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.

Why physicians are clueless about malpractice implications of DVTs

Angry Orthopod, MD

Physician

July 29, 2011

A medical malpractice attorney and an orthopaedic surgeon are on a golf trip. This sounds like the worst joke of all time, but it’s actually the story of my brother and I 20 years ago.

Amidst the rough, he laid some serious philosophy on me. In most families, that might be about life and love and whatnot. Not in our family. We were engaged about deep venous thrombosis (DVT) and …

People accuse doctors of not doing enough, or doing too much

Doctor Grumpy, MD

Physician

July 28, 2011

Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.

There are no easy answers. We’re caught between doing what’s best, without putting the patient through too much, and doing what’s needed to protect ourselves from legal action.

Let’s take Mrs. Summer. She’s a nice 78 year-old lady I saw in the office last week.

Earlier this month she hurt her back. So she saw …

What is defensive medicine in obstetrics?

Amy Tuteur, MD

Physician

July 26, 2011

Consider the explosion in the rate of C-sections and inductions. They satisfy the requirements of assurance behavior.

Reducing adverse outcomes? Check.
Deterring medical malpractice claims? Check.
Pre-empting liability? Check.

Consider the precipitous decline in the rate of VBAC. That’s avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.

There’s an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven …

Medical malpractice doesn’t address patient safety

David Williams

Health Policy

July 24, 2011

Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit. It drives up costs without creating benefits. There’s some truth to this argument, …

Do non-compliant patients really sue their doctors?

Jock Hoffman

Physician

July 14, 2011

The non-compliant patient who sues his physician for an adverse clinical outcome is a storied malpractice bogeyman. After failing to follow a screening regimen, show for appointments, undergo recommended tests, make health-related lifestyle changes, or take their medications, these patients (now plaintiffs) have the audacity to blame the doctors and nurses for not being adequately clear or assertive.

Are they real?

Yes and no. Not every “difficult” patient is a potential …

Pro-actively improve quality, rather than reacting to liability concerns

Charles A. Pilcher, MD

Physician

June 16, 2011

Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. Bottom line: There is no consensus what the future holds.

There is no question that reform is necessary to avoid absolutely bankrupting the country. However, the recent legislation is a work in progress, not yet an achievement. A change in congressional leadership could derail, …

The Golden Moment in medical malpractice

Kathleen Clark, PhD

Physician

June 12, 2011

As Kevin Pho pointed out in his piece, “How malpractice hurts doctors and their future patients,” physicians who have been through trial are often never quite the same.

Physicians who have been sued in medical malpractice case are often referred to as the “Second Victim,” a term that says it all. When a mistake is made and a patient is injured, the physician also suffers, often in silence and …

Emotionally supporting physicians sued for malpractice

Jock Hoffman

Physician

June 6, 2011

A physician or nurse who receives a Summons and Complaint regarding a medical malpractice suit also receives pointers about whom to talk to, what to say, what not to say, and whom not to talk to. Despite some emphatic precautions, the appropriate advice to those malpractice defendants is not strictly “shut up and lawyer up.”

To help defendant clinicians cope, the answer …

Medical malpractice tort reform equals healthcare reform

Darrell E. White, MD

Physician

May 26, 2011

I’m a big game theory guy.

I think you can explain the actions of the participants in any structured activity or enterprise by looking at the rules of the game. When you look backwards in time you discover that the “players” almost always made choices that represented rational self-interest. This is especially true in games played using zero sum rules: someone wins only if someone else loses. How the game is …

Cut hospitalizations to reduce hospital related medical errors

David K. Cundiff, MD

Physician

May 25, 2011

To address the huge problem of errors by health professionals causing injuries and deaths to hospitalized patients, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius unveiled the Partnership for Patients initiative.

Secretary Sebelius referred to a recent study showing that adverse events in hospitalized patients, including those caused by human errors (i.e., preventable), occur about 10 times …

How malpractice hurts doctors and their future patients

Kevin Pho, MD

KevinMD

May 16, 2011

Little has been written about the impact a malpractice lawsuit has on physicians.

But physicians who’ve been sued have a higher rate of suicide, and emergency physician Edwin Leap wrote about how doctors are emotionally scarred from the grueling ordeal of a trial.

A recent piece from American Medical News puts faces on the toll:

The key to surviving is having …

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How malpractice hurts doctors and their future patients

Physicians coping after a medical error

Jock Hoffman

Physician

May 10, 2011

A failed treatment, a surgical complication, a medical error, a patient death. When the going gets tough, even the toughest clinicians should get help.

Physicians and nurses who feel personally responsible for a medical error or a patient’s injury face an immediate quandary—their next patient. In the midst of your angst and guilt, do you suck it up and soldier …

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Physicians coping after a medical error

Where do we draw the line on criminalizing mistakes?

Jeffrey Knuppel, MD

Physician

May 7, 2011

Eric Cropp was a pharmacist who was sent to prison for a mistake that resulted in the death of a child.

This was a high profile case, but it was just one of many examples of a disturbing trend I’ve seen in the U.S. in recent years: a person commits a mistake–with no malicious intent and without being under the …

New ACGME work hour regulations for interns: friend or foe?

angienadia, MD

Physician

May 5, 2011

On the night of October 4, 1984, a young girl named Libby Zion was admitted to New York Hospital in Manhattan for fever, agitation and strange jerking movements. No one knew that her death the next morning would, 27 years later, drastically change the quality of physician training, for better or worse.

When Libby was evaluated in the emergency room that night, neither the ER physician nor her family physician Dr. …

Should nurses be fired for fatal medication errors?

Kevin Pho, MD

KevinMD

May 2, 2011

Kimberly Hiatt was a pediatric critical care nurse who accidentally gave an infant a fatal overdose of calcium chloride last year.

By accounts, it was a calculation error. A human mistake.

After the incident, the hospital fired her.

This past April, she took her own life.

Although it cannot be concluded that the tragedy was directly responsible for her suicide, the incident clearly …

A medical malpractice system that reduces errors and improves quality

Kevin Pho, MD

KevinMD

April 25, 2011

The Affordable Care Act does very little to reform the medical malpractice system.

It only allocates $50 million to various pilot projects around the country.

A recent piece in the New England Journal of Medicine provides more detail. It appears that, instead of capping non-economic damages, many of the projects have a quality …

Diagnostic errors and their role in patient safety

Charles A. Pilcher, MD

Physician

March 31, 2011

American Medical News published an informative essay by Kevin B. O’Reilly on December 13, 2010, about errors in diagnosis and why doctors make them.

According to Gordon Schiff, MD, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital, “The problem of diagnostic errors has gotten short shrift in the broader patient safety movement.” The article focused on …

Uncertainty in the diagnostic methods of the obstetrician

Kevin

Physician

March 20, 2011

by Henry Dorn, MD

In 1974, the noted obstetrician Marcus Filshie published a review of the relatively new electronic fetal monitoring in the British Journal of Hospital Medicine. He stated, somewhat fatefully:

Now that the appropriate technology is available, the obstetrician may virtually eliminate intrapartum stillbirths and reduce morbidity to a minimum.

Similar statements were made in the United States by leaders in the obstetrical …

Health costs need to be addressed by doctors, patients, and lawyers

Kevin Pho, MD

KevinMD

March 15, 2011

It’s no secret that our health system encourages doctors to order too many tests. Compounded with the widespread belief that more tests equates to better medicine, the reasons why health costs are spiraling out of control aren’t a secret.

In a perspective piece from the New England Journal of Medicine, physician Sean Palfrey notes our dire situation:

Recent advances …

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Health costs need to be addressed by doctors, patients, and lawyers

Medical error in a fertility clinic

Kevin

Patient

March 7, 2011

by Carolyn Savage

Our names will be forever connected with one of the most significant medical errors ever made inside a fertility clinic.

In February 2009, through a process referred to as a frozen embryo transfer, another couple’s embryos were mistakenly transferred into my body. Eight months later, I gave birth to a baby boy who we relinquished to his genetic parents a few minutes after …

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Medical error in a fertility clinic