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Tue Apr 22 20:30:57 BST 2008

I 'll agree  as soon as the trial bar immunizes us against liability for
injuries  missed due to patient combativeness or "refusal". 

And Jeffrey — generally speaking from experience most doctors (not
all) try to do the right thing for the patient so I tend to give them
the benefit of the doubt when I don't have all the data. In my
experience most malpractice  lawyers (I would add not all here except
I've never seen the reverse) try to screw the doctor at every turn. And
therefore when making judgements without complete information I am very
comfortable assuming they are lying. 

Specifically in this case — the guy has been unable to work since the
"assault". Seriously. It's obvious the atty told him to stay out to
develop measurable "damages" for which to sue. Whether the exam was
indicated or not it's obviously a ginned up lawsuit.

Like the guy stuck in the elevator for 41 hours that you may have seen
recently, even though he won the lawsuit for "low six figures" his life
is ruined because (among other things) the lawyer told him not to return
to work.  For a good look at this see
http://www.overlawyered.com/2008/04/lawyers-making-clients-worse-o.html

Regards,
Bill

William J. Bromberg, MD, FACS
Chair, EAST Practice Management Guidelines Committee
Savannah Surgical Group
912 350-7412

>>> "Charlene M Morris" <cvmmorris at gmail.com> 4/22/2008 2:21 PM >>>
Apart from the ramifications of an exam the clinician feels is
necessary, I
am STILL of the mind that patients have rights and responsibilities. In
this
instance, I would have documented in bold letters: "PATIENT DECLINES
[OR
REFUSES] RECTAL EXAM DESPITE STATING ITS IMPORTANCE IN HIS CASE FOR
DETECTING NEUROLOGICAL DEFICIT". Whether that holds up in a COURT OF
LAW is
yet another issue.

I once worked with a Dr. who wanted to do a breast exam on ALL women.
His
nurse defended his committment to detecting breast cancer, but to my
mind--
if a woman (PATIENT) says no, she should NOT be subjected to what the
Dr.
*felt* necessary..

JMO--

Charlene Morris

On 4/22/08, Jeffery Hammond <hammond at umdnj.edu> wrote:
>
> I guess it's time to agree to disagree.  :)
>
> JSH
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] 
> On Behalf Of Moore, Rick
> Sent: Tuesday, April 22, 2008 1:30 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: [ccm-l] RE: Rectal Exam Lawsuit DENIED
>
>
> Gee, I didn't hear any indignation about "passing judgment in a
situation
> where we have very limited information" directed towards the other
> comments
> that were uniformly condemning lawyers and praising the "good guys."
>
> That's because until your comments nobody had been indignant calling
the
> procedure unwarranted, unnecessary and hogwash, again based on only
one
> limited side of the story. All conclusions that no one other than
those
> close to the case with all the information should make.
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jeffery Hammond
> Sent: Tuesday, April 22, 2008 12:01 PM
> To: 'Trauma &amp; Critical Care mailing list'
> Cc: 'CCML'
> Subject: RE: [ccm-l] RE: Rectal Exam Lawsuit DENIED
>
> Replies below to Dr Myers comments...
>
> -----Original Message-----
> From: Jeff Myers, D.O., Ed.M. [mailto:myersj at alum.rpi.edu] 
> Sent: Tuesday, April 22, 2008 12:38 PM
> To: Jeffery Hammond
> Cc: 'Trauma &amp; Critical Care mailing list'; 'CCML'
> Subject: Re: [ccm-l] RE: Rectal Exam Lawsuit DENIED
>
> Remember all, we are getting the lay press' report of the events and
> armchair quarterbacking the incident.
>
>           -->>Agreed
>
> All I glen was that this patient was struck in the head at a
construction
> site.  Was the treating team concerned about a head and c-spine
injury?
>
>        -->> You don't need a rectal exam for an injury limited to the
head
> in a patient moving all 4 extremities.
>
> Were they concerned the patient was combative / ? altered from the
head
> injury?
>
>          -->> He was apparently talking to them. He didn't become
> combative
> until they tried  to bugger him.
>
> The patient was not only sedated but intubated (according to the
> description) - doesn't this scenario occur across the country when we
are
> taking care of altered trauma patients so we can obtain timely
imaging and
> intervene rapidly?
>
>          -->> Yes, in heavily intoxicated patients or those with
major
> TBI.
> But, in this case (agreeing that we have only part of the data) I
would
> counsel any trauma team member who intubated a patient just to do a
rectal
> exam.
>
> I just ask you all to reflect on situations where you may have done
the
> same
> thing as reported because you were doing the right thing for the
patient
> before passing judgment in a situation where we have very limited
> information.
>
>           -->> Gee, I didn't hear any indignation about "passing
judgment
> in a situation where we have very limited information" directed
towards
> the
> other comments that were uniformly condeming lawyers and praising
the
> "good
> guys."
>
> Jeffrey Hammond MD, MNPH
> New Brunswick, NJ
>
>
>
>
>
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Rectal Exam Lawsuit DENIED