More than a year passed between the deposition and any talk of a trial. Many times during that year, I felt like giving up, just settle the case and get the whole ordeal behind me. Vinny told me more than once that litigation often becomes a war of attrition – whomever gives up first is the loser. That helped keep my head in the game. I was determined to show everyone that the care I provided was appropriate.

The plaintiff’s attorney repeatedly told Vinny that he “wasn’t focusing on my care.” In fact, even the plaintiff’s expert stated that everything I did was reasonable. The only issue that the expert had with my care was that HE would have contacted a surgeon earlier in the patient’s course. That’s great that he would contact a surgeon sooner knowing the patient’s ultimate diagnosis and sitting in his living room somewhere sucking down a cold one as he flipped through the chart. Things are a little different when it’s real-time, you have eight other patients, you don’t know the diagnosis, and you’re doing what you can to save someone’s life.

The plaintiff also had another paid consultant who made all kinds of outlandish claims against everyone, but he’s a general surgeon who said that the last time he practiced emergency medicine was 30 years ago. Got news for ya, there Aesculapius, emergency medicine was hardly even a specialty 30 years ago. I’ll let Vinny drop that bomb on you during trial, though. This expert had testified in more states than I’ve ever visited. I heard one attorney in Vinny’s firm refer to the expert’s statements as “testilying.”

While I was frustrated that the Grinch was keeping me in the case, I found myself looking forward to trial. I was actually excited to show everyone how I did the best job anyone could do to save this patient’s life. I know some people dread the thought of having 12 people staring at you while some attorneys and experts say great things about you one half of the time and while other attorneys and experts say horrible things about you the other half of the time. Me, I couldn’t wait.

I headed back to Vinny’s office about a week before trial to prepare for my trial testimony. Basically, Vinny wanted to go over all the things we talked about before my deposition.

“You have to memorize every damn word of that deposition,” he warned. “If you say something different from your deposition during trial, the plaintiff’s attorney will jump all over you and make you look like a fool. You’ll be painted as someone who changes his testimony and who can’t be trusted.” The legal term for that technique is “impeachment.”

Vinny had developed a “theme” for the case. He encouraged me to mention the theme over and over during my testimony so that the jury would remember it once they went back to deliberate. Our theme was going to be “THINGS TAKE TIME.” We made the diagnosis, but it took a while for all the test results to come back. Things take time. Makes sense.

We would need to go through each test I ordered, why I ordered it, and how it contributed to the diagnosis. Since the major issue was whether or not there was a delay in obtaining a consult, we had to show that after each lab was ordered, it took time to get the results back. It wasn’t until all the tests were back that the diagnosis became more evident. We needed to hammer home the point that I was constantly acquiring data and that time was needed to retrieve the lab results and to refine the diagnosis.

Vinny told me to think about what the plaintiff was going to try to prove. That way I would know how he would prove me wrong . . . or at least TRY to prove me wrong. In most “failure to diagnose” cases, the physician is allegedly not smart enough to realize that a disease manifests itself in certain symptoms. For example, abdominal pain is usually seen in someone with primary sclerosing cholangitis. When a jury hears that statement, they might begin to think “if the patient had abdominal pain, why didn’t the doctor think of primary sclerosing cholantitis?” The problem is that the question smacks of retrospective bias. No one knew that the patient had primary sclerosing cholantitis when the patient walked into the hospital. So while abdominal pain may be “consistent with” primary sclerosing cholangitis, it is also a finding consistent with at least 740 other diseases as well. An example of a question that avoids retrospective bias might be “when a patient comes in with abdominal pain, what diseases should be in the physician’s differential diagnosis?” Even that question is too broad. No patient has “just” abdominal pain. Physicians have to look at the patient as a whole, not as a single symptom.

The plaintiff’s attorney will introduce the retrospective bias fallacy by asking a question such as “weren’t the patient’s findings consistent with [the missed disease]?” To avoid giving the jury the impression that the patient’s symptoms should have led me to think of the disease immediately, I had to avoid giving “yes or no” answers. Instead, I would need to say things like “In a patient who doesn’t have symptoms X, Y and Z, the findings are not consistent with that diagnosis.” Or I could also say “Possibly, but those symptoms are more likely to represent much more common diseases such as food intolerances, biliary colic, and gastritis.”

“Oh, and one last thing,” Vinny warned. “You have to keep a poker face. No matter what lies you hear, no matter how mad you get, you cannot show emotion while sitting at that table. I don’t want to see you making faces. I don’t want to see you shaking your head. Nothing. You understand me? Jurors don’t like it.”

“Sure.”

He continued on his tirade to drive the point home. “Once we nearly had to withdraw as counsel during a trial because a doctor was making such an ass of himself. He was smacking himself in the forehead, throwing his arms up in the air, and was holding up signs saying “Quack” to the jury when the plaintiff’s expert was testifying. The judge threatened to kick him out of the courtroom.”

I started chuckling while trying to think about how I’d react to the doctor if I was a juror.

“Then he testified and after he got done testifying, he walked down off the witness stand, stopped, looked at a wart on a juror’s nose, pointed at him and said ‘You have skin cancer.’ Then he walked out of the courtroom.”

We both laughed.

“The scary thing was that we won that case.”

“I get it. I get it. World Series of Poker. No goofy signs. Smile at jurors.”

My brain had officially become full. “I’m going home. See you next week.”

I added a page to keep track of all the posts – see the link to the right.

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I was back in Vinny’s waiting room the following week. We were going to walk to the deposition together.
He busted out of the waiting room door with a big smile on his face. “Ready?” He asked.
“Yeah, can’t wait. Kind of like going to get my teeth drilled.”

Once again, the wind blasted us as we walked down the street. I had no idea where I was going, but with Vinny as my tour guide, all I had to make sure to do was avoid losing him. During our walk, he made small talk about another malpractice case he was dealing with. After the physician’s deposition, the insurance company was in a “settlement posture.” Apparently the physician was difficult to understand and had a thick foreign accent. He would make a “poor witness” at trial. “Unfortunately, juries around here just are not very forgiving of foreign doctors.”
Funny, I always thought malpractice was about the appropriateness of care.
Two blocks north, one block to the west, third building to the right.
We were officially in the enemy’s lair.

In the waiting room, there were four other people. They all stood up and shook Vinny’s hand when we entered. Then they all began chatting about “lawyer” stuff. I sat in a chair and watched.
“Can you believe Judge Smith’s ruling last week?”
“Oh I’m sure that Jerry will appeal it.”
“You don’t want to get on Smith’s bad side though. I heard that he got mad at an attorney and made him cancel his honeymoon trip to Greece to show up in court for a hearing.”
“Ah, you just have to milk his ego.”
This must be what it’s like when a bunch of doctors get together at a party – only we talk about wacky patients, funky x-rays, and all the lives we save.

An older man in a designer suit with a Rolex watch rattling around on his wrist opened the waiting room door and greeted everyone. That must be “the enemy.” It was. The plaintiff’s attorney. The thing that struck me most about the plaintiff’s attorney was his smile. When he showed his teeth, it reminded me of the caricature of the Grinch. Never got that picture out of my mind.

I have to admit that I got a little miffed when all of the other attorneys went up to him and shook his hand, then began joking around with him. How could someone that was supposed to be helping me be so friendly and nonchalant with the person that’s trying to bankrupt me?

The Grinch led us back to a large conference room in his office. Everyone took their seats at the table. I couldn’t help thinking how much money was being spent for all the different attorneys by all the different parties in this case just so this guy could ask me questions.

The plaintiff’s attorney asked me all about my history of employment and my family history. What does my wife do? How many kids do I have? What are their ages? I was already annoyed and the deposition had just begun. What does my personal life have to do with the case? I looked over at Vinny and he didn’t seem to mind, so I bit my tongue and answered the questions.
Then the Grinch started asking questions about how to diagnose the disease that the patient had. What signs are typical of this disease? How does one diagnose it? What should someone do to treat it? I did fine with those questions. So far, so good.
He pulled out a copy of the patient’s chart and handed it to me. Then he picked the medical records apart word by word. He wanted me to comment on pretty much everything that was written in the chart.
“Why did the nurse do this?”
“I don’t know. Ask the nurse.”
Then we got into a discussion about the definition of the term “clinically significant.”
“Was there anything of clinical significance to you?”
“In what sense?”
“Your evaluation of the patient.”
“That would lead me to think what?”
“I don’t know. I’m asking you.”
I could tell that the plaintiff attorney was getting frustrated.
“This is not to try to trip you up or anything. Juries just have to understand your thought processes.”
I felt like rolling my eyes and saying “yeah right” at that point, but I just smiled and nodded my head.

He asked me about the patient’s medications. Did I think he was taking them? How was I supposed to know?
I had to go through every aspect of my physical examination of the patient.
I had to comment on every aspect of all of the patient’s laboratory tests.

After an hour and a half, I needed to use the bathroom and asked for a break.
I got into the bathroom and started going when the door opened up. Vinny came in and stood two urinals down from me. Guys can never stand next to each other in an empty bathroom. It just doesn’t look right.
“So far, you’re doing great,” he whispered.
“What about…”
“Ssshhhhhh!” he interrupted and frowned. “People may be listening.”
I didn’t realize that plaintiff attorneys bugged their bathrooms as one of their sneaky tricks. I opened my eyes really wide, mouthed the word “OK,” and made a big “OK” sign with my hand. He squinted his eyes and frowned at me.

When the deposition started again, the plaintiff attorney got more gnarly. Why I didn’t do this sooner and why I didn’t order that test earlier? Why did I waste time ordering this test when the patient didn’t have the disease? Why didn’t I consult the surgeon as soon as the patient arrived? Initially, it appeared as if he was trying to trick me. But the more he asked the questions, the more I could tell that he really had little idea how medicine works or how to manage a significantly ill patient in the emergency department. Later, Vinny would tell me that the attorney was just “locking me in” to my version of the events so that his hired experts could then retrospectively criticize all of my reasoning.

After another 30 minutes, the plaintiff attorney closed his notebook and said “I have nothing further.”
“Sweet. I’m outta here,” I thought to myself as I pushed my chair back from the table.
Then one of the other attorneys spoke up. I slid my chair back in.

She started asking me all kinds of questions about whether the hospital “controlled my actions.” Like I was some marionette or something. Yeah, just call me Pinocchio. I told her that there were several hospital policies that the emergency physicians were expected to follow. She appeared flustered. Apparently, she just expected me to say “no.”
“Any other ways that the hospital controlled your actions?”
“Well, the hospital sometimes doesn’t have certain medications on formulary, so they routinely switch medications that I order … if that’s the kind of thing you’re looking for.”
She became even more flustered and dropped the issue. Later Vinny would chuckle about that. She was the hospital attorney and was trying to protect the hospital. She ended up doing damage, instead. He quipped that “lawyers shouldn’t ask questions when they don’t know what the answers are.”
Eventually, she settled on showing that I was an independent contractor when I performed services at the hospital.
She also asked me whether I had any criticisms of the nursing staff or the residents. I really didn’t. The nurse and residents taking care of the patient were both top-notch and provided excellent care.

After the deposition, I got a better idea of what the plaintiff was going to allege that I did wrong. I waited too long. I didn’t focus on the right things. I didn’t call consultants as soon as the patient hit the door.

I started to question myself, wondering if maybe the plaintiff was right. My doubts sometimes affected my clinical practice. I noticed that especially with critically ill patients, I tended to worry as much about the potential liability I could incur as I did about the patient’s medical problems. For a while, I found myself practicing defensive medicine – almost as if I would be able to compensate for this lawsuit by being “extra careful” with future patients. Looking back on those times, I can’t think of one instance in which those hundreds of thousands of dollars in extra tests made any difference in the patient’s diagnosis or treatment. All they did was penalize the patients on whom I ordered them.

The wind blasted me in the face walking from train station to Vinny’s office. Vinny wanted me to meet him there so we could prepare for my deposition the following week. Even though I had spoken to Vinny on the phone a few times, we still hadn’t met and I was trying to imagine what he looked like.

I printed up a map of the area before I left home and I kept pulling it out of my pocket to make sure I was going in the right direction. People pushed by me as I slowed down to look at the map and get my bearings. If this ever happens again, I’m not scheduling a meeting late in the afternoon when everyone’s leaving work. Don’t roll your eyes at me lady. Do I have a camera around my neck? I’m not some tourist, you know.

Walking down the street trying to avoid being knocked over by everyone else walking up the street to the train station, I noticed how some of the biggest buildings have some of the smallest building numbers. I could play this game with my kids all day … I spy with my little eye … something that is one shade darker than concrete, covered by pigeon droppings, written in 6 point type, and is underneath an awning in the shadows. Right! It’s the building number!

Vinny’s building had security screening personnel who were apparently all disgruntled former TSA employees. I had to show picture ID and state the name of the person I was coming to see. Then they had to call the person to verify that I really was supposed to be there. I got a sticker ID that I had to wear at all times while in the building. This wasn’t an ordinary ID sticker, though. It turned red after being exposed to the air so you couldn’t use it again the following day.

The waiting room of Vinny’s office was smaller than I expected. Contemporary design with a glass motif. Old golf magazines and law journals were scattered about the end tables. There was a constant background din of the secretary answering the phone and transferring calls to different offices. “Smith, Jones, Brown, White, Schmidt, and Rubenschlager, how can I help you?”  I kept hearing the same greeting over and over again. Literally a call or a transfer came in every 30 seconds while I was sitting there. Sometimes after a night shift and little sleep I’ll answer our home phone “Emergency department, can I help you?” I meant to ask her if she ever answered her home phone the way she does at the office, but she was still in the middle of a call when Vinny walked out of the door.

“Hi, are you doctor WhiteCoat? I’m Vinny.” Whoa. Absolutely nothing like I expected. I was expecting an older heavy set balding guy in a designer suit with a Rolex watch rattling around on his wrist. Vinny was young – maybe a little older than me – thin, tall, glasses, and a full head of wavy brown hair. He was wearing a white dress shirt with the sleeves rolled up. No watch at all. So the insurance company’s “go to guy” is a modern day Atticus Finch. Interesting.

We spent several hours going through the medical records and making sure I knew all of the pertinent facts in the case. He also threw a lot of questions at me and showed me how the plaintiff’s attorney would try to trip me up when he asked them. He also showed me how to answer the questions so that I wouldn’t get tripped up.

I also got to meet the attorney working on my case with Vinny. I had received many letters from Louise over the previous year. Most just advised me of what had happened in court hearings and what the plaintiff’s attorney was doing. Louise was in her mid-30s and thin. Her shoulder length blonde hair was gathered back into a ponytail using a scrunchee. Some of her hair had come out of the ponytail and kept falling in her face, so she repeatedly pushed her hair back behind her ears. Every time she leaned forward, the hair flopped out again. She wore a sharp blue suit.

It was easy to tell that Louise wanted to get down to business. She seemed to get annoyed when Vinny went off on tangents not related to the case. I could tell that she was a perfectionist. She would get frustrated on the spot if I did something she didn’t like.

“NO! Repeat after me. ‘The patient didn’t have signs of sepsis when he arrived in the emergency department, so there was no reason to initially suspect it.’”

Louise had a thing for her pen, too. She chewed on the end, doodled intermittently as I talked, and would slam the pen on her pad of paper to make a point. Normally I do little things just to irritate people like Louise to try to get them to loosen up. Louise seemed like she was wound so tight that she’d use the chewed up pen to stab me in the jugular if I gave her a reason, so I just smiled and nodded my head when she talked.

After a few hours of preparation, I felt pretty confident – both in the care I provided and in my ability to deal with the plaintiff’s attorney’s questions.

“Want to get some dinner?” Vinny asked both of us.
“No thanks,” I replied. “Family’s waiting for me. Tonight’s pizza night.”
“Remember – don’t go researching this stuff before next week. I guarantee you’ll get grilled about it if you do.” The tenor in Vinny’s voice started to climb again.
“I know. I know. You told me that before. See? I listen to you. Now relax, will ya? See you next week.”

When I considered blogging about my malpractice case, I just figured that the posts would be of interest to a few. Not the case. The interest in this case has been incredible. Thanks to Kevin MD, Walter Olson at Overlawyered, GruntDoc, Shadowfax, Eric Turkewitz at NY PI Law Blog, Medicine Think, Law.com, Scienceroll, whomever “Stumbled Upon” my post, and any others I may have missed.
I’ll up the ante and aim for trial posts two days a week (there will probably be about 25 posts in total). Hope it lives up to everyone’s expectations.

—————————–

I checked the attorney out online at Martindale.com and researched him on our state web site. I also  had a couple of friends who are lawyers get some information about him. He had a very good reputation. That’s good news. One friend told me that he was the “go to guy” that the insurance company used to handle complex cases. That worried me. I know that I’m looking at the care I provided from my own skewed perspective, but I thought that everyone did a pretty darn good job treating this patient. Why did the insurers want a “big gun” for this case? I’m sure it’s not like he or his firm were hurting for business.

So I called “Vinny” and we talked on the phone for a while. I liked him almost immediately. Very down to earth. Knows his stuff. He did seem a little high strung at times. I could hear the tenor in his voice go up when he told me things to do and things not to do from that point forward.
“Don’t talk about this case with anyone but me – the plaintiff’s attorney will grill you about it during your deposition and you’ll drag other people into the case who may hurt you.”
Check.
“Don’t research the issues before your deposition. You’ll get grilled on any text that you referenced.”
Check.
“Don’t say anything to the family if you happen to see or treat one of them.”
The list went on for another minute or so with each “don’t” being a slightly higher octave than the previous one. I got to the point where I was thinking “OK, OK, relax there, bud. I’ve only spoken to you for 20 minutes and you’re already making my blood pressure go up.”

Vinny promised to keep me informed about any developments in the case.

A few months later I got a large packet in the mail from Vinny’s law firm. There were a bunch of detailed questions called “interrogatories” from the other attorney that I had to answer under oath. I had no idea what the heck some of them had to do with the case. It didn’t matter, I still had to answer them. Vinny asked me to write out answers to the questions I could answer and then told me that he would put them into a “legal” format once he got them back from me. He told me not to worry about things I didn’t know – leave the questions blank. More information would come out as the litigation progressed and we could supplement the answers later. I started to research answers to some of the questions in order to justify each of the actions I took. This time Vinny told me to relax and to let the experts do that.

Easy for him to say.

Vinny’s firm and the insurance company contacted me with the name of an expert that they had chosen to review the case. Everyone seemed impressed with his credentials. He was from a teaching program and his curriculum vitae was reportedly quite large. Hey, great, so  if his testimony isn’t that good he can roll up his “CV” and smack the plaintiff’s expert around with it. Or we can use the CV for a doorstop during trial. Go for it.

The attorney sent the expert with the 5 pound CV a copy of all the medical records. Then the attorney, the insurance representative, and the expert with the 5 pound CV had a meeting to discuss my care. Other experts would review the care by the other doctors. This expert was focusing just on my care. I got a letter a couple of weeks later summarizing their discussions. The expert thought my care was negligent.

I got mad. It seemed like the expert started with the ultimate diagnosis and worked backwards to focus in on what I should have done to begin with. “Dr. WhiteCoat didn’t appreciate how sick this patient really was.” Had he read through the chart, he would have seen that wasn’t the case at all. I called 4 consults on the patient in a few hours, resuscitated him from shock, and ruled out many life threatening illnesses. Yes, it took me a little longer to get to the diagnosis, but I did make it. The expert was criticizing me because he knew the zebra diagnosis before he even got the medical records and I didn’t think of the zebra diagnosis right off the bat. The expert gave several reasons why he thought what I did was wrong, completely criticized my thought processes, and listed another few things that I should have done differently. No basis for his opinions, mind you. Just a bunch of “shoulda, woulda, couldas.” By the time I finished reading that letter I was close to sustaining one of those fractures that occur when you accidentally fall on the floor.

I went back into research mode. I analyzed each of the expert’s statements and wrote a fourteen page letter to my attorney and my insurance company rebutting each of the expert’s statements. I stated that the expert’s opinions were “unsupported by any medical literature” and I attached copies of several articles and textbook passages supporting my care. If “Dr. 5 pound CV” practices medicine in the same manner he reviews cases,” I wrote, “he is jeopardizing the health and safety of [his] patients.”

I got a small amount of satisfaction when the insurance company agreed to get the opinion of another expert. But before the insurance company would consult another expert, I had to agree to abide by whatever opinion the expert rendered. Fine. This time I’m learning more about the expert before he gets his hands on the medical records.

We agreed on expert #2. His CV wasn’t as big. He was the assistant director of an emergency medicine residency program in a large city. They sent him another set of medical records and they had another meeting.

A few weeks later I got a call from Vinny describing the meeting. He made some small talk.
“How ’bout them Mets?”
“Who cares about how the Mets are doing?” I thought to myself. I don’t even like baseball that much.
I cut him off.
“So what did the expert think?”
“Well …” he started, then hesitated … “the expert doesn’t think that you met the standard of care ….”
When I heard those words, my heart sank. I must really be a bad doctor if I not only provided negligent care, but I still think the care was appropriate. What am I going to do now?

He finished his sentence by adding “… he believes that you exceeded the standard of care.”

You bastard. That was a perfectly good pair of underwear I had on.

OK, I can breathe again. Thought I was going this journey alone for a second, there.

Vinny told me not to expect to hear much from him until it was time to schedule depositions.

He owes me one set of Jockey shorts.

Wow.

Congratulations to everyone on making yesterday’s post the most popular blog post I’ve had in a while. The only time I can remember having more hits in one day is when one of my vaccination posts got picked up by Glenn Reynolds at Instapundit.

I appreciate everyone’s good wishes. The blogosphere is a great place where I’ve made a lot of friends and probably a few enemies, but the former far outnumber the latter.

Nurse K, ERP and Ten are right. The trial is over. I know all about Flea and don’t intend to repeat history.

Medical malpractice is a game where neither side wins. On one side, patients suffer bad outcomes – some due to medical negligence, some not. On the other side, an accusation of medical malpractice cuts to the soul of any medical provider (read this story about Philip Ticktin to see what I’m talking about). During the many years inherent to any malpractice litigation, both sides are forced to relive these bad moments over and over again. Both sides are forced to listen to other people question their actions and accuse them for being at fault. It isn’t a matter of who wins in a lawsuit, it’s a matter of who loses least.

The death of a patient is especially troubling because many people, physicians included, fail to remember that death is a part of life. Death is not some abberancy that we can stave off with a futuristic handheld scanner dreamed up by Gene Roddenberry. Death can happen at any time and in any place. Just because death happens does not necessarily mean that someone else is to blame.

The story I will tell is a story that needs to be told. I’m past it now. I’ve licked my wounds and they are healed. It isn’t about me any more. It’s about every other health care professional who has been on the receiving end of a summons who doesn’t know what to feel and who doesn’t know where to turn. You aren’t a bad person. Even if you made an error, you’re human. Sometimes I wish patients could understand that more.

So to those worried that what I write will be used against me by some future plaintiff attorney, let them try. You’ll be reading about them in this blog in the future.
To those who think the HIPAA police will come and lead me away in handcuffs, file a complaint. Here’s the link. The information in this case has been de-identified, facts have been changed, and it is no longer subject to HIPAA laws.
Defamation? Truth is an absolute defense. What isn’t true hasn’t harmed anyone and my observations and opinions aren’t actionable.
Legal scholars want to debate whether it is “unethical” for me to talk about a malpractice trial? Go for it. The more discussion, the better. If this series is what it takes to bring the issues involved in medical blogging to the next level, I’ll be the fall guy. I won’t live my life in fear of what some evil attorney might sue me for.

So …

I’ll try to put up at least a post a week about what happened. I was going to put them all up back-to-back, but thought that readers would become bored. There are a lot of twists and turns in the whole series of events, and I took good notes.

Now stop worrying so much and enjoy reading, will ya?

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.

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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.

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See other posts in this series here.