28.2 MILLION DOLLAR LAWSUIT FOR NOT ORDERING AN MRI

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emergentmd said:
Hey



Hey I just practice medicine how I feel appropriate. I will do stuff I don't think is necessary just to please the O suites but not when it compromises patient care.

If this girl came in the first time and never saw anyone, Of course she doesn't get an MRI. But if she bounced back in intractable pain, and I saw her the 2nd time and the family wanted an MRI....I absolutely would order one even if I get flack from the insurance.

Good aspect of ER medicine is I don't have to get any preapproval crap.
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Im happy that you can order as much imaging as you want in the ER without problems.
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few thoughts:

#1 we dont really know all the details. i dont believe the details in "robertkreisman.com"
#2 if there was any delay, it was with the months wated in seeing a chiropractor. did the chiro get sued? im guessing he didnt have deep enough pockets.
#3 if the patient saw me after 3 months of chiro, i would have probably ordered an MRI. it would have been denied with about half of the insurers i use. then, i would have appealed, and it still would be denied. then she would have gone to PT. she would see me 2, probably three months later by the time all is said and done, and then id have ordered the MRI. that is still a several month delay, and the patient still would have had a crappy outcome because of the nature of the tumor more than anything else

bottom line is that the jury saw a young girl with a bad disability, felt bad for her, and gave her money. i would hope that the decision gets reversed on appeal or at least the dollar amount decreased.
 
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SSdoc33 said:
few thoughts:

#1 we dont really know all the details. i dont believe the details in "robertkreisman.com"
#2 if there was any delay, it was with the months wated in seeing a chiropractor. did the chiro get sued? im guessing he didnt have deep enough pockets.
#3 if the patient saw me after 3 months of chiro, i would have probably ordered an MRI. it would have been denied with about half of the insurers i use. then, i would have appealed, and it still would be denied. then she would have gone to PT. she would see me 2, probably three months later by the time all is said and done, and then id have ordered the MRI. that is still a several month delay, and the patient still would have had a crappy outcome because of the nature of the tumor more than anything else

bottom line is that the jury saw a young girl with a bad disability, felt bad for her, and gave her money. i would hope that the decision gets reversed on appeal or at least the dollar amount decreased.
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Agree !! Do u think u would get sued as bad if u at least ordered the MRI but it was denied?
 
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painfree23 said:
Agree !! Do u think u would get sued as bad if u at least ordered the MRI but it was denied?
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"as bad"? i may not have quite as much liability, but i would definitely get sued, and would probably he held liable, despite optimal practice.

i HATE that you can get sued and have your life turned upside down when you do nothing wrong. i dont see any real way to protect against this. basically, i get an MRI on everyone with a pulse. this may help slightly shield me. but not completely.
 
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bottom line... work in the VA
 
DrCommonSense said:
How "rare" is it though? If we practice like the "guidelines" say, most likely we will run into this problem in the future and a potential lawsuit.

I had a 40 something year old patient present with nonspecific ilioinguinal groin pain that was in the ER 3 times whereby he was discharged for "ilioinginal neuralgia". After a few injections, he never improved.

I decided to order a lumbar MRI that found metastatic CA to the spine that was causing this pain. Luckily the insurance didn't fight me.

ER docs, PCP, etc all missed this. VERY EASY TO DO. I would've missed it as well.
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ESR would have been >100. cheap, ez, no one questions it.
 
DrCommonSense said:
Regardless of the person asking for an LESI or not, that is IRRELEVANT to the lawsuit.

The lawsuit is essentially saying that he should've ordered an MRI within a few months of nonspecific low back pain rather than at 8 months.

According to ALL guidelines from radiological societies, there is ZERO reason to order an MRI quickly in a younger patient with nonspecific low back pain.

If she has severe radiculopathy or weakness in the legs/reflex changes, then you would have a case for him not ordering an MRI being wrong. However, the case clearly shows it was only nonspecific low back pain.
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it was not the patient who wanted the ESI it was the (allegedly) doctor wanting the ESI.
 
emergentmd said:
She should have come to the ER. I would have ordered that in a heart beat, day #1. Parents and pt wants it, looks in pain, MRI it is.
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uh...you would have every PCP in the county sending patients to you in the ER if that is all it takes to get you to order and do an MRI.
 
BobBarker said:
I don't know what administrator gets upset about excessive imaging. They make a lot of money off of imaging.
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all depends on the $$ arrangement. some admins hate more tests - others like them.
 
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Someone got angry at me for saying this at a QA meeting once but WTF. If you are a pain specialist you need an MRI on every spine patient. Here is why - most PCP's are good docs. They hate sending their patients to pain docs. They know their patients way better than you ever will, because they see them for 5-30 years. If they think there is a good reason to refer to a pain doc, and there is no MRI, chances are good there is something going on anatomically that you need to know about. Now this does not apply to poor PCP's, but usually as a specialist you can figure those out. Beware the PCP who never sends you referrals who sends you a referral that looks like it does not need an MRI. That is the one that you will get burned on. The difference is the patient-PCP relationship that has developed over years - that PCP knows something is not right. Which is why the referral to you.
 
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willabeast said:
uh...you would have every PCP in the county sending patients to you in the ER if that is all it takes to get you to order and do an MRI.
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When I was in training 15 yrs ago in EM, CT was hard to get, we got flak for ordering it. MRI was impossible
Shortly after CT was easy as clicking a button and no one complained. Radiology made money, Hospital made money. MRi was still impossible
About 5 yrs ago, MRI is easy to order from most ERs I have worked with and no one even bat an eye even in the middle of the night.

Now, eventhough I don't think an MRI is necessary, a Call to Neurology usually goes, "get an MRI and discharge as negative"

Medicine has changed. It sucks that Well trained Docs in Primary care has to jump through so much hoops just to get an MRI. Instead of being the final decision maker, outpt docs are now beholden to metrics/criterias to make their decisions.
 
Moral of the story

If the patient asks for imaging order it and then ask them if they want would like contrast with it

Order the imaging. I am over this nonsense and to save the insurance companies money

But a 17 year old with back pain. Get the imaging. These HMO's try to save money or make money.

Also not all doctors are innocent. With risk contracts the doctors make more money if they save the insurance companies money.
 
Pretty sure the guidelines are for population basis and includes rare cases like these. The guidelines are not 100% proof. I read the article and a MRI is warranted if she has tried other therapies and has failed. She has had back pain for 8 months, but has she been taking NSAIDs for 8 months or other types of therapy? This should not have been a 28M $ lawsuit. Simply ridiculous

Moral of the story is order a MRI on everyone with back pain. Why take the risk? You try hard to save the system by saving money but whos saving you?

If the MRI on this kid happened to be NEGative. They should allow these docs to get 28M from the family.

In aother article, I read "“Although we understand the jury’s findings and wish only the best for Ms. Rahm, highly respected medical experts testified that the medical care provided was appropriate,” "
 
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anbuitachi said:
Pretty sure the guidelines are for population basis and includes rare cases like these. The guidelines are not 100% proof. I read the article and a MRI is warranted if she has tried other therapies and has failed. She has had back pain for 8 months, but has she been taking NSAIDs for 8 months or other types of therapy? This should not have been a 28M $ lawsuit. Simply ridiculous

Moral of the story is order a MRI on everyone with back pain. Why take the risk? You try hard to save the system by saving money but whos saving you?

If the MRI on this kid happened to be NEGative. They should allow these docs to get 28M from the family.

In aother article, I read "“Although we understand the jury’s findings and wish only the best for Ms. Rahm, highly respected medical experts testified that the medical care provided was appropriate,” "
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It's only "appropriate" in the shadiest practice environment: Kaiser Permanente.
 
SSdoc33 said:
"as bad"? i may not have quite as much liability, but i would definitely get sued, and would probably he held liable, despite optimal practice.

i HATE that you can get sued and have your life turned upside down when you do nothing wrong. i dont see any real way to protect against this. basically, i get an MRI on everyone with a pulse. this may help slightly shield me. but not completely.
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in a way, being a policeman is worse. you shoot someone (all the cops defend you but...) the DA takes it to trial and the only thing standing between you losing your job and going to jail for years is a jury.
 
Off the subject a little, but i would have gotten an MRI to rule out a pars stress fracture if nothing else. Correct age group, and if it is only LBP correct Dx to get one. There are ways around the guidelines.
 
I know this is a month old thread but I hope as many people that replied will read this.

Did anyone stop to take a look at the patient experience based on the guidelines? I am a former Paramedic who now works with medical device manufacturers and have been "through the guidelines" and it's been a miserable experience with no end in sight.

I'm 30 years old, active, healthy, but a bit overweight. I had no immediate trauma to speak of, but in March I had severe back pain in the lumbar region. I have been pretty rough on my back... lifting patients, hauling equipment, car accidents, football and basketball injuries, etc. So I figured it was just another injury, and waited 6 weeks before seeing my PCP.

At this point I told my PCP, that this was not just another injury and that "something is really wrong." He gave me a shot of Toradol and offered me Percocet or Vicodin (which I declined and stuck with Naproxen/Ibuprofen). Doc said come back in 2 weeks. At this point the spasm is my lower back cleared up, but the sciatica down my right leg was worse. Told the doc who gave me some oral steroids and said to keep taking the Aleve for 2 more weeks. No improvement. 2 months of Physical Therapy (I had it solve some problems in the past so was happy to work diligilently with the OR, and I was an athlete so following their training routine was painful, but easy to commit to). No improvement.

At this point I said "Doc, if you don't send me for an MRI by now, I'm calling my lawyer."

Lumbar Non Contrast MRI for "pain and Radiculopathy" took another 3 weeks to get scheduled, and I called all over town. Finally got the results last week. I could have predicted it perfectly. L4-L5 and L5-S1 degenerative disc disease, and a huge herniatuon of the disc at L5-S1 that damn near completely boots out the right neuroforamen.

By the way, I can't get in to see a neurosurgeon for another 3 weeks after the MRI, and it'll be 4 weeks before I get a second opinion from another NSG.

Here I am nearly 5 months into this, with good insurance, and doing everything the docs tell me to... and I'm in pain and struggling to pick up my small children, dying in pain anytime I sit for more than 30 minutes (it's almost incapacitating me and I'm good with pain).

THIS is the treatment guidelines? THIS is the best healthcare money can buy in the United States? Maybe socialized medicine isn't so bad after all (which is hard for me to say as I'm very fiscally conservative).

If my doctor ordered the MRI the day I told him there was something wrong, I'd be out of surgery and fully recovered by now. I've treated patients, some of them can be very challenging to treat but please, please, please, don't ever be like my doc and forget to listen to your patient, or don't do what you think is right because "the insurance company might not pay" or "so I don't get sued." Treat patients. Guidelines? Boo.

FYI I live in Tampa, FL not some po-dunk town with limited healthcare options.
 
Nsbohn said:
I know this is a month old thread but I hope as many people that replied will read this.

Did anyone stop to take a look at the patient experience based on the guidelines? I am a former Paramedic who now works with medical device manufacturers and have been "through the guidelines" and it's been a miserable experience with no end in sight.

I'm 30 years old, active, healthy, but a bit overweight. I had no immediate trauma to speak of, but in March I had severe back pain in the lumbar region. I have been pretty rough on my back... lifting patients, hauling equipment, car accidents, football and basketball injuries, etc. So I figured it was just another injury, and waited 6 weeks before seeing my PCP.

At this point I told my PCP, that this was not just another injury and that "something is really wrong." He gave me a shot of Toradol and offered me Percocet or Vicodin (which I declined and stuck with Naproxen/Ibuprofen). Doc said come back in 2 weeks. At this point the spasm is my lower back cleared up, but the sciatica down my right leg was worse. Told the doc who gave me some oral steroids and said to keep taking the Aleve for 2 more weeks. No improvement. 2 months of Physical Therapy (I had it solve some problems in the past so was happy to work diligilently with the OR, and I was an athlete so following their training routine was painful, but easy to commit to). No improvement.

At this point I said "Doc, if you don't send me for an MRI by now, I'm calling my lawyer."

Lumbar Non Contrast MRI for "pain and Radiculopathy" took another 3 weeks to get scheduled, and I called all over town. Finally got the results last week. I could have predicted it perfectly. L4-L5 and L5-S1 degenerative disc disease, and a huge herniatuon of the disc at L5-S1 that damn near completely boots out the right neuroforamen.

By the way, I can't get in to see a neurosurgeon for another 3 weeks after the MRI, and it'll be 4 weeks before I get a second opinion from another NSG.

Here I am nearly 5 months into this, with good insurance, and doing everything the docs tell me to... and I'm in pain and struggling to pick up my small children, dying in pain anytime I sit for more than 30 minutes (it's almost incapacitating me and I'm good with pain).

THIS is the treatment guidelines? THIS is the best healthcare money can buy in the United States? Maybe socialized medicine isn't so bad after all (which is hard for me to say as I'm very fiscally conservative).

If my doctor ordered the MRI the day I told him there was something wrong, I'd be out of surgery and fully recovered by now. I've treated patients, some of them can be very challenging to treat but please, please, please, don't ever be like my doc and forget to listen to your patient, or don't do what you think is right because "the insurance company might not pay" or "so I don't get sued." Treat patients. Guidelines? Boo.

FYI I live in Tampa, FL not some po-dunk town with limited healthcare options.
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Here is the thing i see all the time but you are unaware of.
95% of the docs who do spine work will do anything to not have a spine operation. The reason is that we all know that fixing a back is not like fixing a car. You do not wind up with an OEM replacement part after a laminectomy. It is more like removing the broken seat in the car and leaving it out. It is difficult to convince the patients that pain is usually not a great reason for surgery, or that herniated discs usually heal with time. If your doctors seem to be delaying operating on you it just may be they are hoping you start healing and decide the risks are not worth it. OTOH if you begin to develop muscle weakness or another new symptom call your doctor ASAP. And Good Luck disc problems are truly a bummer.
 
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MRI 100% of the time before an epidural anything for chronic pain. It will change the outcome 100% of the time there is a tumor discovered, may alter my approach to the epidural steroid injection, and may make early surgical referral more urgent.
 
Ducttape said:
im not sure that this forum is the right venue to ask for, give or recieve personal medical advice.
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Not looking for advice. Told my story as an example. My point is that back pain cases are often treated like a number or just another drug-seeker. Medicine gets less and less personal each year. If my doctor would have listened to me, I could have gotten to a more aggressive treatment with the potential to relieve my pain and suffering much sooner.
 
Nsbohn said:
Not looking for advice. Told my story as an example. My point is that back pain cases are often treated like a number or just another drug-seeker. Medicine gets less and less personal each year. If my doctor would have listened to me, I could have gotten to a more aggressive treatment with the potential to relieve my pain and suffering much sooner.
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you probably would have waited longer in a county with "national health care"

your situation is frustrating, although unfortunately, not uncommon. the major delay is not that your doc didnt order the MRI when you wanted. it is that it wouldnt have been "approved" due to insurance guidelines. really not the doc's fault here. you can blame the CEO of your particular insurance plan for buying his 4th yacht so b/c he makes you wait 5 months for an MRI. would you be prepared to pay 1000 bucks out of pocket for an MRI? most people wouldnt. or how about the cost of the epidural, which also needs approval.

spine patients, and any patients for that matter, dont fit neatly into some algorithm. insurances and nurses love algorithms and flow charts, but they dont work in real life.
 
SSdoc33 said:
few thoughts:
#2 if there was any delay, it was with the months wated in seeing a chiropractor. did the chiro get sued? im guessing he didnt have deep enough pockets.
Click to expand...

I spoke to a doc who reviewed the case at the Kaiser regional level. All hearsay but... the chiropractor got an x-ray, didn't see anything and said get an MRI. But when the x-ray was reviewed, there was an apparent lesion noted. It raised the question of the chiropractor missing the finding and whether this affected the PMR and pediatricians later medical decision making. I.e. if you saw a new patient, the patient said I already got an x-ray and it was normal, does it make you less likely to order an MRI? Also hearsay but chiropractor may have been a friend of the family. Regardless, I doubt anybody would sue the chiropractor if bigger $$$ were available elsewhere.
 
pmrrmp said:
I spoke to a doc who reviewed the case at the Kaiser regional level. All hearsay but... the chiropractor got an x-ray, didn't see anything and said get an MRI. But when the x-ray was reviewed, there was an apparent lesion noted. It raised the question of the chiropractor missing the finding and whether this affected the PMR and pediatricians later medical decision making. I.e. if you saw a new patient, the patient said I already got an x-ray and it was normal, does it make you less likely to order an MRI? Also hearsay but chiropractor may have been a friend of the family. Regardless, I doubt anybody would sue the chiropractor if bigger $$$ were available elsewhere.
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Seen cancer missed by Chiro on his initial films. Didnt stop him from treating worsening L3 met for 4 months.
 
All spine patients I see are getting ordered an MRI unless it's a few days or a few weeks of back pain with no other symptoms and no prior treatment. I have gotten to the point now where I will say in my plan that I will hold the insurance company liable for any further continued pain and suffering on the part of the patient if the MRI is denied. I dont really care about saving medical cost at this point because no one is looking out for us.
 
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lobelsteve said:
Seen cancer missed by Chiro on his initial films. Didnt stop him from treating worsening L3 met for 4 months.
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I've seen this as well. After about a year of unsuccessful chiro, the patient came to the hospital with a bunch of spine mets and a PSA of about 2000.
 
lord_jeebus said:
I've seen this as well. After about a year of unsuccessful chiro, the patient came to the hospital with a bunch of spine mets and a PSA of about 2000.
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I've seen this as well. When I called one Chiro to let him know of his blunder (holding onto this patient with metastatic disease throughout L spine and sacrum) he was completely nonplussed. It was as if the Chiro felt the cauda equina this young patient had been experiencing was just the result of some effin subluxation that the Chiro was so close to resolving
 
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pmrrmp said:
I spoke to a doc who reviewed the case at the Kaiser regional level. All hearsay but... the chiropractor got an x-ray, didn't see anything and said get an MRI. But when the x-ray was reviewed, there was an apparent lesion noted. It raised the question of the chiropractor missing the finding and whether this affected the PMR and pediatricians later medical decision making. I.e. if you saw a new patient, the patient said I already got an x-ray and it was normal, does it make you less likely to order an MRI? Also hearsay but chiropractor may have been a friend of the family. Regardless, I doubt anybody would sue the chiropractor if bigger $$$ were available elsewhere.
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I don't ask for and have zero interest in chiro interpretation of imaging. It would not impact anything I do.
 
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hyperalgesia said:
I don't ask for and have zero interest in chiro interpretation of imaging. It would not impact anything I do.
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But how would you know the patient had "loss of cervical lordosis" without the chiro impression?

I also love when patients want me to interpret the picture of the films they have on their phone.
 
love those chiro films with lines drawn all over them. looks like the work of a architect
 
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One leg is shorter than the other, my hips are uneven, I have a curvature in my back, the curve of my spine is abnormal... Take your pick, one will have been the "diagnosis".
 
pastafan said:
One leg is shorter than the other, my hips are uneven, I have a curvature in my back, the curve of my spine is abnormal... Take your pick, one will have been the "diagnosis".
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"My hip is out..."
Face-palm every time I hear that drivel.
 
i personally have imbalance of the spinal column due to multiple levels of vertebral imbalance when i saw a chiropractor 15 or so years ago.

its a miracle i still walk!
 
Facts and Background: In August of 2008, when plaintiff was 16, she started to experience back pain. It grew worse and in January 2009, she began experiencing radiating pain down her right leg. In February 2009, plaintiff went to the family chiropractor, who was not affiliated with defendant Kaiser. The treatments were unsuccessful and, because the chiropractor was concerned about the cause of plaintiff's pain, he urged her to go to Kaiser Permanente to seek an MRI.

yeah.... why would a chiropractor care about that? im sorry, but if you are going to provide treatments/therapy, then you are just as responsible. if you dont have to tools to do it right, then step off the playing field.

also, she would have lost her leg even if the MRI was ordered early. but, jury sees a poor young woman without a leg and half a pelvis, and they give her money, regardless of cause. a sarcoma is a really bad diagnosis. in most of the world, this woman probably would not be alive today. can we put tort reform in the next iteration of trumpcare?
 
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I didn't expect to come across this, I'm a recent USIMG scribing at a Pain Management clinic to support my application. I made this account just to say that I grew up and went to school with Anna. I'm impartial to your debate, you are all experts and I'm learning but she is the sweetest woman you'll ever meet. She stopped coming to school for a long time and eventually reappeared with a prosthesis, this article stated plainly the story that I heard. We were all collectively devastated about it and the only thing I can confirm is that she does not like conflict and might have done this to cover medical expenses/have money to offset her potential career loss. Maybe (definitely) the lawyers saw money but this happened to that one friend you hope nothing bad ever happens to. We're out of contact but she seems well and is an activist for amputees. Sorry this isn't medically relevant, my heart just sank when I saw her name.
 
PMR&Jelly said:
I didn't expect to come across this, I'm a recent USIMG scribing at a Pain Management clinic to support my application. I made this account just to say that I grew up and went to school with Anna. I'm impartial to your debate, you are all experts and I'm learning but she is the sweetest woman you'll ever meet. She stopped coming to school for a long time and eventually reappeared with a prosthesis, this article stated plainly the story that I heard. We were all collectively devastated about it and the only thing I can confirm is that she does not like conflict and might have done this to cover medical expenses/have money to offset her potential career loss. Maybe (definitely) the lawyers saw money but this happened to that one friend you hope nothing bad ever happens to. We're out of contact but she seems well and is an activist for amputees. Sorry this isn't medically relevant, my heart just sank when I saw her name.
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Thank you for posting. It's medically relevant for the doctors who read The Forum. Many will say money-grubbing lawyers and greedy patients. She was wrong and got relief via financial means. Everything that happened to her was terrible and should not have occurred. It is useful to note that she sounds like a great person with an indomitable spirit. It is not the disease. It is not the drug. It is not the deficit or the handicap. It is the person.
 
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lobelsteve said:
Thank you for posting. It's medically relevant for the doctors who read The Forum. Many will say money-grubbing lawyers and greedy patients. She was wrong and got relief via financial means. Everything that happened to her was terrible and should not have occurred. It is useful to note that she sounds like a great person with an indomitable spirit. It is not the disease. It is not the drug. It is not the deficit or the handicap. It is the person.
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I don't begrudge or deny that she "deserves" the monetary reward. Compensation to help her live her life is entirely appropriate.

What is heinous is that the attorneys will get roughly $10 million. Yes they deserve to get paid. But the excess at the expense of all of us is in my opinion ridiculous.


Sent from my iPhone using SDN mobile
 
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