Posted by: justransparency | April 30, 2018

A Must Attend for Those who Care about Safer Health Care!

Many of us dedicate our lives to efforts to improve health care safety and to resolve cases involving medical error sooner and with more transparency.  But our experience is like driving in Boston, only amplified beyond estimation.  It is an uphill road, full of potholes and frustrating delays, with unexpected frustrating detours or dead-ends.

However, one group continues to pave the way to a better future for all of us.

On Tuesday, May 15th at the Mass Medical Society, MACRMI will be hosting our 6th Annual Forum on Communication, Resolution and Transparency following medical errors.  This is an incredible opportunity for plaintiff and defense med mal attorneys (and health care safety experts) to learn about a means of resolving cases in a more productive 21st Century manner.

Simulation of the how the CARe process works “behind the scenes”


  • Moderated simulation discussion panels
  • Keynote by Richard C. Boothman, JD of the University of Michigan
  • Implementation background and guidance
  • Release and discussion of data on claim rates and costs from pilot study
  • Opportunity to talk with current MACRMI members about implementation.

It takes place from 10:00 am to 12:30 pm and includes lunch.

For those of us who are medical negligence attorneys, our input is essential to improving a noble, if imperfect, method of improving transparency and resolution.

Please be sure to register.  I hope to see many of you there!




Posted by: justransparency | January 19, 2018

An Important Reminder After a Tough Loss.

While suffering from a recent loss of a medical malpractice trial and struggling to make sense of the verdict, I accidentally came across an article I wrote for the Massachusetts Bar Association two years ago.  It is a reflective piece about my experience volunteering at an orphanage in Romania with my family.  I reminds me, as a lawyer, to choose happiness whenever possible.  While we cannot forget that it is those clients who do not receive justice that suffer the most, we must keep the faith and inspiration needed to continue the fight for others, so that their own justice can be achieved.

I hope many of you receive the same inspiration I received from this rather unexpected source – a 10 year old orphan in one of the remotest places on earth.

Posted by: justransparency | December 26, 2017

Double-booked surgeries. Are doctors overlooking patient safety?

A recently published study showed that hip surgery patients were about twice as likely to suffer complications when their surgeon was overseeing concurrent operations, compared to patients whose surgeons were not double-booked.

The Canadian study examined over 90,000 hip operations at 75 hospitals in Ontario, and found that the longer the duration of simultaneous surgeries the more likely patients were to suffer complications within a year, such as infections and follow-up surgery.

Double-booked surgeries are generating considerable controversy in the medical industry, especially here in Massachusetts where they are  the crux of a whistleblower lawsuit filed by a former Mass. General anesthesiologist, who claims that surgeons at the hospital conduct double-booked surgeries to boost their income while putting patients at risk, according to the Globe.

The Canadian study is the broadest to date of the risks of simultaneous surgeries, giving it significant credence as a powerful counter to previous peer-review studies in the U.S. finding no significant difference in complications from concurrent operations.

Given the primacy of patient safety, doctors, at a minimum, must inform patients before a surgery that they intend to overlap surgeries. Obtaining informed consent is both an ethical and legal requirement that can lead to a lawsuit even if the surgeries do not result in any serious complications.  If surgeons are concerned that patients will not grant them permission to perform two operations at once, then that probably tells you all you need to know about whether they should do it.

While proponents of overlapping surgeries point to greater access to specialists and increased efficiency, common sense suggests that divided attention between simultaneous procedures can increase the likelihood of mistakes.  This is especially true of doctors in training who need careful supervision.

What if the primary surgeon is not in the operating room when an urgent need arises? What if a patient is under anesthesia longer than necessary waiting for a doctor to arrive or return?

“If your surgeon is in multiple places, there’s an increased risk of having a complication,” Dr. Bheeshma Ravi, a hip surgeon at Sunnybrook Health Sciences Centre in Toronto and lead author of the Canadian study told The Boston Globe.

The obvious conclusion is that physicians should never place a desire for a fuller schedule and more income ahead of patient safety.

Posted by: justransparency | October 13, 2017


This recent article in the Boston Globe published on July 29, 2017 highlights what has been a major problem in recent years in the United States – increasing deaths of mothers following the birth of their child. While much of the rest of the world has decreasing maternal death rates, the US rates have been increasing at an alarming rate as the Globe chart reveals.

According to a New York Times article entitled “If Americans Love Moms, Why Do We Let Them Die?”(coincidentally published the same day as the Globe article), “motherhood is far more deadly in the United States than in other advanced countries.” They are far more likely to die in the U.S. than in Canada, France, Germany, Great Britain, Italy, Greece, Ireland, and Spain, where death rates have plunged.

What these frightening facts demonstrate is that part of the problem is that we are not paying enough attention to the mother after delivery. Following delivery, the mother is not out of the woods.  Most concerning, she is still susceptible to severe internal bleeding (hemorrhaging) and death.  However, all too often health care providers fail to detect hemorrhaging until its too late.  Part of the reason is that once the baby is born the mother gets neglected by the health care providers who are not monitoring her carefully enough.  This results in unvalidated assumptions that the mother is doing fine when she is not.  Then, when tragedy strikes and the mother bleeds to death, they deem her death “unpreventable” thereby foreclosing any opportunity to learn from mistakes to prevent more deaths.unva

The number one cause of maternal hemorrhaging and death is a common condition called uterine atony, where her uterus fails to contract after delivery. This prevents the uterus from constricting the blood vessels and results in severe bleeding that pools in the uterus.  This can be treated with medication and, importantly, a simple blood transfusion.  However, the danger is that it can go undetected because the mother does not notice it.  In addition, health care providers may assume that she looks fine (or just sleepy) when she is actually in the early stages of hemorrhagic shock.  Therefore, the mother’s vital signs, including her blood pressure, heart rate, and oxygen saturation rate, are critical and must be monitored consistently and carefully to give an accurate picture of how the mother is doing.  Failure to do so can lead irreversibly toward death.

A medical malpractice trial I had in September is a sad case study of this problem. Our client had a C-section to deliver her fourth child.  The child was born healthy but during the delivery complications arose when she suffered uterine atony and when the doctor accidentally cut a hole in her small bowel.  The hole was repaired and she was given medication to treat her atony, but she lost one-fourth of her total blood volume as a result, which qualified as a postpartum hemorrhage under established guidelines.

Due to the hemorrhage and that she was severely anemic during her entire pregnancy up to delivery, the standard of care required an immediate blood transfusion. Post-delivery the OB/Gyn who did the C-section ordered that blood products be available should she need it “in the future.”  He testified that if she lost any more blood, it could be life-threatening.  The cross-matched blood was then available at the blood bank and could be transfused in 15 minutes, but was not.

After the delivery, he left the hospital and signed her out to another OB/Gyn to take over her care. An hour after this defendant took over, the mother started bleeding profusely from her vagina, which the defendant described as “gushes” of blood in the medical record.  The cause of this was that her uterine atony returned once the medications wore off.  However, although the bleeding continued, the doctor consistently failed to order a blood transfusion although she was aware that life-saving blood was immediately available.  Instead, she relied on invalidated assumptions that the mother was doing just fine, despite the fact that her vital signs had not been recorded for over an hour.

Eventually, she lost so much blood that she could not hold out any longer and she went into cardiac arrest. The blood transfusion she desperately needed did not happen until about 10 minutes after she arrested.  Then, it was literally too little, too late.  After hours of CPR, transfusions, and hysterectomy she died.  She left behind her brand new baby and three other young children.

At trial, the defendants relied on an autopsy report which concluded that the cause of death was amniotic fluid embolism (AFE) to avoid liability.  AFE is extremely rare, causing death in 1 out of 100,000 new mothers.  It is considered unpredictable, unpreventable, and untreatable for which doctors cannot be held liable.  However, the autopsy was conducted by a medical examiner who was not given critical medical records by the hospital which would have confirmed that she bled to death due to uterine atony.  We demonstrated that the autopsy was completely flawed and that her death did not fit the criteria for AFE.  We also argued that it was suspicious that the Ob/Gyn called the medical examiner’s office an hour after she died to suggest that the death may have been from AFE, which may have biased the medical examiner’s conclusions.

Following a three week trial and a week of deliberations, the jury found against the second Ob/Gyn in favor of the family in the amount of $4 million for the mother’s conscious pain and suffering.

Nevertheless, this case illustrates another obstacle to saving mother’s lives. Doctors sometimes make invalid assumptions about the new mother’s condition without the clinical evidence needed to substantiate that she is doing fine.  Then, based on that same lack of evidence, they leap to a self-serving conclusion that her death was unpreventable.  Although justice ultimately prevailed, this case illustrates why improvements in preventing maternal death have been ineffective in the U.S.  If we continue to fail to confront this problem with honesty, transparency, and accountability, we will not learn from our mistakes and more deaths and motherless children will result.



Posted by: justransparency | August 18, 2017

Study Shows Room for Improvement.

While the recently released 2017-2018 rankings of hospitals by U.S. News & World Report celebrate top performing medical facilities across the country, the study also shows that too many hospitals are falling short in consistently providing quality care.

The sobering finding that many hospitals have significant room for improvement to meet best practices makes all the more paramount the need for regulators, patient safety advocates, and the legal system to hold medical providers accountable for the critical health services they provide to patients.

The U.S. News rankings of hospitals are an invaluable resource to patients and their families, and help to maintain the spotlight on patient safety. Hospitals have to remain diligent at all times in ensuring the quality of care they provide consistently meets or exceeds what is expected.

For relatively common procedures such as knee or hip replacements, removal of part of the colon, or heart bypass surgery, “[a]ny hospital should be able to treat … patients successfully, and many do – but not all [do],” according to U.S. News.

In rating overall quality of inpatient care, the publication used numerous measures of care to evaluate more than 4,500 U.S. hospitals for nine common procedures and conditions. While more than 1,200 hospitals were rated “high performing” in at least one procedure or condition, only 48 were rated high performing in all nine procedures and conditions.

Medical centers were also rated across 16 areas of complex specialty care, such as cancer, endocrinology, and neurosurgery. Of the nearly 4,700 hospitals reviewed for specialty areas, “only 152 U.S. hospitals performed well enough to be nationally ranked in one or more specialties,” U.S. News writes.

No one would dispute that we cannot expect perfection in all situations and cases. However, it is equally indisputable that we all have a right to expect that all hospitals will have “high performance” in as many categories as possible. Otherwise, if we accept lower standards of care, then lower standards of care is what we will receive.
For more information, please contact Jeffrey Catalano at ( or 617.720.2626.
Jeff has been selected to the Best Lawyers in America directory for personal injury and product liability litigation (plaintiffs) for three consecutive years (2015-17), and has been designated as one of Top Rated Lawyers in Medical Malpractice by The Boston Globe and Wall Street Journal. He has been chosen as a New England Super Lawyer each year since 2009.

Posted by: justransparency | March 14, 2017

Continuing the March Toward Medical Transparency.

At at time in our society when public marches bring to the forefront progress we need to make on a variety of important issues, one march is of the more the silent type.  That is the march toward increasing transparency following medical injuries, which are the third leading cause of death in the U.S.  More and more hospitals are signing up for disclosure programs such as those created by the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI).  I have been proud to be the Massachusetts Bar Association’s representative on this Alliance for several years.  I have been pleased with how receptive this Alliance and its associated hospitals have been to the concept of involving an attorney on behalf of the patient early on.  They recognize it is an imperative that is both moral and efficient.  The patient has the security of an advocate and counselor in her corner in achieving appropriate compensation.  The hospital and insurer see the attorney as someone who can facilitate a productive resolution by advising his client of the risks of rejecting a reasonable offer and choosing protracted litigation.

Nevertheless, many remain skeptical, which is unfortunate.  Still too many doctors and insurers fall back on the old “deny and defend” mentality to avoid accountability.  Still too many lawyers think that suing first, asking questions later, is the best approach.  Neither tactic is beneficial to the person who matters most in these circumstances, the patient.

Recently, the Washington Post wrote an article confirming the benefits and challenges of apologies and disclosures following medical errors.  As I stated in the article, attorneys provide very important roles in helping patients to move on with their lives by achieving fair compensation as soon as practicable.  But in my experience, good attorneys can help both sides navigate through the turbulent emotional waters that often impede just resolution.

So as time marches on, so do we.  And we hope many more will join us so that for every fight we win against something like cancer, we don’t lose another to preventable medical errors.



Recently, a Boston-based doctor underwent a hysterectomy during which a power morcellator was used, and during the procedure undetected cancer was spread throughout her abdomen, resulting in advanced cancer.  The FDA recently reported that three major Massachusetts hospitals failed to properly report patient deaths and injuries potentially caused by medical devices.  The report follows the FDA’s investigation last December of Massachusetts General, Brigham and Women’s, and UMass Memorial, as well as other hospitals around the country, concerning infections possibly linked to duodenoscopes, which examine the small intestine, and the potential spread of uterine cancer by a surgical device known as a power morcellator, which cuts up tissue. Most concerning is that the FDA discovered that the Massachusetts hospitals and others failed to timely report incidents where patients were harmed by these devices, or failed to report the incidents at all.

The FDA requires hospitals to report patient injuries and deaths suspected to be caused by medical devices.  The reason is obvious.  Reporting allows the FDA to analyze potential harm to patients, and determine whether new safety regulations are needed.  Without hospitals fulfilling this mandate, the FDA cannot ensure that devices used in medical settings are safe for patients, potentially compromising the safety of any patient exposed to such devices.  This effectively strips patients of being able to make informed decisions about their medical care, and could expose them to an increased risk of harm or death.

Todd & Weld firmly believes that transparency is a solution to rampant harm and death to patients to due to medical errors and medical devices.  I am proud to participate as the only attorney representing patients on the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI), which promotes hospital programs focused on disclosure and resolution after a medical mistake. 

I look forward to discussing these programs with attorneys of the Worcester County Bar Association on Monday, February 6th from 4 pm to 6 pm at the Worcester Registry of Deeds.  Please contact me if you would like more information about this event.


Posted by: justransparency | March 10, 2016

“We want to say we’re sorry. Now what?”

As a dedicated member of MACRMI, I find it very encouraging that hospitals across the country are embracing the concept of admitting medical errors to patients and apologizing for them.  This was reinforced in a recent Wall Street Journal article where it was reported that “Evidence has accumulated that the approach can improve patient safety and substantially reduce malpractice costs.”  So, now that providers know that apologizing is imperative, for many the question is “Now what?”  Lost in the discussion is how and when to apologize and admit the error.  As an attorney representing patients, I have seen many instances where the hospital intends to do the right thing, but the message is interpreted negatively by the patient.  Most of the time, the admission and apology helps to diffuse the situation and often leads to an early non-adversarial result.  However, it is sometimes the case that the apology or admission initially is seen as an acknowledgement that the provider let them down, and the reason may not be easily excusable (e.g. giving the wrong medication, failing to convey a negative imaging report or lab result).  In all cases, it is important to remember that those who have been harmed are suffering substantial physical and emotional pain after the event.  Their judgments and perceptions are not impartial or objective, especially at the early stages.  They are also overwhelmed with grief, depression, and even anger and may not be in a place to deal with speaking with doctors, risk managers, or insurance claim representatives right away.

The WSJ article goes on to state that “The programs require a commitment from hospital administrators and physicians to be transparent about risks and adverse events.  Patients can still seek legal representation at any time.”  However, for such programs to be effective, patients should be encouraged to seek legal representation early in the process, and certainly before any meeting to discuss what happened and how the provider wants to resolve it.  To accept this concept, it is important to view plaintiff’s lawyers differently than many have viewed them.  Understand them not as obstacles to resolution, but as collaborators toward it.  Many of us understand that one of the hats we wear is as “counselor”, in the broadest meaning of the term.  In that role, attorneys can help patients process information and respond appropriately to pave the path toward early resolution while also protecting their rights.

MACRMI embraces the concept of encouraging patients to seek legal representation because we realize that is it not only beneficial to the patient and the process, it is also the ethical thing to do.  Plainly stated from an objective point of view, few of us would want our elderly parent, infirm friend, or even adult child having substantive discussions about resolution without legal assistance.  Hopefully, this is the mindset all hospitals will have when they decide to embrace the noble goal of transparency.

Posted by: justransparency | October 26, 2015

Double Booking Surgeries? Are You Kidding Me?!

This blog has been dedicated to an impassioned and balanced view based on evidence surrounding medical errors.  I am not one for histrionics or grandstanding.  But when I read the Boston Sunday Globe Spotlight article revealing that Massachusetts General Hospital surgeons are routinely doing two operations at once, I nearly choked on my bagel.  I had just returned from visiting my father after his heart surgery in Phoenix and, among all of the questions I asked the doctors about his surgery, it never occurred to me that I should have asked, “Will you be doing another operation at the same time as you will be doing my father’s?”  Before reading the article, I would have imagined that the surgeon would have laughed in my face at such a preposterous question.  It would be like asking a pilot if he is going to be flying two planes at once.  While that’s physically impossible, whereas doing two surgeries at once technically is not, they both seem equally incomprehensible.

We are not living in a country where medical errors are decreasing.  Errors and deaths are increasing at an alarming rate every year.  Currently, there is a much greater chance of death from a medical error than from a car accident.  There is simply no rational argument that double booking decreases those odds.

Concurrent surgeries indisputably increase the risk of complication. If something goes wrong, and the attending surgeon is not there, the patient must remain under anesthesia longer, increasing the risk of death.  Furthermore, most surgical patients are not even aware that they are consenting to a resident doing their operation.  A resident is a “doctor in training”.  So, things can, and often do, go wrong.  Some of these are small and can wait a while until an attending surgeon intervenes to correct the problem.  Some require immediate attention and correction.  When that happens, you want the pilot there  immediately to take over the controls.

Who among these surgeons who double-book would permit a surgeon operating on their daughter, son, mother or father to do the same?  Surgical patients have a right to the undivided attention of those who literally have their life in their hands.  These surgeons are doing these procedures for two reasons:  one because they want to heal others with their skills; two, because they make a good living doing this.

No one is disputing that skilled surgeons deserve to make a good living.  They work exhaustively under extreme circumstances treating patients with complicated, sometimes life-threatening conditions.  But it is for these exact reasons that double booking should be absolutely prohibited.  These circumstances already make the patient extremely vulnerable to suffering from a mistake.  Hospitals should be trending toward decreasing, not increasing these risks.

The only argument by MGH in the Globe article for permitting this is to increase “efficiency.”  Is there anyone who doesn’t understand that “efficiency” means the ability to make more money?  Making more money is not a sin, but it is when its at the expense of risking a patient’s life.  Under these circumstances, when things go wrong and the patient has been harmed, the physician and the hospital are asking for a lawsuit.

In Massachusetts, we enacted a law prohibiting texting while driving so that others do not get killed or harmed by drivers failing to give the road their undivided attention.  Do we really need to do the same to force physicians to do this during surgery?  Do we need a law requiring them to do what is ethically and morally right?  If so, enlist me as an advocate for such a bill.  I promise it will get my undivided attention.


Posted by: justransparency | August 11, 2015

More Progress on Patient Safety.

I was pleased to have been a part of the well-attended 2015 CARe Forum at the Massachusetts Medical Society on patient safety and transparency efforts in Massachusetts.  The march continues on improving patient safety, transparency, and responsible advocacy for those who have been harmed by medical errors.  For an insight into a successful resolution of a case of unacceptable medical error, where the hospital admitted its mistake and worked with me to resolve the matter amicably, please see these videos available at the MACRMI website.

Also, please join us at the National Patient Safety Foundation’s Lucian Leape Institute 8th Annual Forum on patient safety, where I will be speaking on the approach attorneys can take to achieve fair and expeditious resolution of medical malpractice cases on behalf of their injured clients.



Older Posts »