Preserving Civil Justice- Casper & de Toledo LLC - Representing Plaintiffs Only

Brain Injury Association and Scholarly Journal

2008-11-27T12:56:00.001-05:00

The Brain Injury Association of America (“BIAA”) is the leading voice of brain injury in the United States. It is the parent organization for a network of state affiliates including the Brain Injury Association of Connecticut and the Brain Injury Association of New York State. These organizations service professionals and businesses involved in the diagnosis, care and treatment of acquired head injury. On November 20, 2008, BIAA announced that effective January 1, 2009 it had designated the Journal of Head Trauma Rehabilitation (“JHTR”) as BIAA’s official scholarly journal. JHTR is published by Wolters Kluwer Health/Lippincott Williams and Wilkins. The full press release issued by BIAA can be found on the BIAA web site.

TWENTY-EIGHT CATEGORIES OF PREVENTABLE MEDICAL MISTAKES

2008-08-13T17:37:00.000-05:00

TWENTY-EIGHT CATEGORIES OF PREVENTABLE MEDICAL MISTAKES

The National Quality Forum (“NQF”) is a consensus standard setting organization that has published a list of 28 adverse medical event categories that should never occur in a hospital setting. The list of events has been embraced by eleven states that have directed hospitals not to charge patients or insurance companies for these categories of preventable mistakes. Unfortunately, neither Connecticut nor its hospitals have endorsed this program. Nevertheless, we have listed the 28 categories of “Never Events” as a preliminary “qualifier for patients and family members interested in further investigating potential medical malpractice claims in Connecticut. The categories are as follows:

1. Unintended retention of a foreign object in a patient after surgery or other procedure

2. Patient death or serious disability associated with patient elopement (disappearance)

3. Patient death or serious disability associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration)

4. Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/HLA-incompatible blood or blood products

5. Patient death or serious disability associated with an electric shock or elective cardioversion while being cared for in a healthcare facility

6. Patient death or serious disability associated with a fall while being cared for in a healthcare facility

7. Surgery performed on the wrong body part

8. Surgery performed on the wrong patient

9. Wrong surgical procedure performed on a patient

10. Intraoperative or immediately post-operative death in an ASA Class I patient

11. Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility

12. Patient death or serious disability associated with the use or function of a device in patient care, in which the device is used or functions other than as intended

13. Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility

14. Infant discharged to the wrong person

15. Patient suicide or attempted suicide resulting in serious disability, while being cared for in a healthcare facility

16. Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a health care facility

17. Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility

18. Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates

19. Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility

20. Patient death or serious disability due to spinal manipulative therapy

21. Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances

22. Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility

23. Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility

24. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider

25. Abduction of a patient of any age

26. Sexual assault on a patient within or on the grounds of the healthcare facility

27. Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of the healthcare facility

28. Artificial insemination with the wrong donor sperm or donor egg

An injury or death resulting from one of the category of events does not necessarily justify bringing a malpractice claim. However, it does present an opportunity to further explore the viability of a medical malpractice claim.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
email: scasper@cadetlaw.com

Brain Injury Association of Connecticut Functions

2008-08-13T16:43:00.000-05:00

Annual Summer Picnic -The Brain Injury Association of Connecticut ("BIAC")held its annual Summer Picnic & Volunteer Awards on August 12th at the Wickham Pavilian in wickham Park in Manchester, CT. A fun time was had by all.

The 2008 BIAC Golf Tournament at Wintonbuy Hill raised over $120,000.

The American Academy of Neurology Recognizes – There’s Nothing Mild About Mild Traumatic Brain Injury

2007-08-13T12:21:00.000-05:00

The American Academy of Neurology Recognizes – There’s Nothing Mild About Mild Traumatic Brain Injury

Like never before, the war in Iraq is focusing dialogue on brain injuries. The discussion has been prompted by the large number of casualties who have sustained such injuries and who have survived. Not only are troops experiencing penetrating trauma that often result in prolonged periods or unconsciousness or require brain surgery but they are also experiencing the type of head trauma caused by the concussive effect of explosions, particularly from roadside bombs known as IEDs (Improvised explosive devises).

In the July 3, 2007 of "Neurology Today" reporter Stephanie Cajigal highlights the epidemic of the so-called “mild traumatic brain injury” (MTBI) cases that occur each year in the United States. “Neurology Today” is a bi-weekly publication of the American Academy of Neurology. The article, entitled “Taking the ‘Mild’ Out of Mild Traumatic Brain Injury” also underscores the problems inherent in the word “mild” because for patients who do not recover from mild head trauma, there is nothing “mild” about the injury. By embracing the notion that “mild” does not mean “inconsequential”, the American Academy of Neurology will advance the way we deal with significant injuries, the majority of which occur as a result of car accidents and trip and fall or slip and fall accidents.

There is no consensus about how to define “Mild Traumatic Brain Injury”. In the Textbook of Traumatic Brain Injury (edited by Silver, McCallister & Yudofsky, published by American Psychiatric Publishing, Inc. 2005), Dr. Thomas McCallister listed more than eleven definitions from government sources and peer reviewed literature. There does appear to be a consensus that a concussion is a brain injury and that a patient will fall into the mild traumatic brain injury classification if there is either a short term loss of consciousness (<30 minutes) or a transient impairment of cognitive function. It is also widely known that many head trauma victims are never seen in a hospital and many such patients are treated and released despite suffering an injury that can have far reaching consequences impairing a host of cognitive functions including but not limited to problems with memory, attention and concentration, emotional control, irritability, and decision making.

The article urges neurologists to “be on the lookout” for symptoms of TBI and recognizes that the diagnosis may be challenging. Often such diagnostic tests as CT Scan, MRI, EEG are normal or negative but that is insufficient as a patient can have a brain injury despite negative diagnostic testing.

It is also common for a patient to fail to recognize lasting symptoms from head trauma that is classified as Mild Traumatic Brain Injury. While a majority a patients who sustain head trauma do not have lasting symptoms, nearly 80% of the head trauma population do experience permanent post concussion syndrome. As any of those patients will tell you, there is no good kind of brain injury.

CBIA - AN ENABLER OF DISCRIMINATION

2007-08-01T13:03:00.000-05:00

CBIA – AN ENABLER OF DISCRIMINATION

It frequently happens that when the Connecticut Business and Industry Association (“C.B.I.A.” – and not to be confused with our Connecticut Brain Injury Attorneys “C-B-I-A”) issues a “Government Affairs Report” the content reveals an invidious bias against the ideal of “justice for all.” Today’s missive from the Business Association is no different.

On May 29, 2007, the U.S. Supreme Court issued its decision in Ledbetter. v. Goodyear Tire and Rubber Co., Inc. In Ledbetter, by the barest of majorities, the Court ruled that a woman who discovered that she was receiving unequal pay as compared to her male colleagues could not maintain her claim retroactive to the commencement of the discrimination under Title VII of the Civil Right Act of 1964. The Court held that the statute required that a complaint of discrimination be filed within 180 days of the discriminatory act and therefore the damages related to the earlier period of discrimination could not be addressed. The majority, that included conservatives Samuel Alito, Jr. and Chief Justice John Roberts, failed to explain how it was just to penalize Ms. Ledbetter for her inability to discover the longstanding discrimination that was alleged in her complaint when she did not know about it.

The CBIA has advocated communication with Congressional representative to oppose the “Ledbetter Fair Pay Act” (H.R. 2831) claiming that the legislation that has been passed by the House and is being considered by the Senate will not see the light of day. Of course, any legislation that is calculated to do justice for all will likely be the subject of a Presidential Veto and George W. Bush has threatened to Veto the legislation should it reach his desk.

The CBIA advances its opposition to the legislation because it believes that the Ledbetter decision forces the employee to report discrimination quickly and permits the employer to defend itself while “the evidence is fresh”. Unfortunately for workers victimized by discrimination, the Ledbetter decision is intellectually and pragmatically dishonest. For decades, the prevailing wisdom has permitted the application of Title VII to a course of discriminatory acts that were unknown to the victim thus holding accountable under the law the employer that has violated the law over an extended period of concealment. While all involved in the justice system recognize the advantages of dealing with evidence while it is fresh, when it comes to discrimination, the employer is in a uniquely advantageous position as it controls the evidence including payroll and personnel records. Thus, it is the employee that is at a disadvantage by the failure of the employer to reveal its pattern of discrimination.

The “Ledbetter Fair Pay Act” is an attempt by the Congress to level the playing field in discrimination cases. It is also an affirmation of the Congressional intent concerning the applicable statute of limitations. Remember, when a statute of limitations is used to deny a person a chance to have his or her case heard on the merits, it amounts to a denial of justice. Why should an employee lose out on a claim for discrimination based upon a 180 day notice requirement when one business can sue another business on a written contract 6 years after a breach of that contract? The “Ledbetter Fair Pay Act” will only prove costly to employers that have broken the law. Despite C.B.I.A.’s protests to the contrary, making the wrongdoers pay is the right way to go.

I urge you to write to your representatives and let them know that the Ledbetter bill should have their support.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

Does the Business Community Have a Stranglehold on the Legislature?

2007-06-06T13:30:00.000-05:00

I am a resident of Wilton, CT and I recently wrote to my state legislator John Hetherington asking that he support SB 847 presently pending before the legislature. The bill is designed to provide workers’ compensation commissioners with discretionary authority to award more than the minimum specified benefits for permanent partial disability to a part of the body injured in a compensable workers’ compensation claim. So many workers are injured and not only lose function in one or more parts of their bodies but also many are thereafter precluded from earning a living as previously. The legislation in question is calculated to put some compassion and mercy in a cold and cruel system of compensation where often employees are injured through the negligence of the employer. Ironically, the only justification advanced for not passing the legislation is that it might cost some extra money but there is no independent empirical evidence that demonstrates that the cost will be significant. The following is the party line, business community, CBIA propaganda being spewed back at me.

Dear Mr. Casper:

Thank you for your message. I appreciate hearing from you on labor issues which I note is an area of interest to you.

Honestly, I have to say that I am concerned about the additional costs that are likely to result from SB 847 at a time when our state is not viewed as very friendly to business. But I will pay attention to its debate.

Sincerely,

John Hetherington

Dear Mr. Casper:

Thank you for your message. I appreciate hearing from you on labor issues which I note is an area of interest to you.

Honestly, I have to say that I am concerned about the additional costs that are likely to result from SB 847 at a time when our state is not viewed as very friendly to business. But I will pay attention to its debate.

Sincerely,

John Hetherington

My response follows:

John: When the 1993 measures were adopted, the cost savings attributable to discretionary benefits was extremely marginal. Now, without any additional data to work from because of the 1993 legislation, the cost projection for giving commissioners more discretion somehow mysteriously increases. I would think you would want to call these prognosticators on the carpet for altering their figures to suit their political agenda. Further, if the legislature does not have enough faith in their appointed compensation commissioners to fairly and equitably exercise their discretion and to do justice, shouldn’t we seriously consider scrapping the entire workers’ compensation system in favor of a pure tort system? The fairest system probably is one in which a person is compensated only where he or she is not more at fault than the employer or some third party.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

I CAN FEEL YOUR PAIN

2007-06-01T17:15:00.000-05:00

I CAN FEEL YOUR PAIN

The event that caused me to experience a sudden onset of right arm pain shall remain confidential as it involves a friend. Nonetheless, this Connecticut injury lawyer who has spent a career representing people with just this sort of injury, knew right away that the type of searing pain I was having was a serious problem.

The pain ran from the right side of my neck, shot into my right shoulder blade and then progressed down the back of my arm through my triceps muscle, across my elbow at the funny bone and then went down my forearm into my hand causing tingling in my index finger. The pain in my upper arm was like a hot knife slicing through my flesh and my forearm felt like it was on fire. When I stood or sat, the pain worsened as the weight of my head and upper torso further compressed the nerve and when I was prone, it lessened. I knew that I had a C6-C7 radiculopathy. The question for me was whether or not the nerve pain was caused by an injury to the nerve alone or whether I had herniated the C6-C7 disc or whether the trauma had somehow caused an osteophyte(a boney formation caused by naturalaging or trauma) to damage the nerve.

Unfortunately, the onset of the pain came just before I was to depart for Las Vegas to attend a special seminar that focused on neuroimaging techniques for brain injury. I traveled to Vegas on a Thursday in tremendous pain and attended a great seminar but the pain was constant - probably a 9 out of 10 (it can’t get a ten because I’ve had a kidney stone and that was the worst pain but it passed). When I awoke early Friday morning (it was early in Las Vegas because of the three hour time difference) I waited until it was 9:30 back east and then I telephoned a neurosurgeon’s office to schedule an appointment first thing Monday morning. Despite a fascinating brain injury program that far surpassed anything available in Connecticut, I couldn’t wait to get home on Saturday night. (I didn't gamble but I ate well and saw the wonderful Celine Dione show).

The weekend was a blur of pain and I was thrilled when Monday came and I could see the neurosurgeon. He confirmed my lay diagnosis (my mother calls me an AAD for Almost A Doctor) that I had a C6-C7 radiculopathy with weakness and diminished reflexes in my right triceps. He sent me for an MRI that confirmed that the disc was herniated with disc material in the neural foramen and more disc material was pressing on my spinal cord.

My injury was treated conservatively with steroids and pain killers for about three weeks. During that time I underwent an epidural steroid injection that provided no relief. The next step was apparent to me and that was surgery. So on May 17 I underwent a posterior cervical foraminotomy. I am working on my recovery, resting, going to physical therapy, massage and plenty of swimming for exercise. By mid July I should be fully back to normal

It has been a real eye opener for me. I never adequately understood just how painful a radiculopathy was; how debilitating it could be. I was in so much pain prior to my surgery that I didn’t need any medication to calm my nerves as I awaited my operation. I was only awake in the operating room for a few minutes and someone on the OR staff said she had never seen anyone so happy about having surgery.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905

203-325-8600

www.casperdetoledo.com

CBIA IS AT IT AGAIN

2007-05-31T07:17:00.001-05:00

I have been absent from this blog for Casper & de Toledo for an extended periodof time now. I have been recovering from my own injury and surgery and I will Blog at a later time about how I know I can really feel my clients' pain. As a trial lawyer, we read and study about injuries and learning the medicine is quite helpful. But nothing compares to walking in someone else's shoes.

In any case, today I include an email message that I am sending tothe entire Connecticut state legislature. This morning I opened "The Advocate" and read how there is contention in Hartford in the waning days of the legislative seesion about a mandate for paid sick leave of 6.5 days a year. Naturally, the Connecicut Business and Industry Association ("CBIA") (not to be confused with www.c-b-i-a.com or Connecticut Brain Injury Attorneys) is out lobbying for a bill that makes no difference to the major corporations that set policy for the CBIA. When will these out of touch executives from the insurance companies and large corporations learn that by protecting workers, particularly people with small paychecks who can't afford to miss a day's pay, we actually elevate the level of compasion and humnity in our society. My email to the lLegislators follows:

I am writing to each member of the legislature in favor of mandating paid sick leave of 6.5 days for employees. I also write as a long standing member of the CBIA. I believe that the Connecticut Business and Industry Association is misguided, ill-informed, provides unreliable information to the legislature and is organizationally incapable of analyzing public policy issues beyond the visceral reaction that this will cost our members some money. Not once in my recollection has the CBIA taken any stand on any issue that would benefit employees and fails to recognize that an employee who does not feel penalized by illness is a happier and more productive employee.

I have a total of 11 employees. Our standing benefit policy provides 5 paid sick days, 2 personal days (funerals, sick, appointments etc) and 3 weeks of vacation that rises with longevity. We also are flexible under special circumstances permitting employees to make up hours and to work remotely under specified conditions.

If an employee is sick with something that is contagious whether it is viral or bacterial, I don’t want that employee in the office exposing others to illness. A sick employee also is under productive, inefficient and brings an attitude that can become contagious within the office.

CBIA has taken a position but it has not canvassed its members on this issue. It is another CBIA knee jerk reaction that the proposal is a mandate that will cost small employers (most large to middle size employers already provide such benefits). The irony is that CBIA weighs in opposition to any proposal that will cost an employer any money but usually only does the bidding for its large members who control the CBIA Board. Let the CBIA offer some real evidence or analysis that this proposal would be harmful to the economy of Connecticut. Today I have blogged further on this subject. If you go to my blog I have more to say. http://stamford-trial-lawyer.blogspot.com/

Good luck and hoping your final days of the session will be productive.
insurance companies

2007-05-31T07:17:00.000-05:00

HAVE YOU LEARNED ANYTHING NEW LATELY?

2007-04-02T09:31:00.000-05:00

HAVE YOU LEARNED ANYTHING NEW LATELY?

As lawyers we are granted a license to practice law after completion of a course of study at an accredited law school and then passage of a bar examination. The bar exam tests knowledge in a multitude of subjects, most of which are covered to some degree in course offerings during law school. However, no student can take every law school course and the bar examination usually covers areas of the law in which the applicant has not received any formal education or training. Most applicants sitting for the bar exam, prepare by taking a bar preparation course either in person, by video or video conference that covers some of the areas not covered during the formal legal education. Despite all of this education, the practice of law is so complex that it is difficult to fathom a recent graduate having adequate knowledge to practice law at a level that will ensure that clients receive the best representation.

So once the bar exam has been passed, why isn’t there a requirement in Connecticut that a lawyer take continuing education courses? Regardless of the field of practice, there are continuous developments in the law. The legislature and the courts are constantly changing both the substantive law and court procedure. Lawyers can stay abreast of many of these changes by almost constantly reading various publications such as the “Connecticut Law Journal”, “Superior Court Reports” and the “Connecticut Law Tribune”. But that is not enough.

Can a real estate lawyer stay on top of his or her game without attending a continuing legal education course (“CLE”)? Can a transactions lawyer? Can a lawyer practice family law without the benefit of CLE? How can a tax lawyer know all of the recent developments in the tax code without taking courses?

I ask some of these questions rhetorically because I don’t practice in those areas of the law and I actually have little information about the availability or the need for CLE in those fields. I do practice in the area of personal injury, medical malpractice and workers’ compensation law. I need to know the substantive law in these areas. I need to know the rules of procedure in both the state and federal courts in order to properly handle trial and appeals involving different aspects of medicine, science, physics, human factors, economics and vocational issues. I need to know the rules involving operation of different types of vehicles. I need to know the rules implicated in truck accidents; medical accidents, accidents involving defective machines and other products. I need to know about the latest scientific innovations or at the very least where to go to learn this information. I need to know the latest trial techniques to give my clients the very best representation possible.

To accomplish all of these things, I spend countless hours each week reading about the law, science and medicine. I routinely attend CLE classes each year, some of which I teach. I probably spend more than twenty hours a year in CLE courses, often traveling outside of Connecticut. But there is no mandatory CLE in Connecticut. In New York, where I am also licensed, there is mandatory continuing legal education. The requirement for CLE is only an average of 16 hours every two years for a newly admitted lawyer and an average of 12 hours per year for all lawyers other than newly admitted lawyers. The CLE categories are broken down to include “ethics and professionalism, law office management, skills and areas of professional practice. Here at Casper & de Toledo, despite the absence of any Connecticut requirement for CLE, all of our attorneys regularly participate in a wide variety of educational programs.

It is interesting that the CLE law in New York provides in relevant part:
It is of utmost importance to members of the Bar and to the public that attorneys maintain their professional competence by continuing their legal education throughout the period of their active practice of law. This Program establishes the minimum requirements for continuing legal education for attorneys ….

These same policy considerations should apply no less in Connecticut. I cannot imagine practicing law without the benefit of CLE. And for the life of me, I cannot understand why the Judges in Connecticut have not issued a Rule of Practice, making CLE mandatory. Don’t we owe it to the public that lawyers are required to maintain a level of competence?

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedord St.
Stamford, CT 06905

http://www.casperdetoledo.com/

CBIA'S KNEE-JERK REACTION

2007-03-27T09:31:00.000-05:00

CBIA CALLED ON CARPET FOR KNEE-JERK REACTION

In today’s edition of the “Hartford Business Journal” the Connecticut Business and Industry Association was called on the carpet for its knee-jerk reaction before the legislature to Senate Bill 1244, an act requiring disclosure of insurance policy limits.
I blogged about this subject on March 5.

In the “Journal’s” timely piece, it is noted that CBIA’ reaction to the mandatory disclosure bill was not well thought out nor was the testimony of CBIA staff attorney Kevin Hennessy. The reality is that disclosure of policy limits has nothing to do with the amount of money a particular claimant pursues. Nor is it even a target for a lawyer. The information does enable an attorney to make important informed decisions about how to proceed with a case and disclosure of limited coverage will likely mean no lawsuit and an early settlement in appropriate cases. In other cases, the information is necessary to determine whether and to what extent an underinsured motorist case should be brought. Still in other cases, the amount of coverage may determine the number and type of defendants that may be necessary in a particular case.

Notably, the “Journal’s” hypothesis about cynics believing that injured people will go unrepresented if there is timely disclosure of policy limits is nothing more than speculation. We would certainly have at least anecdotal evidence to suggest that cases were being dropped like “hot potatoes” after suit was commenced and defendants were forced to comply with mandatory disclosure of policy limits consistent with the Rules of Practice.

The “Journal” points out that Carl Anderson, President of the Connecticut Trial Lawyers Association is probably right when he asserts that mandatory disclosure of policy limits will probably lead to less litigation and not more. That view is based upon experience in the litigation trenches. It is well considered and not a “knee-jerk” claim. It is based upon a practical analysis. It should make the legislature concerned about the extent to which other “information” fed to it by the CBIA is similarly “knee-jerk” and wanting for an empirical or at least a practical basis.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. 203-325-8600
Fax 203-323-5970
www.casperdetoledo.com

BRAIN INJURY AND IBUPROFEN

2007-03-20T14:14:00.000-05:00

BRAIN INJURY AND IBUPROFEN

As a trial lawyer who devotes substantial times and resources studying both the law and the science involved in traumatic brain injury, I continue to be fascinated by the amount of learning that I do. In part, this educational process is aided by my role as Editor-in-Chief of the Traumatic Brain Injury Litigation Group Newsletter. The TBILG is a group sponsored by the American Association for Justice .

Recently, I have been engaged in a dialogue that recognizes that a traumatic brain injury is not an event but an evolving process. The injured brain responds like other parts of the body that become injured. The body reacts to a brain injury by producing a variety of chemical substances as a defensive and/or healing mechanism. These chemical reactions, in some cases, actually cause further and continuing damage to the brain that might only be detected by very sophisticated neuropsychological testing that demonstrates cognitive deterioration.

Part of the scientific study that is ongoing in this area of medicine involves the use of pharmaceutical agents to try to overcome the adverse effects of brain injury. Understandably, studies that involve humans are limited because with brain injuries, no one wants to become a human guinea pig. However, conclusions can be drawn from animal studies.

Recently I came across a very interesting study published in the journal Experimental Neurology. The article is entitled: “Chronic ibuprofen administration worsens cognitive outcome following traumatic brain injury in rats” by Kevin D. Browne et al. Experimental Neurology 201 (2006) 301-307. Ibuprofen is a widely used non-steroidal anti-inflammatory drug (NSAID) used to control pain and reduce inflammation either from a chronic condition or an acute traumatically induced condition. According to the article, the use of Ibuprofen has had positive results in treating Alzheimer’s disease and preventing cognitive decline. Thus, it seemed logical that the same result might be found by using Ibuprofen on traumatic brain injury victims. The result, however, was not encouraging as chronic use of Ibuprofen was found to worsen cognitive function in rats studied with induced TBI.

Because most traumatic brain injuries in humans also involve an assortment of other injuries many of which involve inflammatory processes involving the musculoskeletal system (broken bones, torn cartilage and tendons, muscle and ligament injuries, etc), it is quite common for physicians to recommend that a patient use a NSAID or the patient self-medicates with a NSAID. Such NSAIDs include: Advil, Advil Liqui-Gels, Advil Migraine, Genpril, Haltran, Junior Strength Advil, Junior Strength Motrin, Menadol, Midol Maximum Strength Cramp Formula, Motrin, Motrin IB, Motrin Migrain Pain, Nuprin and Rufen. If the conclusions of this Ibuprofen study can be extended to humans who suffer traumatic brain injury, then the use of such NSAIDs chronically may be good for the joints but harmful to cognition.

SLEEP MEDICATION WARNINGS

2007-03-15T11:41:00.000-05:00

SLEEP MEDICATION WARNINGS

On March 14, 2007, the Food and Drug Administration issued a special release warning consumers and physicians about safety risks of many prescription sleep medications. The warnings involve potential allergic reactions as well as activities of daily living where adverse events have been reported such as sleep driving, making telephone calls and preparing food with use of a stove, oven and sharp instruments including food processors, blenders and knives. The combination of these types of complex activities may result in serious personal injuries or death from motor vehicle crashes and trauma in the kitchen and elsewhere. The sleep inducing medications include:

Ambien/Ambien CR (Sanofi Aventis)Butisol Sodium (Medpointe Pharm HLC)Carbrital (Parke-Davis)Dalmane (Valeant Pharm)Doral (Questcor Pharms) Halcion (Pharmacia & Upjohn)Lunesta (Sepracor) Placidyl (Abbott)Prosom (Abbott)Restoril (Tyco Healthcare)Rozerem (Takeda)Seconal (Lilly)Sonata (King Pharmaceuticals)

The FDA is working with drug manufacturers to improve warning labels, alert health care providers and warn consumers.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
www.casperdetoledo.com

CBIA - NO COMPASSION

2007-03-07T17:08:00.000-05:00

CBIA – NO COMPASSION

I knew that I would get around to addressing the heartless attitude of the Connecticut Business and Industry Association for last week’s email to its membership criticizing the legislature’s judiciary committee’s vote for Raised Bill No. 1268. The proposed legislation would permit a family member (parent or child) to make a claim for damages in the event of death or permanent injury to a parent in the case of a child claimant or to a child in the case of a parent claimant.

These types of claims are sometimes known as “loss of parental consortium” or "loss of filial consortium.” Consistent with its single minded devotion to opposing any enlightened legislation calculated to make the world a better place, CBIA opposes the recognition of the legitimate scope of damages that can occur to the family unit when injury is wrongfully inflicted. CBIA flails to criticize the legislation complaining that there are no age limits set and sounding an alarm that this is the slippery slope to more causes of action, double recoveries and making claims more expensive to resolve.

Loss of consortium is presently recognized in Connecticut as a valid cause of action by the non-injured spouse in the case of the injured spouse. As a practical matter, good lawyers do not frequently pursue spousal consortium claims in the absence of death or significant injury that substantially interferes with life and life style. Often these claims are withdrawn before the start of trial so as not to distract the jury from the more severe claim.

However, aside from the role that sexual intimacy places in a spousal context, the losses that a child may suffer when a parent is killed or permanently injured; or the loss of a parent when a child is killed or permanently injured, may be as grave if not more compelling than the losses involving only spouses. It is most often devastating for a child to lose a parent or to experience life with a parent with a crippling injury. The lack of parental guidance can lead to catastrophe including a lifetime of insecurity and psychological problems. Children look to their parents for so much.

And what of the loss of a child to death or permanent injury? Should the parent become a lifetime caregiver to a child who suffers a traumatic brain injury be destined to suffer caregiver burnout? Or suppose the parent is a senior citizen who depends upon an adult child to provide care during the twilight of life. Hasn’t that parent suffered an emotional but also economic loss for which there is no recourse under the law presently unless there is resort to public assistance?

While the CBIA is busy ignoring the humanistic approach to life and focusing only upon whether an insurance premium might rise a few dollars, the legislature has it in its power to elevate the value of life and family relationships and to recognize that those relationships provide nurture, counsel, support and economic value. We all have the right to such relationships and if we are deprived through the fault of a drunk driver, medical negligence, a faulty product or a defective building, there should be a remedy.

INSURANCE IS THE KEY TO MOST LAWSUITS

2007-03-05T09:08:00.000-05:00

INSURANCE IS THE KEY TO MOST LAWSUITS

It is a pathetic demonstration of leadership advanced by the Connecticut Business and Industry Association when it appears to testify before legislative committees to prevent progress in the system of civil justice. I have written about the CBIA’s policy previously and how that policy is calculated to retard any progress that might be made toward improving the efficiency of the judicial system when there is a perceived but fictitious belief that its members will somehow be harmed, usually from a financial standpoint.

Last Friday, the CBIA issued its Government Affairs Report and it issued its propaganda about two bills that its members testified against the previous week. Here is what was said about SB-1244 and SB-1268. I only have time to address the former today.

Judiciary bills encourage lawsuits and higher damages Two proposals in the Judiciary Committee would open the door to more lawsuits, higher damages and a judicial playing field tilted in favor of plaintiffs and trial attorneys.
The actual proposed legislation relating to disclosure of insurance has been offered for years as an efficient and effective way to expedite the resolution of bodily injury claims. The CBIA is in fantasyland about how the civil justice system in general and lawyers specifically address the issue of liability insurance coverage. There is an important role insurance plays in virtually every lawsuit and the Connecticut Business and Industry Association is like an ostrich with her head in the sand when it comes to properly addressing improvements in the civil justice system.
The CBIA falsely hypothesizes that by mandating the pre-suit disclosure of insurance policy limits, the injured victims will look for deep pockets and the playing field will be tilted in favor of the victim. This is hyperbole at best and outright falsehood at its worst.
Here are just some of the reasons that CBIA has a warped sense of how the civil justice system works when it comes to pre-suit disclosure of policy limits:
1. Mandatory disclosure of insurance coverage is already required once suit is filed. So by stonewalling disclosure of insurance coverage, in any case perceived to involve significant damages, the CBIA approach would virtually assure a lawsuit would be filed to obtain information that is deemed important when it might be possible to avoid a lawsuit altogether if there is a limited amount of insurance coverage.
2. The CBIA theorizes that the “playing field” will be tipped in favor of the victim by disclosure of this information. In reality, the proposed legislation is calculated to level the playing field. Any victim who desires to move a claim toward resolution must already provide the opposing side (the insurance company) with plenty of information at the pre-suit stage of the claim process. The information includes personal data such as full name, date of birth, residence, social security number, and copies of personal medical records, job information and in many cases, information about family members. In this context, it hardly seems intrusive or unfair to have a potential defendant disclose the applicable insurance information. The greatest irony is that the insurance industry maintains a huge database that contains personal information on vast segments of the population. It is referred to as The Index Bureau. If the government isn’t watching what you do then rest assured, the insurance industry has a file on you if you have ever made any type of insurance claim and any insurance company that is a member of The Index Bureau simply has to request your file and pay a small fee.
3. The CBIA is delusional in believing that disclosure of insurance coverage will assist in the search for deep pockets. First, in most situations, the CBIA’s members are large commercial establishments, big corporations, insurance companies, trucking companies, HMOs and the like. Everyone knows that those outfits have deep pockets. Even small business members of CBIA are likely to have adequate levels of insurance coverage for most accidents. The greatest desire to have disclosure of insurance limits exists for the operators of private passenger motor vehicles where the present law in Connecticut permits operation with limits of insurance coverage that are ridiculously low. Further, lawyers have access to investigators and other services that will give them some idea about the financial stability of a company. That information will create at least a strong suspicion that there will be adequate coverage. But that type of investigation wastes time and money that can better be used to pay bona fide claims. And finally, when I look at a police report and see the information about the offending party, I can make some assumptions about the level of insurance coverage that will be encountered. Certain insurance companies are notorious for writing minimum limits policies, often because the driver is in the “assigned risk pool”. The police report will tell me about the driver’s address, the make, model and year of the vehicle and the driver’s age; that will suggest whether I should expect minimum or perhaps greater insurance coverage. Yet there are many more decisions that will be made depending upon the amount of available coverage including but not limited to the scope of an investigation, experts to hire and whether I should be thinking about other potential remedies. It is interesting that the CBIA makes much ado about this legislation. As a Plaintiff’s trial lawyer handling truck crashes, motor vehicle accidents, pedestrian accidents, injuries caused by defective products, medical malpractice claims – it is my experience that this legislation will benefit my clients the most in those cases that don’t involve CBIA’s members.
4. Finally, most other states permit this type of disclosure.

WHAT DO YOU KNOW ABOUT BUYING AUTOMOBILE INSURANCE IN CONNECTICUT?

2007-02-28T15:38:00.000-05:00

WHAT DO YOU KNOW ABOUT BUYING AUTOMOBILE INSURANCE IN CONNECTICUT?

What did you pay for a movie in 1977? How about a half-gallon of milk or a loaf of bread? What did it cost you to get treated for broken leg? How much money did an elementary school teacher earn?

With the passage of time, the cost of everything has gone up. That includes the cost of repairing a car and paying “fair just and reasonable damages” negligently inflicted in a car crash. But during all of this time, the minimum insurance limits required to drive a car in Connecticut have not risen. The minimum has remained stagnant at $20,000 per person per car accident; $40,000 per car accident and $10,000 for property damage. This means that no one injured person can receive damages exceeding $20,000 and no matter the number of injured people, the aggregate damages cannot exceed $40,000 with a $10,000 limit to repair or replace all of the “other vehicles involved in the crash.” It should be time for a change.

On February 27 the State Legislature’s Insurance and Real Estate Committee passed a bill to raise the minimum insurance limits to $40,000 per person, $50,000 per accident and $20,000 for property damage. If passed by the majority of the House of Representatives and the State Senate and then signed by Governor Rell, it will be progress. Not only will the state government make some progress toward a more equitable system of legal accountability, but a requirement for increased coverage limits should provide some relief to people who now pay for drivers who are underinsured.

Of course, there are always two sides to a story and by increasing the minimum required insurance coverage the legislature may be inadvertently encouraging more people to drive without insurance in violation of Section 14-112 of the Connecticut General Statutes. But in all fairness, there must be realistic minimum responsibilities met in exchange for the privilege of registering a car and operating on the highways and roads of this state.

Meeting the minimum insurance requirements of the state is rarely adequate protection for you, your family members and people you may injure. Our web site, http://www.casperdetoledo.com/ has a broader discussion of considerations to undertake when purchasing automobile insurance in Connecticut.

You should make your feelings known about this and other legislation pending before the state legislature. Contact your State Representative and State Senator.

CBIA and the Chamber of Commerce - Incestuous Manipulation for the Wealthy

2007-02-26T15:29:00.000-05:00

Connecticut Business and Industry Association and the Chamber of Commerce – Incestuous Manipulation for the Wealthy

While it doesn’t keep me up at night, I must admit that the gross manipulation of the political process by the likes of the Connecticut Business and Industry Association (“CBIA”) and the Chambers of Commerce is insidious. Organizationally, the CBIA is the U.S. Chamber of Commerce’s state affiliate. They think that they can misrepresent facts to political agencies and the public without any consequence.

Last week I received the “CBIA News”, a periodic Journal published by the CBIA. This propaganda tools is used for the ostensible purpose of communicating to CBIA members and who knows who else about issues currently relevant in the public domain. The lead article in the February 2007 edition was an article entitled “Improving health care quality”, certainly a noble venture. Ironically, the CBIA has long teamed up with the Connecticut Medical Society and local medical groups like the Fairfield County Medical Society conniving to find ways to make health care professionals less accountable for their wrongdoing. In doing so the CBIA has fostered a system that was guaranteed to worsen the quality of health care often by using scare tactics to forestall meaningful reform.

So now CBIA is looking for political cover to make it look like it’s a good citizen when in reality, the probability is that CBIA and the Chambers of Commerce are now teaming together to find a way to cut employer expenses on the backs of hospitals, physicians who are underpaid and over-papered. The article boasts that CBIA has become part of a coalition called the Connecticut Health Insurance Policy Council. Part of its goal appears to be the implementation of the U.S. Department of Health & Human Services effort to encourage employers to support health care quality and cost reporting to employees. So which employers does the CBIA refer to in this article? Electric Boat; Boehringer Ingelheim. Aetna; General Electric, Pitney Bowes; United Technologies, Xerox and Cigna – fairly representative of Connecticut’s business environment. Certainly what’s good for these employers must be good for the average employer in Ansonia or Bridgeport.

Connecticut Business and Industry Association - Agents of Deception

2007-02-20T10:53:00.000-05:00

Connecticut Business and Industry Association - Agents of Deception

I continue to be totally frustrated with the approach that the Connecticut Business and Industry Association ("CBIA") has taken in responding to legitimate inquiries concerning the information that it is presenting to the legislature on issues relating to people who get hurt. On January 26 (see this Blog) I wrote to the CBIA requesting some very basic information that was calculated to assess the legitimacy of the position that CBIA has been taking in opposition to very basic and sensible reforms of the workers' compensation system. You may know that in 1993, the legislature capitulated to pressure from the CBIA and Chambers of Commerce that complained the workers' compensation costs were too high and it was creating an anti-competitive environment int he state. Well the pendulum has swung. Insurance companies are making oodles of money and not passing the savings on to customers; the large and wealthy self-insured employers are pocketing the excess; and insured workers are suffering the indignity of being unable to make ends meet.

Here are the questions that I posed to the CBIA:

1. The actuarial data that demonstrates the cost to each class of employer should these measures be adopted including measures that would expand scarring and discretionary awards under 31-308(a)
2. Any analysis that justifies or excuses the routine delay in the payment of workers' compensation benefits.
3. The harm that would be occasioned to employers who were required to advise their employees of their potential entitlement to workers' compensation benefits following injury.
4. The harm that would be occasioned to employers which were required to help their injured employees complete the paperwork necessary to file a workers' compensation claim.

When CBIA finally responded to my inquiry, this is what I received:

CBIA
Connecticut Business& Industry Association

February 13, 2007

Mr. Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford Street
Stamford, CT 06905

Dear Mr. Casper:

I am responding to inquiries you made regarding the position of the Connecticut Business and Industry Association, Inc. (CBIA) on Connecticut's workers compensation system.

You have misinterpreted CBIA's position on the state's workers compensation system. CBIA strongly supports maintaining Connecticut's workers compensation reforms and opposes efforts to increase workers compensation costs. CBIA's position is supported by our membership, approved by our Board of Directors and embodied in testimony that we have presented before the General Assembly's Labor and Public Employees Committee.

We are not unmindful of the impact of the workers compensation system on injured employees. That is why we have worked with the commission for years on streamlining the process and getting workers to work sooner.

It is also important to recognize that Connecticut's workers compensation system and its reforms affect both fully‑insured and self‑insured companies in the state.

We understand that you are an active plaintiff's attorney and that your opinion on this subject differs from CBIA's as well as the vast majority of our membership. However, our membership and our Board have clearly communicated to us to urge lawmakers to maintain the workers compensation reforms and to refrain from doing anything that will increase workers compensation costs.

Sincerely,

Eric J. George

My email response to Mr. George follows:

2/16/07

Mr. George: No sooner than I sent my email to you today I received your letter of February 13. Your letter, however, fails to specify the manner in which I have misrepresented CBIA's position concerning "the state's workers' compensation system." Perhaps I would understand better if you would provide some specifics.

Also, your letter fails to address any of the questions that I posed on January 26. Instead, you have merely suggested that it is the policy of CBIA to resist any effort to reform the system no matter the policy involved if the reform would cost employer's anything.

Perhaps what is most disturbing about your response is your emphasis that CBIA's policies affect "both fully-insured and self-insured companies in the state." I'm not certain why that is significant in your mind. Perhaps it is because the fully insured employers are being gouged by insurers and the self-insured companies, which tend to be the larger and wealthier employers, are simply taking advantage of injured workers.

Finally, the fact that I am an active Plaintiff's attorney and my views differ from CBIA's policy, does not change the fact that injured employees are suffering in this state. As an employer and member of CBIA, I would be content to pay more for a fairer system. My position on income taxes is likewise the same. I am prepared to pay more for better schools, better healthcare and a better environment. And I firmly believe that sound public policy ought to be debated upon facts. Your response to my inquiry failed to provide any factual support for CBIA's position. In this regard, you have exposed CBIA's policy makers for the charlatans they are.

AMERICAN MEDICAL ASSOCIATION: MORE CONCERNED WITH POLITICS THAN POLICY

2007-02-06T10:12:00.000-05:00

AMERICAN MEDICAL ASSOCIATION: MORE CONCERNED WITH POLITICS THAN POLICY

The Henry J. Kaiser Family Foundation publishes a daily report on health care issues at www.kaisernetwork.org . On February 1, Kaiser published an article on political issues from capital hill. With the tide having changed in Washington and Congress now led by Democratic majorities, it appears that the American Medical Association will not concentrate its efforts on consumer friendly issues such as expanding health coverage for the uninsured and resisting efforts to reduce Medicare payments to physicians. This does not mean that the American Medical Association will abandon its efforts the harm patients to enrich physicians by limiting the rights of consumers. Rather that effort will not target state legislatures where such limiting efforts have a chance to be enacted despite their obvious harmful effects on injured patients. Perhaps someday the AMA will focus its efforts on all of the harmful conduct of the insurance and HMO industry.

Malpractice Insurers Should Be Hearing Heavy Steps

2007-01-31T14:41:00.000-05:00

Malpractice Insurers Should Be Hearing Heavy Steps

It warms my heart when an insurance regulator finally catches on to the disingenuous schemes of the industry supposedly being regulated. In the case of medical malpractice, we usually find that the medical societies are unwitting co-conspirators with insurers claiming doomsday scenarios if they do not receive special treatment under the law. Physicians should be screaming louder than patients and consumer groups. Not only are the insurers engaging in “legal” larceny but patients are being harmed in the process by virtue of reduced and more costly medical services.
The co-conspirators usually are seeking caps on damages, limits on the fees the attorneys can charge an injured victim and the creation of countless hurdles and mine fields calculated to diminish even meritorious healthcare lawsuits or at minimum, to arbitrarily limit the recovery that can achieved. In some circumstances, the insurers would continue to gouge the medical community. Occasionally, an alert public interest organization or civil servant catches on. News out of Florida is that the malpractice insurers have been exposed by the State Consumer Advocate and the Insurance Commissioner. Having achieved a cap on damages three years ago, the data on claim frequency and severity now shows that payments to injured parties have dropped 43.6 percent and the rates charged to doctors should be cut 40 to 50%.
Naturally, no one in state government in Florida is concerned about the victims of the malpractice whose recoveries have been limited arbitrarily. The scary thing is that insurance companies routinely engage in this form of skullduggery.

Overtime, wages and Wal-Mart

2007-01-29T10:44:00.000-05:00

Maybe there is hope for Wal-Mart after all. The company has reported itself to the U.S. Labor Department for underpaying nearly 87,000 current and former employees a total of $33.5 million. Most likely the company has been getting worried about all of the negative press it has been getting and the grass roots movement to boycot its stores. Many of us will not shop at Wal-Mart until it cleans up its business practices.

Failure to pay overtime unfortunately is a widespread practice among businesses. Federal and state laws require employers to pay overtime compensation to non exempt employees who work over 40 hours per week. Non exempt employees are employees who do not have supervisory duties and generally work at the direction of a superior. Exempt employee are professionals, executives, administrators or outside salespeople.

Employees who feel they are entitled to overtime should investigate their rights and hold their employers accountable. Wal-Mart held itself accountable; maybe other employers who violate the overtime wage laws, will do the same.

THE CONNECTICUT BUSINESS AND INDUSTRY ASSOCIATION DISTORTS THE TRUTH

2007-01-26T16:22:00.000-05:00

THE CONNECTICUT BUSINESS AND INDUSTRY ASSOCIATION DISTORTS THE TRUTH

The Connecticut Business and Industry Association (“CBIA”) is a propaganda spewing mouth piece for the major corporate interests in this state. It does offer some services to all businesses but make no mistake about it; its primary purpose is to serve the economic interests of major corporations. Simply look at its Board of Directors and its insular policy of restricting access to its inner workings to its major players. CBIA in turn exercise major control over local Chambers of Commerce which in turn is fundamentally controlled by the U.S. Chamber of Commerce. The latter organization is a full-time propaganda machine for major industry – the same companies where the CEO makes four hundred times the earning of the average worker.
The CBIA and the Chambers of Commerce have a single minded dedication to preventing any reform that will improve the lives of workers or people who have been injured. In the case of the CBIA, there has been uniform opposition to any reforms that will ensure that injured workers receive fair treatment and adequate compensation for injuries that are life altering in many cases and in other cases, the injuries severely erode the earning capacity of the injured worker. CBIA argues that it will increase the cost to employers as though that should be the litmus test for public policy. We believe that it is more important to examine the global effect that workers’ compensation legislation ca have. CBIA never mentions the economic impact that an injury has on a family but only the minimal cost to employers. Connecticut cannot be a better place to live if the workers’ compensation law results in increases in home foreclosures, more bankruptcies, college educations that become unaffordable, poorer diets, worse health care, greater stress and the physiological consequences of less income.
Each week CBIA send out the “CBIA Government Affairs Report” and each week it is packed with lies and distortion. It uses propaganda urging its members to get involved in the legislative process and makes distorted claims that it does not support with evidence, facts, empirical studies or peer reviewed research. Today, as a member of CBIA (it does offer a competitive health insurance plan) I accepted an invitation to contact its employee involved with workers’ compensation. I posed questions today as I have posed questions in the past. I have never received an informed response from the CBIA. Here is today’s email:

I received the following email alert today as a member of the CBIA:

Labor Committee looking to increase workers’ comp costs
(Jan. 26, 2007) Numerous proposals to erode Connecticut’s workers’ comp reforms, increase system costs or add administrative burdens will be the subject of a public hearing by the Labor Committee on Tuesday, Jan. 30, at 2 p.m. in the state Legislative Office Building.
Some of the bills being considered include:• Eliminating the two-year statute of limitations on the filing of claims for scarring benefits• Increasing penalties on employers for delays in workers’ comp payments• Eliminating the permanency cap on discretionary benefits• Requiring employers to notify employees of potential workers’ comp benefits immediately upon injury• Requiring employers to help employees file claims for workers comp
If enacted, several of these measures — such as the expanded scarring and discretionary benefits bills — will drastically increase business costs.
As a member of CBIA, would you kindly provide to me the following information:
1. The actuarial data that demonstrates the cost to each class of employer should these measures be adopted including measures that would expand scarring and discretionary awards under 31-308(a)
2. Any analysis that justifies or excuses the routine delay in the payment of workers' compensation benefits.
3. The harm that would be occasioned to employers who were required to advise their employees of their potential entitlement to workers' compensation benefits following injury...
4. The harm that would be occasioned to employers which were required to help their injured employees complete the paperwork necessary to file a workers' compensation claim.
Thank you for your anticipated response.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

PROPOGANDA FROM THE AMERICAN MEDICAL ASSOCIATION

2007-01-16T12:17:00.000-05:00

PROPOGANDA FROM WILLIAM G. PLESTED III, M.D. PRESIDENT OF THE AMERICAN MEDICAL ASSOCIATION

The following letter was written by William G. Plested III, M.D. the current President of the American Medical Association. It is part of an ongoing campaign by the medical industry to profiteer at the expense of their [patients and the constitutional rights of all Americans. Contrary to Dr. Plested’s assertion, the MICRA type bill the former majority in Congress attempted to foist on the American public, was never a success. It was impacted by a California Constitutional Amendment that forced medical malpractice insurance companies to roll back premiums. That fact coupled with the MICRA caps has wreaked untold hardship on the victims of malpractice in California who receive inadequate compensation for their injuries. This population includes many senior citizens, women and children as well as people making a modest living.

Here for your own indigestion is what Dr. Plested had to say:

“The new year is upon us and brings excitement and hope for new beginnings in all of our endeavors. It is time to review our gains and losses in 2006, and to set our goals for 2007. So let's begin with an honest and critical look at the year that has just been completed.
Last year, our No. 1 legislative priority was again medical liability reform. For the 10th time in the past 10 years, our MICRA-type bill was passed by the U.S. House of Representatives, only to be stalled in the Senate. As in past years, the bill was prevented from a floor vote by the filibuster or cloture rule.

Even though it appears that we would prevail in a floor vote, such a vote has been prevented by a handful of senators. The cloture rule necessitates a supermajority vote of 60 to bring a bill to the floor for a final vote that can enact the bill with a simple majority vote of 51.
Another major setback was a ruling by the 3rd Circuit Court of Appeals in Lake Charles, La. A five-judge panel struck down the Louisiana cap on damages in a 3-2 decision. Fortunately, the written decision included some gross inaccuracies, such as a statement that there is absolutely no proof that caps are related to the lowering of medical liability premiums.
Statements such as this give us hope that this unfortunate ruling can be overturned on appeal. However, the crystal-clear lesson for us is that even our most dearly won gains are at risk as long as there are trial lawyers and judges, as long as the tort system is the method by which medical liability claims are adjudicated.

On a much more positive note, we saw continued reductions in the medical liability insurance premiums charged to physicians in Texas. This follows their tort reform efforts and the passage of Proposition 12, which amended the Texas constitution to allow for caps. It is reported that the improvement in the medical liability climate in Texas has been so remarkable that their state medical board has been swamped with applications from physicians who want to practice in the Lone Star State. This Texas experience documents the fallacy of the ruling in Louisiana.”

So Dr. Plested continues to harp on the medical industry’s failure to impose punitive measures on the public. Instructively, the effort that defeated the measure was bi-partisan. Further, it is instructive to note that the electoral revolution last November threw the Republican special interest machine out of power so that it is extremely unlikely that the current Congress will barter with our constitutional rights. Sorry Dr. Plested, Texas is not a shining example of how health care in this country should work. People are getting hurt with limited right of redress. It only makes Texas a great state in which a physician can practice malpractice rather than to practice medicine.

Happily, here in Connecticut, malpractice insurance companies have been exposed for their greed, and skyrocketing profits. Independent studies have demonstrated that absence of need for depriving people of their rights and instead, there is movement toward forcing the medical community to police itself and to hold bad doctors and profiteering insurance companies accountable.

All of my conclusions are supported by a recently released Report by Citizens Action, the public interest watchdog. The report may be found at http://www.citizen.org/documents/NPDB%20Report_Final.pdf.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

ATTENTION ALL PREGNANT WOMEN

2007-01-06T10:50:00.000-05:00

ATTENTION ALL PREGNANT WOMEN

The American College of Obstetrics and Gynecologists (“ACOG”) issued a practice bulletin (New Recommendations for Down Syndrome Call for Screening of All Pregnant Women ) on January 2, 2007 recommending that all pregnant women should be offered screening for Down syndrome. Under previous protocols, only women 35 years of age or older were offered genetic counseling and diagnostic testing for Down Syndrome via amniocentesis or chorionic villus sampling (‘CVS”).

The new standard of practice is to offer all pregnant women less invasive screening options to assess their risk for giving birth to a child with Down syndrome, a relatively common disorder characterized by an extra chromosome that can result in congenital heart defects and mental retardation. The screening should occur before the 20th week of pregnancy

The failure to offer this form of screening which would have prevented the birth of a child with significant limitations and the need for a life time of care, may give rise to a potential claim for medical malpractice.

Connecticut law is quite strict and burdensome, requiring that any such claim be initiated within two years of the occurrence or discovery of the occurrence. (MEDICAL MALPRACTICE-STATUTE OF LIMITATIONS; Statutes of Limitations - Law Firm Casper & de Toledo L.L.C. Attorneys Stamford, Connecticut).

Unlike many other jurisdictions, Connecticut does not protect the rights of children who may be the victim of medical malpractice by tolling or placing on hold the statute of limitations during all or some part of the child’s minority. Many potential claims are rejected because a parent is led to believe that he/she can wait some significant period of time following the child’s birth before seeking legal advice. This is not the case in a Connecticut medical malpractice case.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com
email: scasper@cadetlaw.com

THE INSURANCE INDUSTRY - PERPETUATING THE CONSUMERS' CRISIS

2007-01-01T12:53:00.000-05:00

On December 27, 2006, the Chief Economist for the Insurance Institute reported that the property and casualty side of the insurance industry continued its record setting escalation of profits during the first nine months of 2006. The property and casualty part of the insurance industry includes fire, theft, earthquake, flood, automobile, homeowners’, commercial, marine, governmental liability. Net profits after taxes for the nine month period were $44.9 Billion. The entire report can be found at: III - 2006 - First Nine Months Results.

So when your insurance bills continue to increase making it more difficult for you to make ends meet, ask yourselves why it is that a supposedly regulated industry like the insurance industry is permitted to take advantage of the system.
Ask yourselves why insurance company executives make so much money. And ask yourselves why it is so difficult to get an insurance company to treat customers and people with bonafide claims decently.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905

203-325-8600
scasper@cadetlaw.com

WATCH OUT – THE CONNECTICUT MEDICAL SOCIETY IS AIMING TO STEAL YOUR LUNCH

2006-12-20T18:03:00.000-05:00

WATCH OUT – THE CONNECTICUT MEDICAL SOCIETY IS AIMING TO STEAL YOUR LUNCH

I just received a copy of the Connecticut State Medical Society’s (“CSMS”) 2007 Legislative Agenda. It seems the doctors’ lobbying organization is gearing up to try to abscond with your constitutional rights again, despite clear cut evidence that recent reforms enacted by the state legislature have already dramatically increased the profits of the malpractice insurance companies. Obviously the State Medical Society would rather take from patients rather than fight the just battle with the insurance companies. Ironically, one of the major insurance companies in Connecticut is CMIC, a doctor owned and operated malpractice insurer. But seriously, why is it that the doctors haven’t established as a legislative goal the accountability of the insurance industry?

Beyond its desire to overhaul the legal system to give a special interest group protections and privileges that no one else has, the Medical Society wants to press for a special court system to deal with health issues. Naturally, there is no objective evidence that leads to the conclusion that judges and juries are not fully capable of resolving health care disputes. There is no evidence that the decisions of juries have been inappropriate. And this concept of health courts is just a ploy to have the medical industry hijack the justice system. The Center for Justice and Democracy has exposed the following myths of the health court proposal:

Health "Courts" Are a Terrible Option for Patients

Health courts are a political coup for insurance companies and a nightmare for injured patients. Here’s why:
Bias
While proposals vary, in every health “court” scheme, the decision-making authority is put in hands of either the hospital or insurer involved, or “experts” appointed and commissioned by a panel heavily weighted toward health industry representatives.
These proposals take critical decisions away from unbiased judges and juries, despite consistent empirical studies showing juries to be competent, effective, fair decision makers able to handle complex cases, and supported by the public as the best arbiter of disputes.
Burden
Unlike other administrative compensation schemes, such as workers compensation, heath “courts” are not “no-fault” models. Health courts are based on an “avoidability” standard, which is similar to negligence. In other words, patients would still have a high burden to prove, but would have none of the protections the legal system provides. And patients will find it harder to get an attorney.
Benefits slashed
Compensation for injuries under health “courts” will be determined by a “schedule” developed by political appointees (e.g., a certain amount for a lost eye or severed limb) instead of decided on a case-by-case basis by a jury. There is no room for consideration of circumstances.
The compensation schemes will be modeled after a similar program in Sweden, but without adjusting for Sweden’s array of public benefits that offset costs.
Like other administrative schemes, benefits will inevitably be reduced in future years as politicians try to appease insurers and hospitals, which in the case of workers’ comp has left many permanently injured individuals barely able to survive.
http://www.centerjd.org/free/mythbusters-free/MB_HealthCourtsMyth1.htm

Another interesting tidbit found in the Legislative Agenda of the CSMS is a desire to review existing definitions of the word “surgery”. Undoubtedly, there is some turf war going on and some members of the CSMS are concerned over who, what, when or where surgery can be performed. But the Agenda says that the Medical Society is going to review definitions of the word “surgery” from “authoritative sources.” The use of the phrase “authoritative source” is amusing because no defense expert medical witness has ever agreed that there is anything called an “authoritative source”. It’s one of the oldest and most disingenuous tricks of the defense. Under old rules of evidence, an expert’s opinion could be called into question or “impeached” if the expert admitted that a source (peer reviewed periodical, textbook or treatise) was authoritative. So each witness has been coached to never admit that a publication is authoritative. It would not matter if every obstetrician subscribed to or read a particular journal. It would not matter if every surgeon had the same textbook. It would not matter if every medical library had the same treatise. It is never authoritative. So why would the Connecticut State Medical Society state that it is going to review “authoritative sources” concerning the definitions of “surgery”?
Stewart M. Casper
Casper & de Toledo LLCwww.casperdetoledo.com

MORE EVIDENCE THAT THE CONNECTICUT MEDICAL SOCIETY AND THE FAIRFIELD COUNTY MEDICAL SOCIETY CAN'T DO THE JOB

2006-10-18T11:03:00.000-05:00

Physicians throughout Connecticut continue to complain about their medical malpractice premiums being too high and find it easy to blame lawyers and their injured patients who bring claims for wrongdoing by healthcare providers for driving up their premiums. This is the equivalent of telling a critically sick patient to "take two aspirins and call me in the morning." These very bright people should apply their collective intelligence and diagnose the real problem. If they did that, they would find the problem is GREEDY INSURANCE COMPANIES. No surprise.

What is surprising however, is that wealthy doctors are willing to fund the Connecticut State Medical Society and the Fairfield County Medical Society, paying the salaries of staff and huge sums to lobbyists who are always asleep at the switch. Last year, when one insurance company sought a rate increase against the doctors, there wasn't a peep from the medical profession. Instead, the Connecticut Trial Lawyers Association commissioned an actuarial study that demonstrated that the rate increase was unjustified and the Insurance Commissioner, after considering all of the evidence, denied the increase. Effectively, consumers and the doctors were represented by the Trial Lawyers Association.

Now again, CMIC, the physician owned and controlled insurance company, has been exposed for gouging its own members. A recent report from the same actuary that documented last year's data before the Insurance Commissioner has now documented that CMIC has been enjoying excessive profits; a high level of surplus growth; a surplus that is disproportionately high in relation to the premiums charged; and has engaged in a persistent pattern of reporting excessive reserves which would actually tend to reduce the stated level of profit artificially as well as to reduce taxes paid to the governement.

This matter was the subject of the following news article in The [Hartford] Courant today:

http://www.courant.com/news/health/hc-docrates1018.artoct18,0,6749243.story?coll=hc-headlines-health

Medical Insurer Under Fire

Trial Lawyers Ask For State's Help

By DIANE LEVICKCourant Staff Writer

October 18 2006

Trial lawyers are asking regulators to consider seeking a rollback of malpractice rates at Connecticut Medical Insurance Co., saying the premiums for doctors appear excessive in light of the company's profits and surplus.

Carl D. Anderson, president of the Connecticut Trial Lawyers Association, sent a letter Tuesday to Insurance Commissioner Susan F. Cogswell urging a "thorough examination" of Connecticut Medical's malpractice rates.

The Glastonbury-based insurer didn't raise rates for 2006 and isn't planning any across-the-board increase for 2007, though about 5 percent of policyholders could see some increase or decrease based on their risk classification.

ProMutual Group, which insures just over 3,000 doctors and other medical professionals in Connecticut, isn't planning a rate increase here either for 2007.

Anderson noted that the state insurance department last year rejected a rate increase by ProMutual Group. In a statement Tuesday, he said the department should take action again to "ensure that companies, like CMIC and ProMutual, do not continue to gouge doctors with unreasonably high rates - while guaranteeing ever increasing profits for their insurance company."

Debra J. Korta, a spokeswoman for Cogswell, said the department wouldn't comment Tuesday because it hadn't yet reviewed Anderson's letter or an actuary's report commissioned by the trial lawyers' association.

Allan Schwartz, the report's author and president of AIS Risk Consultants Inc. in Freehold, N.J., said that a double-digit rate reduction - maybe 10 percent or more - would be "consistent with the high level of profit [Connecticut Medical is] showing." Schwartz said he can't give an exact number based on the publicly available data from the company.

Connecticut Medical officials could not be reached for comment Tuesday. The company covered about 2,500 physicians in 2004, but an updated number could not be obtained Tuesday.

Trial lawyers have been clamoring for lower medical malpractice premiums in recent years for at least two reasons. The lawyers want to make sure the insurance remains available and affordable to physicians because it's a source of money for malpractice victims and attorneys' fees.

In addition, the lawyers object to caps on pain and suffering damages and don't want high premiums to be used to justify them. So far, Connecticut legislators have not passed such limits on damages, despite heavy lobbying by physicians and insurers.

Now trial lawyers see an opportunity to reduce premiums.

Schwartz's report, which covers 2004 through June 30 of this year, says Connecticut Medical's net income is "highly excessive" in relation to earned premiums. The company shows a "consistent pattern of over-reserving" for claims, and its surplus - the financial cushion - is "disproportionately high" in relation to premiums, the report says.

However, rating agencies look at surplus too, among other measures, and Connecticut Medical has only the fifth highest financial health rating - B++ ("very good") - from A.M. Best Co.

Connecticut Medical's annual report shows net income - bottom-line profit - of $12.5 million for 2005, up from $7.6 million in 2004. The company noted that 2005 results benefited from $3.3 million of realized capital gains on investments, and from funds set aside in previous years, but no longer needed, to pay claims.

"Doctors have the right to expect their premiums will reflect the fact that this particular carrier is doing extremely well," Anderson said.

Attorney General Richard Blumenthal echoed the call for a review of Connecticut Medical's rates after the trial lawyers sent him copies of Anderson's letter and Schwartz's report.

"The levels of profit seem astonishingly high compared with the gloom and doom reports that insurers have given the public about how unprofitable this business is," Blumenthal said. "Medical malpractice no longer seems to be the poor sibling among insurance lines."

Copyright 2006, Hartford Courant

Is your legislator one who has been duped by the insurance industry and the medical profession?

Stewart M. Casper, Esq.
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
203-325-8600

www.casperdetoledo.com

Lieberman's Distortion

2006-10-17T09:14:00.000-05:00

AS PUBLISHED IN "THE ADVOCATE" OF STAMFORD 10/18/06
Letters To The Editor
Wednesday, October 18, 2006
To the editor:

At the U.S. Senate debate (Advocate news story, analysis, Oct. 17), Joe Lieberman made the contrived claim that his experience with bipartisanship was required and gave as examples recently enacted legislation, including port security and efforts concerning Long Island Sound.He failed to highlight his bipartisan lack of judgment on Iraq, Katrina, Social Security, subsidies for oil companies and special lobbyist-induced legislation for the pharmaceutical industry. Nor did he explain why his so-called bipartisan efforts at homeland security took five years after 9/11.

Lieberman also had the mendacity to accuse Ned Lamont of running a negative campaign and then proceeded to be the most negative participant in the debate, launching many unfounded ad hominem attacks.He also squirmed to distance himself from the very same criticism that he used to tarnish Lowell Weicker 18 years ago and claimed that his absenteeism was justified by his 2000 run for vice president and his quixotic effort to secure the presidential nomination in 2004, which yielded an embarrassingly poor showing in early primaries.But his excuses are shallow and fail to measure up to the serious implications of missing votes on Social Security, health care, education, Iraq and homeland security.

As to his belief that he had possessed the mantle of gravitas to secure the presidential nomination, he forgets he was sent to Washington, D.C., to make decisions and cast votes for the citizens of Connecticut and promised he would not miss votes as did his predecessor. He also promised to serve no more than three terms.So Mr. Lieberman, isn't your time up?

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905

www.casperdetoledo.com

TIRED OF INSURANCE COMPANIES GOUGING - IT'S TIME FOR INSURANCE REFORM

2006-10-13T10:56:00.000-05:00

OPEN LETTER TO PRESIDENT GEORGE W. BUSH:
MR. PRESIDENT, WE NEED TO START TALKING ABOUT INSURANCE REFORM
(as published in October 9, 2006, Michigan Lawyers Weekly)

Dear President Bush:

For years you have attacked lawyers and our civil justice system for a so called “lawsuit crisis” which you claim is causing insurance premiums to skyrocket and hurting the economy. Meanwhile, you have failed to hold the insurance industry responsible for fraudulently raising premiums and denying coverage while making windfall profits on the backs of Americans.

Your stalwart support of the insurance industry over Americans is unsupported even by facts and studies from your own administration. For instance, Justice Department statistics show that injury cases filed in U.S. District Courts fell 80% between 1985 and 2003 and Bureau of Justice Statistics show that the number of state personal injury trials has decreased 32% between 1992 and 2001. In Michigan the insurance industry itself reports a 75% decline in payouts to medical malpractice victims, and the numbers of civil lawsuits regarding wrongdoing and injury have been declining drastically for years.

So what is the real problem if not lawsuits and our civil justice system? The real problem is a runaway, unregulated insurance industry. There’s only one solution to that, Mr. President: insurance reform.

The insurance industry is the only industry (outside of major league baseball) that is unregulated. The trillion-dollar insurance industry, which has been making huge profits for years, must be held to the same standards as other businesses; namely fiscal accountability, transparency, and honesty.

Insurance reform would help working families, doctors, small business owners and our economy by lowering insurance premiums, ending insurance company fraud, and curtailing price gouging by the insurance industry.

There are numerous examples of insurance industry gouging, Mr. President. Despite Hurricane Katrina --and in the face of huge and rising premiums for all of us-- the insurance industry racked up $44.8 billion in profits last year for homeowners and auto insurance alone while raising its surplus by more than 7% to nearly $427 billion.

Even your wealthy friend Senator Trent Lott was cheated by the insurance industry after his Mississippi home was destroyed by Hurricane Katrina. Insurance reform could prevent such huge, economically devastating, and widespread fraud, Mr. President.

Mississippi Attorney General James Hood described insurers who defrauded homeowners after Katrina as “the robber barons of our time.” Mississippi was forced to sue the insurance industry because adjusters tried to cheat homeowners out of millions of dollars in claims. But one state, standing alone, is no match for an industry with hundreds of billions of dollars to protect it.

Here in Michigan, the insurance industry used its muscle to evade and finally destroy a law that merely required the number of medical malpractice insurance cases be reported so that lawmakers might have some idea if these lawsuits were really increasing as the insurance industry claimed (suits were rapidly declining instead).

In Oklahoma, tornado victims were cheated when State Farm acted “recklessly” and with “malice” in denying insurance claims on their family homes. The FBI raided Hospital Corporation of America offices after massive systematic Medicare insurance fraud and HCA pled guilty to 14 criminal counts and agreed to pay $1.7 million to settle the case. California earthquake victims were routinely defrauded by State Farm, and State Farm officials lied in court about it. Prudential agreed to pay a $35 million fine and set aside money to settle policyholder suits after an investigation found the company had defrauded more than 10 million life insurance customers.

In New York, Attorney General Eliot Spitzer uncovered ubiquitous wrongdoing in the insurance industry, testifying that “a small group of brokers and insurance companies essentially control the market, having created a network of interlocking connections and secret payments which ensure that the bulk of business goes to certain insurers and that profits remain high. The bottom line is the consumer pays more for coverage.”

Mr. President, we can all work together to stop this. Insurance reform worked in California. After pro-insurance “caps” on the rights of victims hobbled the legal system, insurance premiums for doctors still increased by an astounding 190%. When insurance reform was enacted, removing the insurance companies’ anti-trust exemptions, doctor’s insurance premiums finally leveled off.

In Missouri lawmakers voted overwhelmingly to give the state insurance director more authority to veto doctor’s insurance premiums that are “excessive” or otherwise inappropriate.

Insurance reform –such as legislation to remove the antitrust exemption for the insurance industry and to create accountability over hundreds of billions of dollars of our premiums dollars-- would go a long way toward helping to lower rates for everyone, and reign in insurance company fraud and price gouging.

Instead of bashing our civil court system and undermining our Constitution Mr. President, you need to stand up to the insurance industry and enact insurance reform.

Yours truly,
Jesse M. Reiter
President, Michigan Trial Lawyers Association

VOTING AND RELIGION

2006-10-08T15:53:00.000-05:00

From the "Hartford Courant" October 8, 2006

"There should be no ambivalence voting for Lamont"

As a Jew, it is disappointing that many of my fellow Jews consider religion or a perceived but unfounded bias in favor of Israel, as a dispositive factor in casting their vote for U.S. Senator. I would hope that the priorities of Connecticut citizens and the best interests of the country would be paramount. After all, blind allegiance to faith and ethnicity seems to have caused most of the world's conflicts.

On Aug. 28, 1963, Martin Luther King, Jr. gave his "I Have A Dream" speech at the Lincoln Memorial in Washington, D.C. To this day, it remains an iconic speech. One of many memorable passages intones: "I have a dream that my four children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character." To be sure, Dr. King was pleading the case of racial equality. Yet there should be little doubt that if alive today he would similarly plead the same case of judging a person by the content of his character, his deeds and his beliefs rather than the color of his skin, his religion or his national origin.

Are we not measured by our deeds and beliefs? And if that is so, isn't it necessary to examine the morality of our political acts when we choose to vote for a candidate because of his ethnicity or his religion rather than the content of his deeds and a pattern of poor judgment?

Those who would support Mr. Lieberman simply because he is Jewish are acting in a way that is antithetical to the core beliefs of this country. Such a vote ignores the wisdom and courage that Ned Lamont has demonstrated leading us in a new direction rather than "staying the course." To those of us who know Ned, we are confident that his voice will resonate with judgment, reason and fairness without any threat to the welfare of Israel.

Stewart M. Casper, Wilton

MEDICAL RECORD ACCESS IN CONNECTICUT

2006-10-06T08:45:00.000-05:00

This post consists of a reproduction of a memorandum from Connecticut's Office of Legislative Research summarizing Connecticut law on access to medical records. This information is quite useful:

Patient Access to Medical Records
John Kasprak, Senior Attorney

This report identifies and explains state law on patient access to medical records in a question and answer format. Throughout the report, the terms “medical records” and “health records” are used interchangeably reflecting their usage in statute. In some cases, the term “hospital records” is also used.

PATIENT ACCESS TO MEDICAL RECORDS FROM INDIVIDUAL HEALTH CARE PROVIDERS

Do Patients Have Access to Their Medical Records?
Yes. The law requires a health care provider, except in limited circumstances, to supply a patient, upon request, complete and current information the provider has about the patient's diagnosis, treatment, and prognosis. The provider must also notify a patient of any test results in his possession or requested by the provider for purposes of diagnosis, treatment, or prognosis. (CGS § 20-7c(b)).
A patient may obtain copies of his or her medical records by asking the provider in writing. The patient's attorney or authorized representative can also make such a request from a health care provider. Such records include bills, x-rays, copies of lab report results, prescriptions, contact lens specifications under certain conditions, and other technical information used to assess the patient's health condition. (CGS § 20-7c(c)).
The provider must supply the health record within 30 days of the request. (CGS § 20-7c(c)).
When Can a Provider Withhold This Information?
By law, a provider can withhold medical information from a patient if he reasonably determines that the information would be detrimental to the patient's physical or mental health or would likely cause the patient to harm himself or someone else. In such a case, the provider can supply the information to an appropriate third party or another provider who can release it to the patient. (CGS § 20-7c(d)).

Is There a Cost to Obtain Medical Records?
A provider can charge up to 45 cents per page, including any research fees, handling fees or related costs, and the cost of first class postage, if applicable, to furnish the patient's health record. Also, the provider can charge a patient the amount necessary to cover the costs of materials for providing a copy of an x-ray. (CGS § 20-7c(c)).
A provider cannot charge for supplying a health record if the person documents that it is necessary to support a Social Security claim or appeal. (CGS § 20-7c(c)).
What about Information Concerning Psychiatric or Psychological Conditions?
The law specifically says that its provisions for patients' access to their records (cited above, CGS § 20-7c(a)-(d)) do not apply to “any information relative to any psychiatric or psychological problems or conditions. ” (CGS § 20-7c(e)).

Which Providers Are Covered By These Provisions?
The law applies to people licensed or certified to furnish the following health care services: medicine and surgery, chiropractic, naturopathy, podiatry, athletic training, physical therapy, occupational therapy, substance abuse counseling, radiography, midwifery, nursing, dentistry, dental hygiene, optometry, optics, respiratory care, pharmacy, psychology, marital and family therapy, clinical social work, professional counseling, veterinary medicine, massage therapy, electrology, hearing instruments, and speech pathology and audiology. (CGS § 20-7b(b); § 20-7c(a)).
Can a Patient's Medical Records Be Released to Another Provider?

If the patient asks in writing, a provider must furnish a copy of the patient's health record to another provider. This includes x-rays and copies of lab reports, prescriptions, and other technical information used in assessing the patient's condition. The written request must specify the name of the provider who is to receive the record. The patient is responsible for the reasonable costs of providing the information. (CGS § 20-7d).

PATIENT ACCESS TO RECORDS FROM HOSPITALS AND OTHER HEALTH CARE INSTITUTIONS

Can a Person Access His Hospital Records?
Yes. By law, a health care institution (which includes a hospital and other health care facilities, see CGS § 19a-490), must provide a copy of a patient's health record upon the written request of the patient, his attorney, or authorized representative. The health record includes copies of bills, lab reports, prescriptions, and other technical information used in assessing the patient's condition. (CGS § 19a-490b(a)).
The institution must also give the patient or his designated provider a reasonable opportunity to examine retained tissue slides and retained pathology tissue blocks. When the patient, his attorney or his designated health care provider asks in writing, a health care institution must send the original retained tissue or slide or original retained tissue block directly to the institution, lab or physician the patient designates. (CGS § 19a-490b(a)).
Another statute requires each private or public hospital receiving state aid to allow a patient it treats and discharges, or his physician or attorney, to examine his hospital record, at the patient's request. The record includes the history, bedside notes, charts, pictures, and plates kept concerning the treatment. The patient, or his physician or attorney must be allowed to make copies of such information. (CGS § 4-104).

Can the Health Care Institution Charge for These Records?
An institution can charge up to 65 cents per page, including any research, clerical, and handling fees or related costs, and first class postage, if applicable. The institution can also charge the amount
necessary to cover the costs of materials for providing a copy of an x-ray or for furnishing an original retained slide, an original tissue block, or a new section cut from a retained pathology tissue block. (CGS § 19a-490b(a)).
The institution cannot charge if the health record is necessary for a documented Social Security claim or appeal. An institution must provide the requested health record within 30 days of the request, unless the patient's request was received less than 30 days from his discharge. In that case, the institution must provide the record when it is completed. (CGS § 19a-490b(b)).
An institution cannot deny a records request because of a person's inability to pay the required fees. The person must have an affidavit attesting to his inability to pay. (CGS § 19a-490b(d)).

RETENTION OF MEDICAL RECORDS—INDIVIDUAL HEALTH CARE PROVIDERS
How Long Must a Health Care Provider Keep a Patient's Medical Records?
Generally, a provider must retain a patient's medical records for seven years after the last treatment date, or three years from the patient's death. (Department of Public Health (DPH) Regs. § 19a-14-42).
Pathology slides, EEGs, and ECG tracings must also be retained for seven years, but as subsequent ECGs are taken, previous ones may be discarded if the results are unchanged. (DPH Regs. § 19a-14-42(a)).
Lab reports and PKU reports must be kept for five years and X-ray film for three years. (DPH Regs. , § 19a-14-42(b), (c)).

What Happens When a Health Care Provider Dies or Retires?
A provider who terminates a practice (or his executor or responsible relative in the case of death) must inform patients by notice published in a local newspaper and a letter sent to each patient seen within the past three years before the date the practice was discontinued. The patients' medical records must be kept for 60 days after the notice. (DPH Regs. § 19a-14-44).

What if a Patient Changes Providers?
If a patient changes providers and asks the former provider to transfer the records to the new primary care provider, the first provider need no longer retain the records. (DPH Regs. § 19a-14-43).

RETENTION OF RECORDS—HOSPITALS

How Long Must a Hospital Retain a Patient's Records?
Medical records must be filed in an accessible manner in THE HOSPITAL AND KEPT A MINIMUM OF 25 YEARS AFTER THE PATIENT'S DISCHARGE. ORIGINAL RECORDS CAN BE DESTROYED SOONER IF THEY ARE MICROFILMED BY A PROCESS APPROVED BY DPH. (DPH REGS. § 19-13-D3(D)(6)).

What Happens to the Records if a Health Care Institution Closes?
When a health care institution that ceases operations gives up its license to DPH, it must provide the department with a certified document specifying where its patient health records will be stored and the procedure for patients, former patients or their authorized representatives to access the records. (PA 05-272; CGS § 19a-490b(e)).

ELECTRONIC MEDICAL RECORDS
Must Health Care Providers and Institutions Keep Medical Records in an Electronic Format?
The law allows licensed health care institutions to create, maintain or use medical records or medical record systems in electronic format, paper, or both if the system can store medical records and patient health care information in a reproducible and secure manner. (PA 05-168; CGS § 19a-25c).
State law also allows health care providers with prescriptive authority to use electronic prescribing systems. (PA 05-168; CGS § 19a-25b).

Hope this information is helpful.

Stewart M. Casper, Esq.
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
203-325-8600
www.casperdetoledo.com

NED LAMONT - A LAWYER'S PLEA

2006-10-05T17:14:00.000-05:00

You are being contacted on this occasion by me because you are currently represented by this firm, you have been represented in the past by this firm or you have consulted with us concerning some legal matter. In any case, Casper & de Toledo LLC and its lawyers, myself included, are grateful for the faith that you have placed in us. I hope that we have served you well.

For many years I have been critical of the performance of Connecticut's junior U.S. Senator Joseph Lieberman. My reasons have been many. In the early years, I became critical of Mr. Lieberman when he was a state legislator who cultivated the interests of insurance companies and big businesses at the expense of the interests of people. When he was attorney general of Connecticut, he resisted joining many other attorneys general around the country suing property and casualty insurance companies for engaging in illegal price fixing. His conduct was in no small measure prompted by the large campaign contributions that he received from the insurance industry.

In 1993, the Connecticut legislature voted overwhelmingly to repeal a failed automobile no-fault statute that cost consumers dearly and enriched insurance companies. Two years later, Lieberman was ignoring the elected legislative leaders of Connecticut and he was co-sponsoring federal no-fault insurance with right winger Mitch McConnell of Kentucky.

Lieberman has voted to deny asbestos victims their due in court. He has sought to restrict claims for victims of defective products. He has sought to restrict class action lawsuits. And he has often sides with insurance companies and HMOs to limit the right of victims of medical malpractice to make a fair recovery fro their injuries.

On top of all of those "law" related reasons that I felt Lieberman was not adequately representing the citizens of Connecticut we can add his stay the course defense of President Bush in Iraq; his advocacy for weakening the War on Terror by effectively running from the battle in Afghanistan; his support for federal intervention in the Terri Schiavo case; his effort to weaken public schools by supporting school vouchers; his support for right wing Judges including Justice Alito; his support of the Bush energy plan that has enriched Exxon-Mobil and other oil companies while the price of gasoline has skyrocketed; his effort to reward his pharmaceutical contributors by sponsoring legislation to extend the patent life on drugs while his wife worked as a pharmaceutical lobbyist. And I could go on.

When I heard about Ned Lamont and his effort to unseat Joe Lieberman, I was intrigued. I asked for a meeting and Mr. Lamont came to meet me at my office. I asked him all sorts of questions and he gave me candid answers. I came away convinced that not only was Ned an bright and honorable man, but also he was fully capable of representing the people of Connecticut in the U.S. Senate. And more. He would, if elected, go to Washington and represent our interests rather than those of the insurance industry, pharmaceutical companies, Halliburton, the HMOs. I found that Ned Lamont cares about the issues that are not only important to me but which are also important to most of my clients.

So having said all of that, I am now urging you to support Ned Lamont for U.S. Senate (assuming you're a registered voter in Connecticut). If you can support him with a campaign contribution that's great. But more importantly, please support him with your vote and tell your friends. Tell them he's no crazy liberal but rather a conscientious citizen who recognizes the folly of Iraq; that Iraq has made us all less safe. That Joe Lieberman and George Bush and Dick Chaney have advanced policies that are militarily inept; fiscally unsound and morally bankrupt.

Thanks for reading.

Stewart M. Casper, Esq.
Casper & de Toledo LLC

DIANE FARRELL - LEADING IN A NEW DIRECTION

2006-07-02T06:02:00.000-05:00

The following letter was written To The editor of the "Wilton (CT) Villager" and published on June 30, 2006. I wrote the letter in response to another reader's letter. That letter writer's viewd Congressman Christopher Shays as a "statesman." That really bothered me as I view Shay's as an opportunistic politician who helps form the exremist Republican majority. He may be a moderate compared to the extremists who dominate his party and its leadership, but it is more important to wrest control of the Republican majority than it is to have a voice whispering in the back of the Rebublican caucus.

June 30, 2006

IT’S TIME FOR A NEW DIRECTION

<> Last week a letter writer (Nation political dialogue little more than soundbite[sic]” 6/23/06) began his letter with a definition of a “statesman” and compared it to a politician and as I read it I anticipated some intelligent dialogue calculated to energize the forgotten bipartisan spirit of this country. Instead, I discovered more inaccurate political propaganda concerning the upcoming Congressional election between Christopher Shays and Christine Farrell. The writer failed to disclose his party affiliation so the reader was unable to discern his objectivity but I strongly suspect that the writer wasn’t the most objective observer. I am a Democrat. I may not be objective either. But I thin I am more realistic than your previous writier. <>

In my lifetime I have been exposed to statesman from this country and from others. Chris Shays is not a statesman. Further it is difficult to know how Mr. Shays thinks. He has shown some streaky moderation as compared to the extreme right wing leaders and the vast majority of the Republican Party in Congress. But Barry Goldwater would have looked moderate compared to the Republicans who actually control Congress. And more often than not, Mr. Shays has stood by President Bush and in sync with the Republican majority. <>

The writer criticizes Diane Farrell for her views and her experience. The writer doesn’t share with us whether he has heard Ms. Farrell actually speak about the issues. I had the pleasure of hearing her last week and her comments about Mr. Shays included phrases like: “I like Chris, he’s a good guy.” “I won’t attack him personally.” “We just differ on the priorities for and the direction of this country.” In the meantime, Ms. Farrell was intelligent, articulate and well prepared for the most complicated issues of our time. Moreover, it seemed that she was well in tune with the mood of this congressional district. <>

One of the greatest aspects of politics in New England for as long as I can remember is that it lacked the bitter partisanship that exists throughout much of our country. That has permitted us to experience crossover voting to elect the candidate that will best serve the region’s interests. I grew up in Massachusetts where the governor was frequently Republican while the legislature was always controlled by Democrats. Massachusetts sent a Republican senator to Washington. We’ve seen a similar history in Connecticut, <>

But Washington is just a scary place where the extremists control all three branches of government now without the proper checks and balances that our forefather anticipated and the majority party is poised to perpetuate the wasteful spending, the brutality and indifference of both national and international policy, the irreparable harm done to our environment every day and a philosophy that permits the intrusion into our personal lives. While New England Republicans have generally been fiscally conservative and socially progressive, our national policy under the Bush administration has been fiscally irresponsible, environmentally devastating, internationally the U.S. has become a world pariah, and many of our liberties have been compromised. <>

The writer supports Chris Shays but Mr. Shays’ voice is a whisper in the Republican party. He has abandoned his base of progressive New England Republicans. He has played along with and supported the likes of Newt Gingrich, Tom Delay, Dennis Hastert and John Boehneur and most importantly, he adds a vote to keep the extreme philosophy in control of a Congress that has accomplished nothing. Isn’t it scary that the first vote that Mr. Shays will caste if re-elected will be to re-elect this same leadership that will keep the country moving in the same direction. <>

In 1994 when Mr. Shays endorsed Newt Gingrich and the “Contract with America.” Chris and his cronies endorsed term limits and he has broken that promise. He endorsed fiscal responsibility and he has broken that promise. He endorsed a fix to the social security system and not only did they break that promise but they hoodwinked the American public and the seniors in particular with the prescription drug program that has delivered more profits to the pharmaceutical industry than it has helped senior citizens. <>

Mr. Shays can only be considered a failed statesman or politician in his role a Chairman of the House Subcommittee on Homeland Security. He has been silent on the quagmire of the War in Iraq. A war that was unnecessary because there was not only no evidence of WMD but it turns out that the reasons for war given by the Republican administration were lies and Saddam Hussein and Iraq were under control of the “no fly zone.” Contrary to the stated goal, there will never be an American–like system of democracy in Iraq because of the ethnic and religious divisions that have always existed there. Instead of chasing Saddam, the leadership of this country, including Chris Shays failed to chase Osama bin Laden into Pakistan that is rapidly turning into another failed diplomatic objective. And while Chairman of the Homeland Security Subcommittee, Chris Shays failed to take steps to prepare this country for Katrina and other tropical storms, has failed to properly reorganize FEMA and stood by while the New York metropolitan area was stripped of much needed Homeland Security federal funding. <>

For those policy areas were Chris Shays does deserve credit for his support, like a woman’s right to choose, the environment and campaign finance reform, Diane Farrell will be as good if not stronger advocate, in part, because she won’t need to temper her enthusiastic support because of the extremists in her party. But perhaps most importantly, Diane Farrell will not be casting her initial votes for the leadership of a Congressional leadership tainted by bribery scandals and that has accomplished little if anything but further polarizing this country. It is time for a change of direction. It is time for Chris Shays to move on to something else and to give Diane Farrell an opportunity with her new ideas and fresh approach.

IT'S NOT JUST ABOUT THE WAR - Lamont vs. Lieberman

2006-06-15T12:03:00.000-05:00

Some politicians and some pundits believe that Ned Lamont is a one issue candidate and that the refrain “peace now” is his only slogan and is his main complaint with Joe Lieberman. They are wrong. Ned Lamont is concerned, like many of us, that Joe Lieberman has cultivated a reputation, not as a Democrat but as a Rebulicrat. He has so frequently sided with the interests of big business, the insurance industry and the Republican Party that his claim to be a Democrat often has seemed farcical. His strident support for the Bush war in Iraq is but one example.

To his credit, Senator Lieberman has supported consumer interests in some instances by refusing to support caps in medical malpractice cases. But his anti-consumer history is long. He supplied a critical vote as a Connecticut State Senator that resulted in the adoption of the old failed no-fault auto insurance system. As Attorney General he was a reluctant participant in the anti-trust action brought by his fellow attorneys general against the property and casualty insurance industry. In the United States Senate he has supported legislation that limits victims’ rights regarding: asbestos, product liability, class actions and securities laws. He also co-sponsored legislation with Mitch McConnell (R-KY) to adopt national no-fault legislation just a year or two after his own state of Connecticut voted to abolish no-fault.

The candidacy of Ned Lamont now affords us a chance at a new beginning. A chance to elect a true progressive to the United States Senate. A man with courage and the convictions compatible with the people of this great state. I should emphasize that my endorsement has nothing to do with any organization of which I am a member.

On Monday June 12 I had the privilege of spending an hour with Mr. Lamont in my office. I knew that he opposed the war in Iraq. He opposes repeal of the federal estate tax, tax cuts for the wealthy and a federal deficit out of control. He favors universal healthcare, affirmative action, keeping the government out of personal decisions like marriage and a woman’s right to control her own body. He opposes the blurring of the line between church and state. He supports public schools and universal pre-school and opposes school vouchers. He will also support sound environmental policy rather than give aways for the oil industry. And contrary to the unfortunate suggestion by the Lieberman campaign, the fact that Lamont is wealthy should hardly seem an impediment to his leadership. I can think of several wealthy current and former Senators who have served the progressive cause ably. Names such as Kennedy, Metzenbaum, Kohl and Corzine come to mind just to mention a few.

What I didn’t know about Ned Lamont was where he stood on the civil justice system. But now I do. He unequivocally opposes caps on damages in malpractice cases or any case. He readily acknowledged how caps on non-economic damages would discriminate against women, children and seniors. He believes that the jury system is the best system of justice available. He personally analyzed the financial claims of the relative cost of the malpractice system and expressed an opinion that the cost of the malpractice system seemed to be a rather minor piece of the healthcare pie. He was aghast at stories of how patients are victimized and appreciated that physicians are also victimized by the malpractice insurers. He also expressed that he was opposed to the two most recent Supreme Court nominees.

I am entirely comfortable believing that Ned Lamont will never choose the corporate interest over the interests of consumers unless there is hard evidence to warrant it. Today I am standing up for Ned Lamont with this communication and with my checkbook.

If you wish to join me in supporting Ned, please make your contribution by going to his web site: https://secure.nedlamont.com/

Or by using his printable contribution form and mailing your contribution. https://secure.nedlamont.com/page/file/20143f2a27f7df344f_ms4dmvbqd.pdf/lamontdonationform.pdf

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

Shopping at Wal-Mart- The Savings Are Not Worth the Price

2006-06-06T14:10:00.000-05:00

Many of you have felt injustice in the workplace. That is why I am writing to you regarding a huge workplace injustice which is occurring across our country and which you can help stop. Wal-Mart, the world’s largest retailer, is abusing its employees. It pays employees such low wages and provides such inadequate health insurance that many employees have to collect public assistance and use Medicaid while they are working. In fact, the store encourages employees to apply for public assistance while they work for Wal-Mart. Cost cutting methods by the mega retailer also include intentionally deleting records of employees’ overtime hours and charging employees with meal breaks they do not take. The retail “titan,” as one judge described Wal-Mart, also tries to save money by paying much lower wages to female managers than male managers and intentionally discouraging anyone with a health condition from applying for a job.

If you shop at Wal-Mart, you may reconsider where you shop after reading the attached article by one of our partners. If you still want to shop there, you may consider one of the other suggestions for action listed at the end of the article.

Victoria de Toledo, Esq.
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905

Tel. 203-325-8600
email: vdetoledo@cadetlaw.com
www.casperdetoledo.com

Shopping at Wal-Mart- The Savings Are Not Worth the Price
By Nina Pirrotti

Do you think of yourself as a smart consumer? Fight back against big retail stores like Wal-Mart that charge low prices but mistreat their employees. You may save at the cash register but you will invariably lose at tax time. Wal-Mart’s brutal cost-cutting practices force many of its employees onto public assistance. In the end, these practices not only harm Wal-Mart’s 1.8 million employees, but all of us taxpayers who must subsidize those Wal-Mart employees who, despite working full-time jobs, hover at the poverty line.

Wal-Mart, the world’s largest retailer, provides a model study guide for a lesson in virtually all forms of unlawful employer conduct. From sub-standard employee wages and health care, to gender, race, and age discrimination, to violations of the Americans with Disabilities Act and Family Medical Leave Act, to child labor violations, Wal-Mart is an offender in every area.

Low Wages at Wal-Mart

Despite nearly $9 billion in profits last year, Wal-Mart’s wages are so low that many of its employees are eligible for food stamps. In fact, in California alone, Wal-Mart workers turn to the state for about $86 million a year in health-related services and assistance such as subsidized school lunches, food stamps and subsidized housing[1]. This heavy reliance on public assistance is not surprising given that workers at California’s Wal-Mart and sister Sam Club’s stores earn 31 percent less than workers in large retail stores as a whole[2].

Not only are Wal-Mart’s wages pitifully low, there are currently more than 40 lawsuits against Wal-Mart in this country which claim that the company short-changes its hourly employees by deleting hours from time sheets or forcing workers to work unpaid overtime hours. One such lawsuit even charges that not only did Wal-Mart delete its employees’ overtime hours, but it falsified time records to make it appear that they were taking meal breaks when they were actually working[3].

Inadequate Health Care Coverage at Wal-Mart

Another area in which taxpayers are inadvertently subsidizing Wal-Mart’s mistreatment of its employees is health care. In a 2005 internal memo obtained by Wal-Mart watch, a nonprofit group, Wal-Mart’s own executive vice president, M. Susan Chambers, acknowledged that 46 percent of the children of Wal-Mart’s employees in the United States were uninsured or on Medicaid. Ms. Chambers acknowledged that: “. . . our critics are correct in some of their observations. Specifically, our coverage is too expensive for low-income families and Wal-Mart has a significant percentage of associates and their children on public assistance.”

In fact, instead of providing affordable health care for its employees, Wal-Mart actually encourages them to seek out public health assistance. A former Wal-Mart manager who had been with the company for ten years stated that managers kept “a list of the state agencies so that we could have some place to send these associates…for Medicaid, for well-baby care, for whatever it is that they need.[4]” In 2003, Las Vegas Wal-Mart managers even gave workers special forms to help them in applying for public assistance by certifying their poverty status [5]. To put the cost to the taxpayer in even more concrete terms, every Wal-Mart store that employs 200 people costs the taxpayer $420,750 in public assistance[6].

Inadequate Women’s Health Care Coverage at Wal-Mart

Wal-Mart’s record on providing adequate health care coverage for its female employees is particularly abysmal. For example, women are covered for only one routine ultrasound per pregnancy.

Ironically, given the poor pregnancy benefits, Wal-Mart’s medical plan is particularly harsh on women who practice birth control. The Wal-Mart Associate’s Medical plan specifically excludes coverage for contraceptive drugs, implants and devices. A class action suit has been brought against Wal-Mart by female employees who are seeking insurance coverage for contraception.

Gender Discrimination at Wal-Mart

Wal-Mart’s record is no better on critical issues of women’s work and worth. In fact, Wal-Mart has been hit with the world’s largest pay discrimination lawsuit ever- a federal class action law suit brought on behalf of 1.6 million former and current female employees. The class action included the following charges:

· Women comprise 72 percent of Wal-Mart’s total workforce, but only 33 percent of its managers.
· Women comprise 92 percent of Wal-Mart’s cashiers, but only 14 percent of Wal-Mart Store Managers
· Female managers earn nearly $5,000 less than male managers in yearly salary.
In his ruling granting the plaintiffs class action status against Wal-Mart, the federal judge stated that the plaintiffs presented virtually uncontested statistics “which show that women working at Wal-Mart stores are paid less than men in every region . . . that women take longer to enter management positions, and that the higher one looks in the organization, the lower the percentage of women[7]”.

Race Discrimination at Wal-Mart

Not surprisingly, Wal-Mart’s record with respect to its African American employees is also poor. The following are some of the lawsuits pending against Wal-Mart for race discrimination:

· In September 2004, a federal lawsuit was filed against Wal-Mart alleging that the company regularly rejects and discourages black applicants for truck driving positions at the chains’ distribution sites in 12 Southern States. According to the EEOC, only one in 20 truck drivers hired by Wal-Mart were African American.

· In July 2005, two African American truck drivers filed a federal lawsuit against Wal-Mart, alleging race discrimination and seeking class action status.

Child Labor Violations at Wal-Mart

In June, 2005, three Wal-Mart stores in the state of Connecticut -- Hartford, Norwalk and Putnam -- were fined for child labor violations, including lack of required working papers and operating dangerous equipment. According to a report issued by the Connecticut Department of Labor, 337 minors worked in Connecticut’s 32 Wal-Mart stores between 2003 and 2005. As a result, Wal-Mart stores were assessed fines in the amount of $3,300, the maximum amount allowed by law.

Family Medical Leave Act Violations at Wal-Mart

According Wal-Mart Watch, a non-profit group dedicated to pressing the company to improve its employee wages and benefits, Wal-Mart is well known for failing to comply with the federal Family Medical Leave Act, which requires employers to permit employees to take up to 12 weeks of unpaid leave to care for themselves or a loved one without losing their jobs. In one case in 2005, Wal-Mart was fined $188,000 for refusing to reinstate a six-year veteran employee upon completion of her maternity leave.

Discrimination against Senior and Sick Employees at Wal-Mart

Not only does Wal-Mart fail to reward the loyalty of its senior employees, it appears eager to discourage these employees from staying with Wal-Mart. In an internal memo sent to Wal-Mart’s Board of Directors by Executive Vice-President M. Susan Chambers and obtained by Wal-Mart Watch, Ms. Chambers proposed ways to cut spending on health care and other employee benefits. Although Ms. Chambers fell short of proposing pushing out its more senior workers, she brooded in the memo that Wal-Mart workers with seven years seniority earn almost 55 percent more than workers with one year’s seniority but are no more productive.

Ms. Chambers then suggested that Wal-Mart discourage unhealthy job applicants by arranging for “all jobs to include some physical activity (e.g. all cashiers do some cart-gathering)” in order to weed out the less physically fit. The memo stated that “these moves would dissuade unhealthy people from coming to work at Wal-Mart.”

While the memo Ms. Chambers wrote was intended for internal review among Wal-Mart’s Board of Directors only, Wal-Mart’s own CEO, H. Lee Scott Jr., has not been shy about Wal-Mart’s goal in keeping employee benefits to a minimum. When a manager inquired about retiree health benefits on a Wal-Mart website supposedly designed to encourage store managers to share their concerns with the CEO, Mr. Scott had this response: “Quite honestly, this environment isn’t for everyone. There are people who would say: “I’m sorry but you should take the risk and take billions of dollars out of earnings and put this in retiree health benefits . . . If you feel that way, then you as a manager should look for a company where you can do those kinds of things[8].”

Current Law Makes it Difficult to Punish Wal-Mart

Unfortunately, it is almost impossible to meaningfully punish Wal-Mart for its violations of Title VII (which prohibits discrimination based upon age, sex, race and other factors) or the Americans with Disabilities Act (which mandates that employers provide reasonable accommodations for employees with certain disabilities) because these statutes cap all punitive damages at $300,000. Such caps, when used to reduce verdicts against behemoths such as Wal-Mart, can lead to absurd results.

For example, in a lawsuit filed in New York federal court, an employee with cerebral palsy sued Wal-Mart for subjecting him to adverse employment action and a hostile work environment in violation of the American Disabilities Act. The jury was so outraged by Wal-Mart’s conduct in that case that it awarded the plaintiff $3 million in punitive damages. The judge was forced, however, to reduce the punitive damage award to $300,000 to comply with the statutory maximum imposed on all Americans with Disability Act and Title VII claims.

In reluctantly reducing the punitive award from $3 million to $300,000, the federal judge spoke out strongly against statutory caps to the extent that they protect a “commercial titan” such as Wal-Mart:

The preceding ruling respects the law, but it does not achieve a just result. . . It took Wal-Mart only 37 seconds this year to achieve sales equal to the $300,000 It must now pay to [plaintiff] in punitive damages. There is no meaningful sense in which such an award can be considered punishment[9].

Taking Action Against Wal-Mart

There are many groups that have formed in reaction to Wal-Mart’s mistreatment of its workers. Wal-Mart watch and Wakeupwal-mart.com are among the most vocal. Employees and concerned taxpayers who want to keep informed about Wal-Mart’s practices, and perhaps even get involved to counter them, should consult these websites[10]. Some ways to take a personal stand against Wal-Mart are to boycott their stores, urge your Attorney General and local representatives to hold large companies such as Wal-Mart accountable for their conduct, and vote in politicians who pledge to do just that.

Conclusion

As the word is getting out about the ugly explanation for Wal-Mart’s attractive low prices, the public’s tolerance for the company’s arrogance is wearing thin. With greater frequency, employees are standing up for their rights and taking legal action against Wal-Mart. In addition to being morally outraged by the company’s unfair practices, consumers are also beginning to recognize they may be spending more at tax time to subsidize Wal-Mart’s abusive practices than they are saving at the register.

We are all affected by companies who mistreat their employees and we must all share in the responsibility of taking action against such companies. That action should include advocating for stricter enforcement of existing laws designed to keep companies such as Wal-Mart in check. Perhaps even more importantly, we should encourage our congressional leaders to implement new legislation to ensure that when huge companies like Wal-Mart violate the law, there will be an equally significant impact to their bottom line.
[1] 2004 study conducted at UC Berkley
[2] Id.
[3] Lawyer’s Weekly USA, February 27, 2006.
[4] December 19, 2003 broadcast of “NOW” with Bill Moyers.
[5] Fortune Magazine, 2003
[6] Everyday Low Wages: The Hidden Price of Wal-Mart, a report by the minority staff of the U.S. Representatives Education and Workforce Committee
[7] Wal-Mart Class Press Release, 6/22/04.

[8] The New York Times. “On Private Web Site, Wal-Mart Chief Talks Tough” by Steven Greenhouse and Michael Barbaro, February 17, 2006.

[9] Brady v. Wal-Mart Stores, Inc. 2005 WL 1521407 *4-5 (E.D.N.Y. June 21, 2005) Orenstein, J.
[10] Those who are interested in learning more about Wal-Mart may also want to rent a documentary that was released in 2005 entitled “Wal-Mart: The High Cost of Low Price.” The movie uses humor to show some of Wal-Mart’s worst employment practices and discusses Wal-Mart’s negative impact on the communities in which it does business.

“AN INCONVENIENT TRUTH” – THE TRUTH ABOUT GLOBAL WARMING

2006-06-04T08:16:00.000-05:00

“AN INCONVENIENT TRUTH” – THE TRUTH ABOUT GLOBAL WARMING

We saw Al Gore’s movie last night and we were spellbound. We had read reviews that were glowing. We knew that it was Al Gore’s movie. We weren’t quite sure what to expect because Mr. Gore, the man who “used to be the next President of the United States” had never previously kept us enraptured. But for one hour and fifty minutes we were spellbound. We were spell bound by the former Vice President and presidential candidate. We were spellbound by the science that supports every claim and statistic that he cited in support of his claim that this country and the world are on a collision course with ecological disaster from global warming. We were spell bound by documented patterns of the ever escalating levels of carbon dioxide in the atmosphere that clearly correlates the with rise in global temperatures that in turn explains the recent dramatic increase in tropical storms, tornados, changes in the patterns of water flow in the oceans, the melting of the polar ice cap, the loss of drinking water and farm land around the world and the threat of dramatic increase in ocean levels that will threaten low lying geographical areas including lower Manhattan including the former site of the World Trade Center. And we were spell bound by some wonderful cinema photography.

Now you may ask yourself: “Why does a personal injury lawyer from Stamford, Connecticut care about global warming in a way that justifies including this information on his law firm’s Blog.” That would be a very good question.

As lawyers who routinely go to court and try cases in front of juries, we are trained to think and analyze scientific data looking for “holes” in arguments. Moreover, we are governed by and work routinely with a series of important court decisions issued by both the United States Supreme Court (the Daubert rule) and here in Connecticut the Connecticut Supreme Court (the Porter rule) (many other states have their own version of similar rules) that command us to examine scientific claims on the basis of opinions and data published in peer reviewed scientific journals to see if the claims being made in court are consistent with accepted science. We do this in all types of cases where the claims involve some assertion of novel scientific theory. We look to these rules in medical malpractice cases, car accident cases, claims involving dangerous medications, traumatic brain injury case and toxic substance cases. The significance of a peer reviewed journal is that it is widely accepted as a standard authority in its field and the articles published are consistent with rigorous scientific standards but then before publication, the articles are also reviewed by panels of experts from the same field who also apply rigorous third party review as a form of “checks and balances”. According to Gore, the facts, theories and conclusions that he cited during “An Inconvenient Truth” concerning global warming are supported by well over 900 peer reviewed scientific journals and there are no peer reviewed journals that refute this science.

For me, Mr. Gore’s reference to peer review was the critical element that convinced me that “An Inconvenient Truth” should not be viewed as environmental propaganda. Rather it should be viewed as Gospel. I am convinced that we are on a collision course with environmental disaster that has been fomented by bad habits and economic interests that resist change. Our failing auto industry and our oil and gas industry resist change despite the threat of environmental disaster. Our auto industry claims it cannot meet stricter emissions standards when such stricter standards are already being met in other countries including China. The petroleum industry resists change to protect its economic interests.

It is a moral and political imperative that we all take steps to improve the environment. To ensure that it is safe and clean for future generations. I hope that you will see “An Inconvenient Truth”.

Stewart M. Casper, Esq.

Casper & de Toledo LLC

1458 Bedford St.

Stamford, CT 06905

Tel. 203-325-8600

http://www.casperdetoledo.com

email: scasper@cadetlaw.com

Big Business vs. Trial Lawyers - Some Sense from Alabama

2006-05-26T09:00:00.000-05:00

It's hard to believe but the publisher of a small town newspaper in Lanett, Alabama of all places has managed to distill the key differences between the interests of Big Business and Lawyers representing people who have been injured. With just a little intelligance, it is easy to distill these differences. Here is what was said in the Valley Times News:

By CY WOOD Editor-Publisher Published Thursday, May 25, 2006 11:52 AM EDT

The June 6 match-up between Sen. Gerald Dial and Kim Benefield for the Alabama Senate District 13 seat started out as a legislative contest, but it’s devolved into a battle of special interests.
Alabama voters can count on at least four special interest groups insinuating themselves into practically any contested election in the state. The big four are the education lobby (Alabama Education Association), the business lobby (Business Council of Alabama), the agricultural sector (Alfa) and the trial lawyers.
The education folks and the Alfa folks tend to spread money around evenly. After all, just about everyone is a supporter of education. It’s just a matter of degree. And what legislator wants to do something that would penalize pine tree growth in the state?
The business folks and the trial lawyers, though, are more into the litmus test mentality when it comes to legislative races. People who don’t understand politics (that’s 99.9999 percent of the sentient population) probably don’t understand why it’s always the business lobby on one side and the trial lawyers on the other.
The simplest explanation is that trial lawyers are prone to sue businesses when ordinary people get hurt, physically or financially, by the products or actions of companies. That’s an understandably adversarial relationship.
Trial lawyers want legislation passed that makes it easier for people to seek relief in the courts. Business wants legislation passed that makes suing companies more difficult.
These two behemoths (in terms of campaign activism) spread huge sums of money around to help people who think the way they do get elected to legislative seats.
Both the trial lawyers and the business groups will tell you, with complete sincerity, that their motivating principle is good government. Most ordinary people understand that what they really mean is they are looking out for their own best interests.
After all, that’s why they are called special interests — they are interested in a special group, themselves.
In recent years the phrase trial lawyers has become the principle pejorative of conservative campaign rhetoric. The effort has been effective: Many voters are scared to death of trial lawyers.
Why? Trial lawyers are the people who take up for the little guy in court. Yes, some trial lawyers make a lot of money suing big companies, and they are often criticized for taking a third or more of the settlement when they win a case.
What’s overlooked in this negative characterization is that sometimes the little guy is a victim, and by definition, because he’s a little guy, he often has no resources to seek redress for the wrongs done to him.
Trial lawyers look at such cases, and if they believe a wrong has been done, they assume the cost of going to trial. If their client wins, they get a big piece of the judgment or settlement. If their client loses, they get nothing.
As a newspaper editor, I often have people tell me I’ll be hearing from their lawyer. In most cases, those folks don’t have a lawyer, and if I were in the wrong, the only way most of them would ever be able to sue me would be if a trial lawyer took their case on a contingency basis.
That doesn’t worry me as a responsible editor, because I’m not intentionally going to hurt someone and leave myself and the newspaper open to a lawsuit.
If the business community was equally confident of the way it conducts business, it wouldn’t have anything to worry about where trial lawyers are concerned.
So here’s the bottom line: If a candidate is getting money from trial lawyers, it’s because the trial lawyers think the candidate will be more supportive of the trial lawyers’ agenda than the business community’s special interests. If a candidate has the financial support of business groups, it’s because that candidate is viewed as favorable to the interests of the business community
Voters need to ask themselves, “Which candidate is most likely to support legislation that will benefit me, an average citizen who doesn’t own a big business and doesn’t have a law degree?” The answer should be obvious.
Have you ever noticed that when it comes to frivolous lawsuits, only people who are being sued consider the lawsuit frivolous?
No doubt there are some bad apples among trial lawyers, but if the same weren’t true of the business community, we wouldn’t need trial lawyers.

Food for thought.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

A Response to the Waterybury Republican American - Sort of A Newspaper

2006-05-23T09:20:00.000-05:00

For the Waterbury Republican American to publish a piece like "Monkeyshine" (May 20, 2006) even though intended as a parody or entertainment of some sort is just another example of distasteful and bigoted publishing seeking to pass as journalism. You certainly have the right to do so as it is protected by the First Amendment. Interestingly, you have identified one of your least favorite groups - the Trial Lawyers as "[H]omo sapiens bloodsuckerus". I was wondering, are you referring to the category of lawyers who represent your newspaper, the insurance industry, major corporations like Merck - the manufacturer of the Vioxx and the concealer of truth?
Are you referring to the trial lawyers who appear to defend your right to publish virtually any dribble that your editorial board chooses? Are you referring to the trial lawyers who who stood in for the state medical society recently before the Hearing Officer for the State Department of Insurance to ensure that doctors and patients in Connecticut would not be ripped off again by a malpractice insurer requesting an exorbitant rate increase? Are you talking about the trial lawyers who who have fought for backup warning devices on industrial equipment, flame retardant pajamas to protect children, automatic reversing garage door openers? Are you talking about trial lawyers who fight for brain damaged babies, the victims of drunk drivers or the victims of corporations who discriminate against women, minorities and senior citizens? When you refer to trial lawyers as blood suckers are you referring to the trial lawyers who have represented the array of Waterbury politicians who have strayed from the law? Are you referring the trial lawyers who fought in Florida in 2000 to make W our president? Can't you see that your bias on your editorial page doesn't accomplish anything constructive?

www.casperdetoledo.com

American College of Surgeons - Lobbying Against Their Own Patients

2006-05-19T16:38:00.000-05:00

Today I emailed the American College of Surgeons, an organization obviously disappointed with the failure of the medical industry to deprive patients of their constitutional right to have a jury decide the issue of damages in medical negligence cases. The defeated legislation is called the Medical Care Access Protection Act of 2006. The title is sugar coated to disguise its purposes of granting effective immunity to doctors, hospitals, nursing homes and pharmaceutical companies.
The way that I see it, doctors, like lawyers and other professionals are licensed by the state and have some serious responsibilities under the law. One responsibility that we all have is to be truthful. I can truthfully say that I know of no epirical study, no data and no evidence that would justify altering the Constitution to deprive injured patients of their rights. So I figured I would give the American College of Surgeons the opportunity to inform me of the evidence that supports its position. I doubt that I will get an answer. I'll post it on this Blog if I do. Here is my email:

I happened to be perusing the American College of Surgeons web site (http://www.facs.org/index.html) and noted the summary concerning the defeat of S-22 and S-23, two bills pending in Washington that would affect the rights of patients and doctors involved in medical malpractice disputes. The web site invited the reader to contact you to obtain more information and that is what I am doing. Specifically, the entry provides:

The American College of Surgeons supports liability reforms that would guarantee all patients access to necessary surgical services. For more information about the bills and the College’s position, please contact cshalgian@facs.org.

I was wondering if you could provide me with some information that correlates the issue of "access to necessary surgical services" to the legislation that was proposed. As I read the legislation, the common theme of each proposed new federal law was caps on non-economic damages. Yet the caps were proposed at a level that strongly suggested that a patient harmed by medical malpractice had not only suffered a significant injury as a result of malpractice but also that the size or magnitude of the injury was such that substantial damages were warranted. I am confused as to how capping damages would help patients gain access to surgical services under such circumstances. Perhaps you can provide me with some economic studies, malpractice premium analysis or other evidence that demonstrates that capping damages will help patients obtain needed surgical services.

I would also like to know if the American College of Surgeons has analyzed the financial records of the malpractice insurance companies to determine the extent to which the real culprit in this debate is the insurance industry rather than your members' patients.

Thank you for your anticipated response.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970

JURY SELECTION AND THE MYTH OF THE McDONALD'S HOT COFFEE CASE

2006-05-19T13:39:00.000-05:00

JURY SELECTION AND THE MYTH OF THE McDONALD’S HOT COFFEE CASE

It’s been over fourteen years since the infamous McDonald’s hot coffee case made headlines and when we select jurors in Connecticut, we still hear about it. But not a single juror who I have interviewed in what we call the voir dire process has ever managed to even closely approximate the true facts of the case. To be sure, people recall that some woman sued McDonald’s after she spilled coffee on herself. From that point onward, potential jurors’ accounts bear no relationship to reality. Clearly, the myth of the McDonald’s cases has morphed into the most often cited mythic case of lawsuit abuse. Politicians, right wing talking heads and the ill informed perpetuate the myth. I’ve heard that the Plaintiff Stella Liebeck recovered millions of dollars from countless people.

The reality, however, is very different. Ms. Liebeck did suffer severe burn injuries when she spilled coffee on herself as she was attempting to add cream to her Styrofoam cup. She was not driving. She was a passenger. Her injuries included 3rd degree burns over 6% of her body including her thighs, buttocks, perineum and genital and groin areas. She was hospitalized for eight days, requiring skin grafts and debridement of her wounds. McDonald’s could have accepted Mrs. Liebeck’s offer to settle the case for a mere $20,000 but it refused. Then the case was filed and McDonald’s outrageous conduct was exposed.

It turned out that Mrs. Liebeck was not the first McDonald’s customer to be scalded by excessively hot coffee. That’s right. McDonald's had received more than 700 other claims in the ten (10) year period prior to trial. McDonald's also admitted to purposefully maintaining the temperature of its coffee between 180 and 190 degree Fahrenheit as compared to coffee at home that is generally in the 130 to 140 degree range. And further, McDonald's own quality assurance manager testified that food and beverages were not fit for human consumption at a temperature of 140 degree or higher because it would burn the mouth and throat.

There are more interesting details including the fact that the jury only awarded Ms. Liebeck $200,000 in compensatory damages and then reduced it to $160,000 representing the 20% comparative fault that it found. In addition, the jury wanted to assess McDonald's with punitive damages under Arizona law in the amount of $2.7 million dollars for its indifference. That amount represented two (2) days of McDonald’s coffee sales. As always happens in a case involving a large award of damages, the trial judge was asked to review the award and he reduced the punitive damage award to $480,000. For Mrs. Liebeck, now a legend in her own time, her recovery was about $400,000 . That amount certainly doesn’t seem disproportionate for a woman suffering 3rd degree burns over 6% of her body and requiring skin grafts in a very sensitive area.

One moral of this story, aside from being extra careful with hot drinks, is to be skeptical about claims made by those people and groups who bash the civil justice system and want to deprive you of your constitutional right to a jury trial. Absent reliable evidence or case citation, anecdotes should not be influential when important rights are at stake.

A second lesson to be learned relates to the types of inaccurate influences that can impact on our ability to pick fair and impartial jurors. The myth of the McDonald’s case has fostered the impression that people bring dumb lawsuits refusing to accept personal responsibility. In reality, the dumb lawsuits that are filed, are roundly condemned by most responsible lawyers and those cases are almost always dismissed. Moreover, it is very common that a person who claims damages in court also bears some responsibility for his or her own negligence. The existing rules provide for reduction of an award to reflect the injured party’s carelessness. That called the comparative negligence rule and that is what happened to Mrs. Liebeck. Finally, while there truly is no incentive for a party or a lawyer to bring a “frivolous” lawsuit, both state and federal rules provide for sanctioning parties and lawyers who bring frivolous cases. There is no need to change our laws.

For more information about how McDonald’s burned Stella Liebeck and then permitted this unflattering myth to be perpetuated, please go to the web site of the Association of Trial Lawyers of America at: http://www.atlanet.org/convention/SE06/
I think you’ll agree that the McDonald’s myth just doesn’t “cut the mustard”.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

REPUBLICAN MAJORITY IN SENATE PROPOSE ANOTHER BIG PRESENT TO ITS INSURANCE COMPANY BUDDIES

2006-05-09T12:07:00.000-05:00

Yesterday Senate Minority Leady Harry Reid (D-Nev) once again exposed the Republican majority as the Emporer without clothes. Reid ridiculed the Republicans' renewed effort to enrich their friends at the big insurance companies as well as the medical industry that seeks to dismantle the U.S. Constitution to protect itself from against all sorts of medical malpractice claims. Reid also credited Connecticut's own Professor Tom Baker for his book entitled The Medical Malpractice Myth published by the University of Chicago Press.

Speculation is that the Rebulicans in the Senate knew their efforts to pass S-22 & S-23 were doomed to fail but that its all politics now. Trying to create an issue for the mid term elections. Yet their fig leaf is transparrent. The proponents rely upon anectdote only foregoing any reference to the numerous studies that prove beyond doubt that the malpractice crisis was manufactured bythe insurance industry; that the medical profession is lead by weak kneed pussycats who afraid of their own shadows and afraid to take on their real adversaries - the insurance industry; that premiums escalated in response to the economy and not lawsuits; that there is no retirement epidemic; that the meidcal profession is always judged by the appropriate standard of care and that the greatest crisis in the malpractice field is the failure of doctors and hospitals to police themselves.

Read more below:

WASHINGTON, May 8 /U.S. Newswire/ -— With Bush Republicans in the Senate seeking to use their "health" week to push Medical Malpractice legislation that will do nothing to fix the health care crisis in America today, Senate Democratic Leader Harry Reid delivered the following remarks on the Floor of the U.S. Senate.
The text of Senator Reid's speech, as prepared, is below.
Mr. President, I rise to object to the Republican medical malpractice bills before the Senate today. These measures do not represent a serious attempt to improve health care or civil justice in the United States. Moving to these bills is a tired political exercise, and the Senate should reject it out of hand.
To think with American consumers paying over 3 dollars for gas, with college tuition moving beyond the reach of many in the middle-class, with the Iraq war dead approaching 2,500, with immigration a security crisis unresolved, with our country's deficit standing at 9 trillion dollars, with 46 million Americans lacking health care coverage, we are moving to bills that are unnecessary and go nowhere. It is wrong.
We could more profitably use the scarce time remaining in the 109th Congress tackling the urgent challenges facing America's families: energy, the war, immigration, and the real health care crisis.
Both of these bills the Senate will consider today contain the same one-size-fits-all cap on damages that this body has rejected time and time again. Both contain the same unjustified protections for hospitals, HMOs and insurance companies from previously discarded bills. In fact, these proposals are virtually identical to legislation we turned aside three times last Congress. These bills are the same old song.
Even though these measures would dramatically rewrite the tort laws of all 50 states, and even though they would denigrate the legal rights of countless Americans, they have undergone no serious legislative review in this Congress. Don't be fooled by the low bill numbers –- S. 22 and S. 23 were simply placeholders for legislative text that was only formally introduced last Wednesday. In fact, the text of these bills was not even available online until two days ago. The Majority Leader used a procedure we call "Rule 14" to bring these bills straight to the Senate floor to avoid consideration by either the Judiciary Committee or the Health Committee.
There has not been a single committee hearing. There has not been a single witness... Not a single opportunity to amend, or a single opportunity to improve, compromise or negotiate. With this insurance industry legislation, every step of the process has been abandoned.
Why has the Majority proceeded in this manner? Because this is not a serious exercise in legislating, it is a political stunt being performed for the sole purpose of allowing Republicans to go back to their special interest friends and say "look what we have tried to do to help." But even they should not be fooled by these transparent theatrics.
The Majority is short-circuiting the committee process because of the illusion of a medical malpractice "crisis."
Mr. President, there is a health care crisis in this country, but it has nothing to do with tort laws. It is a crisis when 46 million Americans have no health insurance. It is a crisis when health care is too costly for average Americans. It is a crisis when medical errors are the sixth leading cause of death in America. But not a single provision in this legislation will provide health insurance to the uninsured, lower healthcare costs, or make patients safer.
In reality, the whole premise of a medical malpractice "crisis" is unfounded.
Over the weekend, I reviewed an insightful book entitled "The Medical Malpractice Myth" by Professor Tom Baker and published by the University of Chicago Press. The author is a Professor of Law and Director of the Insurance Law Center at the University of Connecticut Law School. Both his father and father-in-law are doctors. He is not affiliated with the trial lawyer association –- actually, he is often a consultant for the insurance industry.
In this book, Professor Baker methodically debunks the most common myths in the medical malpractice debate:
Myth No. 1: "Lawyers, not doctors, cause malpractice"
Professor Baker presents numerous studies demonstrating that the real problem is too much malpractice, not too much litigation. Of course most doctors are skilled professionals who do not commit malpractice. But just as there are a few rotten apples in every basket, there are a small number of unskilled or careless doctors in every state. Unfortunately they do not always come to the attention of licensing boards, and some move from state to state to avoid disciplinary action.
These rotten-apple doctors should be held accountable, and the victims of their negligence deserve to be compensated.
Myth No. 2: "Lawsuits make health care unaffordable"
Professor Baker demonstrates that medical malpractice rates are based more on the cyclical nature of the stock market than on malpractice verdicts. When insurance company investments lose money, the companies raise the rates they charge doctors to compensate for the loss.
As a result, caps on damages do not reduce insurance premiums in the long run. For the most part, insurance rates have not gone down in those states that have capped damages. In my state of Nevada, for example, where legislators convened a special session in 2002 to set a cap of $350,000 on pain and suffering damages, OB/GYN malpractice premiums are 37 percent higher than in states without caps; general surgery premiums are 52 percent higher; and internal medicine premiums are 44 percent higher. In fact, since 2001, claims paid by Nevada's largest insurer have dropped 16.7 percent while premiums have increased 32.2 percent.
From 2000 to 2005, the net payouts of malpractice insurers declined 3.1 percent. But over the same period in which payouts were declining, net insurance premiums increased 93.2 percent. So claims decreased, but the companies doubled premiums.
Even if caps on damages did affect malpractice premiums, there is no reason to believe that caps would make health care more affordable overall. According to the Congressional Budget Office, malpractice costs amount to less than 2 percent of overall health care spending. If a reduction of 25-30 percent in malpractice costs were attainable, it would lower health care costs by only about 0.4 percent to 0.5 percent.
Myth No. 3: "Lawsuits deny access to care"
Despite the century-old complaint that lawsuits drive doctors from their practices, the medical profession continues to grow each year, and applications to medical schools have increased. The number of physicians in the US has increased every year since 1996, from about 738,000 in 1996 to almost 885,000 in 2004.
In 2003, the non-partisan General Accounting Office surveyed five states repeatedly cited by the AMA as examples of communities suffering from shortages of care because doctors are fleeing. The report concluded that such claims are wildly overstated: "Many of the reported physician actions and hospital- based service reductions were not substantiated or did not widely affect access to health care." Where doctor shortages exist, they are due to population shifts and the reluctance of doctors to practice in rural and low-income areas.
In any event, caps on damages do not change the availability of physicians. States without caps on damages have more doctors per capita and 14 percent more active physicians than states with caps on damages.
For example, the number of OB-GYNs in the United States has increased by nearly 25 percent -– from 33,000 in 1990 to 42,000 in 2004. But in Nevada, where we have caps on damages, there are 27 percent fewer OB/GYNs than in states that don't have caps.
Myth No. 4: "Lawsuits cause doctors to practice wasteful defensive medicine"
Professor Baker devotes a whole chapter to "defensive medicine" and concludes that it is largely an urban myth. For example, he cites reports from the Congressional Budget Office and the former congressional Office of Technology Assessment that question estimates of defensive medicine. CBO specifically concluded that any savings from reducing defensive medicine would be small at best.
Myth No. 5: "Most lawsuits are frivolous"
Not every lawsuit has merit, but the tort system has plenty of mechanisms for weeding out frivolous claims. According to Professor Baker, "(m)ost undeserving claims disappear before trial; most trials end in a verdict for the doctor; doctors almost never pay claims out of their own pockets; and hospitals and insurance companies refuse to pay claims unless there is good evidence of malpractice."
At the same time, the assertion that there exists an "explosion" in medical malpractice payouts in recent years is untrue. The average verdict size is relatively low and has remained stable. A study by Americans for Insurance Reform found payments have been virtually flat since the mid-1980s. As it is, Americans use the civil justice system as a last resort, going to court after all other efforts have failed.
For these reasons, Professor Baker concludes that the medical malpractice "risis" is the product of exaggeration and distortion. But even if there were a medical malpractice problem that needed to be cured, these bills are not the right medicine. S. 22 and S. 23 are riddled with major flaws. I will highlight only a few of the most egregious aspects of the bills.
First, S. 22 and S. 23 would impose an unreasonably low $250,000 cap on pain and suffering damages. Proponents of these bills claim that the cap is $750,000, but in the typical case where there is a single negligent party the cap remains $250,000.
In cases where the wrong limb is amputated, or a patient is paralyzed for life, or a mother loses a child, $250,000 is grossly inadequate compensation. And it's even worse under S. 23: Under this bill, the life of a woman rendered sterile by the gross negligence of an OB/GYN is worth less than that of a man mistakenly sterilized.
Second, these bills discriminate against women. By capping pain and suffering, while simultaneously preserving full compensation for lost wages and salary, these bills de-value the worth of homemakers and stay-at-home parents. For instance, a homemaker whose reproductive system is destroyed by negligent treatment would only suffer non-economic losses, which are arbitrarily capped by the bill.
At the same time, the bills limit punitive damages, a change which disproportionately affects women patients. Punitive damages are very rare in malpractice cases, but the cases where they occur often involve sexual abuse of a female patient.
Third, the bills unjustifiably protect large corporations that own nursing homes from liability when they abuse or kill their patients. The National Citizens Coalition for Nursing Home Reform released a new book, "The Faces of Neglect: Behind the Closed Doors of Nursing Homes" which profiles the heartbreaking experiences of 36 Americans who have suffered from abuse or neglect while in long-term care facilities.
The book includes the story of Barbara Salerno, a Reno, Nevada woman whose father died in a nursing home. Although he suffered from kidney failure and pneumonia, the nursing home failed to provide proper medical care. Ms. Salerno's father died a prolonged, painful and undignified death. The only way this California nursing home was held accountable was through a lawsuit. S. 22 seeks to take away that right.
The numbers of seniors who could be hurt by this bill are staggering. According to the GAO, 300,000 elderly and disabled residents live in chronically deficient nursing homes where they are "at risk of harm due to woefully deficient care." 26.2 percent of nursing homes nationwide were cited for violations related to quality of care by regulatory agencies in 2004, yet this bill gives sweeping liability protections to these negligent facilities.
Fourth, these bills are an affront to federalism. Republicans love to talk about states' rights, except when they want to impose their federal solution on all 50 states. More than half of all states have already enacted malpractice reforms, but these bills override those state legislative decisions. Specifically, this bill preempts those states that have debated a cap on damages and decided against that step.
For these and other reasons, the pending bills are objectionable. In fact, the entire concept of medical malpractice reform is misguided -- the right way to bring down malpractice insurance premiums is to reform the insurance industry, which is badly in need of oversight.
A study commissioned by the Center for Justice and Democracy showed that insurance premiums more than doubled between 2000 and 2004 even though claims pay-outs remained essentially flat. Given this price gouging, it is little wonder that the profits of the nation's five largest medical malpractice insurers rose by 17.7 percent in 2005 -– more than double the Fortune 500 average.
We need to strengthen federal oversight of insurance industry practices that contribute to these rises in malpractice premiums. Unfortunately the insurance industry enjoys almost complete immunity from the federal antitrust laws, and using this exemption, insurance companies can collude to set rates, resulting in higher premiums than true competition would achieve. Federal enforcement officials cannot investigate any such collusion because of the exemption.
The exemption came about during the Depression with the McCarran-Ferguson Act, named after Senator Pat McCarran of Nevada. This Act was passed to give a few years of relief to the insurance industry. Now, some 70 years later, insurance companies are the only businesses -- other than major league baseball -- not subject to the antitrust laws. The rationale for this exemption has long since passed. Insurance should be subject to federal antitrust laws like every other businesses in America.
I am proud to support Senator Leahy's bill to accomplish this goal.
In sum, to pretend that these medical malpractice bills have anything to do with making health care more affordable is nothing but a cruel joke. These bills override the sound judgment of state legislatures and juries and substitute the arbitrary judgment of Congress.
We should not reward insurance companies making record profits. We should help doctors by reforming the insurance industry rather than undermining the legal rights of seriously injured malpractice victims.
I intend to vote against cloture on the motions to proceed to S. 22 and S.23, and I urge my colleagues to do the same.
http://www.usnewswire.com/

More Evidence That the Medical Malpractice Crisis Isn't A Crisis

2006-05-08T09:42:00.000-05:00

Project HOPE - The People-to-People Health Care Foundation tells us that even the American Medical Association cannot document the so-called medical malpractice crisis.

Bethesda, MD – Despite claims by the American Medical Association and others that rising malpractice premiums are driving physicians out of business, self-employed physicians paid lower premiums in 2000 than they did in 1986, according to data from surveys conducted by the AMA itself from 1970 to 2000.
In constant 2000 dollars, mean malpractice premiums rose from $5,934 in 1970 to $20,106 in 1986, then declined to $15,478 1996, reports a study in the May/June 2006 Health Affairs that analyzes the AMA data. Premiums rose from 1996 until the AMA discontinued the surveys after 2000, but in 2000 mean premiums were $18,400, still below the 1986 level. Moreover, while premiums were falling from 1986 to 2000, all other practice expenses were rising rapidly.
“The reported recent demise of medical practice as a result of rising malpractice premiums has been greatly exaggerated,” Suffolk University law professor Marc Rodwin and coauthors write. The AMA surveys “indicate that premiums have consistently been a small percentage of total practice expenses.” Premiums rose from 6 percent of total expenses in 1970 to 11 percent in 1986, then dropped back down to 6 percent in 1996 before rising slightly to 7 percent in 2000.
Rodwin and coauthors say that these trends held when the data were analyzed regionally and separately for “high-risk” specialties, such as obstetrics, although there are slight variations. They suggest that perceptions of a crisis may stem partly from the 1996-2000 period, when physician income fell as malpractice premiums rose. But the researchers point out that falling revenues, likely caused by managed care, were the primary culprit for the decrease in physician income during this period. Between 1996 and 2000, revenues fell $2,859 a year, between three and four times the amount of yearly premium increases ($731).
Following the AMA’s halt to its surveys in 2000, the much-cited Medical Liability Monitor Report (MLMR) indicated that malpractice premiums increased by10-20 percent per year from 2000 to 2002, and by more than 20 percent in 2003. Rodwin and coauthors assert that the MLMR is a less accurate source of premium data than the AMA surveys, since the MLMR tracks advertised premiums that often are discounted or adjusted to make sales. However, they say, even if premiums rose by as much as the MLMR reports, “premiums in 2003 would still have been a small percentage of total practice costs and thus have had a negligible effect on mean practice income.”
Moreover, add Rodwin and his coauthors, Suffolk law students Hak Chang and Jeffrey Clausen, in 2003 average physician income stood between the 95th and 99th percentiles for all Americans.
The article can be found at http://www.healthaffairs.org/Rodwin.pdf until the full May/June issue is released at 12:01 AM on Tuesday, May 9. After that, the article may be accessed at http://content.healthaffairs.org/cgi/content/abstract/25/3/750.
ABOUT HEALTH AFFAIRS: Health Affairs , published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.
You are receiving this e-mail because you registered on the Health Affairs Web site. If you do not wish to receive such notifications in the future, please go to www.healthaffairs.org/1260_opt_in.php to change your e-mail notification options. If the above links are not activated, please highlight the link and press Ctrl-c (Command-c on a Mac) to copy it. Then place your cursor in the address window of your browser, press Ctrl-v (Command-v) to paste.
SUBSCRIBE
Subscribe today for full online access to Health Affairs -"the bible of health policy" (Washington Post, January 12, 2005).
FREE FROM HEALTH AFFAIRS
Be the first to see what's new in health policy.
Sign up for new content e-mail alerts from Health Affairs.
NEW! Receive Health Affairs tables of contents via RSS feed.
©2006 Project HOPE–The People-to-People Health Foundation, Inc.

Health Affairs - 7500 Old Georgetown Rd., Suite 600 - Bethesda, MD 20814

Distracted Drivers Cause Accidents - No Surprise

2006-05-04T15:05:00.000-05:00

Regardless of whether a motor vehicle accident involves one or more cars, trucks, minivans or other vehicles, there is strong data that leads to the conclusion that 80% of the accidents and 65% of the near crashes result from some form of driver inattention occurring within three (3) seconds of the crash. Drowsiness and cell phone use were the predominant distractions.

It is estimated that drowsiness is grossly underreported as a cause of crashes and near-crashes by a factor of nearly four as it tends to evade accurate reporting. With regard to cell phone use, the acts of dialing and talking appear to be comparably responsible for car accidents although the act of dialing is likely more distracting than talking. The statistics tend to equalize because dialing is accomplished in a shorter time than the act of speaking and thus the relative risk lessens.

Other interesting data revealed that the act of retrieving an object within the vehicle increased the risk of an accident by 9 fold while looking at an external object increased the risk by a factor of 3.7, applying makeup or reading made driving three times as dangerous and using a handheld cell phone increased the risk a mere 1.3 fold.

The type of conduct summarized here further complicates the task of driving, something made increasingly complex because of the congestion on our roadways, roadside distractions, the speed that vehicles travel, complicated interior configurations. In any case, any such distracting conduct is something that should be brought to the attention of all investigating police officers and your attorneys. Certainly the personal injury lawyers at Casper & de Toledo would consider such information to be important.

The results of this study published in April 2006 can be found at the web site of the National Highway Transportation and Safety Administration web site: http://www-nrd.nhtsa.dot.gov/departments/nrd-13/newDriverDistraction.html

"USA Today" Worries About Malpractice

2006-04-27T15:11:00.000-05:00

From USA Today April20, 2006 - if "USA Today" is concerned about medical malpractice - you should also be worried that your rights are to be peddled away by lobbyists and the medical industry looking to avoid accountability.

Whose side are they on? The thought of a surgeon taking a scalpel to the wrong limb, organ or patient sends chills down the spine of anyone who has been in a hospital.
Eighty-four cases of what's known in the business as "wrong-site surgery" were reported in the USA last year. But that's just the "tip of the iceberg," because many hospitals across the country aren't obligated to account for such blunders publicly, says Dennis O'Leary, who heads a group that inspects health care facilities.
The chances of wrong-site surgery are slim — about one in 113,000 operations, a study published Tuesday in Archives of Surgerynotes. Still, any incident is unacceptable. In one typical case, instead of removing a benign tumor from Doug McCoy's right ear last September, surgeons at Maricopa Medical Center in Phoenix operated on his left ear — which had no tumor.
In an effort to eliminate such blunders, surgeons have been required since 2004 to mark the spot they plan to cut while consulting with their patient before the operation. Nurses are supposed to call a "time out" in the operating room to conduct a final safety check to ensure that the right procedure is performed on the right patient.
So why do these catastrophic mistakes keep happening? Mainly because systems designed to prevent errors are faulty, or not followed, researchers say.
Some surgeons who think they'd never make such a stupid mistake often ignore safety protocols. Stubborn resistance to standardized conduct is part of the culture of medicine.
Airline pilots overcame this barrier long ago. Even the most experienced pilots must run through a checklist before taking off. It may be embarrassing for surgeons to be asked if they know for sure which side — or patient — they're about to operate on. But it's a lot less embarrassing than making a grievous error. Swallowing a little pride may save a limb, or a life.
Hazards in hospitals. Surgical screw-ups are a small part of a much larger patient-safety problem in hospitals.
Incidents such as bedsores, post-operative infections and failure to diagnose and treat conditions that develop in the hospital continued to plague American hospitals, according to a new study of Medicare patients by HealthGrades, a health care ratings company.
The study found that 1.24 million patient safety incidents occurred in nearly 40 million hospitalizations from 2002 to 2004. Those incidents were associated with 250,000 potentially preventable deaths and $9.3 billion of excess costs. For the second straight year, incidents increased slightly.
What can be done? Only 23 states have mandatory error-reporting systems, and standards of measurement aren't consistent. More states need to adopt rigorous reporting systems, and they should publicly release the type and number of patient safety incidents at each hospital. Exposure can spur progress.
That's what Minnesota has done, and it's ranked as the nation's top state for improving patient safety. A unique program there allows fiercely competitive hospitals to work together to share data, highlight best practices and implement tested solutions. As a result, Medicare patients in Minnesota had a nearly 30% lower risk of a safety incident compared with New Jersey, listed as the worst state.
Progress in reducing medical errors has been painfully slow. Speeding improvements requires making safety a top priority, publicly identifying hospitals that miss the grade and rewarding those that exceed it.
Growing older. In the face of botched surgeries, hospital goof-ups and myriad other risks, there was some encouraging news on the health front this week: Americans are living longer.
Despite a population that is growing in numbers and waistlines, the actual number of deaths in the USA dropped by nearly 50,000 in 2004 from the year before.
The National Center for Health Statistics said significant drops in the death rates for heart disease, cancer and stroke accounted for most of the decline, though they remain the three biggest causes of death. Deaths from influenza fell 7%.
The provisional death toll was 2,398,343, down 49,945 from 2003 and the biggest such drop since World War II.
In Europe, meanwhile, researchers from the World Health Organization and Greenpeace have been warring over how many "extra deaths" could be attributed to cancers caused by the Chernobyl nuclear disaster 20 years ago next week. Estimates in differing studies range widely, from 9,000 to 90,000.
Thanks to advances in medicine, more Americans may be living a little longer. And thanks to the radiation released at Chernobyl, unknown numbers of Europeans may be dying a little younger.
But death still comes only once, and the one sure thing in life is that eventually it will come for everybody. There are no "extra" deaths, just differences in timing.
Posted 4/20/2006 9:03 PM ET
Updated 4/20/2006 9:16 PM ET
E-m

The Medical Malpractice Myth

2006-04-26T12:39:00.000-05:00

If it were a football game, there would probably be a penalty called for piling on - unnecessary roughness. But Constitutional rights are at stake. So when the Association of Trial Lawyers of America this week wrote about Professor Tom Baker's expose of The Medical Malpractice Myth I felt compelled to share it with you. I don't mean to pile on, but ATLA and Professor Baker are presenting you with the facts and as I have said so many times in my communications to you, there are no facts to support the claims of those who propose to take your right to a jury trial away. That is what an arbitrary cap on damages would be - a deprivation of your right to have a jury decide a case. There are no studies that support their claims. And I truly hope that you promptly communicate with your representatives in Washington, at least those that listen to their constituents, and tell them that you don't support legislation giving health care providers a free pass. No more special privileges.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

CAN THE POLITICAL RIGHT RIGHTLY USE THE RELIGIOUS RIGHT TO DEPRIVE PEOPLE OF THEIR CONSTITUTIONAL RIGHTS?

2006-04-21T12:29:00.000-05:00

Personal injury and medical malpractice lawyers and especially “trial lawyers” have long been in the cross-hairs of right wing zealots doing battle for major corporations, insurance companies, HMOs, lobbyists and favored politicians. I often ask myself whether each of these opponents of the civil justice system truly believes in every issue that they espouse or if they are merely mouthpieces for a cause if not their own wallets.

Please don’t get me wrong, I do believe that many philosophers attempting to reconcile spiritual doctrine with concepts of the law such privacy and due process must struggle mightily with the tension between some of these principles. How else would one reconcile dedication to the right to life with the commandment that “Thou shalt not kill” when it comes to capital punishment?

While I do not consider myself a religious man, I was fascinated when I recently learned that the notion of compensating an injured person with money damages is actually rooted in the Bible and first found in the Old Testament. That alone held no significance to me other than perhaps the age of the wisdom as I believe that the spirit is advanced in the civilized Judeo-Christian role.

I make no pretenses to have researched all of the relevant passages in a scholarly fashion yet there in the book of Exodus verses 33-34 the Old Testament provides:

And if a man shall open a pit, or if a man shall dig a pit
And not cover it, and an ox or an ass fall therein,

The owner of the pit shall make it good; he shall give money
Unto the owner of them, and the dead beast shall be his.

Isn’t this a form of just compensation. Who said anything about arbitrary limits. And what happened to the “eye for an eye and the tooth for the tooth” also found in Exodus? For it does not appear to be a satisfactory response that one would literally take an eye of an assailant who causes another to lose an eye. Rather, the assailant is obliged to pay for loss of time and to pay for full recovery. To literally take an “eye for an eye” would not be a forgiving philosophy and other biblical passages suggest strongly that while there may be punishment, it need not be a punishment of like kind and quality.

And while it might be suitable to condemn someone whose system of belief’s is at odds with your own on issues of “right to life”, when that same Trial Lawyer stands between abuse of government to ensure that constitutional rights are protected or volunteers to represent victims of the terrorist attacks on September 11 or combats the abuses of insurances companies, HMOs, drug manufacturers so that you children won’t be harmed, or send charitable donations for relief of the victims of Hurricane Katrina, what does that make the trial lawyer then?

So the fight is joined. Is it alright with you that the big corporations, insurance companies, HMOs, lobbyists and corrupt politicians are trying to buy your Constitutional rights and change the rules so that you can’t get a fair shot in life? We’re trial lawyers and we say that it’s not alright.

Is Workers' Compensation Insurance Necessary?

2006-04-21T08:09:00.000-05:00

Workers' compensation insurance evolved with the goal of providing an expedious administrative no-fault proceeding in lieu of third party liability to care for injured workers. It has been a flaming failure. Workers' compensation insurers fight these claims as vigorously as traditional third party claims; delay investigations; stonewall the payment of wage replacement and the payment of medical bills and the level of payment once achieved is paltry. That says nothing about the snail's pace that the administrative proceedings crawl at the trial level where formal evidentiary hearing may last over the course of months if not years only to be trumped by a one year delay in reaching an appeal before the Compensation Review Board, followed by a lengthy appeal to the courts. Why?

Massachusetts recently enacted a bold new plan to provide medical insurance for its unisured population. What if there was universal health coverage? What if there was a law that an injured employee would be entitled to salary continuation during recuperation? What if we did away with an inefficient and uneconomic administrative system based upon no-fault thus saving hundreds of thousands of dollars in salary and other administrative costs? Why should my assistant be paid for her injuries if she trips over a waste basket that she left in an unsafe location but I cannot be sued by her ( I have insurance) if she is injured by an unsafe work condition that I created?

Why are there two insurance systems rather than one? One system administers workers' compensation and the second administers liability claims? Why are there two sets of lawyers? One set handles workers' compensation claims and one set handles liability claims?

Why are there three types of insurance? Medical insurance, workers' compensation insurnace and liability insurance?

There formerly was a time that it took so long to have a third party claim adjudicated that it made sense to have a quick and expedient system in its place? That reasoning no longer exists. The judicial system is a blessing now - it moves so swiftly?

And wouldn't workers be safer if work places were safer and employers could be held accountable in money damages if negligence caused a worker to be injured?

www.casperdetoledo.com

April is Sexual Assault Awareness Month

2006-04-20T12:41:00.000-05:00

The Association of Trial Lawyers of America has paid a glowing tribute to Bridget Kelly, a victim of a brutal assault during an intrusion of her home, followed by a robbery, rape and then multiple gunshot wounds. All likely would have been prevented had the management company at her apartment complex in in Killeen, Texas heeded her warnings and the warnings of others that additional security measures were required to adequately protect the occupants. Fortunately, Bridget's physical wounds have healed.

April is Sexual Assault Awareness Month. A time for all of us to give appropriate weight to the safety needs of all people,: women, children and yes, even men. There are untold opportunities when people can be assaulted. Dark parking lots and alleys. Situations when children are left in vulnerable positions.

Should you or a loved one be victimized by a predator, please call 911 immediately, Seek out the necessary help for your physical injuries as well as your emotional injuries. Should you desire a legal consultation, the lawyers at Casper & de Toledo LLC stand ready to assist you in any way we can. A claim in may fall into the category of a personal injury claim or a premises liability claim.

Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
tel. 203-325-8600
fax. 203-323-5970
www.casperdetoledo.com

In many communities there are special agencies that reach out to victims. In Stamford there is the

Sexual Assault Crisis & Education Center Inc(203) 329-2929(203) 348-93461845 Summer St. Stamford, CT 069050
A List of Connecticut Rape Hotlines follows:

Connecticut Rape Crisis Hotlines
Rape Crisis Service753 Fairfield AvenueBridgeport, Connecticut 06604(203)333-2233(203)334-6154(office)
Middlesex County Sexual Assault Crisis ServiceP.O. Box 1514Middletown, Connecticut 06457(203)346-7233
Milford Rape Crisis Center70 W. River StreetP.O. Box 521Milford, Connecticut 06460(203)878-1212
Rape Counseling TeamYale-New Haven Hospital20 York Street, Room 1-218New Haven, Connecticut 06504(203)785-2222
Rape Crisis Center/YWCA48 Howe StreetNew Haven, Connecticut 06511(203)624-2273
Rape Crisis Center of Stamford1845 Summer Street, 2nd FloorStamford, Connecticut 06905(203)329-2929
Sexual Assault Crisis Service/YWCA135 Broad StreetHartford, Connecticut 06105(203)522-6666(203)525-1163 ext. 205(office)
Women's Center Rape Crisis Service16 Jay StreetNew London, Connecticut 06320(203)442-4357

State wide: http://www.dph.state.ct.us/BCH/Family%20Health/Womens_Health/Sexual_assault_prevention.htm

Gay/Lesbian & BiSexual Crisis Intervention may be found at:

Connecticut Rape Crisis Hotlines
Rape Crisis Service753 Fairfield AvenueBridgeport, Connecticut 06604(203)333-2233(203)334-6154(office)
Middlesex County Sexual Assault Crisis ServiceP.O. Box 1514Middletown, Connecticut 06457(203)346-7233
Milford Rape Crisis Center70 W. River StreetP.O. Box 521Milford, Connecticut 06460(203)878-1212
Rape Counseling TeamYale-New Haven Hospital20 York Street, Room 1-218New Haven, Connecticut 06504(203)785-2222
Rape Crisis Center/YWCA48 Howe StreetNew Haven, Connecticut 06511(203)624-2273
Rape Crisis Center of Stamford1845 Summer Street, 2nd FloorStamford, Connecticut 06905(203)329-2929
Sexual Assault Crisis Service/YWCA135 Broad StreetHartford, Connecticut 06105(203)522-6666(203)525-1163 ext. 205(office)
Women's Center Rape Crisis Service16 Jay StreetNew London, Connecticut 06320(203)442-4357

Domestic Violence/Abuse/Sexual Assault
Ansonia:
The Umbrella - 435 East Main Street Ansonia, CT 06401 - (203)736-9944 - fax (203)736-2601 - Serves women, children, and men who are victims of domestic violence.
Bridgeport:
The Center for Women & Families of Eastern Fairfield County Inc. - 753 Fairfield Avenue Bridgeport, CT 06604 - (203)334-6154 hotlines: Domestic Violence (203) 384-9559 Rape Crisis: (203) 333-2233
Dayville:
Domestic Violence Program United Services - PO Box 839 Dayville, CT 06241 - (860)774-8648 - hotline (860)774-2020
Enfield:
Network Against Domestic Abuse - 139 Enfield Avenue, Bldg #3-9 Enfield, CT 06082-4583 - (860)763-4542 - hotline (860)763-7430
Falls Village:
Women's Support Services - PO Box 423 Falls Village, CT 06031 - (860)824-1080 - Domestic violence crisis intervention & prevention; shelter, support, and advocacy for all victim's of domestic abuse.
Greenwich:
Domestic Abuse Services of Greenwich - YWCA of Greenwich - 259 E. Putnam Avenue Greenwich, CT 06830 - (203)869-6501 - fax (203)618-9464 hotline - (203)622-0003 - ywca@discovernet.net - Free and confidential 24 hour hotline, counseling, groups, legal advocacy and education for victims of domestic violence and abuse.
Hartford:
Connecticut Sexual Assault Crisis Services, Inc. (CONNSACS) - 110 Connecticut Boulevard East Hartford, CT 06108 - (860)282-9881 - Statewide association of individual sexual assault crisis programs working to end sexual violence.
Interval House Cecile Enrico - PO Box 340207 Hartford, CT 06134-0207 - (860)246-9149 - hotline (860)527-0550 - Provides services to victims of domestic violence and their children.
YWCA Sexual Assault Crisis Service Judith Vazquez - 135 Broad Street Hartford, CT 06105 - (860)525-1163 - fax (860)543-8919 - Hotlines: English (888)999-5545, Spanish (888) 568-8332 - Educates, advocates, and provides services to all victims of sexual assault and their families.
Middlesex:
New Horizons - PO Box 1036 Middletown, CT 06457-1036 - (860)347-3044 - hotline (800)774-2900 - Domestic Violence services for Middlesex and New London counties.
Middletown:
YWCA/ Central Connecticut Sexual Assault Crisis Service - Jessica Lewis, Program Coordinator - 29 Crescent Street, P.O. Box 1063 Middletown, CT 06457 - (860)344-1474 - fax (860)346-5705 - hotline (888)999-5545 - centralctsacs@erols.com - 24 hour crisis hotline; Support and advocacy for victims/ survivors of sexual assault and their loved ones.
Milford:
Rape Crisis Center - PO Box 521, 70 West River Street Milford, CT 06460 - 24 hour hotline (203)878-1212
New Britain:
Prudence Crandall Center for Women - PO Box 895, New Britian, CT 06905-8703 - (203)322-5380 - hotline (860)225-5187 - Provides caring support beneficial information, referrals and individual advocacy to women, men, and children who are victims of domestic violence. Also provides emergency shelter to women and children who are victims of domestic violence.
Sexual Assault Crisis Service - YWCA - 22 Glen Street, P.O. Box 2545 New Britain, CT 06051 - (860)225-4681 - fax (860)225-7443 - hotline (203)223-1787
New Haven:
Domestic Violence Services of Greater New Haven Sandra Koorejian, Executive Director - PO Box 1329 New Haven, CT 06505-1329 - (203)865-1957 - fax (203)562-9450 - hotline (203)789-8104 - dvsgnh@connix.com - Crisis Intervention and prevention programs, including 24-hour hotline, emergency shelter, support groups, court based advocacy, individual counseling, community education.
Greater New Haven Sexual Assault Crisis Service - 911 State Street New Haven, CT 06511 - (203)789-1425 - hotline (203)624-2273
Norwalk:
Domestic Violence Crisis Center - 5 Eversley Avenue, Suite 203 Norwalk, CT 06851 - (203)852-1980 - hotline (203)853-0418
Stamford:
Domestic Violence Crisis Center - 141 Franklin Street Stamford, CT 06901 - (203)357-8162 - hotline (203)965-0049
Sexual Assault Crisis Center, Inc. (SACC) Cathy Malloy, Executive Director - 1 Dock Street, Stamford, CT 06902 - (203) 348-9346 SACC provides crisis counseling, advocacy and community education
Torrington:
Susan B. Anthony Project - PO Box 846 Torrington, CT 06790 - (860)482-7133 - fax (860)482-6268 - hotline (860)489-3798 - susanbanthony@snet.net - Works to promote the autonomy of women and the safety of all victims of domestic abuse and sexual assault in northwest CT. Also promotes community action towards ending domestic violence and sexual abuse.
Waterbury:
Women's Emergency Shelter Peggy Panagrossi - PO Box 1503 Waterbury, CT 06721 - (203)753-3613 - fax (203)574-3306 - hotline (203) 575-0036 - Provides emergency shelter and supportive services to victims of domestic violence and sexual assault
Willimatic:
Domestic Violence Program United Services - 132 Mansfield Avenue Willimantic, CT 06226 - (860)456-9476 - hotline (860)456-2261
Northeastern Connecticut Sexual Assault Crisis Service - PO Box 24 Willimantic, CT 06226 - (860)456-2789 - hotline (860)456-3595
Statewide:
Domestic Violence Hotline - (888) 774-2900 - This number connects the caller to the nearest Domestic Violence Program.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

It Takes Two to Tango

2006-04-20T10:53:00.000-05:00

While the U.S. Chamber of Commerce and the Christian Coalition of Alabama attack trial lawyers for undermining the way of life in this country, they each forget that "it takes two to Tango" and there is always a trial lawyer on the "other side". So for example you will find trial lawyers prosecuting and defending each of the following cases:

SOME NEWLY FILED CLASS ACTIONS:Super Steel (allegedly discriminated against and harassed former African American employees) ; WellPoint Inc. (allegedly denied claims and payments to policyholders with high medical costs) ; ExxonMobil, Chevron and BP (allegedly stalled the clean up of a massive oil spill) ;Minnesota College Board (allegedly gave students incorrect scores on SAT tests and refused to correct inflated scores) ;Polar Beverages Inc. and In Zone Brands Inc. (allegedly selling products that could contain cancer causing benzene) ; Amcor (allegedly maintained a price-fixing cartel for cardboard boxes) ;

CLASS ACTION SETTLEMENTS AND VERDICTS:Epson America, Inc. Class action settlement provides $45 credit to printer owners. C.H. Robinson Worldwide Proposed $15 million class action settlement alleging gender discrimination in pay and promotion. MasTec, Inc. $10 million securities fraud class action settlement. Tyson Foods Inc., Cargill Meat Solutions and Swift & Co. $9.25 million class action settlement for using incorrect beef prices to drive down cattle prices. EchoStar Communications Corp. $74 million patent infringement settlement awarded to TiVo.

The Chrisitan Coalition and Politics: A Myopic View of Justice

2006-04-20T08:29:00.000-05:00

The Christian Coalition of Alabama has recently attacked the blasphemous trial lawyers because some political donations of trial lawyers are deemed to undermine traditional Christian family values. I'm just one trial lawyer and I'm active in politics. I believe in the separation of church and state. I believe that the the overriding spiritual law that supersedes all religions relates to truth, kindness, reaching out to the needy and respecting the personal beliefs of all citizens.

Within that framework we have a governmental system that was founded in part because of the need for freedom of religion and we have a bill of rights that establishes some of the fundamental precepts of our government and our society. Unlike most countries we enjoy the freedom of religion, the freedom of assembly, the freedom of speech, the right to bare arms, the right to be free from unreasonable searches and seizures, the right to counsel (and that does mean the right to your very own trial lawyer), the right against self-incrimination, the right to due process of law, the right to be free from cruel and unusual punishment.

Interestingly, many of these rights neatly dovetail because the right to counsel would be meaningless if it was unaccompanied by the right to due process of law and the right to due process of law means that in a courtroom, the the legal battle is on a level playing field.

One of the great fears that people knowledgeable about the law have is when the power of the judiciary is not independent but somehow ends up being controlled by religious institutions or religious beliefs. That will quickly undermine our true democracy. Interestingly, the Republican party is quick to embrace our nations greatest president, Abraham Lincoln. How often have you heard about the party of Lincoln. Well, I just finished reading an outstanding and enlightening biography of Lincoln entitled Team of Rivals : The Political Genius of Abraham Lincoln by Doris Kearns Goodwin. The author shows in striking detail how a man of humble origin grew into a giant among leaders, full of compassion and tolerance. The real Lincoln would not be a member of today's Republican Party.

Furthermore, the Christian Coalition attacks trial lawyers in the most foolish and biased manner. For every case in court there is a trial lawyer on every side. Does the Christian Coalition intend to absolve the trial lawyers that fought in Florida for George W. Bush to win the 2000 election? Does the Christian Coalition wish to condemn the trial lawyers who have contributed generously to conservative causes - who have aided the Skillings, the Lays, the Libbeys and the Roves?

I totally respect your beliefs. I only ask that you not pretend that you are somehow better than anyone else and you demonstrate the same respect back to me that I show to you.

Boycott the U.S.Chamber of Commerce

2006-04-19T15:41:00.000-05:00

In case you didn't see the ad by the U.S. Chamber of Commerce this week in the NY Times, go to the following web site:

http://www.instituteforlegalreform.org/harris/pdf/National_Trial_Lawyer.pdf

If you are outraged as I am, please join in a boycott of the Chamber and its members. This is not a CTLA sponsored action but a Casper & de Toledo action. The following is my repsonse:

BOYCOT THE CHAMBER OF COMMERCE

The United State Chamber of Commerce and its subsidiary Chambers in cities and Towns around the country were designed to be trade organizations calculated to promote networking and to assist businesses in constructive ways. The Chamber has morphed into a giant lobbying mouthpiece for the largest corporations in the country, manipulating think tank reports, many of which are less than scholarly or are unreliable and it is spending the vast resources of its members to foment the economic political agenda of one party. In doing so, the Chamber is seeking to deny to the individual citizens of this country their constitutional rights to redress their grievances in court and to deprive citizens of their right to a jury trial.

Ironically, the Chamber’s campaign deals with so-called “lawsuit abuse” and its ads use the slogan: “DON’T FEED THE TRIAL LAWYERS”. It neglects to advise the reader that businesses and corporations rank as the largest consumers of the services of trial lawyers rather than injured people. Business sue businesses all of the time for the sillyiest reasons. It neglects to tell the reader that most states already have fixed their tort laws by providing penalties against lawyers and litigants for the so-called frivolous lawsuit. And it neglects to tell the reader that the Tillinghast Towers Perrin report on which its fallacious campaign relies has be discredited as lacking in scholarly methodology and skewed by data that has nothing to do with the tort system. Indeed the report’s own authors have admitted that "the costs tabulated in this study are not a reflection of litigated claims or of the legal system."

Ironically, the Chamber relies upon a report that says it is focusing upon the tort system when it is really focusing upon the insurance system. Why else include the cost of insurance company CEO’s excessive compensation as a cost of the tort system? So if the Chamber wants to do a public service to its members, it should be attacking the excesses of insurance companies and HMOs.

Should the Chamber prevail in its wish to do away with the tort system, it will leave us with a court system equipped to deal only with the judicial requirements of big business but it will not succeed in doing away with the costs that the tort system addresses like the medical expenses and lost earnings of the victim. Nor will it provide suitable alternatives for maintaining people who may end up on public assistance or who will no longer be meaningful contributors to our economy.

The Chamber of Commerce inflames its campaign by telling the reader not to “feed the trial lawyers.” But it still wants to feed the trial lawyers of corporate America. It wants to feed the executives who are grossly overcompensated while often defrauding stockholders and consumers. And it wants the judicial system reserved for its members, forgetting about “we the people….”

So in this great country of ours, so long as the U.S. Chamber and its subsidiaries want the Constitution for themselves, we say it is time to boycott these organizations and its members.

Stewart M. Casper
Casper & de Toledo LLC
1458 Bedford St.
Stamford, CT 06905
Tel. (203) 325-8600
Fax (203) 323-5970
Board Certified in Civil Trial Advocacy by the National Board of Trial Advocacy
http://www.casperdetoledo.com

Connecticut & Business Industry Lies About Workers' Compensation Insurance

2006-04-19T15:35:00.000-05:00

I have a unique perspective on the pending workers' compensation debate. I am a member of the CBIA, an employer and as a lawyer I practice workers' compensation insurance.

In case you have not realized it, the CBIA is guilty of being a perpetual fibber (that's mild) when it come to justifying its position on matters before the legislature. Not that it fibs about what it wants but rather it spins out of whole cloth the supposed objective basis that support its positions. This has been true anytime it has lobbied for anything to do with the civil justice sytem and the workers' compensation system. It has in the past refused to provide me, as a member of the CBIA, with the objective documentation for its position or even copies of its committee and board minutes that have embraced its positions.

I urge your support on SB 25 (the elimination of the social security setoff) and SB 217 (permitting Commissioner's to extend discretionary benfits when justified). Voting No on SB 25 is unfair to senior citizens. It makes no sense that a person can work , earn entitlement to social security, earn entitlement to workers' compensation with its insufficient and paltry benefits and then effectively loose the benefit of his/her federal entitlement to social security benefits because it acts as a setoff for workers' comp benefits. I would hope that we live in a society that is more compassionate to its seniors. There is no fiscal or actuarial analysis that could possibly predict this change in the law would cost employers $8 million. There aren't enough cases in the system. At worst, the cost would be about $.50 per worker per week.

Further, it is embarrassing that we cap injured workers' benefits in this fashion. It is arbitrary and unreasonable. The legislature has deemed that the WC commissioners are sufficiently capable to mete out justice to workers and employers alike. I think that the Commissioners can be entrusted with the responsibility of not giving money away arbitrarily. After all, they are already entrusted with great financial responsibility.

In conclusion, I hope that you demand much more form the CBIA than the misguided baloney that you are continually fed. Why you might ask am I a member of the CBIA? The answer has to do with CBIA's competitve medical insurance that I provide to all of my employees and the fact that CBIA cannot exclude me as a member and I get to see many of its disingenuous claims like urging its members to write to you on a form that is already prepared with a vote no and its bogus justifications.

Doctors Want Special Treatment

2006-04-19T15:33:00.000-05:00

Dr. Edward Volpintesta of Bethel has been at it again (New System needed for medical disputes (4/ /06) on behalf of the Fairfield County Medical Society. Their previous plan to take your constitutional rights away was soundly defeated last year by the General Assembly and now the doctor and his cronies are attempting to payoff lobbyists to put forward the idea of a special health court to deal with a system that only they believe is out of control. There is no evidence that the medical liability system is broken so there is no need to fix it. Indeed, most of the problems lie squarely in the laps of insurer and HMO executives who are figuratively raping the doctors and patients alike,

Health care courts are unconstitutional. They take the matter of dispute resolution out of the hands of juries and deprive claimants of their constitutional rights. They are also unaffordable and there is no justification to give doctors their own judicial system. We should all be treated alike. Doctors, lawyers, accountants, machine operators and bad drivers are entitled to the same justice.

There is also no merit that lay jurors cannot understand medical issues. That is wrong. Jurors, particularly Connecticut jurors are intellectually equipped to decide cases involving medicine, the law, engineering, patents and trademarks, antitrust and death penalty criminal cases. Juries are fair and so are our judges. It is an insult to them to suggest that they are not.

Likewise, Dr. Volpintesta is wrong statistically. He makes much of the disproportionate number of malpractice cases that are decided in favor of the doctor. Yet he foolishly ignores the number of medical suits that are settled before trial reflecting the numerous meritorious cases decided in favor of the injured party. The system isn't about greed and corruption except when it comes to the insurance companies and the HMOs.

I have a prescription for Dr. Volpintesta and his cohorts. Take two Tylenol and go to bed. That way you may stop looking for special treatment just because you are doctors. You are like the rest of us. You're not special. You are not some form of deity. You are entitled to the same form of justice. No more and no less.

Connecticut State Medical Society Hides Rather than Fights

2006-04-19T15:22:00.000-05:00

A local physician recently wrote lamenting the cost of health care in the country and the lack of predictability for doctors who commit malpractice and find themselves on the receiving end of a lawsuit, and advocating a separate system of justice for doctors that is being promoted by the health care industry without any acceptance at all by consumers or constitutionalists (Advocate Letters from Readers, April 4).The writer fails to inform the reader that Connecticut's recent adoption of reform legislation is working, and that the problem that physicians unjustifiably experience is price-gouging by their own malpractice insurers.When a malpractice insurer seeks to raise rates unjustifiably, both the doctors and the consumers suffer. Doctors suffer if they pay increased premiums. Consumers suffer because the doctors usually blame them and their lawyers, and place a constitutionally mandated system in the cross-hairs of legislative zealots. Recently, both the Connecticut Medical Society and the Fairfield County Medical Society ran from a prior-rate approval battle, apparently willing to accept another 12 percent rate increase rather than fight an insurance company. Fortunately for the citizens of Connecticut, the Connecticut Trial Lawyers Association came to the rescue and intervened in the hearing before the insurance commissioner's hearing officer, and the rate increase was denied. The doctors have been told that the medical society was protecting their interest. That is untrue.Significantly, the writer also distorts the reality of the existing system. There is no study that proves that doctors are held to any standard other than the "prevailing standard of care" when judged in court. Moreover, our constitutionally mandated system of jury trials applies to everyone and every industry. No one suggests that juries are incapable of understanding the evidence in other technical and scientific areas. They even make life and death decisions in death penalty cases.

Ironically, not only did the Medical Society cut and run from doing battle with an insurance company, but then falsely claimed to its membership that it had indeed protected the interests of its members at the public hearing. That claim was a lie. The transcript of the hearing can be found at: https://www.cttriallawyers.org/index.cfm/hurl/SectionID=118/MaxRows=10/StartRow=1/ReportID=23

Doctors, its time to start telling the political truth. Your patients and our clients would be far better off if we joined together in an alliance to fend off the insurance industry, the HMO's, the CBIA and the U.S. Chamber of Commerce.

Duffusion Tensor Imaging

2006-04-19T14:24:00.000-05:00

Pain. 2006 Apr 5; [Epub ahead of print]
Related Articles,
Links
Determining anatomical connectivities between cortical and brainstem pain processing regions in humans: A diffusion tensor imaging study in healthy controls.Hadjipavlou G, Dunckley P, Behrens TE, Tracey I.Pain Imaging Neuroscience (PaIN) Group, Department of Physiology, Anatomy and Genetics, Oxford University, South Parks Road, Oxford OX1 3QX, UK; Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology, Oxford University, John Radcliffe Hospital, Headington OX3 9DU, UK.Neuroimaging methods have so far identified various structures in the brain involved in the processing of pain and its control. However, our understanding of their anatomical connectivities is relatively weak. Diffusion tensor imaging (DTI), a magnetic resonance imaging-based method, allows in vivo mapping of the anatomical connections in the human brain and was used to investigate the white matter connections originating from the periaquaductal grey (PAG) and nucleus cuneiformis (NCF). We performed DTI on 8 healthy right-handed male volunteers. Group analysis showed that tract paths could be defined and their likelihood quantified for connections between the PAG and separately for the NCF, to the prefrontal cortex, amygdala, thalamus, hypothalamus and rostroventral medial medulla bilaterally. The connections identified confirm the existence of an anatomical circuitry for the functionally characterised top-down influences on pain processing via brainstem structures in humans.PMID: 16616418 [PubMed - as supplied by publisher]

Breast Cancer: Risk Assessment, Risk Reduction, and Advances in Diagnostic and Surgical Techniques

2006-04-19T14:17:00.000-05:00

Return to Medscape coverage of: Oncology World Congress 2005

Breast Cancer: Risk Assessment, Risk Reduction, and Advances in Diagnostic and Surgical Techniques
DisclosuresAlbert B. Lowenfels, MD, FACS
With breast cancer now afflicting nearly 1 in 7 women in the United States, it was entirely appropriate for the first annual Oncology World Congress to dedicate a plenary session to discussing prevention and management of this common tumor. During the past 25 years, the mortality from breast cancer has fallen dramatically. In 1975, breast cancer mortality was 48.3/100,000, whereas by the year 2000, the estimated mortality rate had dropped to 38/100,000. But what is responsible for this gratifying change: More widespread use of screening, or more effective adjuvant therapy? One of the main points emphasized by several speakers was that both factors are important. Based on statistical models, roughly 46% of the reduction can be attributed to the effects of screening, with the residual decreases related to more effective adjuvant therapy.[1]
Preventing Breast Cancer in High-Risk Women
Victor G. Vogel, MD, MHS, Professor of Medicine and Epidemiology at the University of Pittsburgh, Pennsylvania, opened the discussion of breast cancer risk assessment and reduction by pointing out that invasive ductal breast cancer develops during several years, implying that to be effective, preventive measures must be instituted well before the onset of cancer. Many preventive agents, such as tamoxifen, act by blocking estrogen receptors, thereby interfering with the transcription process.
In 1998, Fisher and coworkers[2] reported the results of the large US tamoxifen breast cancer prevention trial, which demonstrated that therapy with tamoxifen caused a dramatic reduction in breast cancer incidence. Compared with placebo, tamoxifen use resulted in a 49% overall risk reduction, seen in all age groups and in all risk categories. The effect was particularly strong in women with atypical hyperplasia. Similar results were noted in 2 European trials reported during the same year.[3,4]
Despite its great promise, the use of this effective agent comes with significant drawbacks, mainly because it has potentially serious cardiovascular side effects. Dr. Vogel summarized the current strategies for patient selection as shown in the table.
Table 1. Indications and Potential Contraindications for Tamoxifen Usage
Positive Considerations
Possible Contraindications
History of lobular cancer in situ, lobular hyperplasia, or DCIS.
Prior stroke, TIA, DVT, pulmonary embolus
Premenopausal women with known BRCA1 or BRCA2 mutations
Cataracts (history or surgery)
Premenopausal women ≥ 35 years with 5-year probability of breast cancer ≥ 1.66% or postmenopausal women with 5-year risk for breast cancer ≥ 1.66% and favorable risk-benefit ratio*
Current hormone replacement therapy
*Risk as calculated from Gail model.[5]TIA = transient ischemic attack; DVT = deep vein thrombosis; DCIS = ductal carcinoma in situ
Patient-specific information about using the Gail model[5] for calculating a woman's risk for breast cancer can be obtained at: http://bcra.nci.nih.gov/brc/. This site provides a convenient way to calculate a woman's likelihood of developing breast cancer. For example, for a 55-year-old woman without ductal carcinoma in situ (DCIS), with a prior breast biopsy showing atypical hyperplasia, onset of menarche 12-13 years, first child born when patient was older than 30 years, and whose mother or sister had breast cancer, the risk for breast cancer would be 5.4%, compared with the population average of 1.5%.
Other preventive drug trials are currently under way. For example, the aim of the STAR trial (Study of Tamoxifen and Raloxifene) is to compare the effectiveness of tamoxifen and raloxifene in preventing breast cancer. Already, 19,000 women have joined the study with results expected to be reported in 2006.[6]
Role of Magnetic Resonance Imaging in Breast Cancer Screening
Despite the known effectiveness of mammography as a breast cancer screening tool, the effort to identify even better screening tools continues. How effective is magnetic resonance imaging (MRI) screening and when should it be used? Bruce L. Daniel, Associate Professor of Radiology, Stanford University, California, began his discussion by pointing out that mammography misses some tumors, and that cancers can develop between regular screening examinations. MRI has been available since 1986 and is performed after intravenous injection of a contrast agent, gadolinium, which enhances tumor visualization, perhaps because blood vessels in the tumor selectively pick up gadolinium.
A major advantage of MRI is that it detects small tumors without subjecting the patient to any radiation. But the technique is expensive ($1500-$3500) compared with $200-$300 for conventional mammography. Although, as yet no studies have reported that MRI breast screening results in improved survival, some have found that in high-risk women, MRI is more sensitive than mammography for discovery of small tumors.[7,8] Dr. Daniel concluded with these take-home points: (1) MRI screening is not recommended for the general population, but should be reserved for women at high risk for breast cancer; (2) women should be educated about the possibility of false-positive results; and (3) positive tumor results need to be confirmed with MRI-guided biopsy. These recommendations support those developed by a 2005 consensus conference on the use of MRI scans to detect breast cancer.[9]
Ductal Carcinoma in Situ: Who Should Receive Radiation and Hormonal Therapy?
Ductal carcinoma in situ (DCIS) afflicts an estimated 55,000 women in the United States each year, and questions about how to treat patients with this lesion continue to stir controversy among surgeons and oncologists. After adequate local tumor excision, do women with DCIS benefit from additional radiotherapy and tamoxifen? D. Lawrence Wickerham, MD, Associate Professor of Human Oncology, Drexel University School of Medicine, Pittsburgh campus, presented evidence favoring the use of radiotherapy and chemotherapy for patients diagnosed with DCIS. His recommendations are based on results of the US cooperative NSABP B-17 trial, which demonstrated that radiotherapy reduced the risk for recurrence by over 50%, and the NSABP B-24 trial, which found that adding tamoxifen resulted in an even greater benefit.[10]
Although he agrees that adjuvant therapy helps some patients with DCIS, Michael Lagios, MD, Clinical Associate Professor Pathology, Stanford University Medical Center, San Francisco, believes that for a subset of patients, radiotherapy therapy may be unnecessary. Omitting radiotherapy for this group would avoid the inconvenience of multiple trips to the hospital for radiotherapy for several weeks. This group includes women with small, less aggressive tumors with wide margins of excision. Selecting this subgroup of patients requires extremely meticulous examination of the resected specimen with many samples and the benefit of an experienced breast pathologist.
Participants in this session did not reach a firm agreement on the need for adjuvant therapy in every patient with DCIS. An analysis of the cost-effectiveness of radiation therapy following conservative surgery for DCIS estimated that radiotherapy adds roughly 0.09 extra years (about a month) of quality-adjusted life years (QALYs) at a cost of about $36,700 per QALY.[11] With respect to tamoxifen, 1 study from a large cancer center found that approximately one third of patients with DCIS eventually were offered and decided to accept tamoxifen therapy.[12]
Identification of Patients for Prophylactic Surgery
Is there a role for prophylactic breast removal in the small subset of women for whom the risk for breast cancer is very high? Benjamin O. Anderson, MD, Professor of Surgery, University of Washington, Seattle, presented information on the surgeon's role in identifying and treating these women. As did the other speakers, Dr. Anderson believes that the Gail model is the best available tool for risk estimation, allowing the oncologist and the surgeon to determine the likelihood that breast cancer will develop. For example, if the patient's family history is positive and if the patient has DCIS, then the risk for breast cancer is 11-fold higher than that of the general population. But the Gail model may underestimate the risk for cancer because it does not consider paternal family history, history of ovarian cancer in the family, or the age of onset of familial cancer.
We now know that BRCA1 and BRCA2 mutations greatly increase the lifetime risk for breast cancer, making patients who carry these genetic markers candidates for prophylactic ablative breast surgery. Testing should follow these steps: (1) obtain a complete family history to determine whether or not the patient belongs to a high-risk family; (2) test the affected person; and (3) if a known breast cancer gene is found, then consider testing other members of the family.
The main surgical option for high-risk patients is bilateral mastectomy. Because small amounts of residual breast tissue may be left attached to the chest wall, bilateral mastectomy reduces the risk for breast cancer by approximately 90%, rather than 100%.[13,14] Therefore, although this procedure greatly reduces the risk for eventually developing breast cancer, patients (and their physicians) must still be concerned about the small but real possibility of a breast cancer developing in residual breast tissue. Such prophylactic surgery does eliminate the need for screening mammography, however.
Other options are available for reducing the burden of breast cancer in high-risk women. Contralateral mastectomy is an option for women with unilateral breast cancer and a strong family history. Again, it does not completely eliminate the risk for contralateral breast cancer. Bilateral prophylactic oophorectomy reduces the risk for cancer in BRCA1 and BRCA2 carriers by roughly 50%; as an additional benefit, it eliminates the risk for ovarian cancer.[15]
Although prophylactic mastectomy is a disfiguring operation performed on an organ without known disease, for selected patients the procedure is beneficial. Reconstructive methods using muscle flaps, implants, or a combination of both methods are now available to improve the overall cosmetic result.
Summary
This plenary session focused on the dramatic improvements in the diagnosis, treatment, and prevention of breast cancer that have taken place during the past 25 years. Some of the key points covered include:
Mammographic screening and adjuvant therapy play roughly equal roles in reducing the overall burden of breast cancer;
Clinical trials demonstrate about a 50% reduction in breast cancer risk following the use of tamoxifen; however, the use of estrogen antagonists must be balanced against the added risk for cardiovascular disease, especially in obese, elderly patients;
Other drug trials using different, perhaps safer agents are under way with results anticipated during 2006;
The risk for recurrent cancer in women with DCIS can be reduced with adjuvant therapy, but controversy remains about whether all women need additional therapy, or whether there are women with favorable profiles for whom additional treatment may not be required;
Prophylactic surgery reduces the risk for breast cancer by about 90% and is an option for selected high-risk patients, ie, women with BRCA1 or BRCA2 mutations; and
Further advances in breast cancer prevention and therapy will depend on the continued recruitment of large numbers of patients for randomized clinical trials. Sales of the breast cancer research stamp (Figure) provide research funding for many breast cancer projects.
Figure. Through 2004, purchasing the 45-cent first-class breast cancer stamp has provided approximately $12.2 million for breast cancer research.
References
Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353:1784-1792. Abstract
Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371-1388. Abstract
Veronesi U, Maisonneuve P, Costa A, et al. Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women. Italian Tamoxifen Prevention Study. Lancet. 1998;352:93-97. Abstract
Powles T, Eeles R, Ashley S, et al. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet. 1998;352:98-101. Abstract
Costantino JP, Gail MH, Pee D, et al. Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst. 1999;91:1541-1548. Abstract
Wickerham DL. Tamoxifen's impact as a preventive agent in clinical practice and an update on the STAR trial. Recent Results Cancer Res. 2003;163:87-95. Abstract
Kriege M, Brekelmans CT, Boetes C, et al; Magnetic Resonance Imaging Screening Study Group. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004;351:427-437. Abstract
Leach MO, Boggis CR, Dixon AK, et al; MARIBS study group. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 2005;365:1769-1778. Erratum in: Lancet. 2005;365:1848.
Silverstein MJ, Lagios MD, Recht A, et al. Image-detected breast cancer: state of the art diagnosis and treatment. J Am Coll Surg. 2005;201:586-597 Abstract
Fisher B, Land S, Mamounas E, et al. Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the national surgical adjuvant breast and bowel project experience. Semin Oncol. 2001;28:400-418. Abstract
Suh WW, Hillner BE, Pierce LJ, et al. Cost-effectiveness of radiation therapy following conservative surgery for ductal carcinoma in situ of the breast. Int J Radiat Oncol Biol Phys. 2005;61:1054-1061. Abstract
Yen TW, Hunt KK, Mirza NQ, et al. Physician recommendations regarding tamoxifen and patient utilization of tamoxifen after surgery for ductal carcinoma in situ. Cancer 2004;100:942-949.
Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340:77-84. Abstract
Meijers-Heijboer H, van Geel B, Van Putten WL, et al. Breast cancer after prophylactic bilateral mastectomy in women with BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345:159-164. Abstract
Rebbeck TR, Levin AM, Eisen A, et al. Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst. 1999;91:1475-1479. Abstract
Copyright © 2006 Medscape.

Stewart M. Casper & Victoria de Toledo named by Connecticut Magazine to Superlawyer List

2006-04-19T09:15:00.000-05:00

Among their many accolades, partners Stewart M. Casper and Victoria de Toledo have been named to Connecticut Magazine's list of "Superlawyers". Casper, in the field of medical malpractice and de Toledo, in the are of Employment law. While neither Casper nor de Toledo think the designation itself is significant, it does create a background of recognition that each has achieved the highest stature in their respective fields. This recognition like comparable recognition in Best Lawyers in America, "New York Magazine", "Westchester Magazine" and their "AV" rating in Martindale Hubbell signifies that both Casper and de Toledo have reached the nadir of respect by their peers. They have strived to bring excellence to their work as trial lawyers winning respect for their tenacity and creativity representing clients in personal injury (motor vehicle accidents, slip and fall, premises liability); medical malpractice (failure or delay in diagnosis, birth trauma, treatment below theaccepted standard of care) and employmnet matters including discrimination, sexual harassment, wrongful termination and severance packages. Learn more about Casper & de Toledo LLL by going to its web site: http://www.casperdetoledo.com

Connecticut Residents - Support Raised Bill 25

2006-04-19T09:13:00.000-05:00

Raised Bill 25 is really a modest effort the undo one of the draconian changes pressed and passed several years ago by big corporatrions and their lobbyists with the objective of saving some money in workers' compensation premiums. The net effect of those insurance industry and big business changes is that injured workers in Connecticut suffer through a broken and dilapidated system where the benefits are paultry, insurance company delay is not punished but instead rewarded; where the Compensation Commissioners are overworked and without power to enter pendent lite orders during the pendancy of the claim.

Raised Bill 25 corrects one of the greatest injustices perpetrated on working senior citizens. It deals with an offset provision under the workers' compensation law. If a senior citizen is still working and suffers an injury, the employer's workers' compensation insurer is allowed to reduce the paultry workers' compensation benefits by the amount of the injured workers social security benefit. So lets put this in perspective. My Uncle Joe is 65 years old. He chooses not to retire because he hasn't saved enough for retirement and the additional cost of supplemental insurance and the prescription drug program. His years of work have also entitled him to receive social security benefits. But here's the kicker. He gets hurt on the job one week after his 65th birthday and cannot work any longer. Because he would be entitled to social security benefits and workers' compensation benefits, the insurers and their lobbying outfit the CBIA (Connecticut Business and Industry Association) think that it is alright to reduce Joe's workers' compensation benefits by the amount of his social security benefits. Doesn't seem fair to me. If he was 55 and not entitled to social security benefits he would receive both of those benefits for which he worked. If his workers' compensation benefits are reduced by the amount of the social security benefits, then this as if the state is coming in an taking away his earned federal benefit or if you look at it another way, just because Joe's a senior citizen, he gets less. What is the cost of this addional protection for our senior citizens? Less that .5%. That's right, the CBIA and the insurance industry has found another way to kick our senior citizens for just .5%.

It isn't OK to mistreat our senior citizens.

Insurance Companies and Medical Goups Lie to Get Their Way

2006-04-19T06:50:00.000-05:00

1
MEDICAL MALPRACTICE & LIABILITY – JUST THE FACTS
Proponents of so-called medical liability “reform” assert relentlessly that jury awards in
malpractice cases are out of control and that capping damage awards will lower premium costs
for doctors. They claim too that the tort system dramatically escalates healthcare costs
generally, and that a “crisis” exists in many states because doctors are abandoning the practice
of medicine due to the high cost of malpractice insurance premiums. The truth is that not one
of these assertions is based in fact. By examining the studies, statements and conclusions of
independent experts and governmental entities, the true story can be told.
Caps DO NOT Lower Malpractice Premiums, Just Ask…
Weiss Ratings, Inc - Weiss Ratings is an independent organization that evaluates the financial strength of
numerous institutions, especially insurers. According to a study by the U.S. General Accounting Office
(GAO), Weiss’ insurance ratings were proven to be more accurate than any of the other rating
agencies. Recently, Weiss concluded that capping malpractice damages does not lower insurance premiums
for doctors. Specifically, they found:
• That despite caps on economic damages enacted in 19 states, “most insurers continued to increase
premiums (for doctors) at a rapid pace, regardless of caps.” (Weiss Report 6/3/03)
• That caps did not reduce awards, they only slowed the increase in the size of awards paid by
malpractice insurers, and insurers failed to pass along any savings to those physicians in states with
caps, refusing even in those states to lower physicians’ insurance premiums. (Weiss Report, 6/3/03)
• That the median annual premium between 1991 and 2002 actually increased more in states with caps
(48.2 percent) than in states without caps (35.9 percent). (Weiss Report, June 2003)
• That in states with caps on non-economic damages, doctors generally fared worse than doctors in
states without caps. The report stated: “[D]octors in states with caps actually suffered a significantly
larger increase in insurance costs than doctors in states without caps.” (Weiss Report, 6/3/03)
The Medical Liability Monitor –The Monitor monthly publishes the latest information on medical
liability insurance rate. Its annual rate survey, reported by state and by medical specialty (e.g.,
internal medicine, general surgery, ob/gyn) reports the medical liability insurance rates of all the
major insurers of physicians in the United States. Its data is the most comprehensive anywhere and
is cited by government agencies, legislative bodies and major media. It found that:
• States with caps on damages have average insurance premiums that are 9.8% higher than insurance
premiums in states without caps on damages. (Medical Liability Monitor, October, 2004)
• In the five states that recently passed new medical malpractice caps, premiums rose at nearly double
the rate as states that did not pass a damage cap. Those states are: MS, NV, OH, OK and TX.
(Medical Liability Monitor, October, 2004)
A Leading Texas Medical Malpractice Study – “Stability, Not Crisis: Medical Malpractice Claim Outcomes
in Texas,” is the most extensive examination to date of a state’s medical malpractice claims and its potential
correlation to malpractice insurance premiums. The study was done by leading law and medical school
professors out of the University of Texas, University of Illinois, and Columbia University. The researchers
reviewed every medical malpractice claim resolved by an insurer in Texas over a fifteen year period
beginning in 1988. Their findings include the following:
• “The data present a picture of remarkable stability in most respects and slow, predictable change in
others.”
2
• “We find no evidence of the medical malpractice crises that produced headlines over the last several
years and led to legal reform in Texas and other states.”
• “The rapid changes in insurance premiums that sparked the crises appear to reflect insurance market
dynamics, largely disconnected from claim outcomes.”
• The three biggest insurers in the state have increased rates by an average of 135% over the last five
years (1999-2003). However, data from the Texas Department of Insurance shows that the number of
claims, the value of claims, and the rate of claims per physician have all remained constant or
declined over the last decade.
The National Bureau of Economic Research (NBER) – NBER, founded in 1920, is the nation's leading
nonprofit economic research organization. Twelve Nobel Prize winners in Economics and three past
Chairmen of the President's Council of Economic Advisers have been researchers at NBER. Their
research found little relationship between caps and premium costs. Their findings:
• “There is a fairly weak relationship between malpractice payments (for judgments and settlements)
and premiums – both overall and by specialty.” (pg. 14).
(http://www.dartmouth.edu/~kbaicker/BaickerChandraMedMal.pdf)
• “Past and present malpractice payments do not seem to be the driving force behind increases in
premiums. Premium growth may be affected by many factors beyond increases in payments, such as
industry competition and the insurance underwriting cycle. (pg. 20).
(http://www.dartmouth.edu/~kbaicker/BaickerChandraMedMal.pdf)
The state of California, whose MICRA law is commonly touted as an example of how caps on damages can
lower malpractice premium – California did not see lower premiums until it enacted insurance reform.
• “California doctors’ premiums increased by 450% in the first 13 years after the 1975 passage of
MICRA and only began to decrease after voters enacted the insurance reform initiative known as
Proposition 103.” (Foundation for Taxpayer and Consumer Rights, “How Insurance Reform
Lowered Doctor's Medical Malpractice Rates In California...And How Malpractice Caps Failed,”
March 2003, http://www.consumerwatchdog.org/healthcare/rp/rp003103.pdf)
• "While MICRA was the legislature's attempt at remedying the medical malpractice crisis in California
in 1975, it did not substantially reduce the relative risk of medical malpractice insurance in
California." (James Robertson, Assistant Vice President and Associate Actuary, SCIPIE Indemnity
Company (California's second largest medical malpractice insurer), in written testimony responding
to a question from an administrative law judge who is overseeing a case in which SCIPIE has
requested a 15.6 % rate hike. April 30, 2003)
The state of Texas, whose second largest insurer recently asked for a rate increase despite the state having
passed caps in 2003.
• Texas enacted medical malpractice caps in 2003, and despite the caps the state’s second largest
insurer has requested a 19% rate increase. Medical Protective, a leading insurer, claims on its
website that caps are “critical,” but then admits in its filing that caps do not lead to any significant
savings. In the filing requesting a rate increase Medical Protective stated, “‘Noneconomic damages
are a small percentage of total losses paid. Capping noneconomic damages will show loss savings of
1.0%.’…And yet a white paper dated March 2004 and posted on the Medical Protective website states
that capping noneconmic damages is a ‘critical element [of tort reform] because in recent years we
have seen noneconmic damages spiraling out of control.’” (The Wall Street Journal, 10/28/04, A6,
“Malpractice Insurer Sees Little Savings in Award Caps”)
The award winning publication Modern Physician - Modern Physician reported the results of a study which
concluded that high premiums have to do with factors other than the litigation system.
3
• The article stated, “The real drivers of the rise in premiums over the past four years have been low
interest rates, a sour national economy and the legacy of overly aggressive pricing policies in the
years before the ‘crisis’ began in late 2000, according to the report.” (“Cycles, not suits, drive med
mal trends: study,” Modern Physician, October 15, 2004)
Many of those who support medical malpractice caps – even many tort reform “experts” and insurance
company executives, admit that caps will not significantly lower premiums.
• “[M]any tort reform advocates do not contend that restricting litigation will lower insurance rates, and
‘I’ve never said that in 30 years.’” (Victor Schwartz, General Counsel, American Tort Reform
Association, Business Insurance, July 19, 1999)
• “Insurers never promised that tort reform would achieve specific premium savings . . .” (March 13,
2002 press release by the American Insurance Association)
• “Tort reform” advocates have long rejected the notion that enactment of caps on damages would
lower insurance rates See: http://centerjd.org/air/pr/Quotes.pdf
• "We wouldn't tell you or anyone that the reason to pass tort reform would be to reduce insurance
rates." (Sherman Joyce, President of the American Tort Reform Association, as quoted in "Study
Finds No Link Between Tort Reforms and Insurance Rates," Liability Week, July 19, 1999)
• “In 1986, after insurers and doctors lobbied for, and Florida lawmakers enacted, a cap on nonecomic
damages for medical malpractice claims, insurers Aetna and St. Paul increased doctors’ premiums.
The companies argued that, despite earlier promises, malpractice caps do not actually lead to savings
for doctors, much in the manner of Medical Protective in its recent Texas filing.” (News Release
from Foundation for Taxpayer and Consumer Rights, “Nation’s Largest Medical Malpractice Insurer
Declares Caps on Damages Don’t Work, Raises Docs’ Premiums,” 10/26/04)
• "No responsible insurer can cut its rates after a [medical malpractice tort 'reform'] bill passes." (Bob
White, President of First Professional Insurance Company, the largest medical malpractice insurer in
Florida, talking about a proposed $250,000 cap in the January 29, 2003 Palm Beach Post)
Caps DO NOT Affect Overall Healthcare Costs, Just Ask…
The Congressional Budget Office (CBO) – CBO reported that caps will not significantly reduce overall
healthcare costs.
• It concluded that limiting or capping damage awards to victims would “only lower health care costs
by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be
comparably small.” (Congressional Budget Office, “Limiting Tort Liability for Medical
Malpractice,” 1/08/04)
• Malpractice costs amounted to “less than 2 percent of overall health care spending. Thus, even a
reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about
0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably
small.” (Congressional Budget Office, “Limiting Tort Liability for Medical Malpractice,” 1/08/04)
Even the Budget Submitted by the Bush Administration – the Administration’s FY ’05 Budget did not state any
savings as a result of caps.
• Despite their claims that severe caps on damages for victims will result in lower health care costs, the
Bush-Cheney budget for 2005 does not include any healthcare savings associated with these caps.
(Bush-Cheney FY2005 Budget)
Despite Claims About “Defensive Medicine,” Americans are NOT Getting the
Care They Need, Just Ask…
4
The CBO disputes the claim that litigation is prompting doctors to practice “defensive medicine.”
• According to CBO’s 2004 study: “Proponents of limiting malpractice liability have argued that much
greater savings in health care costs would be possible through reductions in the practice of defensive
medicine. However, some so-called defensive medicine may be motivated less by liability concerns
than by the income it generates for physicians or by the positive (albeit small) benefits to patients. On
the basis of existing studies and its own research, CBO believes that savings from reducing defensive
medicine would be very small.” (Congressional Budget Office “Limiting Tort Liability for
Malpractice,” 1/8/04)
The Institute of Medicine Institute of Medicine study, To Err is Human: Building a Safer Health
System, concluded that as many as 98,000 Americans die every year from medical errors.
Henry J. Kaiser Family Foundation The survey found that 78% of people believe the quality of
health care has stayed the same or worsened over the past five years, and 55% say they are
dissatisfied with the quality of their health care. (“National Survey on Consumers’ Experiences With Patient
Safety and Quality Information” - The Kaiser Family Foundation/Agency for Healthcare Research and Quality/Harvard
School of Public Health, November, 2004
High Premiums are the Result of Insurance Industry Conduct, Just Ask…
USA Today – the newspaper concluded that losses in investment income led to high premiums.
• “Insurance companies are boosting rates partly to make up for price wars in the 1990s, when
competition kept premiums low, and to counter recent declines in their investment incomes. That
investment profit had helped offset losses from malpractice damage awards and the artificially low
premiums charged to doctors.” (USA Today, “Hype Outraces Facts in Malpractice Debate,” 3/5/03)
General Counsel for the American Tort Reform Association (ATRA) – stated that insurance was less
expensive in the 1990s due to the investment market.
• "Insurance was cheaper in the 1990s because insurance companies knew that they could take a
doctor's premium and invest it, and $50,000 would be worth $200,000 five years later when the claim
came in. An insurance company today can't do that." (Victor Schwartz, general counsel to the
American Tort Reform Association, "Dose of Legality," Honolulu Star-Bulletin, April 20, 2003)
Americans for Insurance Reform – A coalition of public interest organizations found that malpractice
premiums increase when investment values decrease.
• “Since 1975, the data shows that in constant dollars, per doctor written premiums - the amount of
premiums that doctors have paid to insurers - have gyrated almost precisely with the insurer’s
economic cycle, which is driven by such factors as insurer mismanagement and changing interest
rates.” (AIR, 10/10/02)
Weiss Ratings – Weiss found that “mismanagement” by insurance companies caused problems.
• A June 2003 study by non-partisan, independent Weiss Ratings, Inc., “Medical Malpractice Caps:
The Impact of Non-Economic Damage Caps on Physician Premiums, Claims Payout Levels, and
Availability of Coverage,” blamed “mismanagement” for the industry’s woes, and labeled the focus
on caps an attempt by “insurance companies and their supporters . . . to divert the public’s attention
away from long years of mismanagement.” (Weiss Report, 6/3/03)
The Wall Street Journal – A Journal headline stated “Insurers’ Missteps Helped Provoke Malpractice
‘Crisis.’”
5
• The Journal showed in detail how one insurer, St. Paul, released excessive reserves, triggered a price
war, and ultimately with other insurers had inadequate reserves to cover payouts, triggering sharp
hikes in premiums. (WSJ, 6/24/02)
The Weiss Report – in 2003, Weiss concluded that Inflation and Other Insurance Industry Forces Drove Up
Doctors’ Insurance Premiums More Than Med Mal Suits.
• They concluded that other factors, aside from medical malpractice suits, play a much larger role in
driving up doctors’ med mal premiums. These factors “continue to drive – med mal premiums up,
evidently overwhelming any reduction in jury awards.” The factors include, among other things, 75
percent inflation in medical costs and dramatic declines in insurers’ investment income as the stock
market collapsed. (Weiss Report, 6/3/03)
Doctors are not Leaving - Their numbers are actually Increasing, Just Ask…
The U.S. General Accounting Office – GAO concluded that the percentage of physicians was actually
increasing and questioned the data used by the AMA in labeling certain states so-called “medical
malpractice crisis states.”
• “The U.S. physician population increased 26 percent, which was twice the rate of total population
growth, between 1991 and 2001. During this period the average number of physicians per 100,000
people increased from 214 to 239.” (GAO Report, “Physician Workforce,” October 2003)
• Their report questioned the data used by the AMA to make its liability “crisis” state determinations.
The GAO noted that an AMA survey on physicians cutting back services had a response rate of only
10% and did not specify cutbacks in specific services. And while the Florida Medical Association
reported that the neurosurgeons in two counties had ceased practicing, the GAO says it found at least
five such specialists at work in each county. (See Modern Physician, 10/1/03)
• The GAO also concluded that, "(M)any of the reported physician actions and hospital-based
service reductions were not substantiated or did not widely affect access to health care."
(Government Accounting Office, Implications of Rising Premiums on Access to Health Care, GAO-
03-836 Aug. 2003)
The American Medical Association – the AMA itself reported an increase in the number of practicing
physicians.
• The number of physicians has risen in every state every year over the last 3 years (of available data –
2000–2002), and the numbers of physicians are higher in every state than they were in 1996.
(American Medical Association, “Physician Characteristics and Distribution in the U.S.,” 2003-2004
edition)
• The number of physicians per 100,000 people has risen in every state every year over the last 3 years.
(American Medical Association, “Physician Characteristics and Distribution in the U.S.,” 2003-2004
edition)
There are no “run away jury awards” - Jury Awards are Decreasing, Just Ask…
The U.S. Department of Justice – DOJ found that jury awards are steadily decreasing.
• In studies done in 1995 and 2004, the median plaintiff award in tort cases has dropped from $50,000
in the 1990s to $37,000 by 2001. (www.ojp.usdoj.gov/bjs/civil.htm#state; University of Chicago Law
Review, Winter 1998)
• Between 1992 and 2001 the number of jury trials with punitive damages remained stable (4%
to 6%) and the median punitive damage award decreased slightly from $63,000 to $50,000.
6
(Civil Trial Cases and Verdicts in Large Counties, 2001, Thomas H. Cohen, Steven K. Smith, Bureau
of Justice Statistics, 2004)
Malpractice Filings are Decreasing – Just Ask…
The National Center for State Courts (NCSC) - NCSC found that medical liability filings have dropped.
• Their research in 2002 showed that since 1992, medical malpractice filings per 100,000 populations
have fallen by 1%. (National Center for State Courts, “Examining the Work of State Courts 2002”)
Lowering Premiums & Increasing Access to Healthcare is not the “Tort
Reformers” True Agenda, Just Ask…
The General Counsel for the American Tort Reform Association (ATRA) – admitted that so-called “frivolous”
malpractice cases are “very rare.”
• "There is no question that it is very rare that frivolous suits are brought against doctors. They are too
expensive to bring." (Los Angeles Times, October 22, 2004)
Chief Executive of CA malpractice insurer – stated that the tort system is not to blame.
• "I don't like to hear insurance-company executives say it's the tort system - it's self inflicted."
(Donald J. Zuk, chief executive of Scpie Holdings Inc., a leading malpractice insurer in California,
Wall Street Journal, June 24, 2002)
The highly regarded publication Business Insurance - Business Insurance reported that limiting awards to
injured patients, not lowering insurance rates for doctors, is a primary focus of ATRA.
• They reported that “Sherman Joyce, president of the American Tort Reform Assn.” said “tort reform
is not just about lower insurance rates. ‘We think the real focus (of tort reform) should be on
(restricting) the payment of punitive damages,’ rather than on lowering insurance costs, he said.”
(Business Insurance, 7/19/99)
Insurance Company Witnesses - insurers told the Florida legislature that there was no problem with
“frivolous lawsuits.”
• In August 2003, tort reform advocates, including insurance industry executives, were forced to admit
their arguments lacked merit after they were placed under oath by the Florida Senate Judiciary
Committee. The St. Petersburg Times reported: “The Senate Judiciary Committee, frustrated by the
conflicting information given it by different interest groups, discredited much of the medical
malpractice rhetoric by placing witnesses under oath. Suddenly, there were no frivolous lawsuits and
Florida was a profitable place for insurance companies to do business after all.” (St. Petersburg
Times, 8/17/03)
Political Professionals and pollsters – for political purposes, powerful interests have set an agenda that
deliberately paints trial lawyers as evil.
• Karl Rove, according to the book “Bush’s Brain,” admitted to being the mastermind behind pushing
the tort reform agenda. Rove stated, “The two issues, education and juvenile justice, were on his
agenda list. … Later, we added tort reform. I sort of talked him (George W. Bush) into that one.”
(Washington Post, 2/25/03)
• GOP pollster Frank Luntz wrote to GOP candidates: “It’s almost impossible to go too far when it
comes to demonizing lawyers. Make the lawyer your villain.” (“The Attack on Trial Lawyers and
Tort Law,” A Commonweal Institute Report, October 1, 2003; St. Paul Pioneer Press, 7/18/04)
7
Spokesperson for the American Insurance Association, Dennis Kelly - admitted that reducing prices is not
the goal of insurance companies.
• “‘We have not promised price reductions with tort reform,’ said Dennis Kelly, an American
Insurance Association spokesman.” (Chicago Tribune, 1/3/05)

FDA Recalls Another Medical Device for Spinal Surgery

2006-04-18T15:07:00.000-05:00

Medscape Alert
Spinal Fixation System Recalled Due to Potential for Failure

Yael Waknine

April 18, 2006 — The US Food and Drug Administration (FDA) and Blackstone Medical, Inc, have notified healthcare professionals via letter regarding the recall of a modular spinal fixation system (ICON) due to the potential for component failure after device implantation.

The device's pedicle screws may separate from the screw heads, or from the rods that run between spinal segments, according to an alert sent yesterday from MedWatch, the FDA's safety information and adverse event reporting program.

The FDA notes that the associated potential for injury may vary with the condition being treated and the degree of postoperative healing; if separation occurs soon after surgery, the spine may not fuse properly and further corrective surgery may be required to avoid long-term pain and disability.

Of approximately 484 devices implanted since initial marketing in June 2005, 4% have required surgical removal or revision due to looseness. No deaths or serious injuries other than surgeries required for removal have been reported to the company thus far.

Although the company considers it unlikely that the loosening will continue to occur at this time due to progression of postoperative healing, hospitals and surgeons are requested to contact patients who have received the recalled products.

The fixation system consists of screws, connectors, and rods that form a construct for implantation in and near the patient's spine for the purpose of spinal immobilization and stabilization.

Healthcare professionals are encouraged to report adverse events related to use of the spinal fixation device to the FDA's MedWatch reporting program by phone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane, Rockville, MD 20852-9787.

The U.S. Chamber of Commerce Lies to Steal Your Constitutional Rights

2006-04-18T11:35:00.000-05:00

Latest U.S. Chamber Propaganda Seeks to Eliminate Corporate Accountability
Related News

(Monday, March 27, 2006 -Washington DC)—In response to new propaganda from the U.S. Chamber of Commerce, Ken Suggs, President of the Association of Trial Lawyers of America (ATLA), today issued the following statement:

"The Chamber, in its never-ending campaign to deceive the American public, has issued yet another bogus survey, releasing its meaningless results with all the solemnity of a crooked undertaker. And they don’t even have the good sense to be embarrassed about it.

"The Chamber’s “survey” is merely a poll of corporate counsel. Asking lawyers representing the wealthiest corporations in the world how they feel about a civil justice system that protects the rights of even the weakest among us is like asking bank robbers how they like the criminal justice system. Companies out for power and profit sure don’t want any checks or balances.

"The Chamber’s constant harping about the civil justice system only goes to show it has no respect for a Constitution of the United States that guarantees the right of individuals to hold even the most powerful wrongdoers accountable or for the men and women who serve on juries. Tom Donohue and his henchmen should be ashamed.

"Even the guy who conducted the survey admits that ranking the various civil justice systems is an impossible task. And is anyone surprised to find states that afford consumers the most legal protections are the lowest ranking? Those living in states with civil justice systems ranked highly by the Chamber should be concerned – what’s good for the corporate interests likely is bad for the consumer. The entire exercise is absurd.

"The survey makes one thing very clear: The drug and oil industries, big insurance companies and other large corporations will do and say anything to continue lining their pockets with the money of people they abuse, both intentionally and unintentionally."

###

As the world's largest trial bar, ATLA promotes justice and fairness for injured persons, defends the constitutional right to trial by jury, and strengthens the civil justice system through education and disclosure of information critical to public health and safety. With 60,000 members worldwide, ATLA provides lawyers with the information and professional assistance they need to serve clients successfully and protect the democratic values of the civil justice system.

See the following fact sheet:

http://www.atlanet.org/pressroom/PressReleases/2006/ChamberAdRebuttal.pdf

African-American & Hispanic WomenMore Vulnerable in Breast Cancer Outcomes

2006-04-18T11:30:00.000-05:00

Mammography Rates Tied to Ethnic Disparities in Breast Cancer Outcomes

NEW YORK (Reuters Health) Apr 17 - Although breast cancer survival overall has increased in recent years, African-American women still tend to have more advanced disease upon diagnosis and higher mortality compared with white women. Results of a large prospective study reported in the April 18th issue of Annals of Internal Medicine suggest that varying mammography-screening intervals may account for some of that difference.

Another study in the Annals supports the use of telephone call reminders and "prevention care managers" to facilitate cancer screening among women.

Dr. Rebecca Smith-Bindman of the University of California in San Francisco, and colleagues examined the role of patterns of mammography use by linking data from the Breast Cancer Surveillance Consortium with tumor registries.

The subjects included more than one million women ages 40 years and more who had undergone mammography at least once between 1996 and 2002. A total of 17,558 women received a first-time diagnosis of breast cancer.

Advanced stage tumors were more frequent in African-American and Hispanic women than whites upon diagnosis, and high-grade tumors were more likely in African-American, Hispanic, and Native American women.

The rate of large tumors increased from 1.8 per 1000 mammograms when performed at 1-year intervals, to 4.8 per 1000 when intervals were 4 years or more. White women were more likely than members of other ethnic groups to be screened every year or two.

When Dr. Smith-Bindman's group stratified the cohorts by screening history, the observed differences in advanced cancer rates between African American and white women were attenuated or eliminated. However, black women were still more likely to present with high-grade tumors. Similar stratification for Asian, Native American, and Hispanic women showed lower overall breast cancer rates and lower rates of advanced cancer compared with whites.

Regardless of ethnicity, "increased adherence to recommended mammography screening intervals... may result in decreased mortality rates," Dr. Smith-Bindman and her colleagues observe.

Dr. Allen J. Dietrich, from Dartmouth Medical School in Hanover, New Hampshire, and colleagues evaluated the effect of a telephone "support intervention" to increase screening among minority and low-income women.

They identified 1413 women, ages 50 to 69 years, who were patients at 11 community and migrant health centers in New York City and whose records showed that they were overdue for breast, cervical or colorectal cancer screening. The subjects were randomized to the intervention or to usual care over an 18-month period.

All women received literature regarding recommended preventive services, and those in the usual care group were called once to answer questions and advise them to have the needed tests performed.

Women in the intervention group received an average of four phone calls or letters (range, 1 to 20). The prevention care manager helped patients to identify and overcome barriers to screening, scheduled appointments, and assisted patients in locating transportation to appointments, as well as provided other motivational support.

In the intervention group, rates increased by 10% for Papanicolaou testing, by 17% for mammography, and by more than 60% for colorectal cancer screening. By the end of the study, the proportion who were up to date for all three forms of screening increased by 105%.

Dr. Dietrich and colleagues conclude that "the intervention seems to be well suited to health plans, large medical groups, and other organizations that seek to increase cancer screening rates and to address disparities in care."

Ann Intern Med 2006;144:541-553,563-571,614-616.

Connecticut Auto Insurance - A Big Gamble If You Don't Understand

2006-04-18T11:18:00.000-05:00

Buying Car Insurance
PROTECT YOUR FAMILY AND YOURSELF
BY INCREASING UNINSURED/UNDERINSURED MOTORIST PROTECTION:
MAKE THE RIGHT DECISIONS WHEN
PURCHASING AUTOMOBILE INSURANCE©

I. Introduction

In 1993, Connecticut lawmakers abandoned a twenty year unsuccessful experiment with no-fault insurance and enacted sweeping reforms in the laws governing automobile insurance designed to provide cost savings to consumers while at the same time preserving the valued rights of injury victims to be fairly compensated when injured through the fault of a drunk, reckless or simply negligent driver. Because of this law, everyone who has automobile insurance has the opportunity to make important decisions when selecting insurance coverage limits and, in particular, the coverage that protects you and your family from devastating injuries and losses caused by an uninsured driver or a driver who has inadequate insurance coverage.

II. Coverage's

The mandatory coverage's affected by the Auto Insurance Reform Act of 1993 are 1) no-fault, 2) bodily injury ("BI"), 3) uninsured/underinsured motorist ("UM") coverage.

1. No-fault coverage has been abolished. Under prior law, minimum mandatory no-fault coverage of $5,000 per accident meant that auto accident related medical bills and lost wages (weekly benefit not exceeding $200/wk) were paid by the auto insurer. Under the current law, such accident related expenses will be paid for in the same manner as expenses of any other illness or injury, primarily through major medical insurance.

2. Bodily Injury ("BI") or liability coverage minimum requirement will remain at the low level of $20,000 per person and $40,000 per accident no matter how many people are injured in one car accident. BI coverage serves two purposes: First, it protects your personal assets up to the stated amount from claims made by someone who you injure; Second, and closely related to the first reason, it provides you with limited funds to pay the claim of the person who you injure.

BI coverage can be purchased in various amounts as either split limits (per person/per car accident) or combined single limits (one limit for one victim or all victims plus property damage) depending on the insurance company. The limits commonly available in Connecticut range from a minimum of $20,000/$40,000 to common increments of higher limits such as $100,000/$300,000; $250,000/$500,000; $300,000 single limit and $500,000 single limit. Additional bodily injury coverage should be and is frequently purchased as umbrella coverage in increments of $1 million. Anyone who owns their own home or condominium should have umbrella coverage. BI coverage provides an injured person compensation for various elements of damages including but not limited to past and future medical bills, lost wages, loss of earning capacity, permanent disability, scarring and disfigurement and pain and suffering.

3. Uninsured/Underinsured Motorist Coverage is the most important coverage you can buy because it protects you and your family from damages caused by someone else in the event the at-fault party has no insurance or not enough insurance to pay your damages.

Your goal should be to maximize car accident protection for your family and yourself. No matter how many vehicles you insure, you will have options to increase your personal protection. If your current coverage includes umbrella protection, there are special steps that you can take so that you are protecting your family almost as much as you are protecting the stranger who you might accidentally injure. Each one of the options recommended will add some additional cost to your insurance, but it is the most important coverage obtainable and should be considered money well spent.

III. UM Options Under The New Law

1. DO NOT REDUCE COVERAGE.

Never sign any election which reduces your UM coverage below your liability limits. If you have previously reduced this coverage, contact your agent or insurance company and revoke that election.

2. DOUBLE YOUR UM COVERAGE.

Double your UM coverage regardless of the number of vehicles you insure. Doubling your UM insurance coverage creates added protection.

3. INCREASE YOUR BODILY INJURY/LIABILITY LIMITS.

Under the current law, personal protection against an uninsured motorist is limited to two times your BI limits. If your BI limits are low ($20,00/$40,000), the most UM protection you can purchase will provide family protection of $40,000/$80,000. If you now have $250,000/$500,000 in BI coverage and a $1 million umbrella and you want to protect your family like you protect strangers, increase your BI limits at least to $500,000 single limit which is generally available and request or shop for higher BI limits ($750,000 or $1 million). These higher limits can be doubled under #2 above.

4. ELECT CONVERSION COVERAGE.

This special option gives you and your family the right to recover the full amount of the UM coverage elected but not exceeding actual damages regardless of the amount paid by the at-fault party or any other payment made to the injured person after the car accident. Without conversion coverage, our attorneys in Stamford stress that there is no guarantee that you or your family can enjoy the benefit of your money spent on UM coverage because your own insurance company will get a credit for other payments.

For example, if your child has damages of $750,000, the at-fault party has $100,000 in insurance and you have doubled your $300,000 BI limits for a total of $600,000 in UM coverage, you can get the following results:

1. With Conversion Coverage-$700,000 recovery
2. Without Conversion Coverage-$600,000 recovery

Assume your child has damages of $200,000 and you have $100,000/ $300,000 UM coverage, if the at-fault party has $100,000 in coverage, you can get the following results:

1. With Conversion Coverage - $200,000
2. Without Conversion Coverage - $100,000

If you have minimum coverage of $20,000/$40,000, your child has $50,000 in damages and the at-fault party has $20,000/$40,000 in coverage, you can get the following results:

1. With Conversion Coverage - $40,000
2. Without Conversion Coverage - $20,000
3. With Double Coverage + Conversion - $50,000.

With item 2 in this example, you get no benefit from the coverage paid for. You get the maximum protection with Double Coverage + Conversion.

If you would like to find out if your insurance will be sufficient to cover the expenses from your car accident, contact the personal injury attorneys of Casper & de Toledo, located in Stamford, Connecticut. Go to http://www.casperdetoledo.com

For the Connecticut Insurance Department's ranking of automobile insurance companies by consumer complaint ratio go to: http://www.ct.gov

Mediterranean Diet and the Risk of Alzheimer's Disease

2006-04-18T11:16:00.000-05:00

Mediterranean Diet Lowered Alzheimer's Risk

By Judith Groch, MedPage Today Senior Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
April 18, 2006
Also covered by: BBC News

MedPage Today Action Points

When talking with patients, be aware that the Mediterranean diet, which showed a decreased Alzheimer's risk in this study, has also been linked to lower risks for cardiovascular disease, several forms of cancer, and overall mortality.

Review
NEW YORK, April 18 - The Mediterranean diet may be brain food, according to a community-based study here.

A group of participants who stuck to elements of the Mediterranean diet -- high in fruits, vegetables, cereals, but low in meat and dairy products -- had a reduced risk for Alzheimer's disease. None was demented at the outset.

Overall, each additional unit of the Mediterranean diet adherence score (a zero to nine-point scale) was associated with a 9% to 10% decreased risk for Alzheimer's, reported Nikolaos Scarmeas, M.D., of Columbia University here, and colleagues, in the April issue of the Annals of Neurology and published online.

Compared with participants who had the lowest adherence to the diet, the risk for those with the highest adherence was 39% to 40% lower, while those in the middle tertile had a decreased Alzheimer's risk of 15% to 21%. This, the investigators said, showing a significant dose response, and sensitivity analysis did not change these findings.

This study suggested that "an overall dietary pattern is likely to have a greater effect on health than a single nutrient," Dr. Scarmeas said.

The Mediterranean diet is characterized by a high intake of vegetables, legumes, fruits, cereals; high intake of unsaturated fatty acids (mostly olive oil), but a low intake of saturated fatty acids; a moderately high intake of fish; a low to moderate intake of dairy products (mostly cheese or yogurt); a low intake of meat and poultry; and a regular but moderate intake of alcohol, primarily wine and with meals.

In the study, 2,258 non-demented community-based individuals from the Washington Heights-Inwood Columbia Aging Project were prospectively evaluated every 18 months for an average of four years. The primary outcome was the rate of decline in cognition as assessed at each study visit, using 12 neuropsychological tests and a semi-quantitative food questionnaire. During the course of the study, 262 individuals were diagnosed with Alzheimer's disease.

Adherence to the diet remained the main predictor even after adjustment for cohort, age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, smoking, medical comorbidity, and body mass index. Those adhering more to the diet tended to smoke less and had a lower calorie intake, the researchers said.

When individual components used to derive the Mediterranean pattern were examined in unadjusted Cox models, mild to moderate alcohol consumption, (0.61 [0.45-0.62] P=0.001) and higher vegetable intake (0.76 [0.60-0.97] P=0.30) were associated with decreased risk. Nevertheless, Dr. Scarmeas said, in adjusted models considering other confounders, none of the individual components was a significant predictor.

Previous research in Alzheimer's disease had focused on individual dietary components or nutrients, such as vitamins C and E, flavonoids, folate, total fats, and fish, often with conflicting results, the researchers said. There have been few studies of the effect of composite dietary patterns, rather than individual foods.

The results of this study, Dr. Scarmeas said, strengthen the researchers' initial hypothesis that composite dietary patterns can capture dimensions of nutrition that may be missed by individual components. Individuals do not consume foods or nutrients in isolation, but rather as components of their daily diet, he said.

The Mediterranean diet, which has been linked to a lower risk for cardiovascular disease, several forms of cancer, and overall mortality, may play a role in several potential mechanisms. These include oxidative stress and inflammation, both important in the pathogenesis of Alzheimer's, the investigators said.

Furthermore, they said, given the contribution of vascular risk factors to Alzheimer's disease, there is strong evidence linking the Mediterranean diet to lower vascular risks, such as hypertension, dyslipidemia, and diabetes. Vascular variables, the researchers said, are likely to be in the causal pathway between the diet and Alzheimer's.

The study had limitations, including possible inaccurate measurement of the patients' diets, though the researchers used previously tested assessments. There was also the possibility of disease misclassification, though experienced practitioners made the diagnoses. Subtle changes in dietary habits as a result of Alzheimer's symptoms were another potential limitation, although adherence was found to be stable. Finally, Dr. Scarmeas emphasized, the diagnosis of Alzheimer's took place in a university hospital with appropriate expertise in dementia.

This study examined the effect of the diet in a multiethnic community in the U.S. and the results support the notion that the diet's beneficial effects can be generalized to different populations, the researchers concluded.

Primary source: Annals of Neurology
Source reference:
Nikolaos Scarmeas, et al "Mediterranean Diet and Risk for Alzheimer's Disease," Annals of Neurology, 2006, 59, (6) and online April 18.

--------------------------------------------------------------------------------
Disclaimer

Children with Traumatic Brain Injury

2006-04-18T10:42:00.000-05:00

Children with Traumatic Brain Injury

So many events can compromise the health and well-being of our children. One such event is when a child sustains a traumatic brain injury as a result of birth trauma or post-natal trauma including playground accidents, car crashes and truck accidents, sports injuries or other trauma.
Pre-natal or birth injury usually results in the child receiving prompt health care intervention and the family can and should be prepared for a lifetime of special needs of the child and the family.
On the other hand, post birth brain trauma often leaves the patient and family reeling with uncertainty and the need for proper guidance for the unique challenges that must be confronted. Aside from the most important priority of obtaining the best health care for the injured child, there are a host of other considerations.
There are the challenges that confront the family unit not only with regard to care for the child but also as the liaison between caregivers and teachers as family members are relied upon to communicate issues and problems. The family often also comes under incredible stress that should be addressed, often with professional assistance.
Another challenge to dealing with the aftermath of a pediatric traumatic brain injury is in the educational arena. Some children with brain injuries require residential treatment but the vast majority of children with traumatic brain injury return to the community and their previous educational environment. However, such a transition may not be smooth depending upon the nature and severity of the traumatic brain injury. Even a brain injury categorized as a mild traumatic brain injury can have devastating consequences to a child’s school performance as various cognitive functions may be impaired including but not limited to memory, concentration, processing and behavioral skills. It is imperative that there be adequate communication between health care providers, parents and school officials to identify, treat and cope with such problems. Special academic programs may be required and the child may be entitled as a matter of federal law (Individuals with Disabilities Education Act also known as the “IDEA”) to an Individual Education Plan (“IE”). The injured child may require special programs, individualized classroom attention including an aide, special services such as physical therapy, speech therapy and occupational therapy; teaching practices may need to be adapted; curriculum may need to be altered and the child may be entitled to extra time to accomplish assignments and tests including standard tests such as the SATs.
A family in need can turn to many resources. A natural beginning point is the child’s health care providers. Also, there are state and national brain injury associations, academic advisors, lawyers who specialize in educational needs (not necessarily the same as lawyers who might handle an accident claim). For a more expansive discussion of the subject we commend for your reading a very informative article entitled “Pediatric traumatic brain injury: a review of pertinent issues” written by Ronald C. Savage et al and published in the journal Pediatric Rehabilitation, April 2005: 8(2): 92-103. This article may be available through the medical library of your local hospital or medical school, a lawyer who handles traumatic brain injury or by contacting the publisher.
Here at Casper & de Toledo (www.casperdetoledo.com) , our trial attorneys are experienced in handling the delicate problems confronted by patients of all ages who have suffered brain injuries. We can assist you during your period of need and guide you to the proper health care, community and educational resources.

Preventing Brain Injury in Sport

2006-04-18T10:21:00.000-05:00

PREVENTING BRAIN INJURY IN SPORTS AND RECREATION

The trial lawyers at Casper & de Toledo (www.casperdetoledo.com) have made a special effort not only to become highly skilled in representing clients who have suffered brain injury through the negligence of others in car crashes, fall downs and other fault based casualty situations, but also our lawyers are very concerned with injury prevention.

While he was President of the Connecticut Trial Lawyers Association, partner Stewart Casper developed a program for CTLA that involved the donation by trial lawyers of bicycle helmets throughout the state of Connecticut. That program was used as a model for similar programs around the country.

Casper & de Toledo has also advocated added caution in the area of high school sports noting that many young people are exposed to brain concussion playing football, soccer, lacrosse and other sports. A concussion is a brain injury and it can cause the same cascade of unfortunate consequences that can result from a motor vehicle crash or a fall. There are specific guidelines applicable to health care providers, coaches, faculty and administrators of school systems when an athlete has been injured. Sitting out one or more games or matches is a far better alternative than experiencing a lifetime of cognitive impairment resulting from a second concussion.

The Center for Disease Control has recently released a package of information made available for coaches, parents and athletes so everyone can learn more about the problem of sports related head injury. You can find this information at: http://www.cdc.gov/ncipc/tbi/coaches_tool_kit.htm

Stamford Trial Lawyers - Casper & de Toledo.com

2006-04-18T10:11:00.000-05:00

The law firm of Casper & de Toledo (www.casperdetoledo.com ) is the culmination of its partners' vision to ensure the judicial system works for everyone, not just a select few. Our personal injury and employment law attorneys are deeply committed to advocating the rights of our clients and striving to attain the best protection and highest compensation permissible under the law.

We are never deterred by aggressive opponents, be they insurance companies, HMOs, governmental agencies, or corporate giants. Our personal injury lawyers and our employment lawyers fight hard for our clients because we believe in them, because we believe that the legal system can and must work for everyone, and because we take pride in our commitment to excellence in our legal practice.

Both as a firm and as individuals, we are dedicated to the principle of maintaining the highest standard of conduct, ethics, and diligence. Our many years of legal practice have provided our personal injury lawyers and employment rights lawyers with a solid foundation in the intricacies of the law, enabling us to be creative in applying the law to a variety of situations.

Our personal injury and employment lawyers are committed to the goal of expanding the law to protect the rights of victims in Stamford and around Connecticut. The practice is limited to litigation and related matters. With respect to tort and employment litigation, Casper & de Toledo represents plaintiffs only.

Stewart Casper and Victoria de Toledo have been recognized by "Westchester Magazine" as two of the best attorneys in Fairfield County, and by "Connecticut Magazine" as among the best lawyers in Connecticut, and "New York Magazine" has recognized them as among the best lawyers in the entire New York area. Click here to view full article.All of the firm's personal injury and employment lawyers are actively involved in state and national legal associations and activities. The firm's founding partners are widely recognized among the state's most prominent legal professionals in their fields of practice. Stewart Casper has been repeatedly recognized for his success in representing victims of car and truck accidents, and recreational accidents. He has represented many individuals who have suffered very serious injuries such as spinal cord and traumatic brain injuries. Victoria de Toledo has been repeatedly recognized for her success in representing victims of age, sex, and disability discrimination. She was recently listed in Connecticut Magazine as one of the top 25 female lawyers in the state. The firm has an A.V. rating, which is the highest rank conferred by the national legal directory, Martindale-Hubbell. Lawyers Stewart M. Casper and Victoria de Toledo are also listed in The Best Lawyers in America™.

Our personal injury and employment law lawyers are supported by a team of trained paralegals and legal secretaries who use state-of-the-art equipment. We have an in-house computerized legal research and litigation support system at our office in Stamford, Connecticut, and we maintain a network of consultants throughout the country.

However, the most definitive measure of the firm's success is our referral base. Many of our employment clients are referred by other attorneys and many of our personal injury clients are referred by health care providers, which is indicative of the esteem in which the firm is held by our peers and health care professionals.

The firm of Casper & de Toledo is listed in the Bar Register of Pre-eminent Lawyers.

If you or a loved one is seeking compensation in a personal injury or employment case, contact the lawyers at Casper & de Toledo (www.casperdetoledo.com)in Stamford, Connecticut.

The Insurance Industry is Robbing us all Blind

2006-04-18T10:08:00.000-05:00

To the editor:

A local physician wrote lamenting the cost of health care in the country and the lack of predictability for doctors who commit malpractice and find themselves on the receiving end of a lawsuit, and advocating a separate system of justice for doctors that is being promoted by the health care industry without any acceptance at all by consumers or constitutionalists (Advocate Letters from Readers, April 4).

The writer fails to inform the reader that Connecticut's recent adoption of reform legislation is working, and that the problem that physicians unjustifiably experience is price-gouging by their own malpractice insurers.

When a malpractice insurer seeks to raise rates unjustifiably, both the doctors and the consumers suffer. Doctors suffer if they pay increased premiums. Consumers suffer because the doctors usually blame them and their lawyers, and place a constitutionally mandated system in the cross-hairs of legislative zealots.

Recently, both the Connecticut Medical Society and the Fairfield County Medical Society ran from a prior-rate approval battle, apparently willing to accept another 12 percent rate increase rather than fight an insurance company. Fortunately for the citizens of Connecticut, the Connecticut Trial Lawyers Association came to the rescue and intervened in the hearing before the insurance commissioner's hearing officer, and the rate increase was denied. The doctors have been told that the medical society was protecting their interest. That is untrue.

Significantly, the writer also distorts the reality of the existing system. There is no study that proves that doctors are held to any standard other than the "prevailing standard of care" when judged in court. Moreover, our constitutionally mandated system of jury trials applies to everyone and every industry. No one suggests that juries are incapable of understanding the evidence in other technical and scientific areas. They even make life and death decisions in death penalty cases.

Stewart M. Casper

Stamford

The writer is an attorney.

--------------------------------------------------------------------------------

Doctors Protest Too Much!

2006-04-18T10:06:00.000-05:00

2006-04-18T10:02:00.000-05:00

By LAURAN NEERGAARD, AP Medical Writer
Mon Apr 17, 7:24 PM ET

WASHINGTON - A newer drug prevents breast cancer in older, high-risk women just as well as today's standby tamoxifen — but with fewer side effects, the National Cancer Institute announced Monday.

ADVERTISEMENT

Called raloxifene, the newer drug already is sold to treat bone-thinning osteoporosis.

But the striking new results, from a government study of nearly 20,000 women, suggest that raloxifene may supplant its older cousin as the first choice for breast cancer prevention in postmenopausal women at high risk of developing the disease.

"Now women have a choice," Dr. Leslie Ford, NCI's cancer prevention chief, said in an interview Monday. "It's good news, because we're giving you a choice with fewer side effects."

Manufacturer Eli Lilly & Co., which sells raloxifene under the brand name Evista, plans to seek Food and Drug Administration approval for the new use.

Until now, tamoxifen has been the only drug approved to reduce the chances of breast cancer striking high-risk women.

Both drugs are "selective estrogen response modulators" — they act like the estrogen hormone in some tissues but like an anti-estrogen in others.

Estrogen can fuel certain breast cancers, making tamoxifen a longtime top choice both to prevent the disease's return in women with estrogen-sensitive tumors and to reduce the odds of it striking high-risk women in the first place.

However, tamoxifen causes some rare but serious side effects: It acts like an estrogen in the uterus and bloodstream, thus increasing users' risk of getting uterine cancer or a life-threatening blood clot.

Raloxifene is a close chemical relative, and earlier research suggested that it might help breast cancer, too. So the NCI launched the $88 million study to compare the two.

Taking either tamoxifen or raloxifene daily for up to five years cut in half women's chances of developing invasive breast cancer, NCI announced Monday.

Raloxifene caused the same side effects, but not as many. Raloxifene users had 36 percent fewer uterine cancers and 29 percent fewer blood clots, according to initial results of the "Study of Tamoxifen and Raloxifene," or STAR project. Raloxifene users also suffered fewer vision-blocking cataracts.

Some 2 million U.S. women every year are thought to be candidates for tamoxifen risk-reduction therapy, but many have avoided it for fear of those side effects, said STAR researcher Dr. Kathy Albain of Loyola University.

While the reduction in those side effects was significant, the study also showed how uncommon the effects are. Thirty-six tamoxifen users developed uterine cancers, compared with 23 raloxifene users. The risk of blood clots was similarly low: 54 tamoxifen users had one in the lung, compared with 35 raloxifene users.

Still, "here we have something that's a little less scary," Albain said of the raloxifene findings. "It might tip the scales for a lot of women."

The new study means no change for premenopausal women — there's no data showing whether raloxifene is safe for them, Albain stressed.

Nor does it mean that tamoxifen users should necessarily switch, she said. Women currently are prescribed tamoxifen for five years, and its breast cancer prevention benefit continues even after they stop taking the drug — as raloxifene's seems to. So a woman already in, say, year four of her tamoxifen course with no sign of side effects probably has little to gain by switching, she explained.

But that's a question researchers were girding for as they spent Monday notifying study participants of the results.

One puzzle: While raloxifene was equally effective in blocking invasive breast cancer, it didn't protect quite as well as tamoxifen against noninvasive types of breast cancer such as ductal carcinoma in situ, noted Dr. Len Lichtenfeld of the American Cancer Society.

That type of tumor isn't life-threatening and shouldn't water down the overall message of raloxifene's benefit, said Dr. Victor Vogel of the University of Pittsburgh, who oversaw the study's design.

Among postmenopausal women, who's at high risk? Most of the study participants had a 4 percent chance of getting breast cancer within five years — because of advanced age, a close relative with the disease, never having a child or having one late in life, or other well-known risk factors that women can calculate on a government Web site: http://cancer.gov/bcrisktool.

In simpler terms, for every 1,000 of those women, doctors expected 40 to develop breast cancer within five years if they did nothing, but taking one of the drugs cut that number to 20, Ford explained.

_____

On the Net:

NCI study information: http://www.cancer.gov/star