NH Hospitals Review Efforts to Reduce C-section Rate

An article in the New Hamsphire Business Review extrapolates new guidelines, Safe Prevention of the Primary Cesarean Delivery, from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, to efforts underway in NH to reduce the rate of cesarean surgery births. Local hospitals named in the article, Dartmouth-Hitchcock and Elliot Hospital are aware of and already implementing much of the guidelines which include considering:

• Prolonged early-phase labor
• Cervical dilation of 6 cm rather than 4 cm as the start of active labor
• More time for labor to progress in the active phase
• Longer pushing (for 2 to 3 hours or longer depending on situation)
• Assist techniques for vaginal delivery, such as forceps.

The effort is being driven more from a cost-saving perspective than a patient safety one. The article cites statistics from a 2011 NH Insurance Department study that:

“the amount paid for C-sections in New Hampshire is 64 percent higher than for vaginal deliveries. The study also showed that the New Hampshire C-section rate grew from 28 percent in 2005 to 32.5 percent in 2008, and that the statewide rise is consistent with national trends."

Please see the full article on NHBR.com: New effort seeks to stem rise of C-sections in N.H.

NH Trial Lawyers Blast Sen. Bradley for Pandering on Med Mal Early Offer Bill

Barney Brannen writes in The Concord Monitor on behalf of the New Hampshire Association of Justice (formerly known as the NH Trial Lawyers Association) that "A New Hampshire state senator has supported the interest of powerful special interests over the rights of patients injured by medical malpractice," by pandering to lobbyists in striking down the state's "early offer" bill.

"After reaching a compromise, negotiated in the spirit of cooperation, state Sen. Jeb Bradley pulled a sinister bait-and-switch move at the behest of lobbyists from Elliot Hospital to amend New Hampshire’s “early offer bill.”

Why is Bradley playing with people’s lives?

The early offer bill’s purported intent was to speed medical malpractice litigation, and reduce stress and expense on the injured party, hospitals and providers. It has been and always will be a law that puts profits over people and is a shameful affront to the rights guaranteed all people under the New Hampshire Constitution.

The two largest medical malpractice insurance companies have already said they want nothing to do with the early offer program. RSA 519-C was passed in June 2012, over the veto and strongly worded accompanying message of Gov. John Lynch. The law was written by the late and long misguided professor Jeffery O’Connell of the University of Virginia who had, for years, proposed its content before multiple states and the United States Congress, all of whom rejected it as patently unfair to injured patients"

Read the full Op-ed here on ConcordMonitor.com.

Medical Malpractice Legislation in NH Under Revision

Kevin Landrigan of the The Nashua Telegraph lays out the goings on regarding NH's early offer medical malpractice law that went into effect last year. Now it looks like an effort is in the works to rewrite the law, which Landrigan calls "one of the most heavily lobbied bills during the Republican-dominated Legislature in 2011-12."

Writes Landrigan,

"The clear advantage for the medical community is the early offer doesn’t include any court-awarded damages for pain, suffering and loss of companionship that can significantly enhance any judgment by a jury. Once they enter into those talks, if it goes to trial and they fail to get 25 percent more than what they were offered to settle the case, the 'victim' has to pay all legal fees. The change would strike all references to losing legal fees for the person who was injured, and also wouldn’t recognize any waiver of the rights to sue, which is signed within 60 days of the incident." 

 Please continue to read about this issue in "The Landrigan Report."

More on Medical Malpractice Panels and the Landry Case

The Clinical Advisor carries an article on the recent medical malpractice trial in which the jury overruled the opinion of the medical malpractice panel. (The case of 36-year old, William Landry, Jr., who sought treatment after two fainting spells in 2004.)

"In 2007, New Hampshire began using medical malpractice panels that consist of a retired judge, a physician and a lawyer. The panel hears evidence in private and does not have to follow typical court rules. Malpractice panel decisions are not binding, and plaintiffs can still seek a jury trial. The process is designed to promote settlement to ease the burden on the court system. If a malpractice panel reaches a unanimous decision, it is presented to a jury for a final decision."

"Malpractice panels have been popular with insurance companies and within the healthcare field, but trial attorneys view them as an additional step that makes it more difficult and costly for plaintiffs to bring a case to court. The malpractice panel law was enacted in 2005, but was not utilized in New Hampshire until 2007." 

 See the full article at: ClinicalAdvisor.com

Medical Malpractice Panel Overruled by NH Jury

As reported in the Union Leader in June, a Hillsborough County jury disregarded the findings of the state medical malpractice panel, to find in favor of the plaintiff in a cardiology death lawsuit.

"The verdict was the first time that a jury snubbed the unanimous decision of a medical malpractice panel, said Joseph McDowell, the Manchester lawyer who brought the case against Dr. Alan Gartska and his practice, NH Cardiology Consultants."

See the full article here: Jury overrules panel, awards malpractice verdict in son's death

Exeter Hospital Denies Liability in Hepatitus C Outbreak

Foster's Daily Democrat reports on Exeter Hospital and the hepatitus c outbreak. The hospital is a defendent along with three co-defendants related to the recent infections that have resulted in more than two dozen malpractice lawsuits from former patients.

According to the report, a summary statement reads:

“The hospital denies liability and maintains that it is not responsible for Kwiatkowski's criminal actions.” The statement was filed by the hospital's attorneys at the Nelson Kinder + Mosseau in Manchester, NH.

Click here for a full archive of articles by Foster's on the Hep C outbreak.

Medical Malpractice Claims Paid in New Hampshire Were $19 Million in 2011

With all the debate over medical malpractice reform and the early offer law in New Hampshire, it would be interesting to take a look at some hard numbers. Such as how many medical malpractice payments are made each year in New Hampshire and the amounts? According to a state-by-state analysis by The Kaiser Family Foundation, which total payments made during 2011 for medical malpractice claims for allopathic physicians (MDs), allopathic interns and residents (MDs), osteopathic physicians (DOs), and osteopathic interns and residents (DOs) (see more on data sources here).

The number of medical malpractice claims paid in NH was 50 in 2011, with an average claims payment of $382,000. That ranks NH 31st on the list of most total dollars paid in claims ($19,100,000). New York, Pennsylvania, Florida, California and Illinois topped the list as the most total dollars in paid claims.

See more on Kaiser's state-by-state medical malpractice claims data at Statehealthfacts.org.

NH Early Offer Med Mal Settlement Proposal Called Bait and Switch

The Nashua Telegraph on April 15, 2012, carried a guest opinion by Attorney David Gottesman regarding the “early offer to settle” proposal contained in Senate Bill 406 now before the N.H. House of Representatives. Early offer to settle, says Gottesman, "is a perfect sound-bite manufactured by medical malpractice insurance carriers to convince the Legislature that there is a better way to resolve medical malpractice claims. 'Bait and switch' may be more appropriate." Gottsman, who is an attorney at Gottesman & Hollis, PA in Nashua, goes on to argue against the bill, summarizing with:

"SB 406 is flawed. It has been rejected coast to coast by states such as Washington and Massachusetts, proving New Hampshire should reject the request to become the new guinea pig of the nation. We just don’t need it."

 You can read his full opinion on the NashuaTelegraph.com here.

NH Considers Early Offer Program to Speed and Reduce Medical Malpractice Claims

The Union Leader carries an article describing a new bill before the New Hampshire Senate — Senate Bill 406: "Establishing an early offer alternative in medical injury claims". The bill "seeks to bypass costly and time-consuming litigation and give patients, providers and attorneys a pathway to a quick resolution."

According to the report by Garry Rayno:

"Under the bill, a patient who believes he has suffered an injury from medical care may request to participate in the early-offer program instead of the [screening panels] system that's already in place. If the provider also agrees to participate, the patient will be guaranteed a payment, Bradley said, though it might not be as big.

A patient who submits a claim under the new system will have to undergo an exam by an independent health care provider as well as submit information about medical costs and lost wages. The participating provider would then respond with an offer of payment based on the severity of the injury, ranging from $1,700 to $117,500 along with lost wages."

For more information, see the full article: Garry Rayno's State House Dome: Bill on injury claims aims to please all

What Makes New Hampshire's Medical Malpractice Laws Unique?

Each state has unique laws specifically governing medical malpractice and medical liability trials, so it is important for your lawyer to be fully experienced in the laws and the courts in the state where your injury occurred. What is unique to NH's med mal laws? Most notably in NH, the state has no limits or caps on damage awards. In addition, the state requires any claims filed to be reviewed by a pretrial screening panel to identify claims that merit compensation and to encourage early resolution of claims before going to trial.

Based on a listing of medical liability and malpractice laws compiled by the National Conference of State Legislatures, 16 states do not have a damage award limit or cap, 36 jurisdictions have a limit or cap. New Hampshire is one of the states that does not limit damages. In fact, the State Supreme Court (see Carson v. Maurer, 120 N.H. 925, 424 A.2d 825 (1980) and Brannigan v. Usitalso, 134 N.H. 50, 587 A.2d 1232 (1991)) has declared limits on non-economic damages (§507-C:7) as unconstitutional. Here is a link to laws governing New Hampshire's screening panels for medical injury claims.

For a comprehensive list of state-by-state laws governing medical malpractice and liability suits, see www.ncsl.org.

Is NH State Medical Board Failing To Discipline Bad Doctors?

According to an analysis by Public Citizen of data from the National Practitioner Data Bank, state medical boards have failed to discipline 55 percent of the nation’s doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked.

In New Hampshire, 54.9% of physicians with one or more clinical privileges suspended or limited received no licensure actions (that's 51 physicians with clinical privileges actions during the 19-year period studied, and 28 physicians with no licensure report). 

The analysis, according to Public Citizen, raises serious questions about whether state medical boards are responding adequately to hospital peer review determinations of substandard care or conduct, and, secondarily, whether state boards are getting copies of hospital reports to the NPDB. Given the value of hospital disciplinary reports, such reports must be received and properly utilized by medical boards to assure patient safety.

Public Citizen calls upon the NH State Medical board to work cooperatively with HRSA to regularly identify physicians in New Hampshire who have had clinical privilege reports submitted to the NPDB but have not had a state licensure action.

Go to Public Citizen for read the full analysis, its findings and conclusions: State Medical Boards Fail to Discipline Doctors with Hospital Actions Against Them

NH Medical Liability/Malpractice Laws

The National Conference of State Legislatures website summarizes the medical liability and malpractice laws by state. The chart is updated as of September 2010. It documents:

• Damage Award Limits or Cap
• Statute of Limitation
• Joint and Several Liability
• Limits on Attorney Fees
• Periodic Payments
• Patient Compensasion or Injury Fund
• Doctor Apologies/Sympathetic Gestures
• Pre-trial Alternative Dispute Resolution and Screening Panels
• Affidavit or Certificate of Merit
• Expert Witness Standards
• Medical or Peer Review Panels

Click here to view New Hampshire's Medical Liability and Malpractice Laws.

NH Screening Panels Scrutinized

Some interesting numbers are included in the NHBR report on New Hampshire's review of medical malpractice review panels. In The jury's still out on malpractice panels, Cindy Kibbe writes that according to figures from the state's Medical Malpractice Panel and Insurance Oversight Committee...

"... there have been some 387 cases brought to the attention of screening panels since 2007, with 147 resolved prior to panel review. Of the 240 remaining cases 87 were waived, 84 have been heard and 69 are pending as of Dec. 10. Only 18 medical malpractice cases have gone to a jury trial after panel review since 2007."

For the full article please click through to NHBR where you can read or listen to the report.

Trend in Medical Malpractice Claims Paid in New Hampshire

According to data from StateHealthFacts.org, a website of the Henry J. Kaiser Family Foundation, New Hampshire had 47 medical malpractice claims paid in 2009 for total of $12,368,750 — that's an average of $263,165 per claim. New Hampshire ranks 37th in dollars paid. The chart below shows the trend in medical malpractice claims paid in New Hampshire from 2003 to 2009.

 

View interactive chart on statehealthfacts.org

For more information, see the StateHealthFacts.org.

Four New Hampshire Hospitals Join Together for Insurance Coverge

The New Hampshire Business Review reports on four New Hampshire healthcare providers — LRGHealthcare, Concord Hospital, Elliot Health Systems of Manchester and Wentworth-Douglass Hospital — have joined to create Granite Shield Insurance Exchange.

NHBR writes:

"With the establishment of Granite Shield, LRGH ends its longstanding relationship with the New Hampshire Medical Malpractice Joint Underwriting Association..."

Read the full article here on NHBR.com: LRGH leaves JUA as 4 hospitals form new insurer

Portsmouth Hospital Makes Changes for Hearing Impaired Following Federal Lawsuit

Seacoastonline.com reports on January 18, 2011, that Portsmouth Regional Hospital is making improvements to "enhance communications with deaf and hard-of hearing patients as a result of an out-of-court agreement to settle a lawsuit filed by the U.S. Attorney's office."

A lawsuit claimed the hospital discriminated against deaf patients... and the hospital agreed to make payments to several deaf patients as well as "to pay a $20,000 civil penalty and to adhere to the terms of a 37-page consent decree outlining changes in the way the hospital interacts with deaf and hard-of-hearing patients." The Portsmouth agreement is the fifth agreement in New Hampshire as the result of the U.S. Attorney lawsuit.

To read the full story on the Seacoastonline.com, click on: Portsmouth Hospital Settles Suit.

New Hampshire Ranks 3rd in Nation for Healthiness

American Health Rankings® has ranked New Hampshire as 3rd in the nation for overall healthiness, up from 4th in that nation last year.

Every state has its successes and every state has its challenges. New Hampshire's strengths include a low percentage of children in poverty at 10.5 percent of persons under age 18, a low violent crime rate at 160 offenses per 100,000 population, a low rate of uninsured population at 10.4 percent, low geographic disparity within the state at 5.7 percent and a low premature death rate with 5,792 years of potential life lost before age 75 per 100,000 population.

It's challenges include moderate public health funding at $63 per person, a moderate prevalence of binge drinking at 16.1 percent of the population and a moderate rate of cancer deaths at 196.2 deaths per 100,00. 

Click here to view the NH E-Ranking Report Card.

Vermont tops the list of healthiest states for the last four years of published reports. Vermont has had a steady climb in the Rankings for the last twelve years from a ranking of 17th in the 1997 and 1998 Editions. Massachusetts is ranked second, an improvement from third last year. Massachusetts has ranked in the top ten for almost 20 years. New Hampshire is ranked third, followed by Connecticut and Hawaii.

Mississippi is ranked 50th, with Louisiana, Arkansas, Nevada and Oklahoma rounding out the bottom five.

NH Gets New Chief Justice

New Hampshire's Executive Council has unanimously confirmed state Supreme Court Justice Linda Dalianis as New Hampshire's first female chief justice. She fills the position left bly retired chief justice John Broderick. This as reported by The Concord Monitor on December 9, 2010.

Submit Your NH Medical Malpractice Verdicts and Settlements

Please submit your news releases on recent medical malpractice verdicts and settlements for consideration in NH Medical Malpractice News. We aim to document significant wins in the state. Names are not necessary, but the result, type of case, and interesting specifics are encouraged. The date and court are also required for verification, but will not necessarily be published. Click here to submit.

NH Could Save 93 Hospital Deaths

According to analytical studies of comparative health care performance data by The Commonwealth Fund, 93 fewer premature deaths (before age 75) might occur from causes that are potentially treatable or preventable with timely and appropriate health care. This is according to the Commonwealth Fund State Scorecard, 2009, which lists state-specific rankings and results compared to industry benchmarks, and predicts the number of lives and dollars each state could save by achieving benchmark levels of performance. Click to view the New Hampshire Scorecard. New Hampshire ranks in the top quartile nationwide.

Sulindac Verdict is $21 Million

Here's the link to the highly anticipated Sulindac products liability case in NH. On September 8, 2010, the federal jury awarded a woman $21 million for injuries including blindness after taking the anti-inflammatory drug Sulindac. To read the Boston Globe article, click here.

Sulindac on Trial in Products Liability Case

A products liability case is now in the hands of a Concord, NH jury for a 45 year old plaintiff who took the drug Sulindac for shoulder pain and quickly developed complications leading to blindness. The plaintiff seek more than $24 million in damages. The lawsuit is reported here by the AP in Bloomberg Businessweek.

NH Couple, Hospital Settle in Medical Malpractice Lawsuit

The Boston Herald reports on a medical malpractice lawsuit involving a failed kidney transplant. Plaintiffs are a New Hampshire couple who have agreed to a $1.25 million settlement in a lawsuit against three doctors and a nurse at a Boston teaching hospital. Plaintiffs claimed that understaffing, rookie doctors-in-training and chain-of-command breakdowns at the teaching hospital led to the donor kidney dying a week after the transplant. The Nashua couple settled with the defendants on the day opening arguments were scheduled in Suffolk Superior Court. The defendants did not admit guilt. See full story here: NH Couple

N.H. Malpractice Premiums Unchanged

NHBR reports that ProSelect Insurance Company has announced it will not be increasing medical liability insurance premiums for New Hampshire providers. See the full article and accompanying podcast here:
Firm keeps N.H. malpractice premiums unchanged

NH Supreme Court Finds Negligence Should Be Left for Jury To Decide in Medical Malpractice Trial

CONCORD, NH — The New Hampshire Supreme Court overturned the trial court's decision in a medical malpractice lawsuit, Beckles v. Madden, agreeing with Lubin & Meyer attorneys for the plaintiff in finding that the burden of proof for causation, an element of negligence, should be left for the jury to decide. Attorney Benjamin Novotny, presented the oral argument before the court. The opinion was issued April 9, 2010 by Chief Justice Broderick.

The case in summary:

"The plaintiffs, Wesley and Maggie Beckles, appeal a decision of the Superior Court (Barry, J.) granting summary judgment on their medical malpractice claims in favor of the defendants, Jennifer E. Madden, M.D., Eugene A. Lesser, D.O., Foundation Medical Partners, Foundation Neurology, and Nagbhushan S. Rao, M.D. We reverse and remand

The opinion cites New Hampshire law as follows:

A negligence action based upon a claim of medical malpractice is governed by RSA chapter 507-E (1997 & Supp. 2009). RSA 507-E:2 provides in part:

I. In any action for medical injury, the plaintiff shall have the burden of proving by affirmative evidence which must include expert testimony of a competent witness or witnesses:
(a) The standard of reasonable professional practice in the medical care provider's profession or specialty thereof, if any, at the time the medical care in question was rendered; and
(b) That the medical care provider failed to act in accordance with such standard; and
(c) That as a proximate result thereof, the injured person suffered injuries which would not otherwise have occurred.

The court's full ruling is available online at Beckles v. Madden.