Attorney Clifford Rieders is one of the country’s leaders in medical malpractice and patient safety. He agreed to conduct a Q and A with this writer touching on the Dennis Quaid lawsuit against the hospital who overdosed he and his wife’s newborn twins.

Q. Name and legal history – expertise.

A. My name is Attorney Clifford Alan Rieders. I am an active trial lawyer in practice for the past 32 years. I am the author of “Medical Malpractice in Pennsylvania,” a member of the Pennsylvania Patient Safety Authority and a past president of the Pennsylvania Association for Justice (formerly the Pennsylvania Trial Lawyers Association) and Citizens for Consumer Justice. I am a board-certified civil trial advocate.

Q. Where do you practice?

A. My law firm is located in Williamsport, Pennsylvania. I am admitted to practice in Pennsylvania, New York and the District of Colombia.

Q. How do you choose your areas of specialty?

A. I am actually interested in many areas of the law, but have focused my law practice in the rather eclectic fields of medical malpractice, constitutional law and federal practice.

Q. Actor Dennis Quaid and his wife experienced every parent’s nightmare, giving birth to twins, then the babies were administered the wrong amount of medication. From your expertise in this field, how could something like this happen in a top medical center?

A. It happens all the time, actually, even in the best hospitals. What happened to the Quaid twins is commonly known as “death by decimal point,” a problem that occurs when a pharmacist can’t read a doctor’s handwriting or someone pulls a bottle off the shelf of the right medication at the wrong dosage, which is what allegedly happened in the Quaid case. All the experts agree that the epidemic of drug errors at hospitals could be drastically reduced through electronic record-keeping.

Unfortunately, the Quaid case is the tip of a much larger iceberg. The number of patients who die due to preventable medical errors in U.S. hospitals is staggering - the equivalent of two 747s crashing every day. The catastrophe of medical errors is sometimes systemic or caused by one or more factors, including a lack of communication, ego, lack of standards, poor education or secretive peer review. Sometimes physicians’ handwriting simply cannot be read. In general, the peer-review system, which involves doctors reviewing adverse events involving other doctors, protects bad doctors. In addition, disciplinary enforcement by state medical boards is nonexistent in most states. All of this and more make our hospitals virtual Petri dishes for medical errors.

Sadly, people have almost come to take medical errors for granted. For instance, while the Pennsylvania Patient Safety Authority and others have acknowledged there should be zero tolerance for hospital-acquired infections, most people today expect infections as a routine possibility in hospital stays.

Q. Who monitors the administering of drugs in nurseries?

A. There is a whole chain of responsibility starting with the prescribing physician through the hospital pharmacy and the in-duty nurses who actually hands the patient the pill or puts the drug into their IV. The Quaid case appears to be a systemic failure, which can occur for myriad reasons. Frequently, in such cases, there is little or no supervision, nurses are overworked, the hospital or unit is understaffed and patients are being cared for by residents (doctors in training). These kinds of systemic breakdowns can lead to the kinds of errors that allegedly occurred in the Quaid case.

Q. Who is permitted to administer drugs?

A. Nurses and doctors primarily.

Q. Legally, what actions can the Quaids take against the hospital?

A. This depends upon the law in California where the alleged incident occurred. The Quaids’ could certainly file a medical malpractice lawsuit, but the issue would be damages. If the twins recovered from the drug overdose and there are no lasting health effects, there really would be no economic damages, such as the future cost of medical care. Unfortunately, California has a $250,000 cap on non-economic damages, which means the Quaids’ recovery for the pain and suffering caused by the incident would be limited to $250,000. But in many states, unless the parents actually witnessed the incident, they would have no independent claim for infliction of emotional distress. Dennis Quaid has publicly stated that he is reluctant to sue Cedars-Sinai Medical Center where the incident occurred, but he is missing a fundamental point: With non-punitive improvement programs, there must be fair or meaningful remediation. As a dean at an important school of public health stated to a medical group at the University of Pennsylvania Medical School, the carrot and the stick is a necessity. That’s probably why the Quaids are pursuing a product liability claim against the drug manufacturer for placing confusingly similar labels on the medication.

If the babies had died, the Quaids probably would have learned firsthand the sad reality facing many families in that state who have lost children to medical errors. Because deceased children have no lost wages or future medical needs, there are virtually no economic damages, leaving a maximum potential recovery of only $250,000 for pain and suffering. Because of the exorbitant amount of money law firms have to shell out to pursue these kinds of cases (and get paid only if they win), most firms would not take a California case involving a deceased child.

Q. Are there long-term health ramifications to the babies?

A. It’s hard to say without knowing more specifics about the case, and the only ones who have access to that kind of information are the Dr’s.

Q. What should be done legally to compensate the Quaids?

A. Again, they can try to recover monetary damages as I discussed above. The hospital also could apologize and undertake a program to make sure this kind of potentially deadly drug mix-up never happens again. That might at least make the family feel better.

Q. What action should be taken against the hospital?

A. In addition to the potential legal actions by the family I’ve discussed previously - either a malpractice or product liability lawsuit - there should be open, non-secretive peer review; disciplinary action against the responsible parties; an effective patient safety officer at the hospital; a patient safety authority in the state; and published safety statistics about every hospital in the state, including their errors.

Q. How can parents protect their own newborns from such horrific mistakes?

A. As with any hospitalization of a loved one, parents, family members and guardians must act aggressively and assertively as patient safety advocates. They must be present as much as possible during the patient’s treatment and ask a lot of questions. Even though it can cause great financial strains on families, a designated family member might consider a leave from his or her job under the Family Medical Leave Act. Thanks to the Internet, family members or guardians can also research medical conditions and get tons of information about how to be an effective patient advocacy.

Q. Can you describe the drug overdose the babies were given?

A. The Quaids’ newborn twins were allegedly given 1,000 times the intended dosage of the blood thinner Heparin at Cedars-Sinai Medical Center. In addition to putting a spotlight on the epidemic of medical errors in America, the case raises the issue of federal regulatory preemption and the fact that the Food and Drug Administration does a poor job of screening pharmaceuticals and medical devices. Because of the doctrine of preemption, immunities have been created that make compensation almost impossible, regardless of how lax or inattentive the FDA is. When there is no regulator worth their salt and no economic remedy, problems and errors multiply like mushrooms in the dark. Dennis Quaid has testified before Congress against changes in federal regulations that bar families from suing in state courts for injuries caused by defective products approved by the FDA.

There is no basis in law or morality to grant immunity to drug manufacturers and the creators of medical products when they create defective products or mislabel drugs simply because the FDA has given a nod of approval to those devices and drugs. It’s worth noting that the FDA is frequently controlled by the very industry that it supposedly regulates.

Q. Can you compare any other legal case that you are aware of or cases you have represented to the Quaid case?

A. The history of tort law in the United States is replete with cases involving drug errors, but I have not handled any.

Calling for change is important and should be encouraged. Likewise, eliminating barriers to legitimate financial remedy must also occur. The largest barrier to medical liability suits is public resentment toward those who sue. Correct information must be given to the public about the number of people who actually do file lawsuits. National statistics show that perhaps 4 percent of people who would be eligible to sue for medical mistakes actually do so. In Pennsylvania, the rate is far below 1 percent. For example, the Pennsylvania Patient Safety Authority receives a third of a million reports each year of incidents and serious events in Pennsylvania hospitals. Yet, there are only 1,300 to 1,500 lawsuits filed annually. Some of the barriers to lawsuits are public resentment, an Iron Wall created by the medical community, making peer review and other deliberations virtually secret, and retaliation against doctors and hospitals against other doctors who tell the truth about medical problems. Legislators must balance any reforms to the tort system with clear anti-retaliation sanctions.

The courtroom ought to be open and affordable to those who have legitimate medical claims in the same way that claims today are screened for merit. Throughout the country, states have enacted certificate of merit rules. This means that medical liability lawsuits cannot be brought unless there is some sort of prescreening procedure, usually by doctors in the same field or subspecialty as those being sued. However, nothing has been done to prevent doctors from retaliating against other doctors who tell the truth. Whistleblower protection for the medical community is nonexistent or un-enforced. The cost of hiring medical experts is astronomical, and doctors and medical communities punish physicians who tell the truth with so-called “peer review” of medical opinions.

A complete bio and media clips of Clifford Rieders are available at: http://www.lyonstrategic.com/rieders/riedersmedia.htm

More information is available on his firm web site at www.riederstravis.com.

By: Amanda Lang