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Stroke Ambulances – The Future Standard in Stroke Care?

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Canada’s first trial of an advanced Stroke Ambulance in Edmonton could signal a new era of significantly improved standard of care of ambulance-level stroke care in this country. Equipped with a mobile CT scanner and an internet link to the on-call neurologist in the hospital, the new stroke ambulance has the potential to dramatically improve patient outcomes and could become the new standard of care of emergency ambulance response to a call where symptoms reported could be those of a stroke. Why are we so excited about Canada’s first highly-specialized Stroke Ambulance and why do we believe that other health jurisdictions in the country should follow?

What is a Stroke?

A stroke occurs when blood flow to the brain is cut off, leading to the death of the affected brain cells. While all strokes are serious matters, they do not all result in debilitating injuries. If identified and dealt with promptly, a stroke can often be contained to only have mild consequences. Doctors estimate that over 100 million brain cells die each hour, so rapid diagnosis and treatment is critical to a patient’s chances of making a successful recovery.

To understand why they say, “time is brain”, it is important to understand that strokes arise from two primary causes, and are classified and treated accordingly:

  1. ischemic strokes are caused by a blood clot restricting blood flow in the brain,
  2. hemorrhagic strokes are caused by a burst blood vessel causing uncontrolled bleeding in the brain.

According to the Canada Heart and Stroke Foundation, ischemic strokes make up approximately 80% of cases, and hemorrhagic strokes make up the remaining 20%. The fundamental difference between the causes of the two types of stroke results in completely different treatment protocols. For example, patients suffering ischemic strokes are commonly administered medication known as tPAs (tissue plasminogen activators) that actively break down blood clots, and the sooner they can be administered the better the chances are of recovery. Importantly, the patient must receive these tPAs within the first three hours of the onset of the stroke symptoms for medication to have any meaningful effect. The tricky issue in the timing is that before the treatment can be administered, it is necessary to determine the type of stroke a person is suffering. If tPAs are administered to a person suffering a hemorrhagic stroke, the medication can exacerbate the already damaging bleeding going on in the brain and can lead to devastating consequences.

With the key technological developments in the Stroke Ambulance of an in-ambulance mobile CT scan and an internet link radiologist and neurologist, the CT scan can be conducted on the spot and immediately sent for review by an expert radiologist, identifying the type of stroke far sooner than possible before. In approximately four out of five cases, it will be the more common ischemic stroke, allowing the vital tPAs to be administered much sooner, potentially by hours for rural patients. This can be the difference between a mild or serious stroke, a short or lengthy recovery, and a small or significant cost to the health care system.

Missed or Delayed Diagnosis of Bacterial Meningitis Worsens Patient Outcomes

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Prompt diagnosis of bacterial meningitis infection is crucial for best treatment outcomes. Death rates from bacterial meningitis are around 10% with up to 1/3 of survivors suffering long-term serious neurological complications. If diagnosed and treated early, most people recover well.

Because the symptoms of meningitis are similar to flu and other viral infections, some physicians may miss the diagnosis and not treat the infection in a timely manner. In some cases where a diagnosis of bacterial meningitis was missed and poor treatment outcomes followed, there may be compensation available to the injured patient.

Meningitis is a life-threatening condition with initial symptoms similar to flu

Acute bacterial meningitis is an infection of the tissues around the brain and/or the spinal cord which causes these tissues to swell. It can result in paralysis, brain damage or death if treatment is not started early. Bacterial meningitis is a serious condition requiring immediate medical attention and treatment. Unfortunately, the symptoms which accompany bacterial meningitis often closely resemble common flu. In both conditions, a person will often suddenly develop high fever, start vomiting and will experience headaches and loss of appetite. Physicians assessing patients who present with these symptoms may rely on the simple fact that common things happen more commonly and fail to consider more serious but unlikely causes of the patient’s symptoms and take steps to test for bacterial meningitis.

Young children and adults with weak immune systems are at a higher risk

Bacterial meningitis can happen to anyone; however, children under 2 years of age are particularly vulnerable to bacterial meningitis. This is because young children’s immune systems are not fully developed yet. Children who do not receive a complete set of vaccinations are even at a higher risk. Pregnant women are at a higher risk of being affected due to their increased risk of contracting listeria bacteria which may cause meningitis. People with compromised immune systems are at increased risk of bacterial meningitis as well. In rare cases, bacteria may be accidentally introduced into the patient’s body during surgery and spread to the spinal cord or the brain, causing bacterial meningitis.

Medical malpractice for missed or delayed diagnosis of meningitis

When a diagnosis of meningitis is missed or delayed and serious complications such as brain damage ensue, injured patients and their families face high costs of care and loss of income. Several cases have successfully been brought against physicians across Canada for failing to consider bacterial meningitis as a potential cause of their patients’ symptoms and initiating prompt treatment. If you or your loved one suffered an injury as a result of the delayed diagnosis of bacterial meningitis, do not hesitate to contact us for a consultation as to whether or not you have a viable malpractice case.

Four Reasons Why Awards are Less in Canada than the USA

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A Canadian courtroom never looks like the American television courtroom. Heated courtroom battles where lawyers dressed in business suits yell at each other using theatrical outbursts to persuade the jury and breathless investigators run into the courtroom at the 11th hour with a newly discovered piece of evidence, culminating in the court ordering a multi-million dollar medical malpractice award for the plaintiff – that doesn’t happen in Canada. Of course some of this excitement is purely tv-land drama, but some of it can be explained by the differences in our legal systems.

While there are many differences between the Canadian and American legal systems, a few of these differences contribute directly to the lower compensation a plaintiff can expect to receive for medical malpractice cases in Canada. This is true even if the negligence is caused by doctors’ mistakes or nurses’ mistakes. Here are some of those differences:

  1. Lower awards for pain and suffering in Canada – In 1978 the Supreme Court of Canada put an inflation-adjusted cap on how much a plaintiff can be compensated for the pain and suffering caused by a negligent defendant. In 2015, the most compensation that can be awarded for pain and suffering in Canada, no matter how catastrophic the injury, is about $350,000. Compare that to New York State alone where in 2011, 10 cases were awarded more than $3,500,000 for pain and suffering. Many US states are starting to put limits on claims for pain and suffering, and some of those limits are even lower than the Canadian cap. Nonetheless, there continues to be large awards available in a number of US jurisdictions.
  2. Socialized medicine lowers plaintiffs’ future costs – Plaintiffs can be awarded compensation for health care costs they will have to pay for themselves in the future. In Canada, defendants do not pay the plaintiff for provincially-funded health care, such as hospital in-patient care or physician appointments. In the United States, since an injured plaintiff may have to pay for future hospitalizations out of their own pocket, defendants can be required to compensate for those costs as well – this can amount to tens of millions of dollars.
  3. Jury awards are smaller in Canada – When judges decide how much a successful plaintiff should be awarded they must explain their decision in detailed written reasons. They are bound by the evidence presented and by decisions made in previous cases. Juries, on the other hand, do not write reasons to explain their findings. A sympathetic jury can award extremely high awards. Canadian juries tend to be much more conservative than their US counterparts, in part because the money to pay the awards often comes from tax funded programs such as ICBC, or hospitals. Large awards are viewed by some Canadian juries as coming out of their pockets as taxpayers. In addition, Canadian jury awards can be appealed if they are inordinately high and fall well outside the range of damages a judge would award.
  4. Punitive damages are less common in Canada – Our tort law system is aimed at compensating victims of negligence, not punishing the defendants. The compensation is intended to put the plaintiff back in the condition they would have been in if the negligence had not occurred – to the extent that is possible. In Canada, punitive damages are much less common than they are in the USA – in fact in medical malpractice lawsuits punitive damages are exceedingly rare.

People who have been injured by the negligence of a doctor, nurse or other health care professional can expect to be fairly compensated in Canada, and although the compensation awarded here is more modest than in the US, it can still provide some measure of comfort and assistance as people try to move forward with their lives after an injury caused by medical malpractice.

Bursary for Children Living with Cerebral Palsy

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Pacific Medical Law has established a bursary fund in honor of Janna Epp, a beautiful, determined young girl with cerebral palsy, who faced challenges that few of us could imagine. Sadly, on October 11, 2012 Janna passed away.

In memory of Janna, Pacific Medical Law will donate $5,000 to a child living with cerebral palsy every year, to assist with that child’s care, therapy or recreation. The recipient of the bursary is selected by Janna’s mother.

Last year Pacific Medical Law provided the $5,000 bursary to a little girl named Leila. Leila is an extraordinary child with cerebral palsy who is amazingly strong and has a true zest for life. Leila works hard with her therapies and wanted the opportunity to try Feldenkrais therapy and therapeutic horseback riding to improve her muscle tone and decrease stiffness. She also wanted a Squiggles postural support system to keep her safe and comfortable when she is out exploring the world. Pacific Medical Law was pleased to support Leila and her mother, in this small way, to help Leila reach her full potential in life.

This year the bursary recipient will be selected on July 30, 2015. Applications are due July 15, 2015. For more information, please click; Janna Epp Bursary Application Form 2015, or go to https://www.pacificmedicallaw.ca/jannaeppbursary.shtml

Hospital acquired infections – a new era in germ warfare

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In our practice, we get a number of calls from people who have suffered injuries due to infections contracted during their hospital stay. Studies have shown that more than 220,000 Canadians develop infections during a hospital stay each year and, on average, these infections kill 22 patients each day – more than leukemia and breast cancer combined.

In an attempt to combat this issue, scientists are developing new antibiotics, hospitals are redesigning wards to have more single-patient rooms to reduce the spread of infections, and companies are developing new technologies to wipe out bacteria. However, one of the simplest ways to combat infections in hospitals may be one of the most effective.

Hospital Cleaners are the Gatekeepers

A recent Globe and Mail article identified hospital cleaners as gatekeepers in preventing the spread of infectious bacteria. This is becoming more of an issue as worldwide concern grows over the pervasiveness of hospital-acquired infection, and the threat of antibiotic resistance looms.

Hospitals represent an ideal environment for “superbugs” – bacteria that are resistant to antibiotics – to thrive, due to high antibiotic use and invasive medical procedures being performed on patients with weakened defenses. Where antibiotics are used unnecessarily, they kill some bacteria, but produce an ideal breeding ground for resistant strains to multiply and spread. If every surface is not completely disinfected with industrial strength chemicals, an outbreak of drug-resistant bacteria can occur, killing vulnerable patients in its path.

Infection control experts warn that Canada is not doing enough to control the issue of hospital infections and the threat of superbugs, and that national monitoring of hospital-acquired infections is badly underfunded. Adding to the problem is the fact that health is a provincial responsibility in Canada, leading to an uncoordinated response to the issue of antibiotic resistance.

Unfortunately, despite the essential role that hospital housekeepers play in combatting infection, cleaners are an easy target for cuts when health care budgets are tight and demands on hospitals greater than ever. In British Columbia, hospital cleaning was privatized over a decade ago, and hospitals across the country are increasingly following suit – a trend that has a number of negative consequences. A 2008 report by the Hospital Employees’ Union of BC found that privatization of this service led to increased staff turnover and dramatically reduced the time cleaners spent at health care facilities.

Whatever problems hospitals may face regarding infection control, the law demands that reasonable care be taken to protect patients from harm while they are in the hospital, and to recognize infections and provide prompt and appropriate treatment. Patients who suffer harm due to a failure to prevent, or detect and treat, hospital-acquired infections have the right to compensation. The courts will only award this compensation if it can be proven that the appropriate standards were not followed and that if the standards had been followed, the harm would not have occurred.

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