Thursday, February 26, 2009

Fil-Am doctor-lawyer wins landmark case

Medical doctor, lawyer, chemist, molecular biologist, PhD and MBA degree holder. Professor of medicine, cancer director in several US hospitals, leading figure in stem cell research, cancer therapy and bioregenerative medicine. He is also a cancer survivor.

Filipino-American Dr. Samuel D. Bernal has a string of letters and dots after his name. He has authored numerous books and scientific articles and embarked on groundbreaking researches which have gained him fame and respect in the daunting field of molecular science and cancer therapy. But the latest feat that excites him has something to do with both medicine and law—in one blow, that is.

This doctor lawyered and won on behalf of a cancer-stricken Filipino-American based in San Francisco, California. Bernal filed a malpractice suit against a group of doctors, a hospital and an HMO last year. (He’s handling other cases of this nature.) He sued for extraordinary damages and after several months of litigation, the contending parties arrived at a settlement last December 2008. The settlement was in the vicinity of $.5 million which exceeded the usual.

“What we want to convey here is not the specifics of this case,” Bernal explains, “but that care of patients must be personalized and not based on menus or so-called standard-of-care and evidence-based medicine that often do not apply to specific individual patients. Doctors have an obligation to carefully consider the unique condition of each patient.”

Bernal is a staunch advocate of personalized, customized diagnosis and care of patients. “We sued based on the argument that you cannot put patients in boxes where they do not belong. Population-based statistics do not always reflect the situation of an individual patient.”
Patient X was diagnosed as suffering from late-stage liver cancer that was inoperable and, from the looks of it, no longer curable. It shouldn’t have come to that, Bernal rues, had the patient’s doctors not put him in a box.

“Had he been treated by a doctor who used clinical judgment, he could have been diagnosed early and cured of his disease. Instead, he ended up with no chance of cure.” The patient died last month.

Bernal says that Patient X’s family approached him. Looking at the records, he saw that the doctors, in dealing with the patient, simply adhered to standard-of-care and evidence-based medicine based on population statistics.

He rages: “When you are a doctor you cannot be a librarian. You must use your ability to evaluate a patient and look at what is unique about that patient. Now these doctors have to realize that when they just follow standard-of-care and evidence-based medicine they are going to be sued and they are going to lose!”

In the past, Bernal says, a lot of cases were won by hospitals and doctors whose defense was, well, standard of care. “This is one of the remarkable cases where the hospital and the doctors lost because they used that defense. They can no longer hide behind that defense.”

So, is it laziness or negligence? It is the menu and the protocolized approach, Bernal answers. Then he threatens: “When you stick to menus and protocols and guidelines that you memorized and then put patients into simplified categories out of convenience, be careful, because you are going to be sued and you are going to lose.”

Bernal offers some lessons. “You have to practice personalized medicine. Your clinical judgment trumps any population-based statistics. Treatments that are evidence-based or FDA-approved are just guides. Remember statistics are a bell curve. There are those who do not fit. Many are either on the right or the left of averages. If the patient does not fit protocol A, do you put him in protocol B? It does not make sense. An Asian patient is different from an American patient. A smoker who got lung cancer is different from a non-smoker.”

And then Bernal speaks about the field of molecular biology which now makes personalized medicine even more imperative. “At the molecular level, things are even more dramatic,” Bernal gushes. “In this era of molecular biology, we are now recognizing even more that personalized medicine involves analyzing the molecular characteristics of a patient.”

But not everything has to go under the microscope. “You must also listen to the patient, pay attention, use your clinical judgment, not the assembly-line approach. In the past, when doctors entered the room, they talked to the patients, listened carefully and observed. That is part of the art of healing. Look carefully at the urine sample, don’t just order a CAT scan. Spend time, observe the patient, how is he is emotionally, spiritually.”

Then he speaks of the physician-healer. “A physician-healer should not be trained to do rote memorization. This is one of the mistakes of medical schools. Filipinos imitate the American approach.”

There is more to Bernal, molecular biology, bioregenerative medicine and stem cell therapy in the Philippines which he has helped significantly to be in step or several steps ahead of other countries. Few people know that. And so I am writing a series on this exciting subject. By the way, stem cell therapy was Time magazine’s cover story recently.

“Molecular medicine,” Bernal proclaims, “is now, the present. Not the future.” He is here and in many parts of the world spreading the news about bioregenerative medicine. He had applied it on himself when he was thought to be dying. Many patients, Filipinos included, have thrived under his care. He is here often, cheering, rooting for the Philippines. He is teaching, researching, healing, giving. On a clear day, you will find him at The Medical City. Brilliant guy.

We called him Sammy when we were kids.