Malpractice and Medical Liability

Physicians writing on KevinMD about being sued and about making mistakes: the summons, the deposition, and the verdict that does not feel like winning, whether damage caps and safe harbors work, frivolous claims argued from both sides, expert witnesses, nuclear verdicts and premiums, apology laws, and how physicians say errors happen and what it is like to make one. Two maintained records draw on this archive: Medical malpractice: what physicians say, in their own words and Medical errors: what physicians say, in their own words.

Waiting for a story that could potentially decimate my life

Kate O'Reilley, MD

Physician

December 6, 2012

Waking before dawn, I scurry into the study. Sitting in front of the computer, I wiggle the mouse, bringing the screen to life. Hesitantly, I call up the site for the major local newspaper. Since being notified by my attorneys one week prior that a reporter was hunting me down for comment, I am on heightened alert. Every day spent awaiting a story that could potentially decimate my life.

The home …

Stopping extensive pre-op testing requires malpractice reform

Skeptical Scalpel, MD

Physician

December 4, 2012

As predictable as the leaves falling this time of year, another paper on the subject of unnecessary preoperative laboratory testing has appeared.

A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in the National Surgical Quality Improvement Project (NSQIP) database. Almost 2/3 of the patients had preoperative laboratory tests. Of that group, 58.6% had a CBC, 53.5% had electrolytes, 23.7% had …

The difference between complications and negligence

Michael Kirsch, MD

Conditions and Diseases

November 17, 2012

A patient who was minutes away from his colonoscopy, asked me how many colonoscopies I had performed. Before I could answer, he quickly followed-up asking if any of my patients developed perforation of the colon after the procedure.

I satisfied his initial inquiry when I informed him that I have intruded into at least 20,000 colons in the past 2 decades. With regard to his second and more ‘penetrating’ question, I …

Why it’s important to place limits on liability by association

Chris Rangel, MD

Physician

November 12, 2012

In June of 2006 Mary Ann Ambrogio went to see her gastroenterologist Dr. Frank Troncale in Connecticut for a follow up of her history of liver cirrhosis and associated hepatic encephalopathy.

Reportedly following this visit Mrs. Ambrogio was driving home when she passed out and hit a pedestrian John Jarmie causing “severe and permanent” injuries. The injured pedestrian sued Dr. Troncale claiming malpractice under Connecticut law in that the doctor did …

National reporting isn’t the answer to reduce medical errors

Kevin R. Campbell, MD

Health Policy

October 21, 2012

Two articles recently addressed medical errors.

In the Wall Street Journal, surgeon Dr. Marty Makary discusses the alarming costs of medical errors and offers suggestions to improve the system. In medicine, particularly during the training years of residency and fellowship, young doctors are not given the opportunity or security to report shortcomings of their superiors.

As discussed in the article, all of us have a memory of a particular surgeon …

Cause of death: Defensive medicine

BirdStrike, MD

Physician

October 5, 2012

1. A 40-year-old female sees her family physician for burning chest pain after she eats hot peppers. She had it only once while exercising. Her family physician sends her to the emergency department and she gets admitted for chest pain. Rather than going home with treatment for her GERD, she ends up dead. This never should have happened, but the family never learns what really killed her.

2. A 33-year-old father of …

Read more…

Cause of death: Defensive medicine

Why punishing medical mistakes won’t make patients safer

Edmund Kwok, MD

Physician

September 25, 2012

An interesting story came across my desk recently. Apparently, some states in the U.S. have moved towards a punitive model in trying deal with medical errors and adverse outcomes – this particular story describes how Utah will no longer fund healthcare providers and hospitals for dealing with illnesses that resulted from avoidable errors and infections.

On the surface, it kind of makes sense – one should be punished for making a …

Inducing anesthesia on YouTube: How many ways is this wrong?

Karen S. Sibert, MD

Physician

August 24, 2012

Really, sir. What were you thinking?

I’m talking to you—the anesthesia provider (I hate to think that you might be an anesthesiologist) who allowed himself to be videotaped while a patient injected his own induction dose of propofol. Most people know something about propofol even if they aren’t in the anesthesia business–that’s the medication that Dr. Conrad Murray gave Michael Jackson to everyone’s sorrow.

I would insert the link here, but the …

Doctors in no win situations: Damned if you do or don’t

Skeptical Scalpel, MD

Physician

August 17, 2012

Here’s a little story from the early days of my first job as a chairman of surgery.

Shortly after I assumed the role of surgical chairman in a community teaching hospital at the ripe old age of 40 and having absolutely no administrative experience, I visited a mentor of mine whom I had known since I was a medical student. He had been serving in a similar role at a larger …

Why always saying yes could be dangerous for you and your patient

Jock Hoffman

Physician

August 14, 2012

Encouraging patients to be more engaged, may also encourage more people to go beyond assertive to demanding care unsupported by good clinical judgment. Of course, physicians worry that saying “no” to a patient increases their risk of being disliked, dismissed, or even sued for medical malpractice.

Greater transparency in health care means patients are more aware of options for screening, testing, procedures, and medications—often via direct advertising or public service campaigns. …

Is the death of Rory Staunton really the result of a simple mistake?

Skeptical Scalpel, MD

Physician

August 8, 2012

If you pay attention at all to news about medicine, you must have heard about the tragic death of a 12-year old boy who was seen and discharged from the emergency department of the prestigious New York University Medical Center. He had developed sepsis from what appears to have been a small cut and the diagnosis was missed. When he eventually returned to the ED and was admitted, it …

Why does fear of litigation turn into preference for action?

Peter Ubel, MD

Physician

July 18, 2012

LeBron James exploded past his defender and raced towards the lane. Serge Ibaka, the Thunder’s mountainous center, planted his feet and raised his hands straight up into the air. LeBron ducked his left shoulder and plowed right into Ibaka, who went crashing backwards into a nearby cameraman.

Offensive foul?

Maybe if it had been the first quarter. But given that this was the last minutes of a tightly fought game, the referees …

The New York medical malpractice crisis: Who’s to blame?

Kevin Pho, MD

KevinMD

July 16, 2012

Is this the endgame for the medical malpractice crisis?

A recent cover story in the New York Times describes how some financially struggling hospitals are “going bare,” meaning they are partially or completely forgoing malpractice coverage.

From an economic standpoint, it’s a rational thing to do. Malpractice insurance costs are skyrocketing, forcing these hospitals into uncomfortable choices.

As one administrator bluntly puts …

How copy and paste in electronic medical records affects patient care

Elizabeth Hipp

Health Technology

July 1, 2012

With many hospitals and medical providers still in the early adoption stages of EHR, objections or problems with the various systems are still just coming to light. However, one particularly growing concern is providers using the copy-paste or copy-forward function in patient records. This is a shortcut that many physicians have found to be handy after the implementation of the new system, however using it actually can violate patient confidentiality …

The problem of expert witnesses in medical malpractice trials

Jim deMaine, MD

Physician

June 28, 2012

I went to court recently sitting quietly in the gallery listening to the testimony of two designated experts who criticized the care of a cardiologist (admired in local medical circles for his brilliance and excellent care of patients). The case on first glance didn’t look very good for this defendant. The patient had presented to the ER with atypical chest pain, was admitted and evaluated with an exercise test and …

James Reason and the foundation of patient safety

Robert Wachter, MD

Physician

June 18, 2012

Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus.

Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by …

Protecting patients by solving the problem of defensive medicine

Ellis Weeker, MD

Physician

June 2, 2012

In the United States many people feel it is their God given right to sue anyone, anytime for anything. Whether you are successful or not may be another story. So what are the cost implications for healthcare in the United States? Few other developed countries rely upon this method for resolving malpractice issues. What is the cost-benefit equation? To protect themselves, American physicians practice what is called defensive medicine designed …

How we need to take risk to reduce risk in hospitals

Richard Corder

Physician

May 31, 2012

The show-stopping line from the Hans Christian Anderson’s 1837 fairytale is actually, “But he has nothing on!”

A brave, young, clear thinking boy in the crowd is the only person confident enough to say what he thinks and speak up. Perhaps even more simply, the young voice in the crowd has not had the life experience that often builds (and rewards) the filters of loyalty, flattery and only saying and thinking …

What medicine can learn from the Titanic

Rushil Patel

Physician

May 26, 2012

April 15th marked the 100th anniversary of the sinking of the Titanic, yet the mystique surrounding its demise has not faded. When the colossal vessel first collided with the iceberg, eyewitness accounts described an eerie sense of serenity that pervaded the ship. Passenger J.J. Astor even remarked, “We are safer here than in that little boat,” before later drowning.

To prefer drowning over safety strike us as irrational, but this behavior …

Are the poor more likely to sue their doctors?

Neil Baum, MD

Health Policy

May 26, 2012

Many physicians, including myself, have the misconception that the indigent patient is more likely to be litigious than those patients with greater financial resources. A well-organized study that was reported in Clinical Orthopeaedics and Related Research reported that socioeconomically disadvantaged patients tend to sue physicians less often than their more affluent patients.

Dr. Ramon Jimenez and his colleagues at the Monterey Orthopaedic and Sports Medicine Institute and his team demonstrated that patients …