Global Neurocare Works with the UN to Combat Neurological Disorders

A prominent neurologist and medical law specialist, Dr. James C. Johnston has been in private practice for nearly 30 years. In addition to his work as a neurologist, James C. Johnston, MD, JD, also serves as a partner with Global Neurology Consultants, where he is mostly concerned with improving health care quality and access in developing regions. To further this vision, Dr. Johnston founded Global Neurocare, a nonprofit organization dedicated to advancing patient care and increasing medical training and research in developing countries such as Ethiopia.

Neurologists are scarce and resources limited in these developing regions, resulting in the needless deaths of those suffering from neurological disorders every day. Global Neurocare was granted Special Consultative Status with the United Nations in 2013, the highest status granted to a non-governmental organization. The Economic and Social Council (ECOSOC) Committee at the United Nations looks at numerous applications to find non-governmental organizations that coincide with the aims and purposes of other United Nations programs.

Members of organizations granted Special Consultative Status are able to serve as UN delegates at sessions in various locations around the world. Global Neurocare’s status with the UN allows it to raise public awareness, implement international trade agreements, and provide expert analysis on relevant issues, among other benefits. Neurological disorders are recognized by the World Health Organization as one of the greatest threats to public health, and organizations such as Global Neurocare are poised to help with the crisis.

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“Electronic Fetal Monitoring, Cerebral Palsy, and Medical Ethics”

A Consultant Neurologist in private practice, Dr. James C Johnston holds an MD from the University of Texas Health Science Center, is a Diplomate of the American Board of Psychiatry and Neurology, and an Attorney and Counselor at Law. Dr. James C Johnston is also an accomplished clinical researcher and medical author.

Among Dr. James C Johnston’s numerous peer-reviewed articles on cerebral palsy and electronic fetal monitoring, he published “Electronic Fetal Monitoring, Cerebral Palsy, and Medical Ethics: Nonsense of a High Order” with coauthors Berna Arda and Thomas P Sartwelle. This article appeared on May 2, 1017 in the medical law, health governance, and bioethics journal Medical Law International.

Electronic fetal monitoring (EFM) is employed to monitor the heart activity of unborn babies during the labor process. The inventors of EFM saw great benefits for the prevention of cerebral palsy (CP), believing that the technology could predict CP and allow physicians the time to prevent CP by ordering immediate C-sections.

“Electronic Fetal Monitoring, Cerebral Palsy, and Medical Ethics” demonstrates that EFM has done nothing to combat CP since the technology became the standard of care almost half a century ago. Furthermore, the article describes how EFM harms mothers and babies alike and discusses how physicians relying on EFM violate the fundamental bioethical principles of autonomy, beneficence, and nonmaleficence.

James C. Johnston, MD, JD and his colleagues have also published an article in the 2018 Surgery Journal highlighting the failed arguments of a typical EFM advocate. This article, “Continuous Electronic Fetal Monitoring During Labor: A Critique and Reply to Contemporary Proponents” is freely available in the open access journal or through the following link on Researchgate.net:

https://www.researchgate.net/publication/323614188_Continuous_Electronic_Fetal_Monitoring_during_Labor_A_Critique_and_a_Reply_to_Contemporary_Proponents

The Medical Law International article is also open access and available through Researchgate.net under Dr. James C. Johnston: https://www.researchgate.net/publication/316693326_Electronic_fetal_monitoring_cerebral_palsy_medical_ethics_Nonsense_of_a_high_order.

UN High-Level Political Forum

With 30 years of experience as a neurologist, James C. Johnston, MD JD is the Founder and Director of Global NeuroCare® and serves as a Partner with GlobalNeurology®, organizations dedicated to advancing the field on a global scale. Dr. James C. Johnston is uniquely qualified through his medical and legal training and experience to address international medical law concerns that impact healthcare. Dr. Mehila Zebenigus is a board-certified internist and neurologist in Addis Ababa, Ethiopia, and Director of the largest private neurology clinic in eastern Africa.

Serving as Delegates for Global NeuroCare at the United Nations, they provide expert analysis on neurological care in developing nations and makes policy recommendations to intergovernmental organizations. Mehila Zebenigus, MD and James C. Johnston, MD JD, recently published statements for the UN Economic and Social Council on improving access to healthcare as a means of poverty reduction, and for the UN Commission for Social Development pointing out that equitable access to essential, affordable, quality healthcare is an absolute prerequisite for implementing more comprehensive social protection policies.

Drs. Zebenigus and Johnston will present recommendations to the upcoming High Level Political Forum (HLPF) explaining how improving healthcare underpins the ability to achieve the Sustainable Development Goals. This HLPF serves as the central platform for follow-up and review of the 2030 Agenda for Sustainable Development and the Sustainable Development Goals, providing for full and effective participation of all States Members of the UN and States members of specialized agencies. Forty-seven countries will present voluntary reviews including 17 in Africa.

Drs. Zebenigus and Johnston, both serving as Directors of Global NeuroCare®, will focus on how following their recommendations “will ensure government, private sector, non-government organizations and international and local communities effectively engage in an integrated, multi-faceted, cross-sector approach to implementing sustainable social protection policies, promulgated through cooperative alliances with a goal of attaining universal healthcare coverage including access to healthcare services and access to safe, effective, quality and affordable medicines and vaccines [SDG 3.8], particularly in developing regions [SDG 3(c)], which will play a critical role in poverty reduction [SDG 1], serve to advance overall health capacity and security [SDG 3(d)], reduce maternal and childhood morbidity and mortality [SDG 3.1, 3.2], decrease communicable and non-communicable diseases [SDG 3.3, 3.4], diminish deaths and injuries from accidents [SDG 3.6], promote social protection systems [SDG 1.3] to progressively achieve greater equality [SDG 10.4], eliminate harmful practices including gender inequality [SDG 5.4], and stimulate economic growth [SDG 8.5].” [Johnston JC and Zebenigus M. UN E/CN.5/2019/NGO/33].

Medical Error: Third Leading Cause of Death in the United States

Medical Error Third Leading Cause of Death in the United States

Medical Error Third Leading Cause of Death in the United States

Role of Evidence-Based Guidelines in Medical Malpractice

Medical errors rank behind heart disease and cancer as the third leading cause of death in the United States (see BMJ 2016; 353:i2139), with over 250,000 deaths a year.  700 a day.  And despite tort reform, medical malpractice litigation will never entirely disappear.  It remains important for physicians to understand the elements of a malpractice claim not only to protect themselves but more importantly to improve patient care.

The most confusing aspect of a medical malpractice claim is the standard of care element, and this is further complicated by the increasing use of evidence-based guidelines (EBG) or practice guidelines.  In some countries, EBG provide the legal standard of care, while most common law countries such as UK, Australia and New Zealand place great reliance on guidelines but allow courts discretion in accepting them on a case by case basis.

In the United States, most courts allow testimony using EBG both for and against physicians.  Whether a particular guideline applies to a specific case is simply another argument for the expert witnesses with the jury deciding who to believe.  In most cases, the actual written EBG may not be admissible as an exhibit.  It would fall into the same category as learned treatises and medical journals – the witness can talk about it and be cross-examined, but the document itself is not admissible.  Some courts have adopted a more liberal approach by admitting EBG as demonstrative aids.  Regardless of which approach, a physician on trial for malpractice must recognize that although EBG are not sacrosanct, any deviation from the guideline represents a very powerful argument to the judge or jury.

Neurologist and Attorney James C. Johnston, MD, JD and renowned medical malpractice attorney Thomas P. Sartwelle published the seminal article on expert witnesses discussing guidelines in the Journal of Child Neurology (http://journals.sagepub.com/doi/abs/10.1177/0883073813479669).

Dr. James C. Johnston is one of the very few neurologists in the world that is also qualified in law, and licensed to practice both professions.  He wrote the comprehensive chapter on advancing a neurology malpractice claim in Preparing and Winning Medical Negligence Cases, Third Edition (http://www.jurispub.com/Neurology-Chapter-11-Preparing-And-Winning-Medical-Negligence-Cases-Third-Edition.html).

He has published a number of journal articles and book chapters on how neurologists can improve patient care and protect themselves from malpractice claims.  These publications include book chapters in multiple editions of the American College of Legal Medicine textbook Legal Medicine and Medical Ethics, the Medical Malpractice Survival Handbook, and the landmark three volume treatise Legal and Forensic Medicine.  Dr. Johnston has published peer-reviewed articles in Neurology Clinics, Journal of Child Neurology, Headache, Medical Law International, Journal of Legal Medicine, Medicine and Law, and a number of other journals.

In a recent Neurologic Clinics, Dr. Johnston published a case studies article highlighting specific neurology claims related to malpractice (https://www.neurologic.theclinics.com/article/S0733-8619(16)30011-1/abstract).  This was co-authored with Thomas P. Sartwelle and leading neurosurgeon Professor Dr. Knut Wester, with the purpose of providing recommendations to improve patient care and safety.

GLOBAL NEUROLOGY REPORT: WORLD ASSOCIATION FOR MEDICAL LAW MEETING 2018

Topic:  Electronic Fetal Monitoring in Developing Nations – A Public Health Threat

The 24th World Association for Medical Law (WAML) Congress was held in Tel Aviv, Israel on 2-6 September 2018.  Leading international experts discussed topics related to Global Health, Medical Law and Bioethics, with a focus on Public Health concerns.

James C. Johnston, MD, JD, reviewed the use of electronic fetal monitoring (EFM) in Africa, and presented a paper co-authored with pre-eminent medical malpractice attorney Thomas P. Sartwelle, renowned medical ethicist Professor Dr. Berna Arda, and leading neurologist Dr. Mehila Zebenigus from Ethiopia.

Dr. James C. Johnston raised the concern that EFM has no proven efficacy in childbirth yet it is being increasingly employed in sub-Saharan Africa in a misguided approach to reduce perinatal morbidity and mortality.  In fact, EFM has a 99.8% false positive rate, and does not prevent or predict cerebral palsy or any other neonatal neurological disorder.  It does cause significant harm by dramatically increasing the cesarean section rate with all of the attendant risks and complications of that procedure, as well as increasing the risk that babies born in this manner may have a higher incidence of developing chronic diseases such as juvenile arthritis, asthma, inflammatory bowel disease, and neurodevelopmental problems.

After reviewing the overwhelming evidence against EFM, Dr. Johnston discussed the recent trend of developed countries to stop this procedure through specific guidelines published by birth-related professional organizations in the United States, United Kingdom, Canada, Australia and New Zealand.  For example, the United Kingdom National Institute for Health and Care Excellence states “Do not offer electronic fetal monitoring to women at low risk.”

Dr. James Christopher Johnston

The 24th World Association for Medical Law (WAML) Congress was held in Tel Aviv, Israel on 2-6 September 2018. Leading international experts discussed topics related to Global Health, Medical Law and Bioethics, with a focus on Public Health concerns.

And yet, EFM is rapidly increasing throughout sub-Saharan Africa due to a combination of intense marketing from the EFM manufacturing companies, and the failure of the medical community to understand that the procedure causes more harm than good to mothers and babies.  Dr. James C. Johnston provided specific examples of the marketing, including the Allied Market Research ‘Global Fetal Monitoring Report’ which concluded that the fetal monitoring market is expected “to reach USD 3.6 Billion by 2022,” that the market in “developing countries is lucrative,” and there is a “perpetual need” for these EFM machines.

Dr. Johnston and his colleagues concluded that the WHO should establish guidelines stating that EFM is an experimental procedure that is not scientifically reliable, the standard of care does not warrant EFM in low risk pregnancies, and it should not be performed.  This will allow local health boards in each country to adopt the guidelines, and ensure the medical community stops harming mothers and babies through this procedure.  Then, the resources wasted on EFM can be properly allocated to provide additional training of midwives and healthcare workers, and provide care for children with cerebral palsy and related conditions.