Saturday, July 25, 2009

Vicki Forman's twins weighed only a pound at birth. She thought they should be allowed to die. Doctors disagreed

Born too soon
By Katharine Mieszkowski
July 25, 2009

After years of trying to conceive, writer Vicki Forman's twins were finally coming. Way too early.

Evan and Ellie were only 23 weeks gestation when Forman went into labor. They were so premature Forman thought she was having a miscarriage. At birth, each baby weighed only about a pound.

"One of life's great illusions is the notion that we can want -- and get -- things on our own terms, no matter what. It's human nature to seek pleasure and avoid suffering, but what happens when suffering finds you?" Forman writes in her harrowing new book "This Lovely Life: A Memoir of Premature Motherhood." "My husband and I had tried for two long years to conceive these twins, had lived through miscarriages and fertility treatments to bear them. When I learned they were coming so early and so fragile, I had only one wish: to let them go."

While Forman thought the twins should be allowed to die, their doctors struggled to save them. While Ellie lived for only four days, Evan, who endured severe disabilities including the inability to speak or see, died just shy of his eighth birthday...

Tuesday, July 14, 2009

Dr. Yorobe and Kaiser Permanente both guilty of "repeated negligent acts"

Dr. Yorobe sounds just like the Kaiser Permanente doctors who treated my friend Sandra Wiltgen.

Sandra died of uterine cancer in 1992 at the age of 44. She went to the Kaiser Emergency Room on Zion in San Diego with bleeding, and each time the doctors did the same thing: a blood test. Each time the blood test revealed that Sandy was severely anemic, so doctors did the usual: a blood transfusion. Each time they sent her home. This went on for a year and a half, at which time the doctors had the brilliant idea of checking for uterine cancer. Sandy received external radiation at a non-Kaiser clinic where the radiologist recommended--no, urged--that a radioactive implant be used. But the gynecologist at Kaiser did not approve this idea. Sandy died without ever having seen an oncologist.

Treatment of patient who died draws fire
Medical Board claims doctor was negligent
By David Hasemyer
San Diego Union-Tribune Staff Writer
July 13, 2009


Incidence: The third most common cancer and the third most common cause of cancer death in the United States.

Detection: Usually no symptoms in the early stages. Can be detected by colorectal cancer screenings. As it progresses, the disease may cause symptoms such as a change in bowel habits, bleeding from the rectum or blood in the stool, or cramping or gnawing stomach pain.

Risks: Chance of developing colorectal cancer increases as people age. Over 90 percent of cases occur in people older than 50. The mortality rate for males was 25.3 per 100,000 and 17.7 per 100,000 for females from 1997 to 2001.

Prevention: About 26,000 deaths a year could be prevented in the U.S. if everyone older than 50 were screened for colorectal cancer.

Source: American Cancer Society

Online: For the California Medical Board accusation against Dr. Edwin Yorobe, go to

When Teodoro Galvez started feeling ill with back pain and rectal bleeding, he sought treatment from a doctor from his native Philippines.

The Navy veteran and Rancho Peñasquitos resident just felt more comfortable in the care of a doctor from his homeland, said his daughter Sucett Galvez. So he became a patient of Edwin Mendez Yorobe, a 1970 graduate of Far Eastern University in Manila who had his medical practice in Tierrasanta.

But the doctor Galvez placed so much trust in has been accused of negligence and incompetence by the Medical Board of California, which says Yorobe overlooked signs of rectal cancer in Galvez for more than a year before Galvez died of the disease.

Yorobe, who has been licensed in California since 1975, did not respond to numerous requests for an interview.

The Medical Board accusation filed in Administrative Law Court says Yorobe failed to properly diagnose the cause of Galvez's rectal bleeding with appropriate diagnostic studies and seeks the revocation or suspension of Yorobe's license.

“(Yorobe) departed extremely from the standard of care for treatment of a 73-year-old man with rectal bleeding by failing to properly and fully investigate the exact cause of (Galvez's) rectal bleeding with timely and appropriate diagnostic studies,” the accusation says.

A hearing date for the case has not been set.

“My dad put his trust in his doctor,” Sucett Galvez said, but throughout repeated visits, he began to wonder why he wasn't starting to feel better. “But we just thought he's going to see a doctor, so he's being taken care of.”

According to the court documents:

Yorobe first examined Teodoro Galvez in March 2003 and noted hemorrhoids, bleeding in the gastrointestinal tract and a stool sample that suggested colorectal cancer.

In response to those findings, Yorobe directed his patient to stop taking ibuprofen, which increases bleeding by thinning the blood, and to start taking Zantac, which is used to treat bleeding ulcers. He told Galvez to come back in three weeks.

After the follow-up visit, Yorobe again noted the bleeding and the warning signs associated with cancer but then “concluded his inquiry into this condition,” the accusation says.

Yorobe, 63, examined Galvez 11 more times between May 2003 and August 2004 without any mention of the bleeding or signs indicating cancer.

During an August 2004 visit, Galvez told Yorobe that he had developed a painful mass in his groin and had lost his appetite.

The doctor diagnosed Galvez with a hernia and recommended the use of an athletic supporter.

Galvez was back in three weeks. He was diagnosed with rectal bleeding and told to take hot baths, use Anusol, watch his diet and exercise.

Two weeks later, in mid-September, with Galvez still bleeding, Yorobe referred his patient to another doctor for a consultation.

“However, before (Galvez) was seen by a specialist, he went to the emergency room at Sharp Memorial Hospital where he was admitted and diagnosed with metastatic inoperable rectal cancer to the liver,” the accusation says.

Galvez died October 27, 2004.

Medical Board authorities say the acceptable standard of care would have been to conduct physical examinations and tests to establish the location of the bleeding and to rule out cancer. Yorobe did not perform those tests, including a colonoscopy and rectal exam.

The Medical Board said that failure constitutes “repeated negligent acts” by the doctor in his care of Galvez.

In 2006, Yorobe and another doctor settled a malpractice lawsuit filed by Sucett Galvez, her brother and mother for $125,000.

Saturday, July 11, 2009

Problem nurses stay on the job as patients suffer

Problem nurses stay on the job as patients suffer

By Charles Ornstein, Tracy Weber and Maloy Moore
July 12, 2009

Nurse Owen Jay Murphy Jr. twisted the jaw of one patient until he screamed.

He picked up another one -- an elderly, frail man -- by the shoulders, slammed him against a mattress and barked, "I said, 'Stay in bed.' "

He ignored the alarms on vital-sign monitors in the emergency room, shouted at co-workers and once hurled a thirsty patient's water jug against the wall, yelling, "How do you like your water now?" according to state records.

Murphy's fellow nurses at Kaiser Permanente Riverside Medical Center finally pleaded with their bosses for help. "They were afraid of him," a hospital spokesman said.

Under pressure, Murphy resigned in May 2005. Within days, Kaiser alerted California's Board of Registered Nursing: This nurse is dangerous.

Tracy Weber and Charles Ornstein, both former Los Angeles Times staff writers, did significant reporting for this article before leaving The Times last year and have continued to cover the issue for ProPublica.

Maloy Moore is a Times researcher. Doug Smith, The Times’ director of database reporting, contributed to this report.
But the board didn't stop Murphy from working elsewhere, nor did it take steps over the next two years to warn potential employers of the complaints against him. In the meantime, Murphy was accused of assaulting patients at two nearby hospitals, leading to convictions for battery and inflicting pain, board and court records show.

Even Murphy, who has since taken classes to curb his anger, was surprised the board didn't step in earlier.

"The nursing board is there to protect the public from me," he said in an interview.

The board charged with overseeing California's 350,000 registered nurses often takes years to act on complaints of egregious misconduct, leaving nurses accused of wrongdoing free to practice without restrictions, an investigation by The Times and the nonprofit news organization ProPublica found.

It's a high-stakes gamble that no one will be hurt as nurses with histories of drug abuse, negligence, violence and incompetence continue to provide care across the state. While the inquiries drag on, many nurses maintain spotless records. New employers and patients have no way of knowing the risks.

Reporters examined the case of every nurse who faced disciplinary action from 2002 to 2008 -- more than 2,000 cases in all -- as well as hundreds of pages of court, personnel and regulatory reports. They interviewed scores of nurses, patients, families, hospital officials, regulators and experts.

Among the findings:

* The board took more than three years, on average, to investigate and discipline errant nurses, according to its own statistics. In at least six other large states, the process typically takes a year or less.

"It's really discouraging that when you do report people . . . they don't take action," said Joan Jessop, a retired chief nursing officer in Los Angeles who filed multiple complaints with the board during her 43-year career. "What is so frightening to me is that these people will go on and do it to somebody else."

* The board failed to act against nurses whose misconduct already had been thoroughly documented and sanctioned by others. Reporters identified more than 120 nurses who were suspended or fired by employers , disciplined by another California licensing board or restricted from practice by other states -- yet have blemish-free records with the nursing board.

* The board gave probation to hundreds of nurses -- ordering monitoring and work restrictions -- then failed to crack down as many landed in trouble again and again. One nurse given probation in 2005 missed 38 drug screens, tested positive for alcohol five times and was fired from a job before the board revoked his probation three years later.

* The board failed to use its authority to immediately stop potentially dangerous nurses from practicing. It obtained emergency suspensions of nurses' licenses just 29 times from 2002 to 2007. In contrast, Florida's nursing regulators, which oversee 40% fewer nurses, take such action more than 70 times each year.

In interviews last week, the board's leaders and other state officials defended its record. "We take what we do -- protecting the public -- very, very seriously," said Executive Officer Ruth Ann Terry.

Terry, at the helm for nearly 16 years and on staff for 25, acknowledged that the pace of the disciplinary process has "always been unacceptable" and said the system was being streamlined. But she blamed other parts of the state bureaucracy for delays and was vague about what changes would be made...

This report, one in a series of occasional articles about oversight of nurses, was prepared in collaboration with ProPublica, an independent investigative newsroom in New York.

Wednesday, July 8, 2009

Antibiotic rapamycin delays aging in mice

Antibiotic Delayed Aging In Experiments With Mice
New York Times
Published: July 8, 2009

A new star has appeared in the field of drugs that delay aging in laboratory animals, and are therefore candidates for doing the same in people.

The drug is an antibiotic, rapamycin, already in use for suppressing the immune system in transplant patients and for treating certain cancers.

...[T]here are now many ways of extending life in small laboratory animals through a variety of compounds, including resveratrol and sirtuins, PGC1-alpha and now rapamycin. All these compounds seem to be involved in helping an organism detect and respond to the level of nutrients in its environment.

“It’s no longer irresponsible to say that following these up could lead to medicines that increase human life span by 10, 20 or 30 percent,” Dr. Miller said.

But it will be at least 10 years before matters are sorted out, in his view. As of right now, he said, “I don’t think there’s any evidence for people that there’s any drug that can slow aging down.”