The plaintiff’s daughter then got up on the stand. She was sneaky.
Apparently from the time her father came to the emergency department, she had been taking notes about everything that had happened. So she had many pages of notes that she used to describe the hospitalization of her dad. According to Vinny, she and the Grinch didn’t make those notes available to everyone else until much later in the litigation. She described much of the same things that her mother described, but she was much more vivid in her descriptions of his condition.
She described the presence of blood on her father’s abdomen. She even described black marks on his skin where the blood was coming from. None of these findings were anywhere in the notes she had taken. She said that her father came into the emergency department a “normal man” and left the emergency department “completely ravaged.”
She stated that she was there for my whole history and that I never asked him about several things, including whether or not he was taking a blood thinner or how he had managed the symptoms of his medical problem. She said that my history lasted about 10 to 15 minutes and admitted that I performed a complete physical after taking the history.
She also stated that she was present when the resident physician arrived. She quoted several things that he told her, including his alleged statement that there were “no risks” with the condition that had been diagnosed.
“What a bunch of bullshit,” the doctor whispered in my ear, “I would never tell someone that.” His voice stuttered for a second as his attorney kicked his chair to tell him to shut up.
As she watched her father being wheeled from the emergency department, “he was a different man.” His skin was ashen gray. His abdomen was distended and he was unable to talk. He looked “horrific.” She started to cry, but it didn’t have the same effect as her mother’s tears.
“By that time I knew it was too late to save my father.”
Her father was taken to the intensive care unit and the surgeons discussed the pros and cons of surgery with the family. Any procedure would likely only be palliative and he was at a high risk for surgery, anyway. Instead of increasing his pain and suffering, the family decided to let him die in peace. Again, she began crying, but her tears just didn’t seem real.
The plaintiff’s daughter folded under cross examination. Vinny showed her the notes she had taken about the emergency department visit.
“Your notes don’t say anything about blood on your father’s abdomen or black marks on his skin, do they?”
“Of course not. I just used the notes to describe the care my dad received and how my dad felt. I didn’t care as much about his appearance at the time.”
“Well your memory is pretty vivid about your father looking ‘horrific’ but you didn’t think enough of his appearance to write a single word about it in your notes?”
She didn’t have an answer for that one. After hesitating a little, she just said “No.”
“You know Coumadin causes bleeding?”
“Yes.”
“And you were there when Dr. WhiteCoat did the history?”
“Yes”
“Well if you were so concerned that Dr. WhiteCoat didn’t ask your dad whether he was taking blood thinners, why didn’t you mention your father’s blood thinner use to Dr. WhiteCoat?”
“I’m not a doctor. I didn’t know it would be important.”
“You say that your father was bleeding and you didn’t think that blood thinner use would be something important to tell the doctor — assuming the doctor really didn’t ask about it.”
“He didn’t ask about it and I’m not a doctor.”
That line was getting old.
Vinny also got her to admit that she did not remember any of the testing that took place, any medications he was given, the specifics of my physical exam, or the timing of when he seemed to get so much worse.
“If you couldn’t tell when your dad got so much worse, how do you expect Dr. WhiteCoat to do so?”
“He’s a doctor, I’m not.”
Could have called that answer 10 minutes ago.
The plaintiff’s son then took the stand. He looked rather odd. He was dressed in a police uniform. Initially he was very cold and appeared aloof. Then all of a sudden he began crying out of nowhere. A couple of the jurors made strange faces and looked at each other when that happened. His testimony didn’t add much to the evidence that was already there. His testimony came across as pretty unconvincing to me. Then again, I was a biased observer.
When Vinny got done doing his cross examination, he seemed happy. He walked back to the table, winked at me, and said “this is our case to lose.”
That’s kind of a good feeling.
Trial ended for the day and I tried making small talk with the hospital representative.
Since the hospital is on trial, it has one of its employees as a representative. She obviously hadn’t gotten the same pep talk that I received. She was in her early 40′s, wore a very expensive suit, and had on all kinds of gaudy rings. A Starbucks cup sat on the table in front of her the entire day. She wasn’t paying much attention to the trial, either. Instead, she had finished about half of a Stephen King novel during the testimony. Her rings would periodically clink back and forth as she turned the pages of the novel.
Every time the hospital defense attorney spoke, he would state “My name is Louie and I represent County East Hospital. Ms. Hilton is here on behalf of the hospital as a hospital representative.”
I asked her whether some of the more well known physicians at the hospital still worked there, but she didn’t seem to know much about the hospital or the doctors. Said she didn’t go there much. Some representative.
I casually mentioned the representative to Louise as we were walking together to the train. She made a crack about the hospital representative’s rings, too. Apparently the hospital’s law firm hires representatives to sit there at trial. Representatives don’t work at the hospital and this one has only been to the hospital a couple of times as a patient. She knows nothing about the place. She sits at trial after trial representing hospitals and other businesses. Instead of the business owners or hospital administrators taking time off from work, she sits there instead to “personalize” the businesses to the jury so they don’t look like some faceless institution.
Nice.
Taking copious notes during an emergency of a loved one is unusual. Why did the daughter do that?
It makes sense to take notes of instructions from the doctor at the end, since one is upset and will forget everything.
It’s creepy. Especially because generally the patient is the nice family member; the polite one, and the one who thanks you for trying to help them.
They’re the family members out to get the medical staff for some reason. Creeped me out every time, but I offered to spell medications, etc. for them just to make sure they had ‘complete’ notes. Passive aggressive, yes, but what the hell….
Great stuff here. If it was a book, I would have bought it.
I worked in a non-clinical position at a hospital for 14 years so I have a little understanding of what happens there.
When my mother went through an ER and was eventually admitted for bleeding, I took lots of notes about what the staff was doing and what they said to us. The ED staff even offered a notepad and pen when they saw me writing onthe back of receipts from my wallet. I had no intention of suing but I wanted a good record of what was happening and what I was told so that I could explain it to other family members (my wife is an RN and I knew that she was going to ask a thousand questions about the treatment and diagnosis) and my mom when she became more lucid.
did you notice she was taking notes during the exam? I’ve had the experience of family members keeping logs making sure they have all the caregivers’ names, times, meds etc staring at everything you do.. It’s very creepy as if they’re just hoping you screw up.
These last two installments have been your best.
Another fascinating post. Keep them coming, I can’t wait to see what happens in part 14.
People get paid to sit in a courtroom reading novels? How do I get one of these jobs?
In answer to the question about taking notes during an emergency, I sometimes did that when I was taking care of my parents. I usually didn’t do much of it while I was actually at the hospital; I went home at night and wrote up what I thought were the important points of the day. I did it for two reasons. One reason was to help fix things in my memory (I had to keep a running record of my parents’ care in my head, because the next doctor in line would certainly ask) and identify for myself any areas of confusion. If I couldn’t write sensibly about something, I knew I needed to ask more questions the next day. The other reason was my own fear, anxiety, helplessness, anguish, relief, elation, exasperation, etc. I wrote for the same reason people blog; I needed to vent a little. I needed, for my own psyche, to see it in writing that a diagnosis had been made and a crisis resolved, or that a condition had been judged terminal, or whatever. When each of my parents died, I wrote a narrative about the death and then got rid of those notes. So I’m not surprised she took some kind of notes, but keeping them after her father’s death — when the emotions are gone and no doctor is ever going to question you again — is outside my experience. Either her psychological needs are profoundly different from mine (how is that possible?;-)) or the family planned to file suit from the very get-go.
What amazed me in this episode was the “hospital representative.” I’m with Finn: how do I get that job? I’d even be willing to pay attention to the trial.
My mom has preserved all the notes from my brothers time in the hospital before he died. It was important to her during so she could accurately share what was going on with family members and sometime when shift changes would occur because staff would ask questions about who had been by, had they changed medication, etc. She’s saved them because they are part of his life and he dies young. Unless you’ve had someone die unexpectedly who is really close to you it’s hard to understand how you hold on to every minor thing about their life.
I take notes on my own care. If of course I am able to. I want to know what the hell is happening and what to expect. I take notes on my husbands care too but then again he is dealing with military medicine and not only had 4 different military doctors, he has about 5 civilian doctors too. What a nightmare.
Nice representative. Thank goodness no one got to ask her questions except for you that is.
For those fastidious note takers in the ER I make sure they or their loved ones recieve the same exam that lawyers get: complete and detailed social and sexual history, cold caloric testing, rectal exam with and without anoscope, bulbocavernosus reflex, anal wink, pinprick of every dermatome, two IV’s (just to be ready), NPO (just to be ready), withhold pain meds (don’t want to mask anything).
I also document their fastidious note taking in that there should be no excuse for subsequent noncompliance.
Of course, you’re probably also the same guy who bitches when his patients don’t follow his instructions.
Dirk: Dictate to the note taker. “Hon, put in, the Organ of Zuckerkandl could not be appreciated on palpation.” Then, just borrow the note taker’s notes, copy and put in the chart. Free secretarial service. The family should be filling out the coming bogus electronic record, then anyone could access it on the web. I do not want my doc hunting and pecking while I am in agony. I would throw his laptop through the window, and say, I am not suing you. Pay attention to my injury. I am in pain. If you fix, I do not care if your record is a single squiggle. Get me out of pain. We are becoming too lawyerized.
I don’t know about your dead patient of course, but I take and keep significant notes because I have an extremely complicated medical history. The doctors I see actually rely on my notes to find things in their charts to determine when particular proceedures were performed because my notes are easier to search than the computerized records they use. If I lost my notebook I would be lost as to what and when various things have happened over the last three ears or so. Not because I have a bad memory but because it’s simply impossible to recall what happened at each of 50 appointments when I see one to four doctors each visit.
I don’t usually take notes but I’m going to have to start. I have issues with concentration. I’m also going to have to write down stuff I want to talk to the doctor about beforehand, even though I know doctors hate that stuff.
Hospitals I’ve defended always send a representative to trial, but it has always been someone who actually works for them, usually in risk management or, in the case of Catholic hospitals, a nun or priest from pastoral care. They pay close attention because they report trial progess to the hospital administrators on a daily basis. I would think that some random person, so uninterested she read a novel all day, would do more harm than good in putting a sympathetic face on the soulless corporation.
JPG: Do you ever demand total discovery on the plaintiff lawyer. Matt told us he lost a brother. That makes for a rebuttable presumption of an improper motive in every medmal case. Why won’t defense lawyer seek the personal discovery of every plaintiff lawyer, then publish it so others may start out deep, and go even deeper.
I hope you’re not charging for this legal advice.
Total e-discovery of an enemy of clinical care wiil turn up bias, and this enemy should be disqualified in pre-trial motions. As the enemy shows no quarter, so it should expect none.
I support a boycott of all lawyers by all service and product providers. As you attack all productive sectors, so should they attack back. If this boycott does not deter this criminal syndicate, self-help has full moral and intellectual justification.
My question was not about how heinous and biased the plaintiff bar is. My question was about why the defense bar refuses to counter-attack them in meaningful and painful way. The defense bar are traitors posing as friends. They should be crushed under total all out attack by the personal lawyer of the defendant.
It would be slightly off topic, but… I would be very interested to hear your thoughts on the supposed moon landings.
Adam: That’s funny. Isn’t it the lawyer who believes in mind reading, future forecasting, 12 strangers off the street can detect the truth using their gut feelings, and that standards of conduct should be set by a fictional character. Why? So the standards may be “objective.”
You do not find those core doctrines in the least bit odd. They are psychotic and delusional.
As for medical history, I’m recovering from an open fracture of my right tibia and I’ve given history to more people than I can count in the last two months.
I’m also the poster child for adult ADD, and compensate for this by chronic, acute Palm Pilot dependence.
I found a free Personal Medical Record application for the Palm called ProfileMD Classic-
and have spent most of today loading it up with information.
I have notes in the med card in my wallet and in my cell phone directing emergency personnel to where it is located on my Palm.
I just hope it’s a case of closing the barn door after the horse has left the barn, but I now realize that I keep omitting my vasectomy from my surgical history. And I thought I’d NEVER forget that initial Novacaine injection…
Matt: I request that you blog your next medmal plaintiff case in real time.
I’m curious, how would a WC feel about a patient or family member using a voice recorder during an exam?
That would be OK after medmal and the lawyer profession have been banned. A video recording would be a suitable substitute for the record, eliminating the need to make a record. Until then, any recording is legal suicide if a negative outcome of the clinical decision takes place.
A video recording, subject to discovery, would then have to be mandated for all lawyer client encounters, and for all strategy and lawyer decision making meetings, including those in the criminal law. “My client is willing to tell you the location of the little girl whose throat he cut for sexual pleasure in exchange for your dropping the death penalty.” That recording needs to be seen by the jury in the trial after the plea deal does not go through.
There are two schools of thought on this issue.
Some docs would welcome it – as long as they got to tape the interaction as well. I would personally like it. Video or at least audio recording would resolve any issues of fact regarding what was said and done. I usually talk through my exam anyway (“your heart sounds good, your lungs sound good, I don’t feel anything abnormal in your abdomen, etc”), so I could show I provided a complete exam and gave the patient proper instructions. I think doctors should be allowed to audio/video tape any exam they want.
On the other hand, some docs hate the thought of being taped.
If I had had a tape of the patient’s visit in my trial, there wouldn’t have been a trial to begin with.
I have crossed out permission to record or witness procedures from the surgical release paperwork. Got funny looks about it but the doctor accepted it.
we looked into recording pateint encounters as well as care. We have closed circuit tv on all patients in the ICUs to help respond if there is a problem. We thought, why not record it? The HIPPA red tape turned out to be a nightmare. It turns out that because of HIPPA you can film and keep the tape on the parking lot but not in patient care areas!
Police resisted taping stops for years, but now most will say that it’s a wonderful thing. Much less ambiguity about what happened, particularly with DWI stops.
Wow- WhiteCoat, this is such a riveting story and also so valuable to hear about all of these little tricks, twists, and turns first hand. While I hope to never experience this situation personally, I am very grateful to you for putting this out there to Teh Interwebs. If my turn comes, I’ll be better prepared thanks to you. Thanks!
Wow – that bit about the hospital rep is shocking and pathetic.
Why are you shocked? It’s a corporation, not a human. They’ve made a financial decision that it’s not worth their time to send an exec to sit and watch. They probably figure they’ll appeal if they’re hit, and settle within policy limits. They, and their insurer, know the odds.
WC hasn’t talked about it, but the defense undoubtedly knows what the hard economic damages are because those would have been produced in discovery and the economist deposed. The insurer has run the numbers and knows what the verdict range is. The hospital likely isn’t terribly worried.
Likewise, if WC is shocked about the wife’s testimony and the daughter’s, it’s probably because he didn’t go to their depositions. Their testimony was almost certainly covered there, and in more detail. There are likely multiple reports in the hands of all the defendant’s insurers about the depositions, the attorney’s rating of the witnesses, etc.
When I did defense work, every file, even the lowliest car wreck, is papered up with regular case status reports for the insurer.
I’m betting White Coat made a great witness.
You’ll just have to wait to find out.
A hint, though. The Grinch said that I was “snarling” when he described my testimony in his closing argument.
Oh no! Only TWO to go and I will have to wait for the next installment like everyone else!
What to do…what to do?
I’ll keep reading.. caught up in it now.
I wrote notes when my mother was in the hospital. But in no ways detailed. Names of doctors and meds. I was in shock. Most of the time it was…what is your name? What do you do?