses also late to recoup from. Failure to provide therapy in a prompt manner to guarantee the very best feasible result for the individual. Suggesting medications that trigger a negative response and bring about damage of crucial body organs. Suggesting incorrect medications and also does to clients with allergies.

Misinterpreting laboratory data and, or mistakes made by laboratories your medical professional collaborates with. Failure to buy appropriate medical examinations to conclusively establish what is incorrect with a client. Surgical mistakes Anesthesia mistakes and also allergies Health centers and healthcare centers that give unnecessary treatment, very early launch as well as, or not being watched patients. Birth injuries TMIs (Terrible Mind Injuries) Peck Legislation Group offices lie in Van Nuys, Ontario, as well as Hand Desert, California.

Medical Malpractice We trust doctors and clinical specialists with our health and wellness, our well-being, and also our lives. Nevertheless, medical professionals who acted negligently or carelessly when exercising can harm their patients. The Institute of Medicine (IOM) reported that 98,000 clinical malpractice-related deaths were reported in 2009. The injuries experienced by patients when physicians and other medical facility personnel are irresponsible are often life-altering and also extreme.

When you are hurt with the neglect of a doctor, it is very important that you look for a qualified and experienced legal representative, one that will have your benefit in mind. A 2017 study on clinical malpractice by the Institute for Medical Care Enhancement (IHI) located that 41 percent of people in the USA have experienced a clinical mistake with their Steinman & Associates of San Diego medical professional.

If you've been injured because of medical negligence, it remains in your best rate of interest to call an injury lawyer today. People make blunders, yet there is no reason for negligent and reckless actions with the medical career. Do not endure calmly. The lawyers at Yarian & Associates, APC are experienced in clinical negligence litigation.

Yarian & Associates, APC helps clients throughout the better San Diego Region and also Tulare County location consisting of Visalia, Waterfront, San Diego, Glendale, Irvine, Fresno, and Pasadena. Phone Call (844) 291-1911 or arrange an online visit today for an experienced San Diego medical negligence attorney. Review for Californian Clinical Malpractice Do I sue? Kind Statute of Limitations Damages Practices Additional Resources Medical Negligence, defined under the UNITED STATE

. The medical mistake should likewise lead to injury to the client. To get settlement for medical negligence, you should sue . It is best that you work with an attorney to aid you in submitting your insurance claim, as it has to satisfy specific demands. General principals and also board classifications of regulations put on a lot of clinical malpractice cases; however, exceptions do happen.

It is quite easy to verify that your doctor was seeing you with medical documents. The clinical expert may attempt to utilize the protection that they launched you before the injury occurred. The Medical professional was Irresponsible-- To sue, you should warrant that your health and wellness care expert was negligent.

Nonetheless, if a physician is not promoting a requirement of https://www.washingtonpost.com/newssearch/?query=medical malpractice lawsuit treatment as well as is acting recklessly then it is taken into consideration clinical negligence. Medical Negligence Led to Injury-- The plaintiff must have experienced an injury or harm by the medical mistake to submit a case. A person can file an insurance claim for physical pain, psychological suffering, added medical expenses, and also lost work or gaining ability.

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Payment for medical malpractice cases differ based on the circumstances of the mistake. It is essential that you collect as much info feasible concerning your condition as well as the physician's clinical error. Some kinds of medical malpractice include the adhering to. The term birth injury offers with medical neglect while pregnant as well as the giving birth procedure.

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How To Find A Competent Medical Malpractice Attorney? Can Be Fun For Anyone

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Most of the time when an individual experiences a not successful arise from clinical treatment it is not since the clinical service provider made an error. Many of the moment when there is a poor medical result it is regardless of good, quality treatment not because of sub-standard treatment. When discussing a case with a client it is necessary that the customer have the ability to claim why they believe there was clinical oversight.

However, we without effort recognize that individuals typically do not pass away from knee surgical treatment, appendix elimination, hernia fixing or "minor" surgical treatments. When something unexpected like that happens it deserves exploring whether there was a clinical blunder that is worth submitting a medical negligence tort. When in question a San Diego clinical negligence lawyer will review your case with you informally.

We have actually obtained considerable amounts for those damaged as a result of negligent healthcare and also therapy. Although 80 percent of medical malpractice trials lead to a defense decision, we have dominated in 80 percent of the cases we have taken to test in behalf of complainants. In enhancement, we have actually had the ability to work out numerous clinical oversight instances over the last 25 years.

He educated his medical professional of an individual background of lack of breath as well as tightness in his upper body, as well as a family history of hypertension and stroke. The physician supplied no treatment various other than aspirin and also water pills. As the symptoms continued and progressed in complying with months, the doctor got 2 separate upper body X-rays, disregarding the results on both although they suggested added assessment and also follow-up.

Three days later on, the client broke down from a stroke inevitably resulting in his fatality. Result: Significant Six-Figure Negotiation Our client, now a young adult, was left a quadriplegic and psychologically deferred after a West Covina obstetrician delayed purchasing an emergency situation C-section during her birth. A nurse suggested to the supplying medical professional that the mom was in distressed labor, showing indicators of a partially removed placenta reducing oxygen to the fetus.

The medical professional's failure to respond swiftly and also suitably led to our client's serious birth issues. Outcome: $7,100,000 (Future worth of $24,000,000) Judgment Following a dual body organ transplant, our client, a 40-year-old insulin-dependent diabetic, created an infection that caused a myriad of clinical troubles needing numerous surgeries and also an abnormally lengthy health center stay.

We succeeded within a worked out negotiation with the Regents of the College of California. It is one of the largest negotiations of its kind. Outcome: $3,000,000 Negotiation Our client's desire was to be a fire fighter. Due to a fall, he suffered a severe injury to his ankle. A noticeable orthopedic cosmetic surgeon recommended surgical procedure.

We had the ability to verify that the surgeon stopped working to offer ideal care, which his foot might have been fixed with prompt intervention. Our client was incapable to go into the fire academy as well as accomplish his dream. Outcome: $1,100,000 Court Decision (decreased to $805,000 because of MICRA law) - the biggest clinical negligence verdict in that court.

Because of the delayed medical diagnosis and postponed surgery, his leg needed to be truncated. Result: Confidential Significant Negotiation Our customer, a married 46-year-old technician for the government of Guam, required cardio-thoracic bypass surgery. Throughout the surgery, the cosmetic surgeon harmed a significant nerve, creating paralysis to our customer's best arm. He shed substantial use his ideal arm as well as was incapable to continue to function in his former occupation.

The The golden state Supreme Court published its opinion when it comes to Bonds vs. Roy. The situation is often pointed out with respect to classification of expert witnesses. Our client, a solitary man, went to a surgical facility for routine occupational shoulder surgical procedure and also sustained severe brain injury during the treatment.

We were able to prove that the anesthesiologist was negligent in lugging out his anesthetic duties during the shoulder treatment. Result: $765,000 Settlement (furthermore, there was a substantial recuperation consisting of lifetime care) Our client, a single retired female, presented to a local healthcare facility's emergency situation space with neck discomfort. She was confessed to the health center for more care.

She ended up permanently disabled as well as limited to sedentary tasks. Outcome: $675,000 Jury Judgment Our client, a 55-year-old pharmacist and also daddy of 4, offered to a vascular doctor with agonizing leg signs and symptoms. His first issues were overlooked. Subsequently, he returned and also was identified with an occluded popliteal artery. Surgical intervention was not effective and he lost his leg.

The solitary mommy of a 12-year-old girl collapsed at job and also was required to Centinela Medical facility's emergency area. Although the 30-year-old woman remained in the emergency clinic for about 10 hours, no initiative was made to detect or treat her while her problem remained to weaken. Instead, the emergency situation room management was concentrating on locating a method to carry her to a Find a Medical Malpractice Lawyer in San Diego Kaiser center where she was a participant.

In an effort to cover up the negligent care, a health center registered nurse changed the person's documents. Outcome: Confidential Considerable Settlement.

In case of a severe injury or death brought on by the negligence of a clinical professional or health care center, you should have the finest legal representation offered. You require a lawful advocate who not only recognizes the ins and outs of clinical negligence lawsuits-- you require an attorney that understands the clinical industry.

Fagel is an attorney who is also a medical doctor. Dr. Fagel specifically represents injured individuals and their enjoyed ones in situations versus doctors and hospitals. Generally, The Law Offices of Bruce G. Fagel & Associates has actually efficiently fixed greater than 700 clinical negligence and also negligence cases. Dr. Fagel has likewise: Gotten among the top 100 jury verdicts in the nation (2002, 2005) Attempted as well as resolved more of these cases than any type of various other California law practice Been elected among the "Top 10 Test Lawyer in the Country" (National Law Journal) Been chosen 8 times for "Trial Attorney of the Year" (Consumer Lawyer Association) If you or your enjoyed one was hurt by the neglect, recklessness, or misdeed of a medical facility, doctor, or various other clinical specialist, call Bruce G.

As a medical professional, Lawyer Fagel recognizes what need to as well as must not be happening in a medical center. As a result of his considerable training and experience in this area, he can quickly find neglect and also wrongdoing. Medical professionals and hospitals have a duty to care for their clients, and when they stop working to uphold that requirement of treatment, individuals typically endure serious injuries and also fatality.

Fagel today to find out if you have a clinical malpractice situation. Dr. Fagel is an attorney as well as a certified medical professional, and also will certainly have the ability to evaluate your situation as well as provide the advice you require to learn your civil liberties as well as lawful choices. Dr. Fagel has actually taken care of many instances for clients in and also near San Diego, and overall, his company has actually won more than $1 billion in judgments and settlements for clients.

Fagel & Associates today. Call us to discuss your instance, and also if you do have an insurance claim, there will be no charge unless we win your instance.

Lead Advise's unbiased process separately validates lawyer records, giving with state bars across the country and also conducting yearly testimonials to verify that the attorney methods in the lawful groups as indicated, has a valid bar certificate, and also is eligible to exercise in the certain territory.

Click listed below to share this short article: In times of vulnerability, we put our complete count on our medical experts. But when the neglect of your nurse or doctor leads to physical, financial, as well as emotional repercussions, that do you rely on? If you have ended up being target of clinical errors, negligence laws exist to secure your legal rights to declare payment from the injuries you have actually suffered.

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Haffner Regulation is well positioned to battle for you in a medical negligence situation. Through personal focus, extensive legal experience, and hostile depiction, we assist you obtain the compensation you need as well as should have. Medical negligence happens as a result of a negligent act or omission by a healthcare company: a doctor, nurse, therapist, medical facility, or other specific or entity accredited to provide clinical treatment.

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Medical Malpractice Lawyers In The San Diego Area for Beginners

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The majority of the moment when a person experiences a not successful outcome from medical therapy it is not since the clinical company made a mistake. The majority of the time when there is a poor clinical result it is in spite of good, quality treatment not because of sub-standard medical treatment. When reviewing an instance with a client it is necessary that the customer have the ability to state why they believe there was clinical negligence.

Nonetheless, we intuitively understand that individuals usually do not pass away from knee surgical treatment, appendix removal, rupture repair service or "small" surgical treatments. When something unforeseen like that occurs it is worth exploring whether there was a clinical mistake that is worth submitting a medical malpractice tort. When unsure a San Diego clinical malpractice lawyer will certainly review your instance with you informally.

We have actually obtained substantial quantities for those hurt as a result of irresponsible treatment as well as therapy. Although 80 percent of clinical negligence trials result in a protection judgment, we have dominated in 80 percent of the cases we have taken to trial in behalf of complainants. On top of that, we have actually had the ability to clear up countless medical oversight instances over the last 25 years.

He educated his physician of an individual background of lack of breath and http://www.bbc.co.uk/search?q=medical malpractice lawsuit also tightness in his breast, as well as a family history of high blood pressure and stroke. The physician offered no treatment other than pain killers as well as water tablets. As the signs lingered and proceeded in complying with months, the medical professional bought two different chest X-rays, neglecting the outcomes on both although they suggested added analysis and also follow-up.

Three days later on, the individual collapsed from a stroke ultimately causing his death. Outcome: Substantial Six-Figure Negotiation Our customer, now a young adult, was left a quadriplegic as well as emotionally retarded after a West Covina obstetrician postponed getting an emergency situation C-section throughout her birth. A nurse showed to the providing physician that the mommy remained in distressed labor, showing signs of a partly detached placenta decreasing oxygen to the fetus.

The medical professional's failing to react swiftly and also appropriately caused our customer's extreme abnormality. Outcome: $7,100,000 (Future value of $24,000,000) Verdict Following a dual organ transplant, our customer, a 40-year-old insulin-dependent diabetic person, developed an infection that led to a myriad of clinical troubles calling for numerous operations and also an abnormally lengthy medical facility stay.

We succeeded within a discussed settlement with the Regents of the College of The golden state. It is one of the largest settlements of its kind. Outcome: $3,000,000 Settlement Our customer's desire was to be a fireman. As a result of a fall, he suffered a significant injury to his ankle. A noticeable orthopedic specialist recommended surgical treatment.

We had the ability to confirm that the doctor fell short to give appropriate care, which his foot might have been corrected with timely treatment. Our customer was unable to go into the fire academy and also meet his desire. Result: $1,100,000 Jury Judgment (reduced to $805,000 due to MICRA law) - the largest medical malpractice verdict because court room.

Due to the delayed medical diagnosis as well as delayed surgical procedure, his leg needed to be truncated. Outcome: Confidential Substantial Negotiation Our customer, a https://en.search.wordpress.com/?src=organic&q=medical malpractice lawsuit wedded 46-year-old mechanic for the federal government of Guam, required cardio-thoracic bypass surgery. During the surgical treatment, the doctor damaged a major nerve, creating paralysis to our client's appropriate arm. He lost considerable usage of his right arm and was overcome to function in his former line of work.

The The golden state High court released its opinion in the case of Bonds vs. Roy. The instance is often pointed out when it come to classification of specialist witnesses. Our client, a single man, mosted likely to a medical facility for routine work-related shoulder surgery as well as sustained severe mind injury Medical Malpractice Lawsuit San Diego, Ca throughout the procedure.

We were able to verify that the anesthesiologist was negligent in performing his anesthesia obligations during the shoulder procedure. Outcome: $765,000 Settlement (additionally, there was a substantial recovery including lifetime treatment) Our customer, a solitary retired woman, presented to a regional hospital's emergency clinic with neck discomfort. She was confessed to the health center for more treatment.

She wound up permanently disabled as well as limited to sedentary tasks. Result: $675,000 Court Decision Our customer, a 55-year-old pharmacist as well as daddy of 4, offered to a vascular surgeon with excruciating leg signs. His preliminary problems were ignored. Ultimately, he returned and also was detected with an occluded popliteal artery. Surgical treatment was not effective as well as he shed his leg.

The single mother of a 12-year-old lady passed out at the workplace and also was required to Centinela Health center's emergency clinic. Although the 30-year-old lady remained in the emergency clinic for approximately 10 hours, no effort was made to diagnose or treat her while her problem proceeded to weaken. Instead, the emergency room administration was focusing on discovering a method to deliver her to a Kaiser facility where she was a participant.

In an initiative to cover up the irresponsible treatment, a health center nurse modified the person's documents. Result: Confidential Significant Settlement.

In the event of a severe injury or death brought on by the carelessness of a medical expert or healthcare facility, you should have the very best legal representation available. You require a lawful advocate that not only understands the ins and outs of medical malpractice legal actions-- you need a lawyer that recognizes the clinical sector.

Fagel is a legal representative who is likewise a clinical doctor. Dr. Fagel solely represents damaged patients and also their enjoyed ones in cases against doctors and also healthcare facilities. Generally, The Regulation Offices of Bruce G. Fagel & Associates has successfully resolved greater than 700 clinical negligence and also neglect situations. Dr. Fagel has likewise: Acquired among the leading 100 court judgments in the country (2002, 2005) Tried and also worked out more of these situations than any kind of other The golden state legislation firm Been voted one of the "Leading 10 Test Attorneys in the Nation" (National Legislation Journal) Been chosen eight times for "Test Lawyer of the Year" (Consumer Lawyer Organization) If you or your liked one was harmed by the negligence, carelessness, or wrongdoing of a medical facility, medical professional, or other medical professional, contact Bruce G.

As a medical professional, Attorney Fagel recognizes what should as well as need to not be taking place in a clinical center. Due to his substantial training and experience in this area, he can rapidly spot neglect and also wrongdoing. Physicians as well as healthcare facilities have an obligation to take care of their patients, and when they fail to promote that criterion of care, clients commonly endure severe injuries and also death.

Fagel today to find out if you have a clinical negligence situation. Dr. Fagel is a legal representative as well as a certified medical professional, as well as will have the ability to review your instance and provide the counsel you need to learn your legal rights and also lawful choices. Dr. Fagel has actually dealt with countless instances for clients in and also near San Diego, as well as on the whole, his company has won greater than $1 billion in judgments and negotiations for clients.

Fagel & Associates today. Call us to review your situation, as well as if you do have an insurance claim, there will certainly be no cost unless we win your situation.

Lead Counsel's unbiased process independently confirms attorney documents, giving with state bars throughout the country and conducting yearly testimonials to validate that the lawyer methods in the lawful classifications as indicated, possesses a valid bar permit, and is eligible to practice in the certain jurisdiction.

Click below to share this article: In times of susceptability, we placed our complete count on our medical experts. However when the negligence of your registered nurse or physician results in physical, economic, and also emotional repercussions, that do you count on? If you have come to be sufferer of medical mistakes, negligence regulations exist to shield your rights to claim compensation from the injuries you have received.

https://www.google.com/maps/embed?pb=!1m18!1m12!1m3!1d427396.8152080185!2d-117.59782001168372!3d33.18688379221253!2m3!1f0!2f0!3f0!3m2!1i1024!2i768!4f13.1!3m3!1m2!1s0x80dc711406b96c21%3A0x75cfcfce16eb5e81!2sSteinman%20%26%20Associates%20Medical%20Malpractice%20Attorneys!5e0!3m2!1sen!2sus!4v1576600137736!5m2!1sen!2sus

Haffner Legislation is well positioned to combat for you in a clinical negligence instance. Through personal interest, extensive legal experience, and also hostile depiction, we help you obtain the settlement you require and also should have. Clinical malpractice occurs as an outcome of a negligent act or omission by a healthcare service provider: a doctor, nurse, specialist, health center, or various other specific or entity accredited to give healthcare.

[biid-org]

Medical malpractice is a situation when a health care professional fails to provide the right treatment or take actions that cause harm or even death of the patient.  This is usually medical negligence or unintentional mistake. The deciding factor on medical malpractice is in understanding if the health care professional has acted in a manner that is different from how the other professional would have reacted under the same situation.  Extreme cases of medical malpractice might result in the cancellation of the doctor’s medical license.

What can be considered medical malpractice?

Lawyers in the United States lay down certain conditions that need to be met for a case to be considered as medical malpractice. 

The health professional has failed in providing certain standard care that is legally expected of them.

The negligence should result in an injury or harm which would have otherwise not occurred. Without injury, there cannot be a case for medical malpractice.

The onus is on the patient to prove that the injury has caused considerable damage which could be suffering, constant pain, disability, hardship, or loss of income. 

Types of medical malpractice

Medical malpractice can be classified based on the mistake which causes the error.

Inaccurate reading noted by the health care professional in the chart.

Wrong prescription by the doctor or filling a prescription with the wrong medication by the pharmacist.

Mistakes happening from the side of anesthesiologists while administering the anesthesia before surgery.

 Delay of diagnosis especially for terminal illness where even a day counts in saving a life.

A misdiagnosis that can lead to the wrong prescription or surgery.

Childbirth malpractice that can result in damaging the mother or baby permanently.

How medical malpractice is settled?

Certain cases of malpractice are clear without any room for doubt.  An example would be the negligence on the part of a surgeon by conducting an operation on a wrong artery. There are also cases where the pieces of evidence for malpractice are not clear-cut. This can happen if any emergency situation made a doctor take a decision which ultimately backfires. These kinds of cases are usually dragged to the courtroom. Most cases are settled outside the court with the family receiving the settlement amount from the malpractice insurance.  

In any medical malpractice case, the burden of proof lies on the patient or plaintiff. This often requires a thorough investigation of the medical records usually carried out with the help of experts.  Settlement money is usually restricted to the monetary loss suffered due to the injuries. The monetary loss covers the lost wages, loss of consortium, and medical care expenses incurred.

Lawsuit and settlement is a tedious process where the insurance company tries to lower the settlement amount to the maximum. So it is advised to hire an expert attorney to fight the case. If the parties involved cannot come to an agreement on the settlement amount the case goes for trial and the jury would decide the settlement money which is final.

The post What is Medical Malpractice? appeared first on Biid.org.

[battybat-boss]

How to Wean Off Opioids

Opioids, narcotic painkillers, killed 33,000 Americans in 2015,1,2,3 and nearly 42,250 in 2016 - over 1,000 more deaths than were caused by breast cancer that same year4 - and the addiction trend shows absolutely no signs of leveling off or declining.

On the contrary, recent statistics suggest the death toll is still trending upward, with more and more people abusing these powerful narcotics. According to the most recent data5 from the U.S. Centers for Disease Control and Prevention (CDC), overdose cases admitted into emergency rooms increased by more than 30 percent across the U.S. between July 2016 and September 2017. Overdose cases rose by:

30 percent among men

31 percent among 24- to 35-year-olds

36 percent among 35- to 54-year-olds

32 percent among those 55 and older

Considering opioid overdose is now the No. 1 cause of death of Americans under the age of 50, it's quite clear we need safer alternatives to pain management and more effective ways to wean off these extremely addictive drugs.

Risk of Addiction Is Very High

Studies show addiction affects about 26 percent of those using opioids for chronic noncancer pain, and 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription.6

Despite the drugs' high risk of addiction, a 2016 NPR health poll7 indicated less than one-third of people said they questioned or refused their doctor's prescription for opioids. The most common drugs involved in prescription opioid overdose deaths include8 methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®).

However, as noted by Dr. Deeni Bassam, board-certified anesthesiologist, pain specialist and medical director of the Virginia-based The Spine Care Center, “There's very little difference between oxycodone, morphine and heroin. It's just that one comes in a prescription bottle and another one comes in a plastic bag.”9

Indeed, many addicts find the transition from prescription opioids to street drugs like heroin to be a relatively easy one. When a prescription runs out, the cost to renew it becomes unmanageable or a physician refuses to renew a prescription, heroin, which is often cheaper and easier to obtain than opioids, is frequently a go-to solution.

Postsurgical Intervention Lowers Patients' Risk of Opioid Addiction

Unfortunately, many patients are still under- or misinformed about the addictive nature of these pills, and are often not told how to get off them. Addiction can occur within weeks of use, and if a patient is prescribed a narcotic for long-term or chronic pain, addiction is extremely likely. In one 2016 Canadian study, 15 percent of complex surgical patients developed severe postoperative pain leading to extended use of opioids.10

To minimize the risk of addiction, the Transitional Pain Service at Toronto General Hospital includes follow-up meetings twice a month for the first two months following surgery, and then monthly meetings for another four months. As explained by Science Daily, the goal of these meetings is to “prevent acute pain from becoming chronic post-surgical pain and taper opioid use or wean to zero if possible.”11

To help patients with their pain, the program uses a variety of methods, including nonopioid medications, exercise, acupuncture and mindfulness training, the latter of which has been shown to help patients with pain-related stress and disability, thereby allowing them to successfully wean off higher doses of opioids.12

In the U.S., Stanford University offers a similar program, called the Comprehensive Interdisciplinary Pain Program. These kinds of programs are really crucial, as expecting patients to quit cold turkey is a recipe for disaster. Many state authorities and insurance companies are now cracking down on opioid use, restricting how much a doctor can prescribe.

While this is needed, it leaves long-term opioid users in a pinch. Many who are now unable to refill their prescriptions receive no guidance on how to quit or support to help them find other ways to relieve their pain.

Little Is Known About How to Safely Wean Off Opioids When You're in Chronic Pain

As noted in Scientific American,13 “ … [T]here's very little research on how best to taper opioids for chronic pain patients. For example, although studies show that drugs such as buprenorphine can help addicts recover, little is known about their value in the context of chronic pain.”

One scientific review,14 which included 67 studies on tapering opioids for pain patients found only three of the studies to be of high quality; 13 were found to of “fair” quality while the rest were weak. Still, the evidence available suggested that tapering off the dosage does improve both pain and quality of life.

However, the strongest evidence was for multidisciplinary care with close patient monitoring and follow-up - methods that are not widely available and rarely covered by insurance. Scientific American reports:15

“One thing seems clear from research and clinical experience: Reckless restriction is not the right response to reckless prescribing. 'Forced tapers can destabilize patients,' says Stefan Kertesz, an addiction expert at the University of Alabama at Birmingham School of Medicine. Worried clinicians such as Kertesz report growing anecdotal evidence of patient distress and even suicide.

The brightest rays of light in this dark picture come from a burst of new research. In May a team led by Stanford pain psychologist Beth Darnall published the results of a pilot study16 with 68 chronic pain patients. In four months, the 51 participants who completed the study cut their opioid dosages nearly in half without increased pain.

There were no fancy clinics, just an attentive community doctor and a self-help guide written by Darnall. A key element was very slow dose reduction during the first month. 'It allows patients to relax into the process and gain a sense of trust with their doctor and with themselves that they can do this,' Darnall says.”

Canadian Study Shows Tapering Dosage Post Surgery Helps Many Patients Avoid Long-Term Opioid Use

A study17 evaluating the success rate of Toronto General Hospital's Transitional Pain Service found nearly half of those who had not used opioids prior to surgery successfully weaned themselves off the drugs. Among those who had already used opioids prior to surgery, 1 in 4 was successful. As reported by Science Daily:18

“The study followed patients at high risk for developing chronic pain and problematic opioid use for six months after surgery. In patients who did not take opioids for a year before surgery, the study found that 69 percent were able to reduce their opioid consumption, with 45 percent of them being able to stop completely.

Those patients who were taking a prescription opioid before surgery reduced their opioid use by 44 percent, with 26 percent of them weaning off completely.

'The assumption is that all patients after surgery are fine with their opioid use, but we have found that in a high-risk segment of patients, that is not the case,' says Dr. Hance Clarke, director of the Transitional Pain Service at [Toronto General Hospital].

'We need better ways of identifying these patients, and then helping those who are having difficulty in reducing or eliminating their opioid use. Otherwise, we run the risk of de-escalating patients too fast and having them look elsewhere for opioids or other drugs if we don't guide them' …

One of the strongest predictors in the study of remaining on opioids long-term after hospital discharge is the dose upon discharge: the higher the dose, the more likely the patient will remain on opioids long-term.

For patients who were on opioids before surgery, emotional distress factors such as anxiety or depression, and pain catastrophizing - excessive pain-related worry, along with an inability to deflect thoughts from pain - were important factors in how well these patients could wean off opioids.”

Guidance on Opioid Tapering

Guidance on opioid tapering published in the March/April issue of the Canadian Pharmacist Journal includes the following highlights:19

Adult patients with chronic noncancer pain who are on a 90-milligram (mg) morphine equivalent dose daily or greater should consider opioid tapering to the lowest effective dose and discontinue use if possible

Other reasons to consider tapering include lack of improvement in pain and/or function, nonadherence to the treatment plan, signs of addiction, serious opioid-related adverse effects or patient request

Prescribers are urged to collaborate with pharmacists to support and monitor patients during opioid tapering

A multidisciplinary approach is associated with success in weaning patients off opioids

Benefits of tapering include relief of withdrawal symptoms (e.g., pain, sweating or anxiety), reduction in opioid adverse effects and improvements in overall function and quality of life

The Guideline urges physicians to discuss tapering with their patients, and to “prepare them by optimizing nonopioid therapy as appropriate for their pain and comorbidities.” This includes the use of acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids20 and cannabinoids, just to name a few. The guideline also recommends:

“… [O]ptimizing nonpharmacological therapy and psychosocial support, setting realistic functional goals, creating a schedule of dose reductions and frequent follow-up and having a plan to manage withdrawal symptoms.”

To taper opioids for chronic noncancer pain, the guideline recommends:

Gradually reducing 5 to 10 percent of the morphine-equivalent dose every two to four weeks, with frequent follow-up

Switching from immediate-release opioids to extended-release on a fixed schedule

Collaborating with the patient's pharmacist to assist with scheduling of the dose reductions

Two alternative methods include doing a medically supervised rapid dose reduction at a withdrawal center, as withdrawal symptoms can be severe and/or dangerous, or switching to methadone or buprenorphine (naloxone), followed by gradual tapering of these drugs.

How Kratom Can Help With Opioid Withdrawal

Two other alternatives I want to address here are kratom and medical cannabis. It's a toss-up as to which one is more controversial, but there's evidence to support both. In the video above, I interview Christopher McCurdy, professor of medicinal chemistry at the University of Florida College of Pharmacy about the use of kratom for pain relief and opioid withdrawal.

McCurdy, a former postdoctoral fellow in opioid chemistry at the University of Minnesota under a National Institutes of Health (NIH) postdoctoral training fellowship, has spent nearly 15 years investigating how kratom affects opiate addiction and withdrawal, and is convinced it may be of tremendous benefit.

Kratom (mitragyna speciosa) is part of the coffee family, but has a very different chemistry than coffee beans. It's been used in traditional medicine in Thailand and Malaysia for centuries, both as an energy booster and opium substitute. The plant contains a number of alkaloids, a primary one being mitragynine, which has opioid activity.

It and many other alkaloids in the kratom plant were recently called out as opioids by the Food and Drug Administration (FDA) commissioner. “A lot of people were upset about that at first, but I think they need to understand that an opioid is any molecule that can interact with opioid receptors or those proteins in the body,” McCurdy says.

In other words, an opioid is not identical to an opiate, derived from opium poppy, such as morphine, oxycodone or oxymorphone. Opioid is a generic term that includes even endogenous endorphins that bind to opioid receptors in your body. And, while mitragynine has opioid activity, it's very different from other opioid molecules.

McCurdy's research shows that compared to methadone and buprenorphine (two drugs used to treat opioid addiction and opioid withdrawal), kratom had a much cleaner profile and was milder in its action. Whereas buprenorphine and methadone are full agonists or activators of opioid receptors, mitragynine appears to be only a partial agonist. McCurdy explains:

“We initially sent out purified alkaloid of mitragynine for a screen across a whole panel of central nervous system drug targets … What we found was a really remarkable profile of this molecule. Mitragynine binds with opioid receptors … but it also interacts with adrenergic receptors, serotonin receptors, dopamine receptors and adenosine receptors.

Adenosine receptors are the target for caffeine. It kind of explains why some of these alkaloids in the plant might cause this stimulant-like effect. It also interacts with alpha-2 adrenergic receptors, [which] are … used in opioid withdrawal. Agents that activate alpha-2 receptors, like clonidine, are used in opioid withdrawal treatment to stop withdrawal symptoms such as shaking, sweating and heart racing …

In all honesty, when I got the report back from the company that screened the molecule, I thought, 'Wow. We just found nature's answer to opiate addiction' because here it was interacting with many of the same targets that we would target pharmacologically on an individual basis.”

How Kratom Curbs Opiate Addiction

As explained by McCurdy, there are three traditional opioid receptors: mu, delta and kappa, all three of which are associated with numbing or dulling pain. In other words, they're analgesic receptors. They block or slow pain signal transmissions at the spinal cord level, so your brain doesn't process the pain signals as much.

The Mu receptor was named for its ability to interact with morphine. The mu receptor is responsible for the euphoric effects associated with opiates. It's also primarily responsible for respiratory depression.

The delta receptor is also a target for selective analgesics, and does not appear to have as strongly addictive capabilities as the mu receptor. Unfortunately, the delta receptor is linked to convulsions, and many drug trials aimed at the delta-selective opioid receptor had to be halted due to seizures that could not be resolved. Kratom does not appear to significantly interact with delta receptors.

The kappa receptor, while good for killing pain, causes dysphoria or aversion, meaning when you take a compound that activates kappa, it makes you feel so awful you don't want to take it again. For this reason, kappa-activating pain drugs have repeatedly failed in clinical trials and people don't want to continue the drug.

Kratom appears to be a partial agonist for all of these receptors, only weakly affecting delta and kappa. And, while the mu receptor is the primary target of kratom, animal trials suggest the abuse potential of kratom is quite low. To learn more, see “Kratom as an Alternative for Opium Withdrawal” or listen to McCurdy's interview.

Medical Cannabis - Another Effective Pain Reliever That Is Much Safer Than Narcotic Pain Killers

Medicinal cannabis is another effective pain reliever which, unlike narcotic pain killers, cannot kill you.21 The reason a cannabis overdose remains nonlethal is because there are no cannabinoid receptors in your brain stem, the region of your brain that controls your heartbeat and respiration.

Statistics bear this out as well. In states where medical marijuana is legal, overdose deaths from opioids decreased by an average of 20 percent after one year, 25 percent after two years and up to 33 percent by years five and six.

In 2010, the Center for Medical Cannabis Research released a report22 on 14 clinical studies about the use of marijuana for pain, most of which were FDA-approved, double-blind and placebo-controlled. The report revealed that marijuana not only controls pain but in many cases, it does so better than pharmaceutical alternatives.

Cannabis has also been shown to ease withdrawal symptoms in those trying to wean off opioids. CNN Health reports23 Dr. Dustin Sulak, a renowned integrative medicine physician based in Maine, has helped hundreds of patients wean off opioids using cannabis, as has Dr. Mark Wallace, a pain management specialist and head of the University of California, San Diego Health's Center for Pain Medicine who started studying cannabis in 1999 with a state grant.

“He looked at the literature and realized that pot had a long history of therapeutic use for many disorders including … pain. Within a decade, there were enough studies to convince him that marijuana was a real alternative to use in his practice. He estimates that hundreds of his patients … have been weaned off pills through pot,” CNN reporter Nadia Kounang writes, adding:

“According to the Drug Enforcement Administration, marijuana is a Schedule I drug, meaning it has no medical use and a high potential for abuse. 'We have enough evidence now that it should be rescheduled,' Wallace said. Sulak wonders, 'When will the medical community catch up with what their patient populations are doing?'"

Nonopioid Pain Relievers Work Just as Well as Opioids for Acute Pain

If a person comes to the emergency room with severe acute pain, most physicians will prescribe them an opioid to relieve pain. However, research24 published in JAMA suggests opioid-free options may work just as well. This is valuable information, considering the fact that many get hooked on opioids when prescribed an opioid for acute pain caused by a sports injury or oral surgery, for example.

The study evaluated the effects of four different combinations of pain relievers - three with different opioids and one opioid-free option composed of ibuprofen (i.e., Advil) and acetaminophen (i.e., Tylenol) - on people with moderate to severe pain in an extremity due to bone fractures, shoulder dislocation and other injuries.

The patients had an average pain score of 8.7 (on a scale of zero to 10) when they arrived. Two hours later, after receiving one of the pain relief combinations, their pain levels decreased similarly, regardless of which drug-combo they received.

"For patients presenting to the ED [emergency department] with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at two hours among single-dose treatment with ibuprofen and acetaminophen or with three different opioid and acetaminophen combination analgesics," the researchers concluded.

Speaking to Vox, the study's lead author, Andrew Chang of the department of emergency medicine at Albany Medical College, Albany, New York, said,25 "Some (not all) physicians reflexively think fractures require opioids, but this study lends evidence that opioids are not always necessary even in the presence of fractures."

Considering the steep risks involved - even when taken as directed, prescription opioids can lead to addiction as well as tolerance, along with other issues like increased sensitivity to pain, depression, low levels of testosterone and more26 - the less you expose yourself to opioids, the better. For a list of additional suggestions for how to relieve pain without resorting to opioids, see “Do We Really Need Opioids for Pain?”

Please understand though that although nonopioid pain relievers are not likely to cause addiction, they are fraught with their own problems. Tylenol taken even for a few days can cause severe liver and kidney problems in susceptible people. Taking N-acetyl cysteine (glutathione precursor) can alleviate many of the problems though.

It is also important to recognize that opioids do have a legitimate purpose for those in acute pain, but the evidence is beyond overwhelming that they are being prescribed indiscriminately in many cases as a result of greedy drug companies and doctors that are paid to prescribe opioids, resulting in tens of thousands dying from addiction.

These numbers are so high that they have actually resulted in a loss of two years in the average life expectancy of the average American. So, if you know someone that is on these dangerous medications, do everything you can to warn and plead with them to get off opioids as soon as possible.

[jakehglover]

How to Wean Off Opioids

Opioids, narcotic painkillers, killed 33,000 Americans in 2015,1,2,3 and nearly 42,250 in 2016 — over 1,000 more deaths than were caused by breast cancer that same year4 — and the addiction trend shows absolutely no signs of leveling off or declining.

On the contrary, recent statistics suggest the death toll is still trending upward, with more and more people abusing these powerful narcotics. According to the most recent data5 from the U.S. Centers for Disease Control and Prevention (CDC), overdose cases admitted into emergency rooms increased by more than 30 percent across the U.S. between July 2016 and September 2017. Overdose cases rose by:

30 percent among men

31 percent among 24- to 35-year-olds

36 percent among 35- to 54-year-olds

32 percent among those 55 and older

Considering opioid overdose is now the No. 1 cause of death of Americans under the age of 50, it’s quite clear we need safer alternatives to pain management and more effective ways to wean off these extremely addictive drugs.

Risk of Addiction Is Very High

Studies show addiction affects about 26 percent of those using opioids for chronic noncancer pain, and 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription.6

Despite the drugs’ high risk of addiction, a 2016 NPR health poll7 indicated less than one-third of people said they questioned or refused their doctor's prescription for opioids. The most common drugs involved in prescription opioid overdose deaths include8 methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®).

However, as noted by Dr. Deeni Bassam, board-certified anesthesiologist, pain specialist and medical director of the Virginia-based The Spine Care Center, “There’s very little difference between oxycodone, morphine and heroin. It’s just that one comes in a prescription bottle and another one comes in a plastic bag.”9

Indeed, many addicts find the transition from prescription opioids to street drugs like heroin to be a relatively easy one. When a prescription runs out, the cost to renew it becomes unmanageable or a physician refuses to renew a prescription, heroin, which is often cheaper and easier to obtain than opioids, is frequently a go-to solution.

Postsurgical Intervention Lowers Patients’ Risk of Opioid Addiction

Unfortunately, many patients are still under- or misinformed about the addictive nature of these pills, and are often not told how to get off them. Addiction can occur within weeks of use, and if a patient is prescribed a narcotic for long-term or chronic pain, addiction is extremely likely. In one 2016 Canadian study, 15 percent of complex surgical patients developed severe postoperative pain leading to extended use of opioids.10

To minimize the risk of addiction, the Transitional Pain Service at Toronto General Hospital includes follow-up meetings twice a month for the first two months following surgery, and then monthly meetings for another four months. As explained by Science Daily, the goal of these meetings is to “prevent acute pain from becoming chronic post-surgical pain and taper opioid use or wean to zero if possible.”11

To help patients with their pain, the program uses a variety of methods, including nonopioid medications, exercise, acupuncture and mindfulness training, the latter of which has been shown to help patients with pain-related stress and disability, thereby allowing them to successfully wean off higher doses of opioids.12

In the U.S., Stanford University offers a similar program, called the Comprehensive Interdisciplinary Pain Program. These kinds of programs are really crucial, as expecting patients to quit cold turkey is a recipe for disaster. Many state authorities and insurance companies are now cracking down on opioid use, restricting how much a doctor can prescribe.

While this is needed, it leaves long-term opioid users in a pinch. Many who are now unable to refill their prescriptions receive no guidance on how to quit or support to help them find other ways to relieve their pain.

Little Is Known About How to Safely Wean Off Opioids When You’re in Chronic Pain

As noted in Scientific American,13 “ … [T]here’s very little research on how best to taper opioids for chronic pain patients. For example, although studies show that drugs such as buprenorphine can help addicts recover, little is known about their value in the context of chronic pain.”

One scientific review,14 which included 67 studies on tapering opioids for pain patients found only three of the studies to be of high quality; 13 were found to of “fair” quality while the rest were weak. Still, the evidence available suggested that tapering off the dosage does improve both pain and quality of life.

However, the strongest evidence was for multidisciplinary care with close patient monitoring and follow-up — methods that are not widely available and rarely covered by insurance. Scientific American reports:15

“One thing seems clear from research and clinical experience: Reckless restriction is not the right response to reckless prescribing. ‘Forced tapers can destabilize patients,’ says Stefan Kertesz, an addiction expert at the University of Alabama at Birmingham School of Medicine. Worried clinicians such as Kertesz report growing anecdotal evidence of patient distress and even suicide.

The brightest rays of light in this dark picture come from a burst of new research. In May a team led by Stanford pain psychologist Beth Darnall published the results of a pilot study16 with 68 chronic pain patients. In four months, the 51 participants who completed the study cut their opioid dosages nearly in half without increased pain.

There were no fancy clinics, just an attentive community doctor and a self-help guide written by Darnall. A key element was very slow dose reduction during the first month. ‘It allows patients to relax into the process and gain a sense of trust with their doctor and with themselves that they can do this,’ Darnall says.”

Canadian Study Shows Tapering Dosage Post Surgery Helps Many Patients Avoid Long-Term Opioid Use

A study17 evaluating the success rate of Toronto General Hospital’s Transitional Pain Service found nearly half of those who had not used opioids prior to surgery successfully weaned themselves off the drugs. Among those who had already used opioids prior to surgery, 1 in 4 was successful. As reported by Science Daily:18

“The study followed patients at high risk for developing chronic pain and problematic opioid use for six months after surgery. In patients who did not take opioids for a year before surgery, the study found that 69 percent were able to reduce their opioid consumption, with 45 percent of them being able to stop completely.

Those patients who were taking a prescription opioid before surgery reduced their opioid use by 44 percent, with 26 percent of them weaning off completely.

‘The assumption is that all patients after surgery are fine with their opioid use, but we have found that in a high-risk segment of patients, that is not the case,’ says Dr. Hance Clarke, director of the Transitional Pain Service at [Toronto General Hospital].

‘We need better ways of identifying these patients, and then helping those who are having difficulty in reducing or eliminating their opioid use. Otherwise, we run the risk of de-escalating patients too fast and having them look elsewhere for opioids or other drugs if we don't guide them’ …

One of the strongest predictors in the study of remaining on opioids long-term after hospital discharge is the dose upon discharge: the higher the dose, the more likely the patient will remain on opioids long-term.

For patients who were on opioids before surgery, emotional distress factors such as anxiety or depression, and pain catastrophizing — excessive pain-related worry, along with an inability to deflect thoughts from pain — were important factors in how well these patients could wean off opioids.”

Guidance on Opioid Tapering

Guidance on opioid tapering published in the March/April issue of the Canadian Pharmacist Journal includes the following highlights:19

Adult patients with chronic noncancer pain who are on a 90-milligram (mg) morphine equivalent dose daily or greater should consider opioid tapering to the lowest effective dose and discontinue use if possible

Other reasons to consider tapering include lack of improvement in pain and/or function, nonadherence to the treatment plan, signs of addiction, serious opioid-related adverse effects or patient request

Prescribers are urged to collaborate with pharmacists to support and monitor patients during opioid tapering

A multidisciplinary approach is associated with success in weaning patients off opioids

Benefits of tapering include relief of withdrawal symptoms (e.g., pain, sweating or anxiety), reduction in opioid adverse effects and improvements in overall function and quality of life

The Guideline urges physicians to discuss tapering with their patients, and to “prepare them by optimizing nonopioid therapy as appropriate for their pain and comorbidities.” This includes the use of acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids20 and cannabinoids, just to name a few. The guideline also recommends:

“… [O]ptimizing nonpharmacological therapy and psychosocial support, setting realistic functional goals, creating a schedule of dose reductions and frequent follow-up and having a plan to manage withdrawal symptoms.”

To taper opioids for chronic noncancer pain, the guideline recommends:

Gradually reducing 5 to 10 percent of the morphine-equivalent dose every two to four weeks, with frequent follow-up

Switching from immediate-release opioids to extended-release on a fixed schedule

Collaborating with the patient’s pharmacist to assist with scheduling of the dose reductions

Two alternative methods include doing a medically supervised rapid dose reduction at a withdrawal center, as withdrawal symptoms can be severe and/or dangerous, or switching to methadone or buprenorphine (naloxone), followed by gradual tapering of these drugs.

How Kratom Can Help With Opioid Withdrawal

Two other alternatives I want to address here are kratom and medical cannabis. It’s a toss-up as to which one is more controversial, but there’s evidence to support both. In the video above, I interview Christopher McCurdy, professor of medicinal chemistry at the University of Florida College of Pharmacy about the use of kratom for pain relief and opioid withdrawal.

McCurdy, a former postdoctoral fellow in opioid chemistry at the University of Minnesota under a National Institutes of Health (NIH) postdoctoral training fellowship, has spent nearly 15 years investigating how kratom affects opiate addiction and withdrawal, and is convinced it may be of tremendous benefit.

Kratom (mitragyna speciosa) is part of the coffee family, but has a very different chemistry than coffee beans. It’s been used in traditional medicine in Thailand and Malaysia for centuries, both as an energy booster and opium substitute. The plant contains a number of alkaloids, a primary one being mitragynine, which has opioid activity.

It and many other alkaloids in the kratom plant were recently called out as opioids by the Food and Drug Administration (FDA) commissioner. “A lot of people were upset about that at first, but I think they need to understand that an opioid is any molecule that can interact with opioid receptors or those proteins in the body,” McCurdy says.

In other words, an opioid is not identical to an opiate, derived from opium poppy, such as morphine, oxycodone or oxymorphone. Opioid is a generic term that includes even endogenous endorphins that bind to opioid receptors in your body. And, while mitragynine has opioid activity, it’s very different from other opioid molecules.

McCurdy’s research shows that compared to methadone and buprenorphine (two drugs used to treat opioid addiction and opioid withdrawal), kratom had a much cleaner profile and was milder in its action. Whereas buprenorphine and methadone are full agonists or activators of opioid receptors, mitragynine appears to be only a partial agonist. McCurdy explains:

“We initially sent out purified alkaloid of mitragynine for a screen across a whole panel of central nervous system drug targets … What we found was a really remarkable profile of this molecule. Mitragynine binds with opioid receptors … but it also interacts with adrenergic receptors, serotonin receptors, dopamine receptors and adenosine receptors.

Adenosine receptors are the target for caffeine. It kind of explains why some of these alkaloids in the plant might cause this stimulant-like effect. It also interacts with alpha-2 adrenergic receptors, [which] are … used in opioid withdrawal. Agents that activate alpha-2 receptors, like clonidine, are used in opioid withdrawal treatment to stop withdrawal symptoms such as shaking, sweating and heart racing …

In all honesty, when I got the report back from the company that screened the molecule, I thought, ‘Wow. We just found nature's answer to opiate addiction’ because here it was interacting with many of the same targets that we would target pharmacologically on an individual basis.”

How Kratom Curbs Opiate Addiction

As explained by McCurdy, there are three traditional opioid receptors: mu, delta and kappa, all three of which are associated with numbing or dulling pain. In other words, they’re analgesic receptors. They block or slow pain signal transmissions at the spinal cord level, so your brain doesn't process the pain signals as much.

The Mu receptor was named for its ability to interact with morphine. The mu receptor is responsible for the euphoric effects associated with opiates. It's also primarily responsible for respiratory depression.

The delta receptor is also a target for selective analgesics, and does not appear to have as strongly addictive capabilities as the mu receptor. Unfortunately, the delta receptor is linked to convulsions, and many drug trials aimed at the delta-selective opioid receptor had to be halted due to seizures that could not be resolved. Kratom does not appear to significantly interact with delta receptors.

The kappa receptor, while good for killing pain, causes dysphoria or aversion, meaning when you take a compound that activates kappa, it makes you feel so awful you don’t want to take it again. For this reason, kappa-activating pain drugs have repeatedly failed in clinical trials and people don’t want to continue the drug.

Kratom appears to be a partial agonist for all of these receptors, only weakly affecting delta and kappa. And, while the mu receptor is the primary target of kratom, animal trials suggest the abuse potential of kratom is quite low. To learn more, see “Kratom as an Alternative for Opium Withdrawal” or listen to McCurdy’s interview.

Medical Cannabis — Another Effective Pain Reliever That Is Much Safer Than Narcotic Pain Killers

Medicinal cannabis is another effective pain reliever which, unlike narcotic pain killers, cannot kill you.21 The reason a cannabis overdose remains nonlethal is because there are no cannabinoid receptors in your brain stem, the region of your brain that controls your heartbeat and respiration.

Statistics bear this out as well. In states where medical marijuana is legal, overdose deaths from opioids decreased by an average of 20 percent after one year, 25 percent after two years and up to 33 percent by years five and six.

In 2010, the Center for Medical Cannabis Research released a report22 on 14 clinical studies about the use of marijuana for pain, most of which were FDA-approved, double-blind and placebo-controlled. The report revealed that marijuana not only controls pain but in many cases, it does so better than pharmaceutical alternatives.

Cannabis has also been shown to ease withdrawal symptoms in those trying to wean off opioids. CNN Health reports23 Dr. Dustin Sulak, a renowned integrative medicine physician based in Maine, has helped hundreds of patients wean off opioids using cannabis, as has Dr. Mark Wallace, a pain management specialist and head of the University of California, San Diego Health's Center for Pain Medicine who started studying cannabis in 1999 with a state grant.

“He looked at the literature and realized that pot had a long history of therapeutic use for many disorders including … pain. Within a decade, there were enough studies to convince him that marijuana was a real alternative to use in his practice. He estimates that hundreds of his patients … have been weaned off pills through pot,” CNN reporter Nadia Kounang writes, adding:

“According to the Drug Enforcement Administration, marijuana is a Schedule I drug, meaning it has no medical use and a high potential for abuse. ‘We have enough evidence now that it should be rescheduled,’ Wallace said. Sulak wonders, ‘When will the medical community catch up with what their patient populations are doing?’"

Nonopioid Pain Relievers Work Just as Well as Opioids for Acute Pain

If a person comes to the emergency room with severe acute pain, most physicians will prescribe them an opioid to relieve pain. However, research24 published in JAMA suggests opioid-free options may work just as well. This is valuable information, considering the fact that many get hooked on opioids when prescribed an opioid for acute pain caused by a sports injury or oral surgery, for example.

The study evaluated the effects of four different combinations of pain relievers — three with different opioids and one opioid-free option composed of ibuprofen (i.e., Advil) and acetaminophen (i.e., Tylenol) — on people with moderate to severe pain in an extremity due to bone fractures, shoulder dislocation and other injuries.

The patients had an average pain score of 8.7 (on a scale of zero to 10) when they arrived. Two hours later, after receiving one of the pain relief combinations, their pain levels decreased similarly, regardless of which drug-combo they received.

"For patients presenting to the ED [emergency department] with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at two hours among single-dose treatment with ibuprofen and acetaminophen or with three different opioid and acetaminophen combination analgesics," the researchers concluded.

Speaking to Vox, the study's lead author, Andrew Chang of the department of emergency medicine at Albany Medical College, Albany, New York, said,25 "Some (not all) physicians reflexively think fractures require opioids, but this study lends evidence that opioids are not always necessary even in the presence of fractures."

Considering the steep risks involved — even when taken as directed, prescription opioids can lead to addiction as well as tolerance, along with other issues like increased sensitivity to pain, depression, low levels of testosterone and more26 — the less you expose yourself to opioids, the better. For a list of additional suggestions for how to relieve pain without resorting to opioids, see “Do We Really Need Opioids for Pain?”

Please understand though that although nonopioid pain relievers are not likely to cause addiction, they are fraught with their own problems. Tylenol taken even for a few days can cause severe liver and kidney problems in susceptible people. Taking N-acetyl cysteine (glutathione precursor) can alleviate many of the problems though.

It is also important to recognize that opioids do have a legitimate purpose for those in acute pain, but the evidence is beyond overwhelming that they are being prescribed indiscriminately in many cases as a result of greedy drug companies and doctors that are paid to prescribe opioids, resulting in tens of thousands dying from addiction.

These numbers are so high that they have actually resulted in a loss of two years in the average life expectancy of the average American. So, if you know someone that is on these dangerous medications, do everything you can to warn and plead with them to get off opioids as soon as possible.

from HealthyLife via Jake Glover on Inoreader http://articles.mercola.com/sites/articles/archive/2018/10/25/opioid-alternatives.aspx

[pronktechtools-blog]

What To Look For when Choosing Medical Equipments

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[mrmarknewman]

A physician’s group disability nightmare

My last operative day was October 15, 2009. My last attempt at getting to understand my group disability policy was on May 10, 2018. I’m a disabled anesthesiologist who lost his career when my left median nerve stopped functioning properly. I had two disability policies, a private and a group. My dealings with these two companies have been day and night.

My group insurance carrier hammered my dignity for years. In 2018, under ERISA law, I lost again, this time in federal court. For me, the end was bittersweet. Bitter because group disability companies do not have to tell you what will happen to your benefit when you begin to resume income sources. Sweet because during my ordeal, I exhausted every means of understanding my group disability policy. And now I get to teach what I learned in hopes of helping prevent this tragedy for other physicians.

My group disability provider would not assist me in understanding how my group disability policy functions when it comes to what happens should I generate income. Imagine yourself unable to use your hard-earned education to generate income. Imagine that, if you did earn income, you have no idea what would happen, unsure of the fiscal pain you might cause your family if you even tried. More than eight years is a long time for an anesthesiologist to be frustrated, anxious, and to live in fear that his income source is in doubt.

Anesthesiologists like certainty, really like certainty! I’m betting you like certainty, as well.

Continue reading ...

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[abdallahalhakim]

What I’ve learned from 547 doctor suicides

Five years ago today I was at a memorial. Another suicide. Our third doctor in 18 months.

Everyone kept whispering, “Why?”

I was determined to find out.

So I started counting dead doctors. I left the service with a list of 10. Now I have 547.

Immediately, I began writing and speaking about suicide. So many distressed doctors (and med students) wrote and phoned me. Soon I was running a de facto international suicide hotline from my home. To date, I’ve spoken to thousands of suicidal doctors; published a book of their suicide letters (free audiobook); attended more funerals; interviewed surviving physicians, families, and friends. I’ve spent nearly every waking moment over the past five years on a personal quest for the truth of “Why.”

Here are 34 things I’ve discovered:

High doctor suicide rates have been reported since 1858. Yet more than 150 years later the root causes of these suicides remain unaddressed.

Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.

Most doctors have lost a colleague to suicide. Some have lost up to eight during their career—with no opportunity to grieve.

We lose way more men than women. For every woman who dies by suicide in medicine, we lose seven men.

Suicide methods vary by region and gender. Women like to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India, doctors are found hanging from ceiling fans.

Male anesthesiologists are at highest risk. Most die by overdose. Many are found dead in hospital call rooms.

Lots of doctors die in hospitals. Doctors jump from hospital windows or rooftops. They shoot or stab themselves in hospital parking lots. They’re found hanging in hospital chapels. Physicians often choose to die where they’ve been wounded.

“Happy” doctors die by suicide. Many doctors who die by suicide are the happiest most well-adjusted people on the outside. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head. Doctors are masters of disguise. Even fun-loving, happy docs who crack jokes and make patients smile all day may be suffering in silence. We are all at risk.

Doctors’ family members are at high risk of suicide. By the same method. Cardiothoracic surgeon Thomas Gahagan died by hanging himself leaving behind seven children ages three to fifteen. Two died by hanging themselves as adults. Another physician died using the same gun his son used to kill himself. Kaitlyn Elkins, a star third-year medical student, chose suicide by helium inhalation. One year later her mother Rhonda died by the same method. At Rhonda’s funeral, I asked her husband if he thought his wife and daughter would still be alive had Kaitlyn not pursued medicine. He replied, “Yes. Medical school has killed half my family.”

Doctors have personal problems—like everyone else. We get divorced, have custody battles, infidelity, disabled children, deaths in our families. Working 100+ hours per week immersed in our patients’ pain, we’ve got no time to deal with our own pain. (Spending so much time at work actually leads to divorce and completely dysfunctional personal lives).

Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate self-punishment.

Malpractice suits kill doctors. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court on TV, and in newspapers (that live online forever). We continue to suffer the agony of harming someone else—unintentionally—for the rest of our lives.

Doctors who do illegal things kill themselves. Medicare fraud, sex with a patient, DUIs may lead to loss of medical license, prison time, and suicide.

Academic distress kills medical students’ dreams. Failing boards exams and being unmatched into a specialty of choice has led to suicides.

Doctors without residencies may die by suicide. Dr. Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out the flawed system that undermined his career prior to his suicide.

Assembly-line medicine kills doctors. Brilliant, compassionate people can’t care for complex patients in 10-minute slots. When punished or fired for “inefficiency” or “low productivity” doctors may choose suicide. Pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients. Many doctors cite inhumane working conditions in their suicide notes.

Bullying, hazing, and sleep deprivation increase suicide risk. Medical training is rampant with human rights violations illegal in all other industries.

Sleep deprivation is a (deadly) torture technique. Physicians have suffered hallucinations, life-threatening seizures, depression, and suicide solely related to sleep deprivation. Resident physicians are now “capped” at 28-hour shifts and 80-hour weeks. If they “violate” work hours (by caring for patients) they are forced to lie on their time cards or be written up as “inefficient” and sent to a psychiatrist for stimulant medications. Some doctors kill themselves for fear of harming a patient from extreme sleep deprivation.

Blaming doctors increases suicides. Words like “burnout” and “resilience” are often employed by medical institutions as psychological warfare to blame and shame doctors while deflecting attention from inhumane working conditions. When doctors are punished for occupationally induced mental health conditions (while underlying human rights violations are not addressed), they become even more hopeless and desperate.

Sweet, sensitive souls are at highest risk. Some of the most caring, compassionate, and intelligent doctors choose suicide rather than continuing to work in such callous, uncaring and ruthlessly greedy medical corporations.

Doctors can’t get confidential mental health care. So they drive out of town, pay cash, and use fake names to hide from state medical boards, hospitals, and insurance plans that ask doctors about their mental health care and may then exclude them from state licensure, hospital privileges, and health plan participation. (Even if confidential care were available, physicians have little time to access care when working 80-100+ hours per week).

Doctors have trouble caring for doctors. Doctors treat physician patients differently by downplaying psychiatric issues to protect physicians from medical board mental health investigations. Untreated mental health conditions may lead to suicide.

Medical board investigations increase suicide risk. One doctor hanged himself from a tree outside the Florida medical board office after being denied his license. He was told to “come back in a year, and we will reinstate your license.” Meanwhile, he lost everything and was living in a halfway house.

Physician Health Programs (PHPs) may increase suicide risk.��Forcing doctors with occupationally induced mental health issues into these 12-step programs with witnessed random urine drug screens (when they’ve never had a drug problem!) is humiliating and unethical. So doctors hide their mental health conditions for fear of being punished by PHPs.  [Note: PHPs have helped some doctors with substance abuse especially]

Substance abuse is a late-stage effect of lack of mental health care. Since doctors may lose their license for seeking mental health care or get locked into PHPs; they self-medicate with alcohol, illicit drugs, or self-prescribe psychotropic medications.

Doctors develop on-the-job PTSD. Especially true in emergency medicine. Then one day they “snap” like this guy.

Cultural taboos reinforce secrecy. Suicide is a sin in many religions. Islam and Christian families have asked that I hide the suicides of family members. Indian families often claim a suicide is a homicide or an accident, even when it’s obviously self-inflicted.

Media offers incomplete coverage of suspicious deaths. Articles about doctors found dead in hospital call rooms claim “no foul play.” No follow-up stories.

Medical schools and hospitals lie (or omit the truth) to cover up suicides—even when media and family report cause of death. Medical student Ari Frosch stood in front of a train, yet his school reported he died at home with his family. Though the family of psychiatrist Christine Petrich shared that she bought a gun and killed herself (after just getting her hair done and planning a surprise trip to Lego Land and Disney for her kids) on their GoFundMe page, her employer wrote she “passed away.” Shouldn’t the department of psychiatry take a more active interest in physician suicide?

Euphemisms cover up doctor suicides. Suicide is omitted from obituaries, funerals, clinics, hospitals, and medical schools. Instead, we hear “passed away unexpectedly in her sleep” and “he went to be with the Lord.”

Secrets will not save us. We’re unlikely to make a medical breakthrough on a hidden medical condition.

Doctors choose suicide to end their pain (not because they want to die). Suicide is preventable. We can help doctors who are suffering if we stop with all the secrecy and punishment.

I’ve been shunned for speaking about doctor suicide. After being invited by the AMA to deliver my TEDMED talk, I was disinvited shortly before the event because they were “uncomfortable” with physician suicide.

Ignoring doctor suicides leads to more doctor suicides. Thankfully, an Emmy-winning filmmaker is completing a documentary on physician suicide this month. To honor a doctor or medical student who has died by suicide in the film, submit their name and specialty here.

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Physician Suicide Letters — Answered and Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor. She hosts the physician retreat, Live Your Dream, to help her colleagues heal from grief and reclaim their lives and careers.

Image credit: Pamela Wible

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