Robert W. Painter

Hi I'm Robert Painter, and today we are going to be talking about a birth injury called Erb's palsy, or also known as a brachial plexus injury.

Now the brachial plexus refers to a bundle of nerves that is found in on both sides of our bodies, really in the armpit area. Now during the birth process those nerves can get injured, and those can have devastating effects because the brachial plexus takes care of the motor, or the movement, function, in our arms, as well as the in sensation we have in this whole area - and even into the chest to some extent.

Now brachial plexus injuries occur in about one to two out of every thousand births in the United States. Now in many of the cases, it is noticed right at birth, but sometimes it is up to the parents or loved ones to spot this.

One of the most telltale signs ofa brachial plexus injury, or Erb's palsy, is what's called the waiter's tip deformity. If you can just think about a waiter holding his hand like this, just looking for a tip. If you see the baby holding his or her hand in this fashion, then you have a good idea that there is a brachial plexus injury, or Erb's palsy.

Now the way these can happen - and I will say that, unfortunately, they are almost always avoidable - but during the birth process, the baby might be breach, it could be a really prolonged labor, or even a rather large baby. And during the birth process, the doctors and nurses are helping to bring the baby out, and sometimes brachial plexus is stretched or other times, in more severe cases, it is even torn.

Now when the nerves are damaged because of stretching, a lot of times immediate physical therapy can help restore some of the function. But in other cases, where the nerve is torn or damaged in some other fashion, then actually surgery will need to take place.

Physical therapy and surgery have the best chances of success if they are done really close to birth, so that means that if you see this type of problem you need to get this baby into the doctor as soon as possible. And again, unfortunately, those types of therapies that the baby will need cost a lot of money. And these are often avoidable injuries, so the people who cause those injuries need to be held accountable.

If your baby was injured at birth and has a brachial plexus injury or Erb's palsy, then I encourage you to call a medical practice attorney as soon as possible. As I mentioned, it is very important that these types of injuries get evaluated and treated very quickly. But also in terms of the legal case, it is essential to have an attorney who is familiar with handling these cases because they are really fraught with a minefield hurdles.

We here at Painter Law Firm handle these cases very frequently and are available to speak with you at 281-580-8800 or at www.painterfirm.com.

Hi. I'm Robert Painter. Today I want to talk to you about brain injuries, and one specific tip on how you can avoid brain injuries during a hospitalization.

There are a lot of ways we can injure our heads or experience a brain injury. It could be in a football game - getting a concussion. I've had clients that have fallen off horses. But something that I've seen happen with an increasing frequency over the last few years would be people who are patients in a hospital doing fine recovering, but they end up having a brain injury because of the nursing and doctor care.

I want to tell you one specific way that you can help avoid that.

Doctors and nurses have to take care of a lot of patients in the hospital, and they don't know all of them. And in particular, they don't know their specific baseline for how they normally behave. But one of the things we know, as family members and friends, is we know how our loved ones behave. When they're in the hospital, we can perceive much more quickly when there are subtle changes in our loved ones' behavior. Those changes need to be communicated to the nurse, so the nurse can make sure the doctor gets in to evaluate them immediately.

This is so important. Study after study has shown that a change in mental status (that just means a change in the way a patient is behaving - that could be just that they're behaving a little weird) could be the earliest indicator of a problem that could lead to neurological compromise or a brain injury. And, when you're dealing with a brain injury, time is so utterly important.

What I recommend is that if you have a loved one in the hospital, make sure that someone who knows them well is with them 24/7, and watching them. If there are even subtle changes that are uncharacteristic for that persons personality, make sure that you inform the nursing staff so the nurse can tell the doctor. Then the doctor can get in and figure out what's going on.

This could literally be life and death. It could save someone's brain from a permanent injury.

If you've had an experience with a brain injury during a hospitalization, you need to speak with an attorney who handles medical malpractice cases. Under Texas law, and many other states, it's a real mine field to navigate these cases. You need to get someone who's experienced.

We here at Painter Law Firm handle a lot of such cases.

You can reach us at 281-580-8800, or www.painterfirm.com.

Today we're going to speak about something that happens in every prenatal visit—or at least it should in any prenatal visit with an OB/GYN—and that's the fundal height measurement. I'll tell you one of the most exciting things that ever happened in my life is when I learned that I was going to be a father—a dad. And, of course, once we learned of this news my wife started having a lot of prenatal visits with her OB/GYN. And I got to accompany her to many of those. One of the important things that happens on those prenatal visits is an assessment of the mom's fundal height. Now fundal height is just a medical term that means the height of the mom's uterus. Now what's so important about the fundal height is study after study has shown that the fundal height is directly related to the gestational age of the baby. And that just means how old the baby is. So if you have a fundal height that is measured to be equal to or greater than the age of the baby, that's a good indicator that the baby is growing at a healthy and good rate. But if you're off by three centimeters or so then the doctor needs to rule out a very serious condition that could be life threatening to the baby known as intrauterine growth restriction. What that means is there' something going wrong in the mom, in the placenta and with the baby, where the baby is just not growing at the proper rate. It could mean that the mom's BP is too high, it could mean that there's not enough nutrients getting to the baby—it could be a variety of things. Some of them could require medication. The mom might need to be placed on bedrest. And if those things don't work, there could need to be an urgent delivery in a premature way. It is very important for moms, once they find out they're pregnant, to immediately call an OB/GYN or a health care provider of their choosing, and do these prenatal visits, because getting the fundal height measured and having those assessments can mean the difference between a healthy and happy baby and family or really a tragedy that could be avoided. I'm Robert Painter with Painter Law Firm and we're always here to help you at 281-580-8800 or www.painterfirm.com.

With the holiday season upon us there are two things I want to talk to you about today that can keep you and your family safe when it comes to hospitalizations.

Number one, if you can avoid a hospitalization during the holiday season, you should do it as much as possible. Now what this means if you have an elective surgery—meaning that something you could put off for a month or two—it would be better to wait until the holiday is over. And the reason for this is this: a lot of time we will try to schedule hospitalizations or doctor visits during the holidays because we have time off from work. But if you think about it, at hospitals, the most senior doctors and nurses take that opportunity to be with their families as well. That means on those holiday shifts, you will have the less experienced doctors and nurses working and taking care of you, in general.

Now there are studies galore that show that there is an increase in errors when you have the more senior people off work—whether that would be on the holiday season, during the summer months, even on weekends or evenings.

Number two, if you find yourself in a position where you have to go to a hospital, make sure you bring a trusted family member or friend with you who can be your eyes and ears and be an advocate for the health care that you need. After all, during many holiday seasons, some hospitals are short staffed. That means that, unfortunately, sometimes people can fall through the cracks. And when you fall through the cracks there can be devastating consequences—either new injuries or even the loss of life.

So if you have a family member or friend with you, that person can advocate and ask questions like, "What's this medicine for?", make sure that the medication is being dosed and administered on the proper schedule, or even ask questions for a doctor—or make sure that the doctor shows up to evaluate you in person. That way you can have that extra layer of security to make sure you aren't the patient who falls through the cracks.

I'm Robert Painter, at Painter Law Firm, and on behalf of all of us, I want to wish you a Merry Christmas and happy holidays. We're always here to assist you at www.painterfirm.com or 281-580-8800.

Watch fetal movements & prevent brain injury

One of most rewarding things about helping people as an attorney in the area of medical malpractice is I get to learn a lot about narrow areas of medicine as they relate to the law. One of the areas where I spend a lot on time is cases is brain injuries and, in particular, the tragedies of brain injured babies. And as a father of four, these types of injuries are particularly bothersome to me. In case you or a loved one is going through a pregnancy and are looking forward to successful, healthy delivery, I want to share with you some observations that I have on some things that you can do as a patient or family member to prevent these types of brain injuries. As you get closer and closer to delivery—let's say about 30 weeks plus—one of the most important things to look out for is fetal movements.
Each mom will tell you how her baby reacts. Some of them will be up kicking at night, some during the day, and so forth. You want to play close attention to that fetal movement pattern. If that changes it is very important to report that to the doctor. The reason is that as you closer to the delivery date a decrease in fetal movement is one of the earliest indicators of a problem with the baby, and that needs to be communicated by you to the doctor immediately.
I am working on some cases right now where I have seen that the doctors or the doctors’ staff do not take them mom's complaints of decreased fetal movements as seriously as they should. And in those cases, unfortunately, if they had acted quicker, we believe that some terrible brain injuries could have been avoided. So you have to be politely pushy when it comes to communicating a change in fetal movements. And if you go to the gatekeeper—the receptionist or nurse that your OB/GYN’s office and that person says you don't need to see that doctor—just go drink some juice, try to get the baby to perk up, go rest, or go run or whatever, to try to wake up the baby—tell them, ‘I really want to see the doctor and you really want to have a thorough evaluation by the doctor because you're concerned about a decrease in fetal movement.’ No one will know better about a decrease in fetal movement than the mom.
So, number one, make sure you get seen by the doctor. And if you can’t get seen by the doctor go straight to the labor and delivery department, and politely insist on having a doctor come to come and evaluate you. You need to make sure as a patient you ask questions, make sure you're clear about the decreased fetal movements, and speak up and make sure you are just rushed out of the labor and delivery or doctor's office without a full evaluation. I recommend really in these cases that you be hooked up and evaluated for at least an hour, because during an hour or more period the nurses or doctors can see what is going on with the baby. You might have heard on a TV show or something that someone had ‘flatlined’ on an EKG.
Well it's the same thing on a fetal monitor strip—when you look at the tracing, you want to see a lot of variability and movement in the strip and the tracing. If you see something that is low and nonreactive with no bumps, or just almost is flatlined, that is something that needs serious evaluation. It might even need that it is necessary for emergency delivery. I am not suggesting you go in and tell the doctors and nursing how to practice nursing and medicine, but you can as a mom or a family member communicate things that you see, communicate things that you feel, and make sure that they have the information they need.
You need to make sure that you are getting the attention from the healthcare providers that you need, because quite often these injuries can be avoided. If you been in a situation where there has been a labor and delivery or birth injury, you're always welcome to contact us at Painter Law Firm for a free evaluation. Our number is 281-580-8800 or you can also reach us on the web at www.painterfirm.com.

Many people do not realize that hospitals are dangerous places. Studies have shown that nearly 100,000 people die each year from preventable medical errors. In my practice, the most common culprit I see for hospital medical errors will probably surprise you—poor or entirely absent communication.

I have handled a lot of cases where a doctor has given a nurse in order for some urgent lab work or a CT exam or maybe some sort of test—and the unbelievable happens, it doesn't get done.

Normally, it happens in one of a couple of ways. One, the nurse just doesn't follow the order and the test doesn't get done at all. Or number two, it does get done after maybe some delay but it's not communicated back to the doctor. And finally, the doctor might just not follow up and never knows if the test order was done or not.

Well, in cases like that both the nurse and doctor are at fault, but the person who ends up losing is the patient. Think of it like a relay race where you have one runner passing the baton to the next runner, but right before the passing happens the runner drops the baton. What happens in a race is you lose, but a healthcare setting the consequences are even more dire – you can die.

The doctor and the nurse are both responsible, but the person who loses the patient. The delay in treatment that is called by poor communication can be hours or days and can cause serious injury or worse—even death. Remember, the doctors and nurses at the hospital are there to help you and that is their businesses. But they are often so overworked that sometimes your care can fall through the cracks because they're busy taking care of the patients.

You can help make sure you are not a victim of poor communication by making sure that any time you're in the hospital you take someone there with you. Both you and your friend or family member can politely ask questions– ‘Hey I heard about that order, when is it going to be done?’ or ‘When am I going to get taken to the CT room?’ or ‘When are the lab going to be done and what are the results?’ You can do this and make sure that you don't fall through the cracks.

If you been a victim of medical negligence or poor communication in a hospital setting that has caused an injury, please give us a call at Painter Law Firm. Our number is 281-580-8800 or you can reach us on the web at www.painterfirm.com. We will be happy to discuss your case with you.

'The Minute Lawyer' Series by Robert W. Painter
www.painterfirm.com
Painter Law Firm PLLC, Houston, TX

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