Things that puzzle me about PCa #7 in an endless series - malpractice

[Guest guest]

The recently published piece What's Impeding Active

Surveillance in Prostate Cancer? (available at

http://www.medscape.com/viewarticle/748782 - registration is free if required)

includes amongst the reasons for the low level of choice of AS (Active

Surveillance) these comments:

<snip> " Once you know there is a cancer,

you have to be very careful, " Dr. Thrasher noted. If the patient opts for

active surveillance but then is noncompliant with regular follow-up tests, and

a metastatic prostate cancer is discovered after a few years, then there is danger

— especially in the litigious environment of the United States — of

a claim of medical negligence, because there might have been a window of

opportunity for curative treatment that was missed, he explained.

Dr. berg and colleagues also cite " medicolegal "

risks as a retardant to the uptake of active surveillance.

But Dr. Lam said that, with a patient who is

carefully oriented to active surveillance, " we are not very concerned

about lawsuits. " <snip>

Leaving aside the very low probability of a man

whose diagnosis indicates suitability for active surveillance having metastatic

disease after a few years, just how big is this medicolegal risk? Let me

explain some of the points that lead me to wonder how much of these oft

repeated issues may be more spin than reality:

1. There was a recent exchange on another

Forum concerning what appeared to be a very clear case of negligence with the

doctor said to have admitted that they missed the high and rapidly increasing

PSA level. The man was urged by some to seek compensation for the additional

costs now incurred but was also counselled to be very cautious in how he went

about any kind of legal action, since this was fraught with difficulties.

2. In another Forum a man reported that after

he had a positive PSA after surgery and being told not to be concerned, another

doctor carried out a full examination and it was found that only half his gland

had been removed. This was categorised as a fairly common ‘surgical

mishap’ and, as he says “I met with a malpractice lawyer and he

didn't want to take the case because he felt it would be too hard to

prove.”

3. Although my memory isn’t what it

was, I seem to recall a retired attorney who was a regular poster at one time

setting out just how difficult it was to establish solid grounds to support a

medical malpractice suit.

4. Against these three points, it may be said

that there are reports of enormous payouts; that insurance premiums are high

and continue to rise and so on. But how much of that is spin, managed by those

who have most to gain from such reports? I spent my working career in the

insurance industry. I will not bore anyone with the rationale behind

establishing estimates for future claims that are much higher than necessary

beyond saying that in most environments there are significant tax advantages in

doing this. These high estimates of future claims are also the rationale for

increasing the costs of the insurance. The insurer’s rationale for the

high estimated future costs are often based on the high court awards which make

the headlines but which are often overturned (and not reported) on appeal.

5. And finally, if there is a substantial

medicolegal risk in failing to take early action for all prostate cancer

diagnoses, surely there must be a growing risk for such suits if early

unnecessary action is taken. It is becoming ever more clear than many

procedures are not in the man’s best interests and all lead to some loss

of quality of life. Surely these men will have grounds for action, as will men

whose post surgical pathology report shows no sign of prostate cancer as is the

case in a small percentage of men which might be growing with the Gleason

migration as reported.

Just some thoughts of a puzzled man.

All the best

Prostate men need enlightening, not frightening

Terry Herbert - diagnosed in 1996 and still going

strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html