how often are ER docs sued?

[emtji]

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so i'm aware of the fact that ER is one of one of the more litigious fields, but to what extent? One of the things that has me leaning away from going into ER is the place in the FAQ section about how "ER docs aren't offended when they're sued". i tried looking this up, but was wondering if others could discuss the extent to which ER live in fear of being sued...

thanks...

 

[docB]

About every 4 years. I've been lucky so far but it's really just a matter of time. It really does hang over you every day. Defensive medicine is as bad in EM as anywhere. It's still a good field but the med mal does suck.

 

[EctopicFetus]

About every 4 years. I've been lucky so far but it's really just a matter of time. It really does hang over you every day. Defensive medicine is as bad in EM as anywhere. It's still a good field but the med mal does suck.

Now this is just heresay but when I was rotating at Orlando Regional one of the attendings there (who isnt there anymore) told me that across the nation it was 1 in 7 years but was 1 in 4 years in Florida. Take it FWIW since I havent read or seen an article on it anywhere.

 

[beyond all hope]

I've heard once every five years quoted, but that means nothing for the individual doc. It's mostly luck. I know a guy who's been in practice 15 years and sued 8 times, and he's not a bad doc. I know another in practice 25 years who's never been sued, and he isn't the greatest doctor in the world.

The best way to handle malpractice is to realize that it's a game, that it usually has nothing to do with your competance as a doctor but just how unlucky you are.

Decathect. Don't get emotional about it.

I haven't been sued yet but I've been around them. I've probably already seen the patient that will be my first lawsuit. She or he is probably making a case right now.

I've learned a lot from the doctors around me that have been sued. The best realize that it's just part of the cost of doing business, don't get stressed about it, and just go through the motions.

The cases that go to court are often ones without merit, and the worst mistakes you make will probably never go to court. As one of my attendings says.

"I've committed malpractice, and I've been sued, but I've never been sued for malpractice."

 

[docB]

I've probably already seen the patient that will be my first lawsuit. She or he is probably making a case right now.

That's an excellent way to articulate the kind of feeling we all live with day to day. It's why I hate med mal lawyers. The worse feeling is that your next patient could be the one. That's why certain patients like pregnant SOBs make me cringe.

 

[ERMudPhud]

I've probably already seen the patient that will be my first lawsuit. She or he is probably making a case right now.

I know what you mean. Whenever a patient or especially a law firm request copies of medical records we get notified by risk management. Sometimes its obvious from the record that they are suing someone else. Sometimes they are pissed about their bill. Sometime you look at the medical record, shrug your shoulder, and say what the hell because you can't imagine what they are after. So far none of the latter have turned out to be suits but I'm sure the day is coming.

The part I like best about the whole tort thing is exemplified by the recent round of vioxx suits. Same drug, same company, same circumstances, virtually indistinguishable patients yet in about half the cases the company has been found liable for millions and in half they were found not liable. Shows what a crap shoot the whole thing is.

 

[emtji]

Decathect. Don't get emotional about it.

I've learned a lot from the doctors around me that have been sued. The best realize that it's just part of the cost of doing business, don't get stressed about it, and just go through the motions.

how do you avoid getting stressed about it? i think being sued would cost me a few nights of lost sleep....

 

[Apollyon]

how do you avoid getting stressed about it? i think being sued would cost me a few nights of lost sleep....

Well, a lot of people DON'T avoid getting stressed - most people in medicine - like most people in general - are good people, and the accusations strewn in a suit can be heartbreaking. People that don't drink start, those that do drink more, some people turn to drugs, some have BAD family problems, sleepless nights, horrible GI days - and that is even when you are RIGHT. Getting served, guaranteed, will ruin your day - period. Some people question their worth as a doctor or a person, or obsess over the idea of "how many other people did I hurt or kill?".

It can be helped, and, almost always it isn't as bad as you think - but the mind can develop some pretty gnarly scenarios.

 

[Sheerstress]

how do you avoid getting stressed about it? i think being sued would cost me a few nights of lost sleep....

To AVOID getting sued in the first place, work (as a medical student and as a resident) to build up the knowledge base that you'll need to be a competent EM physician. Know when it's OK to send a patient home, and know when you have to admit or get a specialist involved. Know how to set up appropriate follow-up. And be prepared to deal with physicians who don't want to admit a patient or consult on one.

Towards the end of your residency, or perhaps when you start out as an attending, it may be worthwhile to attend one of the many EM risk management conferences that highlight how to stay out of trouble in high-risk situations. Remember that your goal is to prevent a lawsuit from happening, not winning at trial.

Beyond that, as long as you're staying current and not getting sloppy, what use is it to get stressed or lose sleep? You know what you're getting into in this field, and as noted above, some situations are no-win from the time they hit your ED.

And finally, if you GET sued, it certainly won't be a good day for you (the first lawsuit is often the worst), but you'll deal with it like any other adversity in your life - you'll face it head on, and learn how to navigate the legal system. This is all probably not very pertinent to you right now, but here's information on what to expect:

http://www.acep.org/NR/rdonlyres/6057BE52-F60F-4379-B686-F4477DE38E1F/0/syhbs.pdf

 

[Telemachus]

If you're really worried/interested, I just saw a thing saying Hopkins has a one-year medico-legal fellowship for EM, maybe you could look into something like that.

 

[DrQuinn]

I worked as a med mal defesne paralegal during med school (and still do some consulting work). Having spoken to lots of lawyers, basically I've come up with the following rule (named after myself):

"Just practice good medicine."

Honestly, there's nothing more you can do. Be a good bedside physician. Be dogmatic about chest pain patients. Do what you would do for every patient WITH every patient. Just follow the algorithms/evidence that has been taught to you in residency, and that's honestly all that people (and lawyers) can ask of you.

I've never been named in a suit... but I"m still a resident. Its going to happen, I promise you... to each and every one of us. But worrying about it, and even worse, changing the way you practice medicine is not going to help. Just give the best patient care that you can and move onto the next patient.

Q

 

[SoCuteMD]

Be a good bedside physician.

According to my touchy-feely med school classes, this is the true way to not get sued...

 

[southerndoc]

To AVOID getting sued in the first place, work (as a medical student and as a resident) to build up the knowledge base that you'll need to be a competent EM physician. Know when it's OK to send a patient home, and know when you have to admit or get a specialist involved. Know how to set up appropriate follow-up. And be prepared to deal with physicians who don't want to admit a patient or consult on one.

Being sued rarely has anything to do with how much you know or what you didn't do. It's how you made the person feel. If you take a 2-minute history and then screw up the diagnosis, then yea, you're going to get sued. Take a 15-minute history and screw up the diagnosis, and the person feels like you were a caring physician who spent time with him/her.

The better rapport you generate the less likely you are to be sued. It has nothing to do with how good of a physician you are. The most knowledgeable physician in the world will be sued if his/her bedside manners suck.

 

[MossPoh]

Certain states are just more prone to suing than others as well......My father isn't an ER doc..rather a radiologist (I'm just scanning through stuff as a premed person now)..but he talked about getting lawsuits all the time while in Florida..all b.s...and that it was the same in other sue happy places like cali and new york.....but as soon as we went to indiana he got sued only once in 15 years of practice.....

 

[leviathan]

The most knowledgeable physician in the world will be sued if his/her bedside manners suck.

And even if his bedside manners are excellent, I bet it's still unavoidable when you run into certain patients who will try to sue everyone they come into contact with in the world.

 

[BKN]

how do you avoid getting stressed about it? i think being sued would cost me a few nights of lost sleep....

Once you get sued, you can expect to be an "impaired physician" for the duration of the ordeal. I used to say fight it to the end if it's unjustified (75% of the notices) and get out as cheaply as you can if your experts have any significant criticisms. The national practitioner databank changed all that. Now I don't know what to say.

 

[8744]

According to my touchy-feely med school classes, this is the true way to not get sued...

It's true. In the Specialty That Dare Not Speak Its Name they rarely, if ever, get sued even though the opportunities to miss a diagnosis are legion.

 

[Sheerstress]

Being sued rarely has anything to do with how much you know or what you didn't do.

I don't completely agree - Bad outcomes certainly do increase the likelihood of being sued no matter how nice you are, and bad documentation of your findings and treatment plan can be the difference between getting or not getting sued.

But you're right - the patient's perception of your concern for their problem and how well you addressed it is a HUGE factor in medical malpractice claims, and some physicians just don't get it.

 

[vtucci]

Being competent is very important regardless of the fied of medicine one seeks to pursue. However, as an attorney, I can tell you the main reason for any lawsuit is someone did something to piss off the plaintiff. That may seem very elementary but the quickest way to be sued is for the patient to feel that you are an dingus or do not care about them and their needs (i.e., looking rushed and harried, not looking at them in the eye, leaving all the check ups to the nursing staff). It is pretty frightening to look at the stats for some doctors- it is not that they are incompetent (most lawsuits are not about that), it is that they are not warm and fuzzy or at least are not good at appearing to be so.

 

[VA Hopeful Dr]

Being competent is very important regardless of the fied of medicine one seeks to pursue. However, as an attorney, I can tell you the main reason for any lawsuit is someone did something to piss off the plaintiff. That may seem very elementary but the quickest way to be sued is for the patient to feel that you are an dingus or do not care about them and their needs (i.e., looking rushed and harried, not looking at them in the eye, leaving all the check ups to the nursing staff). It is pretty frightening to look at the stats for some doctors- it is not that they are incompetent (most lawsuits are not about that), it is that they are not warm and fuzzy or at least are not good at appearing to be so.

That's just downright infuriating

 

[BKN]

That's just downright infuriating

Sure it is. But if you knew nothing about the field, how would you evaluate somebody who is doing specialized work for you? Pick the field: aircraft engine design, law, plumbing etc.

 

[emtji]

That's just downright infuriating

i agree.

how does the national practitioner database work? once you get sued, you're listed as an impaired physician? how does the matter when a patient has to see you? or does this make changing jobs difficult?

did the litigious nature of EM factor have any effect on your choice of specialty? i'm planning on going into radiology as of right now, which admittedly is also a highly sued specialty, but this is all very troubling.

 

[mysophobe]

I know a few docs that have been sued for ridiculous reasons (i.e., mother sueing an OB/GYN on behalf of her 16 yo son because she feels his ADD is a result of the way he was delivered), so you can't really do anything to prepare. Being a good doctor is not enough to prevent a lawsuit. You gotta remember that just because you get sued doesn't mean your career is over, or that they will even win.

 

[docB]

how does the national practitioner database work?.

If you or anyone on your behalf (ie. insurance companies) pays money to someone either for a judgement (you got found liable by a judge or jury) or as part of a settlement (you didn't want to go to court) you go into the data bank forever and for all to see your shame.

once you get sued, you're listed as an impaired physician?

No. Once cash goes out you are listed as someone who paid out cash. Impaired usually means you are addicted to something. Getting sued doesn't put into the databank if you win. Only if you lose.

how does the matter when a patient has to see you?

Patients and anyone else can look at the databank. The idea is that if you go into the databank patients will look it up and not go to you.

or does this make changing jobs difficult? .

Yes. It depends what happened. Actually it really depends how much the payment was. It doesn't mean you'll never get another job but it will be harder.

 

[BKN]

i agree.

how does the national practitioner database work? once you get sued, you're listed as an impaired physician? .

No I wasn't suggesting that there is an official title called "impaired physician". I was saying that once you are in the process of being sued you will feel terrible, doubt your self worth and competence, not be able to sleep etc and it will adversely affect your work. And it goes on as long as the suit does.

DocB was saying that the term refers to an addicted physician, and it certainly includes that, but it really refers to a physician who is unable to practice effectively for any reason. Thus psychosis, social disasters etc, including being sued.

Also, the Data Bank is only open to State Boards, hospitals, medical societies with regulatory functions (specialty boards) and other organizations providing health care. Lawyers and the general public should not be able to see it. Rules are here: http://www.npdb-hipdb.com/entity.html

State boards usually post some information about adverse actions but not stuff from the NPDB, I think.

 

[docB]

I meant that there is not a catagory in the NPDB for "impaired" based on getting sued. I didn't realize that emtji was refering back to something else.

I always thought that the NPDB and the other one were open for a fee to whoever. I stand corrected. I know that I had to query myself at my own expense the last time I applied for a license.

 

[MacGyver]

Also, the Data Bank is only open to State Boards, hospitals, medical societies with regulatory functions (specialty boards) and other organizations providing health care. Lawyers and the general public should not be able to see it. Rules are here: http://www.npdb-hipdb.com/entity.html

State boards usually post some information about adverse actions but not stuff from the NPDB, I think.

If thats true, then how the hell do newspaper reporters have access? I have read many newspaper articles about the data bank, and they freely report data from it. They dont give doctors names, but they will say stuff like "one doctor in lincoln county has been implicated in X number of malpractice payouts"

There must be some kind of loophole where journalists can get access

 

[BKN]

If thats true, then how the hell do newspaper reporters have access? I have read many newspaper articles about the data bank, and they freely report data from it. They dont give doctors names, but they will say stuff like "one doctor in lincoln county has been implicated in X number of malpractice payouts"

There must be some kind of loophole where journalists can get access

Lots of possibilities, much of the info is elsewhere, the NPDB is only a collection of info for the agencies I mentioned before:

1. Most likely they are just searching court records,

2. They may have an informant who does have access, and

3. It may not be true, do you believe everything you see in the papers?

 

[TX515]

Once you get sued, you can expect to be an "impaired physician" for the duration of the ordeal. I used to say fight it to the end if it's unjustified (75% of the notices) and get out as cheaply as you can if your experts have any significant criticisms. The national practitioner databank changed all that. Now I don't know what to say.

For instance if you have prescriptions for narcotic pain pills that are not self-prescribed, can a lawyer have access to your medical records and use this as a crutch for impairment? Thanks

 

[dchristismi]

Kind of an odd way to jump into this waay old conversation, isn't it?

Just be aware, that this is a discoverable forum, and that your anonymity isn't assurred. I'm really not exactly sure what you're asking, but it doesn't really sound like something you want out on the 'net, unless, you were, um, asking, hypothetically, for a friend. Unless you were being vague, and it didn't seem vague enough.

I mean, I have some percocet lying around here somewhere. I got it when I had appendicitis, prescribed by my surgeon. I wouldn't think that would label me impaired - we've had 2 ER docs have rotator cuffs repaired in the last year, and I'm sure they were on pain pills. I think that of all specialties, we are relatively prone to (especially orthopedic) injuries.

 

[TX515]

Thank you for the response you answered my question.

 

[Stitch]

In some countries, med mal cases are settled by a judge experienced in medical matters and not a jury. I couldn't agree more. Your average idiot off the street is in no position to decide whether appropriate medical decisions were made. I think it's hard enough to teach medical students and residents how to make appropriate medical decisions.

Generally it seems people are sued more on outcomes than decision making ability. In my field, if I attend a delivery in the nursery as a general pediatrician I'm liable for 18 years after that delivery. That's rather tough. I don't know what the limit is for ER cases.

Liability is one of the reasons I considered doing a child abuse fellowship: you bring parents to court rather than getting sued by them. Pretty awesome.

 

[Octagonecology]

For instance if you have prescriptions for narcotic pain pills that are not self-prescribed, can a lawyer have access to your medical records and use this as a crutch for impairment? Thanks

I'm curious as to what is wrong with having legally prescribed medications?

I'm not sure why he/she responded like that....

 

[Stitch]

Does anyone know where to find info on the best states to practice in terms of med mal? I know Florida is bad, as is most of New England, but is there a site that lists states?

 

[Toohotinvegas33]

Does anyone know where to find info on the best states to practice in terms of med mal? I know Florida is bad, as is most of New England, but is there a site that lists states?

I have heard that there are counties in Iowa that have never sued a doctor, probably because there is only one doc and they would rather have him around cause noone else would live out there.

 

[ccfccp]

Texas H.B. 4 (2003) is one of the most comprehensive tort refrom bills I've heard of. It's worked fantastically and Texas has gone from being one of the most unfriendly towards physicians to one of the better places to be.

 

[deleted77919]

…

 

[Cerberus]

If thats true, then how the hell do newspaper reporters have access? I have read many newspaper articles about the data bank, and they freely report data from it. They dont give doctors names, but they will say stuff like "one doctor in lincoln county has been implicated in X number of malpractice payouts"

There must be some kind of loophole where journalists can get access

When and Why did MacGyver get banned? He could certainly be an ass but I never thought of him as a troll.

 

[Jeff698]

Texas H.B. 4 (2003) is one of the most comprehensive tort refrom bills I've heard of. It's worked fantastically and Texas has gone from being one of the most unfriendly towards physicians to one of the better places to be.

It has been an incredible success. In addition to the cap, the standard of proof in EMTALA-mandated care (i.e. us) is "willful and wanton". This is a big deal.

ACEP ranked us #2 in the nation, behind Colorado, which apparently is doing something really well.

While I'm obviously worried about being sued, I really don't think it directs my management of patients as much as the ever-present concern about missing zebras.

If we really want to cut down unnecessary costs, we need (in addition to malpractice reform) to agree that there is an acceptable miss rate in medicine. We demand perfection right now and, shockingly, it ain't happening. As much as I would like to say this is entirely because of unrealistic patient expectations, we physicians are also guilty of the same thing. Look at work-up of DVT/PE for example. How many times do we order an US or CTA when our clinical suspicion is very, very low?

Take care,
Jeff

 

[hornsfan]

So if everybody gets sued (esp. in EM) and everybody gets put on the list of people who have been sued, does anybody really care? Furthermore, if you sign the line that allows the insurance company to settle early on, regardless of whether the lawsuit is warranted or not, couldn't you get by with a lot less stress considering from that moment on the insurance companies' money is on the line vs yours? Are there any reasons not to do this (other than not wanting to swallow your pride)? Thanks for your responses.

 

[docB]

So if everybody gets sued (esp. in EM) and everybody gets put on the list of people who have been sued, does anybody really care? Furthermore, if you sign the line that allows the insurance company to settle early on, regardless of whether the lawsuit is warranted or not, couldn't you get by with a lot less stress considering from that moment on the insurance companies' money is on the line vs yours? Are there any reasons not to do this (other than not wanting to swallow your pride)? Thanks for your responses.

If you're in the databank too much it will make it hard to get jobs. You also have to explain every suit on every license app and renewal and priveledge app and renewal forever. If most of those end with "and the case was dismissed." it's better. If too many end with "so $XXX was paid to the plaintiff." it's worse.

 

[Stitch]

So where would you all start with tort reform? What are the top three or four changes in your eyes?

 

[docB]

So where would you all start with tort reform? What are the top three or four changes in your eyes?

Cap non-economic damages at $250,000 like the CA MICRA law.

Ensure that experts must be from the same specialty as the defendant.

Provide soverign immunity for docs and hospitals who were providing EMTALA mandated indigent care.

Create a board that is a part of the justice system (ie. headed by a judge) that gets multidisciplinary input that decides if a suit has enough merit to proceed before the defendant can be compelled to spend lots of money on depositions and lost work.

Enact national tort reform in general. Medicine isn't the only industry being crippled.

 

[gman33]

Cap non-economic damages at $250,000 like the CA MICRA law.

Ensure that experts must be from the same specialty as the defendant.

Provide soverign immunity for docs and hospitals who were providing EMTALA mandated indigent care.

Create a board that is a part of the justice system (ie. headed by a judge) that gets multidisciplinary input that decides if a suit has enough merit to proceed before the defendant can be compelled to spend lots of money on depositions and lost work.

Enact national tort reform in general. Medicine isn't the only industry being crippled.

Loser paid legal expenses would also be great, but I can't believe that will ever happen.

 

[docB]

Loser paid legal expenses would also be great, but I can't believe that will ever happen.

I think loser pays should be a part of a more general tort reform program.

From a medical perspective what we really want to avoid are the big jackpot pain and suffering awards a la John Edwards which are ended by caps and the nuisance suits that are cheaper to pay off than fight which would be addressed by a review board.

 

[ccfccp]

Provide soverign immunity for docs and hospitals who were providing EMTALA mandated indigent care.

As Jeff mentioned earlier, I actually like what Texas has done more than this. It makes the statute for malpractice in ED care "gross negligence" (ie "willful and wanton") instead of immunity. I think this provides protection for the patients for true malpractice while protecting physicians more completely.

 

[dienekes88]

You guys should read White Coat's blog about his malpractice trial:

Trial of a White Coat

 

[GeneralVeers]

You guys should read White Coat's blog about his malpractice trial:

Trial of a White Coat

Jury trials should only be involved in cases of criminal negligence or other felonies. All other cases should be adjudicated by a judge or medical review panel trained to evaluate these cases.

It will never happen as the lawyers are in charge of all, and the public has little sympathy for "rich" doctors.

 

[DoctorMedic]

wow that hooked me in pretty quick...lol can't wait for the next installment

 

[Apollyon]

All other cases should be adjudicated by a judge or medical review panel trained to evaluate these cases.

Be careful what you wish for. About 80% of cases are settled in favor of doctors - and that is with general public juries. A professional level panel might find that fault that was not uncovered by the scumbag and not handed cleanly to the general jury. (Greg Henry may have been the one that pointed this out last year or so.)