Friday, February 29, 2008
This lawyer traitor to clinical care, Richard Roberts, MD, JD, suggests apologizing. What a catastrophe for discovery. Every word will be used by the plaintiff lawyer. The doctor will face each word again at deposition. This is a lawyer traitor trick.
What the lawyer traitor fails to mention as a coping method, is to hire a private attorney. The latter should threaten the insurance company hack with firing and legal malpractice action every time he refuses to act against the source of his job, the plaintiff lawyer. All motions should be forced on this hack who needs a trial to break even. If a motion fails, the defense attorney should understand, he is fired. Every tiny infraction of the plaintiff side should result in a request for sanctions from the judge, including a demand to declare a mistrial, and to sanction double the legal costs from the personal accounts of the plaintiff lawyer and expert. If the pro-lawyer rent seeking judge refuses to act, the lawyer should act against the judge, filing repeated complaints with the administrative judge. There is a long list of actions that never get taken by the defense hack, to deter the plaintiff side. The defense attorney owes his job to the plaintiff lawyer, and not to the doctor. He cannot be trusted, and must be watched, and bullied by another lawyer.
Wednesday, February 27, 2008
Some tort savvy sarcasm about the scope of duty from readers:
They should sue whoever paved the road he traveled on to pick her up.
Posted by: Woody | Feb 26, 2008 10:46:47 AM
Tuesday, February 26, 2008
Monday, February 25, 2008
1) It is done by psychologists. They have a vested interest to promote psychological methods.
2) The most severe patients were likely excluded from the trial, to avoid litigation. Left wingers intimidate drug companies into excluding severe patients. When mild patients fail to respond to drug, they get second guessed, yet again.
3) There is a trend toward greater response for severer patients, even within the narrowly mild ratings of the patients in these studies.
4) On-off experiments in individual patients were not reviewed.
5) The left bashed the use of anti-depressants by family doctors. Population studies show this increased use is among the rare effective methods to reduce the suicide rate at the population level. If family doctors get discouraged, and the suicide rate increases, these authors must resign, as well as any editor, funding reviewer, or peer reviewer. They will have been responsible for mass murder.
Sunday, February 24, 2008
Saturday, February 23, 2008
2. Phone call starts treatment.
3. Patients must have hotline numbers.
So says, Robert Simon, M.D., here. I invite Dr. Simon to provide the data showing that these standards have ever helped to prevent a suicide. I will keep people posted of his reply.
Given the evidence in the prevention of suicide, the above could apply to all plaintiff suicide malpractice experts.
All plaintiff experts should be be disqualified. If they cannot be disqualified, they should be impeached for promulgating ideologically based garbage science. Every word of their testimony should be parsed for perjury. If perjury about a fact is found, it should be referred to the District Attorney for investigation and possible prosecution.
The psychiatrist interviewer promulgates dubious science. She is a frequent expert witness. She presents no balance whatsoever, to the biased and misleading claims of the plaintiff side. "Oh well, that is so sad," she agrees. She blames the prescribing of anti-depressants by non-psychiatrists as a factor in skyrocketing suicide. Suicide rates have been dropping, as more family doctors have chosen to treat depression. This psychiatrist self-serving claim has no evidence. The psychiatrist list deviations from her own invented standards of care. None carries any evidence of preventing suicide. He should have been seen in one hour of arrival. His belt should have been removed.
The vengeful, scapegoating family contains mental illness. The suicider experienced relationship problems. Skippy chimes in with his psychiatric expertise. He knows all about the thinking and tactics of the suicider. "You can kill yourself easily in 15 minutes," he asserts. "Of course, it was about money, the $1000 a day." "This is across the country, 1600 patients a year die of suicide." (in hospitals). Skippy tells us that patients be made to waive confidentiality. Perhaps, Skippy can get an injunction against the patient who wants nothing to do with his toxic family. Make sure what observation level is selected, and accept no less than observations every 5 minutes apart. Review the after care plan to insure safety after discharge, and seen on a frequent basis. He refers those who want to learn about managing suicidal patients to this site. So advises Skippy.
These plaintiffs will not share the plaintiff expert opinion for public review. I do not know why.
The biased interviewer forgot to ask, 1) was this an open facility, and the suicider a voluntary patient?; 2) if staff had laid a hand on the suicider, what criminal charges (plus this) and torts could they have generated for themselves? Skippy failed to address a standard of care that is breaks the law, and is an intentional tort itself.
Friday, February 22, 2008
Thursday, February 21, 2008
Tuesday, February 19, 2008
Monday, February 18, 2008
Sunday, February 17, 2008
Most people want pain relief and to enjoy the rest of their life, doing what they usually enjoyed.
In the case of psychiatric patients, one meets a patient with "terminal" depression, perhaps once every 10 years of a busy practice. Rare, but still deserving of respect for their pain and for their wish.
Friday, February 15, 2008
Thursday, February 14, 2008
Wednesday, February 13, 2008
Monday, February 11, 2008
This appellate decision held that a lawyer should have Googled a party to find them. The judge did that from the bench. He found them, rebutted the claim, they could not be found.
See p. 2 below for an establishment review of the nascent case law on the duty to Google. This idea is not even new nor creative. It just awaits application by the defense bar.
http://www.ali-aba.org/doc/IFF0705.pdfThe patient has knowledge superior to any party, second by second facts of bodily sensations and functioning, reaction to a medication. That should become part of the contributory negligence defense, including the failure to communicate every gurgling and twinge in contemporaneous, time stamped emails.
Next, the ongoing process of informed consent is literally impossible if delivered by the doctor, even if an hour is spent reading the surgery text word for word together. The patient will forget it all 15 minutes after leaving. Only repetitious review helps people understand and remember.
Sunday, February 10, 2008
If one corrects for the large sample sizes, the differences in the rates of suicidal ideas becomes no longer statistically significant. This error would get points off on a high school statistics test.
Wednesday, February 6, 2008
Monday, February 4, 2008
Sunday, February 3, 2008
Saturday, February 2, 2008
Friday, February 1, 2008
A lawyer ran ads for clients with suicidal ideas on these medications, many responded. No denominator for these responses is possible. Thus any conclusion represents only ascertainment bias.
Here, the FDA reviews the compiled studies. The total number of patients ran to 44,000. Four committed suicide in the 24 weeks of most trials. The expected rate for males in a half year is 8 per 100,000. The four suicides are expected for the total population. This is a generality from 11th grade statistics. If the sample size is huge, a cell with fewer than 5 should be removed from the analysis. It is too unstable to be reliable. When the more proper Fisher's Test is run, the P < .16, and is not statistically significant. It certainly has no clinical significance. Epileptics have higher rates of psychopathology, and undiagnosed psychopathology. Thus the 4 suicides may represent a marked suppression of the expected suicide rate in epileptics.
Suicidality and antiepileptic drugs: is there a link?
The main purpose of the present article is to review the possible risk factors for suicidal behaviour in epilepsy with a special emphasis on the different antiepileptic drugs (AEDs). Epidemiological data show that, in general, the suicide rate among patients with epilepsy is 5-fold higher than that in the general population, while in temporal lobe epilepsy and complex partial seizures it is approximately 25-fold higher. A certain psychiatric comorbidity may provoke suicidality in patients with epilepsy, and depression and cognitive impairment seem to be the main risk factors for suicidality in epilepsy. In addition, depression and cognitive deterioration in epilepsy may share common neuropsychological mechanisms in terms of hypofrontality. This may cause similar psychopathological signs in both diagnostic categories, including suicidality. Analysis of the literature has shown that serotonin metabolism disturbances are involved in the pathogenesis of suicidal behaviour irrespective of primary diagnosis. Serotonin disturbances also seem to be a common link between depression, suicidality and even epilepsy itself.The various AEDs differ not only in their mechanisms of action, but also in influences on cognition and mood in epileptic patients and suicidality, respectively. Until now, only Ketter's hypothesis has been proposed to explain the psychotropic effects of different AEDs, although it does not explain the positive psychotropic effects of some AEDs, such as carbamazepine and oxcarbazepine. According to this model, all psychotropic effects of AEDs may be the result of effects on the function of two types of receptor functions: gamma-aminobutyric acid (GABA) ergic and antiglutamatergic; other possible mechanisms have not been incorporated. Presumably, other neurochemical mechanisms, and a serotonergic mechanism in particular, should also be taken into account when explaining the psychotropic effects of different AEDs. Based on these data, it has been suggested that AEDs with certain serotonergic properties should reduce the suicidality risk because they exert effects similar to antidepressants (i.e. selective serotonin reuptake inhibitors), whereas AEDs that lack serotonergic mechanisms would not be effective in suicidality prevention. In line with this paradigm, phenobarbital and phenytoin seem to be the only drugs with proven suicidality risk. On the other hand, carbamazepine, oxcarbazepine, valproate and lamotrigine could be regarded as drugs with antisuicidal properties because they all improve cognitive functions and mood in epileptic patients, and possess serotonergic mechanisms of action. The other AEDs, including topiramate, tiagabine, vigabatrin, levetiracetam and zonisamide, all exert negative effects on mood and cognition, although their influence on suicidality has not been proven in evidence-based studies yet. Although zonizamide has serotonergic properties, it exerts negative psychotropic effects, whereas gabapentin is devoid of serotonergic properties but has positive psychotropic effects on mood and cognition. To more fully explain the positive and negative psychotropic effects and influence on suicidality of AEDs, Ketter's paradigm should be supplemented by an understanding of the serotonergic mechanisms of different AEDs. Further trials are required to prove or refute this model.