Lawsuit hair-trigger

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fakin' the funk

fakin' the funk

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15+ Year Member
Jet just posted this in the recently closed dentist thread:

"Our country is in dire need of tort reform and a reprogramming of the general public to let go of the lawsuit-hair-trigger."

I think this is an excellent point and obviously one that affects day-to-day practice...especially in anesthesia where adverse events can be particularly adverse.

I'm wondering if some of my elders can share stories or advice on your run-ins with patients who clearly have such a lawsuit hair-trigger, or who are threatening such and you have avoided it, or if/when this comes up in preop, postop, etc.

How do you handle patients who seem or are lawsuit-happy? What should we know before we actually get our licenses and start practicing medicine and anesthesiology? Is the general public really as lawsuit-happy as we in medicine would believe?
 
I explain every detail as clear as possible to the pt. I then ask them if they are comfortable with having me as their anesthesiologist. They have always said yes and to date no suits filed.
 
i have been involved in a lawsuit as a resident, although it did not go anywhere it certainly left quite an impression on my young mind...
ok, here is fasto's take on lawsuit avoidance:
1. be nice! as in "hi, i'm dr. sprintini and i'll be your best friend for the next 4 hours, here's why..."
2.look them in the eye, shake their hand and introduce yourself ! i am not "anesthesia" , a commodity, but rather dr. sprintini and i am providing a service.
3. explain what you are doing and what can go wrong in away they understand.
4.once things went wrong (and they will or you haven't been in this for long enough) don't abandon them. you are genuinely interested what's happening, follow up visits and phonecalls are crucial . show them that you care , which you do , right?
5 . generally, treat people as human beings, most folks look for a kind word, an explanation and the impression that you care about the way things go.
my$0.02 ,fasto
 
fakin' the funk said:
Jet just posted this in the recently closed dentist thread:

"Our country is in dire need of tort reform and a reprogramming of the general public to let go of the lawsuit-hair-trigger."

I think this is an excellent point and obviously one that affects day-to-day practice...especially in anesthesia where adverse events can be particularly adverse.

I'm wondering if some of my elders can share stories or advice on your run-ins with patients who clearly have such a lawsuit hair-trigger, or who are threatening such and you have avoided it, or if/when this comes up in preop, postop, etc.

How do you handle patients who seem or are lawsuit-happy? What should we know before we actually get our licenses and start practicing medicine and anesthesiology? Is the general public really as lawsuit-happy as we in medicine would believe?
Click to expand...

What I really love is when someone tells me "this is Dr. Jones mother-in-laws best friend" or "this is the administrator's cousin", and of course "your patient is a trial lawyer". Whoop-de-doo!! My response is always along the lines of, "I provide the same high standard of care to every single patient I do", which is what I do. I don't do "extra" because it's a VIP, and I don't do less because it's an attorney, tempting as both may be. I treat all my patients with respect (except for maybe the one that spit at me about 25 years ago 😉 ) and do my best for each and every one of them.
 
I loved it once when I was resident and this annoying patient was saying "If you screw up anything I told my family to sue your pants off."

My attending was standing there and just matter of factly said " that's okay cause that guy you just told that to is my ticket to getting your payment capped at 250k. Good luck suing the state governent and good luck finding a lawyer who will take that case. Now do you want your Versed?
 
geauxg8rs said:
I loved it once when I was resident and this annoying patient was saying "If you screw up anything I told my family to sue your pants off."

My attending was standing there and just matter of factly said " that's okay cause that guy you just told that to is my ticket to getting your payment capped at 250k. Good luck suing the state governent and good luck finding a lawyer who will take that case. Now do you want your Versed?
Click to expand...

I just recently heard a story from a colleague who, when interviewing the family in the holding area for their 2-y.o. son who was going in for surgery, the father was noted to say at the end, "Just know that if anything happens to my boy, I'm coming after you."

Now, as you can imagine, this did not go over well with my colleague or his attending. In fact, it prompted calls to the hospital's omsbudsman and patient advocate reps... as well as security.

We do not need to be bullied by our patients or patient's families. I agree, using the patient-centered approach, that a physician should try to uncover the root of such feelings. But, frankly, some people are just childish low-IQ a**holes who you're never going to get through no matter how much explaining you do. This guy, forget being beyond putting my colleague on notice about a lawsuit, made a what-was-beyond-innuendo clear physical threat to my colleague.

When I signed-up for this job, I did not agree to be pin-cushion, martyr, whipping boy, saviour, self-immolator, or Jesus H. Christ himself. Personally, I would've delayed the case too (which they did) if such a comment was made to me until we could've sorted out why the father would say such an incredibly stupid and juvenile thing. I sure as heck would not have taken that kid into the OR, despite it being a relatively minor surgery, after that either.

There are no guarantees in life. Our f**ked-up society, however, over the past sixty years or so has apparently done an expert job of accomplishing and inculcating the false belief that there is.

-copro
 
I suppose when people hear about a large salary+10-12 more years of school, the idea of perfection pops up into there head. There is a flaw in human society though. When it comes to our mortality and quality of life, or a close family members, then it is a HUGE deal. There are so many times when I've seen someone I know hear the news of someone they may have not know, or barely knew, dying. There reaction is minimal and they shrug it off. BUT, if they hear of someone close to them dying then they curse humanity and are quick to lose belief in whatever omnipresence they may have believed in. I know that's natural for everyone, but people are capable of understanding that bad **** happens to everyone, everywhere and there is no way of full proofing anything.

And what is the deal with people hating doctors? I love them. They saved me from Cystic Fibrosis.
 
CowsLoveJourney said:
I suppose when people hear about a large salary+10-12 more years of school, the idea of perfection pops up into there head. There is a flaw in human society though. When it comes to our mortality and quality of life, or a close family members, then it is a HUGE deal. There are so many times when I've seen someone I know hear the news of someone they may have not know, or barely knew, dying. There reaction is minimal and they shrug it off. BUT, if they hear of someone close to them dying then they curse humanity and are quick to lose belief in whatever omnipresence they may have believed in. I know that's natural for everyone, but people are capable of understanding that bad **** happens to everyone, everywhere and there is no way of full proofing anything.

And what is the deal with people hating doctors? I love them. They saved me from Cystic Fibrosis.
Click to expand...

I think it's mostly a case of greedy bastards thinking doctors are inhuman machines that make a hundred grand a day doing nothing but sipping coffee. That and the fact they think it's an easy ticket to getting rich. Screw the doctor, it's all for them.
 
coprolalia said:
I just recently heard a story from a colleague who, when interviewing the family in the holding area for their 2-y.o. son who was going in for surgery, the father was noted to say at the end, "Just know that if anything happens to my boy, I'm coming after you."

Now, as you can imagine, this did not go over well with my colleague or his attending. In fact, it prompted calls to the hospital's omsbudsman and patient advocate reps... as well as security.

We do not need to be bullied by our patients or patient's families. I agree, using the patient-centered approach, that a physician should try to uncover the root of such feelings. But, frankly, some people are just childish low-IQ a**holes who you're never going to get through no matter how much explaining you do. This guy, forget being beyond putting my colleague on notice about a lawsuit, made a what-was-beyond-innuendo clear physical threat to my colleague.

When I signed-up for this job, I did not agree to be pin-cushion, martyr, whipping boy, saviour, self-immolator, or Jesus H. Christ himself. Personally, I would've delayed the case too (which they did) if such a comment was made to me until we could've sorted out why the father would say such an incredibly stupid and juvenile thing. I sure as heck would not have taken that kid into the OR, despite it being a relatively minor surgery, after that either.

There are no guarantees in life. Our f**ked-up society, however, over the past sixty years or so has apparently done an expert job of accomplishing and inculcating the false belief that there is.

-copro
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I agree with him. I would not have done the case either. This is an elective case. FInd yourself another anesthesiologist. you dont have to take that. I you walked into your surgeons office and said, "if anything happens to me, im coming after you". the surgeon would discharge you from his practice and you would never see him again period.
 
I had a lady come in L&D 2 days ago in labor wanting an elective C/S under general because she was giving the baby up for adoption and didn't want to hear him cry when he came out. She was a legal secretary and threatened to sue if it didn't go the way she planned. The OB's gave in so when I went to pre-op her I told her we do our sections under spinal because her risk of dying goes up substantially if we put her to sleep. (and I'm not about to risk my medical license for her on a non-emergent section, but I didn't say that).

She got got screaming, crazy mad but then the next thing I knew, they were taking her to a delivery room for an epidural. I won. I can't even think of what my defense would be in a court room had she died. I wouldn't have one!
 
coprolalia said:
When I signed-up for this job, I did not agree to be pin-cushion, martyr, whipping boy, saviour, self-immolator, or Jesus H. Christ himself. Personally, I would've delayed the case too (which they did) if such a comment was made to me until we could've sorted out why the father would say such an incredibly stupid and juvenile thing. I sure as heck would not have taken that kid into the OR, despite it being a relatively minor surgery, after that either.
Click to expand...

So what ended up happening? Did your attending refuse to do the case or did the hospital bureaucracy say it was a bad idea? Obviously it wasn't the kids fault... was pops forced to eat his words and then the case was done another time?
 
Jalopycat said:
I had a lady come in L&D 2 days ago in labor wanting an elective C/S under general because she was giving the baby up for adoption and didn't want to hear him cry when he came out. She was a legal secretary and threatened to sue if it didn't go the way she planned. The OB's gave in so when I went to pre-op her I told her we do our sections under spinal because her risk of dying goes up substantially if we put her to sleep. (and I'm not about to risk my medical license for her on a non-emergent section, but I didn't say that).

She got got screaming, crazy mad but then the next thing I knew, they were taking her to a delivery room for an epidural. I won. I can't even think of what my defense would be in a court room had she died. I wouldn't have one!
Click to expand...

So if you went through with the general because she wanted it and then she died, you would have been screwed? Even though she was the one requesting the general.

Or, because you knew the risks, you wouldn't have done it regardless?
 
Jalopycat said:
I had a lady come in L&D 2 days ago in labor wanting an elective C/S under general because she was giving the baby up for adoption and didn't want to hear him cry when he came out. She was a legal secretary and threatened to sue if it didn't go the way she planned. The OB's gave in so when I went to pre-op her I told her we do our sections under spinal because her risk of dying goes up substantially if we put her to sleep. (and I'm not about to risk my medical license for her on a non-emergent section, but I didn't say that).

She got got screaming, crazy mad but then the next thing I knew, they were taking her to a delivery room for an epidural. I won. I can't even think of what my defense would be in a court room had she died. I wouldn't have one!
Click to expand...
I'm confused - you talked to her about a spinal, then someone else does an epidural after "taking her to a delivery room". So did she have the C/S, or did the OB's end up having her deliver?

We would not have touched this case with a general anesthetic. However, we probably would not have a patient show up unannounced for an elective primary C-Section wanting a general anesthetic either. That's something we would have been clued in about ahead of time by our OB docs and the whole issue would have been resolved ahead of time.
 
dilated said:
So what ended up happening? Did your attending refuse to do the case or did the hospital bureaucracy say it was a bad idea? Obviously it wasn't the kids fault... was pops forced to eat his words and then the case was done another time?
Click to expand...

I'm not exactly sure. What I relayed above is the only part of the story I heard. But, I'm sure the case got done... and by the same staff that was assigned. And, I didn't hear anything about it going badly. But, clearly, that's not the point.

-copro
 
coprolalia said:
I just recently heard a story from a colleague who, when interviewing the family in the holding area for their 2-y.o. son who was going in for surgery, the father was noted to say at the end, "Just know that if anything happens to my boy, I'm coming after you."

Now, as you can imagine, this did not go over well with my colleague or his attending. In fact, it prompted calls to the hospital's omsbudsman and patient advocate reps... as well as security.

We do not need to be bullied by our patients or patient's families. I agree, using the patient-centered approach, that a physician should try to uncover the root of such feelings. But, frankly, some people are just childish low-IQ a**holes who you're never going to get through no matter how much explaining you do. This guy, forget being beyond putting my colleague on notice about a lawsuit, made a what-was-beyond-innuendo clear physical threat to my colleague.

When I signed-up for this job, I did not agree to be pin-cushion, martyr, whipping boy, saviour, self-immolator, or Jesus H. Christ himself. Personally, I would've delayed the case too (which they did) if such a comment was made to me until we could've sorted out why the father would say such an incredibly stupid and juvenile thing. I sure as heck would not have taken that kid into the OR, despite it being a relatively minor surgery, after that either.

There are no guarantees in life. Our f**ked-up society, however, over the past sixty years or so has apparently done an expert job of accomplishing and inculcating the false belief that there is.

-copro
Click to expand...

what's jesus middle name
 
jwk said:
I'm confused - you talked to her about a spinal, then someone else does an epidural after "taking her to a delivery room". So did she have the C/S, or did the OB's end up having her deliver?

We would not have touched this case with a general anesthetic. However, we probably would not have a patient show up unannounced for an elective primary C-Section wanting a general anesthetic either. That's something we would have been clued in about ahead of time by our OB docs and the whole issue would have been resolved ahead of time.
Click to expand...

sorry..guess that was confusing. I put in an epidural (with her screaming at me the whole time)and she had a vaginal delivery about 10 minutes later.
 
Jalopycat said:
I told her we do our sections under spinal because her risk of dying goes up substantially if we put her to sleep
Click to expand...

Are you sure?

So now you put an epidural in a non cooperative patient and she gave birth before it had time to kick in 😕 . I think you're setting yourself up for more morbidity then a GA.
 
Umm..she did request..more like DEMAND the epidural. That's why I put it in. And it was working well. She was screaming at me because I wasn't putting it in fast enough to her liking.

Since when is a normal vaginal delivery more dangerous than a c/s under GA? I'd like to see some literature about that.

I don't do procedures on people who don't give consent. I'm sorry I didn't include all the nit-picky details of the story but I wasn't really expecting somebody to really want all of that.

I think you are reading a lot more into this than there really was. My point was that she was threatening to sue if we didn't do a c/s under general, neither which was clinically necessary. She was just a spoiled brat teenager who thought she could boss everyone around. 🙄
 
Jalopycat said:
Umm..she did request..more like DEMAND the epidural. That's why I put it in. And it was working well. She was screaming at me because I wasn't putting it in fast enough to her liking.

Since when is a normal vaginal delivery more dangerous than a c/s under GA? I'd like to see some literature about that.

I think you are reading a lot more into this than there really was. My point was that she was threatening to sue if we didn't do a c/s under general, neither which was clinically necessary. She was just a spoiled brat teenager who thought she could boss everyone around. 🙄
Click to expand...

It was unclear in your story that she changed her mind from c/s under GA to vag under epidural. You said she delivered the baby 10min after the epidural was in which usually is no enough time to provide analgesia.

I did not say a GA was better i challenged you to prove that it is less safe than a spinal.

My point is i do what the patient wants if it's reasonable and i think you're less at risk for a lawsuit if you do so.
 
Jalopycat said:
I think you are reading a lot more into this than there really was. My point was that she was threatening to sue if we didn't do a c/s under general, neither which was clinically necessary. She was just a spoiled brat teenager who thought she could boss everyone around. 🙄
Click to expand...

Now I got it - I was under the impression that she came in for an elective primary C-Section under general. So she was in labor, wanted the epidural, but then IF she had a C-Section, she wanted a GA.
 
If she was other wise healthy, non morbidly obese, and had a reasonable looking airway, I dont see the problem with the general. I would make sure that she was aware of the increase in risk over a regional anesthetic and if she was fine with that then I would go ahead. I would also clearly document this discussion in the consent. If she is threatening to sue me from the beginning, then she can go ahead and find herself another anesthesiologist for this elective procedure.
 
Newbie student here...I thought that patient refusal was a contraindication for regional anesthesia. To me, it doesn't sound like things went well. I guess "you won", but you still had an angry, upset patient for the epidural.

I don't mean to rag on you because she sounds like a jerk. Still, if avoiding a lawsuit was your goal, I'm not sure that what you did gets you there. She was probably terrified and psychologically wigged out about giving up her baby, just the kind of person who would transfer her anger (and lawsuit) to you if you got into a power struggle with her.
 
Carmengia said:
Newbie student here...I thought that patient refusal was a contraindication for regional anesthesia.
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Not in obstetrics.

Carmengia said:
To me, it doesn't sound like things went well. I guess "you won", but you still had an angry, upset patient for the epidural.

I don't mean to rag on you because she sounds like a jerk. Still, if avoiding a lawsuit was your goal, I'm not sure that what you did gets you there. She was probably terrified and psychologically wigged out about giving up her baby, just the kind of person who would transfer her anger (and lawsuit) to you if you got into a power struggle with her.
Click to expand...

Getting sued and getting sued successfully are two different concepts. The real problem is not being sued in and of itself, but the cost of winning.

-copro
 
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