This is the first in a series of posts I’m going to do about my malpractice trial.
Names and minor facts about the patient and his family have been changed.
Everything else is the real deal.
—————————–
I was in the middle of writing admission orders on a patient when the secretary told me that someone needed to see me in the front.
I headed toward the triage desk when a security guard ran up, grabbed my arm and stepped in my path. “What the hell is going on?” I thought to myself. He told me that the person who wanted to see me up front was a process server. He said that he could keep her from coming back and that I could sneak out the back door after my shift if I wanted.
I thought about it for a few seconds and realized that it would only delay the inevitable. I thanked him for “having my back” and walked out to see the woman. When she saw me, she fiddled with her briefcase for a moment, finally got the latch undone, opened the briefcase, and handed me some ruffled papers. I asked her if she wanted me to sign for them and she raised her eyebrows, making it seem as if my offer was not something ordinarily done. She handed me another piece of paper. I scribbled my signature on it and walked away.
The front page of the stack of papers was a summons commanding me to appear in court. I turned the page and saw the name of a Plaintiff as the executor of the estate of another person. Not a good sign. Someone died. Below that was my name, the name of the hospital where I had previously worked, the names of a few other doctors, and a couple of nurses. As I paged through the complaint, I had no idea who the patient was. All I knew was that everyone allegedly delayed diagnosis of a surgical problem in the hospital emergency department and that the patient walked into the hospital, but didn’t walk out.
The rest of my shift that day sucked. I looked at patients as adversaries rather than as people needing help. I ordered more tests than I probably needed to. Wasn’t for defensive medicine purposes or anything like that. Everyone knows that defensive medicine doesn’t exist. Maybe it helped me feel better about “not missing anything.” Maybe I didn’t want to get named in another lawsuit a few years from now. My head wasn’t in the game at that point. My brain was full and I wanted to go home. The shift couldn’t end quick enough.
When I got home, I wasn’t myself, but I didn’t say anything about the lawsuit to my wife. Still hadn’t gotten over the shock and I didn’t want her worrying about me. Didn’t get much sleep that night.
The next day was a day off, so I canceled plans to take my kids to the park and went to my old hospital to review the patient’s chart. “Had some important business suddenly pop up,” I told my wife. I could see the concern on her face, but I just wanted to be alone, so I gave her a peck on the cheek and took off. Tooling down the highway with Motown blasting on the car stereo helped me take my mind off of things for a little while. I even caught myself singing to a couple of the songs.
The chart had been placed in a secured area and I was only able to review it with a member of the medical records department watching me go through it. Like I’m going to write extra notes in it or something. You know that the attorneys already have copies of the whole thing. Otherwise they wouldn’t be able to tell what had been done to the patient. Do I look that dumb to make a change in the records now? The staff member looked around at the walls and paced in the room as I flipped through the chart.
The patient had come by ambulance with a nonspecific complaint. Soon after he arrived, he began to complain of severe back pain. He got pain medication and then went into shock shortly afterwards. While treating his shock, we also looked for the cause of his nonspecific complaint. It took several hours, but we finally made the correct diagnosis in the emergency department. Unfortunately, the patient’s disease had progressed too far. He died from sepsis the next day.
After reading through the chart, I remembered the patient. Nice older fellow who was laughing and joking with the staff when he first came in. I also remembered the patient’s daughter. As soon as she arrived, she began questioning everything we did and everything I ordered. I remember asking her if she had any suggestions for her father’s care. She wanted him transferred to his regular doctor at a hospital across town. By the time she made that request, he was already in shock and we couldn’t transfer him. That made her even more upset. Fortunately, because of the daughter’s animosity, I documented that chart very well.
Once I had read the chart, I felt the need to validate the care I provided. I spent the rest of the day in the medical library reading through all the sources I could find about the patient’s diagnosis and about management of patients in shock. The more that I read, the more that I thought my care was entirely appropriate. I got angry. If I missed something, that’s one thing. But we diagnosed a very obscure problem and provided excellent care. I couldn’t wait to see what the “expert” said that I should have done different.
I notified the group I was working for at the time and they notified our insurer.
The following day, I got a call telling me that I had been assigned a malpractice attorney.
—————-
See other posts in this series here.
Just a piece of advice. I know you feel the need to vent but for your own sake, stop here and do not discuss this case in public. You are not completely anonymous as you may think. Anything you write here can be used against you.
O shit! I’ll keep my fingers crossed that all ends well for you Whitecoat! Malpractice suits are a, pardon my french, bitch!
Especially with “experts” with almost non-existent knowledge in this specific situation, telling you what to do “generally”.
A good attorney on your side will find experts on your behalf.
I had 4 on my side, the Plaintiff had one. I chose to ‘cave” just before trial because I couldn’t stand the chance of losing a million or more when we could settle for 150,000. Even a 10% chance of losing was not worth it. My attorney agreed and my malpractice insurance agreed.
Now I get to pay for it because I am reported the the National Practitioner Databank. I get to pay every time I re-apply to insurance contracts, every time I re-apply for hospital and clinic privileges, etc.
Fight it to the end if your attorney thinks you have at least an 80% chance of winning.
I agree. Don’t blog about your case anymore. We don’t need to lose another good blogger.
Dude…
Remember Flea? It wasn’t that he ad blogged about his malpractice trial, it was that he (and more importantly his lawyers) were surprised when he was confronted on the stand with the existence of his blog – that forced the settlement. So, if you persist in writing, even in vague and nonspecific terms, about your trial, for the love of god make sure your counsel is aware of the blog so they can prepare a defense.
Unless you’re writing about past events…
Im pretty sure that this is a past event. It sounds like it from the way it is being written.
[...] like from “The Trial of a WhiteCoat, pt 1” entry that he’s gearing up for or has just gone through a malpractice trial. Reading [...]
Best wishes to you. Take care of yourself. Please, don’t let the stress harm you or your family (well, as little as possible).
@shadofax,
Whoah boy, do I remember the Flea debacle. Although I agree with Blacksails in that this sounds like a past event.
Once it is settled (in our out of court), it’s game to talk/blog about, right?
Technically it is OK to talk about it after the fact but I believe that eveything you write here can be used against you in future cases also. I could be wrong but I’d rather not find out in court in front of the so called “Jury of my Peers”, yeah right.
“Once it is settled (in our out of court), it’s game to talk/blog about, right?”
Two big issues:
(1) Settlement language may prohibit it. Defense lawyers routinely demand as restrictive language as they can get; plaintiffs oppose as much as possible. But once in there, that language swings both ways.
(2) HIPAA may still prohibit much of it, despite the public trial. I really don’t know, and I wouldn’t be surprised if there wasn’t much law on the subject.
As for “Technically it is OK to talk about it after the fact but I believe that eveything you write here can be used against you in future cases also,” that’s always a risk, but an unlikely one. Judges are loathe to permit even a whiff of reference to prior malpractice allegations, and so the only way it could come out is in a highly-veiled form. In that, what he writes probably won’t differ much from everything else up here, it’ll just be descriptions of something he experienced at work.
The case of Dr. Flea
http://www.newyorkpersonalinjuryattorneyblog.com/labels/Flea%20Medical%20Malpractice%20Case.html
WhiteCoat isn’t stupid, people.
[...] by GruntDoc on June 1st, 2009 The Trial Of A WhiteCoat – Part 1 « WhiteCoat’s Call Room The Trial Of A WhiteCoat – Part [...]
Do you remember Dr. Flea and what happened when he did this? Plaintiff found out and it was not pretty. You should stop this and take down this post. At the very least please inform your own attorney you are blogging about this and give him/her your web site address. Don’t let your attorney get blindsided during trial about it.
nurse K, If he is really telling of a past trial and doing it as though it is real time, then great. That’s what I had assumed Flea was doing also, but he wasn’t. Otherwise, if this is real time blogging then it is not being very smart.
Like I say, WhiteCoat isn’t stupid. I wanna hear about a malpractice trial experience from a doc’s perspective. This is what blogging is about, people, so chill out.
Dear White Coat,
I am a former med mal defense atty and daughter of an old fashioned, country doc. With deep respect, I urge you to run this by your atty, even if the case is over and you got a defense verdict at trial. You might be subject to another lawsuit, possibly for defamation or intentional infliction of emotional distress. I may be wrong because I’m going on almost no info here. Thanks for sharing your experience but PLEASE cover yourself by notifying your atty.
Best regards
Nurse K. Then I hope you are blessed with information that we don’t have (like knowing for fact it is past history) because YOU wanting to hear about something is not a good enough reason for a Dr. to lose a malpractice case. Chill out yourself!
I am sure it is in the past. I am considering doing a series of posts on my case – which is also in the past.
And one thing is clear – you realised that the case was going bad and the patient had an annoying family member so you did extra-careful documentation. I am sure that will get you out of it. The worst part is not even the plaintiff or their lawyer, it is the “expert” who will come on the stand and flat out lie saying that you did not follow standard of care when you did. These lying witnesses need to lose their licenses.
I agree with Nurse K/ERP. Why does everyone assume he’s live blogging?
Maybe this hasn’t happened at all. Maybe Whitecoat is THAT good of a writer that it is all fictional. I really doubt it though. Good luck sir! And keep them coming, inquiring minds want to know.
Agree with nurse K… this is a personal journey through the malpractice machine.
What I find interesting is the level of panic in the comments. The commenters (myself included) are so afraid of the legal system that everybody is screaming at WC to 1) stop and 2) see a lawyer to protect himself. What a biting indictment of the entire legal system.
I wouldn’t call it a “biting indictment of the entire legal system.” He’s talking about something (1) made doubly-confidential by federal law and ethical standards which (2) is made triply-confidential by most settlement agreements. So a handful of folks suggesting he be cautious doesn’t mean much.
I didn’t get the impression this was live, and I assumed the case was closed. I’m sure he’s heard of Flea. If he adequately conceals identity then I’d imagine he’ll be fine.
My initial panic was that I thought of Flea and would be very sad and going through some kind of serious WhiteCoat blog withdrawal (Icd.9 code for that?
if he had to stop blogging.
My 2nd thought is WC knows about Flea and he’s changed the facts but also using facts from everywhere and creating an interesting series sure to evoke many responses.
We all like WC and don’t want to lose him as a fellow blogger. people care.
That’s sweet.
If it is the real deal..I’m sorry it happened.
What if it is a misunderstanding of the facts on daughter’s part?
After someone sues for malpractice…is there ever a mediator involved that can shed light on the facts, demonstrating why the appropriate protocols were followed? before court? Does anyone ever say..Oh now I understand and drop the case?
Sometimes I think we forget that the system we have for settling disputes between physicians and patients, though it isn’t perfect, is the only system we have. Essentially, a lawsuit is an injured party’s only way to get answers.
I became involved as a med-mal expert because I was tired of hearing of “hired gun” experts. If I were to make a mistake – and I have, and we all do – I would want someone with integrity similar to my own explaining why, and how the matter could be resolved. It’s a painful process, but if every average Dr. Joe or Dr. Jill opts out, we’re left only with “hired guns.”
I have worked with both defense and plaintiff attorneys for 25 years and have never seen a frivolous lawsuit. I’m like the “mediator” above. About 70% of the time cases already screened by plaintiff attorneys and presented to me have no merit, and those attorneys are happy to hear that. Saves them a ton of money, time and grief. And they can reassure the plaintiff/family that even though a bad thing happened, it was not malpractice.
Less than 5% of bad medical results reach the trial stage, and even then stats say that WC has an 80% chance of coming out on top here.
Well some of us came here from New York Lawyers blog, Eric Turkewitz, who very strongly suggested it might be live blogging of a malpractice trial. He was well aware of Flea and his trouble so I also thought it probably was real time blogging. I now doubt that it is. No one would be that silly again. and if they were, and knew all the dangers and still did it, then Que sera sera.
Watching the comments here is interesting.
I agree that perhaps this shouldn’t be blogged about….
But on the other hand, the fact that we are so scared for Whitecoat’s sake means that the lawyers are winning. We (doctors) are living in fear about malpractice and lawsuits.
Kudos to Whitecoat for talking about it, we need to talk about it and the ridiculousness of the tort system that affects every medical decision we make, like it or not.
You’re right in the sense that if it can’t be talked about (while omitting names and sensitive specifics) then the “lawyers win.”
The opposite thing would be true if we lived in a world where lawyers felt intimidated by incompetent doctors. (ha, ha) I think that in this case information is ultimately empowering so that doctors can collectively demonstrate why our current “lawsuit-orgy” has gone too far.
Unlike most careers, I don’t know of any doctors who enter into medicine simply for the money. (i’m sure there are some egos out there though) Anyway, I hate to see our health care system compromised like this by lawyers and health care executives who see patients only in terms of dollars.
I think on some level the plaintiff and their lawyer are in a no-lose situation, while the doctors are in a no-win situation once a lawsuit has been filed. There should be some degree of “risk” to the lawyer who accepts a questionable case, as there is risk for every doctor who lets a patient come through their door.
chairman meow
http://www.obeythepurebreed.com
[...] « The Trial Of A WhiteCoat – Part 1 [...]
It’s a sad thing, that people do not realize all medical care providers are human. This series will show others what a human being, that has gone into a profession to help others, suffers through as a results of a case brought against them. Whether it be from a mistake that was made or by circumstances out of anyone’s control. Life is life, and things don’t always work out the way we think they should.
That was said with respect to the parties that have suffered loss, as well as to all that put forth their very best everyday, to try and ensure the positive outcomes born from years of training, skill, and experience in the service of others.
As the daughter of an attorney, I can tell you that blogging about a malpractice trial is bad news – present or past. IMHO, a blog isn’t the place to air a discussion about this issue – it creates a cyber fingerprint that can’t easily be removed.
You have to watch out for those hostile, note-taking family members. Honestly, I have a couple relatives that sue for a living and are doing quite well from settlements.
no offense, but your relatives are bottom of the barrel scum.
not a care in the world where this money comes from, or what repercussions this kind of behavior would have so long as they get their jackpot. people like that should be considered to have waived their right to health care.
[...] his/her medical malpractice trial. The blog is the WhiteCoat’s Call Room and here is the first part of the trial. Today, the blogger published a disclaimer. So to those worried that what I write will be used [...]
I’m glad that the original medical records are kept locked up. As a plaintiff in a wrongful death case, I’ll never forget the moment during my deposition when the attorneys realized they had two different versions of my chart. Sweet!
[...] so much trouble a couple of years ago after the posts came to the attention of opposing lawyers. [first, second posts] Some reactions: Eric Turkewitz, [...]
[...] just got finished reading part 1 of WhiteCoats trial story and I am actually depressed. I see it all the time at work: to the point that you can almost smell [...]
This is a past trial, folks. It’s public record. White Coat is free to write about it – as other doctors have.
In fact, I blogged about my own experience getting sued (albeit after the case was dismissed and not in excruciating detail) . . . as the Flea debacle was going down:
http://drjshousecalls.blogspot.com/2007/05/fear-not-picking-up-gauntlet-in-medical.html
This is our world. We have got to STOP being afraid of the *&^%$#@ lawyers!
Perhaps if more of you spent more time learning about the process you fear, rather than just reading anecdotal horror stories with 1/2 the facts, there wouldn’t be so much fear.
I can’t resist a mystery. I wonder what the outcome was.
I find the comments here much more disturbing than the blog entry. Not one person referenced concern for the patient that died and their family. I think that says a lot about the healthcare system as a whole. Let’s pretend that it was your father.
Was the family contacted by the physician following their loved ones death? Did they send a card, attend the funeral, offer to review records with them and explain their side of what could have gone wrong?
When their is no contact from the hospital, CEO, nurse or physcian, it is assumed that they had no regard for their loved ones life. If we start there instead of immediatly running to your attorney, many of these cases would be dropped. Be human. Talk to them like you care. Did the physician say that he was sorry that the family member died? Let’s all grow up a bit and not blame the family or the attorney.
Nice to see the readers from Mayberry are in attendance…
I used to live in Mayberry, before the death of my child. I now live in hell.
I am sorry for your loss.
Truth is almost every day I work someone dies, maybe 2 or 3. Even if I was a saint I could not attend 100 plus funerals on my day off, or talk on the phone, or comb the isles at Hallmark.
I’m also sorry for your loss. In the current medical environment, the good intentions you mentioned are not always reasonably possible.
[...] June 3, 2009 My Day In Court Posted by Ten out of Ten under ER, Life, Medicine No Comments A malpractice claim is not the only way to end up in court. [...]
I only want to say, about the chart and not writing in it *now*…it’s happened. I’m sure of it. People who are scared to death can do pretty stupid things.
I was aghast at the incompetence of the defense lawyer of Dr. Flea. Before allowing my client to answer a surprising, befuddling question, I would have stopped the testimony and demanded a recess.
Once apprised of the situation, I would have demanded a mistrial, and sanctions for all legal costs from the personal assets of the vile plaintiff lawyer.
Failing that, I would have moved to make an appeal to a higher court before the trial could continue. I would have demanded a new trial, a new jury, and a new judge. The old judge failed to stop the question.
The blog of Dr. Flea was completely irrelevant to the validity of the claim. Dr. Flea was punished for his Free Press rights.
Given that, all medmal defendants have an affirmative moral duty to clinical care. Not only should they never settle if they feel they did nothing wrong. They must counterattack and seek the total personal destruction of the plaintiff, the plaintiff lawyer, the plaintiff law firm, the plaintiff experts, the plaintiff witnesses, and the judge after an adverse ruling. To deter.
The defense lawyer will refuse to participate in such a duty. Why? Total deterrence ends his job. He owes his job to the plaintiff lawyer, and not to the doctor client. His is a traitor. The doctor must hire a legal malpractice expert to terrorize the defense attorney into a more vigorous defense. If the insurance company demands to settle, get an injunction and sue the insurance company for fraud and bad faith. The bad faith is in their calculation that a settlement would cost less than a trial.
Lawyers learn from case experience. They will shun an area pretty much permanently after seeing the massive retaliatory destruction of their plaintiff bar colleague.
As a patient, as a parent of a patient, every penny the land pirates takes comes from the care of my loved one, either by increased cost or reduced access or by reduced risk taking into clinical innovations. I would have no hesitation in crushing these vile land pirates. Indeed, I would like to see a group of patients and patient advocates form direct action groups, and to drive the land pirates out of town.
Hello Supremacy. I agree about our dear, departed Flea’s legal representation. He was essentially crucified for having a blog (and it was a beautiful, wonderful blog) . . . as opposed to seeing his case tried on it merits.
And “Been/Am There”, in my own experience of being sued (linked above), I actually did address the issue of empathy for the family.
Very respectfully, you speak of “sides” and make the assumption that silence means a physician has “no regard” for a patient’s life. And I am sorry. You assume WRONG.
Oftentimes, in the event of a death, the physician is never given the opportunity to speak with the family – indeed the doctor/nurse/CEO is usually instructed (by hospital & malpractice lawyers) not to have any contact the family.
If you defy those instructions, you jeopardize your malpractive coverage.
And you need that when the patients run to the lawyers.
I’m a Pediatrician, and I trained at an institution that tried to hold grief conferences for the family & staff (doctors/nurses) when a child died (especially in the NICU or PICU) . . . usually after the post-mortem results came in. The case and chart would be candidly reviewed – and it usually brought great comfort to the family. I always thought it was a good idea – very cathartic for everyone. And yes, I did attend a few funerals. But when I got out into the real world, I was dismayed to discover that the practice was an exception rather than the rule.
I’ve been the victim of surgical malpractice twice – requiring revision both times. I did not sue. I don’t believe the doctors involved were “evil” or “bad”. They made mistakes. Would I like to hear an “I’m sorry” (from the surgeon who is still alive)? Yes. But given the world we live in (and I practice in) I completely understand why I won’t ever get it.
A long time ago, I used to live in Mayberry too. If you need to hear, “I’m sorry” from a doctor, I AM sorry for your loss . . . and that you have not heard it before.
Hi, great!, an institution with proactive communication. We can begin to reduce the number of lawsuits by hospital administrators and risk departments making it easy to communicate. Perhaps if they followed the model of Zappos.com – ever shopped there?, great customer service and the company asks for feedback at every turn which informs the company of the effect of its people and its policies so that it can self-correct.
Re: the daughter who took notes and was a proactive communicator (PC) during the ER event. Was the hospital a PC after the event and she sued anyway?
Should a hospital anticipate that a death or undesirable outcome might spur those involved to seek information and to ask questions? Yes, but who can get answers from hospitals that hide b/c of fear of lawsuits and that discourage staff from speaking? The Joint Commission/JCAHO (good luck there), your congressperson, a t.v. station, a lawyer? Hospital systems which discourage questions and cross-communication create a need for lawsuits IMhO. Questioning outcomes and asking “what if we’d done this..” are normal processing steps, aren’t they? Aren’t they what lead to systems improvements?
[...] Just Tickled Me Filed under: Forensics — williamthecoroner @ 12:45 WhiteCoat is blogging about his experiences in a medical malpractice case. One of the points he has made is [...]
[...] Trial of a WhiteCoat: Part 1, Disclaimer, Part [...]
“Do I look that dumb to make a change in the records now?”
You say that, but there are plenty of cases where physicians change the records. I once worked a case where the physician undoubtedly performed an act on the patient that wasn’t consented to and was not reflected in the records. They tried to go back and change them over a month later after they knew word was getting out about their action. Watching you was a reasonable precaution, not a reflection on you personally.
“? It wasn’t that he ad blogged about his malpractice trial, it was that he (and more importantly his lawyers) were surprised when he was confronted on the stand with the existence of his blog – that forced the settlement.”
It was also the contempt he showed in his posts about the lawyers, jurors and process in general that made him look extremely arrogant.
Matt: No. It was the incompetence of his defense attorney and the anti-doctor bias of the hate filled judge that allowed a violation of the Rules of Evidence.
[...] WhiteCoat is blogging a (previously resolved) malpractice case. [...]
I’ve been reading your column on your med mal case with interest as I an ER doc who writes medicolegal articles for http://www.epmonthly.com and have a book coming out soon about how to survive a med mal lawsuit. I see some things that you mention that could really help doctors if they read more about the important issues you discuss.
See my blog at http://drbrenner.blogspot.com/2009/06/commenting-on-whitecoats-blog-parts-1.html for detailed discussion of Parts 1&2. In particular, I discuss issues about conflict of interest, consent to settle your case, picking an attorney, and much more.