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Be sure you read the link to my webpage. The American Society for Gastrointestinal Endoscopy says that almost anyone can have a colonoscopy with an INR of 2.5. Therefore, there is almost no reason for anyone with a mechanical valve to stop warfarin or have bridge therapy.
http://www.warfarinfo.com/colonoscopy.htm
 
Tom,
Just saw my cardio today. She said that a routine colonoscopy is not something you need to go off Coumadin for. So she echos Al's information.
 
Karlynn said:
Tom,
Just saw my cardio today. She said that a routine colonoscopy is not something you need to go off Coumadin for. So she echos Al's information.

The only problem comes up if you are one of the 10% in whom they find a fair sized polyp. Most gastroenterologists would not want to excise it even if the INR is 2.5 at the low end of the therapeutic range. You probably would then need to "bridge" and have a second colonoscopy. One of our contributers had a colonoscopy with this understanding and it worked out for her. Her exam was negative. So she had her colonoscopy while on warfarin and an INR at 3.0.
 
Thanks again for the information. The GI doc's office leads with "you have to go off Coumadin". That gives me pause to dig in a little deeper. Thanks to your information, I'm aware that it ain't that simple.

Hope I'm in the 90%. That would be a win-win.

What bothers me most about the "bridge" is that as soon as I take the Lovenox shot, I may bleed. Historically I have more trouble clotting with Lovenox than with Coumadin. My hernia incision oozed for 5 days until my INR reached 2.5 and I could go off the Lovenox. Then I was fine.
 
Your physicians duty to you

Your physicians duty to you

The following is a statement by one of the Insurance Companies for hospitals and physicians.

BREACH OF DUTY
Your duty, once created by the physician-patient relationship, is to practice within a reasonable standard of care. This standard is well known to all physicians. It is what medical school, postgraduate medical training, practice experience and continuing medical education teach us. The standard of care might be simply stated as good medical practice.

It is incumbent upon you to keep your medical knowledge current and updated. This will reduce your malpractice risk. Guidelines of practice such as those promulgated by the American Society for Gastrointestinal Endoscopy should be familiar to all endoscopists. Endoscopists should practice within these and other appropriate guidelines in order to maintain a practice level at a reasonable standard of care.(7) http://www.asge.org/nspages/practice/patientcare/anticoagulation.cfm#PageLink05

There sure are a lot of physician's, dentist's and gastroenterologists out there that tell you to stop taking coumadin 4-5 days prior to simple dental procedures and colonoscopies and don't discuss the stroke risk with you.

It seems to me that they are not keeping there medical knowledge current and updated. According to Risk Management Insurance Companies , this would be "A BREACH OF DUTY" by your physician's and dentist's.

If the different medical assoc such as the ASGE have set guidlines concerning perioperative anticoagulation management and the insurance companies for the physicians and hospital's say that they shall operate under these guidlines then were is the breakdown.

It seems that these doctor's are just disregarding all of this info. It is almost crimanal in my opinion.

You valvies need to show the ASGE guidlines to your doctor's and also show or remind them what breach of duty is as outlined by the managed risk insurance companies.

thanks again
warren r mead
 
update on my father

update on my father

warrenr said:
The following is a statement by one of the Insurance Companies for hospitals and physicians.

BREACH OF DUTY
Your duty, once created by the physician-patient relationship, is to practice within a reasonable standard of care. This standard is well known to all physicians. It is what medical school, postgraduate medical training, practice experience and continuing medical education teach us. The standard of care might be simply stated as good medical practice.

It is incumbent upon you to keep your medical knowledge current and updated. This will reduce your malpractice risk. Guidelines of practice such as those promulgated by the American Society for Gastrointestinal Endoscopy should be familiar to all endoscopists. Endoscopists should practice within these and other appropriate guidelines in order to maintain a practice level at a reasonable standard of care.(7) http://www.asge.org/nspages/practice/patientcare/anticoagulation.cfm#PageLink05

There sure are a lot of physician's, dentist's and gastroenterologists out there that tell you to stop taking coumadin 4-5 days prior to simple dental procedures and colonoscopies and don't discuss the stroke risk with you.

It seems to me that they are not keeping there medical knowledge current and updated. According to Risk Management Insurance Companies , this would be "A BREACH OF DUTY" by your physician's and dentist's.

If the different medical assoc such as the ASGE have set guidlines concerning perioperative anticoagulation management and the insurance companies for the physicians and hospital's say that they shall operate under these guidlines then were is the breakdown.

It seems that these doctor's are just disregarding all of this info. It is almost crimanal in my opinion.

You valvies need to show the ASGE guidlines to your doctor's and also show or remind them what breach of duty is as outlined by the managed risk insurance companies.

thanks again
warren r mead
Well, it has been quite a while since I last visted this site. I have been so wrapped up in research and the lawsuit. I recieved an email several weeks ago from one of the members here asking for an update on my father's condition and legal proceding's. Here it is.

He is still in a long term care facility. Absolutely no use of left arm or leg, severe depression, no visual field to his left side, can speak fairly well, very short attention span, is on zyprexa for hallucinations, long term memory is good but has short term memory problems. I visit him 3 times daily and put him to bed almost every night. Going to bed is his favorite time. I set his night stand up with a mini coca cola and six turtles (candy). Other than the complications from the stroke/brain damage he is very healthy and will probably live for many year's to come. As originally thought, he will spend the rest of his life in the nursing home. It is mind boggling how much it cost's to keep a person in a long term care facility. To date the out of pocket expense is at $77,000.00. Looks like the out of pocket is going to run about $100,000 per year.

As far as legal proceeding's, the action was filed in Jan 2005 with a trial date set for Jan 2007. Thank's to a special member here (I won't mention Marty's name ;) ) we have retained a top trial attorney/firm. Here is an exerpt from the filing:

COMMON ALLEGATIONS:

18. Warren Mead, a 73 year-old man, had a St. Jude Mechanical Mitral Heart Valve implant on November 23, 1999, performed at Riverside Methodist Hospital in Columbus, Ohio

19. Prior to this surgery, it was recommended to Dr. Roger Wilt placing Warren on long-term Coumadin anticoagulation therapy with a target INR range of 2.0 to 3.0. Warren began the Cournadin therapy and between October 26, 1999 and November 8, 1999, Warren's INR levels ranged from 1.3 to 1.9; below the therapeutic range protocol of 2.0 to 3.0.

20. On November 27, 1999, following the implant surgery, Dr. Duff wrote a letter to Dr. Wilt informing him of the surgery implanting the St. Jude Mechanical Mitral Valve and recommending that the long-term anticoagulation therapy be changed to achieve a therapeutic range of 2.5 to 3.5

21. On November 29, 1999, Dr. Wilt received the November 27, 1999 letter from Dr. Duff and made a handwritten note on Warren's chart indicating receipt of Dr. Duff's letter; however, Warren's Coumadin Anticoagulation Record indicates that Dr. Duff's recommendations were not followed. At no time between November 23, 1999 and February 20, 2004, did Warren's Coumadin levels fall within the INR of 2.5 to 3.5, the range recommended by Dr. Duff.

22. On February 24, 2004, Warren presented to Dr. Wilt for an INR check. On that date, Warren's INR was 1.5. Dr. Wilt instructed Warren to stop taking his Cournadin as of March 4, 2004 in preparation for a routine screening colonoscopy that was scheduled for March 8, 2004. Dr. Wilt also informed Warren that his INR would be checked after the colonoscopy.

23. On March 8, 2004, Warren presented to Dr, Joseph Laney of Ohio Gastroenterology Group at Riverside Methodist Hospital for his routine colonoscoopy. The colonoscopy was performed by Dr. Laney with no complications and no biopsy was performed. Later that same afternoon, following the colonoscopy, Warren's son took Warren home. Warren's son returned to the house later that evening to discover Warren on the floor covered in vomit. The paramedics were called and Warren was taken to the Emergency Room.

24. At the hospital, it was determined that Warren had suffered a massive right side embolic stroke. His INR was checked at the hospital and it had dropped to a level of 1.1. Warren is now confined to a long-term care facility and can no longer enjoy the active life-style he once enjoyed.



PLAINTIFFS' FIRST CAUSE OF ACTION

[Medical Malpractice - All Defendantsl

25. Plaintiffs incorporate the proceeding paragraphs as if fully restated herein.

26. Dr. Roger Wilt fell below the accepted standard of care, skill and diligence for physicians practicing in Ohio or other similar communities in the care and treatment of Warren Mead. Dr. Wilt's failure to meet the accepted standard of care, skill and diligence include, but

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are not limited to his (1) failure to properly monitor and maintain Warren Mead's INR levels within the therapeutic range recommended by Dr. Duff, for over four years; (2) failure to timely schedule INR checks when Warren Mead's INR levels were below the recommended therapeutic range; (3) failure to recognize and communicate the risks of stopping Coumadin to Warren Mead prior to his colonoscopy; (4) failure to properly inform Dr. Laney, the gastroenterologist, of Warren Mead's medical condition and Coumadin levels; (5) failure to recognize Warren Mead as a high condition risk for stopping Coumadin for a low risk colonoscopy, (6) instructing Warren Mead to discontinue Coumadin use for four days prior to the colonoscopy, (7) failure to recommend bridge therapy for the colonoscopy, (8) failure to consult with Dr. Laney, and other negligent acts.

27. Dr. Joseph Laney fell below the accepted standard of care, skill and diligence for physicians practicing in Ohio or other similar communities in the care and treatment of Warren Mead. Dr. Laney's failure to meet the accepted standard of care, skill and diligence include, but are not limited to his (1) failure to discuss Warren Mead's condition risk and the risk of stopping Coumadin for the colonoscopy; (2) failure to check and monitor Warren Mead's INR levels prior to the colonoscopy; (3) failure to recognize Warren Mead as a high condition risk for for stopping Coumadin for a low risk colonoscopy; (4) failure to remain current with the standard procedures and protocols for Coumadin patients, (5) failure to recommend a screening colonoscopy only, as this type of colonoscopy would not have required stoppage of Coumadin or bridge therapy; (6) failure to inform Warren Mead that he should not discontinue Coumadin prior to the colonoscopy; (7) informing Warren Mead through literature that he should discontinue Coumadin for four days before the procedure, (8) failure to consult with Dr. Wilt, and other negligent acts.

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28. The care and treatment rendered to Warren Mead by employees, agents and servants of Defendant Northwest Family Physicians, Inc. fell below the accepted standards of care, skill and diligence for physicians, nurses, and other health care personnel and breached their duties of care owed Warren Mead.

29. The care and treatment rendered to Warren Mead by employees, agents and servants of Ohio Gastroenterology Group fell below the accepted standards of care, skill and diligence for physicians, nurses, and other health care personnel and breached their duties of care owed Warren Mead. Further, Ohio Gastroenterology, Inc. was negligent in informing Warren Mead through pre-colonoscopy literature to discontinue Cournadin.

30. The care and treatment rendered to Warren Mead by employees, agents and servants of Riverside Methodist Hospital fell below the accepted standards of care, skill and diligence for physicians, nurses, and other health care personnel and breached their duties of care owed Warren Mead.

31. Defendants John Doe Physicians Numbers 1-3 fell below the accepted standards of care, skill and diligence for physicians practicing medicine in the Sate of Ohio and similar communities in the care and treatment of Warren Mead. Defendants John Doe Physicians Numbers 1-3 failed to meet the accepted standards of care and treatment of Warren Mead and other negligent acts which may appear during the discovery or at the trial of this action.

32. The care and treatment rendered to Warren Mead by employees, agents and servants of John Doe Corporations Numbers 1-3 fell below the accepted standards of care, skill and diligence for physicians, nurses, and other health care personnel and breached their duties of care owed Waffen Mead.

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33. The named Defendants and John Doe Corporations Numbers 1-3 by and through their agents, servants and employees, breached their duties of reasonable care owed Warren Mead and are liable for the negligent acts and omissions of their employees.

34. As a direct and proximate result of the failure of Defendants to discharge their duties of care owed to Warren Mead and their failure to meet the accepted standards of care, skill and diligence, Warren Mead has suffered a stroke and will continue to suffer physical pain and mental anguish. Warren Mead will incur permanent medical expenses and care expenses, loss of enjoyment of life, inability to do usual functions, brain injury, lost wages and a lost earning capacity. All such damages are permanent.



PLAINTIFFS' SECOND CAUSE OF ACTION

lRespondeat Superiorl

35. Plaintiffs incorporate all allegations contained in the proceeding paragraphs as if fully rewritten herein,

36. At all times relevant hereto, Dr. Roger Wilt was duly employed by and/or acting on the behalf of his employer, Northwest Family Physicians, Inc,

37. Dr. Wilt was in the scope and course of his employment with Northwest Family Physicians, Inc. at the time of his negligent acts,

38. By virtue of the doctrine of respondeat superior, Defendant Northwest Family Physicians, Inc. is and remains liable for Plaintiff's injuries.

39. At all times relevant hereto, Dr. Joseph Laney was duly employed by and/or acting on the behalf of his employer, Ohio Gastroenterology Group.

40. Dr. Laney was in the scope and course of his employment with Ohio Gastroenterology Group at the time of his negligent acts.

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41. By virtue of the doctrine of respondeat superior, Defendant Ohio Gastroenterology Group is and remains liable for Plantiff's injuries.

42. At all times relevant hereto, Dr. Joseph Laney was duly employed by and/or acting on the behalf of his employer, Riverside Methodist Hospital.

43. Dr. Laney was in the scope and course of his employment with Riverside Methodist Hospital at the time of his negligent acts.

44. By virtue of the doctrine of respondeat superior , Defendant Riverside Methodist Hospital is and remains liable for Plaintifrs injuries.

45. At all times relevant hereto, Defendants John Doe Physicians Numbers 1-3 were duly employed by and/or acting on the behalf of their employer, Defendants John Doe Corporations 1-3

46. Defendants John Doe Physicians 1-3 were within the course and scope of their employment with John Doe Corporations 1-3 at the time of their negligent acts.

47. By virtue of the doctrine of respondeat superior, Defendants John Corporations 1-3 are and remain liable for Plaintiff's injuries.

PLAINTIFFS' THIRD CAUSE OF ACTION

[Loss of Consortium of Warren Mead, Jr. and Deborah Mead - All Defendants]

48. Plaintiffs incorporate all allegations contained in the preceding paragraphs as if fully rewritten herein.

52. Plaintiffs Warren Mead, Jr. and Deborah Mead state that by virtue of the negligence of Defendants and the resulting injuries to their father, Warren Mead, they sustained a loss of his society, companionship, services, attention, consortium, and care, and also sustained mental anguish, and incurred reasonable and necessary expenses, including out-of-pocket expenses, in connection with the treatment and care of their said father, or otherwise.

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Again, sorry for my absence from this sight. I will come back more often and provide updates. My thanks to all for your support.
 
What an emotionally and physically exhausting process this has been for you and your Father. I wish you success in your suit. Your Father and the rest of your family will be remembered in my prayers. It may be small comfort, but I'm sure your Father's experience has and is saving others from the same fate.

God bless.
 
Anyone whose doctor wants them to go off warfarin for a colonoscopy should ask them if they ever heard of anyone who suffered worse consequences than this by staying on warfarin.
 
I have been in medicine since 1948 and never once testified against a doctor in a malpractise case. However after my operation my surgeon told me among other things that poor management of warfarin anticoagulation is endemic throughout the country. When the details of Mr. Meads case became known I got mad. His son Warren had contacted a "family" attorney who was going nowhere in my view and this irritated me. I contacted the top malpractise attorney in our area, the " king of torts" , and he gave us a name for Warren, a former president of the American Trial Lawyers Association, a Trustee at Ohio State, etc.His firm is right in Warren's hometown. They have filed an expert complaint and the Meads now have a chance on a level playing field. I did this because I want to see anticoagulation care improve in Ohio and elsewhere. I also post this information because finding the right lawyer in a medical malpractise case is critical. The percentage of lawyers that know how to deal with medical malpractise is about the same as the percentage of doctors that can replace mitral valves.
 
Just my perspective...

The risk of colon cancer is about 1 in 2000 (5/100ths of 1%) at age 50. Although it increases after age 65, it remains less than 3 in 1000 (less than 3/10ths of 1%). Source: http://www.reutershealth.com/wellconnected/doc55.html

The stroke risk of going off of coumadin for a few days for colonoscopy (without bridging) was recently quoted as 2%-3%, although I suspect it is actually somewhat lower than that.

Anyway, you do the math...

Each person must decide for himself what is appropriate in his life. If I were on warfarin, I would not go off it for colonoscopy without at least bridging ACT, unless there were very strong reasons to believe that I was at greater risk for colon cancer than for a stroke.

And I would never go off it for dental work, period.

Best wishes,
 
I have a very conservative cardio who doesn't take chances with coumadin at all. Before my last surgery, I was having regular TIAs. I needed to have a cath prior to my surgery and he did the cath while I was on my regular dose of coumadin. He took a lot of flack from the cath nurses who got the results of my admission bloodwork and called in reinforcements when they saw my INR.

As I was being prepped for the cath, the head nurse of the cath lab came in and told me they couldn't do the cath because my INR was too high. My cardio came in right after that and, in no uncertain terms, told her he was proceeding with the cath and would take full responsibility. She was so concerned about it she told him that her staff would not handle the post-cath artery pressure to stop the bleeding (this was before they starting using the clamps). My cardio spent over an hour putting pressure on the artery because he felt so strongly about preventing a stroke.

He handled bridge therapy when I had a colonoscopy by admitting me to the hospital prior to the procedure. I never go off coumadin for dental work.

So there is at least one doctor in Ohio who knows how serious the coumadin control issue is.
 
Marty,
I completely agree with you. Warren's original attorney contacted me and while it would have been nice to have made some extra $$ advising on the case, it would have just been one person's word against another. The jury might have seen it in Warren's favor but it would have been on sympathy rather than a sound trouncing.

I never thought that I would testify against anyone either. Still, I find it much easier to defend health-care professionals than the other way around.

At the last anticoagulation meeting I was at one of the physicians said that she ordered a copy of the Chest guidelines for every physician on her staff. Her secretary said that when she ordered 300 copies, the person taking the order asked, "What law firm are you with"? When she replied that they were for doctors the order taker answered, "Wow, I've never heard of ordering these for doctors. Only the lawyers want them."

It looks like warfarin is going to be the standard for years to come, so the doctors had better get wise about how to use it.
 
allodwick said:
"Wow, I've never heard of ordering these for doctors. Only the lawyers want them."

And we wonder why so many doctors aren't up to speed on warfarin management and guidelines. :mad: I bet if they knew lawyers were reading the guidelines, they'd start reading them too!

Now there's a catchy ad for the medical journals -
Coumadin Guidelines
Call for your copy now and learn what the lawyers already know
!
 
Read the filing by Warren Meads lawyers. They got right to the heart of the problem ,didn't they? Warrens' doctors did not follow the guidelines. Soon we will find out what a jury thinks of this. The news of this case will spread far and wide in the medical profession.
 
Unfortunately things don't always happen according to plan. Five years ago the big thing was that warfarin was underprescribed - no for people with valves - but other conditions. Many people with atrial fibrillation had strokes because their doctors were afraid to prescribe it.
 
update

update

Well, today it has been one year since my father's stroke and just happens to be his 73rd birthday. Looks like the next thing on the agenda for him is ortho surgery. His left hand is clubbed and the different braces they have used on it are not doing much good. The hand is almost all the way curled down into the underside of the left rist and is extremely painfull when they try to stretch it out. The procedure calls for cutting the tendons in the left rist/ hand. I can't wait until I talk to the surgeon and see what he want's to do for perioperative anticogulation management. I have researched this and it will be interesting to see what he want's to do.
 
Last edited:
update on lawsuit

update on lawsuit

Even though this malpractice stuff is a long and drawn out process, things are starting to move forward.

I went to the first deposition yesterday. The depo was on dad's primary care physician, the one that had been managing his coumadin. The deposition lasted about 4 hours. Present at the deposition besides myself and dad's attorney were not only the attorney for the pcp but also the attorney's for the gastro and the hospital were the colonoscopy was performed.

To our surprise, the primary care physician stated that a person with a mechanical heart valve should never be unprotected. He is all for not stopping coumadin but if it is necessary to stop then he is all for bridge therapy. The pcp has been using the same gastro group for 14 years. He stated that all of these years he assumed that the gastro group had been using bridge therapy. He also stated that once he wrote the prescription for the screening colonoscopy that it then became the gastro's responsibility to manage the coumadin. Our attorney showed the pcp the written instructions from the gastro group to my father that stated "if you take coumadin, you must stop 4 full day's prior to colonoscopy unless otherwise directed from your physician". The attorney then asked the pcp, if you new that Mr. Mead had been instructed to stop taking coumadin what would you have done. The pcp replied that he would have called my father asap and told him to not stop his coumadin. The pcp stated over and over again that it was not his responsibility but the gasto's. He also asked the pcp if they had changed any of there protocal's since dad's stroke and he said most definitely. Especially in the are of communications. He also stated that he never had any conversations with the gastro prior to the colonoscopy because he assumed that they would use bridge therapy. As far as keeping dad's INR between 1.5 and 2.0 for over 2 years (mechanical mitral valve) he stated that because dad was so active he was concerned about him bleeding. When asked what guidelines/protocal he uses for managing anticoagulation, he could'nt even name any. He was not familiar with any guidelines, protocal's, or consensus statements. He did'nt even know anything about how the half life of coumadin works. He did not know how much the stroke risk would be increased with subtherapeutic INR. He thought that dad had plenty of protection staying at 1.5 to 2.0.

I have always thought that it was the pcp's responsibility for anticoagulation management even when the patient has a procedure conducted by another physician. Doe's anyone know of a written guideline that lays out the responsibility.

When I get a copy of the transcript from the deposition I will post it.
 
Sounds like the PCP's intent to throw all blame on the gastro went down the drain when he demonstrated his lack of knowledge on management protocol and risks of subtheraputic INR's. He kept your Dad's INR at 1.5 to 2.0 because he was "active". :confused: :confused: This really makes me want to kick something.
 
I hope that by reading this people also start to understand why I get upset when I read, "my cardio wants me at ..." All too often this does not demonstrate genuine tailor making of the range for the benefit of an individual. It usually indicates complete lack of knowledge of the guidelines established by people who concentrate their primary focus on understanding warfarin.
 
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