As outlined in an article in a HuffPost College, the case involved a real tragedy:

“During opening arguments in the wrongful death trial, attorneys representing his parents said the 19-year-old died three years ago from complications of sickle cell trait after an excessive workout where Coach George O’Leary ordered water and trainers off the practice field. They claim the university never told Plancher that he tested positive for the genetic problem. They also said coaches and trainers didn’t follow proper emergency procedures after Plancher stumbled, gasped for breath and collapsed.”

The truth is many times our civil courts are backed up because the insurance carriers are in total control of the money and the decision making. I cannot tell you the number of times where the plaintiff wants the case settled, the defendant wants the case settled, the lawyers want the case settled, the mediator and Judge wants the case settled, but sadly the insurance company just wants to make money by holding on to its money longer.

No, I haven’t “drank the Kool-Aid.” All insurance professionals aren’t bad and all lawyers aren’t good.

However this does appear to be a case where the carriers are playing fast and loose with UCF’s reputation and brand. It is reckless to keep doubling the risks for the parties with appeals and dragging the case out. It is tragic for Ereck’s family to be forced to relive the circumstances of his tragic and, apparently, unnecessary death.

I am not even talking just about the moral thing to do for this poor family, I’m talking about the insurance carrier’s duty to the “insured” (the UCF Athletics Association) who paid them significant premiums for the promise that they would be protected and that the insurance company would compensate parties for the negligence of the insured.

The jury was not a run away. They found no punitive damages, but did find negligence in the policies and methods used by UCF; and the jury clearly found that Ereck’s untimely death was the result of ignoring obvious safety issues.

The verdict is not a message that UCF acted monstrously or nefariously, but simply UCF and its staff made serious mistakes; hopefully, mistakes that have been or will be corrected so this young man’s death is not in vain.

The Orlando Sentinel reporter, Mr. Bianchi, is correct. Entities such as UCF need to show some muscle and push back on these aggressive insurance carriers. The idea of insurance is you pay premiums because you are going to potentially make mistakes and face the results of those mistakes. If a carrier simply takes in money and is unwilling to recognize compensible claims then that’s a shell game.

According to published reports in this case it could have settled for half of the verdict! So who’s to blame for a lingering, extended court battle? The family? Please, tell me a wrongful death is not viewed as frivolous even by my conservative peers? UCF? I doubt it. I suspect they want this over as badly as the plaintiffs.

When I see this type of situation, my money is with a “cowboy” carrier that likes betting the farm, especially when it’s not entirely their farm; an insurance company who is quite willing to gamble theirs and their insured’s reputation; an insurance carrier going all in, in order to hold onto moneymaking dollars as long as possible.

Is that what has happened here? Reach your own conclusions.

Next time when you read about one of these verdicts ask yourself who was in control of getting the case to that posture? I bet the farm it’s an insurance carrier that could have avoided it, and saved a lot of money and valuable court resources. I’ll bet it’s an insurance company willing to gamble its insured’s reputation and assets in exchange for just a little more profit.

I guess Mel Brooks was right, “It’s good to be the king”.

It is no secret that many industry-wed lawmakers have been working for a long time to place damage caps on injuries caused by the negligence of others.

Those same industry-owned lawmakers stand for protecting the profits of hospitals and insurance companies over the protection of citizens. These are legislators and executive branch folks who are willing to sacrifice our rights in the interests of promises to lobbyists or keeping alive their favorite bill.

Currently, Congress, state legislators and governors are busy trying to protect corporate healthcare and insurance companies on the backs of victimized patients. Add to that a concerted effort to dismantle the only attempt, albeit flawed, to fix a flawed and dysfunctional health care system. These politicians are not builders; they seek to create or enhance nothing. These lawmakers want to dismantle anything lobbyists tell them to defeat in the best interests of their corporate constituents.

Fact: It has been estimated that medical errors cause $17 – $29 billion every year in lost income, disability and healthcare.

Fact: The Department of health & Human Services estimates that medical errors result in $4.4 billion in additional Medicare costs.

Fact: Patient rights have been taken away or diminished in 48 of the 50 states already. This has done nothing to improve health care quality or costs in any of those 48 states.

Fact: In the 48 states already enacting limits on the rights of the injured there has been no tangible savings in terms of insurance reductions or health care cost reduction.

Fact: Preventable medical errors cause the death of 98,000 people each year (Institute of Medicine). Limiting the constitutional right of injured victims has done nothing to improve the quality of health care or to reduce the numbers of injured people or the number of patients killed by preventable medical care errors.

Fact: Defensive medicine is a myth dreamed up by those who desire increased corporate profits. Defensive medicine may be motivated more by a desire to increase profits to doctors and hospitals as the alleged defensive medicine.

Fact: The “lawsuit crisis” is a well conducted campaign of propaganda, spin and lies.

Fact: Lawsuits filed by injured people represent a very small percentage of the total burden on the court system. Actually, the largest numbers of lawsuits involve divorce, estates and corporations suing each other.

Fact: Passing laws to protect one special class of Americans to the detriment of the majority of Americans is in violation of the constitution. Protecting doctors, hospitals and insurance companies while denying patients their rights, is simply unfair and unlawful.

Fact: The groups fighting the hardest to infringe on the rights of citizens of individual states are the same groups who have repeatedly told Americans that “Big Government” is bad and that the federal government should stay out of the business of the states. So much for smaller government.

Fact: People in favor of tort reform can not use facts to support their arguments. They rely on hyperbole and spin fed to them by groups supported by business interests.

Fact: Who will pay for the costs of medical care, lost income and rehabilitation caused by medical errors if the rights of victims to pursue legal remedies are taken away? You and I will pay through increased taxes to fund medicare, social security and increased insurance premiums.

Fact: Who will benefit from taking away rights? Hospitals, insurance companies and corporations.

Before you take a position on this very important constitutional battle, educate yourself, be informed, and do not blindly accept information given to you by anyone.

Read, research and rely on your own common sense.

Who is paying for all these campaigns and lobbyists who have the ears of YOUR law makers?

In the JAMA July 14 issue, one of the major themes covered was research articles and commentary on the Physician Peer Review process and its effectiveness. The medical peer review is the process by which a committee of physicians examines the work of a peer and determines whether the physician under review has met the accepted standards of care in rendering medical services. This process is put in place specifically to assure physicians that their statements will remain confidential when commenting on the behaviors of their colleagues (many of whom are a physician’s primary referral sources).

An original research study titled “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues” found that overall, “…physicians support the professional commitment to report all instances of impaired or incompetent colleagues in their medical practice to a relevant authority; however, when faced with these situations, many do not report.

The study reported in JAMA was a questionnaire-based study sent to a randomized group of 3500 physicians in the fields of family practice, internal medicine, pediatrics, anesthesiology, cardiology, general surgery and psychiatry (excluding certain physician specialties and hospitals).  Some of the results in the report suggest:

• 64% of the total physicians that responded to the survey completely agreed that physicians should report all impaired or incompetent colleagues.
• Women were more likely than men to agree with that statement.
• Graduates from US medical schools were also more likely to agree with that statement when compared with non-US medical schools.
• Physicians were more likely, in university or medical schools, to report all impaired or incompetent colleagues when compared to solo or 2-person practices (the least likely to report).
• Among the specialties, anesthesiologists and psychiatrists were the most likely to be prepared to deal with impaired or incompetent colleagues and pediatricians were the least likely to feel prepared to report.
• Physicians practicing in medical school and university settings were significantly more likely to report than those in other practice settings.

While 64% of physicians, overall, reported being prepared to deal with colleagues who were incompetent in their medical practice, only 17% of physicians reported having knowledge of an impaired or competent colleague in or around their practice. Among the 17% that had knowledge, the most frequently cited reason for not reporting was the belief that someone else was taking care of the problem, that nothing would happen as a result, or simply, fear of retribution.

The study has not accounted for every reason that a physician may not report fellow physicians. For example, it is entirely plausible that a physician with knowledge of an impaired or incompetent colleague did not have reliable and accurate information to allege such an incompetency on their peer. Notwithstanding such shortcoming to the published research, the suggestion is clear: there needs to be stronger external regulation in the medical profession to ensure that internal regulations are working as expected. A commentary in the JAMA issue suggests that reporting systems should be better maintained to protect confidentiality and raise confidences among the physician community that real action and investigation will be taken when reports are made.

Professionalism dictates that physicians and physicians groups work together to establish the highest level of care a patient can receive. Patients also have a duty to make informed and educated decisions about physician choice. So, when considering a particular physician or a method of treatment recommended by a health care professional, be your own advocate by:

• Be an active participant in the decision process
• Speak out – ask questions and insist on well explained answers
• Insist that health care professionals speak with you in non-medical language so you may fully understand them
• Investigate physician credentials and experience
• Insist on background information from your physician
• Insist on knowing the physician’s level of experience in performing a given procedure or in treating a particular disease
• Ask your physician for research and information to better and fully inform you before you make decisions
• Seek 2nd opinions for any recommendations involving serious surgery or treatment

What is the standard of care in its most basic terms?

If I am a pedestrian, do I have a “standard of care” as I walk along the street? Of course I do. I must watch the pavement as I am walking so as not to trip over obvious hazards. If I come upon a blocked area of the sidewalk, where work is being done for example, I have the duty to navigate carefully and as safely as I can around that hazard in continuing my walk. I have a duty to avoid running into other pedestrians using the sidewalk. If I must cross the street, I have a number of additional duties I must fulfill.

Why do we have “duties” and “standards” by which we must act? Without them, no one would know what was expected of them and we would not be able to anticipate how to expect others to conduct themselves in given situations.

A car is traveling down a dark, deserted country road, approaching an intersection with a stop sign. The car does not stop at the stop sign and, instead travels through it at highway speed. No other cars were approaching the intersection at the time. Was the driver negligent? Did the driver deviate from the reasonable standard of care? The driver was negligent, but, luckily, caused no damage to anyone. So, if a police officer was around, a ticket would be issued, but nothing further.  So, was it excusable, since no one was hurt? Absolutely not. The same example, but the approaching driver does not see an approaching motorcycle. The motorcyclist is struck and killed. A completely different set of circumstances results, but culminate from the exact same perceptions on the part of the driver in the car. In both situations, the driver “honestly” saw no harm by running the stop sign.

This is particularly true for professionals. The public absolutely must be able to depend on certain standards of performance from professionals. For an engineer who constructs a bridge, we expect that the bridge will carry the weight reasonably expected and will not collapse with that weight. We expect that the professional will act in a manner expected from other similar professionals.

When a doctor decides to treat people, she decides to work within a reasonable standard of care accepted by other physicians. Does that mean if a physician or other professional makes a mistake that they have deviated from the acceptable standard of care? Not necessarily. It means that the professional is obliged to act reasonably as judged by similar health care providers.

If a patient arrives at the hospital with symptoms consistent with 3 or 4 different potential illnesses, it is the job of any physician to determine those illnesses, which are life threatening and try to eliminate or include those first. If the condition could be life threatening, the professional is obligated to continue their investigation until they can determine what course of treatment is best for the patient.

Physicians, like any professional, have pressures extraneous to their profession. In the case, of an engineer, it may be cost overruns and their client may be pushing to cut corners somewhere to minimize those cost overruns. With physicians, it may be a hospital or insurance company. It is the job accepted by the any professional to comply with the reasonable standard of care. In the case of physicians, it is to determine those patients who require hospitalization in order to determine their illness and those who do not need hospital care.

Professionals are required to reach reasonable, well thought, courses of action within their profession. They typically go through additional schooling to prepare them for evaluating a reasonable course of action.  The subject of a professional’s decision may seem complex, but their standard of care is no less real than the driver or pedestrian.

“…the old code of equity law under which we live commands for every wrong a remedy, but in too many communities, in too many parts of the country, wrongs are inflicted on Negro citizens and there are no remedies at law.”

Click here to view the embedded video.

Unfortunately, President Kennedy’s reference to our system of justice having the ability to remedy every wrong states only an ideal, but, sadly, not reality. Sometimes the difference between principle and truth is the result of legislative inaction or by legislative activism. Perhaps the most glaring example of legislative activism stripping away the “guaranteed” rights of citizens to have both their day in court and a remedy for every wrong can be seen in the medical negligence arena.

Let us examine the following two hypothetical scenarios.

First, a fifty six year old unmarried man is killed while traveling home one night. He is stopped at a red light when his car is smashed into by a dump truck, driven by an inattentive driver who was hurrying to get through his assigned route on-time. The deceased man leaves behind three surviving children who are each over the age of twenty five. Each of his three children are emotionally devastated by the sudden, unexpected, and totally avoidable death of their father.

Second, take the same man, but instead of being killed by an inattentive truck driver, he is the victim of medical malpractice. He is hospitalized and a doctor fails to read the clearly documented chart showing that her patient suffers from a severe allergy to penicillin. The physician administers the antibiotic anyway. Her patient dies on the operating room table from severe anaphylactic shock in what is a clearly avoidable death caused by medical negligence.

The surviving children of the victim in our first hypothetical would each have a claim as a legal survivor of their deceased father for their lost parental companionship, instruction, and guidance and for their mental pain and suffering caused by the loss of their father.

In the first scenario, they would have an opportunity to explain to a jury of their peers the tremendous sorrow, pain, and loss they feel as a result of their father’s tragic and untimely death. The jury would then be able to award each surviving adult child an amount of money that was fair and just in light of the evidence. In essence and at least to the extent that our system of justice is able to do, there would be a remedy for this horrible wrong.

The surviving adult children in our second hypothetical, however, are going to be victimized first, by the medical malpractice which claimed their father’s life, and second, by the fact that Florida’s tort system has created special protections for healthcare providers when their negligence results in the preventable deaths of their patients. Specifically, Florida Statute 768.21(8) prevents the adult children of a parent who dies as a result of medical malpractice from bringing a claim for their pain and suffering. In essence, the courthouse doors are closed to them. There is a wrong, but not a remedy. Is the pain felt by the surviving adult children somehow less profound, less real, less debilitating in the second example than in the first? Of course not.

Legislative activism in the medical malpractice arena has left a gaping black hole where medical errors resulting in death can leave grieving survivors without any remedy whatsoever to address the tremendous pain and suffering they experience as a consequence of a parent’s untimely and avoidable death. In essence, Florida Statute 768.21(8) provides healthcare professionals with a virtual “get-out-of-jail-free-card” when their malpractice kills unmarried adults with no children under the age of 25.

There is a wrong, but justice has been taken away.

There have also been mistakes in which parents have had their eggs tested for genetic defects only to have the genetically damaged egg implanted rather than the genetically sound egg.  It is a very costly investment both emotionally and financially.

A California couple discovered that the Laurel Fertility Care Clinic destroyed 7 of 13 viable embryos because they were mistakenly inseminated with the wrong sperm.  In this case the couple had a contract that provided no embryos were to be destroyed and the decision by the clinic prevented the couple from the opportunity to make their own decisions.

What is the cause of this problem? At least in part it is likely connected to the burgeoning demand for fertility treatment in the last several years. A report from Mail OnLine sets forth that the number, in Great Britain, of women going through in vitro fertilization has increased from 23,000 in 1995 to 35,000 in 2009. Yet, the number of facilities who handle in vitro fertilization there has not increased with the numbers of women seeking this treatment.

Last Thursday, Carolyn Savage gave birth to a child belonging to another couple. The embryo was mistakenly implanted in Ms. Savage, but actually belonged to Shannon Morrell. Both Ms. Savage and Ms. Morrell were hoping for a child; because of Ms. Savage’s unselfish act, she will be denied her child, but she will provide another family with their child.

The American Fertility Association issued the following press release:

The American Fertility Association Responds to Alleged Embryo Mix-Up Case in Ohio
September 24, 2009 – An Ohio woman, 40 year old Carolyn Savage, claims a fertility clinic implanted the wrong embryo and that the baby she’s due to deliver the first week in October is not hers.  Several media reports state Savage and her husband plan to give the baby boy to his biological parents.  The name of the clinic is not being released in this very rare alleged case.
The AFA is issuing the following statements regarding the matter:
Medical:
“If the facts in the Ohio case are concordant with media reports, it’s a very unfortunate circumstance for all concerned, a result not to be minimized or trivialized. The story is newsworthy, however, because it is an extremely rare event.
In 2007, there were 132,262 IVF cycles performed in the United States (Fresh, Frozen and Donor Egg, per the CDC) in which more than 300,000 embryos were placed into the intended recipients. Embryology laboratories have extremely rigorous procedures to maximally ensure public safety and the health of our patients and their children born of IVF.
The Ohio case is rarer than 1 in a million and I speculate that human error, not malintent, will prove to be the root cause. I have every confidence that each IVF program in the country will review their procedures and discuss this case to reinforce what we already know, that the work we do each and every day is very special and that the hundreds of thousands of patients we help each year are counting on us to do our best every day.”
-Alan Penzias, MD, Member, AFA Board of Directors
Legal:
“Unfortunately, due to the acknowledged negligence of the IVF Physician and clinic, this Ohio couple, by choosing to proceed with the pregnancy, is obligated to afford the other couple the legal rights to this little boy.  Any case, such as this that would go before a court of law, would likely grant full legal and physical custody to the other couple without any visitation to the Ohio couple.  They appear to be aware of this – such an unfortunate event for all parties involved.”
-Theresa Erickson, Esq., Member, AFA Board of Directors; Member, AFA Legal Advisory Council
Mental:
“As a psychotherapist and co-chair of The American Fertility Association, patients receiving treatments live in fear of this happening to them.  The AFA continues to encourage patients to become educated consumers and ask their treatment providers about their procedures for safeguarding their genetic materials. Programs are required to have in place strict guidelines that are overseen by numerous state and federal agencies requiring very specific procedures to be practiced and in place by each reproductive center.
These incidents are rare and patients should feel assured that the majority of centers follow these rigorous guidelines.  When these rare accidents do occur, it can be not only psychologically devastating to the couples involved in this mix-up but emotional damaging to the thousands of patients who are currently receiving or starting fertility treatments. We at the AFA hope that the media will allow these couples, the children involved, and the baby yet to be born to privately get the support that they need to cope with this emotionally difficult experience.”

This type of error can certainly be characterized by the national association as a “rare” error, but I am sure that neither Carolyn Savage nor Shannon Morrell can find much solace in this representation. Carolyn Savage will undoubtedly always wonder about the baby she brought into this world.

Making the decision to go to a fertility clinic in the hope of trying to conceive a child and/or have eggs tested for genetic factors must be a very difficult decision. All clinics and laboratories should have protocols in place to prevent these devastating errors from happening; causing devastating consequences to the parties involved. This is really a zero error tolerance business engaged in by fertility clinics. Providing an explanation such as that offered by the American Fertility Association is simply insufficient and lacks the very personal consideration due to these victims.

Become an educated consumer. Read, ask questions, be a persistent presence in the process of any medical procedure you undergo.

Regardless of our efforts to prevent injury and disease, inevitably we will require the services of a medical professional.  What is often overlooked is the important role of the patient in making sure the medical professional renders the very best of care.  This role is more important than we think.  For example, a 1999 study by the Institute of Medicine estimates that up to 98,000 people die in hospitals each year due to medical errors.  .  This exceeds the deaths from motor vehicle crashes, breast cancer and AIDS.

There was an excellent article on the CNN Health website advising patients to be proactive during a hospital stay to ensure that the very best care is received. The article suggests the following:

1.    Bring a list of the medications you are taking;
2.    Make sure the hospital gets your name right;
3.    Ask about every medication they give you;
4.    Make sure everyone washes their hands;
5.    If you think something’s wrong, don’t back down;

This is sage advice.  Many times, people admitted to a hospital feel helpless and confused and are hesitant to speak up when interacting with nurses and doctors.  We live in a culture that has for many years accepted the notion that what doctors say and do is not to be questioned.

Doctors are well regarded in our society, and for good reason. But let’s face it, no one knows your body and medical history like you do.  That is why it is very important to speak up when interacting with your medical providers.  One of the things that we see in our law practice is the failure of hospitals to properly document a patient’s medical history, which becomes very important in correlating medical events, management, lab & X-ray findings, etc. Like bad gossip, once a patient’s information is inaccurately recorded it ends up being passed on in that erroneous fashion, oftentimes taking on new twists and misinformation in the process. Fueling this problem is the transfer of data into computerized medical databases by non-medical personnel, like technicians and even I.T. staff, who are asked to take written patient questionnaires and type them into computer record systems. Thus, a good practice is to always ask to see what was recorded as your medical history in your medical chart before you leave a medical provider.

Even if a doctor or nurse responds defensively to questions or directions, a few awkward moments in a hospital room is a small price to pay for making sure you receive the very best of care.  The Joint Commission, which accredits hospitals, has embarked on an initiative to increase patient awareness and give patients more control over their medical care.  This initiative is called “Speak Up”.

The Joint Commission’s website provides excellent brochures in both English and Spanish that you can download free of charge. We encourage everyone, particularly patients, parents and caregivers to review these important materials. It just might end up saving your life or the life of someone you love.

The pain pump is attached to a catheter, which was routinely inserted into the soft tissue near the affected joint. This use of the pump worked fine until the manufacturers of these devices started recommending that physicians could insert the catheter directly into the affected joint space and provide a much higher degree of pain relief. This was, of course, welcome news for physicians who always want to attempt to relieve or minimize the suffering of their patients. So all was good, then?

What pain pump manufacturers failed to tell physicians is that the Food & Drug Administration had never reviewed, let alone approved, the use of the pumps directly into the joint space. What the manufacturers should have known is that at least one of the manufacturer’s, McKinley Medical, asked the FDA to permit insertion of the devices into the joint space and the FDA asked for proof of efficacy. As far as we know, no data or evidence was presented to the FDA. Soon after this, Stryker Corporation purchased the exclusive rights to the pain pump from McKinley.

With full knowldge, the pain pump manufacturers failed to tell doctors that:

1. The FDA never cleared or approved the use of pain pumps to administer medications in a joint space
2. The safety of pain pumps for use in the joint space is unknown and has not been tested or otherwise established through proper studies; and
3. Medications commonly used in these pumps are reported to be harmful to cartilage
4. The FDA rejected proposed requests for a new marketing indication for use of pain pumps in the synovial cavity;

Studies seem to be reasonably clear that the use of the pain pump within the joint space causes potentially significant damage to cartilage . The damage caused by use of the pumps in the joint space often result in requiring full joint replacements and more.

The recent headlines from Florida’s west coast had to shock every parent who has a child in a daycare center: “Children Watch ‘Monster’ Kill Daycare Teacher.” This was not just another one of those horribly frequent reports of school shootings. This was not just another one of those horribly frequent reports of a crazy man murdering his wife. We have not become so hardened by the frequency of these reports that we can ignore this article and move on through the news. In fact, this incident begs us, as parents, to revisit all of our carefully researched efforts to find and provide our children with a safe place to be while we are away from them. And it compels us to look critically at the decisions we make ourselves, and the decisions that are made by our daycare providers.

Daycare centers, and all schools, have a duty to use reasonable care with regard to the safety and security of the children that come through their doors each day. As attorneys, we learn in law school that this duty is heightened by the knowledge that the daycare center is providing these services to the children by and through the use of its employees. The risk of harm increases and the employer’s duty to use reasonable care increases with each employee or, for that matter, visitor that is permitted access to the children.

From all recent news accounts, it appeared that a teacher at the Cape Coral daycare center was having severe marital problems with her estranged husband. He had threatened her, and she reported the threats to her supervisors at the daycare center. She warned them to be on the lookout for him and to not let him enter the premises. The front door to the school was locked and could only be opened by entering a code in a keypad next to the door. Every parent and employee had been given the code. On several previous occasions, the school had gone into a “lock-down mode” and on special alert because of concern for this same teacher and fear that she might be harmed. Notwithstanding this concern, the school did not require the teacher to stay home, or in some other safe haven, until the tension between the couple was reduced and the risk of harm removed. The teacher, now raising her child as a single parent, was considered to be very good at her work and was admired by parents and children alike. The school chose to keep the teacher on their premises and did not inform the parents of the risk.

On January 25, 2008, the estranged husband came to the school with a gun in his hand, looking for his wife. The school authorities called 911 for help and tried to lock all of the other doors. Teachers gathered the children and raced into closets and restrooms to hide. The gunman found a back door not yet locked, and entered the building. Searching the hallways, he found his wife hiding in a restroom with a group of two- and three-year-old children. The husband then brutally shot and killed his wife as she sat surrounded by the children. The children were not physically harmed, but were terrorized by the incident. A parent of one of the students had arrived just before the shooting. Having quickly moved her child into the safety of a hiding place with other children and teachers, this very heroic parent went back and confronted the gunman, grappled with him briefly, and took his gun from him. The police arrived and took the man into custody.

The news reports and commentary on this tragedy included statements such as, “Why should the daycare center be held responsible for this killing? If someone is going to shoot another person in a situation like this, nothing can prevent it.” Our response is that if the daycare center knew the teacher was under threat and, in fact, had locked down their facility in the past out of fear for her being harmed, why didn’t they require her to stay away from the center, in some other safe haven for herself and her child? Why didn’t the daycare center think first and foremost about the safety of the children at the center? Why didn’t the daycare center notify the children’s parents and allow those parents to make their own decision about risking their child’s safety under the circumstances of this poor teacher and the fatal relationship she had with her husband? Would any of these precautions have made a difference? There may have been no difference to the fate of the teacher who was murdered. However, if she had not been on the daycare center’s premises, the gunman would not have forcibly entered that school looking for her and, in doing so, placed the children at such considerable risk.

As parents, we have every right to expect the people who care for our children to exercise due diligence and responsibility in providing a safe and caring environment for them, and to make decisions that place the safety of the children paramount to any other concern.

Every single time anyone has a surgical procedure performed, whether the surgery is life-saving or elective, there are risks involved. That “simple” and “routine” tonsillectomy for your five year old can actually result in death. The liposuction that your Aunt Sally has always wanted to remove those saddle bags could leave her with a pulmonary embolism. Nothing is without risk, even though most surgical procedures are much safer than they used to be – picture that bullet removal from Marshall Dillon’s chest from an old episode of “Gunsmoke” and you know what I mean.

CNN’s Medical News’ correspondent, Judy Fortin, wrote a great article about what research you can do and what questions you can ask to protect yourself or a family member before having surgery.

Step One in reducing the risk of complications during surgery is determining whether the surgery is necessary at all. Elective surgery should be weighed against the risks which could arise during the procedure. Get a second, or third, opinion about whether the surgery is necessary and whether there are options about how the surgery will be performed (i.e. general anesthesia versus local, open or laprascopic procedure) and how extensive the surgery needs to be.

Step Two is to ask friends, colleagues and neighbors for recommendations. You need to feel comfortable with, and have confidence in, your surgeon. Whenever possible, choose a board certified surgeon. Check the qualifications by asking the doctor questions about how many times s/he has performed the procedure. Go on the internet and confirm the education and training (each state has a Board of Medicine, or its equivalent) of your doctor. In Florida, the Department of Health maintains the site.

Step Three is to go through the risks of the procedure slowly and carefully with the doctor. Have him/her explain the likelihood of the risk occurring and what will happen if each event happens. Know what you are signing; really read those forms.

Step Four is to be completely honest with your physician about your complete medical history, current medications you are taking, any surgical procedures (and complications) you have had in the past and give an accurate family medical history.

Step Five is to ask more questions – how long should the surgery last, what are the expected complications, how long should the recovery take, what type of problems should be expected after the procedure, what limitations will there be following the procedure, etc. No good surgeon should shy away from, or be insulted by, such questions.

Step Six is to follow the directions of your surgeon during the recovery period. Failing to do so can lead to a longer recovery time and unnecessary complications.

Nothing can eliminate all of the risks associated with having surgery, but following these simple steps will go a long way toward providing you with the information you need to make an informed decision about the surgery, the surgeon and the potential risks of the procedure.