Lawsuit again?

[meow1985]

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Update: first attending job still a go in just over a month. Finishing up residency by doing a stint on inpatient. I was named in a lawsuit based on something that happened when I was an intern, and the case was dropped with prejudice.

Today, I was discharging someone. They were not benefiting from care, engaging in care seeking/care rejecting, splitting staff, all the classic stuff. I could take the personal attacks, the emotional manipulation, the if-I-end-my-life-out-there-it-will-be-your-fault. I knew discharge was the right thing to do, and to keep them was the wrong thing to do.

I could not take it when I walked into their room and they were on the phone and I heard them say "lawyer." I didn't hear the context, and based on my knowledge of their life it's conceivable that it was related to something else.

But I can't do this twice before I'm even out of residency. I made it through the day somehow but I've been having low-grade panic symptoms all day. I know I am a good psychiatrist. But who else will look at this history and think so?

 

[Sushirolls]

Patient didn't threaten to kill you, so it's a good day. Shrug it off. I stopped counting the number of patients saying they'll sue or kill me. Got a few restraining orders out there, too. Let your attending know, and if they want you to talk to the hospital risk management or not. If so, talk with them, and then move on. If not, move on. It really is that simple. This won't be the last time either.

Worry about moving. Worry about where the food is at your new job. Worry about your commute to the new job. Worry about learning the ropes of wRVUs and billing with your new job. Worry about closing down the chapter of residency and starting the next one of your life.

 

[meow1985]

Patient didn't threaten to kill you, so it's a good day. Shrug it off. I stopped counting the number of patients saying they'll sue or kill me. Got a few restraining orders out there, too. Let your attending know, and if they want you to talk to the hospital risk management or not. If so, talk with them, and then move on. If not, move on. It really is that simple. This won't be the last time either.

Worry about moving. Worry about where the food is at your new job. Worry about your commute to the new job. Worry about learning the ropes of wRVUs and billing with your new job. Worry about closing down the chapter of residency and starting the next one of your life.

🙂 Thanks. I needed that.

My attending knows the whole thing in gory detail. I am still a resident, after all 🙂 Since the patient didn't say the word "lawyer" to *us*, just to someone on the phone, and who knows what the conversation was even about, we didn't see a reason to talk to risk management.

 

[Mad Jack]

Removed for inaccuracies

 

[michaelrack]

I'm pretty much an expert in bankruptcy -just got notice that my chapter 7 case filed over 5 years is closed (done). A bankruptcy does not wipe away a judgment of any type. You can't just walk away from a judgment. You can try to settle for a lesser amount, and you may not have many assets they can go after, but you probably won't get away with paying nothing for a judgment that exceeds the limits of your malpractice.

 

[splik]

Someone threatening to sue or kill me is a regular occurrence, comes with serving the underserved. With lawsuits, never forget that they are civil judgments and the worst that happens is you declare bankruptcy and move on with your life, but that 98% of cases are dismissed without settlement and of the 2% remaining most won't exceed your malpractice limit. Mathematically you'd need 50 lawsuits to have one judgment against you, and you'd need many judgments to exceed or lose coverage. Furthermore in psychiatry the majority of judgments are for inappropriate sexual relationships rather than poor care or suicide. You basically need to be the worst of the worst or incredibly unlucky to lose a lawsuit. Chill, do your best, and recognize that even in the worst case scenario you're still staring over at zero as a doctor in America, far from the worst fate one could imagine

There are lots of inaccuracies in this post.
If a plaintiff attorney takes on a case it’s unlikely to be dismissed, will be successful about 20% of the time and will go to court in about 10% of cases. If the patient files a suit pro se it’s probably not going anywhere. Attorneys typical undertake a preliminary review of a case before taking it on. Most such attorneys work on contingency so they only take a case if they think they could make money off it. The annual risk of a lawsuit for a psychiatrist is about 2.5% and depending on the study about 20-40% of psychiatrists can expect to be sued (the lower figure is more accurate) over their career. Sanctions by the medical board are even more common and psychiatrists while at lower risks for lawsuits are at greater risk of disciplinary action by state boards (though this is uncommon too).

Wrongful death is the most common cause for lawsuit, not sexual relationship with patient. This is not even in the top 3 anymore. As psychiatry has moved away from dynamically oriented therapy solo practices this is less of an issue though is still common.

 

[Mad Jack]

There are lots of inaccuracies in this post.
If a plaintiff attorney takes on a case it’s unlikely to be dismissed, will be successful about 20% of the time and will go to court in about 10% of cases. If the patient files a suit pro se it’s probably not going anywhere. Attorneys typical undertake a preliminary review of a case before taking it on. Most such attorneys work on contingency so they only take a case if they think they could make money off it. The annual risk of a lawsuit for a psychiatrist is about 2.5% and depending on the study about 20-40% of psychiatrists can expect to be sued (the lower figure is more accurate) over their career. Sanctions by the medical board are even more common and psychiatrists while at lower risks for lawsuits are at greater risk of disciplinary action by state boards (though this is uncommon too).

Wrongful death is the most common cause for lawsuit, not sexual relationship with patient. This is not even in the top 3 anymore. As psychiatry has moved away from dynamically oriented therapy solo practices this is less of an issue though is still common.

I'll admit a lot of the digging I did on malpractice was years ago and with further years older data. I guess the gist was this:

Could a malpractice mega-verdict wipe you out?

In theory, yes. But in reality, doctors rarely lose their personal assets.

www.medicaleconomics.com

With regard to inappropriate sexual relationships, I think I might have been recalling the most common reason for board discipline and loss of licensure rather than the most common reason for lawsuits, but even that data is old and flimsy. These days I'd imagine it's far less common.

Psychiatry Online

ajp.psychiatryonline.org

 

[meow1985]

There are lots of inaccuracies in this post.
If a plaintiff attorney takes on a case it’s unlikely to be dismissed, will be successful about 20% of the time and will go to court in about 10% of cases. If the patient files a suit pro se it’s probably not going anywhere. Attorneys typical undertake a preliminary review of a case before taking it on. Most such attorneys work on contingency so they only take a case if they think they could make money off it. The annual risk of a lawsuit for a psychiatrist is about 2.5% and depending on the study about 20-40% of psychiatrists can expect to be sued (the lower figure is more accurate) over their career. Sanctions by the medical board are even more common and psychiatrists while at lower risks for lawsuits are at greater risk of disciplinary action by state boards (though this is uncommon too).

Wrongful death is the most common cause for lawsuit, not sexual relationship with patient. This is not even in the top 3 anymore. As psychiatry has moved away from dynamically oriented therapy solo practices this is less of an issue though is still common.

I guess if I get sued twice before I even leave residency, I will be massively unlucky. But stranger things have happened.

My first lawsuit had a pro se plaintiff and was completely frivolous, but some judge gave it a brief time of day. So now I'm stuck with explaining it for the rest of my career and being worried that it'll happen again.

If a lawyer is considering taking the case, does their review include medical records?

 

[Armadillos]

This is obviously something you think about a lot, as splik mentioned it’s a real concern that a psychiatrist may be sued someday during their career, but also true that very few psychiatrists have significant financial issues caused by a lawsuit so statistically you are most likely to come through your career just fine.

That being said if your always going to be thinking about it, maybe consider working in a state where awards are capped at reasonable level so you can easily insure to that level and not worry. Or work for a government entity that may not expose you to personal liability.

 

[meow1985]

This is obviously something you think about a lot, as splik mentioned it’s a real concern that a psychiatrist may be sued someday during their career, but also true that very few psychiatrists have significant financial issues caused by a lawsuit so statistically you are most likely to come through your career just fine.

That being said if your always going to be thinking about it, maybe consider working in a state where awards are capped at reasonable level so you can easily insure to that level and not worry. Or work for a government entity that may not expose you to personal liability.

Odd though this may seem, I don't care about the financial piece. I am in a state where settlement caps are very low, and the new state has screening requirements before the case can go to court.

What I worry about is the stain on my reputation. I've had to get credentialed, get approved by payors, apply for a license, etc with one case on my record. Everyone wanted "more information" - statements, granular details that don't matter, even legal documents. It is on the second page of results if you google me. I can't imagine searching for a new job with this on my record since it's part of the screening process. The trauma has to be exhumed again and again. I was an intern who did nothing wrong, literally, and everyone acts as if "where there's smoke there's fire." This is the real issue.

 

[AD04]

I am in a state where settlement caps are very low, and the new state has screening requirements before the case can go to court.

You're likely in a state with a huge, huge need. You'll get credentialed without any problems. You most likely signed on with a hospital and everyone wanting more information is just part of the process. It is not there to screen you out. Hospital has to show it did its due diligence and to cover its own butt.

Remember what you learned in therapy? Focus on what you can control. These are what you can control to minimize risk of being named or suffer financial loss in a malpractice lawsuit:

- practice good, evidence-based medicine
- document well (justify your plan)
- have malpractice coverage
- treat people with respect (don't be hated)
- move to a physician-friendly state (which you seem to be doing)
- serve a small community most doctors don't want to live in (local jurors will not be inclined to vote against one of the few physicians there and drive him / her away)

The less reward or less chance of reward for lawyers to bring a malpractice lawsuit against you, the less likely you will get sued. It's business. Nothing personal.

The article posted by @Mad Jack from Medical Economics is very good on how to mitigate financial risks of malpractice suits. If you are sued, it's not your money on the line. So let the insurance companies worry about how to protect their money.

 

[Sushirolls]

In a short period of time you will no longer be a resident. You will be free. You don't need to be under the scrutiny of any one (within reason, good clinical practice, etc as AD04 pointed out).
Insurance company doesn't want to panel you? So? Their loss. Job doesn't want to hire you? So? Their loss.
Open your own practice and breathe in the freedom.
Just make sure you maintain your liability insurance, and heck even worst case scenario, in many states, even if uninsured you can still practice, just give the disclaimer to the patients.

 

[meow1985]

In a short period of time you will no longer be a resident. You will be free. You don't need to be under the scrutiny of any one (within reason, good clinical practice, etc as AD04 pointed out).
Insurance company doesn't want to panel you? So? Their loss. Job doesn't want to hire you? So? Their loss.
Open your own practice and breathe in the freedom.
Just make sure you maintain your liability insurance, and heck even worst case scenario, in many states, even if uninsured you can still practice, just give the disclaimer to the patients.

Patients can google this lawsuit stuff, though. I think the average person would be given pause if they found something like that. They don't know how ridiculous medical litigation is.

 

[Candidate2017]

Patients can google this lawsuit stuff, though. I think the average person would be given pause if they found something like that. They don't know how ridiculous medical litigation is.

Some of my attendings have hilariously negative, albeit accurate, reviews on the internet. They still have no lack of patients.

Some of my former or current co-residents have serious non-frivolous lawsuits winding their way through court, including some high profile cases. Some appear to be taking it well, some are not. It doesn't seem to be affecting employment/prospects though. We're all going to be sued one day, one way or the other. Like everyone said, we can only practice good medicine. And good medicine is always medically and legally sound.

Maybe you can speak to a therapist about your anxiety. I think it's worthwhile to pay a medical malpractice defense lawyer for an hour or two to give pointers and tips about malpractice. It's not something we get in our training and can only augment good medical practice. Talking to a med mal lawyer may be therapeutic in and of itself.

 

[PistolPete]

Sanctions by the medical board are even more common and psychiatrists while at lower risks for lawsuits are at greater risk of disciplinary action by state boards (though this is uncommon too).

Any idea why psychiatrists are at greater risk of disciplinary action by state boards?

 

[Liquid8]

If hearing a single word "lawyer" is enough to cause you to worry and trigger anxiety, I would strongly consider the option of therapy as has been suggested already by a few others.

In the longer term, you might one day find yourself utilising this negative experience as something that could help one of your patients. During my early years as a doctor, I had an unfortunate run in with a personality disordered psychiatrist known for going out of his way to destroy the careers of others. Now I don't tend to self disclose to patients, but did make an exception with one of my long standing ones who had gone through a similar experience of extreme workplace bullying.

On the topic of questionable psychiatrist behaviour - I hope none of us here end up like this guy:

Katz v Medical Board of Australia (Review and Regulation) [2020] VCAT 589 (28 May 2020)

Should have had his registration suspended but given a stay of execution due to covid…

 

[meow1985]

If hearing a single word "lawyer" is enough to cause you to worry and trigger anxiety, I would strongly consider the option of therapy as has been suggested already by a few others.

In the longer term, you might one day find yourself utilising this negative experience as something that could help one of your patients. During my early years as a doctor, I had an unfortunate run in with a personality disordered psychiatrist known for going out of his way to destroy the careers of others. Now I don't tend to self disclose to patients, but did make an exception with one of my long standing ones who had gone through a similar experience of extreme workplace bullying.

On the topic of questionable psychiatrist behaviour - I hope none of us here end up like this guy:

Katz v Medical Board of Australia (Review and Regulation) [2020] VCAT 589 (28 May 2020)

Should have had his registration suspended but given a stay of execution due to covid…

I am curious about her other psychiatrist, Stephen Xu. Didn’t they have some version of the PMP that you’re required to check if someone is filling controlled substance prescriptions provided by someone else?

 

[Mass Effect]

Document, document, document. I would document very carefully why you're discharging and if the patient is at risk of getting worse with hospitalization (as is the case in many people with the same symptoms) I would document that.

 

[meow1985]

Document, document, document. I would document very carefully why you're discharging and if the patient is at risk of getting worse with hospitalization (as is the case in many people with the same symptoms) I would document that.

I did.

But all it takes is some lawyer to decide there's a case to be had here and this is going to be on my record.