Out-of-the-Box Lawyering

One out-of-the-box way to reduce medical malpractice suits — Reduce the medical malpractice that leads to the suits — First example (in an ongoing series) — Use of bar codes by hospitals for drugs and blood and blood products

We all keep hearing about how there are too many "frivolous lawsuits" (somehow those words are always used together). Of course we never hear those words used together if a comment is about a suit that one business files against another business or even a suit by a business against an individual.

Anyway, the Institute of Medicine of the National Academy of Sciences (not many people would say that the Institute is a plaintiff-oriented group) has estimated that ANNUALLY between 44,000 and 98,000 Americans die as a result of medical negligence. The full study is at http://www.iom.edu/ObjectFile/Master/4/117/0.pdf. Here's how the Institute, excluding its citations, summarizes the extent of the "error" problem:

"Between 44,000-98,000 Americans die from medical errors annually

"Only 55% of patients in a recent random sample of adults received recommended care, with little difference found between care recommended for prevention, to address acute episodes or to treat chronic conditions

"Medication-related errors for hospitalized patients cost roughly $2 billion annually

"41 million uninsured Americans exhibit consistently worse clinical outcomes than the insured, and are at increased risk for dying prematurely

"The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years

"18,000 Americans die each year from heart attacks because they did not receive preventive medications, although they were eligible for them

"Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents

"More than 50% of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are currently managed inadequately"

And, for those patients who died, how many physicians or hospital employees told the patient's survivors that, "We just made a mistake." Moreover, for the patients who survived the "inadequate" care, how many were told that their care had been inadequate?

I will be giving other examples of systemic problems in subsequent postings; this message arises because by the Food and Drug Administration's announcement on February 25 of its final rule entitled Bar Code Label Requirements for Human Drug Products and Biological Products.

Will this rule help reduce lawsuits? The FDA says that, because of its rule, there will be at least 500,000 fewer "adverse events" over the next 20 years. That's a reduction of over 25,000 per year — or a reduction of more than 2,000 "adverse events per month"!!!. Can you imagine what would happen if just one plane dropped out of the sky each month and only (only!!) a couple hundred people died or were injured each month. Here's what the FDA says about the effect of its rule:

"The Institute of Medicine and other expert bodies have concluded that medical errors have substantial costs in lives, injuries, and wasted health care resources, and that drug-related adverse events are a major component of those errors.

"FDA estimates that the bar code rule, once implemented, will result in more than 500,000 fewer adverse events over the next 20 years. Thus, FDA estimates a 50% reduction in medication errors that would otherwise occur when drugs are dispensed or administered. . ."

Moreover, the reduction will probably be greater than 50% because, as the FDA notes, "some hospitals that currently have bar code systems in place report a higher error reduction from bar code usage."

Here are a couple of ways, again according to the FDA, that the bar coding will help prevent injuries and deaths:

"[A] bar code system could prevent a child from receiving an adult dosage of a drug and prevent a patient from mistakenly receiving a duplicate dose of a drug he or she had already received. A bar code system can also allow the computer to record the time that the patient receives the drug, ensuring more accurate medical records.

And just this one way of reducing error will, among other effects, the FDA notes, reduce hospital litigation, reduce liability insurance, and, oh yes, avoid pain, suffering, and extensions of hospital stays:

"Patients would avoid pain, suffering, and extensions of hospital stays with an estimated value of $93 billion over the next 20 years. In addition, hospitals are expected to avoid litigation associated with preventable adverse events, reduce malpractice liability insurance premiums, and increase receipts from more accurate billing procedures."

Because of all of the demonizing of plaintiff attorneys, I would like to repeat just one of the Institute's conclusions: "Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents." (The Institute has noted that 16,516 die from AIDS, 43,458 from motor vehicle accidents, and 42,297 from breast cancer.)

Rather than demonizing the messenger, maybe, just maybe, we ought to be looking for additional ways to reduce the number of patients who are injured or killed by the ongoing medical malpractice problem.

An addendum: After I drafted the above, I found a February 26 article from the Washington Post. (You may have to register to read the article.) The Post reported that "Federal officials said . . . that the rule has the potential to cut in half the 7,000 hospital deaths attributed to medication error every year." The article also reported that, according to Kenneth W. Kizer, the man who had introduced the bar code system in the VA, after the system was introduced the number of deaths from medical errors had plummeted and that the FDA's new rule was "long overdue." He added, "It's pretty striking that health care has been so far behind in terms of using new technology." (The emphasis is mine. The lament is his.)

A second addendum: I have practiced plaintiff personal injury law almost exclusively. However, I believe that this is the first plaintiff-oriented posting that I have made in my blog. I want this weblog to be open to all kinds of out-of-the-box solutions regardless of whether they are plaintiff- or defendant-related or related even to areas other than personal injury law. So, if you have an out-of-the box solution in any area of law, please let me know.

Did you know that over 1,400 municipal codes are searchable online? FOR FREE?

Genie Tyburski publishes TVC Alert, "a free weekday news bulletin [which] reports on industry events and Web-based resources for library and legal professionals." She noted in her February 18 mailing, about municipal codes being online and gave a link to a Seattle Public Library site that in turn links to seven publishers of municipal codes. Apparently there is some degree of overlapping, and there are also situations in which some codes are listed under one publisher and not under others. I checked Louisiana, and the Seattle page had only one listing and that was for Shreveport, Louisiana. However, one of the seven links on the Seattle page was to the Municipal Code Corporation. I clicked on that link, and, when I checked, I found this description on its site:

"Contained on this website are Codes for more than 1,100 local governments in searchable online databases, and information about many other services and products including community planning templates, custom publishing and document imaging."

I frankly was surprised to learn that so many codes were available for searching. For instance, I found that the Municipal Code site included 36 different codes just for Louisiana, including not only one for New Orleans, but also others for cities that had populations of less than five thousand.

If you want to subscribe to Genie's newsletter, just follow the instructions on her site.

3/8/2004:

Here's a message with additional iformation that I received from Municode's customer support:

"1. We currently host 1,418 municipal codes online.
"2. They are updated based on their supplement schedule, usually either bi-weekly, quarterly, or bi-annualy.
"3. The banner page tells the ordinance codified through and latest supplement date.
"4. We provide a wide range of legal publishing services, more fully explained at: http://www.municode.com/services/codification.asp. . ."

Are you a "senior lawyer" who wants to get out of your law box? Do you want to do something different during your retirement in addition to — or even instead of — playing golf full time? Here's how you can go to foreign countries and help loca

I recently came across an article in the Legal Times entitled: "Ambassadors of the Law: How two D.C. lawyers built a group that spreads American legal values abroad." Dec. 29, 2003, p. 1. (You need to subscribe to the Legal Times to be able to download the article, but you can register for a free 30-day trial, which will allow you to download it.) The article details the history and work of the International Senior Lawyers Project (www.islp.org) "a pro bono group that sends experienced attorneys — both practicing and retired — to do a range of legal work in developing countries."

Lawyers who started the ISLP include a partner in Hogan & Hartson and retired partners from Clifford Chance. Beginning with a study that was funded with about $100,000 from the Open Society Institute, the Nathan Cummings Foundation, and the Pew Charitable Trusts, the Project has sent lawyers around the world to fulfill its mission statement, which is "To advance democracy and the rule of law, to protect human rights and to promote equitable economic development."

You can find a variety of stories about lawyers who have enjoyed working with the group and have helped others. For example, an article in the American Lawyer points out that one of the Project's volunteers went to Bulgaria and established its first public defender office. Another article shows how the Project has formed a partnership with a pro bono group in India.

Other articles, such as one in the New Jersey Law Journal and others on the website of Power of Attorney describe not only ISLP but how lawyers can become involved with other pro bono groups.

If you want more information, just Google "International Senior Lawyers Project." And make sure that your passport is up to date.

How to find state statutes on the Internet

I just discovered that Robert Ambrogi, among his other postings on his web site, has "a comprehensive set of links to state laws available on the Web."

He adds that the list includes not only all states, but also the District of Columbia, Guam and the U.S. Virgin Islands.

Tips and Tricks for searching Google — How you can get the latest news on Google. And how you can you can keep track of what news sources are saying about your clients and your opponents (and maybe even about you)

Did you know that you can search Google for the most recent news stories on some 4500 news sources? (Just click on the News tab above the regular Google search bar.) Google continuously updates its news and it's not unusual to see a posting that's only 30 minutes old. And Google archives its entries for the past 30 days.

Some of the newspaper sources might surprise you. For instance, I checked and discovered that our local New Orleans newspaper, the Times-Picayune, is one of the 4500 sources. And so was the Baton Rouge daily, the Advocate. So, check to see if your own local paper is included.

You can click on About Google News and discover some interesting information about the service. For instance, Google doesn't use human editors. The headlines are generated with computer algorithms. As Google describes it, "The headlines that appear on Google news are selected entirely by computer algorithms, based on how and where the stories appear elsewhere on the web. There are no human editors at Google selecting or grouping the headlines and no individual decides which stories get top placement."

Google is not just limited to U.S. sources but includes sources from around the world. If you're particularly interested in recent or even late-breaking news regarding a particular country, Google has different versions for Australia, Canada, France, Germany, India, Italy, New Zealand, Spain, the U.K., and, of course, the U.S.

Additionally, the news sources are not limited to just newspapers. For instance, two of the news sources are the B.B.C. and even Voice of America. You can also check the latest from Playbill. And there are even some TV sources, so you can check the latest on what MTV has to say on Janet Jackson. (To get the most recent stories first, click on "sort by date.")

Google News also allows you to search by categories such as business, health, and sci-tech.

With the news, you can keep up to date about whether your clients, your opponents, and maybe the experts in your cases are being discussed.

There is a caveat, however. Google does not include the full text from all its news sources. For instance, I searched Google using the name of a local columnist and did not find his weekly column. So, just because your search does not find an entry in a news source does not necessarily mean that nothing is there. But you can't beat the price and what you do find may be invaluable.

As you may know, you can also search other online sources such as CNN and Yahoo. (Yahoo says it has 7000 sources in 35 languages. I couldn't find the number of sources for CNN.) I haven't checked what the overlapping is among the three, and what each has that the others don't. When you search, you might try all three to see which gives the best results.

You can also – for free – sign up on Google for a daily alert on up to five different searches. CNN and Yahoo also provide alerts. But, more on the alerts in another posting.

Tips and Tricks for Google searching — Do you need a photograph, drawing, or other image for a case? Try using Google

Did you know that you can find photographs and drawings and other visual material with Google? You didn't? You're not alone.

Do you need a diagram of a heart? Go into Google and just enter Heart. But, before you click on Search, look above the Google search bar and click on "Images." Then click on "Google Search."

If you want to limit your search to JPG files, or to GIF files, or to PNG files, you can do that also. Just click on "Advanced Image Search" at the top of the main Google search page. Then, look down the Advanced page and you will see filetypes. You can then select the type of file you want to see and to download.

Similarly, while you're in the Advanced Search Page, you can go the "Domain" line and limit your search to .gov or .edu sites. Or even to .com sites.

Some (perhaps all) of the images are subject to copyright, so be careful.

In any event, I did a search on "heart" and then limited the search to ".gov" (without the quotes). In the result, the first two images were from the National Institutes of Health. When I clicked on the first image, I was led to an NIH page that showed several images from the Proceedings of the Second Visible Human Project. Clicking on the second, I was led to even more images from the Project.

And, if you want to see what Bourbon Street in New Orleans looks like during Mardi Gras, just use this search (with the quotation marks): "Bourbon Street" "Mardi Gras".

Happy searching.