Category Archives: Medical Expert

Warning For Users Of The Phillips Mobile Cardiac Outpatient Telemetry.

Sometimes legal theories collide, and more than one theory applies to a set of facts.  This is true when a product combines with medical care to cause death or catastrophic injury. When this happens, there are both considerations for a medical malpractice theory and a product liability theory of recovery.  

Product Liability and Defects

Our firm has experience dealing with complex factual situations that may involve a combination of legal theories. Recently, we were hired by a family whose loved one died after being prescribed a mobile heart monitoring device known as Philips Mobile Cardiac Outpatient Telemetry.   

What Functions Do Mobile Telemetry Monitoring Devices Serve?

For many years, cardiac rhythm monitoring has been used by physicians, most notably cardiologists, to diagnose and treat patients. Traditionally, these were devices fitted to a patient and worn for anywhere between 24 hours and up to 30 days. During that time, the patient would keep a diary of any symptoms they experienced (date, time, description of activity, symptom). At the end of the prescribed duration of monitoring, the patient would submit the diary as a complement to the data that was collected by the device. A physician would then analyze the data side-by-side with the patient’s diary. In this instance, a final assessment would be made after the fact.

Interface Between The Telemetry Leads and Data Sent To The Central Hub

As mobile phone data and Bluetooth transmission capabilities became more commonplace—basic mobile phone plans nearly all carry such a feature—interactivity with many elements of daily life became commonplace. Home security systems, home appliances, electronics, and audiovisual systems, medication administration and monitoring, etc. This has expanded to medical devices such as mobile telemetry monitoring, but with a twist: a patient’s phone serves as the interface between the telemetry leads on the body and then sends that data to a central monitoring hub in real-time.

The Communication Path

The real-time telemetry monitoring is akin to what many understand occurs in a hospital setting in that an admitted patient has wires and stickers adhered to their chest wall, and in the event of an arrhythmia, cardiac pause, or asystole (absence of electrical activity), a technician in the hospital would recognize this and, following facility protocol, activate the emergency response team to assess and tend to the patient. And, like the patient in the diary above, a patient admitted to a hospital may just communicate their symptoms to a member of the care team, at which point a call would be made to the technician to query what the telemetry monitoring revealed at a given time. The obvious difference between the hospital setting and the mobile platform is that a patient with a mobile phone coupled with a cardiac monitoring device is not in a facility. However, the concept remains the same: abnormal heart rhythm is captured and transmitted, a technician recognizes such an abnormal rhythm, the technician communicates that to the prescribing provider, and the prescribing provider then contacts the patient or advises on the next best step.

Phillips Mobile Cardiac Outpatient Telemetry




What If You Have a Dysfunction?

The system works well if all the components are functional. If there is a dysfunctional link anywhere, then the system fails.

Types Of Failure:
1. One such component would be if the patient was out of mobile phone range (not near a mobile tower, no signal to their phone), then their cardiac data would be collected but not transmitted to the monitoring hub.

2. Another such dysfunctional link would be if a technician recognized an arrhythmia but did not follow through on notifying the prescribing physician.

Continue on with that same logic, and it makes sense that any missing component could be detrimental to the purpose of the study (which is why the physician prescribed this in the first place).

Real Time Component

One of the benefits of the newer mobile-based platforms is the real-time component. Physicians and other care providers are best able to intervene in the event of a concerning rhythm disturbance or malignant dysrhythmia.

Necessary Intervention

In a nutshell, the product is designed to function by monitoring the heart rate and rhythm of the patient, and it is programmed to notify the device company representative, who is supposed to then immediately notify the treating physician’s office so that they can intervene if need product Defect Leads to Death

It appears from the information that we have that either the device manufacturer failed to notify the physician’s office or the physician’s office failed to communicate with the patient.  Then we discovered that another patient died from a similar circumstance using a device manufactured by Philips Mobile Cardiac Outpatient Telemetry.  This means that at least two people in the Pensacola area have died while wearing this device that should have prevented them from doing so.



If you or a loved one was wearing any cardiac monitoring device manufactured by Philips Mobile Cardiac Outpatient Telemetry and suffered a catastrophic injury or death related to their cardiac condition, you or your family should consider discussing the same with our firm.  You can find us at or call us at 855HireJoe.

Joe Zarzaur is a Board Certified Civil Trial Attorney whose firm is dedicated to promoting community safety since 2007. ZARZAUR LAW’S AREAS OF PRACTICE: Serious Personal Injury, Product Defect, Auto Accidents, Cycling Accidents, Motor Vehicle Accidents, Products Liability, Wrongful Death, Community Safety, Boat and Jet Ski Accidents, Slip and Fall Injuries, and more. Licensed in Alabama and Florida.

If you’ve been injured due the carelessness of another, it’s important that you don’t make any rash decisions. Put yourself in the best possible position to receive the justice you deserve. It is also important to consult with a Board-Certified Trial Lawyer who has the knowledge and experience to help you. We know accidents can be stressful and want to make the process as easy as possible for you. Call Zarzaur Law, P.A. today at (855) Hire-Joe, or by requesting a free case review through our website.

Florida Health – Important Vibriosis Outbreak Update

Courtesy of Florida Health

Vibriosis causes an estimated 80,000 illnesses and 100 deaths in the United States every year. People with vibriosis become infected by consuming raw or undercooked seafood or exposing a wound to seawater. Most infections occur from May through October when water temperatures are warmer.

The Florida Department of Health is observing an increase in cases of Vibrio vulnificus infections as a result of exposure to flood and standing waters following Hurricane Ian. As the post-storm situation evolves, please make yourself aware of the following reminders regarding reporting, testing, and treatment.

How Do Persons Get Infected With Vibrio Vulnificus?

People can get infected with Vibrio vulnificus when they eat raw shellfish, particularly oysters. The bacterium is frequently isolated from oysters and other shellfish in warm coastal waters during the summer months. Since it is naturally found in warm marine waters, people with open wounds can be exposed to Vibrio vulnificus through direct contact with seawater. There is no evidence of person-to-person transmission of Vibriosis.

How Can Vibrio Vulnificus Infection Be Diagnosed?

Vibrio vulnificus infection is diagnosed by stool, wound, or blood cultures. Notifying the laboratory when this infection is suspected helps because a special growth medium should be used to increase the diagnostic yield. Doctors should have a high suspicion for this organism when patients present with a stomach illness, fever, or shock following the ingestion of raw seafood, especially oysters, or with a wound infection after exposure to seawater.

What Type of Illness does Vibrio Vulnificus Cause?

Vibrio vulnificus can cause disease in those who eat contaminated seafood or have an open wound that is exposed to warm seawater containing the bacteria. Ingestion of Vibriosis can cause vomiting, diarrhea and abdominal pain. Vibrio vulnificus can also cause an infection of the skin when open wounds are exposed to warm seawater; these infections may lead to skin breakdown and ulcers.Healthy individuals typically develop a mild disease; however Vibrio vulnificus infections can be a serious concern for people who have weakened immune systems, particularly those with chronic liver disease. The bacterium can invade the bloodstream, causing a severe and life-threatening illness with symptoms like fever, chills, decreased blood pressure (septic shock) and blistering skin lesions. Vibrio vulnificusbloodstream infections are fatal about 50 percent of the time.A recent study showed that people with these pre-existing medical conditions were 80 times more likely to develop Vibrio vulnificus bloodstream infections than healthy people. Wound infections may also be serious in people with weakened immune systems. The wound may heal poorly and require surgery. Sometimes amputation may even be needed for recovery.

How Common Is Vibrio Vulnificus Infection?

Vibrio vulnificus is a rare cause of disease, but it is also underreported. Between 1988 and 2006, the Centers for Disease Control and Prevention (CDC) received reports of more than 900 Vibrio vulnificus infections from the Gulf Coast states, where most cases occur. Before 2007, there was no national surveillance system for Vibrio vulnificus, but CDC collaborated with Alabama, Florida, Louisiana, Texas and Mississippi to monitor the number of cases in the Gulf Coast region. In 2007, infections caused by Vibrio vulnificus and other vibrio species became nationally notifiable.






What Are Some Tips For Preventing Vibrio Vulnificus Infections?

  • Do not eat raw oysters or other raw shellfish.
  • Cook shellfish (oysters, clams, mussels) thoroughly.
  • For shellfish in the shell, either a) boil until the shells open and continue boiling for 5 more minutes, or b) steam until the shells open and then continue cooking for 9 more minutes. Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil at least 10 minutes at 375°F.
  • Avoid cross-contamination of cooked seafood and other foods with raw seafood and juices from raw seafood.
  • Eat shellfish promptly after cooking and refrigerate leftovers.
  • Avoid exposure of open wounds or broken skin to warm salt or brackish water, or to raw shellfish harvested from such waters.
  • Wear protective clothing (e.g., gloves) when handling raw shellfish.

How Is Vibrio Vulnificus Infection Treated?

If Vibriosis is suspected, treatment should be initiated immediately because antibiotics improve survival. Aggressive attention should be given to the wound site; for patients with wound infections, amputation of the infected limb is sometimes necessary. For more information on care and treatment specifics, please visit the CDC’s website. Information about the potential dangers of raw oyster consumption is available 24 hours a day from the FDA’s Seafood Hotline: 1-800-332-4010. For more information on Vibrio vulnificus, visit the CDC’s website.

Watch Our YouTube Video On This Topic >

Joe Zarzaur is a Board Certified Civil Trial Attorney whose firm is dedicated to promoting community safety since 2007. ZARZAUR LAW’S AREAS OF PRACTICE: Serious Personal Injury, Product Defect, Auto Accidents, Cycling Accidents, Motor Vehicle Accidents, Products Liability, Wrongful Death, Community Safety, Boat and Jet Ski Accidents, Slip and Fall Injuries, and more. Licensed in Alabama and Florida.

If you’ve been injured in a car accident, it’s important that you don’t make any rash decisions. Put yourself in the best possible position to receive the justice you deserve. It is also important to consult with a Board-Certified Trial Lawyer who has the knowledge and experience to help you. We know accidents can be stressful and want to make the process as easy as possible for you. Call Zarzaur Law, P.A. today at (855) Hire-Joe, or by requesting a free case review through our website.

Midwifery Care And Risk Factors

When planning for the birth of a new baby, there are many options and decisions that soon-to-be new moms need to make. One of the most important decisions is choosing a healthcare provider during your pregnancy. One type of provider is a midwife.

Midwives are healthcare providers who deal with pregnancy, childbirth, newborn care, and postpartum health. Some midwives provide routine reproductive care like pelvic exams, Pap tests, or counseling on birth control. Midwives tend to be more holistic and supportive of natural approaches to pregnancy and birth. Midwives are normally used by those who choose to have a planned home birth. 

Are There Risks Associated With Using A Midwife?

While midwives provide the majority of care in countries like the U.K. and the Netherlands, midwife-led home births account for only about 10% of births in the United States.  (

While in recent years, more families have sought out a more holistic, non-hospital location for giving birth and for the care provider, such as a home birth using a midwife, the complications of giving birth outside of a hospital have their own risk factors and cause concern.

Midwives consult with OBGYNs, maternal-fetal medicine specialists, and other healthcare providers to mitigate risk in your care. Working with a midwife who attends births in a hospital setting is usually recommended if you are worried about delivery. This can give you the safety net you’re looking for if a complication arises.

CASE STUDY: Recent Midwifery Medical Malpractice Case At Zarzaur Law

In a recent medical malpractice case, the firm handled an expecting mother who enrolled the services of midwives for an out-of-hospital birth.  The risks of this pregnancy and labor included:

  • Advanced maternal age
  • Absent collaboration with a physician with admitting privileges at a hospital in the immediate area
  • Incomplete emergency backup plan
  • Pregnancy extending to late-term and post-term (41-42 weeks)
  • Meconium stained amniotic fluid
  • Arrest of cervical dilation, with the ultimate outcome resulting in severe medical complications for the laboring mother and intrauterine fetal demise.

If you would like more information on the particular case or have had a similar, complicated experience, please reach out to the firm at or call us at 855hirejoe.

Why Would You Use A Midwife Instead Of A Doctor?

Many women choose a midwife over a doctor because they want additional emotional support before, during, and after delivery. A midwife will get to know you, your family, and your preferences over the course of your pregnancy. Midwives also allow for a planned home birth in Florida.

What Are The Possible Risks Of A Planned Home Birth?

midwifery care and risk factorsMost pregnant people who choose to have planned home births deliver without problems. But research suggests that planned home births are associated with a higher risk of infant death, seizures, and nervous system disorders than planned hospital births.

There are several factors that might reduce the risks of these problems, including having:

  • Assistance from a certified nurse-midwife
  • Access to a doctor who specializes in obstetrics
  • A plan for transportation to a nearby hospital, if needed

It’s important to talk to your health care provider before you make a decision about a planned home birth. For some people with certain health conditions, as well as those who have never given birth before, the risks of a planned home birth may be higher than they are for others.

What Is A Midwife?

Midwives are healthcare providers who deal with pregnancy, childbirth, newborn care, and postpartum health. Some midwives provide routine reproductive care like pelvic exams, Pap tests, or counseling on birth control. Midwives tend to be more holistic and supportive of natural approaches to pregnancy and birth. People often choose a midwife when they know they want a nonmedicated birth or want to give birth at home.

Midwives are usually not physicians. They often work alongside obstetricians and gynecologists (Ob/Gyns) in a hospital to ensure you have access to any care you need. A midwife is recommended when your pregnancy is low-risk or if you have only mild complications.

Pregnancy and labor are very personal experiences. You have a choice about the kind of care you’d prefer. That’s why it may help to know the differences between midwives and Ob/Gyns.

What Does A Midwife Do?

It depends on their credentials, certifications, schooling, and where they practice. Certified midwives and certified nurse midwives can offer the most services. Midwives who aren’t certified offer fewer services.

Some of the health services a midwife may provide include:

A certified nurse midwife can practice at hospitals, clinics, birth centers, or your home. Midwives who are not certified are limited in where they can practice. It’s best to ask your midwife what credentials they have and ask your hospital or birth center what the regulations are for midwife care.

What Are The Different Types Of Midwives?

There are a few different types of midwives:

  • Certified nurse midwives (CNMs): CNMs have completed nursing school and have a graduate degree in midwifery. In addition to pregnancy care and delivery, they can provide general reproductive care, prescribe medication, order lab tests and diagnose conditions. They’re qualified to work in hospitals, homes, and birth centers. CNMs are certified by the American Midwifery Certification Board. They work in all 50 states and the District of Columbia.
  • Certified midwives (CMs): CMs have a master’s degree in midwifery, but they haven’t completed nursing school. CMs have an undergraduate degree in something other than nursing. They’re certified by the American Midwifery Certification Board and can prescribe medications. CMs are only licensed to practice in a few (nine) states.
  • CPMs (certified professional midwives): CPMs work in birth centers or at home.They have completed coursework and are certified by the North American Registry of Midwives. CPMs aren’t licensed to practice in all states and can’t prescribe medications.
  • Unlicensed or lay midwives: These midwives don’t have certification or a license to practice. They are either self-taught or have received some other type of training, which could include an apprenticeship. Unlicensed midwives work almost exclusively in homes.

Are Midwives Doctors?

Most midwives aren’t doctors. Some earn doctorates in nursing practice.

The Differences Between A Midwife And An OB-GYN

OB-GYNs and midwives both provide great pregnancy care and safely deliver babies. But there are some fundamental differences.

OB-GYNs and midwives have different credentials and educational backgrounds.

While OB-GYNs and midwives are part of the same specialty area, the training, education requirements, and credentials they hold are different.

OB-GYNs are medical doctors

An OB-GYN (which is short for obstetrician-gynecologist) is a medical doctor who specializes in women’s reproductive health, as well as pregnancy care and delivering babies. They’re also surgically trained and can perform cesarean sections (C-sections) when necessary. You may already have visited an OB-GYN for your annual well-woman’s visit.

When it comes to training and education, OB-GYNs complete four years of medical school, a four-year residency program, and a three-year fellowship.

Board-eligible vs. Board-certified OB-GYNs

OB-GYNs – like other medical doctors – can also pursue certification from the American Board of Obstetrics and Gynecology (ABOG) after they’ve completed their residency and gotten their license to practice. Board-certification is optional but a mark of distinction, implying that a doctor has gone above and beyond the minimum standard of education in their field.

The path to certification requires passing a qualifying exam, preparing an extensive case list demonstrating expertise in multiple categories, and then passing a certification exam. At HealthPartners, all our OB-GYNs are board-certified.

Is A Midwife Better Than An OB/Gyn?

It’s a personal preference. Some people prefer midwives, and others prefer OB/Gyns. A midwife is typically only recommended for low-risk pregnancies. Most pregnancies in the United States are low-risk. Some advantages of using a midwife are:

  • There is less chance of induction or assisted delivery.
  • Cesarean delivery is less likely.
  • Reduced use of epidurals or other medications.
  • There is less risk of third and fourth-degree perineal tears.
  • More flexibility for home births.
  • You have greater control over your care.

Midwives are typically not trained to perform surgeries. Midwives will refer people to OB/Gyns if their pregnancy or birthing experience becomes complicated or high-risk.

Should You Have A Midwife?

A midwife might be for you IF you have a low-risk, routine pregnancy and if you desire a more personalized relationship with your provider. If you have a health condition that could complicate your pregnancy or delivery, close collaboration between your midwife and obstetrician is ideal. Some of these conditions include:

If you decide to use a midwife, we recommend finding one who’s licensed and certified to practice in your state.

The links below provide information on midwifery practices and licensed midwives in the state of Florida.


Florida Rule 64B24-7 Midwifery Practice >

Florida Statute Chapter 467 Midwifery >

FL DOH Licensed Midwifery >

Do Midwives Do C-sections?

Midwives can’t perform c-sections, but they can assist in them. If you require a c-section, a collaborating physician will be called on to assume care.

Do Midwives Give Epidurals?

Some midwives can prescribe epidurals, but midwives can’t give epidurals. They consult with an anesthesiologist or a certified registered nurse anesthetist (CRNA). Anesthesia providers are typically available in hospital settings only.

What Questions Should You Ask Before Choosing A Midwife?

A lot of people interview potential midwives to make sure they feel comfortable with them prior to beginning services. Some questions you should consider before choosing a midwife are:

  • Where will I deliver my baby?
  • What kind of training do you have?
  • How long have you been a midwife?
  • How many births have you attended?
  • What are your philosophies or values when it comes to childbirth?
  • What kinds of tests or screenings do you perform during pregnancy?
  • Does insurance cover any of the cost?
  • Do you work with any local Ob/Gyns?

If Necessary, Prepare To Go To A Hospital

Make the following preparations for a smooth transition to a hospital, if you need it:

  • Discuss with your health care provider the symptoms that might mean you’ll have to go to a hospital. Talk about how that fits into your birth plan.
  • Make sure you have access to transportation. Ideally, your home or other birth location is within 15 minutes of a hospital with 24-hour maternity care.
  • Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly moved to the hospital and treated, if necessary.

The links below provide important information with regards to emergency backup plans and agreements for midwives in the state of Florida.


Florida Department of Health Emergency Plan for Licensed Midwifery >

Florida Department of Health Collaborative Management Agreement >

Hospitals or certified birth centers are the safest settings for delivery. However, you have the right to make an informed decision about where you prefer to deliver your baby. Keep in mind that life-threatening problems can occur during labor and delivery. In those cases, the need to take you and your baby to a hospital could delay care. That could put your lives at risk. Understand the risks and benefits of a home birth before you make a decision about where to deliver.

Watch Our YouTube Video On This Subject 

Joe Zarzaur is a Board Certified Civil Trial Attorney whose firm is dedicated to promoting community safety since 2007. ZARZAUR LAW’S AREAS OF PRACTICE: Serious Personal Injury, Product Defect, Auto Accidents, Cycling Accidents, Motor Vehicle Accidents, Products Liability, Wrongful Death, Community Safety, Boat and Jet Ski Accidents, Slip and Fall Injuries, and more. Licensed in Alabama and Florida.

If your newborn child has been injured or have experienced a birth injury, while in the care of a midwife, it’s important that you don’t make any rash decisions. Put yourself in the best possible position to receive the justice you deserve. It is also important to consult with a Board-Certified Trial Lawyer who has the knowledge and experience to help you. We know accidents can be stressful and want to make the process as easy as possible for you. Call Zarzaur Law, P.A. today at (855) Hire-Joe, or by requesting a free case review through our website.


Florida Rule 64B24-7 Midwifery Practice

Florida Statute Chapter 467 Midwifery

FL DOH Licensed Midwifery

FL DOH Emergency Backup Plan For Licensed Midwifery

FL DOH Collaborative Management Agreement

SARS-CoV-2 Recovery and Athletes

SARS-CoV-2  Infection recovery for AthletesArticle by:

It is not difficult to speak with someone and not have them share their first-hand experience with SARS-CoV-2 infection.  If anything, someone close to them has been infected and impacted by the infection.

Rebound and Recovery From Acute Infection

What is not as readily discussed is the rebound and recovery from an acute infection.  Acute infection being distinct from a positive test in that there is a period of defining symptoms:  fever, myalgia, dyspnea, cough, lethargy, etc.

Just as the spectrum of symptoms is broad – ranging from nuisance, innocent symptoms (loss of smell, mild headache) to the more extreme hypoxia warranting hospitalization – the same is true for the duration of the symptomatic period across various individuals – some limited to less than two days, others spanning many weeks.

Can I Go Back To Working Out/Exercising?

Applying this nebulous symptom severity index and symptom duration timeframe to acute infection in an otherwise active, fitness-minded, perhaps obsessed age-group athlete and leaves one wondering “can I get back to working out?”  For the first many months of the global pandemic, this perhaps may have been taken as a bit of a selfish query – the desire to return to exercise when raised in the context of the gravity of the illness for many (death, hospitalization, loss of livelihood).

Along the way, in 2020 we collectively learned about the virus and its impact on the population and the human body.  Research into the mechanisms of infection, transmission, prevention, treatment, recovery, and short- and long-term impact – a different study or dataset or conclusion was being published nearly every hour of every day.

In the late summer of 2020, some guidance began to take shape for the exercise-minded individual recovering from acute infection.  Domestically, much of this was driven by research focusing on collegiate-level athletes, to understand when and in what manner it was safe for these young athletes to return to their respective sports.

Joe’s COVID Journey, Recovery, and Return to Exercise.

In Joe’s situation his symptom onset was around September 5, 2020 (Labor Day weekend), his positive PCR sample would result on September 7, 2020.  During the next many days his prime goal apart from strict isolation protocol was managing his symptoms and monitoring any systemic manifestations (shortness of breath, chest pain, confusion).  As that initial string of days wound by, interrupted by Hurricane Sally (landfall September 15-16, 2020, he would be confronted with fatigue and the sensation of breathlessness which was temporized and stabilized with supplemental oxygen use and a combination of systemic (oral) and inhaled steroid agents.  At this point, he understood that this was likely impacting his cardiopulmonary system beyond the simple nuisance symptoms which are mostly contained to the upper respiratory tract (nasal and sinus congestion).  This added another layer to what would end up being an additional step to take prior to returning to physical exertion (exercise) which is part of his daily routine as a multi-sport athlete.  This was somewhat uncharted territory for both Joe as well as the medical community as a whole – studies were being conducted to best understand the next step or steps to take.

Studies On The Heart and COVID-19 Infection

One of the first such studies was published on September 11, 2020, in JAMA Cardiology (Rajpal S, Tong MS, Borchers J, et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol. 2021;6(1):116–118. doi:10.1001/jamacardio.2020.4916) detailing cardiac evaluation including studies such as the electrocardiogram (EKG), echocardiogram (ultrasound of the heart), and cardiac MRI.  The test modality of choice is to be dictated by the severity of the symptoms and the findings along each step of the algorithm.  This would provide some guidance as to which athletes were at higher risk for myocarditis, cardiomyopathy, malignant dysrhythmia, or even sudden cardiac death and then to help apply some guidelines on activity limitations moving forward.

Lingering Effect of COVID-19 Infection

So, using that as a launching pad for the discussion with his physician, Joe and his medical provider team decided it was best to proceed with cardiac screening – EKG (electrocardiogram – electrical tracing of the heartbeat and myocardial contraction) and echocardiogram (ultrasound of the heart).  These studies would occur in late September, roughly 4 weeks after his initial symptom onset.  The tests were not fully “normal” as the echocardiogram (ultrasound image of the heart) revealed some enlargement of the right side of the heart – a potential sign that there was some increased stress or workload on the right side of the heart attempting to pump blood to the lungs for oxygenation (and carbon dioxide removal).  This prompted Joe and his medical provider to lean on some of these recent studies and pursue the cardiac MRI study to best visualize and understand if there was any myocardial involvement (i.e. myocarditis) otherwise known as inflammation of the muscle tissue which makes up the heart.  Inflamed muscles are something Joe is keenly aware of with his exercise routine, but an inflamed cardiac muscle is not on the same level as inflamed skeletal muscles weary from a long workout or race.

As the cardiac MRI was being coordinated, the instructions were simple:  “take it easy and don’t get the heart rate up.”  Translated, this meant no exercise.  The potential risk being cardiac arrhythmia or heart failure if the already-angry myocardial tissue was additionally stressed.

Fortunately for Joe, the cardiac MRI would reveal normal myocardial tissue and the right side of the heart appeared normal as well.  The suggestion of the abnormal right-sided chambers on the echocardiogram was not present (or had resolved with additional time for recovery) on the MRI study.

Joe was now free to get back into his daily exercise routine – only limitation being “do what you can, take it easy getting back into it, and listen to your body.”



Fast forward many months later, and very similar guidance has emerged for application to the recreational athlete desiring to return to exercise.  The algorithm is meant to accompany the examination by and assessment of a qualified medical professional.

Key Points on Returning To Play.

For any age-group athlete looking to get back to fitness, exercise, physical exertion the first step following the acute infection (i.e. isolation period) should be an evaluation by your primary care provider.  A “return to play” or “return to physical exertion” discussion should be had.  For some it may be as simple as routine, annual bloodwork, or non-invasive testing.  For others it may include a larger, more-involved battery of tests.





Joe Zarzaur is a Board Certified Civil Trial Attorney whose firm is dedicated to promoting community safety since 2007. ZARZAUR LAW’S AREAS OF PRACTICE: Serious Personal Injury, Product Defect, Auto Accidents, Cycling Accidents, Motor Vehicle Accidents, Products Liability, Wrongful Death, Community Safety, Boat and Jet Ski Accidents, Slip and Fall Injuries, and more. Licensed in Alabama and Florida.

If you’ve been the victim of an accident, it’s important that you don’t make any rash decisions. Put yourself in the best possible position to receive the justice you deserve. It is also important to consult with a Board Certified Trial lawyer who has the knowledge and experience to help you. We know accidents can be stressful and want to make the process as easy as possible for you. Call Zarzaur Law, P.A. today at (855) Hire-Joe, or by requesting a free case review through our website.

New Florida Law (HB21) Targets Opioid Addiction at the Root Level.

Opioid Epidemic—How Did We Get Here?
According to a report from the National Institute on Drug Abuse, in the early 1990s through 2012, opioids were commonly prescribed to relieve pain. But over time, abuse of the drugs grew.
Some facts on the opioid crisis:


• Opioid addiction and overdose are the leading cause of accidental death in the U.S.

• In 2016, more than 40,000 Americans died from drug overdoses that involved an opioid.

• Between 21 percent and 29 percent of patients who are prescribed opioids for chronic pain misuse the drugs.

• Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.

3.6 percent of kids aged 12 to 17 years old misuse opioids as well as 7.3 percent of those 18 to 25 years old.

• In Florida, opioid-related deaths increased 35 percent from 2015 to 2016, with opioids associated with 5,725 deaths in 2016.

As of July 1, 2018, most opioid prescriptions will have a 3-day limit.

What are Opioids and Why Are They Addictive?
Dr. Evan Malone, Board Certified in Internal Medicine and physician consultant for Zarzaur Law, P.A. provided insight on this important subject. Opioids are a class of drugs that include synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). Regular use—even when prescribed by a doctor—can lead to dependence, the National Institutes of Health (NIH) says. As the brain becomes used to the dosage, it requires more of the drug to provide pain relief and the feeling of well-being. This makes it easy to become addicted. In a report from the Center for Disease Control (CDC), prescription opioid addiction can serve as a gateway to use and misuse of illicit drugs (i.e. heroin, illicitly-manufactured Fentanyl) or controlled substances (i.e. Fentanyl, Dilaudid, Oxycodone).

As of July 1, 2018, This Law Now Implements the Following:

• Limits prescribing of Schedule II medications to a 3-day supply for management of acute pain

• Defines acute pain as – the normal, predicted, physiological, and time-limited response to adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute “illness”

• May not apply to management of chronic pain, terminal condition and palliative care (i.e. Hospice care)

• May not apply to qualified cases of severe trauma

• A 10-day supply of medications may be provided if the provider documents accordingly

• Requires providers to access the Prescription Drug Monitoring Program (PDMP) when prescribing controlled substances

• The PDMP is a state-wide database which details a patient’s history of controlled substance prescriptions

So, How Does This Impact Patients?

According to Dr. Malone, the end-point of preventing dependence upon opioid agents will hopefully be realized over time. This could directly benefit patients, their family members, friend, co-workers, etc.

The offset will require patients to be diligent in their follow-up and management of acute pain whether it be following an accident, following a planned procedure, or the like.

Besides the aforementioned appropriate use of controlled substances, should a patient’s health care provider deem appropriate for the condition, below are some helpful points to remember:

– If patients continue to have pain beyond the expected “acute” timeframe (a few days in most instances), make sure the pain is not a harbinger of an undiagnosed cause of pain or worsening of the initial condition by following up with their provider (which may include a visit to the ER depending upon the condition or circumstances)

-Once more concerning conditions have been ruled out and after consulting with their provider, consider alternatives to opioids for management of acute pain:

– Over-the-counter agents (Ibuprofen, Tylenol, Aspirin)
– Systemic or local corticosteroid
– Physical therapy
– Massage therapy
– Chiropractic care

The 3-day supply of medications is not limited to a one-time instance – appropriate follow-up with a provider may result in an assessment (following interview, examination, and medication review) which indicates the need for a renewal of the 3-day medication supply should it be appropriate for your condition

What are the Alternate Chronic Pain Management Options?

Pain is a subjective problem, and different people experience pain differently. An injury one person might shrug off is an excruciating experience for another.

The definition of chronic pain is a pain condition that lasts for more than six months. Less than six months, it’s considered subacute pain. It’s something of an arbitrary cutoff, but it’s a standard definition.

The effectiveness of alternative treatments for chronic pain has been known for a long time. There were a large number of multi-disciplinary pain clinics opened on a somewhat experimental basis back in the early 2000s, where patients would come in and see a physician, a physical therapist, a psychologist, a massage therapist, an acupuncturist, etc., all under one roof. These practices were very successful in alleviating pain in chronic pain patients, as the CDC later confirmed, but the idea wasn’t widely adopted because the approaches were expensive and some insurance companies didn’t want to pay. Opioids were cheaper. Unfortunately, opioids don’t work.

If you have a chronic pain condition and the current regimen of treatment is with opioid medications, you have more effective and more long term options without as many side effects. It will require an investment of time and effort, but, in the long run, you will be happy that you made the change. If you have a chronic pain condition, and you’re not satisfied with how things are going, challenge your doctors to see if there is a better approach.

If you or a loved one have been involved in an accident and suffer from chronic pain caused by negligence of another, it is important to consult with a Board Certified Trial Lawyer who has the knowledge and experience to help you.

Pensacola Personal Injury Attorney, Joe Zarzaur works in all areas of personal injury including motor vehicle accidents, truck accidents, pedestrian accidents, motorcycle and boating accidents, medical malpractice, slip and fall and wrongful death. Call Zarzaur Law, P.A. today at (855) Hire-Joe for a free legal consultation or visit Offices in Pensacola and Destin, Florida.

Florida Law Chapter 2018-13 (Controlled Substances)

Florida’s Controlled Substance Prescribing Law Patient FAQ


CDC Opioid Overdose

DEA Drug Schedules

5 Controversial Medical Treatments Still Used Today

Pensacola Medical Malpractice

Pensacola medical malpractice is a controversial issue nationwide, pitting doctors and hospitals against lawyers and patients in a he-said, she-said battle over healthcare providers’ responsibility, the cost of malpractice insurance, and so-called “tort reform” measures in states that limit recoveries for devastating harm inflicted upon victims of Pensacola medical malpractice.

Controversial Medical Treatments

It’s easy to look back at medieval medical practices and wonder how they ever thought it would work. Theories about the four bodily humors may seem quaint in retrospect, but given the way medical knowledge and technology evolves, it’s almost certain future generations will look back at medicine in our time and similarly wonder what we were thinking.

So which controversial medical treatments are still in practice? Here’s a look at a few.

1. Removing Part of the Skull to Relieve Pressure in the Brain

As WebMD notes, a craniectomy for patients suffering from brain swelling can save a person’s life, but also leave them permanently disabled. A recent study found that the procedure “can drastically reduce risk of death, with about 30 percent of patients dying following the procedure compared to 52 percent of those treated with standard medical care,” but at the same time, “people treated with a craniectomy were three times more likely to wind up in a vegetative state … and often were as likely to suffer long-term disabilities as patients receiving standard medical care.”

2. Chiropractic Treatments

It’s a running theme — among non-chiropractors of course — that chiropractors aren’t medical doctors. And as a recent Pain Science article noted, “The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.” Which is not to say chiropractic treatments don’t work, just that their scientific basis hasn’t been established.

3. Electroshock Therapy

Ernest Hemingway blamed it for his memory loss and diminishing writing ability late in his life. According to Live Science, “Today, the therapy is safer, because patients receive anesthesia and electricity doses are much more controlled … Still, the treatment can impair short-term memory and, in rare cases, cause heart problems.”

4. Leech Therapy

If you thought doctors stopped applying leeches to patients in the dark ages, think again. Heathline notes that leech therapy is making a comeback, treating “nervous system abnormalities, dental problems, skin diseases, and infections.” Even Demi Moore thinks so.

5. Maggot Therapy

Battlefield surgeons first started to notice that injured soldiers would heal more quickly in the field if flies laid eggs in their wounds. Later studies revealed that fly larvae “secrete digestive enzymes that can dissolve the wound’s dead and infected tissue, a process known as debridement.” Even though the FDA cleared maggots for medical use in 2004, it doesn’t sound all that appealing.

Pensacola Medical Malpractice laws are aimed at protecting the patient from negligent medical treatment. These cases usually arise when the patient has been injured due to the improper actions of a healthcare professional. Take note, though–these cases can also arise through the inaction of the healthcare professional.

Joe Zarzaur is a Board Certified Civil Trial Attorney whose firm is dedicated to promoting community safety since 2007. OUR AREAS OF PRACTICE: Serious Personal Injury, Product Defect, Auto Accidents, Cycling Accidents, Motor Vehicle Accidents, Products Liability, Wrongful Death, Community Safety, Boat and Jet Ski Accidents, Slip and Fall Injuries, and more. Licensed in Alabama and Florida.

If you or a loved one has been involved in a car accident and are suffering from delayed symptoms, it is important to consult with a Board Certified Trial lawyer who has the knowledge and experience to help you. We know accidents can be stressful and want to make the process as easy as possible for you. Call Zarzaur Law, P.A. today at (855) Hire-Joe for a free legal consultation or visit

Informed Consent for Minor Patients

Informed ConsentInformed Consent for Minor Patients

The law authorizes parent(s) or guardian(s) of a minor (anyone under the age of 18) to give informed consent for most medical decisions on behalf of the child. Claims by parents alleging treatment of a minor patient without the consent of the parent are relatively rare. Laws vary from state to state, but here is a general approach to the situation.

Q & A: Your Questions, Answered.

Q:  Do minors who are undergoing a series of treatments need a signed parental consent each time they are seen at the office?
A:  If a minor patient needs a series of treatments or exams, it is strongly advised that the parent/guardian sign a consent form prior to the first treatment stating that the minor patient can be treated and examined by the ophthalmologist and staff even if the minor patient is not accompanied by an adult. Of course, if the nature of the treatment or exam changes, a new consent must be obtained.

Q:  Do both parents have to agree to a proposed treatment/procedure?
A:  For most medical procedures, it is sufficient to obtain the consent of one parent (in an intact married couple). However, if treatment poses a significant risk to the minor or violates the personal or religious beliefs of one or both parents, it is advisable to obtain the consent of both parents. If the parents disagree about the advisability of the procedure, and the dispute cannot be resolved, it may be necessary for a juvenile court to intervene.

Q: Who can give consent when parents are divorced?
A:  If the parents share joint legal custody, they “share” the right to make health care decisions for their child. Either parent alone may consent to a recommended medical procedure unless the court issuing the order of joint legal custody has specified that the consent of both parents is required for certain, or all, medical decisions. If parents have joint legal custody and are unable to agree about treatment, it may be necessary to obtain a court order before treatment is provided unless there is an emergency. If a parent has sole legal custody, that parent has the sole legal right to make health care decisions for the child.

Q: Do legal guardians have the same rights as parents to give consent to treat a minor?
A: A legal guardian has the same authority to consent to medical treatment for a minor as a parent would have.

Q:  Can a stepparent give consent for a minor?
A: A stepparent does not have the authority to give legal consent to medical treatment for a minor stepchild unless the stepparent has legally adopted the child or been designated a legal guardian.

Q:  Can a foster parent give consent for a minor patient?
A:  A foster parent may legally give consent to “ordinary” medical and dental treatment for the child, including immunizations, physical exams, and x-rays.

Q: In what situations can minors be treated if their parents or guardian are unavailable?
A:  An emergency exception may apply to permit examination and treatment of minors requiring immediate services for alleviation of severe pain or immediate diagnosis and treatment of unforeseeable medical conditions, which if not immediately diagnosed and treated, would lead to serious disability or death. Some state education codes establish qualified immunity for physicians who treat school children during regular school hours for emergency treatment.

Also, a child’s parents or legal guardians may sign a statement authorizing a third party to consent to medical care in the event the child or child’s parents (guardians) will be away from home, such as during vacations. A copy of the authorization signed by the parents or legal guardian should be retained with the child’s medical records.

Q: Are there any exceptions to minors consenting for themselves?
A: Some exceptions exist to allow minors to consent to their own treatment; for example, married or divorced minors, minors on active duty in the armed forces, and minors “emancipated” by a court order.

If you have an informed consent question involving a minor patient, please contact Pensacola Auto Accident Attorney, Joe Zarzaur of Zarzaur Law, P.A. Our knowledgeable staff can assist with your questions or concerns.

Enjoy the Water, but be Smart and Avoid the Vibrios

Pensacola Personal Injury LawyerSmall wounds can happen easily when you are out fishing or enjoying some time on the beaches, for example, getting hooked on your own fishing tackle or stepping on an oyster shell. At the time, it may seem an insignificant injury.  But, the Vibrio vulnificus bacterium can enter through a new wound or through an existing wound, like a tiny cut, scratch or even a mosquito bite. For most healthy individuals, any infection or irritation is minor and hardly noticed. The case is different for people who have weakened immune systems. The bacterium invades the bloodstream, potentially causing a severe and life-threatening illness. Vibrio wound infections happen fast; symptoms may become evident in only four hours.

Dr. Evan Malone explains that Vibrio has always been in Gulf Waters. Here are some facts and tips about the bacteria:Pensacola Personal Injury LAwyer

  • Vibrio has always been in the Gulf waters
  • Vibrio thrives in warmer water months
  • Healthy, immunocompetent individuals are at low risk for becoming infected
  • Immunocompromised individuals are at increased risk of infection
  • Those with open wounds, independent of underlying health history, are at increased risk of infection

Swim. Enjoy the Gulf. 

Avoid the Gulf with open wounds or underlying systemic illness (uncontrolled diabetes, kidney disease, liver disease, cancer, immunosuppressant therapy). 

If you are injured in or around Gulf waters seek medical attention, even if you “think it doesn’t need stitches” — these wounds need to be evaluated by a medical professional to determine the best treatment. 

Most people are unaware of a dangerous flesh eating  bacterium, Vibrio vulnificus, which thrives in our coastal salt water. Scientists have identified more than 100 distinct species of Vibrio bacteria.

But only a few are pathogenic and harmful to humans. Among those are  Vibrio cholerae, the bacterium that causes cholera which still kills over 500,000 people annually. CDC states that Vibrio parahaemolyticus causes on average about 45,000 cases of disease in the U.S. each year, 86% of which are food-borne gastorenteritis. By comparison, CDC estimates that Salmonella causes 1 million cases of gastroenteritis annually, Shigella 500,000 and Listeria 1,600. The V. parahaemolyticus death rate is low, about 2% for gastroenteritis and 20-30% for wound-related cases.

The CDC states that Vibrio infections may be under-reported. Since 1988, the CDC has maintained a voluntary surveillance system for culture-confirmed Vibrio infections in Alabama, Florida, Louisiana, Mississippi, and Texas. Between 1988 and 2006, CDC received reports of more than 900 infections from the Gulf Coast states. In 2007, surveillance was expanded to national notification of infections caused by any Vibrio species. Wounds account for approximately 60% of all U.S. Vibrio vulnificus cases.

Pensacola Personal Injury Lawyer, Joe Zarzaur, founder of Zarzaur Law has created this blog in an effort to educate the many citizens and visitors of Pensacola, Florida about their legal rights. Joe Zarzaur knows the ins and outs of Florida law, and offers friendly-quality legal help whether you have experienced an auto accident/car wreck, have been a victim of medical malpractice or are in need of a personal injury lawyer.

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Pensacola, FL 32502

Telephone: 850-444-9299


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The Emerald Coast & The Zika Virus: What You Need To Know

The Emerald coast andRecent coverage of the Zika virus can seem a bit overwhelming and confusing. My non-scientific, anecdotal experience finds that the name “Zika” itself brings back some of the same “Ebola pandemic” concerns. The Zika virus carries somewhat of an ominous connotation — “The Zika Virus has spread here, what do we do?” “Someone at work may have brought Zika virus to the office…” “The news has the Gulf Coast and Pensacola as the next Zika virus hotbed…”

As of February of 2016, PNJ reported Santa Rosa County has a confirmed case of the Zika virus, bringing the total number of travel-related health cases in Florida to nine. To date, Florida has confirmed nine travel-associated cases in the following counties: Miami-Dade, 4; Hillsborough, 2; Lee, 2; Santa Rosa, 1.

Here is a summary of some of the information which you need to know during the warm-weather months when the conditions are most opportune for the spread of said virus. Hopefully, this bullet point listing of some factoids will provide some reference on this topic.

The take home message is to enjoy this fantastic time of year here on the Gulf Coast and to be empowered with knowledge and understanding of the environment we live in.

If you would like to know more I suggest following the guidelines as set forth by the Centers for Disease Control and Prevention:

Stay Informed: The Zika Virus

  • WHAT: Zika is a virus. Not a bacteria. Not a fungus. Not a parasite. Not an insect (though it is spread by insects).
  • REGION: Latin America, Southeast United States
  • INSECT SPREAD: Mostly transmitted to humans by mosquito bites (Aedes mosquito to be more specific).
  • HUMAN TRANSMISSION: Via direct blood contact — blood transfusion, pregnant mother to fetus, sexual transmission. Note that no other bodily fluids currently are understood to harbor the virus.
  • SYMPTOM ONSET: Two to seven days following a bite from an infected mosquito.

    The Zika Virus and The Emerald Coast Panhandle Pensacola Florida
    Most people infected with Zika virus won’t even know they have the disease because they won’t have symptoms. The most common symptoms of Zika are fever, rash, joint pain, or conjunctivitis (red eyes).
  • SYMPTOMS: fever, rash, eye pain and redness (conjunctivitis), muscle aches (myalgia), fatigue
  • SYMPTOM DURATION: Several days to one week.
  • PREGNANCY: Women who become infected during any trimester of pregnancy can transmit the Zika virus to their fetus, which is associated with microcephaly of the child (small head, small brain).
    The Zika Virus and The Emerald Coast Panhandle Pensacola Florida
    Microcephaly is a birth defect where a baby’s head is smaller than expected when compared to babies of the same sex and age. Babies with microcephaly often have smaller brains that might not have developed properly.

    Prior Zika virus infection does not place future pregnancies at risk, though planning for pregnancy should take possible recent Zika virus infection into consideration.

  • COMPLICATIONS (non-pregnant individuals): As with any other viral infection, those with pre-existing chronic illness are open to a more-complicated infectious course. In no particular order, these diagnoses would place one at higher risk for complications — heart disease (congestive heart failure, cardiomyopathy), chronic lung disease (COPD, emphysema, asthma), diabetes mellitus, chronic kidney disease, immunocompromised state (cancer, chemotherapy).
  • RARE COMPLICATION: Though rare, Guillain-Barré syndrome can occur. This is marked by progressive muscular paralysis which can contribute to further cardiopulmonary dysfunction if not diagnosed or treated. It should be noted that this same process can occur from many other viral and bacterial infections so this is not a new or unique issue in regard to infectious disease.
  • TESTING FOR ZIKA VIRUS: Laboratory testing does exist, however diagnosis is often based upon possible virus exposure and clinical history (signs, symptoms). Blood (and, recently urine) tests are being used for disease monitoring. Consult your healthcare provider with regard to what testing protocol may currently be in place as these tests are evolving.
  • TREATMENT: Supportive therapy is the standard. The same as with many other viral infections (common cold, gastroenteritis). Hydration. Rest. Attention to co-morbid conditions which may need to be supported more aggressively, consult your physician.
  • PERSONAL PROTECTION: Avoidance of mosquito bites — window and door screens, long-sleeve clothing, insect repellents (sunscreen is first layer, then apply repellent).
  • TRAVEL: Pregnant women should avoid travel to regions with known, ongoing Zika virus transmission. Non-pregnant individuals need to understand the same information as listed above when considering travel plans.
  • PREVENTION: Limit or reduce optimal breeding grounds for mosquitoes (standing water, yard debris).

Taking this information into consideration be safe and enjoy the season. If you have more specific questions in regard to Zika please consult your community and governmental resources – local health department, CDC, and your medical provider.