Teen Who Killed Four People Got Off On Probation Because He's Rich

A 16-year-old boy who drunkenly killed four people got probation this week because the judge — with no apparent irony — agreed with the boy's defense that he was a victim of "affluenza," whose parents taught him wealth and privilege shield consequences. The teen had faced up to twenty years in prison.

Sixteen-year-old Ethan Couch admitted to four counts of manslaughter after he and seven other boys stole alcohol from Walmart, piled into his car and struck and killed four pedestrians while going 70 miles per hour in a 40 zone. One of his passengers remains in the hospital with severe brain damage, and nine other bystanders were also injured.

Couch's BAC was a .24 and he also had Valium in his system. According to reports, he was belligerent at the scene, at one point saying, "I'm outta here." Prosecutors were hoping to get up to 20 years.

Couch's defense was that he was a victim of his parents' wealth and privilege; in that he never had to face consequences, which an expert summarized prior to sentencing.

He said Couch got whatever he wanted. As an example, Miller said Couch's parents gave no punishment after police ticketed the then-15-year-old when he was found in a parked pickup with a passed out, undressed 14-year-old girl.

Miller also pointed out that Couch was allowed to drive at 13. He said the teen was emotionally flat and needed years of therapy. At the time of the fatal wreck, Couch had a blood alcohol content of .24, said Tarrant County Sheriff Dee Anderson. It is illegal for a minor to drive with any amount of alcohol in his or her system.

The victims' families sort of agree with the reasoning, in that they too feel that Couch's privilege helped him avoid consequences.

Couch is now being sent to a $500,000-a-year counseling center. There are apparently five civil wrongful death suits pending against him totaling tens of millions of dollars.

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Source: Gawker (Bluestone, 12/10)

Cruise passengers are sunk before they ever sue

After an engine room fire caused the Carnival Triumph cruise ship to lose power off the coast of Mexico's Yucatan Peninsula Feb. 10, conditions deteriorated rapidly.

With the ship adrift and power out, the onboard water and sewage systems failed. During the next five days, as the ship was being towed to port in Alabama, the Triumph listed sharply, "causing human waste to spill out of non-functioning toilets, flood across the vessel's floors and halls and drip down the vessel's walls," according to a lawsuit filed Friday in Miami by Cassie Terry, a passenger from Brazoria County.

Terry and other passengers had to "wade through human feces in order to reach food lines where the wait was counted in hours, only to receive rations of spoiled food," the lawsuit said.

What was supposed to be a four-day vacation cruise became a nightmare aboard "a floating toilet, a floating Petri dish, a floating hell."

Terry was one of the first passengers to sue Carnival over the Poop Ship debacle, but she and others considering lawsuits may find the legal journey on which they are about to embark even more harrowing.

Maritime law experts say passengers waive most legal rights when they buy cruise tickets. The fine print in ticket contracts basically requires any lawsuits be subjected to arbitration in a federal court in Miami. That's going to be inconvenient for the Poop Ship's predominantly Texas-based passengers.

Only cases involving personal injury, illness or death can be heard in court. The squalid conditions or allegations of gross negligence described in some of the lawsuits may not be enough to get around the arbitration clause.

"The cruise lines want each person to have to go to arbitration and get a lawyer and spend money," said attorney Adam Brum of Morgan & Morgan in Miami, who has talked to several passengers but hasn't filed a case yet. "It makes it very hard."

What's more, Carnival's ticket contract, available on its website, shows that passengers waive their rights to a jury trial and to joining in a class-action lawsuit. That means for most potential plaintiffs, the legal costs would exceed any amount they could reasonably hope to recover.

"There's a built-in impediment," said Michael Doyle, a Houston lawyer who specializes in maritime law and who isn't involved in any of the Triumph cases. "You don't realize how little you're protected and how few remedies you have."

Chance to cruise again

Carnival has said each passenger will receive a full refund for the cruise and transportation expenses to Galveston, where the ship departed on Feb. 7, as well as an additional payment of $500 a person.

Each will also get a credit for a future cruise. Seriously.

Not since the airline tarmac strandings of 2008 have we seen such a laughable attempt at compensation. If you fail to maintain adequate separation between passengers and sewage, offering customers a chance to experience it again isn't recompense.

"The situation onboard was difficult, and we are very sorry for what has happened," Carnival chief executive Gerry Cahill said in a statement on the company's website. "We pride ourselves on providing our guests with a great vacation experience, and clearly we failed in this case."

This, though, wasn't the only case. In 2010, a fire in the engine room incapacitated the Carnival Splendor, toilets stopped working and tugs were dispatched to tow the disabled vessel to shore. In the past three years, at least three other similar incidents involving other cruise lines have been reported, according to Cruise Critic, an online guide for cruise passengers.

Redundancy rules

The International Maritime Organization, the United Nations group that oversees safety at sea, issued new guidelines for cruise ships in 2010 that would require redundancies to maintain propulsion, steering and other vital systems in case of an accident.

The new rules, though, apply only to ships built after mid-2010, which covers just a few of those in service. Most active cruise ships are older than that. The Triumph, for example, was launched in 1999.

Retrofitting the vessels with redundant systems was deemed too expensive, Cruise Critic reported.

Instead, the cruise industry has opted to insulate itself by requiring that passengers sign away their rights before they get onboard.

That leaves little recourse if you find yourself standing in human feces, waiting hours for a ration of spoiled food.


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Source: Houston Chronicle (Steffy, 2/20)

Despite Counsel, Amputee Hindered by Tort Laws

SAN ANTONIO — When Connie Spears arrived at a Christus Santa Rosa hospital emergency room in 2010 with severe leg pain, she told medical staff about her history of blood clots. Doctors sent her home with a far less serious diagnosis.

Days later, swollen and delusional, Spears was taken by ambulance to another hospital where doctors found a severe clot and extensive tissue damage. With her life on the line, they amputated both of her legs above the knee.

Nearly three years later, Spears says she is a victim not only of a medical mistake but also of Texas’ tort reform laws.

The massive tort reform package that Texas lawmakers approved in 2003 capped noneconomic damages a plaintiff can receive for medical malpractice at $250,000 and set a “willful and wanton” negligence standard — interpreted as intentionally harming the patient — for emergency care. It also required plaintiffs to find a practicing or teaching physician in the same specialty as the defendant to serve as an expert witness, and to demonstrate evidence of negligence ahead of a trial. Under the strengthened rules, if plaintiffs fail to produce adequate expert reports within 120 days of filing their cases, they are liable for defendants’ legal fees.

Spears said the laws obstructed her ability to find a malpractice lawyer and forced a judge to order her to pay thousands of dollars to cover some defendants’ legal bills. Her lawyers plan to challenge the constitutionality of the laws.

“How can that law be?” Spears asked. “Maybe the law was too loose before, but they went way too far the other way.”

Tort reform proponents say that such restrictions are the only way to curb frivolous lawsuits against health care providers, and that they have drawn more medical professionals to a state with exploding population growth.

“Our purpose had never been to have a procedural hurdle,” said Mike Hull, a lawyer for the pro-tort-reform Texas Alliance for Patient Access. “It had been to have the plaintiffs really get the case reviewed.”

For two years, Spears struggled to get legal representation, because several lawyers said they feared her case did not meet Texas’ new negligence standards. Justin Williams, a Corpus Christi lawyer who eventually took the case, said he believed it was so strong it might challenge the state’s tort reform laws. “Her life has basically been ruined by all of this, and there was just no way I could turn her down,” he said.

But the case fell apart under the new expert witness rules. After the first attempt at an expert witness report failed to identify the proper defendants, Williams said, he was unable to find another expert witness in a time frame that would satisfy Texas’ requirements.

Tina York, an attorney for Christus Santa Rosa, said it is unusual for a case to get dismissed because of problems with an expert witness report. The rules are in the statute, she said, to weed out plaintiffs who “can’t legally support their claim” from the beginning.

York said Christus Santa Rosa did not pursue compensation for its legal fees out of sympathy for Spears. But Spears said other defendants in the case had. With her retirement savings tapped and her husband out of work, she is afraid they will lose their home.

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Source: The Texas Tribune (Aaronson, 1/25)

Cosmetic surgery laws often aren't enough

Early last year, Irma Carabajal LeCroy was a successful Dallas real estate broker who owned two homes, a luxury car, an SUV and a small office building. Today, she is out of work, uses a walker and wheelchair to get around and says she has nothing left to her name.

And it's because of what she thought was a minor cosmetic surgery procedure.

LeCroy is one of a growing number of women who have had liposuction, sometimes combined with fat-transfer surgery, in doctors' offices or med spas — salon-like medical facilities that have doctors on the premises and offer skin care treatments, such as Botox injections, facials and laser resurfacing.

Some patients have found themselves disfigured or disabled. Others have died. Critics say the victims may not know that the rules that govern hospitals do not necessarily apply to the medical offices or spas popping up across the country. That's where a new breed of cosmetic surgeon now practices, often down the hall from where they do routine physicals, perform gynecological exams or pull wisdom teeth, according to state regulators, lawyers and plastic surgeons.

USA TODAY reported last year that only half of states require licensing or accreditation of medical offices where surgery is performed. But even when there are office-based surgery rules or laws in place, they often aren't enough, critics say. For example, most accreditation or licensing rules cover surgeries only if the patient is fully anesthetized. Some rules apply only if private insurance or Medicare is billed, which typically isn't the case in cosmetic procedures.

There are now about 4,500 med spas in the United States, up from about 800 five years ago, says Allan Share, executive director of the International Medical Spa Association. The growth of med spas has states scrambling to figure out how much legal oversight is needed. The Federation of State Medical Boards recently hosted a workshop for medical board attorneys that covered the regulatory oversight of med spas and office-based cosmetic surgery.

State medical boards and the laws regulating the practice of medicine were "created 100 years ago when cosmetic procedures or surgeries weren't anything that anyone had contemplated," says Mari Robinson, executive director of the Texas Medical Board. "It was about treating illness and disease — not this idea of people personally pursuing medical procedures solely based on improving their appearance."

In September, Maryland's health department shut down the Monarch Medspa in Timonium after three women contracted Group A Streptococcus infections during liposuction and one died. The department cited "deviations from standard infection control practices."

The Group A Streptococci bacteria, which can cause strep throat, are often found in the throat and on the skin and are spread through direct contact with mucus from infected people or contaminated surfaces, according to the health department. Most of these infections are relatively mild, such as with strep throat, but they can cause serious and even life-threatening complications.

Protecting consumers

Joshua Sharfstein, Maryland's secretary of Health and a pediatrician, sent a letter to three committee chairmen in the Maryland legislature last month asking them to tighten laws governing outpatient surgery. The existing law doesn't apply to outpatient surgery centers unless insurance companies are involved, according to a department press release. Health insurance typically covers only medically necessary or reconstructive plastic surgery after cancer. He also asked that the state Board of Physicians database include information on whether doctors perform cosmetic surgery and whether their facility is accredited.

"We asked ourselves if more needs to be done to protect consumers from unsafe cosmetic surgery," says Sharfstein. "There are some protections that exist for bigger surgical centers, but gaps in regulation might put consumers at risk" because smaller operations, including med spas, can take advantage of loopholes.

In Texas, doctors with office-based surgery centers or med spas that aren't accredited by one of three outside entities or licensed as ambulatory surgery centers, can register them for any level of anesthesia used that is above local anesthesia.

It wasn't the anesthesia that harmed LeCroy, however. It was the surgery itself, according to a lawsuit filed on her behalf against internal medicine doctor Hector Molina and the company that sold him the liposuction machine. The suit charges that Sound Surgical Technologies should have known of the risks of a non-surgeon who was not adequately trained in liposuction using the machine. In its response to the suit, Sound Surgical denied the allegations and says it was not to blame for any of LeCroy's injuries. In a statement provided to USA TODAY, the company said LeCroy's attorneys aren't suggesting the liposuction machine was defective, so it "is confident that it will be dismissed from this lawsuit either before or during trial." LeCroy's attorney, Jim Mitchell, says it wasn't that the machine was defective, it was that "Dr. Molina simply didn't know how to use the system."

When they prohibited Molina from performing cosmetic surgery in April, a Texas Medical Board disciplinary panel found his "entire knowledge" of the procedure he performed on LeCroy (who it did not name) "consisted of reading a book provided by the manufacturer of the liposuction equipment, completing an online program over two weeks, passing an online exam and completing one procedure under the direct supervision of another surgeon."

Texas-size problems

LeCroy was left permanently disabled by Molina due to problems including massive infection and the nerve and muscle condition known as "compartment syndrome," which causes body tissue to die, according to her lawsuit and an expert witness report by Miami plastic surgeon Alberto Gallerani. Molina denied the allegations in an answer to the lawsuit, and his lawyer declined to comment.

After LeCroy's more-than-nine-hour liposuction and fat-transfer surgery, Molina and a doctor assisting him abandoned her in his office "without any medical supervision or monitoring," according to Gallerani's report. Her friend, Marilyn Walker, found her "short of breath, unable to stand" and in severe pain in her legs and feet, the report said. She was rushed to the emergency room and transferred to a trauma center. So much fat was injected into the muscles in her buttocks, it caused the compartment syndrome, which Molina failed to diagnose, according to Gallerani's report. LeCroy needed 27 more surgeries to treat the compartment syndrome and related complications, according to Gallerani's statement. She spent a month and a half in the hospital.

LeCroy, 49, now has a home health aide coming to her house three times a week. The money she earned selling real estate, which she did starting at age 25, went to pay medical bills, because complications from cosmetic surgery aren't covered by insurance. She says she is unable to walk without a walker and needs a wheelchair for long distances. "I have nothing," says LeCroy. "I'm down to $698 a month in disability benefits."

Harlan Pollock, a Dallas plastic surgeon and past president of the American Association for Accreditation of Ambulatory Surgery Facilities, says Texas' law doesn't go far enough to protect patients.

When offices register with the state of Texas, certain requirements kick in for the safe administration of anesthesia, according to Texas Medical Board spokeswoman Leigh Hopper. These include the presence of a doctor and another person certified in treating cardiac arrest and a "crash cart" containing life-saving equipment. But Pollock says these requirements apply only to anesthesia and have little to do with the safety of the surgery itself. Accreditation, on the other hand, would require sterile procedures, physical requirements for the operating room, safety equipment and thorough record-keeping procedures, Pollock says. Sterile procedures are key for infection control, which was what Maryland officials found lacking at Monarch Medspa, medical experts say.

This kind of "an out," in Pollock's words, means "The public has no real assurance that the facility is an adequate facility, and that is disturbing and a real concern," he says.

On Nov. 30, the Texas Medical Board barred Molina from ever performing surgery or dispensing controlled substances, a category that includes some pain medications, such as those with codeine. But Texas has done little to crack down on the offices and med spas where doctors like Molina practice cosmetic surgery, say plaintiff attorneys and plastic surgeons.

Hopper emphasizes that Texas' medical board "rigorously screens" doctors who apply for medical licenses. And once they have these licenses, doctors are required to meet what's known as the generally accepted standard of care no matter what area they practice in, she says.

Still, if Texas' state Legislature wanted to address office-based surgery, Robinson says, the board would "be happy" to implement any new rules.

LeCroy isn't the only Texas patient to suffer after cosmetic surgery in a doctor's office or med spa. The Texas Medical Board also found OB/GYN Barbara Marino didn't meet the "standard of care," have emergency procedures in place or maintain a sterile operative facility during liposuction on patients at Medspa 21 in Houston. One died two days after his liposuction, and an autopsy report said the cause of death was "acute toxicity" from the combined effects of four medications, including a patch for the pain medication Fentanyl, according to the medical board's records. Another patient had excessive levels of pain medicine, the board said.

Late last month, Marino was ordered to observe at least 30 hours of cosmetic surgery by a board-certified plastic surgeon and document other procedures for treating at-risk patients and dealing with emergencies. She did not respond to calls seeking comment.

In November 2011, Laura Bennack, an emergency room doctor who owns Radiance MedSpa in San Antonio, had her practice put under the supervision of another physician by the Texas Medical Board. It had investigated the treatment of 10 cosmetic surgery patients and found she didn't meet what it considers the appropriate "standard of care" or keep adequate surgery records. According to the board's disciplinary order, Bennack performs tummy tucks, liposuction and breast augmentation while patients are awake. The board said in an order in February 2010 that Bennack acknowledged her medical record keeping was "sparse at best." Bennack did not respond to calls seeking comment.

Little regulation

Med spas typically offer only procedures without anesthesia or under local anesthesia, which isn't regulated in Texas or many other states. "There is absolutely no regulation of med spas," Pollock says. "That's something that to me is very frightening."

Some doctors, including Marino and Molina, register their facilities for higher levels of anesthesia. Several states require accreditation for offices intending to use deep sedation or general anesthesia, since it is the type used for the most serious procedures, says Tampa anesthesiologist Hector Vila. But doctors can get around the law by registering for a lower level of anesthesia or using large volumes of local anesthesia, says Vila.

Vila says existing laws need to be more strictly enforced to ensure people don't continue to skirt them. Performing surprise inspections and more frequent inspections could be one way to accomplish this, he says.

Some of the toughest laws:

Florida. The state changed its law early this year to authorize the state to inspect any facility, including med spas, that remove more than 1,000 cc's of fat during liposuction. That would cover all but the most minor procedures, says Democratic state Sen. Eleanor Sobel, who introduced the bill. Previously, the inspection authority existed only for facilities that accepted Medicare or other insurance. The law was passed after two women died of an overdose of lidocaine, a local anesthetic similar to novocaine, after liposuction.

California. Under a law passed in January, California's medical board keeps a list of accredited outpatient surgery settings. The board approved four accreditation agencies that inspect and accredit outpatient surgery settings, including medical offices and spas. These agencies can reject, revoke, or otherwise restrict a facility's accreditation. If that happens, the medical board is notified and alerts the public on its website.

New York. Any office-based surgery facility that removes more than 500 cc's of fat during liposuction or uses anything more than minimal sedation must be accredited. Still, even though New York has some of the most stringent regulation of office-based surgery, any licensed physician can perform cosmetic surgery under a local anesthetic in an unaccredited facility, says Manhattan plastic surgeon Adam Schaffner. "My hope is that they will require that physicians who perform such procedures perform them in accredited facilities (and) that they have hospital privileges for any procedure they perform outside the hospital," says Schaffner.

The issue of med-spa regulation is "absolutely rising to a national level ... everyone is really looking at it right now," says Robinson.

"Every single person needs to pay attention to the training of the person who's doing the procedure and the status of the facility — whether it's accredited or not," says Sharfstein. "What you find out can make the difference between life and death."

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Source: US Today (O'Donnell, 12/10)