Large lawsuit against ER physician for stroke mismanagement

[Brigade4Radiant]

Documentation makes a difference in blocking Med Board reviews that occur in the course of medmal cases. Even if you win or settle a civil case, the state AG office can choose to prosecute on Med Board or DHHS recommendation IF there are allegations of violations of state licensed practice laws and the record meets the standard of evidence. Further, the Med Board could act to control a doc’s license as well.

You’re never going to stop people from suing. It’s always best to settle. But documentation matters when you’re getting checked by your peers in a way that can affect your license.

Not when you do it after the fact because you can’t change your actual management

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[nikolaite]

Not when you do it after the fact because you can’t change your actual management

That’s what provides the burden of “standard of evidence”. Attributed alterations of the record are fine and common. Ex post facto alterations = big no-no.

Better to confess mismanagement, admit the reason, take your lumps and move on.

 

[trackrunner321]

If the EM Physician is on the hook for 60% of 75 million, where does that money come from?!?! His or her policy coverage is probably around 1 million. I do not think that most EM physicians have 44 million lying around... Do you just declare bankruptcy and never work again so your wages do not get garnished???

 

[KarlPilkington]

This case is a total mess. A couple of truly insane things jump out:

• The plaintiffs turned down a ~$30,000,000 settlement to take it to trial.
• Georgia has a gross negligence standard meaning that the jury felt that the physicians didn't exercise even a basic amount of caution. I'd argue that seeing the pt when they arrived and ordering a CTA to r/o dissection was enough to clear this gross negligence standard.
• There wasn't a unified defense so the jury heard weeks of various defendants pointing their fingers at each other
• The neurologist has two previous med-mal losses for missed posterior strokes yet the jury wasn't allowed to hear this.
• The ED doc could have done a better job charting in real time but the jury was told that he changed his note yet in reality he simply added details about his conversation with the neurologist when he went to sign his notes the next day.
• There was really no causation. When this case happened we had almost no agreement when it comes to how we treat these kinds of strokes. Even if the pt had gotten TPA or IR the odds that they would get better would be well less than 50%. Somehow the defense didn't convey this adequately to the jury.

This verdict is truly absurd. I'd argue that if any of us are 75 million dollars negligent we should face criminal charges, otherwise the injured party shouldn't get above our insurance limits. I hope this gets flipped on appeal but I'm not optimistic.

 

[KarlPilkington]

I think the ****ed up part is that the chiropractor was the one who inflicted the stroke, which almost certainly not treatable, yet it's the MDs who fall on the sword.

He settled ahead of time. In the land of chiropractors dissections are an accepted complication so it's fairly easy for them to say oops and just pay out.

 

[forchinet121]

This case is a total mess. A couple of truly insane things jump out:

• The plaintiffs turned down a ~$30,000,000 settlement to take it to trial.
• Georgia has a gross negligence standard meaning that the jury felt that the physicians didn't exercise even a basic amount of caution. I'd argue that seeing the pt when they arrived and ordering a CTA to r/o dissection was enough to clear this gross negligence standard.
• There wasn't a unified defense so the jury heard weeks of various defendants pointing their fingers at each other
• The neurologist has two previous med-mal losses for missed posterior strokes yet the jury wasn't allowed to hear this.
• The ED doc could have done a better job charting in real time but the jury was told that he changed his note yet in reality he simply added details about his conversation with the neurologist when he went to sign his notes the next day.
• There was really no causation. When this case happened we had almost no agreement when it comes to how we treat these kinds of strokes. Even if the pt had gotten TPA or IR the odds that they would get better would be well less than 50%. Somehow the defense didn't convey this adequately to the jury.

This verdict is truly absurd. I'd argue that if any of us are 75 million dollars negligent we should face criminal charges, otherwise the injured party shouldn't get above our insurance limits. I hope this gets flipped on appeal but I'm not optimistic.

Again can someone comment on this insane number of 30 mil or 75 mil. Where is that money coming from? Will the malpractice insurance company if the plaintiffs had agreed to settle settle for 30 mil or will they pay the 75 mil verdict? Or where the hell will this money come from?

 

[Brigade4Radiant]

Again can someone comment on this insane number of 30 mil or 75 mil. Where is that money coming from? Will the malpractice insurance company if the plaintiffs had agreed to settle settle for 30 mil or will they pay the 75 mil verdict? Or where the hell will this money come from?

Since it’s not criminal they can’t go after 401k

Also to read the entire case

https://belllawatlanta.wpenginepowered.com/wp-content/uploads/2022/10/17-08-29-Buckelew-COMP-FSC.pdf

So basically he ordered the CTA but the neurologist says that the ER Physician didn’t discuss it with him. Using the call records he was only called once and not updated about the lp results

The radiologist hedged on the read as well

 

[forchinet121]

Since it’s not criminal they can’t go after 401k

Also to read the entire case

https://belllawatlanta.wpenginepowered.com/wp-content/uploads/2022/10/17-08-29-Buckelew-COMP-FSC.pdf

So basically he ordered the CTA but the neurologist says that the ER Physician didn’t discuss it with him. Using the call records he was only called once and not updated about the lp results

The radiologist hedged on the read as well

Can they go after future earnings?

 

[nikolaite]

Can they go after future earnings?

Yes, if you mean requiring a doc to make payments over a designated time period by court decision. That type of payout is designated as “structured” rather than a lump sum.

 

[nikolaite]

This verdict is truly absurd. I'd argue that if any of us are 75 million dollars negligent we should face criminal charges, otherwise the injured party shouldn't get above our insurance limits. I hope this gets flipped on appeal but I'm not optimistic.

Based on the record reviews and pt/family affidavits I’ve read over the last 9 months alone (cases stretching back to early 2020), the rejection of the $30M offer is likely because some truly heinous behavior occurred in the ED that did not make it into the record. This makes pts very willing to suffer the 10 years of litigation (and risk the loss) to get their word on record and have a jury punish the medicoes. If it’s clear negligence from one provider on a single point or a frivolous suit, pts tend to be ready to settle as soon as they see an offer.

The case will hinge on the record, but the awards tend to be based on sympathy.

While docs in some cases ought to face criminal charges, many criminal prosecutors will not press it. The standard of evidence is different from civil proceedings and the perception is juries do not like to put doctors, even abusive/criminal doctors, in jail.

 

[Brigade4Radiant]

Yes, if you mean requiring a doc to make payments over a designated time period by court decision. That type of payout is designated as “structured” rather than a lump sum.

However they payments can’t be the majority of his paycheck or interfer with things such as child support

 

[nikolaite]

However they payments can’t be the majority of his paycheck or interfer with things such as child support

Indeed. Typically the insurance companies have to cough up the awards for structured payouts anyway…as long as they can’t find the doc violated terms of service.

For example, if a doc gets prosecuted criminally, and found guilty, the insurance company will dump the doc. Then he/she has to figure it out alone: pay by wage, liquidation of property, or declare bankruptcy.

 

[nikolaite]

Again can someone comment on this insane number of 30 mil or 75 mil. Where is that money coming from? Will the malpractice insurance company if the plaintiffs had agreed to settle settle for 30 mil or will they pay the 75 mil verdict? Or where the hell will this money come from?

If the $30M settlement offer is coming from the doc’s legal defense team, then the money is going to come from the insurance company, the doctor directly, or a combination of both. Typically, offers or awards of that size are covered by the insurance company alone.

 

[forchinet121]

If the $30M settlement offer is coming from the doc’s legal defense team, then the money is going to come from the insurance company, the doctor directly, or a combination of both. Typically, offers or awards of that size are covered by the insurance company alone.

So is it safe to say the doc is financially screwed?

 

[Brigade4Radiant]

So is it safe to say the doc is financially screwed?

No they can’t go after 401k and they can’t imprisonhim for this debt. The payments can’t be the majority of his paycheck either

 

[HemeOncHopeful19]

No they can’t go after 401k and they can’t imprisonhim for this debt. The payments can’t be the majority of his paycheck either

So he can work as long as he gives up 49% of his paycheck? Insanity

 

[Rekt]

I'm confused. Isn't that the point of malpractice insurance? Why would the doc have to pay out unless it was criminal etc

 

[nikolaite]

So is it safe to say the doc is financially screwed?

Not really. That’s a bit of an oversimplification. The most likely is that he will have only to pay a higher premium for continuing his insurance policy. Medmal may wreck him emotionally or his confidence to practice, but it’s rare that the compensation ordered by a court wrecks a doctor financially. The whole reason medmal is tolerated as a tort is same as any other, to keep business moving on the day after the dust from the trial settles.

 

[nikolaite]

I'm confused. Isn't that the point of malpractice insurance? Why would the doc have to pay out unless it was criminal etc

Docs only pay out directly by personal choice, on special court order, or because they’re uninsured.

 

[forchinet121]

No they can’t go after 401k and they can’t imprisonhim for this debt. The payments can’t be the majority of his paycheck either

Not really. That’s a bit of an oversimplification. The most likely is that he will have only to pay a higher premium for continuing his insurance policy. Medmal may wreck him emotionally or his confidence to practice, but it’s rare that the compensation ordered by a court wrecks a doctor financially. The whole reason medmal is tolerated as a tort is same as any other, to keep business moving on the day after the dust from the trial settles.

These are conflicting posts though, will they garnish his future wages? Or just his insurance will go up and he’ll pay nothing in terms of the settlement? Those are very very big differences

 

[WilcoWorld]

I think the first describes worst case scenario, the second describes most likely scenario.

 

[Brigade4Radiant]

So he can work as long as he gives up 49% of his paycheck? Insanity

Georgia Wage Garnishment Laws

Learn about the wage garnishment laws and limits in Georgia for each type of income.

www.nolo.com

I believe there are limits like 25% also nothing criminal happened so he can work he just had a malpractice claim you list it and move on.

He can also stop paying it for some months without much consequence other than credit damage since debtors prisons are outlawed.

Child support is different though

Many OBs in Florida don’t even carry malpractice they call it going “bare”

 

[WilcoWorld]

Georgia Wage Garnishment Laws

Learn about the wage garnishment laws and limits in Georgia for each type of income.

www.nolo.com

I believe there are limits like 25% also nothing criminal happened so he can work he just had a malpractice claim you list it and move on.

He can also stop paying it for some months without much consequence other than credit damage since debtors prisons are outlawed.

Child support is different though

Many OBs in Florida don’t even carry malpractice they call it going “bare”

I thought "going bare" meant something different, but it does intersect with obstetrics...

 

[forchinet121]

Georgia Wage Garnishment Laws

Learn about the wage garnishment laws and limits in Georgia for each type of income.

www.nolo.com

I believe there are limits like 25% also nothing criminal happened so he can work he just had a malpractice claim you list it and move on.

He can also stop paying it for some months without much consequence other than credit damage since debtors prisons are outlawed.

Child support is different though

Many OBs in Florida don’t even carry malpractice they call it going “bare”

Having 25 percent of your paycheck for eternity go to a lawsuit for something like this sounds like actual hell

 

[johnny_bananas]

Apparently, the attorneys representing the plaintiff wanted an additional $30 million from the ED physician, but ultimately the jurors denied the additional fee request.

"Buckelew had a 40% contingency fee arrangement with his attorneys, meaning their fees were tied entirely to the outcome of his case. During Friday's arguments, attorneys Laura Shamp of Shamp Silk and Lloyd Bell of The Bell Law Firm, who represent Buckelew, argued that Womack should have to cover that cost, which would be around $30 million, instead of it coming out of their client's award, because he wasn't fully transparent during the trial."

"I am asking you to require Womack to pay the fees so that it doesn't come out of Jonathan's portion. I am going to ask you to place that responsibility on him, for, frankly, not being straight with y'all," Bell said. "Make him hear his full responsibility. Make him know that what he did was not okay and that justice requires full compensation."

Jurors Say Doctor Won't Have To Pay Paralyzed Man's Fees - Law360

One day after an Atlanta jury awarded $75 million to a Georgia man who said medical negligence caused him to suffer "locked-in syndrome" paralysis following a stroke, the jury said the emergency room physician who treated him shouldn't have to cover his attorney fees and expenses.

www.law360.com

 

[Birdstrike]

Non-Wage Garnishing States

North Carolina
South Carolina
Texas
Pennsylvania

 

[NYEMMED]

Non-Wage Garnishing States

North Carolina
South Carolina
Texas
Pennsylvania

Texas and South Carolina also have some form of Tort reform or caps. Its just reassuring that in those states, while driving into work, you don't worry about being homeless tomorrow for one mistake at work today. Also the malpractice rates are not any higher, they are actually lower in those states. Seems to be a win win, except of course, if you were a lawyer....

 

[forchinet121]

Non-Wage Garnishing States

North Carolina
South Carolina
Texas
Pennsylvania

That’s only 4 states though, in the other 46 this doc is going to lose his pay for the rest of his career having to pay back 70 million?

 

[Birdstrike]

That’s only 4 states though, in the other 46 this doc is going to lose his pay for the rest of his career having to pay back 70 million?

Debt collection works different in every state. I’m not sure how it will play out in his state. There’s also a possibility it gets reduced on appeal. Considering the award is far greater than an EP could earn in a lifetime, it seems an easy decision for a judge, although I won’t claim to know what factors are at play in a judge’s decision on something like this.

 

[forchinet121]

Debt collection works different in every state. I’m not sure how it will play out in his state. There’s also a possibility it gets reduced on appeal. Considering the award is far greater than an EP could earn in a lifetime, it seems an easy decision for a judge, although I won’t claim to know what factors are at play in a judge’s decision on something like this.

So malpractice insurance won’t really do much if the jury or settlement is higher than your limit?

 

[NYEMMED]

So malpractice insurance won’t really do much if the jury or settlement is higher than your limit?

Your malpractice insurance (standard for EM) is usually $1 million/$3 million. That is all they will pay. If the judgement is above that, then thats on you....

 

[bravotwozero]

Your malpractice insurance (standard for EM) is usually $1 million/$3 million. That is all they will pay. If the judgement is above that, then thats on you....

As stated many times before, the vast majority of these cases get reduced to policy limits on appeal. Instances where that doesn’t happen are rare.

 

[Brigade4Radiant]

As stated many times before, the vast majority of these cases get reduced to policy limits on appeal. Instances where that doesn’t happen are rare.

This is true OB gets large lawsuits all the time the jury isn’t really educated on these things

If they gave this guy heparin he might if had a bleed and you get sued anyway. This isn’t an MI where the treatment leads to good outcomes

 

[forchinet121]

As stated many times before, the vast majority of these cases get reduced to policy limits on appeal. Instances where that doesn’t happen are rare.

So the 75 million is going to get reduced to 3 million..? And they refused 30 million settlement? How does that make sense?

 

[RustedFox]

That’s only 4 states though, in the other 46 this doc is going to lose his pay for the rest of his career having to pay back 70 million?

No.
I was involved in a "Jackpot!" suit in 2014.
The insurance company generally "does the right thing and pays to either (what was settled for) or (what was reduced to on appeal).

In my case, a settlement was reached and the insurance company paid my limit, plus the settlement.

So the 75 million is going to get reduced to 3 million..? And they refused 30 million settlement? How does that make sense?

 

[thegenius]

This case is a total mess. A couple of truly insane things jump out:

• The plaintiffs turned down a ~$30,000,000 settlement to take it to trial.
• Georgia has a gross negligence standard meaning that the jury felt that the physicians didn't exercise even a basic amount of caution. I'd argue that seeing the pt when they arrived and ordering a CTA to r/o dissection was enough to clear this gross negligence standard.
• There wasn't a unified defense so the jury heard weeks of various defendants pointing their fingers at each other
• The neurologist has two previous med-mal losses for missed posterior strokes yet the jury wasn't allowed to hear this.
• The ED doc could have done a better job charting in real time but the jury was told that he changed his note yet in reality he simply added details about his conversation with the neurologist when he went to sign his notes the next day.
• There was really no causation. When this case happened we had almost no agreement when it comes to how we treat these kinds of strokes. Even if the pt had gotten TPA or IR the odds that they would get better would be well less than 50%. Somehow the defense didn't convey this adequately to the jury.

This verdict is truly absurd. I'd argue that if any of us are 75 million dollars negligent we should face criminal charges, otherwise the injured party shouldn't get above our insurance limits. I hope this gets flipped on appeal but I'm not optimistic.

This s**t happens all the time in legal proceedings and I hate it. Can't bring up the fact that the neurologist probably isn't good.

 

[forchinet121]

No.
I was involved in a "Jackpot!" suit in 2014.
The insurance company generally "does the right thing and pays to either (what was settled for) or (what was reduced to on appeal).

In my case, a settlement was reached and the insurance company paid my limit, plus the settlement.

Oh then what’s the point of the limit being 3 mil if they’ll pay 30?

 

[maxxor]

Oh then what’s the point of the limit being 3 mil if they’ll pay 30?

Because policy limits are revealed during discovery and set up the initial settlement offers.

 

[Birdstrike]

I’m still not following why an insurance company would willingly pay more than they’re contractually required to pay as contractually agreed upon in policy limits, whether in a settlement or judgement. This does not compute.

 

[RustedFox]

I’m still not following why an insurance company would willingly pay more than they’re contractually required to pay as contractually agreed upon in policy limits, whether in a settlement or judgement. This does not compute.

Happens all the time, as it was explained to me.

 

[emergentmd]

$75M Verdict in Med Mal Trial Over Stroke That Profoundly Paralyzed Patient

Jurors handed down a $75 million verdict against a pair of Georgia physicians last week, after finding them responsible for the “locked-in” paralysis one of their patients suffered during a catastrophic stroke.

blog.cvn.com

Locked-In Syndrome Malpractice Case Ends With $75M Verdict

After a chiropractic neck adjustment led to a stroke, the patient's attorney alleged that hospital physicians failed to act swiftly, resulting in locked-in syndrome.

www.medscape.com

Lawsuit just awarded to the plaintiff in GA. Appears that the young patient went to a chiropractor and developed a vertebral artery dissection after neck manipulation. IT appears the ER doc got slammed and the majority of punishment due to him editing his note after realizing what had happened. The neurologist was cleared of any wrongdoing and it appears the radiologist may have also missed some of the imaging. I am wondering why the chiro was not named and charged for actually causing harm to the patient, although it does appear the ER physician was negligent.

This is why I would never allow or have my family get any manipulations esp the neck. How the heck do you "realign" the spine when it is essentially fixed without tearing something?