Sin embargo, los proyectos presentados por la Senadora Soto Villanueva presentan un verdadero balance entre los intereses de las víctimas y de los médicos.  Dichos proyectos proponen las verdaderas soluciones para los problemas de la impericia medica en Puerto Rico.  Vamos a enumerar las mismos para el beneficio del lector:

PS 2169-le confiere al médico el derecho al Hogar Seguro, protegiendo hasta por $250,000 el valor de su residencia principal;

PS 2170-enmienda las Reglas de Procedimiento Civil para requerir que todo demandante en un caso de impericia medica presente un informe pericial de un médico dentro de los 45 días de presentada la demanda, con el propósito de desalentar la radicación de pleitos “frívolos” y brindarles mas herramientas a los jueces para desestimar casos sin peritos.

PS 2171-requiere que a los médicos de ciertas especialidades medicas de alto riesgo se les requiera comprar seguros por impericia medica de no menos de $250,000.00.

PS 2172-confiere al médico un beneficio adicional (al de descontar el pago de su póliza de impericia como gasto de su práctica para fines contributivos) al permitir un incentivo del 100% de la prima pagada de su planilla de contribución sobre ingresos.

PS 2173-requiere que los Tribunales de Primera Instancia en Puerto Rico designen salas especializadas para el maejo de casos de impericia médica.

PS 2174-permite que las corporaciones de servicios  profesionales medicos sean consideradas como partes “asegurables” para que puedan adquirir sus propias pólizas de impericia medica.

Sin duda que en conjunto, todos y cada uno de estos proyectos representan las medidas necesarias para preservar al máximo los balances de médicos y víctimas en pleitos de impericia medica.

De igual forma, la Senadora Lornna Soto Villanueva demostró su indignación ante dicho proyecto de ley y públicamente solicitó que su nombre fuera retirado como coautora de dicho proyecto.  La Senadora Soto es la vicepresidenta de las Comisiones de Salud, Corporaciones Públicas, Consumidor y Seguros del Senado de Puerto Rico, y ha sido una valiente defensora de los derechos de las víctimas de impericia médica. La Senadora Soto se ha expresado públicamente en contra de dicho proyecto de ley, y ha prometido que cabildeara en contra de la aprobación de los mismos.

Los proyectos 2195 y 3453 pretenden despojar a la víctima de impericia médica de su derecho más básico; obtener indemnización por los daños causados a raíz de actos de impericia médica.  Alegando un éxodo de profesionales médicos al exterior, y la proliferación de alegados pleitos frívolos, dichos proyectos pretenden limitar a la suma de $250,000 la cuantía que una víctima puede obtener por sus daños no económicos. 

Las premisas sobre las cuales dicho proyecto están fundamentados son incorrectas.  Primero, las estadísticas de SIMED, que es la compañía aseguradora de impericia médica que cubre casi un 90% de los médicos en Puerto Rico y la única entidad con estadísticas confiables en Puerto Rico sobre impericia médica demuestran que el número de médicos en Puerto Rico no ha disminuido, sino todo lo contrario, ha aumentado.  De igual manera, la Junta de Licenciamiento de la Profesión Médica en Puerto Rico, en cuales un brazo del Departamento de Salud ha desmentido la premisa del alegado éxodo de médicos especialistas al exterior, indicando que cada vez hay más en Puerto Rico, y no menos.

Por otro lado, las propias estadísticas de SIMED demuestran que la radicación de reclamaciones por impericia médica en Puerto Rico se ha mantenido al mismo ritmo y hasta ha disminuido en los últimos tres años.

Además, los propulsores de dicho proyecto han dejado de presentar evidencia o estadísticas algunas que demuestren que dicho caso de impericia médica sean “frívolos”, que quiere decir que no cuentan con un informe pericial de un médico que establezca que ocurrió negligencia que causó daños a las víctimas.

Lo irónico del caso es que el fin de dichos proyectos no cumple con el propósito para el cual fueron promulgados. En realidad, el tope de $250,000 penalizar y a la víctima como un caso meritorio, cuando en realidad lo que estos proyectos quieren perseguir es la presentación de casos frívolos.

Se propone también la creación de un panel de arbitraje para evaluar a priori el mérito de una reclamación por impericia médica antes de que el caso pueda ser evaluado en sus méritos por un tribunal. Sabemos ya que en Puerto Rico los paneles de arbitraje en casos de impericia médica consistentemente han sido declarados inconstitucionales.

Los proyectos disponen, por vía de excepción, que no aplicarían los topes de $250,000 sólo en casos en los cuales el médico haya cometido el acto de impericia médica bajo los efectos de bebidas embriagantes o drogas ilícitas.

Se propone además el establecimiento de un Fondo de Compensación, sin siquiera saber de dónde saldrán los fondos para el mismo. Dicho Fondo costeará única y exclusivamente los gastos médicos de aquellas víctimas de impericia médica con “daños catastróficos”, los cuales han sido definidos como daños que causan incapacidad permanente, perlesía cerebral, y otros daños que causan incapacidad total al ser humano. El resto de las víctimas de impericia médica quedan desprotegidos totalmente.

En fin, dichos proyectos le quitan derechos a las víctimas para dárselos al grupo protegido de médicos que propulsa la medida legislativa.  Es una gran pena y una verdadera desgracia y vergüenza que dicho proyecto de ley, de privilegio, esté siendo propulsados desde la Fortaleza.

Nos mantendremos informados de los próximos  movimientos de dichos proyectos.

Rejecting the Department of Health and Human Services’ claim to a large share of a nursing home negligence settlement, the court found that compensation for the loss of a parent belongs to the decedent’s children, “not the secretary of HHS.” Robert Peck of the Center for Constitutional Litigation, who represented the plaintiffs in Bradley v. Sebelius, said the decision “clears the way to making these cases viable.”

In a case of first impression, the Eleventh Circuit ruled last week that Medicare is not entitled to the proceeds of a wrongful death settlement paid to the surviving children of a Medicare recipient. Reversing a lower court decision, the appeals court found that “any claim of the estate is separate and distinct from the claim of a survivor” and that Medicare is entitled only to “the estate’s allocated share of the proceeds.” (Bradley v. Sebelius, 2010 WL 3769132 (11th Cir. Sept. 29, 2010).)

Robert Peck, president of the Center for Constitutional Litigation in Washington, D.C., who represented the plaintiffs, said the decision provides long-overdue clarity on a question that has confounded courts.

“Medicare’s insistence that it is entitled to first and full reimbursement has been a problem in settlements, and also in bringing such cases to begin with,” he said. “This ruling clears the way to making these cases viable and allowing lawyers to bring real benefit to their clients.”

In 2005, Charles Burke died while under the care of a nursing home in Gainesville, Florida. His daughter, Carvondella Bradley, presented a wrongful death claim to the nursing home on behalf of Burke’s estate and his 10 surviving children.

The case settled for the facility’s insurance limits of $52,500 before a lawsuit was filed, and Bradley notified the Department of Health and Human Services (HHS)—which administers Medicare—of the settlement. In response, HHS claimed that it was entitled to $22,481.89 of the settlement proceeds as reimbursement for its share of Burke’s nursing home medical expenses.

A Florida probate court hearing to adjudicate the matter was set. Bradley notified HHS of the hearing, but no agency representative attended. The probate court awarded $787.50 to HHS. The rest was allocated to Burke’s children for their nonmedical losses.

HHS disputed the probate court’s decision, arguing that it was merely “advisory in nature or superseded by federal law.” The agency argued that a clause in its Medicare Secondary Payer Manual should control in the case. The clause provides that HHS will accept an allocation of settlement proceeds to nonmedical losses only “when payment is based on a court order on the merits of the case.”

HHS ordered Bradley to pay the $22,480.89 within 60 days. Bradley paid the agency, exhausted her administrative remedies, and then appealed to the district court, which found for HHS.

Writing for the court of appeals, Judge James Hill noted that the facts of the case were not in dispute and that “the issue of first impression in this case is therefore: ‘Whose property is the settlement?’”

In answering that question, Hill found HHS’s reliance on the Medicare Secondary Payer Manual “unpersuasive” and said it would “have a chilling effect on settlement” because it would force all plaintiffs to bring their claims to trial. Hill also cited Florida’s wrongful death statute as the controlling statute in this case.

“Under Florida law, any claim of the estate is separate and distinct from the claim of a survivor,” Hill wrote. “All loss of consortium or companionship recoveries are the property of the person who incurred the loss. Not the secretary of HHS. A child’s loss of parental companionship claim is a property right belonging to the child. Not the secretary of HHS.”

Hill also criticized HHS for “citing no statutory authority, no regulatory authority, and no case law authority, merely rely[ing] upon the language contained in one of its many field manuals,” and for failing to attend the probate court hearing.

“Essentially, the court said, ‘They had their chance, and they declined, and it’s too late to cry now,’” said Peck.

Doctors who disclose having made medical errors are good for a hospital’s bottom line, reducing claims for compensation and lowering liability costs. That’s the conclusion of a recent study published in the Annals of Internal Medicine.
The study looked at the results of a comprehensive claims management program begun in 2001 at the University of Michigan Health System (UMHS) based in Ann Arbor. The UMHS includes three hospitals, a medical school, and several health centers. Before launching the program, the system typically cut off communication between doctors and patients while parties prepared to go to trial. Now, UMHS conducts an internal review of each case and shares the findings with the patient—including whether the physician acted in error.
Under the program, physicians and health system employees are encouraged to watch for instances where medical errors occurred, and then issue a full disclosure—with an offer of compensation if the doctor was in error—to the affected patients. The study looked at claims for medical malpractice filed from 1995 to 2007 to compare results before and after the program was instituted.
According the study’s authors, establishing the disclosure program led to a decrease in new legal claims, time to resolve claims, and total liability costs. The researchers found a 61 percent decrease in spending on legal defense costs and a dramatic drop in the number of presuit claims and pending lawsuits (from 260 in 2001 to just over 100 this year).
In a press release, the university noted several elements unique to the system that could affect the program’s results. Among these is the fact that UMHS is self-insured for malpractice and all claims against its medical staff are handled by its general counsel. Another is a Michigan statute that requires plaintiffs to file a notice of intent to sue with defendants, followed by a six-month “cooling off” period. According to the press release, “UMHS systematically uses that period to investigate complaints and establish a dialogue with our patients, and their attorneys if they are represented, which often eliminates their need to resort to litigation.”
Richard Boothman, chief risk officer for UMHS and a coauthor of the study, said that limiting liability costs was not the goal of the claims management program.
“The real pot of gold is patient safety,” he said. “The emphasis is not on claims but on improving our communications, and speaking openly and honestly with our patients. You can’t improve until you admit you have a problem. Too many hospitals have had a problem with patient safety, and that’s what needs to be fixed.”
Ray DeLorenzi, communications director for AAJ, said, “Apology programs can be successful when they encourage the disclosure of errors and offer appropriate compensation to affected patients. However, safeguards must be in place so these programs are not coercive and the legal rights of patients and their families are preserved.”
Boothman, a former trial lawyer, said he dislikes the terms “apology program” or “sorry works,” saying the UMHS plan is “a comprehensive program that integrates patient safety, peer review, and an educational program.”
Details about the study, Liability Claims and Costs before and after Implementation of a Medical Error Disclosure Program, and the UMHS claims management program can be found at the university’s Web site.

Dr. Carlos Ramirez is an obstetrician/gynecologist with at least 26 years of experience that had been board certified in at least 2 occasions and had labored as a part time faculty member of the University of Puerto Rico Medical Center and also maintained a private practice. During his practice, Dr. Ramirez had taken care of approximately 500 premature labor patients and thousands of non-premature labor patients. There was no doubt that Dr. Ramirez was and still is a qualified expert in obstetrics and gynecology. But, as the Honorable Court for the First Circuit put it, “the District Court excluded Dr. Ramirez’s testimony on the ground that Dr. Ramirez was biased in favor of plaintiffs in medical malpractice cases”.

Soler Law successfully argued before the First Circuit court that in disqualifying our expert, the Honorable District Court abused its discretion because it had invaded the “province of the jury” in weighting the credibility of the expert and in failing to apply the criteria enunciated in Daubert v. Merrel Dow, 509 US 579 (1993) and its progeny, which mandates that the district court’s gatekeeping function is limited to determine the expert’s “specialized knowledge”, in this case as a physician and if the proposed testimony is relevant to the issue at hand and rests on reliable foundations. The First Circuit Court finally found that the district court deviated from that field of inquiry and excluded Dr. Ramirez’s testimony on the basis of bias. “In so doing, the district court invaded the province of the jury and exceeded its discretion.” Cruz, supra.

The Hazel Cruz opinion restates that court’s opinion concerning the admission of expert testimony in the case of Pages-Ramirez v. Ramirez-Gonzalez, 605 F. 3d 109 (1st. Cir. 2010) and adds a few more points to that same topic. In Pages, that court stated that “as part of its inquiry, the trial court must “determine whether the putative expert is qualified by knowledge, skill, experience, training, or education,” to offer testimony. Mitchell v. United States, 141 F.3d 8, 14 (1st Cir. 1998) (citation omitted). We have explained, however, that “[t]he proffered expert physician need not be a specialist in a particular medical discipline to render expert testimony relating to that discipline.” Gaydar, 345 F.3d at 24. In Mitchell, we held that an expert, an internist with a specialty in hematology and oncology, was qualified to opine on the standard of care that should have been met by a gastroenterologist performing a colonoscopy. 141 F.3d at 15. Similarly, in Gaydar, we found that “the mere fact that [an expert] was not a gynecologist does not mean that he was not qualified to give expert testimony regarding [the plaintiff's] pregnancy.” 345 F.3d at 24. Although credentials such as board certification in a particular medical specialty may indicate that an expert’s opinion is “entitled to greater weight,” such certification has “never been held a prerequisite to qualification as an expert medical witness.” Alvarado v. Weinberger, 511 F.2d 1046, 1049 (1st Cir. 1975) (per curiam). Indeed, we have noted that it would be an abuse of discretion to exclude testimony that would otherwise “assist the trier better to understand a fact in issue,” simply because the expert does not have the specialization that the court considers most appropriate. Gaydar, 345 F.3d at 24-25 (citing Holbrook v. Lykes Bros. S.S. Co., 80 F.3d 777, 782 (3d Cir. 1996) (finding an abuse of discretion when the trial judge prohibited physician specializing in internal medicine from opining on plaintiff’s cancer because he was not an oncologist)).
In this case, the Court adds that the jury “must be free to weight the credentials of the witness and the cogency of the bases given for his opinions” if the expert’s opinion is relevant to the task at hand. Also, any question as to bias of the witness are matters for the jury to decide and affect only the probative weight of the expert’s testimony, not its admissibility. Further, specific credentials, such as up-to-date board certification, are not required for an expert to be qualified to testify.
This is a big win for medical malpractice victims and for any party who wishes to use a qualified expert during trial, insofar as this opinion restates with precision the “test” that the trial court must use to evaluate the admissibility of any expert’s testimony. The opinion is a big loss for anyone trying to limit the availability to experts in any type of case.
Finally, the First Circuit Court granted the costs to appellants and sent the case back to the district court. Plaintiffs will request that a new trial be set.

2. Protecting American Families From Unfair, Abusive Financial Practices
Too many responsible American families have paid the price for an outdated regulatory system that left our financial system vulnerable to collapse and left families without adequate protections. We must protect and empower families with the strongest consumer protections ever.  An Independent Bureau of Consumer Financial Protection Will Set And Enforce Clear, Consistent Rules For The Financial Marketplace. A single consumer bureau will set clear rules of the road and ensure that financial firms are held to high standards. For example:

• For families who want to buy a home: The piles of forms needed for a regular mortgage can be overwhelming, and many brokers have taken advantage of that confusion to give borrowers loans they didn’t need or couldn’t afford. The new consumer financial protection bureau will take steps to consolidate and simplify with plain language two overlapping and sometimes inconsistent federal mortgage forms. The bureau will, for the first time, provide ongoing federal oversight of both nonbank companies and banks in the mortgage market and protect borrowers from unfair, deceptive or other illegal mortgage lending practices.
• For families with credit cards: The new consumer financial protection bureau will enforce the new credit card law signed by President Obama that bans rate hikes on existing balances and other unfair practices. For families who have used credit cards to get by when times are tight, the law will give them clarity on the interest rates they are charged.
• For families caught by unexpected overdraft fees: Many households have been automatically enrolled in expensive overdraft programs. These programs can hit consumers with costly overdraft fees for even the smallest purchases. For example, the FDIC found that the average overdraft charge for a single purchased item—like a $2 cup of coffee—is $30 at banks with assets more than $1 billion. The new consumer financial protection bureau will enforce new rules that give consumers a real choice as to whether to join expensive overdraft programs so that they are not unknowingly charged unnecessary fees. [FDIC, “FDIC Study of Bank Overdraft Programs” (November 2008) at Table IV?3]
Until Now, There Have Been Seven Different Regulators With Authority Over The Consumer Financial Services Marketplace. Accountability has been lacking because responsibility is diffuse and fragmented. In addition, many mortgage lenders and mortgage brokers were almost completely unregulated. All that will change..
3. Closing The Gaps In Our Financial System
We depserately needed to modernize our financial system and take the necessary steps to close the gaps in our system and eliminate regulatory arbitrage.  Reform Will Address the Gaps that led to Regulatory Failure – At Its Peak, The “Shadow Banking System” Financed About $8 Trillion In Assets. In the lead-up to the financial crisis, our regulatory system as a whole failed. One of the greatest weaknesses of our financial system was the risk that built up in the “shadow banking” system where there was explosive growth in a range of financial firms that acted much like banks – but operated without oversight.
Market Discipline Was Not Enough. Relying on market discipline to compensate for weak regulation and then leaving it to the government to clean up the mess was not a good strategy for economic growth nor financial security.
Our Financial System Will Have Clear Accountability. There is no substitute for vigorous, consistent enforcement of the laws governing the financial system. But each regulator should have a clear mission and the authority to execute that mission.
• Gaps and loopholes that allowed large firms like AIG to avoid strong, comprehensive federal oversight will be eliminated.
• To achieve accountability, one entity will have the responsibility and the authority to supervise the most complicated firms.
4. Reform is Critical to Market Certainty and Stable Growth
Reform is central to providing a foundation for stable growth. Our financial system is most competitive when our system is stable, resilient and transparent.Reforms Will Make The Financial Industry And The Markets They Operate In Stronger, Safer, And More Competitive.
• Clearer accountability in supervision and regulation so that financial firms can operate under a coherent set of rules and expectations without the current regulatory arbitrage opportunities that allow some firms to “game the system.”
• Stronger capital buffers to increase the ability of financial companies to weather the ups and downs of financial markets.
• Lesser concentration of risk among the largest financial firms so that any one firm can fail without creating a domino effect throughout the entire financial system that jeopardizes jobs, family savings and the entire economy .
• Greater transparency in the derivatives market that will make the system safer by providing regulators with the data they need to manage systemic risk and help ensure the integrity of financial markets so we can prevent future AIG-like disasters.
Comprehensive Reform Will Help Generate Innovation And Economic Growth. A key test of a strong financial system is whether or not it effectively channels savings to finance future innovation. The old system produced waves of credit bubbles and real estate booms followed by severe financial shocks and damage. Under reform, the financial system serve not only short-term profits, but long-term growth, entrepreneurship, and savings.
Leading the Way on International Financial Reform. We have worked in parallel with our international partners to make sure that as we move to reform and strengthen our financial system at home, the G20 is moving to implement reforms to achieve a level playing field.

Pharmaceutical giant GlaxoSmithKline knew of possible heart attack risks tied to its controversial diabetes drug Avandia years before evidence of a link became public, according to a U.S. Senate report released Saturday.

Based on its knowledge of those risks, GlaxoSmithKline “had a duty to sufficiently warn patients and the FDA of its concerns in a timely manner,” said the Senate Finance Committee report, which followed a two-year inquiry. Instead, the company tried to play down findings that the drug could increase cardiovascular risks while also working to minimize findings that a rival medication might reduce such risks, according to the report.

The senators who released the report — Max Baucus (D-Mont.), chairman of the Finance Committee, and Charles E. Grassley (Iowa), the committee’s ranking Republican — are also asking the Food and Drug Administration why it allowed a clinical trial of Avandia to continue even after the agency estimated that the drug caused 83,000 heart attacks between 1999 and 2007.

The Senate report suggests sharp disagreements remain at the FDA over how to handle Avandia’s risks.

GlaxoSmithKline said in a statement that the drug is safe and that the committee report took data out of context from analyses of Avandia.

“Contrary to the assertions in the report, and consistent with the FDA-approved labeling, the scientific evidence simply does not establish that Avandia increases cardiovascular ischemic risk or causes myocardial ischemic events,” the company said.

At the FDA’s request, GlaxoSmithKline agreed in 2007 to conduct a six-year study of its drug and rival Actos, to give a definitive picture of Avandia’s safety. The study, which will involve 16,000 participants, is still enrolling patients.

But FDA researchers quoted in the Senate report called the study “unethical and exploitative,” since patients will continue taking Avandia, a drug with known risks, over Actos, which has not been linked to heart problems.

FDA spokesman George Strait said the agency is reviewing new data on Avandia and will present those findings to an advisory committee this summer.

Avandia was GlaxoSmithKline’s third-best-selling drug in 2006, with revenue of $2.2 billion. But the safety concerns disclosed the following year slashed revenue to $1.2 billion by the end of 2008.