John Ritter: Discuss fellow pre-meds.

[fisko82]

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Do cases like John Ritter's scare you from practicing medicine? For me, in some ways, they do. I don't want to work my tail off the next 10-15 years, trying to become great at what I do, all in effort to help people...just to have some lawyer tell me, "Fisko, you messed up and didn't save this guy/girl's life. Shame on you. We'll take 67 million and your kid's new set of Tonka toys as compensation. Oh and btw, you can't practice medicine any more. I hear McDonald's is hiring. Kthnxbye."

Discuss.

http://abcnews.go.com/Entertainment/WireStory?id=4382065&page=1
http://abcnews.go.com/Entertainment/WireStory?id=4242074&page=2

"Ritter, 54, fell ill earlier in the day while working on the sitcom '8 Simple Rules ... for Dating My Teenage Daughter' and died of a torn aorta at Providence St. Joseph Medical Center in Burbank. His family is suing Lee and a radiologist, Dr. Matthew Lotysch, who did a body scan on Ritter two years earlier, for $67 million."

"The procedure for treating a heart attack is the 'exact opposite' of what a patient with Ritter's condition would have undergone, according to legal papers filed by lawyers for the plaintiffs."

"The doctors deny wrongdoing. The radiologist has testified the aorta was normal in the scan but Ritter had coronary artery disease at a relatively young age."

"Defense lawyers say that Ritter's condition aortic dissection, a tear in the aorta mimics a heart attack and that the doctors did nothing wrong."

"The doctor's lawyers say that there wasn't enough time for that and that a chest X-ray ordered earlier inexplicably was not done. They say Ritter's symptoms were more consistent with a heart attack than anything else and had to be treated quickly."

"Lotysch's lawyer, Stephen C. Fraser, said the radiologist found calcifications in all of Ritter's coronary arteries and told him to follow up with a cardiologist. 'He did no follow-up,' Fraser said, noting that Ritter also had very high cholesterol."

​

 

[Maxprime]

I know it's not much help - but it's all part of the gig. When family members die, people want to blame someone that's still alive.

I think the case sounds like a crock - but what do I know? I assume that a middle aged man presenting to the ER with chest pain is probably best treated for an MI until otherwise - purely a guess though.

 

[hra87]

I'm not familiar with this particular case, but I've read a bunch of studies (one a couple of years ago in the New England Journal of Medicine) finding that people tend to under-sue, not over-sue (i.e. there is far more negligence then there are lawsuits), and that almost all the patients that win suits deserve to.

Anecdotally from my shadowing experiences, I can certainly buy it.

Edit: This may or may not be the one.

http://content.nejm.org/cgi/content/abstract/354/19/2024

 

[Ashers]

While a lot of law suits may not be able to be avoided, the outcomes can be in one's favor due to proper charting.

The article just focuses on the feelings of the situation. It doesn't say anything about how he "fell ill" what sort of symptoms he was having in the morning, what he was having at the ER. Aortic dissection and an acute MI can be similar, and there are MANY more AMIs than aortic dissections. I just finished my surgery rotations, one of which was CT surgery; we had a teaching rounds we where we specifically discussed aortic dissection presentation which can be varied; but the one thing the attending said was EXTREMELY important was that the doctor has to have a high index of suspicion for it, or it will be missed. I can see it being missed in a situation in a guy with CAD who had previously had a normal whole body scan (I don't even see the purpose of that). Not having the chest Xray is a problem though. We also don't know his entire medical history (whether or not he had HTN, a connective tissue disorder, some sort of family history of it).

That's just my take on it, but I'm not too worried about stuff like this happening with horrid consequences like working at McD's. Just be thorough, document everything, and think.

It's also really hyped up because he was a relatively young famous person.

 

[Law2Doc]

Do cases like John Ritter's scare you from practicing medicine? For me, in some ways, they do. I don't want to work my tail off the next 10-15 years, trying to become great at what I do, all in effort to help people...just to have some lawyer tell me, "Fisko, you messed up and didn't save this guy/girl's life. Shame on you. We'll take 67 million and your kid's new set of Tonka toys as compensation. Oh and btw, you can't practice medicine any more. I hear McDonald's is hiring. Kthnxbye."

Discuss.

If you do a search you will find that someone posted pretty much the same question a few weeks back, when the suit was first announced. Should contain all the discussion you desire.

 

[Phenol312]

Could someone explain how one man's life = $67,000,000? If they even get $6.7 million i would consider it unjust. Ritter was a celeb and probably had a large life insurance policy plus money tucked away for a rainy day. His family will not be out on the street anytime soon.

The body scan was two years old...how is that admissible? What if he just started eating nothing but McD's everyday after that body scan?

 

[45408]

His wife is clearly trying to profit from his death. Disgusting.

 

[Law2Doc]

His wife is clearly trying to profit from his death. Disgusting.

Agree, but what's really disgusting is that someone who was in multiple hit TV shows and a few well received movies didn't manage to adequately provide for his family upon his unfortunate demise. With some decent estate planning, this family should really have so much that they have no need for lawsuits.

 

[Phenol312]

Agree, but what's really disgusting is that someone who was in multiple hit TV shows and a few well received movies didn't manage to adequately provide for his family upon his unfortunate demise. With some decent estate planning, this family should really have so much that they have no need for lawsuits.

wait...exactly what did he leave behind for his family?

If he didn't leave anything its his own fault and his wife's as well ... you have to be crazy to be 50+ in this day and age and not have something set up.

 

[BigRedder]

They've already settled separately with the hospital and some other doctors for $14 million. Now they want to sue for how much he would have made had he not died. Is 14,000,000 JBCs not enough?

 

[fisko82]

If you do a search you will find that someone posted pretty much the same question a few weeks back, when the suit was first announced. Should contain all the discussion you desire.

But then I wouldn't be contributing to the redundancy of these forums, which his half the fun.

To be fair, when I typed up the topic I saw five previous Ritter threads, but the dates were in 2002-2005. So, I thought this was new, evidently I was wrong. It seems like every thread I start has 9 or 10 duplicates created the previous week or so. WTH SDN? Stop taking my thoughts and posting them before me 👎

Also, hr870, good stuff. Under-litigation is what I like to hear, because I'm sure I'll be making lots of mistakes as a medical student

 

[Maxprime]

I'm not familiar with this particular case, but I've read a bunch of studies (one a couple of years ago in the New England Journal of Medicine) finding that people tend to under-sue, not over-sue (i.e. there is far more negligence then there are lawsuits), and that almost all the patients that win suits deserve to.

Anecdotally from my shadowing experiences, I can certainly buy it.

Edit: This may or may not be the one.

http://content.nejm.org/cgi/content/abstract/354/19/2024

No. The wrong people sue - it's not that there is too little litigation. There are plenty of *****s willing to sue for stupid reasons.

 

[hra87]

No. The wrong people sue - it's not that there is too little litigation. There are plenty of *****s willing to sue for stupid reasons.

The study shows there aren't that many frivolous lawsuits, and it shows that of the frivolous ones, hardly any get compensation, AND that the vast majority of expense is due to the ones that deserve compensation.

 

[mc4435]

This might be a stupid question, but if that doctor has to pay 67 million that would be covered by the thousands of dollars he spends each year in malpractice insurance right? So basically the insurance company would pay?

 

[45408]

I'm not familiar with this particular case, but I've read a bunch of studies (one a couple of years ago in the New England Journal of Medicine) finding that people tend to under-sue, not over-sue (i.e. there is far more negligence then there are lawsuits), and that almost all the patients that win suits deserve to.

They may under-sue when malpractice occurs, but in general, people are WAY too litigious in the US these days. After that woman died on the flight last week, I've heard dozens of people suggest that her family sue the airline. 🙄 Let's get all the facts first, people.

Secondly, the fact that most patients who win a lawsuit is a good sign, but even if a stupid lawsuit is eventually thrown out, it still puts a physician through the wringer for no reason. That costs time, money, and years off your life.

 

[45408]

This might be a stupid question, but if that doctor has to pay 67 million that would be covered by the thousands of dollars he spends each year in malpractice insurance right? So basically the insurance company would pay?

It may well exceed his insurance coverage, in which case, he is royally screwed.

 

[Doublecortin]

I'm not familiar with this particular case, but I've read a bunch of studies (one a couple of years ago in the New England Journal of Medicine) finding that people tend to under-sue, not over-sue (i.e. there is far more negligence then there are lawsuits), and that almost all the patients that win suits deserve to.

Anecdotally from my shadowing experiences, I can certainly buy it.

Edit: This may or may not be the one.

http://content.nejm.org/cgi/content/abstract/354/19/2024

wow! 😱 just wow! Did you notice how many of the authors had law degrees? Hm, I wonder if that has anything to do with the conclusions of the study.

But a medical journal basically making the case for vermin with law degrees who specialize in putting doctors out of business??? Just Wow! I wonder whose side NEJM is on

 

[Law2Doc]

wow! 😱 just wow! Did you notice how many of the authors had law degrees? Hm, I wonder if that has anything to do with the conclusions of the study.

Well, between the 8 authors I see 4 JD degrees, 4 MD degrees, one nurse. Pretty fair cross-representation -- I don't think any of the folks listed are practicing lawyers actually (they are largely physicians and law professors). So no, I don't think you can conclude bias from this. This has actually been a fairly well known fact in the legal community for some time (that frivolous suits simply don't happen that often due to some of the impediments), but took the NEJM to finally pass on this info to the medical community.

 

[Doublecortin]

Well, between the 8 authors I see 4 JD degrees, 4 MD degrees, one nurse. Pretty fair cross-representation -- I don't think any of the folks listed are practicing lawyers actually (they are largely physicians and law professors). So no, I don't think you can conclude bias from this. This has actually been a fairly well known fact in the legal community for some time (that frivolous suits simply don't happen that often due to some of the impediments), but took the NEJM to finally pass on this info to the medical community.

I am afraid it might take a little more than an article in NEJM to convince ob/gyns that it is the case .

Below is a response by macgyver22 to someone asking about the career path of an ob/gyn, post #285 from an award winning thread "A poll from an old timer- Why are young people still going into medicine?"

Dr. M,

Could you talk about OB/GYN a bit? I really really really want to be one, and yes, I realize the lawsuit thing, as well as the drawbacks of the profession. I have talked to many about it, but I'd love to hear your opinion too. Is your wife happy? Would she choose it again? I love the GYN aspect also, and there are some activism issues I'm planning on going into, as well as relief efforts, so switching to primarily GYN is definitely something I'm planning (as many seem to do) halfway through my career. Please share your thoughts...





I guess I should really let my wife answer this but she's currently trying to catch up on another night of no sleep. She got called in at 2am and the last words I heard from her is " I can't do this anymore". She's only 47 and has been doing this for 15 years but it really wears on you. That should give you some idea of how she might answer this if she was awake at the moment and had the energy. I'll ask her later if she's up to it before we head out to attend a family gathering, assuming I can wake her up.

None of this is a surprise. She always knew ObGyn required being up nights. The problem is that when she got into this field it didn't require 50 year olds to be up so many nights. 15 years ago the usual arrangement was that the younger partners took the lion's share of the call to earn their place in the practice. As you got older you scaled back your practice and the new younger partners took over the that role. With declining reimbursements that has become impossible. The practice needs to get the maximum number of hours out of every doctor. One of her partners is 60 and taking full call supplemented by extra calls for the hospital service to make ends meet.

My wife has seen a bigger decline in income than I have. Her income is now about 50% of what it was 8-10 years ago. In 1992 her practice was getting paid $5,000 for 9 months of obstetrical care and the delivery. Now they get $3,000 and have to fight for that. You then have to figure in the fact that overhead including malpractice insurance has gone up tremendously. We live in NY and last years ObGyn premium was $170,000 ( holy freakin' siht!!! 😱)for each doctor in her practice. The insurance companies are asaking for a $50,000 surcharge per doctor to cover their losses this year and another 20-30% increase on top of that per year for the next 3 years. Needless to say that will make it easy for a lot of doctors to finally say enough already and give up Ob since it will no longer be economically feasible to provide that service to patients.

Its not just the financial cost of malpractice that's a problem for doctors but the emotional cost. Contrary to what the public may believe, getting sued has little to do with actually comiting malpractice. Ob's know this better than anyone. Imagine putting in all those hours losing all that sleep and then being sued despite providing exemplary care, and worse yet, having a jury of people who are totally ignorant of the subject deciding the plaintiff was right and awarding them damages. I could tell you stories that would curl your hair. Every ObGyn ( every single one) in hour area has been sued multiple times. There isn't a single Ob who doesn't have at least one suit hanging over their head at any given moment. They obviously aren't all comiting malpractice on a regular basis, but that's the system we live in.

Would she become an ObGyn again? I don't even need to wake her up and ask her that. The hours are hard, the pay has reduced dramatically meaning you will have to work those insane hours well into your 60's, and you have to face the constant inevitablility of your next law suit, the outcome of which will be decided by a group of people who know nothing about the subject and may not even have a high schooll education.

As I've mentioned in other posts above, things are a bit different in other parts of the country. Ob's who practice in rural isolated areas may have it a little better, but if you live in virtualy any metropolitan or suburban area you're going to hear the same story.

Sorry to sound so negative, but its hard to watch my wife go through this all the time knowing there's no end to it any time soon. That's not the way things were when she signed up for this job, but the world has changed a lot in 15 years.
😱

 

[Crimson doc]

On a related note, isn't it possible for the doctor to tie up all of his/her assets to someone else (a wife/husband, significant other) so essentially they are bankrupt? That way if someone sues for more than the insurance covers, the person suing is screwed because the doctor can't pay for it. I swear I heard something about this being a way to get around malpractice-anyone know better than I do?

 

[fisko82]

isn't it possible for the doctor to tie up all of his/her assets to someone else (a wife/husband, significant other) so essentially they are bankrupt? That way if someone sues for more than the insurance covers, the person suing is screwed because the doctor can't pay for it. I swear I heard something about this being a way to get around malpractice

Go on, I'm listening... this idea sounds fantastic! 😀

 

[hra87]

I am afraid it might take a little more than an article in NEJM to convince ob/gyns that it is the case .

Below is a response by macgyver22 to someone asking about the career path of an ob/gyn, post #285 from an award winning thread "A poll from an old timer- Why are young people still going into medicine?"

Dr. M,

Could you talk about OB/GYN a bit? I really really really want to be one, and yes, I realize the lawsuit thing, as well as the drawbacks of the profession. I have talked to many about it, but I'd love to hear your opinion too. Is your wife happy? Would she choose it again? I love the GYN aspect also, and there are some activism issues I'm planning on going into, as well as relief efforts, so switching to primarily GYN is definitely something I'm planning (as many seem to do) halfway through my career. Please share your thoughts...





I guess I should really let my wife answer this but she's currently trying to catch up on another night of no sleep. She got called in at 2am and the last words I heard from her is " I can't do this anymore". She's only 47 and has been doing this for 15 years but it really wears on you. That should give you some idea of how she might answer this if she was awake at the moment and had the energy. I'll ask her later if she's up to it before we head out to attend a family gathering, assuming I can wake her up.

None of this is a surprise. She always knew ObGyn required being up nights. The problem is that when she got into this field it didn't require 50 year olds to be up so many nights. 15 years ago the usual arrangement was that the younger partners took the lion's share of the call to earn their place in the practice. As you got older you scaled back your practice and the new younger partners took over the that role. With declining reimbursements that has become impossible. The practice needs to get the maximum number of hours out of every doctor. One of her partners is 60 and taking full call supplemented by extra calls for the hospital service to make ends meet.

My wife has seen a bigger decline in income than I have. Her income is now about 50% of what it was 8-10 years ago. In 1992 her practice was getting paid $5,000 for 9 months of obstetrical care and the delivery. Now they get $3,000 and have to fight for that. You then have to figure in the fact that overhead including malpractice insurance has gone up tremendously. We live in NY and last years ObGyn premium was $170,000 ( holy freakin' siht!!! 😱)for each doctor in her practice. The insurance companies are asaking for a $50,000 surcharge per doctor to cover their losses this year and another 20-30% increase on top of that per year for the next 3 years. Needless to say that will make it easy for a lot of doctors to finally say enough already and give up Ob since it will no longer be economically feasible to provide that service to patients.

Its not just the financial cost of malpractice that's a problem for doctors but the emotional cost. Contrary to what the public may believe, getting sued has little to do with actually comiting malpractice. Ob's know this better than anyone. Imagine putting in all those hours losing all that sleep and then being sued despite providing exemplary care, and worse yet, having a jury of people who are totally ignorant of the subject deciding the plaintiff was right and awarding them damages. I could tell you stories that would curl your hair. Every ObGyn ( every single one) in hour area has been sued multiple times. There isn't a single Ob who doesn't have at least one suit hanging over their head at any given moment. They obviously aren't all comiting malpractice on a regular basis, but that's the system we live in.

Would she become an ObGyn again? I don't even need to wake her up and ask her that. The hours are hard, the pay has reduced dramatically meaning you will have to work those insane hours well into your 60's, and you have to face the constant inevitablility of your next law suit, the outcome of which will be decided by a group of people who know nothing about the subject and may not even have a high schooll education.

As I've mentioned in other posts above, things are a bit different in other parts of the country. Ob's who practice in rural isolated areas may have it a little better, but if you live in virtualy any metropolitan or suburban area you're going to hear the same story.

Sorry to sound so negative, but its hard to watch my wife go through this all the time knowing there's no end to it any time soon. That's not the way things were when she signed up for this job, but the world has changed a lot in 15 years.
😱

You're right, why take a large, well researched study in the most famous medical journal in the world over some anecdotal evidence?

Malpractice preimums skyrocketing is not due to lawyers, it's due to insurance company (and the fact that they are immune from anti-trust laws). Malpractice premiums go up and down in cycles (based on interest rates which are exploited by the insurance companies); unless lawsuits have a similiar cyclical trend (they obviously do not), it's silly to think they're the cause.

Edit: I'm sick of doctors being used as an excuse for far-reaching tort reform that leaves citizens without protection (be it from doctors or companies...look at what happened in Texas).

Edit2: And I'm sick of the media portraying trial lawyers as evil for this vary same reason (people tend not to feel the same way when they are exploited and in need of one)

Edit3: I'm not a lawyer nor do I even know any lawyers nor have I ever hired a lawyer nor have I ever been in need of a lawyer nor do I know anyone who has ever been in need of a lawyer.

 

[Terpskins99]

Could someone explain how one man's life = $67,000,000? If they even get $6.7 million i would consider it unjust. Ritter was a celeb and probably had a large life insurance policy plus money tucked away for a rainy day. His family will not be out on the street anytime soon.

The body scan was two years old...how is that admissible? What if he just started eating nothing but McD's everyday after that body scan?

Well, considering some idiot sued a korean dry cleaners $54 million for losing a pair of pants last year, nothing really surprises me.

A 2 year old body scan supposedly able to demonstrate that someone is about to have an aortic dissection is pretty unrealistic. Aortic dissections are unpredictable almost by definition. But older imaging studies are certainly admissible in court, particularly with regard to diseases like cancer (breast cancer in particular due to how difficult it is to identify via mammography).

 

[Doublecortin]

You're right, why take a large, well researched study in the most famous medical journal in the world over some anecdotal evidence?

Malpractice preimums skyrocketing is not due to lawyers, it's due to insurance company (and the fact that they are immune from anti-trust laws). Malpractice premiums go up and down in cycles (based on interest rates which are exploited by the insurance companies), unless lawsuits have a similiar cyclical trend (they obviously do not), it's silly to think they're the cause.

Well, all I am wondering is if the authors have an agenda, and who sponsored/paid for the study, and just because it's NEJM, doesn't mean there is no politics involved, and I'd like to know who's behind the scenes pulling the strings. . .

On a different note, states who've passed tort reform laws have SIGNIFICANTLY lower premiums for all specialties compared with states that don't have such laws, e.g. California, Texas vs. PN, NY. The difference for such high risk fields like ob/gyn and neurosurg is 2-3 fold

 

[hra87]

Well, all I am wondering is if the authors have an agenda, and who sponsored/paid for the study, and just because it's NEJM, doesn't mean there is no politics involved, and I'd like to know who's behind the scenes pulling the strings. . .

On a different note, states who've passed tort reform laws have SIGNIFICANTLY lower premiums for all specialties compared with states that don't have such laws, e.g. California, Texas vs. PN, NY. The difference for such high risk fields like ob/gyn and neurosurg is 2-3 fold

This is simply not true from everything I have read. Please provide a citation.

Edit: wait, this may be true (though I'm not sure), but in any case is irrelevant. The point isn't whether pennsylvania and new york have higher rates (they may have had higher rates to begin with), but rather whether the rates in california and texas decreased after tort reform laws were passed (they have not, from everything I have read).

I don't know the statistics comparing the states, however.

Edit2: I'm getting lost in all this conflicting research by the different lobbying groups. Never mind, I found the citation. This will require more reading on my part.