Malpractice - Case Reviews, Q&A, whatever else!

[Arch Guillotti]

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My standard statement is this:
There are a entire host of things that can occur with surgery and anesthesia. This consent lists many of them but can not include everything. I have gone over the more common things like nausea etc. Would you like to discuss these in more detail? They always say “no”. Then I say please read them if you wish and ask me any questions you may have. After that please sign HERE.

What is everyone’s thoughts on my approach?

Not bad.

I save the come to Jesus talk for the ones that really need it.

 

[vector2]

Why is OP on probationary status? Probably the most helpful non-MD poster we've had in ages

 

[Noyac]

Not bad.

I save the come to Jesus talk for the ones that really need it.

It takes me less than 5 min and pts appreciate the approach for the most part. I put the ball in their court to some degree. They are participants in this adventure and they must take some responsibility. Obviously, if there are things that I feel are likely to occur or have a greater chance of occurring in a particular case then we discuss them.

In my many years of doing this I have had one pt that said I must go over every possible risk in detail. She was unhappy with my approach. I apologized and started to go into more detail and then she stopped me and said she was good. WTF? She worked for RM somewhere. Total control freak with no ability to reason.

 

[anbuitachi]

My standard statement is this:
There are a entire host of things that can occur with surgery and anesthesia. This consent lists many of them but can not include everything. I have gone over the more common things like nausea etc. Would you like to discuss these in more detail? They always say “no”. Then I say please read them if you wish and ask me any questions you may have. After that please sign HERE.

What is everyone’s thoughts on my approach?

Oh we dont have an anesthesia consent (with risk factors and stuff) for the patient to sign. we just document in the chart consent obtained , r/b/a discussed in the chart. no one actually lists them here except maybe for teeth damage. the consent the surgeon gets and have the patient sign says consent for surgery and anesthesia, so technically its 1 consent for both. but it doesnt have anesthesia risk factors and i doubt the surgeon is explaining the anesthesia to the patient when they sign it.

 

[pgg]

My standard statement is this:
There are a entire host of things that can occur with surgery and anesthesia. This consent lists many of them but can not include everything. I have gone over the more common things like nausea etc. Would you like to discuss these in more detail? They always say “no”. Then I say please read them if you wish and ask me any questions you may have. After that please sign HERE.

What is everyone’s thoughts on my approach?

I think it's totally reasonable. Whenever I get a patient who resists hearing anything, I do annotate the consent form that the patient declined to discuss the risks. I don't know how much that would matter but I'd feel better in court being able to point to a consent form that says "offered detailed explanation of risks but patient verbally refused to discuss" ... I think even the most hostile jury would have a hard time buying the "he never told me this could happen" complaint.

I fall on the document more side of the spectrum.

 

[deleted126335]

My standard statement is this:
There are a entire host of things that can occur with surgery and anesthesia. This consent lists many of them but can not include everything. I have gone over the more common things like nausea etc. Would you like to discuss these in more detail? They always say “no”. Then I say please read them if you wish and ask me any questions you may have. After that please sign HERE.

What is everyone’s thoughts on my approach?

That phrase (and the documentation of it and patient refusal) is key legally.

 

[Noyac]

Oh we dont have an anesthesia consent (with risk factors and stuff) for the patient to sign. we just document in the chart consent obtained , r/b/a discussed in the chart. no one actually lists them here except maybe for teeth damage. the consent the surgeon gets and have the patient sign says consent for surgery and anesthesia, so technically its 1 consent for both. but it doesnt have anesthesia risk factors and i doubt the surgeon is explaining the anesthesia to the patient when they sign it.

What state do you practice in because there are three different laws that pertain to this and each state has chosen new law to follow. We looked into this very thing and my state Colorado is sort of an in-between type state which doesn’t necessarily support getting consent or not. We chose to continue to get our own consent. Maybe I will have time later today to present the three different laws.

 

[anbuitachi]

I think it's totally reasonable. Whenever I get a patient who resists hearing anything, I do annotate the consent form that the patient declined to discuss the risks. I don't know how much that would matter but I'd feel better in court being able to point to a consent form that says "offered detailed explanation of risks but patient verbally refused to discuss" ... I think even the most hostile jury would have a hard time buying the "he never told me this could happen" complaint.

I fall on the document more side of the spectrum.

I feel like the opposing team can easily make an argument and put the blame on the doctor. "oh the patient was anxious and scared so of course they didnt want to hear the risks. it's your job as the doctor to calm the patient down and explain the risks in a way that doesn't increase the patients anxiety. clearly you failed your job as the doctor" The opposing lawyer can easily say something to sway the jurys emotions..

What state do you practice in because there are three different laws that pertain to this and each state has chosen new law to follow. We looked into this very thing and my state Colorado is sort of an in-between type state which doesn’t necessarily support getting consent or not. We chose to continue to get our own consent. Maybe I will have time later today to present the three different laws.

NY state

 

[Noyac]

I feel like the opposing team can easily make an argument and put the blame on the doctor. "oh the patient was anxious and scared so of course they didnt want to hear the risks. it's your job as the doctor to calm the patient down and explain the risks in a way that doesn't increase the patients anxiety. clearly you failed your job as the doctor" The opposing lawyer can easily say something to sway the jurys emotions..



NY state

You can not account for every argument a lawyer will come up with. You can do what is expected from a reasonable physician discussing risks with a reasonable pt.

With that being said, just last month I called a surgeon in to my pts room to witness what I was seeing. He ended up cancelling the case. The pt was extremely anxious and making improper comments. He was a risk to my staff and no matter what I told him or how I explained the procedure and risks to him he would not change his behavior.

 

[pgg]

I feel like the opposing team can easily make an argument and put the blame on the doctor. "oh the patient was anxious and scared so of course they didnt want to hear the risks. it's your job as the doctor to calm the patient down and explain the risks in a way that doesn't increase the patients anxiety. clearly you failed your job as the doctor" The opposing lawyer can easily say something to sway the jurys emotions..

There's only so much you can do.

For the rest, that's why we have liability insurance.

Keep the faith and worry about things you can control.

 

[deleted171991]

My standard statement is this:
There are a entire host of things that can occur with surgery and anesthesia. This consent lists many of them but can not include everything. I have gone over the more common things like nausea etc. Would you like to discuss these in more detail? They always say “no”. Then I say please read them if you wish and ask me any questions you may have. After that please sign HERE.

What is everyone’s thoughts on my approach?

I think it's defensible. I use the same tactic with anxious patients.

 

[deleted171991]

There's only so much you can do.

For the rest, that's why we have liability insurance.

Keep the faith and worry about things you can control.

The problem is not with the liability, but with one's stress level and career. Getting sued hurts both big time, at least in the short-term.

 

[abolt18]

You can not account for every argument a lawyer will come up with. You can do what is expected from a reasonable physician discussing risks with a reasonable pt.

With that being said, just last month I called a surgeon in to my pts room to witness what I was seeing. He ended up cancelling the case. The pt was extremely anxious and making improper comments. He was a risk to my staff and no matter what I told him or how I explained the procedure and risks to him he would not change his behavior.

I'm intrigued...

 

[pgg]

The problem is not with the liability, but with one's stress level and career. Getting sued hurts both big time, at least in the short-term.

That's fair. I've never been sued so I can't completely predict how I'll react. For now it's easy for me to be philosophical about it, but I don't get worked up about much in life.

 

[sigrhoillusion]

My standard statement is this:
There are a entire host of things that can occur with surgery and anesthesia. This consent lists many of them but can not include everything. I have gone over the more common things like nausea etc. Would you like to discuss these in more detail? They always say “no”. Then I say please read them if you wish and ask me any questions you may have. After that please sign HERE.

What is everyone’s thoughts on my approach?

That's pretty much what happens with me. I tell them "feel free to read all the risks and ask me questions". 99% of the time they just grab the form and sign it well telling me to make sure they wake up.

 

[Noyac]

So I am on call today and I took a lady to the OR for a case. She was one of those pts that just rubs you the wrong way. Inconsiderate and demanding. After going through my consent in my usual fashion the discussion turned to if I knew what I was doing. Both the nurse and surgeon made statements like, there aren’t many better and you are in good hands. Thanks to those two. Then she said, well you better or my husband will be a rich man. WTF?

 

[deleted171991]

So I am on call today and I took a lady to the OR for a case. She was one of those pts that just rubs you the wrong way. Inconsiderate and demanding. After going through my consent in my usual fashion the discussion turned to if I knew what I was doing. Both the nurse and surgeon made statements like, there aren’t many better and you are in good hands. Thanks to those two. Then she said, well you better or my husband will be a rich man. WTF?

And that's when you refuse to provide anesthesia. No brainer.

I don't care if I get fired. I don't treat elective cases who threaten me (even with just a lawsuit). Or who insult me. Pretty sure it also qualifies as disruptive behavior.

 

[sigrhoillusion]

And that's when you refuse providing the anesthesia. No brainer.

I don't care if I get fired. I don't treat elective cases who threaten me. Or who insult me.

Well if he's on call, maybe it wasn't purely elective.

That being said, I am also on call today, and had a patient who HAD surgical consent, I got anesthesia consent in the holding area.
We rolled back to the OR and as soon as he was on the OR table he started yelling that he didn't want to have the surgery. The surgeon attempted to convince him to continue but he started getting more agitated. We ended up putting him back on the stretcher and sending him back to the room.

Also, had a patient earlier in the week who finished up a IR case under MAC. She refused to leave the IR table at the end cause we didn't "do what her surgeon had promised". She insulted everyone, especially me and our profession. And when the IR doc figured maybe they could perform the procedure again, I told them I wasn't comfortable taking care of the patient in her current state of mind, and they could have their nurses provide sedation if they felt necessary.

Two cases are very vague, but don't want to give too many details unless in private forum.

 

[deleted171991]

Well if he's on call, maybe it wasn't purely elective.

That being said, I am also on call today, and had a patient who HAD surgical consent, I got anesthesia consent in the holding area.
We rolled back to the OR and as soon as he was on the OR table he started yelling that he didn't want to have the surgery. The surgeon attempted to convince him to continue but he started getting more agitated. We ended up putting him back on the stretcher and sending him back to the room.

Also, had a patient earlier in the week who finished up a IR case under MAC. She refused to leave the IR table at the end cause we didn't "do what her surgeon had promised". She insulted everyone, especially me and our profession. And when the IR doc figured maybe they could perform the procedure again, I told them I wasn't comfortable taking care of the patient in her current state of mind, and they could have their nurses provide sedation if they felt necessary.

Two cases are very vague, but don't want to give too many details unless in private forum.

Case 1 is clear-cut. The patient withdrew his consent. Done. End of story.

Case 2 sounds interesting. Why did she insult the anesthesia team if the IR team was the one who did not do the procedure she thought they would? There must have been a huge problem with the informed consent process in that case, both for the IR doc and the anesthesiologist. It seems that the patient felt she got substandard care from both. Which brings me back to my point about setting the right expectations (when consenting a patient).

 

[sigrhoillusion]

Case 1 is clear cut. The patient withdrew his consent. Done. End of story.

Case 2 sounds interesting. Why did she insult the anesthesia team if the IR team was the one who did not do the procedure she thought they would? There must have been a huge problem with the informed consent process in that case, both for the IR doc and the anesthesiologist.

Second case was definitely an informed consent issue. That being said her doctor's note in the chart specifically talked about the different options, so he may have told her but she may have selectively omitted what she didn't want to hear. That being said, what are everyone's thoughts on when it is feasible to get consent on a patient after already getting an anesthetic? Is there a specific timeframe your group/hospital uses or is it based solely on mental status and ability to have appropriate dialogue? Again, with this patient, I felt that she was so angry I couldn't get informed consent to give her more sedation, and anything after our original sedation could have been classified as assault even if she really really wanted to be put to sleep. (Granted the procedure probably didn't need us in the first place, which is why I didn't feel bad walking away, even though I felt I did a reasonable job trying to accommodate her.) I blamed my resident for doing toooo good of a job by having her wide awake at the end. If he let her sleep a little longer, she'd have woken up in PACU and prevented a possible call to security.

 

[deleted171991]

You did the right thing. The patient was not consentable anymore (for a different anesthetic plan).

Million dollar question (pun intended): Did you ask the patient what procedure she was supposed to have, as part of your (not your resident's) preop? Was that the only procedure on the signed surgical consent? (It's irrelevant what the doctor's note said if the patient did not consent to his plan.) Did the IR doc perform THAT specific procedure?

There are also some other questions people may ask themselves regarding the timeout process, and your supervision level. 😉

 

[pgg]

Case 1 is clear-cut. The patient withdrew his consent. Done. End of story.

When I was a fellow, I was rolling a patient into the OR when she started crying and said she didn't want the surgery. The periop nurse in the room asked me why I didn't give her more Versed to calm her down.

 

[deleted171991]

When I was a fellow, I was rolling a patient into the OR when she started crying and said she didn't want the surgery. The periop nurse in the room asked me why I didn't give her more Versed to calm her down.

I have regular exchanges with PACU/ICU nurses about (chemically) restraining a patient just because s/he wants to get out of bed, remove his Foley etc., or do something different than the nurses would like. They don't even bother to interview the patient. Many of them have little respect for patient autonomy.

During my fellowship, I was called for a consult for ICU transfer (and intubation). When I arrived, 4 nurses were wrestling with an agitated big guy who wanted to sit up, nothing more. I also noticed that his sats sucked. So I convinced them to let him sit and dangle his feet on the side of the bed, put an oxygen mask on him, allowed him to catch his breath, and then had a conversation with the patient and his desperate wife, who had been told all kinds of insults about her poor husband, while witnessing his air hunger. Those were cardiac nurses, btw. But, hey, nurses protect patients from doctors, right?

 

[timgasman]

Can they ever go after your personal assets if you have a malpractice policy?

 

[Man o War]

Can they ever go after your personal assets if you have a malpractice policy?

Yes, if the award exceeds the limit to your policy.
Every new attending needs to get a good estate planning/asset protection attorney before they graduate residency.
I know one anesthesiologist who got a huge judgment against him due to a CRNA. It exceeded the limit of his policy by approx $10 million. They attempted to come after his personal assets to make up the difference, but he had a good attorney who had everything sheltered well.
Expect to pay several thousand for compete estate planning and asset protection, it’s money well spent.

 

[mmag]

Can they ever go after your personal assets if you have a malpractice policy?

Yes but it is extremely rare. Lawyers are after an easy and fast payout which is why many cases settle to the malpractice insurance limits. Anesthesiologists generally like to be prepared for everything/anything so many will recommend shelling out money to a lawyer. Everyone's risk tolerance is different. It's worthwhile to at least learn the laws of your state and do the simple stuff like maxing money in retirement accounts and having the house in both spouses' names etc. I don't do anything beyond the simple/free strategies: I like to dream about having the med mal attorneys duking it out with ex-spouse's attorney to collect money.

Medscape: Medscape Access
Protect personal assets if you're sued for malpractice | 2007-03-01 | AHC Media: Continuing Medical Education Publishing
Asset Protection - Debunking the Myths | The White Coat Investor - Investing And Personal Finance for Doctors
Little chance of losing personal assets to malpractice suits | FierceHealthcare

The extreme illustration of this point is that malpractice lawyers are extremely reluctant to sue doctors who have no malpractice insurance because the chances of collecting is so low.
Patients, Beware When Doctors 'Go Bare' | HuffPost
Is It Worth It to Sue a Doctor With No Malpractice Insurance?

 

[Dejavu]

I once heard a lecture on the subject by a high-up guy from the Closed Claims Project and talked with him after, about what to tell patients.

He said to mention things that happen more than 1/10,000 and the really big things. Lawyers say, in typical vague fashion, to mention anything “material to the ‘reasonable man’s’ decision making process.”

Death is really big, so I mentioned it to everyone. Believe me, everyone thinks about it. Especially parents of a four year old. Mentioned PONV, teeth, sore throat, breathing problems, coma , not waking up, death.

Then anything unique to the situation, like respiratory support after interscalene block, block no work- spotty like leopard. ( Hidden clue that tells some of you where I worked).

Retired just a bit ago.
Got through career without getting sued or written up.
Patients often thanked me for thoroughness.

 

[BLADEMDA]

We live in an outcome driven healthcare system with the expectation of a good outcome. That means the patient and his/her family EXPECT no complications or postop morbidity. This EXPECTATION is what can drive a lawsuit especially in my State. My goal is to get a consent where the likely complications are explained in a simple, honest manner. I document this discussion with patient and family because I can't control outcomes no matter how hard I try. While this doesn't guarantee a lawsuit won't occur (especially in my State with dozens of lawyers advertising on TV) I think it minimizes the chance any lawyer will actually take the case.

Noyac's case of Urosepsis is a prime example. I've had more than 6 cases of severe Urosepsis in my career where the Urologist failed to grasp the underlying severity of the patient. I explained to the family how sick the patient really was and the increased risk of prolonged hospital stay, possible ICU with Inotropes and the need for invasive monitoring.

I've had more than a few patients undergo ELECTIVE procedures who didn't survive the surgery or end up with an MI perioperatively. But, by screening these patients and assessing risk an Anesthesiologist can mitigate the chances for a lawsuit. Be honest, do a good preop, get the appropriate tests and proceed after a discussion with patient, family and sometimes the surgeon/Cardiologist.

By managing the expectations (be realistic) and doing your job as we have discussed on SDN countless times, the malpractice risk can be kept fairly low even in a litigious State like mine. You may still get sued once or twice during your career of 30 years but the case will be settled for a small amount or you will win at trial.

The longer I do this the more I realize the importance of the preop and the discussion with the patient/family.

 

[deleted171991]

Yes but it is extremely rare. Lawyers are after an easy and fast payout which is why many cases settle to the malpractice insurance limits. Anesthesiologists generally like to be prepared for everything/anything so many will recommend shelling out money to a lawyer. Everyone's risk tolerance is different. It's worthwhile to at least learn the laws of your state and do the simple stuff like maxing money in retirement accounts and having the house in both spouses' names etc. I don't do anything beyond the simple/free strategies: I like to dream about having the med mal attorneys duking it out with ex-spouse's attorney to collect money.

Medscape: Medscape Access
Protect personal assets if you're sued for malpractice | 2007-03-01 | AHC Media: Continuing Medical Education Publishing
Asset Protection - Debunking the Myths | The White Coat Investor - Investing And Personal Finance for Doctors
Little chance of losing personal assets to malpractice suits | FierceHealthcare

The extreme illustration of this point is that malpractice lawyers are extremely reluctant to sue doctors who have no malpractice insurance because the chances of collecting is so low.
Patients, Beware When Doctors 'Go Bare' | HuffPost
Is It Worth It to Sue a Doctor With No Malpractice Insurance?

Just FYI, even with joint tenancy, they can come after your half when you sell or at your death. 😉

 

[IMGASMD]

We live in an outcome driven healthcare system with the expectation of a good outcome. That means the patient and his/her family EXPECT no complications or postop morbidity. This EXPECTATION is what can drive a lawsuit especially in my State. My goal is to get a consent where the likely complications are explained in a simple, honest manner. I document this discussion with patient and family because I can't control outcomes no matter how hard I try. While this doesn't guarantee a lawsuit won't occur (especially in my State with dozens of lawyers advertising on TV) I think it minimizes the chance any lawyer will actually take the case.

Noyac's case of Urosepsis is a prime example. I've had more than 6 cases of severe Urosepsis in my career where the Urologist failed to grasp the underlying severity of the patient. I explained to the family how sick the patient really was and the increased risk of prolonged hospital stay, possible ICU with Inotropes and the need for invasive monitoring.

I've had more than a few patients undergo ELECTIVE procedures who didn't survive the surgery or end up with an MI perioperatively. But, by screening these patients and assessing risk an Anesthesiologist can mitigate the chances for a lawsuit. Be honest, do a good preop, get the appropriate tests and proceed after a discussion with patient, family and sometimes the surgeon/Cardiologist.

By managing the expectations (be realistic) and doing your job as we have discussed on SDN countless times, the malpractice risk can be kept fairly low even in a litigious State like mine. You may still get sued once or twice during your career of 30 years but the case will be settled for a small amount or you will win at trial.

The longer I do this the more I realize the importance of the preop and the discussion with the patient/family.

I think all of that came from “experience”. Which most of us don’t develop until we are your age. 😉

I had attendings who will not have that conversation with patients or just dump the case to a junior attending. The other part of EXPECTATION is also societal/hospital/our own, that we suppose to handle everything when we become attendings. Everyone learn to cover their own ass and no one lending a helping hand. But that’s another conversation.

 

[caligas]

We live in an outcome driven healthcare system with the expectation of a good outcome. That means the patient and his/her family EXPECT no complications or postop morbidity. This EXPECTATION is what can drive a lawsuit especially in my State. My goal is to get a consent where the likely complications are explained in a simple, honest manner. I document this discussion with patient and family because I can't control outcomes no matter how hard I try. While this doesn't guarantee a lawsuit won't occur (especially in my State with dozens of lawyers advertising on TV) I think it minimizes the chance any lawyer will actually take the case.

Noyac's case of Urosepsis is a prime example. I've had more than 6 cases of severe Urosepsis in my career where the Urologist failed to grasp the underlying severity of the patient. I explained to the family how sick the patient really was and the increased risk of prolonged hospital stay, possible ICU with Inotropes and the need for invasive monitoring.

I've had more than a few patients undergo ELECTIVE procedures who didn't survive the surgery or end up with an MI perioperatively. But, by screening these patients and assessing risk an Anesthesiologist can mitigate the chances for a lawsuit. Be honest, do a good preop, get the appropriate tests and proceed after a discussion with patient, family and sometimes the surgeon/Cardiologist.

By managing the expectations (be realistic) and doing your job as we have discussed on SDN countless times, the malpractice risk can be kept fairly low even in a litigious State like mine. You may still get sued once or twice during your career of 30 years but the case will be settled for a small amount or you will win at trial.

The longer I do this the more I realize the importance of the preop and the discussion with the patient/family.

Blade, I’ve heard that if both you and your carrier want to fight a claim but it ends up going to court and getting a plaintiffs verdict in excess of your policy limits, that they will indemnify you above your limits. Do you know how that stuff works?

 

[BLADEMDA]

Blade, I’ve heard that if both you and your carrier want to fight a claim but it ends up going to court and getting a plaintiffs verdict in excess of your policy limits, that they will indemnify you above your limits. Do you know how that stuff works?

Correct, if your Carrier agrees that your defense is "solid" and willing to go to trial they will cover for whatever the outcome. The problem arises is if you believe your case is "solid" but the carrier can settle for $100K. The carrier will push hard to settle the case and may even threaten to not cover any of the losses beyond your policy limits.

The way the USA system works is even if you win at trial the case will cost the carrier $200K+ to defend. The Plaintiff doesn't pay a dime of these costs so the malpractice carrier eats it.

 

[caligas]

Correct, if your Carrier agrees that your defense is "solid" and willing to go to trial they will cover for whatever the outcome. The problem arises is if you believe your case is "solid" but the carrier can settle for $100K. The carrier will push hard to settle the case and may even threaten to not cover any of the losses beyond your policy limits.

The way the USA system works is even if you win at trial the case will cost the carrier $200K+ to defend. The Plaintiff doesn't pay a dime of these costs so the malpractice carrier eats it.

Got it. One more question: is it true that the plaintiff attorneys will always or almost always accept a “reasonable” settlement within policy limits? In other words, are all cases “settleable” if the defendant agrees they are at fault?

 

[BLADEMDA]

Got it. One more question: is it true that the plaintiff attorneys will always or almost always accept a “reasonable” settlement within policy limits? In other words, are all cases “settleable” if the defendant agrees they are at fault?

Yes, that is the way our system works. If you make an offer to settle for the MAX like $1 million (limits of your policy) the lawyers will accept 99% of the time. This isn't about justice or fairness it's about money. I have never heard of one case where the defendant offered up the limits of his/her policy and the plaintiff's lawyer rejected the offer. Now, I'm sure there are cases where the malpractice is so so bad the families will demand more or a trial but the lawyers are typically thrilled to get the maximum from your policy. They then try to use you against other defendants (like the surgeon for example) to get him/her to settle as well.

 

[caligas]

I’m in Virginia now: Malpractice cap of 2.2mil. So it always seemed strange that we wouldn’t have coverage of 2.2 mil instead of 1 million. But understanding the settlement process helps explain why you would not want that higher coverage. Just become a bigger target.

 

[BLADEMDA]

I’m in Virginia now: Malpractice cap of 2.2mil. So it always seemed strange that we wouldn’t have coverage of 2.2 mil instead of 1 million. But understanding the settlement process helps explain why you would not want that higher coverage. Just become a bigger target.

The lawyers believe that if the income of the patients in your area are higher than the norm then you have an "obligation" to carry higher malpractice limits. This avoids any potential personal liability. For example, if you live in PODUNK Georgia then $500K limits may be quite reasonable. But, if you live in an affluent area of Virginia with a median income of $100K perhaps $2 million is a much more reasonable policy. Sounds crazy? The lawyers control the whole system so that is the way it works.

You need to have "reasonable limits" and guess who determines what reasonable means? Hint: It isn't you, the AMA or the ASA.

 

[BLADEMDA]

Understanding Your State’s Liability Limits
Understanding the minimum liability limits in each state is important for every medical care professional seeking medical malpractice insurance. Obtaining the proper minimum coverage ensures that a physician’s personal assets are protected from liability in the event of a lawsuit. Additionally, knowing what caps are in place in each state helps medical professionals determine the best policies to meet their specific needs and budgets. The most common policy liability limits are $1 million per occurrence and $3 million aggregate.

Minimum Liability Limits by State
The states of Massachusetts, Rhode Island, Connecticut, New Jersey, Wisconsin, Kansas and Colorado all require physicians to insure themselves for $100,000 to $1 million per occurrence for an aggregate amount of $300,000 to $3 million. Eligibility to receive the benefits of state reforms such as damages caps and patient compensation funds is dependent on a physician maintaining medical malpractice insurance with a minimum liability limit in the states of New York, Pennsylvania, Indiana, Louisiana, Nebraska, New Mexico and Wyoming. For example, Indiana’s Patient Compensation Fund covers damage awards over $250,000, allowing physicians to maintain lower per-occurrence liability limits.

Minimum Liability Limits in Non-Mandated States
Many states do not mandate that physicians carry a minimum level of medical malpractice insurance. In these states, hospitals often require that medical professionals maintain a certain minimum level of liability insurance to obtain hospital staff privileges. Furthermore, many client contracts that hospitals and medical practices enter into require that minimum liability limits be maintained. Thus, in practice, the minimum level of liability that a medical professional must maintain is often in line with the state cap on medical malpractice claims. For example, California, Florida and Texas limit damage awards in medical malpractice cases.

 

[BLADEMDA]

Anderson notes that limits are something an oncologist just starting practice should look for in a policy. “You want to have limits that are what everyone else has,” he advises. “Having higher limits may help you sleep better, but it means you will be the deep pocket in a lawsuit naming other defendants. Normally, you want prevailing limits based on your geographical area and your specialty.”


Malpractice Insurance: What You Need to Know

 

[BLADEMDA]

I’m in Virginia now: Malpractice cap of 2.2mil. So it always seemed strange that we wouldn’t have coverage of 2.2 mil instead of 1 million. But understanding the settlement process helps explain why you would not want that higher coverage. Just become a bigger target.

Most Physicians carry $500k-$1 million per incident. If you don't carry enough insurance there is personal liability risk so you may need good asset protection. With a $1 million dollar policy you can sleep like a baby. While the risk of being sued personally is very low most Physicians are risk averse and carry at least $500K.

http://www.law.uci.edu/lawreview/vol5/no3/Silver.pdf

 

[BLADEMDA]

Please read the case below. This is a rare event. 99% of cases are resolved within the policy limits. But, if you don't carry enough insurance the Plaintiff may seek your personal assets. My advice is to either carry enough malpractice insurance or carry the minimum but protect your personal assets. I choose the former over the latter and sleep quite well at night.


Mitigate the risk of excess judgment in malpractice litigation

 

[Man o War]

Please read the case below. This is a rare event. 99% of cases are resolved within the policy limits. But, if you don't carry enough insurance the Plaintiff may seek your personal assets. My advice is to either carry enough malpractice insurance or carry the minimum but protect your personal assets. I choose the former over the latter and sleep quite well at night.


Mitigate the risk of excess judgment in malpractice litigation

This does happen folks! Like I mentioned, I know someone it happened to. He gave 2 middle fingers to the plaintiff’s lawyer because his assets were basically untouchable due to smart estate planning/asset protection.
This will cost 3-5,000 bucks most likely. Over a career, it’s nothing.

 

[BLADEMDA]

The first issue to address in any asset protection plan is to have adequate insurance. Have high liability limits on your auto, boat, and property insurance. Add an umbrella policy on top of those. Not only does this provide more protection for you from large claims, it also brings you the benefit of having the insurance company’s highly paid, experienced attorneys on your side. Carry an appropriate amount of malpractice insurance for the same reasons. Most of us worry about a malpractice suit ruining us financially. The truth is very few malpractice claims exceed the physician’s malpractice insurance policy limits, and those that do usually could have been settled for less than the policy limit. Malpractice suits and settlements are very unlikely to affect you financially. Don’t get me wrong, being sued for malpractice is likely to drastically affect your life and practice of medicine (especially if you get sued enough that you can’t get credentialed at a hospital or can’t get insurance at a reasonable rate.) But one or two suits are unlikely to have a significant financial on you. You’re much more likely to meet financial ruin from divorce, stupid, undiversified investments, and problems with your practice. Perhaps we ought to include such things as a prenuptial agreement in this section on insurance. Certainly, if you are getting married to someone after either of you has accumulated a significant amount of assets, you ought to get a prenup.

Introduction to Asset Protection | The White Coat Investor - Investing And Personal Finance for Doctors

 

[BLADEMDA]

It could be argued that the concern with respect to the threat posed by a medical malpractice plaintiff is exaggerated. While I am not aware of any published data on instances in which physicians have had to use personal funds to resolve malpractice claims, our firm's experience is that this is very rare. In the 40 years that we have represented physicians and physician groups, we have encountered only six instances in which physicians had to use personal funds. Four cases involved very low levels of insurance, and two cases involved no insurance at all. The total amount paid in all six cases was less than $300,000.

That personal payments seem to be rare is probably the result of a variety of factors. In an era of higher policy limits, "umbrella coverage" or separate policy limits for the physician's employer, there are simply more insurance dollars available. The typical "shotgun" approach common in medical malpractice litigation assured that there would be multiple defendants, many with "deep pockets" who could be persuaded to contribute to a settlement. In addition, malpractice plaintiffs and their attorneys have generally not evidenced interest in pursuing physicians' personal assets except in unusual circumstances. Of course, to some extent this lack of interest may also have been attributable to the fact that many physicians had engaged in asset-protection planning, thereby rendering themselves essentially judgment-proof to any but the most determined judgment creditor

Asset-protection Strategies for Physicians | ABI

 

[BLADEMDA]

 

[BLADEMDA]

So, are you scared about losing all your money from a malpractice lawsuit? Well, IMHO, the odds are that your wife/husband or teenager are far more likely to be involved in an accident where the other party gets injured and seeks to sue you personally. Since you are the likely "deep pocket" the lawyers will come after you hard. That's why you need an UMBRELLA policy and really good auto/home insurance.

Nothing wrong with asset protection but common sense starts with Umbrella insurance.


Liability Insurance Umbrella Policies Vital for Physicians | Physicians Practice

 

[anbuitachi]

If you get sued, and you settle to make it go away, won't that look bad on your resume for future jobs? Vs going thru it and winning the lawsuit.

Also they teach us about how difficult it is to for doctors to actually lose lawsuit since they need to satisfy each criteria like damage done, negligence, etc but how do they really prove stuff like negligence in many scenarios in real life?
Let's say I do an arterial line, nothing unusual happens, and 2 days later the patients hand goes ischemic and 2 fingers fall off, and the patient sues the anesthesiologist blaming it on the arterial line. Or the patient gets a corneal abrasion despite the anesthesiologist protecting the eye with lube/eye tape with documentation. Or you do an epidural like usual, 2 days later the patient has weakness in lower legs despite normal imaging. I can imagine the patient suing in all these cases, but if the anesthesiologist is adhering to 'standard of care' but a rare consequence still happens, how do they even prove its due to negligence cause without negligence the anes shoudn't be losing the lawsuit

 

[nimbus]

If you get sued, and you settle to make it go away, won't that look bad on your resume for future jobs? Vs going thru it and winning the lawsuit.

Also they teach us about how difficult it is to for doctors to actually lose lawsuit since they need to satisfy each criteria like damage done, negligence, etc but how do they really prove stuff like negligence in many scenarios in real life?
Let's say I do an arterial line, nothing unusual happens, and 2 days later the patients hand goes ischemic and 2 fingers fall off, and the patient sues the anesthesiologist blaming it on the arterial line. Or the patient gets a corneal abrasion despite the anesthesiologist protecting the eye with lube/eye tape with documentation. Or you do an epidural like usual, 2 days later the patient has weakness in lower legs despite normal imaging. I can imagine the patient suing in all these cases, but if the anesthesiologist is adhering to 'standard of care' but a rare consequence still happens, how do they even prove its due to negligence cause without negligence the anes shoudn't be losing the lawsuit

Nobody lists their lawsuits on their resume.

Medicolegally it is in your long-term best interest to defend all lawsuits as vigorously as possible. That is how the system is designed to work. You do not want a reputation for being an easy target among the plaintiffs bar within your community. Remember plaintiffs attorneys work on contingency. They front all the costs of a lawsuit until a settlement is reached. When a lawyer considers taking on a malpractice case, they do a risk benefit analysis. How much will this cost them in terms of time and money? What is the likelihood of a payout? What is the likely amount of payout?

If your practice has a reputation for writing checks in order to “make it go away”, your future will be a medicolegal nightmare filled with nuisance suits. If the practice vigorously defends every lawsuit, the plaintiffs attorneys are more likely to take on a case based on the facts and not because they know you will settle without much effort and expense on their part.

As we all know, a complication or a bad outcome does not equal negligence.

 

[Arch Guillotti]

If your practice has a reputation for writing checks in order to “make it go away”, your future will be a medicolegal nightmare filled with nuisance suits. If the practice vigorously defends every lawsuit, the plaintiffs attorneys are more likely to take on a case based on the facts and not because they know you will settle without much effort and expense on their part.

This may be a matter of semantics but it isn't necessarily up to the practice what to do. The insurance carrier that covers the practice ultimately decides what to do.

 

[Low Flow]

EMCrit RACC - A Refractory Anaphylaxis Mock Trial by Mike Weinstock

Great mock trial recreating a trial against an ED doc back in '08. Came across my feed a few days ago and reminded me of this thread. Definitely worth a listen.

 

[Rcola23]

This may be a matter of semantics but it isn't necessarily up to the practice what to do. The insurance carrier that covers the practice ultimately decides what to do.

This is not always the case. Certain policies carry a "consent to settle" clause which requires the accused to agree to the settlement - even to the financial detriment of the insurance company.