Thursday, May 28, 2009

Knowledge Management for Solos and Small Firms

McGowan, Hood & Felder, LLC has handled numerous actions involving complex legal matters in South Carolina and outside the state. Attorneys with McGowan, Hood and Felder, LLC have represented clients involving construction litigation, catastrophic injury, business litigation, class action and multi district litigation.

What if you could spend a few moments thinking about drafting a complaint, and then, with a couple of keystrokes, find exactly the go-by you needed? What if your staff had time to “tag” every work product document with keywords? What if your computer silently, constantly, indexed your document files by keyword and by full text? And what if finding that elusive complaint were as easy as using Google? Chances are, you would be working for a large firm with unlimited resources.

What if you feel like you do not have the time to learn about expensive programs and acronyms like DM, KM, and CRM. So what if you can’t remember the file your law partner had that was just like the trip and fall you got in yesterday?

There is no reason why small law firms can’t enjoy the same organization and recall for their work product as the big firms. Whether you start using the tools you already own in a different way, install free or low-cost solutions, or invest in a dedicated program, you can retrieve exactly the information you need, quickly and efficiently. So what are you waiting for?
Face it. All we have to sell is time and knowledge. In theory, at least, the more knowledge we have the less time it should take us to get work done for our clients. Knowledge management, or KM, includes document management but it is more. Most law firms have some system for finding documents that are capable of repetition. Some attorneys file copies in a drawer and others have a “Forms” folder on their computer. Some forms folders are broken down by document type, or by subject matter. Filing in a drawer means walking to the file cabinet and thumbing through all the complaints until you find the one you’re looking for. Saving files to a computer file cabinet isn’t much different, except you get to stay in the chair. E-mailing to your partners, or posting to a listserv, is really convenient only for you.

Managing documents is important. But documents don’t capture knowledge, except in the limited sense of our work product. We need to save and retrieve what we know about other lawyers and expert witnesses. Which lawyer habitually hands up a memorandum when the motion hearing begins? How do we recall circuit judges’ preferences, like district judges’ that are posted on the Internet? Likewise, we need to remember techniques for trial and deposition. The stab in the dark on the defense engineer’s qualifications that hit the mark? It might keep him out altogether the next time around. The damages argument I read about, or saw in a CLE, or watched another lawyer make to the jury? How can I make sure to remember it for the next trial?

Finally, our most important asset is our goodwill with clients. We can take care of the little things, like spelling their names right and sending their mail to a new address right after we learn about it. What about other things? Who goes ballistic when we send lawsuit-related papers to the house where his ex-wife lives? Who was so grateful for the Christmas card that she wrote us a thank-you note? Managing our relationships with our clients is a very different subset of knowledge management, but it’s no less important than managing documents or judges’ preferences.
I’ll explore ways we can collect and retrieve—and share with our law partners and associates—all this information in future newsletters. Next time, we’ll look at a few simple ways to find that Word or Acrobat document from the case we tried four years ago.

Dixon Robertson works for homeowners whose homes don’t work the way they should. From shoddy construction to defective building materials, he has represented hundreds of individuals and a class of 8000 homeowners to resolve their claims and win them relief for their building problems. He practiced solo for nearly thirteen years before joining McGowan, Hood & Felder last year. When he isn’t working for clients, he studies the management side of a law practice, particularly how computers can make life easier for solo firms and small firms. You can reach Dixon in our Columbia office at (Toll free 1-877-644-6400).

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate complex cases are constantly updating their education and ability to litigate these types of cases. Dixon Robertson of McGowan, Hood & Felder has helped to litigate many cases that involve construction litigation. Dixon Robertson is available for consultation by email at DRobertson@mcgowanhood.com or telephone (Toll free 1-877-644-6400).

Please visit our website at mcgowanhood.com for comprehensive information on construction defect litigation.

Very truly yours,

McGowan, Hood & Felder, LLC

W. Dixon Robertson, 1517 Hampton Street, Columbia, SC 29201

Nursing Home Negligence

McGowan, Hood & Felder, LLC has represented numerous clients in regard to personal injury and wrongful death lawsuits against nursing home (and assisted living) facilities. Neglect, such as the types listed below, in a long-term healthcare setting can lead to painful injuries and death.

• Pressure Sores
Pressure sores or “bedsores” are caused by unrelieved pressure, typically on the bony areas of the body, e.g. tailbone, heels, elbows, etc. in bedridden patients resulting in damage to the underlying tissue. Most bedsores are preventable. A nursing home must develop and maintain a pressure ulcer prevention program.

Preventive measures include turning and repositioning schedules, pressure relief mattresses or pads, regular skin care and assessment, proper hygiene, proper toileting, adequate nutrition, and wound care. Failure of the care planners to properly assess and plan for prevention or treatment of bedsores, as well as failure of staff to provide the care and services required by the care plan, makes it very difficult for a long term care facility to defend a bedsore case on the grounds that the pressure ulcers were unavoidable.

• Nutrition and Weight Loss
Nutrition is an essential element of nursing home care. This includes proper nutritional assessment, care planning and intervention by the health care provider. Malnutrition often precedes the onset of pressure ulcers and, according to most experts, can impact the ability of pressure ulcers to heal. Often residents are chronically ill and require special assistance to ensure proper nutritional needs are being met. This requires the nursing home to have in place proper staffing in terms of numbers and qualifications.

Nutritional care, assessment and care planning is an interdisciplinary practice. Dieticians, speech therapists, and restorative nurses should be used to address particular conditions leaving certain patients at higher risk of weight loss or dehydration. Some residents will require a specialized diet, such as mechanically softened meals, pureed food, and food supplements. Certain residents require the use of feeding tubes. Whatever the resident’s particular situation, it is the duty of the long-term care facility to ensure that the interdisciplinary care team meets its responsibilities in ensuring nutritional needs are met.

• Medication Errors
One of the most common types of negligence in any health care setting, nursing homes included, is medication error. Errors can be the result of transcription error on physician’s orders, MAR’s (medication administration record), nurses’ notes or physician’s progress notes. Medication errors can also simply result from human error in administration of the drug or in failing to follow doctor’s orders. Often, medications are not given as the physician directs and this can ultimately be proved by a close review of the patient’s chart. For example, it is not uncommon to have a facility chart that medication has been administered despite a resident not even being in the facility at the time the medication is noted to have been given.

• Falls and Fall-Related Injuries
Falls are not uncommon in the nursing home setting. Nursing home residents typically carry a variety of risk factors for falls. These falls can result in loss of physical function and decreased quality of life. Assessments for residents at a high risk for falls are a federally mandated requirement. The assessment should lead to an individualized plan of care that will set forth preventive measures for that resident’s risk of falls (or wandering, etc.).

Prevention measures include frequent monitoring, toileting schedules, use of lowered beds, removable restraints (lap belts, lap “buddies”, etc.), electronic body and bed alarms, and even specialized equipment such as electronic tethering devices that sound an alarm when a resident leaves certain areas of the building or when passing through exits from a building.

Once a fall does occur, a facility must provide appropriate and timely assessment for the injury, and generate an incident report. If the injury is serious, there should be an investigation as to the incident’s cause. Severe injuries of unknown cause must be reported to DHEC.

• Choking/ Asphyxiation
Residents with special diets or neurological damages from strokes or other medical conditions are often at increased risk of choking, particularly at mealtime. Proper nutritional assessments should include an assessment of the risk of such injuries which are most often fatal if a patient aspirates food, chokes, or asphyxiates while unsupervised at mealtime. In addition to specialized diets, the need for restorative dietary aides to assist at mealtime must be addressed and each particular resident’s needs met in order to avoid injury or death.

• Burns/Scalds
Burn injuries are more common than one might expect in long care facilities. Often, burns involve residents who are smokers and accidently ignite themselves or burns from uncontrolled water temperatures in showers or whirlpool therapy. The uncontrolled water temperature can be due to nursing home staff errors, plumbing company negligence, product defects, or some combination thereof.

• Physical and Chemical Restraints
Each resident has certain rights including quality of care and quality of life. There are federal regulations in place to ensure that these rights are not compromised by the improper use of physical and/or chemical restraints in the nursing home setting. Often the over use of physical and chemical restraints actually has the resultant effect of more falls and fall related injuries.

The problems in nursing homes will not go away in the foreseeable future. As the baby boom generation ages, the demand for nursing home care continues to grow. Nearly 17,000 nursing homes in the United States currently care for 1.6 million residents, and that number is expected to quadruple to 6.6 million residents by 2050. These staggering numbers will dramatically increase the stressors on a system already crippled by staff shortages, poor working conditions, lack of supervision, and inadequate training.

Some of the attorneys at McGowan, Hood & Felder are well versed in how to decipher nursing home records and determine whether the standard of care is being met. We have an on-staff nurse who assists with an initial impression of whether a case has merit or not. Our lawyers have been litigating nursing home cases for many years. We aggressively litigate nursing home cases and strive to provide our clients with top tier representation.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys at our firm who litigate nursing home cases are constantly updating their education and ability to resolve nursing home cases. John G. Felder, Jr. of McGowan, Hood & Felder is currently litigating nursing home cases and is available for consultation by email at jfelder@mcgowanhood.com or telephone (Toll free) 1-877-644-6400.

Please visit our website at www.mcgowanhood.com for comprehensive information on nursing home abuse and neglect.

Very truly yours,

McGowan, Hood & Felder, LLC

John G. Felder, Jr., 1517 Hampton Street, Columbia, SC 29201

Tuesday, May 5, 2009

Laparoscopic Cholecystectomy

McGowan, Hood & Felder, LLC has handled numerous actions involving Laparoscopic Cholecystectomies in South Carolina and North Carolina.

While “lap chole’s” are not part of the everyday lexicon, the procedure is very common and is simply the surgical removal of the gallbladder. The procedure can be done either laproscopically, where the surgeon makes several small incisions in the abdomen to allow the insertion of surgical instruments and a small video camera, or with an “open procedure” which is major abdominal surgery in which the surgeon removes the gallbladder through a 10 to 18 cm (4- to 7-inch) incision and requiring at least an overnight stay in the hospital.

One of the more common types of injuries resulting from a lap chole is when the surgeon mistakenly identifies the common bile duct for the cystic duct. In order for a surgeon to remove the diseased gallbladder normally he will clip the cystic duct and simply remove the gallbladder. However, before he can remove this organ he must first properly identify the different structures of the biliary tree. A surgeon will do this by removing connective tissue and other types of scarring around the area know as the Triangle of Calot. When sufficient tissue is removed an actual triangle will appear bound by the liver, cystic duct and the common hepatic duct.

When this triangle appears proper identification of the biliary tree is almost without fail. This dissection, however, usually takes about an hour to perform and some surgeons “think” they have identified the cystic duct but are mistaken. A common mistake occurs when the surgeon clips and transects what they believe to be the cystic duct when in fact they mistakenly clip and transect the common bile duct (aka common hepatic duct). It has been my experience that “short cut” mistakes often happen during procedures that are performed late in the day or after the surgeon has already performed a number of other procedures.

When the common bile duct is transected (cut) it cannot simply be sewn back together. Normally transfer to a skilled organ transplant surgeon is required to perform what is known as an hepaticojejunostomy, which is when the small bowel (jejunum) is cut and then connected to the liver (hepatic).

While the common bile duct is improperly transected in only about .4% of cases, there are almost 500,000 of these procedures performed each year in the United States. This number makes it likely that an attorney will see at least one of these cases during his or her career.
Has there been malpractice?

The issue in these cases is not so much if it was negligence to transect the common bile duct, but rather was the surgeon negligent in not positively identifying the cystic duct before he clipped anything. A surgeon should keep cutting away/dissecting until the Triangle of Calot can be positively identified. Clips are then placed on the cystic duct and it is transected. For a number of reasons mentioned above, surgeons will mistake the common bile duct for the cystic duct and proceed to clip and transect it.

The logic can be quite simple when presented in the proper light. If a surgeon positively identifies the cystic duct (which makes up one of the three sides of the Triangle of Calot) then the surgeon should never mistakenly cut the common bile duct. The common defenses are 1) there were so many physical abnormalities (the biliary tree has more differentiation than any other section of the human body), 2) there was too much scar tissue, 3) there was too much bleeding, etc., that the surgeon could not make a positive identification.

These above defenses can be overcome since a surgeon should always revert from laparoscopic to an open procedure when one of the problems above occurs. An “open procedure” provides a surgeon with a much improved field of vision when complications arise. If the injury to the common bile duct occurred during an open procedure, the case may have a stronger defense possibility.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate Laparoscopic Cholecystectomy cases are constantly updating their education and ability to litigate these types of cases. Robert V. Phillips of McGowan, Hood & Felder has helped to litigate many cases that involve laparoscopic cholecystectomy claims. Robert Phillips is available for consultation by email at rphillips@mcgowanhood.com or telephone (Toll free 1-877-327-3800).

Please visit our website at mcgowanhood.com for comprehensive information on Laparoscopic Cholecystectomy.

Very truly yours,

McGowan, Hood & Felder, LLC Robert V. Phillips, 1539 Healthcare Drive, Rock Hill, SC 29732

PARENTAL LIABILITY

McGowan, Hood & Felder, LLC has handled numerous actions involving Parental Liability in South Carolina. This type of action can take the form of suing a child, a parent, a guardian or any combination of these people.

It’s the middle of the night, and you wake up to the sound of someone pelting your new car with eggs. You recognize the assailants as some of the kids in the neighborhood. Your paint job is now ruined, and even though the car is insured, you’re out your $500.00 deductible. Or, your child comes in dazed and confused, bleeding as a result of a rock thrown by one of his ‘friends.’ Of course, you rush him to the doctor for treatment, and await the bills. Surely, you think, the parents of these children can be held responsible to pay for the damages caused by their children. However, many people who have watched one of the daytime courtroom shows have learned that parents are “not an insurer that [their] child will not harm another.”

Instead, the law typically holds children legally responsible for their own conduct, which in many instances will leave the victim without any way to collect on a judgment under the scenarios above, since most children don’t have a great deal of money. There are exceptions to this rule, to be sure, such as if the parent was negligent in supervising the child, or negligent in providing a dangerous object to a child. However, those situations are often difficult to prove.
There is, however, one provision of South Carolina law which still provides relief for parental liability under a particular set of circumstances. Although it has recently changed location, it still exists. South Carolina Code §63-5-60 provides that private individuals, including corporations and partnerships, are “entitled to recover damages in an amount not to exceed five thousand dollars in a civil action ...from the parents or legal guardian ...of a minor under the age of eighteen years and residing with the parents or the legal guardian of the person who maliciously or willfully causes personal injury to the individual or destroys, damages, or steals property....” While the statute limits this liability to malicious or willful acts, it does provide for joint and several liability of the parent up to the $5,000.00. However, it doesn’t cover acts of a child which are merely negligent or accidental, and is limited only to actual damages.
Nevertheless, this statute has its uses, and may cover a wide variety of acts, including bullying and vandalism. Furthermore, it may be useful to have a parent named personally in the suit, for purposes of gathering additional information on the history of the child, insurance coverage, and other facts not readily obtained solely through a subpoenaed deposition of the parent. The parental liability statute can be used to file suit, gather the information referenced above and then amend the complaint to attempt to pursue a remedy for a much larger claim than $5000.00
This statute is perhaps too often overlooked even by experienced attorneys, which may be largely due to the fact that a similar predecessor, S.C. Code §15-75-30 was repealed when the current statute was first added to the Children’s Code. Another reason it is probably overlooked is that it is inappropriately titled: “Parental civil liability for damage to state property.” Although the current statute has not been interpreted by our appellate courts, the clear language used indicates that this liability extends to injuries caused to private citizens, or their property. Thus, this statute may be useful in addition to claims of negligent supervision or negligent entrustment under the right facts.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate Parental Liability cases are constantly updating their education and ability to litigate these types of matters. Kevin Hayne Sitnik, ESQ of McGowan, Hood & Felder has helped to litigate cases that involve parental liability. Kevin Hayne Sitnik is available for consultation by email at ksitnik@mcgowanhood.com or telephone (Toll free 1-877-644-6400).

Please visit our website at mcgowanhood.com for comprehensive information on different types of torts which can lead to catastrophic injuries.

Very truly yours,

McGowan, Hood & Felder, LLC

Kevin Hayne Sitnik, ESQ, 1517 Hampton Street, Columbia, SC 29201

Pharmaceutical Mass Torts

McGowan, Hood & Felder, LLC has handled numerous actions involving mass torts in South Carolina and outside the state. Mass torts are a type of action where a large number of people have been injured through the conduct of one or more companies or people. An example of these types of cases are drugs which are recalled by the food and drug administration to medical devices that are found to cause severe injury to tainted food products which are placed into the stream of commerce. There are multiple areas in which people are exposed to dangerous products by a mass tort.

Attorneys with McGowan, Hood and Felder, LLC have represented clients involving a number of prescription medications, medical devices and food products. Below is a list of drugs or medical products that have either been recalled, had a black box warning attached to the product or had other information which may indicate the drug can cause injury. We currently have clients we are representing against the manufacturers of these products or are investigating the possibility of litigating claims against the manufacturers of these products.

Avandia - This is a pharmaceutical drug generally prescribed for the treatment of diabetes. Literature from a researcher in Canada in May 2007 found an association with the ingestion of this drug and increased chance of a heart attack (and other conditions as well). In November 2007, the FDA required the manufacturer of Avandia to issue warnings of the potential increase in heart attacks that could be caused by taking this drug. If you have a client who had a heart attack while on this medication, please call us today.

Byetta - This is a pharmaceutical drug generally prescribed for the treatment of diabetes. It comes in a pen type apparatus used to inject a type II diabetes drug into the body. Byetta is known to cause pancreatitis and necrotizing pancreatitis. If you have a client who suffered from pancreatitis or necrotizing pancreatitis while on this medication, please call us today.

Duragesic/Fentanyl Pain Patches - This is a pharmaceutical medication generally prescribed for the relief of pain. If used improperly or prescribed improperly, these pain patches can lead to overdose and death. On December 31, 2008, Ortho McNeil Janssen Pharmaceuticals, Inc., a unit of consumer and health care products company Johnson & Johnson, announced that its PriCara division had recalled two lots of 50 mcg Duragesic pain patches. The patches were recalled because of cuts in the products that could expose users directly to the product's powerful Fentanyl gel, causing a potentially fatal overdose. This is the latest in a long line of product recalls and FDA Public Health Advisories that have plagued Fentanyl pain patches over the last several years. If you have a client who has died or was severely injured while on this medication, please call us today.

Gadolinium Contrast Dye - This is a dye used in contrast MRIs. This agent can cause a condition known as nephrogenic systemic fibrosis (NSF). NSF is a horrific condition that leads to devastating medical problems. There are more than 500 NSF cases that are thought to be caused by the Gadolinium contrast agent. If you have a client who suffers from NSF, please call us today.

Raptiva - This is a pharmaceutical drug generally prescribed for the treatment of moderate to severe psoriasis. This drug was removed from the market in April 2009. The FDA has received reports of people on Raptiva contracting progressive multifocal leukoencephalopathy (PML). PML is a rare, serious, progressive neurologic disease caused by a virus that affects the central nervous system. There is no known effective treatment for PML. If you have a client that suffers from PML, please call us today.

Reglan - This is a pharmaceutical medication generally prescribed for gastroesophogeal reflux disease (GERD). It is usually prescribed for 4-12 weeks. The FDA required the manufacturer of the medication to put a black box warning on the drug on February 26, 2009 warning of the side effect of Tardive Dyskinesia. This devastating condition consists of involuntary body movements that can be permanent in nature. The drug seems to affect older women more than any other population. If you have a client that currently suffers from Tardive Dyskinesia and developed the condition while on this medication, please call us today.

Although clients are individually represented in mass tort cases, the system allows for consolidation and streamlining by allowing lawyers for numerous clients to "pool" discovery. Numerous witness depositions and document gathering can be conducted once, with the information centralized and shared among the parties for each individual trial or settlement negotiation. The firm handles cases in North Carolina, South Carolina and Georgia.

The attorneys at our firm work closely with referring attorneys to bring a case to successful resolution. The attorneys in our firm who litigate mass tort cases are constantly updating their education and ability to litigate these types of cases. S. Randall Hood of McGowan, Hood & Felder has helped to litigate many cases that involve mass tort claims. S. Randall Hood is available for consultation by email at rhood@mcgowanhood.com or telephone (Toll free 1-877-327-3800).

Please visit our website at mcgowanhood.com for comprehensive information on defective drug recalls.

Very truly yours,

McGowan, Hood & Felder, LLC

S. Randall Hood, 1539 Healthcare Drive, Rock Hill, SC 29732