Hospital Chain’s Revenue Strategy Puts Patients at Risk

Health Management Associates has been named in eight lawsuits alleging the for-profit hospital has been increasing revenue by admitting more patients—whether they needed inpatient care or not—resulting in unnecessary tests and other procedures. This bizarre quota system, with a goal of admitting at least half of all patients over 65 who visited the emergency room, was purportedly designed to defraud Medicare and Medicaid.

While this dubious scheme is chilling on its own merits, the patients involved may have suffered economic setbacks or even been subjected to dangerous conditions.

Each year, thousands of patients suffer harm due to avoidable mistakes, known as preventative adverse events (PAE). While many potential risks are associated with surgical procedures, such as post-op bleeding or anesthesia complications, just being admitted to a hospital carries some amount of risk.

Nosocomial Infections, also known Healthcare-Associated Infections (HAIs), are infections that patients acquire while receiving healthcare for other conditions. According to the Centers for Disease Control and Prevention (CDC), “In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, was approximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries; 19,059 among newborns in well-baby nurseries; 417,946 among adults and children in intensive care units (ICUs); and 1,266,851 among adults and children outside of ICUs.”

Older patients and those with weakened immune systems are especially susceptible to HAIs, which may include tuberculosis, septicemia, endocarditis, meningitis, hepatitis, hospital-acquired pneumonia, and illness due to antibiotic-resistant bacteria such as MRSA.


Source: “Hospital Chain Said to Scheme to Inflate Bills” by Julie Creswell and Reed Abelson, New York Times, January 23, 2014.

You Are What You Eat

FDA proposes new guidelines for nutrition labels

Making healthy choices at the grocery store may soon get a bit easier. The FDA announced that it will focus on updating nutrition labels this year. The details have not been made public yet, but nutrition experts are hopeful that the new labels will be more straightforward.

“It’s time to update [labels] to make [them] easier for consumers to use,” said Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest (CSPI).

The Center’s “wish list” for label changes includes:

  • Calories per serving should be more prominent
  • Eliminated extraneous information
  • Updated serving sizes
  • Eliminating deceptive single-size servings and providing nutrition information for large single serving containers
  • Differentiate between natural and added sugars and establish a Daily Value for added sugars
  • Fiber content should only reflect intact fibers from whole grains, beans, vegetables, fruit and other foods 


We like the CSPI nutrition label proposals, but wouldn’t it be nice if we knew what pesticides are used on the foods we eat? The American Academy of Pediatrics, the President’s Cancer Panel, and physicians nationwide have publicly advised consumers, especially children and pregnant women, to reduce our dietary exposure to synthetic pesticides. For example, the synthetic pesticide DDT – banned in the United States since 1972 but still used as a pesticide in other countries – may increase the risk of Alzheimer ’s disease.

In a study recently published JAMA Neurology, Rutgers scientists discuss their findings in which levels of DDE, the chemical compound left when DDT breaks down, were higher in the blood of late-onset Alzheimer’s disease patients compared to those without the disease.

Although the levels of DDT and DDE have decreased significantly in the United States over the last three decades, the toxic pesticide is still found in 75 to 80 percent of the blood samples collected from the Centers for Disease Control and Prevention for a national health and nutrition survey. This occurs, scientists say, because the chemical can take decades to breakdown in the environment. In addition, people may be exposed to the pesticide by consuming imported fruits, vegetables and grains where DDT is still being used and eating fish from contaminated waterways.


As more and more crops containing genetically modified organisms, known as GMOs, make their way into the marketplace, there has been a rise in public sentiment to require GMO labeling.

Reuters reports, “The issue is hotly contested, with more than 20 states considering laws to mandate labeling of foods made with gene-altered corn, soybeans, sugar beets and other biotech crops. Currently, labeling of such foods is voluntary.”

If you want to avoid GMOs in your diet, look for foods labeled as “organic.” Federal law prohibits the use of genetic engineering prohibited in foods defined as organic. Nevertheless, these products may contain slight traces of genetically modified organisms in certain cases.

Knowledge is power 

Please take the time to read the labels on foods you buy. Be wary of front labels claiming a product is “natural,” that it can reduce cholesterol, or provides other medical benefits.

“In a perfect world, agencies such as the Food and Drug Administration and the Federal Trade Commission would be aggressively policing the marketplace and taking enforcement action against companies like these,” said CSPI executive director Michael F. Jacobson. “Until then, lawsuits by consumer groups and private citizens can play an important role by using the courts to get companies to change their labeling and advertising for the better.”

What information would YOU like to see on nutrition labels?
Post your suggestions in the comments section below.



Fat, calories, sugar: Nutrition labels getting a makeover” by Jen Christensen, CNN, January 24, 2014.

Food Labeling Chaos: The case for reform” by Bruce Silverglade and Ilene Ringel Heller, © 2010 by Center for Science in the Public Interest.

DDT exposure more common in people with Alzheimer’s: study” by Genevra Pettman, Reuters Health, January 27, 2014.

Organic food and farm groups ask Obama to require GMO food labels” by Carey Gillam, Reuters, January 16, 2014.

What will my car accident cost?

by Arthur Elk

Car accidents are devastating events that can change the course of the victim’s life in an instant. Not only can they cause severe injuries and emotional trauma, they can also have shocking financial effects. Depending on the severity of the collision, car accidents can cost victims and their families thousands, tens of thousands, or even hundreds of thousands of dollars. For this reason, it is best to call a car accident attorney if you’ve been involved in a collision.

Some financial consequences of car accidents are quite obvious. You may have to spend money to get the car fixed and pay your medical bills. If the accident resulted in a totaled car, you may also have to pay all or part of the cost of buying a new vehicle. However, many less obvious financial consequences exist as well. For example, if you are injured and cannot work, you may lose income. You may also have to pay for physical therapy if you are having trouble recovering from your injuries or spend money on psychiatric treatment if the accident caused emotional trauma.

Because of the high costs associated with being the victim of a collision, it is wise to seek the help of a car accident attorney if you’re involved in a crash. These lawyers are trained in evaluating and litigating personal injury claims. They can help you determine if the other party is legally responsible for the accident. If this is the case, your car accident lawyer can help you file a lawsuit to attempt to obtain monetary damages from the other driver or his or her insurance company. These damages can cover anything from your medical bills to lost wages to the cost of buying a new car.

Limits on Your Personal Injury Compensation

Attorney Gary Cowan explains caps on pain and suffering in Ohio lawsuits.


After being injured in a personal injury accident, you have only one chance to become made whole again and this is to bring a lawsuit against the person who caused you harm.

The amount you may be awarded, either by a jury or through a settlement, is primarily based on the types of injuries you sustained in the accident. While some accidents leave only a few scratches and bruises, other times you may suffer much more severe injuries which can be permanent.

Normally, the more severe the injury is and the greater impact it has on your life, the more compensation is awarded. Our main goal is to seek enough recovery money for you to take care of your health and the consequences of your injuries — not just currently but in the future. You may also be able to receive another type of compensation called ‘pain and suffering.’ Also known non-economic damages, this type of claim is based on intangible injuries.

In Ohio, there are caps or limits on non-economic damages. This can range between $250,000 and $350,000 per each accident lawsuit. However, it is possible to go beyond these limits and receive more for your accident case. In cases regarding physical deformities and other permanent injuries your attorney may be able to break through the caps of pain and suffering limits. Not all injuries will lead to damages for pain and suffering. In general, damages for pain and suffering can be awarded for past, present, and future physical distress in a personal injury case.

To learn more about personal injury law, I encourage you to watch the video above and to explore our educational website at If you have legal questions, please call us at 1-800-ELK-OHIO. I welcome your call.

Gary Cowan joined Elk & Elk Co., Ltd. in 2000 as a trial attorney and litigator. He has been involved in personal injury and medical malpractice litigation since 1988, and has been lead trial counsel in over 80 jury trials.

Nursing Home Fire leaves 3 Dead, Dozens Missing

Night of horror in L'Isle-Verte
Photo: Francois Drouin,

A deadly fire broke out overnight in a Canadian nursing home and The Toronto Star reports Quebec police are in “mass casualty management mode.”

The facility located in L’Isle-Verte, Quebec was home to more than 50 elderly residents, many of them unable to walk on their own. The National police of Quebec have confirmed 3 deaths, 13 residents transferred to local hospitals and 10  others taken to another senior home. About 30 people remain missing.

Eyewitnesses described a horrifying scene, with family members trying to reach residents trapped on the balcony, only to watch them perish in the flames.

According to, which posted video of the blaze, firefighters helped some residents to evacuate, but were unable to rescue everyone. “These are elderly, some of which are very limited mobility. Others were afraid and they hid under blankets,” said local Fire Chief Yvan Charron.*

Authorities say the building was equipped with fire and smoke alarms and a “partial” sprinkler system.

Lack of Federal Regulations

As Americans, we’d like to think such a tragedy could never occur in our country. Surely, we have regulations requiring nursing homes to have sprinkler systems throughout the entire building. Unbelievably, until last year, U.S. federal regulations only required some nursing homes to have automatic sprinkler systems.

A recent article by the New York Times reports,

Automatic sprinklers, the most effective protection against fires, have been mandated in any new nursing home certified by Medicare and Medicaid, or in new construction added to an existing facility, since 2000. But for older nursing homes, there was no such regulation until August 2008 — and the industry, complaining about high costs, was given five years to comply.

Despite the new regulations, many facilities have not fully complied. The National Consumer Voice for Quality Long-Term Care has diligently tracked the progress of nursing homes across the country and published a list of non-compliant facilities on their website. Most recently updated in December 2013, their list contains the names of over 700 nursing homes across the country that have yet to either install automatic sprinklers or only have partial systems—including five in Ohio. [NOTE: The list may contain errors or may not reflect the most current information.]

Do your Homework

When selecting a nursing home or other long-term facility, make sure you ask about their policies.

  • Are emergency exits clearly marked? Check to make sure there is an evacuation plan in place that involves all staff and is practiced regularly.
  • Are there safety systems in place such as alternative exits, smoke detectors, and sprinklers throughout the entire facility?
  • Is the facility well maintained and free of clutter?
  • What is their smoking policy?
  • Does the nursing home have an emergency evacuation plan and hold regular fire drills?
  • What is the staff-to-resident ratio? (Keep in mind; staff levels may fluctuate at night, on weekends and holidays.)
  • Ask to see their most current Health & Fire Safety Inspection Reports. The nursing home must have the report of the most recent state or federal survey of the facility available for you to look at. You can also find reports on most State agency websites, as well as on

Fire and evacuation plans for nursing homes have gained nationwide attention since fires in Hartford, Connecticut and Nashville, Tennessee claimed the lives of 31 residents in 2003. However, the deadliest nursing home fire took place in Ohio in 1963 when flames destroyed the Golden Age Nursing Home in Fitchville Township. Although more than 60 people died, the fire didn’t make national news because it occurred just hours after the assassination of President John F. Kennedy.



Quebec seniors home fire: 3 dead, 30 missing” by Allan Woods, The Toronto Star, January 23, 2014.

Nuit d’horreur à L’Isle-Verte” (Night of horror in L’Isle-Verte) by Francois Drouin,, January 23, 2014.
*Originally reported in French; translation by Google Chrome.

Many Nursing Homes Operate Without Adequate Sprinkler Systems” by Paula Span, New York Times, September 30, 2013.


Mass Torts and Class Action Suits

Most of the things we purchase are safe. Unfortunately, however, sometimes a defective product, drug, or medical device causes consumers to suffer an injury. In the U.S., when many people are harmed by the same defendant (or group of defendants), depending on the circumstances, individual lawsuits may be grouped together.

Learn the Lingo


A tort is a civil wrong that results in injury to someone’s health or property. The person (or corporation) who commits the tort is liable for the harm suffered by the victim.

If a lawsuit is filed, the victim becomes a plaintiff and party sued is the defendant. The plaintiff typically sues the defendant to recover damages (monetary compensation for the plaintiff’s injury).

To begin preparing for trial, both sides engage in discovery – the formal exchange of information between parties about the witnesses and evidence they will present at trial.

Class Action

A Class Action is a type of legal action where a single lawsuit is filed on behalf of an entire group of plaintiffs who share a set of similar circumstances, damages and injuries. These proceedings are designed to cut down on the number of court cases, and occur when each person’s injury is not worth the time and money of hiring an attorney on an individual basis.

A class action lawsuit must meet certain criteria. Members of the class must be notified of the suit and given the change to “opt out” or find their own private counsel. Before filing a class action lawsuit, a motion is filed in court for the lead plaintiff to act on behalf of the group or class.

Mass Tort

In a Mass Tort action, sometimes referred to as Multi District Litigation (MDL), each plaintiff has an individual claim resulting from distinct damages. Although Mass Tort claims also seek to streamline the court schedule, they are handled differently than a Class Action.

In most cases, Mass Tort claims are brought when dangerous drugs or defective products injure a large number of consumers who reside in different states. Since drugs and product defects can cause a wide range of problems for different individuals, their cases rarely fit into a single class.

Mass Tort litigation allows one attorney (or groups of attorneys) to represent several injured parties in individual cases. To speed things along, pretrial investigations conducted by one attorney can be shared among all cases. This permits a nationwide network of lawyers to pool their resources, information and ideas to help secure fair settlements for all plaintiffs. Once the pretrial discovery phase is complete, each case returns to the local court where it was originally filed for trial.

If you have been injured by a defective product, drug, or medical device, you may be entitled to recover money damages. Call 1-800-ELK-OHIO or contact us online to schedule your free consultation.

Fuel Shortage May Bring More Drowsy Drivers to Ohio

Truckers hauling flammable cargo declared exempt from federal safety rules.


With yet another cold snap looming, Ohio Governor John Kasich has declared a state of emergency in response to the state’s heating fuel shortage. The proclamation, issued on January 18, allows commercial truckers transporting propane or heating oil to drive more hours and more consecutive days than normally permitted by law.

Citing health and safety concerns, Kasich claims the inclement weather is causing longer driving times, making it difficult to meet demand while complying with federal hours-of-service regulations and requirements. The proclamation reads in part,

Motor carriers and drivers transporting propane and heating oil to address transportation issues arising from the severe weather, heavy snowfall, and difficult driving conditions in Ohio, are exempt from compliance with Rule 4901:2-5-02 of the Ohio Administrative Code and 49 CFR Part 395 – any such provision of a state statute, order, or rule pertaining to the hours-of-service is suspended.

FMCSA Hours of Service Rule

The latest federal Hours of Service Rule, which went into effect in July of 2013, reduced the number of average weekly hours from 82 to 70. According to the U.S. Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA), the new federal regulations were designed to improve safety for the motoring public by reducing drowsy driving.

The agency estimates the new safety regulations will save 19 lives and prevent approximately 1,400 truck accidents and 560 injuries each year.

Duty of Care

Even though drivers hauling propane and heating fuel will not have to comply with the hours-of-service regulations and requirements, they still owe a legal duty to other motorists:

The Proclamation does not alter a carrier’s duty to monitor its drivers, to maintain records of duty status and to ensure that drivers are not ill, fatigued, impaired, or otherwise unable to operate a commercial motor vehicle safely.

This state of emergency may remain in effect up to 30 days, and Ohio isn’t alone. Similar exemptions are in place in more than two dozen states across the country.



“State declaration aims to ease propane gas shortage” by Bowdeya Tweh, Cincinnati Enquirer, January 18, 2014.

The Trouble with Low T Treatments

Have you noticed the ever-increasing collection of commercials targeting men with low testosterone, or “Low T?” Much like the advertising for Viagra and other ED medications, these ubiquitous sales pitches prey on the insecurities of mature men with promises of increased vitality, improved muscle mass, alleviating depression, and improved sexual performance.

But for some men, these drugs come at steep price.

A recent study published in the Journal of the American Medical Association indicates testosterone treatments may increase risks of heart attack, stroke and death in men. A previous study had to be cancelled in 2009 due to “an increased risk of adverse cardiovascular events.”

What is Low T?

Testosterone is an androgen, or male hormone, produced in the testicles and regulated by glands in the brain. Low testosterone, also known as androgen deficiency or hypogonadism, can result from problems in the testicles or the brain. This is different from the normal decrease in testosterone levels in men over 30, which is a normal part of the aging process and does not necessarily require treatment.


Testosterone Replacement Therapy (TRT) has been proven effective, but for whom? Low T diagnosis can be difficult since the symptoms of hypogonadism are arguably vague and may develop over time. Adding to the problem are aggressive marketing campaigns by pharmaceutical companies, which have resulted in blockbuster sales for drug makers like AbbVie and Eli Lilly. Reports indicate that the percentage of men being treated for “Low T” has almost quadrupled since 2000, reaching $1.6 billion in U.S. sales in 2011.

The Endocrine Society recommends testosterone treatment for men who are diagnosed as having low testosterone based on both symptoms and blood tests showing indisputably low testosterone levels, but some doctors are prescribing testosterone replacement therapy to healthy men who want to boost their libido, energy and strength.

However, testosterone treatment “offers no proven benefits for healthy men,” says Dr. Adriane Fugh-Berman, of Georgetown University Medical Center. “Low T syndrome is invented by pharmaceutical companies to sell treatment products.”



Testosterone treatments linked to heart risksAP/USA Today, November 5, 2013.

Too many men take testosterone when they don’t need it” by Endocrine Society, The Washington Post, January 13, 2014.

Popular ‘low T’ therapy divides the medical field” by Laura Ungar, The (Louisville, Ky.) Courier-Journal, June 12, 2013.

Association of Testosterone Therapy With Mortality, Myocardial Infarction, and Stroke in Men With Low Testosterone Levels” JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386.

“Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline” The Endocrine Society®, The Journal of Clinical Endocrinology & Metabolism, June 2010, Vol. 95(6):2536–2559.

First Spine Surgeon Patient Awarded $1M, More Cases Pending

Medical MalpracticeA Hamilton County jury has awarded $1.04 million to Crystal Pierce, the patient of Dr. Atiq Durrani in the well-publicized medical malpractice trial of the Cincinnati spine surgeon. Hundreds of Durrani’s patients have also filed similar malpractice claims.

The jury awarded the plaintiff $500,000 for pain and suffering, $40,000 for lost wages, and $500,000 in punitive damages. However, due to Ohio’s damage cap laws, the amount will be reduced to a maximum of $790,000 – minus attorney fees and costs.

Local news outlet WCPO reports:

The eight-member jury found for Pierce in three of the four claims in her suit:

  • Negligence, based on accusations that Durrani violated the standard of care during her surgery on Jan. 30, 2009.
  • Lack of informed consent. Deters said Durrani operated beyond Pierce’s consent and that she never agreed to his use of BMP-2, a bone-growth hormone. The North American Spine Society had warned spine doctors not to use it in surgeries like Pierce’s, a witness for Pierce testified. Since then, some studies suggested it could lead to increased risk of cancer.
  • Fraudulent misrepresentation, based on the claim that she could be paralyzed if she didn’t have the surgery.

The jury did not accept the fourth claim of battery. Deters argued that Durrani’s surgery amounted to intentional, unconsented contact.

According to Dr. Keith Wilkey, who testified at the trial, Durrani used a commercial bone growth protein (INFUSE) despite warnings against its use from the North American Spine Society. He also told jurors that Durrani had misread or disregarded X-rays, chose a more painful and complicated procedure than other U.S. surgeons would have performed, and worsened Pierce’s condition by misplacing screws and plates in her spine.

Dr. Durrani, who is still facing hundreds of additional civil suits and a 36-count federal fraud indictment, has fled the country and is reported to be in Pakistan. However, the jury could not consider that fact in their deliberations. By order of the judge, they were only told that Durrani had chosen not to testify.



“First plaintiff wins malpractice case against Mason spine doctor Atiq Durrani” by Greg Noble, WCPO, January 14, 2014.

Tips on Sharing the Road with Semi Trucks

by Arthur Elk

Driving next to an 18-wheeler or other large semi truck can be scary, especially for new drivers or those driving very small vehicles. The drivers of these 18-wheeler trucks have large blind spots to the right and rear of the vehicle. There are additional, smaller blind spots on the right front corner and mid-left side of the semi truck.

Driving in these blind spots can be quite dangerous because the driver of the truck may not see you and attempt to merge lanes. If this happens and you get in an accident, you should consult with a car accident lawyer to determine if the driver of the semi truck was at fault. If you’re driving on a highway and drive up right next to a semi truck, it’s good practice to pass the truck quickly, but within the speed limit, to minimize the risk of driving in one of the truck’s blind spots.

You should also be careful not to be too close to a truck when it is reversing. Because of the truck’s large size, it is more difficult for the driver to reverse, and doing so may take several tries. If a semi truck hits you while reversing, you should seek the advice of a car accident lawyer to determine if you can get compensated for the accident. If the truck driver is liable, you may be able to get a settlement for any injuries and property damage that you sustain in the accident.

Share the Road

The Federal Motor Carrier Safety Administration offers these tips to motorists:

  • Leave more space for trucks and buses. Truck and bus drivers leave extra room behind the vehicles they follow because it can take them twice as long as a car to stop. 
  • Pay attention – don’t get distracted. Stay focused! Using cell phones, navigation devices and even laptops while driving makes the roadways more dangerous. 
  • Avoid the "No Zone"Stay out of the “No Zone.” Drivers of large commercial vehicles must react faster than car drivers in emergency situations due to the size and weight of their truck or bus. Truck and bus drivers have huge blind spots around the front, back and sides of their vehicles, otherwise known as the No-Zone. Be safe and don’t hang out in the No-Zone.
  • Stay Alert. Pay close attention to the side effects of prescription and over-the-counter drugs. Coupled with fatigue or a distraction, prescription or over-the-counter drugs can be dangerous on the road, and potentially deadly.
  • Wear your seatbelt. Buckling your seatbelt is the single most important thing you and your passengers can do to save your lives in a crash. Be safe and always buckle up!