January 2006

Hospital-acquired infections are a major concern in healthcare facilities, affecting at least 2 million patients annually and resulting in extended durations of care and substantial morbidity. Such infections are estimated to cause or contribute to 88,000 deaths annually in the US, as well as requiring nearly $5 billion in treatment costs. The incidence of infections in acute care facilities is about 9.8 infections per 1,000 patient care days and in long-term care facilities, approximately 7.2 infections per 1,000 resident care days. Maximizing Hand-Hygiene Compliance to Improve Outcomes: A New Tool for Infection Control

Last month I had occasion to spend a couple of weeks in and around Massachusetts General Hospital in Boston, where my daughter was a patient. As a teaching hospital of Harvard Medical School, Mass General has always been a leader in setting the highest standard of care in medical practice.
One simple thing I observed struck me as different from many other hospitals I have visited. Outside the door of every patient room, and at every entrance to a patient floor, there was a conveniently located dispenser of hand sanitizer. Every time a doctor or nurse entered my daughter’s room, they were rubbing hand sanitizer on their hands. After surgery, prophylactic antibiotics were prescribed for a period of time after discharge.
In most hospitals I have visited, if there is a hand sanitizer dispenser available it tends to be mounted by a sink in the patient’s room and seldom used. My daughter went from Mass General to another hospital in another state for another surgery. I don’t intend to pursue it or go to the trouble to closely analyze it, but I did note that the degree of fanatical attention to infection prevention we saw at Mass General was not followed at the second hospital. A few days after the second surgery she did get a staph infection and an epidural abscess in the incision site of the first surgery.
A lot of doctors consider hospital acquired infections, such as staph infections, unavoidable risks of any hospitalization. Some think prevention is attainable.
Those Harvard doctors are pretty smart. It would be interesting to compare the infection complication rates at Mass General with that of other hospitals where those rigid precautions are not followed.
The Centers for Disease Control Guideline for Hand Hygiene in Healthcare Settings says that “If hands are not visibly soiled, caregivers should use an alcohol-based waterless antiseptic agent for routinely decontaminating hands.” That’s what they do at Mass General, and it’s what I’m doing now at home in changing my daughter’s IV pump every day, whether the nurses tell us to or not.

A variety of injuries, illnesses and genetic disorders can cause damage to the auditory nerve, resulting in hearing loss for which hearing aids provide little or no help. Since sensory nerves have less capacity for recovery than motor nerves, such damage is often permanent and irreparable. The isolating effect of resulting deafness can be devastating. While there has been considerable progress on auditory brainstem implants, there is still a long way to go.
Some researchers have begun work on the prospect of stem cell treatment to repair damaged auditory nerves. See, e.g., “UCI Researcher Pinpoints Cause Of Inherited Auditory Neuropathy,” “Investigating a cell replacement therapy in the inner ear,” “Central migration of neuronal tissue and embryonic stem cells following transplantation along the adult auditory nerve,” and “Tissue Engineering: STEM CELLS”.
People who have lost hearing in both ears due to damage to auditory nerves face tough decisions about living with deafness, getting currently available treatments such as ABI which might preclude later stem cell treatment, or waiting years hoping clinically effective stem cell therapy.

The big law firms in Atlanta are raising the starting salary for new associates straight out of law school to $115,000. I have a lot of friends in those firms, and certainly enjoy the view from their regal offices when I visit. However, I have yet to see a first year associate who is worth $115,000.
Some politicians and news media folks like to blame plaintiff’s personal injury lawyers for all the ills of a “litigious society.” However, you haven’t seen litigation til you’ve seen business litigation, with big firms assigning platoons of senior partners, junior partners, senior associates, junior associates, paralegals and support staff, all billing by the hour. The big firms tend to engage in a vicious cycle of overpaying bright young lawyers, and then needing to generate enough billable hours to carry exorbitant overhead expenses (salaries, lavish offices, etc.), and still pay the partners very well. Generally their incentives are to increase complexity and expense rather than to get to the bottom line quickly and efficiently.
Those of us representing individuals and families on a contingent fee basis get paid only in proportion to the results we obtain for our clients, and only when the case is concluded. We control our overhead, staff lean, expand on an ad hoc basis when necessary, and work hard. It is a model of economic efficiency, as our focus is necessarily on getting optimal results for our clients as quickly and efficiently as possible. While I was never in one of the giant law firms, I did spend a decade in a defense litigation firm where we all had hourly billing quotas. Often one looked for things to do on a file more to meet a billing quota than to advance the client’s interest.
Occasionally corporations are willing to “think outside the box” and hire a small law firm to handle business litigation on a contingent or blended fee basis. Certainly there may be concerns about a small firm’s capacity to handle some very large, complex cases that may legitimately require a higher level of staffing. And I recognize that the big firms generally have bright people doing high quality work. On the other hand, I have seen cases in which large firms assign platoons of lawyers to matters which a sole practitioner with a focus on the bottom line could handle at least as well.
Frankly, I don’t spend a lot of time marketing to corporate legal departments because I realize that no one in a large corporation ever got fired for hiring a blue chip law firm to represent the company, but one could fear criticism in a corporate culture for hiring a small plaintiffs’ firm for corporate litigation. It takes a degree of courage to make such a choice, even if it could help control legal expense and tie fees to performance.