Real Justice for Real People. MEDICAL NEGLIGENCE Volume 3 Issue 1 STRITMATTER KESSLER WHELAN COLUCCIO

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1 Real Justice for Real People MEDICAL NEGLIGENCE Volume 3 Issue 1 1 March 2013 SKWC-MedNeg-Bklt-v4.indd 1 3/31/13 6:19 PM

2 2 SKWC-MedNeg-Bklt-v4.indd 2 3/31/13 6:19 PM

3 ABOUT THE COVER ART Ancestors-2007 : This artwork was selected because of its compelling image of a mother with her child along with ancestral figures in the background. The care that a child receives from her doctor/nurse should always value the mother s love. ABOUT THE ARTIST Jose Ramirez is an artist, teacher and the father of three girls, Tonantzin, Luna, and Sol. He received a BFA (1990) and an MFA (1993) in art from UC Berkeley. In 2001, he received the Brody Award/Getty Visual Arts Fellowship. Jose has illustrated seven children s books, including Quinito s Neighborhood, Frog and Friends Save Humanity, Zapata para los Niños, Papito Dios, and Quinito Day and Night. Among his commissions, he has worked for several nonprofit organizations, hospitals, cities, film and television companies and cultural centers across the country. In addition, he has lectured and exhibited his work in museums, universities, galleries and cultural centers in New York, Washington DC, San Francisco, San Diego, Texas, Japan, and Mexico. For more info please visit ramirezart.com. You may contact him at or SKWC-MedNeg-Bklt-v4.indd 3

4 Although I met Paul almost 20 years ago and co-counseled at least a dozen cases with him, I still regard Paul as my mentor and a source of inspiration. I have seen him pull down the biggest adversaries. Paul is a brilliant advocate on behalf of his clients, as well as a wonderful teacher. Readers of Paul s medical negligence booklet will learn from Paul, as I have over the years. Lawrence Baron In the complex, and often misunderstood, field of medical negligence litigation it is absolutely essential to learn from those skilled legal practitioners who have worked in the trenches, know the field and have a heart for the people whose lives, and families, have been torn apart by unnecessary and preventable medical neglect. Paul Whelan is an outstanding trial lawyer who fully understands the field and has represented numerous victims of preventable medical neglect. This booklet is an excellent survey of this area of law with specific examples taken from the many difficult cases Whelan and his partners have successfully handled. Jack Connelly Paul Whelan is a brilliant trial lawyer with a wealth of knowledge and experience, obtained in the trenches, which is surpassed by no one. This concise booklet touches upon and succinctly summarizes every aspect of screening, investigating, handling and winning these difficult, expensive and usually tragic cases. A must read for any trial lawyer operating in the field of healthcare negligence. Ron Perey 4 SKWC-MedNeg-Bklt-v4.indd 4

5 ABOUT Stritmatter Kessler Whelan Coluccio (SKWC) is a premier Pacific Northwest law firm devoted to representing plaintiffs in personal injury and wrongful death claims. Experienced in trial, SKWC attorneys welcome tough, complex cases. Our verdicts and settlements include product liability, nursing home, government liability, medical negligence, highway design, premise and construction site, class action, vehicle crashworthiness, major vehicle collision, maritime and aircraft crash cases. The attorneys at SKWC are committed to making a difference in the lives of our clients, in helping to ensure justice for the injured, and in contributing to the legal community through leadership and education. 5 SKWC-MedNeg-Bklt-v4.indd 5

6 ABOUT PAUL W. WHELAN Throughout a legal career that has spanned four decades, Paul Whelan has been known for three things. First is his deep compassion for his clients he takes the wrongs they have suffered very personally. Second is his vast well of knowledge of engineering and medicine that rivals many experts in the field. Third is his ability to explain both the emotion and the complexities of a case in a plain manner that juries and judges can easily understand. Few attorneys have tried as many product cases as Paul. In the seventies, Paul tried multiple asbestos cases at the same time, literally running from courtroom to courtroom. In the 6 SKWC-MedNeg-Bklt-v4.indd 6

7 eighties, he represented several children who were victims of lead poisoning, settling over forty-two cases after the very same company that had its hands in the Watergate scandal was caught hiding secret documents proving liability. The scientist who established causation, developed data that led to the first ambient air lead standard in the U.S. In the nineties, Paul took on auto manufacturers, helping to improve the safety of seats, doors, airbags, and other components we take for granted. Paul is a frequent speaker to legal and medical groups on product liability, toxic torts, structured settlements, occupational and environmental disease, patient rights, and physician responsibilities. Paul was named Trial Lawyer of the Year by the Washington Chapter of the American Board of Trial Advocates in He is a member of the American Board of Trial Advocates, the Washington State Bar Association, the Washington State Association for Justice, the American Association for Justice, the Federal Bar Association and Trial Lawyers for Public Justice. He is listed in Best Lawyers in America. When not helping his clients find justice, Paul can be found at his children s many sporting events, on his boat, or up in the mountains. 7 SKWC-MedNeg-Bklt-v4.indd 7

8 ACTIONS FOR INJURIES RESULTING FROM MEDICAL NEGLIGENCE Introduction The practice of medicine is an honorable profession. Doctors save lives. But that doesn t mean they should be put on a pedestal. They should be subject to the law like everyone else. For over forty years, it has been my privilege and honor to represent people who have had the wrong organ removed, body parts mutilated, and clear diagnoses missed. I take pride in helping to hold health care providers responsible when they fail to meet the profession s standards of care and injure or kill their patients. Washington is unique in that it is one of the few remaining states where both its Supreme Court 1 and its voters have rejected caps on damages in medical malpractice cases. 2 Washington is also one of the few states that does not allow punitive damages. 1 I had the honor of representing Mr. and Mrs. Sofie in their asbestos case in the lower court. The Washington State Supreme Court overturned the damages cap in Sophie v. Fibreboard, 112 Wn.2d 636, 171 P. 2d 711, 780 P. 2d 260 (1989). 2 In 2005, Initiative 330 (I-330) attempted to cap damages for victims of medical negligence, which would force them to give up their constitutional right to a jury trial. The insurance and medical industries spent almost $10 million to sway voters. 8 SKWC-MedNeg-Bklt-v4.indd 8

9 Note: Grey indicates states adopting caps from ; black indicates states with no caps in place; and white indicates states with caps existing before observation period. Despite the fear mongering of insurance companies, no correlation exists between capping damages and the alleged health care funding crisis. 3 Overview Medical malpractice issues are mostly covered by statute, RCW 7.70 et seq, (WPI et seq). This statute spells out the elements of proof including what testimony is required to establish liability. Most cases include failure to properly diagnose and/or failure to properly treat. RCW defines a health care provider to be virtually any licensed person or entity providing healthcare and related services, from acupuncturists to paramedics to surgeons. Entities include hospitals, clinics, HMOs, nursing homes and their employees, officers and agents. RCW (3). If a health 3 See, e.g. Donohue, John, The Impact of Damage Caps on Malpractice Claims: Randomization Inference with Difference-in-Differences (2007). Faculty Scholarship Series. Paper SKWC-MedNeg-Bklt-v4.indd 9

10 care provider dies, their estate can be held responsible. RCW Some actual cases illustrate both failure to diagnose and failure to treat cases. A failure to diagnose case that SKWC handled recently involved a woman who had a growth on her tongue. Because her doctor had delayed a diagnosis, she was required to have her tongue removed. 4 What the doctor should have done was to send the growth to the lab for an evaluation. In another failure to diagnose case, a surgeon removed what was thought to be a cyst on a woman s buttocks. The specimen was never sent to the pathology department for analysis. As it turned out, the growth was actually Merkel cell carcinoma (MCC) a very aggressive and deadly cancer. Because MCC was not timely diagnosed, it spread to the lymph nodes in her right groin. It was found a half year later and was treated with radiation and surgery. Now, she faces a severely diminished life expectancy. 5 An example of a failure to treat case involved a 10-month old baby girl. Kevin Coluccio, and I represented the parents. The 10-month old was hospitalized several times over a period of approximately four months. A day before her death, small bowel contents were dumped into her abdomen through a perforation adjacent to a duplication cyst. The cause of death was peritonitis. Her providers failed to follow up on an earlier radiology report, which had identified the then 4 Other details of the case are confidential due to a settlement agreement with the defendants. 5 See Section VII for a more detailed discussion on loss of a chance of a better outcome. 10 SKWC-MedNeg-Bklt-v4.indd 10

11 potential problem. The radiologist recommended a follow up evaluation that never happened. In 2008, Paul Stritmatter and I represented parents who lost a baby due to the doctor s failure to recognize a dangerous cord presentation. The patient complained to her OB/GYN about leaking fluid. But her concerns were brushed off. At 38 weeks pregnant, she persisted with her complaints. The doctor finally conducted an exam that revealed unusually low levels of amniotic fluid. There was no additional follow up. When she experienced contractions, she went to the hospital, where a Doppler exam could not identify whether the heartbeat was the mother s or the baby s. It turned out that the mother was sitting on the umbilical cord, as it was wrapped around the baby s neck. I. Scope of the Problem According to Dr. Sidney M. Wolfe, hospital errors result in approximately 100,000 preventable deaths a year 6. A surgeon somehow operates on the wrong body part 40 times a week 7. In January 2012, Medicare reported that in spite of mandatory reporting, 86% of medical negligence cases go unreported. The adverse events that are reported are tallied in the Washington State Department of Health Adverse Events Report. The most recent report (2006 to 2011) quantified various adverse events: 6 A July Effect in Fatal Medication Errors: A Possible Effect of New Medical Residents, Journal of General Internal Medicine, May 29 (www.ncbi.nlm.nih.gov/ pubmed/ ). 7 Makary, Marty. How to Stop Hospitals from Killing Us. N.p., Web. 11 SKWC-MedNeg-Bklt-v4.indd 11

12 Wrong procedure, wrong site or wrong patient 120 Wrong medicine 24 Retained foreign object 166 The author once had a case involving a surgeon who removed the wrong kidney, leaving the cancerous kidney to kill the patient. At his deposition, the doctor could not explain how he made the mistake. Kevin Coluccio and I represented a skilled carpenter who was admitted to a hospital for shoulder surgery. His anesthesia was mishandled. The surgeon wanted the patient seated in a beach chair position which meant that the patient s brain was much higher than if he was in a supine position. The standard of practice required a calculation of how much additional oxygen was needed to compensate for the elevated brain. As a result of the incorrect dosage of anesthesia, the patient suffered serious debilitating brain injury. He never returned to work, and his wife divorced him. Medication errors in hospitals are epidemic. The nonprofit watchdog group Public Citizen reports that each year children under five years old are injured as the result of 23,158 therapeutic medication errors. 8 A few decades ago, live cell pertussis vaccine somehow passed FDA testing. The FDA later concluded that the batch was a hot lot that should never have been distributed. A safer acellular vaccine was patented by another pharmaceutical firm. The defendant bought and retired that patent. This left only dangerous live 8 See Public Citizen, Worst Pills, Best Pills News, Vol. 18 No. 2, Feb SKWC-MedNeg-Bklt-v4.indd 12

13 cell vaccines for use in America, when pertussis vaccinations were universally required by schools as a condition for attendance. In 1987, a boy in Western Washington was vaccinated by one of the live cell hot lot vaccines. The boy experienced seizures. The local emergency room doctor did not know how to deal with his seizures. He opted to give him a Nembutal (pentobarbital) suppository instead of antiseizure medication that was available. The child eventually died. II. Statute of Limitations A. In general In Washington State, cases against health care providers must be commenced within three (3) years of the act or omission alleged to have caused the injury, or within one (1) year of the date the patient discovered or should have discovered the injury and its cause. RCW In cases where there is a continuing course of treatment, the statute of limitations begins to run upon the patient s last visit to the health care provider, Olson v. Severling, 52 Wn. App. 221, 758 P. 2d 991 (1998), rev. den. 111 Wn. 2d 1033 (1989). B. Death and survival claims Cases involving wrongful death based upon medical malpractice are governed by the statutes relating to wrongful death and survival claims, RCW and SKWC-MedNeg-Bklt-v4.indd 13

14 C. Statutes of Repose Disability of the plaintiff tolls the statute of limitations, except that no case may be filed after eight (8) years from the date of the act or omission, RCW This eight year provision is constitutionally suspect. See Unruh v. Cacciotti, 172 Wn. 2d 98, , 257 P. 3d 631. My client, Ms. Unruh, began orthodontic treatment when she was nine years of age. The treatment was done improperly and resulted in root resorption. As a result, her permanent teeth feel out and she required implants. Ten years later, she learned from a dentist that the resorption was caused be improper braces. Under the statute of repose, her claim was too late. We challenged the statutes, and in July 2011, the Washington State Supreme Court rendered its opinion in favor of our client. Unruh held that older claims can survive if the case was filed within three years of majority, which can be extended for another 12 months, if a request for mediation is made. 9 Ray Kahler, Garth Jones and I made up the team that represented Ms. Unruh. D. Request for mediation A good faith request for mediation extends the statute of limitations for one (1) year, RCW ; Unruh supra. E. Public Hospitals 60 Day Tort Claim Notice Public Hospital Districts are governmental agencies (municipal corporations) that ordinarily require a 60 day 9 RCW SKWC-MedNeg-Bklt-v4.indd 14

15 Notice of Claim to be served on their appointed agents. RCW The applicable period of limitations is tolled until the 60 days has expired. In other words, if the statute of limitations is about to expire when the notice is sent, the tolling ends on the 60 th day. Great care is required in counting the days. Both RCW and RCW specifically state injuries from healthcare are governed solely by the procedures set forth in chapter 7.70 of the Revised Code of Washington. Confusion among medical malpractice litigants arose from RCW which imposed a 60 day Notice of Intent to Sue to be served on defendant health care providers. The Supreme Court struck down the 60 day notice requirement on equal protection grounds as to nongovernmental health care providers. Waples v. Yi, 169 Wn. 2d 152, 234 P.3d 187 (2010). The defense bar, however, claimed the 60 day notice was still required as to a public hospital because the State Constitution gives the legislature authority to decide how suits can be brought against government agencies. McDevitt v. Harborview ruled six to three that the 60-day notice requirement was constitutionally valid. A scathing dissent by Justice Tom Chambers accused the majority of creating law that the legislature never intended. 291 P.3d 876, 2012 WL (2012). III. Corporate Negligence of Hospitals Hospitals grant staff privileges to independent contractor healthcare providers. Respondeat superior may apply in 15 SKWC-MedNeg-Bklt-v4.indd 15

16 certain circumstances where health care employees or agents are involved, see WPI Corporate negligence of hospitals applies where independent contractors have negligently been granted staff privileges. The concept arises because hospitals and patients are in what the court says is a special relationship. Hospitals owe an independent, non-delegable duty of care directly to the patient, regardless of the details of the doctor hospital relationship. Thus, a hospital has a duty to carefully review and evaluate the competency of the staff physicians, review the patient s treatment and facilitate appropriate consultations. Pedroza v. Bryant, 101 Wn. 2d 226, 677 P. 2d 166 (1984). See also Pederson v. Domouchel, 72 Wn. 2d 73, 431 P. 2d 973 (1967); Osbourn v. Public Hospital Dis. #1, 80 Wn. 2d 201, 205 P. 2d 1025 (1972); WPI Some of the factors that persuaded the Court to adopt corporate negligence include: 1) The hospital s role as a multifaceted health care center thought to coordinate community health. 2) The hospital s role evolved away from simply providing physical facilities and medical equipment. 3) Hospitals are in a superior position to evaluate and control physician performances. Standards for granting staff privileges are decided by hospital governing board committees. 10 Hospitals seek accreditation 10 A hospital is required by law to adopt bylaws regarding its medical staff. RCW WAC SKWC-MedNeg-Bklt-v4.indd 16

17 in accordance with the Joint Commission on Accreditation of Hospitals (JCAH). The first medical negligence case that this author tried was with Leonard Schroeter and Judy Massong in 1985 in Hollingsworth v. Enumclaw Community Hospital. We represented the family of a young boy. At a small community hospital, the physician used high forceps. He did not have privileges to use such surgical instruments. The nurse who handed the forceps to the physician was fully aware that he did not have privileges to use them. It is below the standard of care for a hospital to allow an unqualified physician to utilize equipment that he has no business using. The infant suffered a spinal cord injury. The doctor settled separately. The Court held the hospital to be liable for the negligence of its nurse. Two things to keep in mind: 1) a hospital s corporate negligence does not extend to acts or omissions which occurred outside the hospital in a private office setting. Pedroza at 235; 2) the standards of practice are not based upon local standards but are state wide standards. Pedroza at 234. IV. Apparent Agency A hospital may be vicariously liable for wrongful acts of an employee on the basis of the normal rules of agency. See Restatement Agency 3d. (2006). A hospital may also be liable for the acts of a non-employee physician based upon ostensible or apparent agency. See Adamski v. Tacoma 17 SKWC-MedNeg-Bklt-v4.indd 17

18 General Hospital, 20 Wn. App 98, 579 P. 2d 970 (1978). Here, the basis for liability is said to be affirmation representation or holding out causing the patient to rely upon the skill and care of the apparent agent. See Restatement 2d Agency 267. Seven factors to consider regarding a hospital s apparent agency are listed in WPI as follows: In determining whether the relationship between the hospital, physician, and patient was such that the physician was the apparent agent of the hospital, you may consider, among others, the following factors: 1. Whether the patient sought treatment primarily from the hospital or from the physician; 2. Whether it was the hospital that designated the physician to perform the services in question; 3. Whether the type of care provided was an integral part of the hospital s operation; 4. Whether the hospital handled the billing for the services of the physician; 5. Whether the hospital s drugs and supplies were utilized by the physician; 6. The nature and duration of any hospital-physician agreements; and 7. Whether the hospital made any representations to the patient, verbally or in writing, regarding their relationship with the physician. 18 SKWC-MedNeg-Bklt-v4.indd 18

19 The above factors, no one of which is controlling, should be considered by you with any other evidence bearing on the question. This is an important concept because hospitals hire so called hospitalists who are salaried hospital employees. V. Medical Negligence Proof The law regarding proof of medical negligence is spelled out in RCW The plaintiff must prove there was a violation of the accepted standard of care, that the patient was promised the injury would never occur or that the injury resulted from healthcare to which the patient did not consent. See WPI A. Standard of Care Except where a foreign object is unintentionally left in a patient s body, expert testimony is required to establish the applicable standard of care, causation and, in most cases, the extent of the harm. Young v. Key Pharmaceutical, 112 Wn. 2d 216, 770 P. 2d 182 (1989); RCW ; WPI The phrase standard of care has replaced standard of practice. Harris v. Groth, 99 Wn. 2d 438, 663 P. 2d 113 (1983). A specialist is held to the standard of care of a specialist, a family practice doctor is held to the standard of care of a family practice doctor, and so on. See WPI ; WPI The standard is reasonable prudence not average care. Harris v. Groth, Id. at SKWC-MedNeg-Bklt-v4.indd 19

20 Evidence Rules apply to expert testimony in medical negligence cases. In the past decade, the specialty boards that certify a physician as Board Certified have developed evidence based practice guidelines that are often referred to by expert witnesses. These practice guidelines are available by a specialty search on the internet. B. Quality Assurance Peer Review Committee Findings The findings of and testimony given before a duly constituted peer review Quality Assurance Committee are not subject to litigation discovery. See Coburn v. Seda, 101 Wn. 2d 270, 677 P.2d 173 (1984); RCW Of course, the problem for patients is that the hospital can ask everyone who knows about the negligent event to participate in a committee review in an attempt to thwart discovery of otherwise discoverable evidence. In Coburn, supra at 277, the Court said a peer review committee may not be used as a shield to obstruct discovery of information generated outside of review committee meetings and does not grant immunity to information otherwise available from outside sources. Hence, a report from a regularly constituted committee is not discoverable, but whether there was such a committee and where it met is discoverable. Coburn, supra at 278. The names of committee members are not discoverable. Coburn, supra at 279. In one of Justice Chamber s last opinions, the Court held that an internal review of quality assurance committee 20 SKWC-MedNeg-Bklt-v4.indd 20

21 records was required to answer an interrogatory about other similar instances of the particular adverse outcome suffered by the plaintiff. Lowry v. PeaceHealth, 174 Wn.2d 769, 280 P.3d 1078 (2012). The Court stated, By its plain language, RCW (3) protects only information created specifically for, and collected and maintained by a quality improvement committee. Id. at 779. Hence, only externals reviews, not internal reviews, are protected. Id. VI. Earwigging Earwigs supposedly got their name because they were said to burrow into people s ears to eat their brains. The term earwigging is an apt description of the practice that defendants such as HMOs and insurers routinely follow. It means to annoy or attempt to influence by private talk. These organizations have developed the insidious practice of requiring their insureds to notify them if they are subpoenaed for a deposition or are otherwise asked to talk to the plaintiff s lawyers. This is an obvious attempt to suppress relevant evidence. In the recent case of Smith v. Orthopedics International Limited, 170 Wn. 2d 659, 244 P.3d 939 (2010) the Court said that contact with a treating doctor through so called friendly counsel violated physician patient confidentiality. The seminal case is Louden v. Overlake Hospital, 101 Wn. 2d 675, 756 P.2d 138 (1998), which held that the defense may not engage in ex-parte contact with plaintiffs health care 21 SKWC-MedNeg-Bklt-v4.indd 21

22 providers. Smith is simply an extension of that principal to the context of litigation formal discovery. Supra. Institutional health care providers (HMOs) routinely advise their employees when they are sued. This has a chilling effect on non-speaking agent employees and often they refuse exparte contact with the victim s attorneys. Ex-parte contact with regular non- speaking agent employees is simply not forbidden, Tegland, 14 Washington Practice, (2d ed) Sect. 532, but getting them to talk is another matter. Finally, when an employee of a health care provider is deposed, the defense lawyer will sometimes appear and claim that he or she is also a lawyer for the deponent. The practice is clearly an attempt to obstruct discovery of relevant evidence. In such a situation when the lawyer has not formally appeared in advance on behalf of the deponent in advance, a call to the trial judge would be appropriate. VII. Loss of a Chance of a Better Outcome Herskovits v. Group Health, 99 Wn. 2d 609, 664 P.2d 474 (1983) involved an allegation of delayed diagnosis of lung cancer. Mr. Herskovits went to Group Health with complaints of chest pain and coughing. A chest x-ray revealed infiltrate in the left lung. Chest pain and coughing persisted and Group Health prescribed cough syrup. The next year, a second opinion was sought outside of the Group Health network that led to a diagnosis of cancer. Mr. Herskovits died two years later. Group Health argued the plaintiff needed to prove on a more probable than not basis that plaintiff would have survivied 22 SKWC-MedNeg-Bklt-v4.indd 22

23 had the defendant not been negligent, i.e. that there was at least a 51 percent chance of survival. A plurality of the Court held that a 14% reduction in the decedent s chance of survival (from 39% to 25%) provided sufficient evidence of causation to consider that the delayed diagnosis was a proximate cause of death. Mohr v. Grantham, 172 Wn. 2d 844, 262 P.3d 490 (2011), involved a trauma induced stroke. Mrs. Mohr suffered a hypoglycemic event that caused her to run her car into a utility pole. The treating doctors neglected to analyze her neurological condition, sent her home with pain relievers and her injuries. Mrs. Mohr was left permanently brain damaged with a up to one-third of her brain tissue destroyed. Two of Mrs. Mohr s sons were doctors. They along with two other doctors testified that the treaters fell far below the standard of care. Plaintiff alleged negligent treatment reduced her chance of a better outcome. In extending the ruling in Herskovits, the Court ruled that loss of a chance at a better outcome is a compensable injury, even if the patient survives. Id. at 857. VIII. Medical Screening Tests There are dozens of medical screening tests for infants, children and adults. Examples include mammograms, colorectal stool samples, colonoscopies, fasting glucose, and electrocardiograms. Medicare pays for virtually all screening, including prostate screening. The American Urological Society encourages prostrate screening for men over 50. Other groups encourage a discussion about screening. 23 SKWC-MedNeg-Bklt-v4.indd 23

24 Various tests are repeated at recommended intervals. If a test is not performed and the patient is struck by the disease, can the health care provider by liable? Since metastasizing prostate cancer is always fatal, the Herkovits case should provide a remedy when screening is not offered. Obviously to a HMO and health insurance provider this is a big issue. In 1991, a local HMO sought to reduce PSA screening, claiming that they saved $56 million in so doing. However, the risk to the HMO is that treating the disease costs more than providing the tests. The whole purpose of screening is based on the assumption that early detection leads to better outcomes for the patient. In May 2012, the U.S. Preventative Medicine Task Force recommended against prostate cancer screening. There was not even one urologist on the panel. There were no urologists and no cancer experts on the task force. This recommendation was challenged by nine leading urologists and prostate cancer experts in a publication, What the U.S. Preventive Services Task Force Missed in Its Prostate Cancer Screening Recommendation. 11 The authors noted significant methodological flaws and a serious misinterpretation of the data. The authors expressed concern that Medicare and insurance companies would adversely affect: the health and lives of men at high risk for life threatening disease. [And] eliminating reimbursement 11 William J. Catalona, MD, Anthony V. D Amico, MD, William F. Fitzgibbons, MD, Omosfolasade Kosoko-Lasaki, MD, Stephen W. Leslie, MD, Henry T. Lynch, MD, Judd W. Moul, MD, Marc S. Rendell, MD, and Patrick, C. Walsh, MD. What the U.S. Preventive Services Task Force Missed in Its Prostate Cancer Screening Recommendation, Annals of Internal Medicine, May 22, 2012, at SKWC-MedNeg-Bklt-v4.indd 24

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