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I've dragged my feet for awhile on posting about this due to being busy with life but wanted to write up some of my experiences on getting sued.
It's not discussed too heavily in training but it's a reality of life and part of the game when practicing medicine in the United States.
I do some obstetrics which as everyone knows is a fairly litigious specialty. I'm fellowship trained so don't do call really anymore except maybe a few times a year to maintain my obstetrics privileges. For some reason I'm hesitant to give up my delivery privileges. I'd feel like part of my residency went to waste.
On to my cases:
I was year two into my second job out of fellowship. I did general OBGYN and was trying to get my subspecialty volume going. Part of the job was taking in house call 5 times a month (24 hour). Truly a miserable experience due to how frequent call was and how grueling it could be.
Unassigned obstetric patients are usually some of the worst patients out there. Usually they have major medical issues, commonly druggies, personality disorders, and are just ungrateful @$$holes.
This particular call shift, an obese term patient came into triage with contractions on a Sunday night. Limited prenatal care until 24 weeks but no records but appeared to be term. 3 prior c sections and having regular painful contractions.
She had actually seen a local OB for care but she was dismissed from his practice because of non-compliance/missed visits.
I tell the patient she needs a c section since it looks like she's in labor and has 3 prior sections.
We roll her back.
I do the section. Significant adhesions. Her being so fat doesn't help either. Operative time was about 50 minutes. Deliver the kid and hand off to NICU team who is there for every c section.
They evaluate the kid and notice a humerus fracture. F$#k me. The delivery was okay. Some difficulty with the delivery but wasn't the worst.
I finish the section and talk to the patient. I tell her about the fracture and that I'm not sure what happened but I am sorry this happened. She looks at me blankly.
I see her the next morning and she's more agitated about the fracture. She's discharged after a few days.
I follow up in the NICU. The neonatologist tells me these fractures typically heal well with a splint. But the notes comment on a possible Erb's palsy. Fantastic...
I set her up for a follow up in the clinic to see me for an incision check which she doesn't show up for.
Maybe 2 weeks later, I get a letter of intent to sue because of the fracture. The lawsuit is on behalf of the baby. The mom also sues for emotional distress and dad sues for loss of consortium.
The lawyer had named me, the assistant OB, anesthesiologist and the hospital.
F@&k me.
I contact hospital risk management and we talk. She walks me through the process.
So starts a ~4 year process of delays, expert witnesses, and general annoyances.
The first thing that was asked was if I wanted the same law firm who was representing the hospital. I stupidly said yes. It worked out for me in the end but remember that the goals for the hospital and yourself may not align.
Lesson- Make sure your lawyer is just representing you.
My lawyer submitted a motion to dismiss the case. The patients lawyer only has to submit an "expert" opinion that says the lawsuit has some credence for a judge to allow it to go through.
The expert opinion was anything but. They found some local OB (Howard Mandel) who basically does plaintiff work. His opinion was the injury occurred because I was did the c section too quickly. A big f$$k you to Howard Mandel for selling his soul for a few thousand dollars.
Completely bogus but per my lawyer, this joker is who scumbag lawyers use who will write/say whatever. He claims to be an expert but really isn't. Just a jack@$$ who will anything other than actual clinical medicine.
So now it is full steam ahead.
My lawyer (who was also representing the hospital) also sent an estimated bill which I have attached. This bill is based on an approximately week long trial and includes the estimated costs for everything. Interesting to see how much it costs to defend a case.
One thing people should remember that this will be a long, dragged out process. Delays are the norm. COVID happened which really dragged things out.
My lawyers had a physician review the case and submit an opinion etc. It was a MFM who is the chair of a large academic OB department nearby. He basically indicated that there was no malpractice etc.
After about 2 years of delays/COVID, we finally had a trial date. Before that we were going to do depositions.
A month before the deposition date, my lawyer forwards an email from the patients lawyer indicating they were willing to settle for $29,999 x 3 ( baby, mom, dad).
The amount is odd because in California, if you have a malpractice award/settlement of $30,000 or more, you must report it to the state medical board.
At this point, nearly 3 years have passed. We've gotten updates on the kid. Thankfully, baby healed with conservative management with full range of motion and no neurological deficits.
Patients lawyer is trying their hardest to salvage this case.
I talk to my lawyers who tell me that ultimately it looks like we are headed to a settlement. They tell me that they will only settle if the plaintiff agrees to drop me from the lawsuit and only the hospital pays out.
Eventually the patients lawyer agrees to this. The hospital settled the case for $29,999 total. I was dropped with prejudice and an agreement I wouldn't try to sue the lawyer.
All this grief for $30k. After lawyer fees etc , patient probably got very little cash.
So I never even gave a deposition in this case.
-----------------------------------------------------------------------
Case 2:
I was working as laborist again. There are still a couple of private practice physicians who deliver their own patients.
There is a particular OB who basically runs a slum practice. He sees a bunch of patients, offers substandard care but usually gets away with it
This night, he had a patient in labor. It's around 10pm, the patients nurse calls me and states that the patients OB is asking if I can break her water to speed things up. I check the patient, fetal head is too high so I don't break her water.
I go do other things. I get called again a few hours later after midnight. OB is asking if I can evaluate and see if I can break her water. I check the patient . Her fetal tracing is fine, Category 1 basically. The head has come down and I break her water. I document a note an hour or two later because I was running around doing other patient care things. Since it wasn't my patient I didn't get called again. I assume the nurse is in contact with the attending.
I finish my shift a couple hours later at 7am. The patient eventually delivers at 7pm that day, 12 hours after I finish my shift.
Baby came out bad. Apparently the fetal tracing went to h$ll later on during the labor. Baby gets transferred out etc.
I eventually get a notice of intent of a lawsuit in my mail. I didn't even recognize the name of the patient since she wasn't even my patient.
I go through the same process and let risk management know. I have her number on standby by this point.
I eventually get deposed on the case. It's me, my lawyer, the plaintiff lawyer and the other OBs lawyer. I believe there was a fourth representing the hospital.
The deposition process is annoying. The plaintiff lawyer will go through very basic questions such as name, education, etc.
Then they will slowly get into the details of the case.
One thing they perseverated on was the fact that my progress note was done a few hours after I saw/examined the patient. And it wasn't due to laziness but just because of being so busy. There was nothing wrong with the note but they try to claim something was wrong because a note was completed a few hours later. Very stupid stuff.
I was eventually dropped from the case as it was clear I did nothing wrong. From what I understand, the OB settled for a $1 million.
Some tips:
Don't guess or make up answers
If you don't know or recall, just say so
Sometimes I just read the statement of my note in response to a question
The lawyer will often ask basically the same question several times looking for you to alter your answer hoping for a gotcha moment and to attack your credibility.
"As I previously stated" then repeated my response...
Be calm
Don't take it personally. Easier said than done.
Lawyers in general are dirtbags
-------------------------------------------
Lawsuits unfortunately are a reality
I don't like to call them malpractice lawsuits. What they are in reality is bad outcomes lawsuits.
You can do everything perfectly and have a bad outcome or you can screw things up and have a great outcome. Guess who will be sued?
I don't do much obstetrics at this point. I see some patients in the office and do maybe 12 c sections a year.
I do urogynecology mainly and have done numerous challenging cases including fistula repairs, complex hysterectomy, ureteral reimplant for some of the local gynecologists when they tagged a ureter and urology refused to come in. Even with all that stuff, never been sued for that.
Just obstetrics.
And people wonder why there is a shortage of OBs. I know several who have given up doing deliveries and they are young too. They don't even care about a potentially decreased income, the stress and liability wasn't worth it.
It's not discussed too heavily in training but it's a reality of life and part of the game when practicing medicine in the United States.
I do some obstetrics which as everyone knows is a fairly litigious specialty. I'm fellowship trained so don't do call really anymore except maybe a few times a year to maintain my obstetrics privileges. For some reason I'm hesitant to give up my delivery privileges. I'd feel like part of my residency went to waste.
On to my cases:
I was year two into my second job out of fellowship. I did general OBGYN and was trying to get my subspecialty volume going. Part of the job was taking in house call 5 times a month (24 hour). Truly a miserable experience due to how frequent call was and how grueling it could be.
Unassigned obstetric patients are usually some of the worst patients out there. Usually they have major medical issues, commonly druggies, personality disorders, and are just ungrateful @$$holes.
This particular call shift, an obese term patient came into triage with contractions on a Sunday night. Limited prenatal care until 24 weeks but no records but appeared to be term. 3 prior c sections and having regular painful contractions.
She had actually seen a local OB for care but she was dismissed from his practice because of non-compliance/missed visits.
I tell the patient she needs a c section since it looks like she's in labor and has 3 prior sections.
We roll her back.
I do the section. Significant adhesions. Her being so fat doesn't help either. Operative time was about 50 minutes. Deliver the kid and hand off to NICU team who is there for every c section.
They evaluate the kid and notice a humerus fracture. F$#k me. The delivery was okay. Some difficulty with the delivery but wasn't the worst.
I finish the section and talk to the patient. I tell her about the fracture and that I'm not sure what happened but I am sorry this happened. She looks at me blankly.
I see her the next morning and she's more agitated about the fracture. She's discharged after a few days.
I follow up in the NICU. The neonatologist tells me these fractures typically heal well with a splint. But the notes comment on a possible Erb's palsy. Fantastic...
I set her up for a follow up in the clinic to see me for an incision check which she doesn't show up for.
Maybe 2 weeks later, I get a letter of intent to sue because of the fracture. The lawsuit is on behalf of the baby. The mom also sues for emotional distress and dad sues for loss of consortium.
The lawyer had named me, the assistant OB, anesthesiologist and the hospital.
F@&k me.
I contact hospital risk management and we talk. She walks me through the process.
So starts a ~4 year process of delays, expert witnesses, and general annoyances.
The first thing that was asked was if I wanted the same law firm who was representing the hospital. I stupidly said yes. It worked out for me in the end but remember that the goals for the hospital and yourself may not align.
Lesson- Make sure your lawyer is just representing you.
My lawyer submitted a motion to dismiss the case. The patients lawyer only has to submit an "expert" opinion that says the lawsuit has some credence for a judge to allow it to go through.
The expert opinion was anything but. They found some local OB (Howard Mandel) who basically does plaintiff work. His opinion was the injury occurred because I was did the c section too quickly. A big f$$k you to Howard Mandel for selling his soul for a few thousand dollars.
Completely bogus but per my lawyer, this joker is who scumbag lawyers use who will write/say whatever. He claims to be an expert but really isn't. Just a jack@$$ who will anything other than actual clinical medicine.
So now it is full steam ahead.
My lawyer (who was also representing the hospital) also sent an estimated bill which I have attached. This bill is based on an approximately week long trial and includes the estimated costs for everything. Interesting to see how much it costs to defend a case.
One thing people should remember that this will be a long, dragged out process. Delays are the norm. COVID happened which really dragged things out.
My lawyers had a physician review the case and submit an opinion etc. It was a MFM who is the chair of a large academic OB department nearby. He basically indicated that there was no malpractice etc.
After about 2 years of delays/COVID, we finally had a trial date. Before that we were going to do depositions.
A month before the deposition date, my lawyer forwards an email from the patients lawyer indicating they were willing to settle for $29,999 x 3 ( baby, mom, dad).
The amount is odd because in California, if you have a malpractice award/settlement of $30,000 or more, you must report it to the state medical board.
At this point, nearly 3 years have passed. We've gotten updates on the kid. Thankfully, baby healed with conservative management with full range of motion and no neurological deficits.
Patients lawyer is trying their hardest to salvage this case.
I talk to my lawyers who tell me that ultimately it looks like we are headed to a settlement. They tell me that they will only settle if the plaintiff agrees to drop me from the lawsuit and only the hospital pays out.
Eventually the patients lawyer agrees to this. The hospital settled the case for $29,999 total. I was dropped with prejudice and an agreement I wouldn't try to sue the lawyer.
All this grief for $30k. After lawyer fees etc , patient probably got very little cash.
So I never even gave a deposition in this case.
-----------------------------------------------------------------------
Case 2:
I was working as laborist again. There are still a couple of private practice physicians who deliver their own patients.
There is a particular OB who basically runs a slum practice. He sees a bunch of patients, offers substandard care but usually gets away with it
This night, he had a patient in labor. It's around 10pm, the patients nurse calls me and states that the patients OB is asking if I can break her water to speed things up. I check the patient, fetal head is too high so I don't break her water.
I go do other things. I get called again a few hours later after midnight. OB is asking if I can evaluate and see if I can break her water. I check the patient . Her fetal tracing is fine, Category 1 basically. The head has come down and I break her water. I document a note an hour or two later because I was running around doing other patient care things. Since it wasn't my patient I didn't get called again. I assume the nurse is in contact with the attending.
I finish my shift a couple hours later at 7am. The patient eventually delivers at 7pm that day, 12 hours after I finish my shift.
Baby came out bad. Apparently the fetal tracing went to h$ll later on during the labor. Baby gets transferred out etc.
I eventually get a notice of intent of a lawsuit in my mail. I didn't even recognize the name of the patient since she wasn't even my patient.
I go through the same process and let risk management know. I have her number on standby by this point.
I eventually get deposed on the case. It's me, my lawyer, the plaintiff lawyer and the other OBs lawyer. I believe there was a fourth representing the hospital.
The deposition process is annoying. The plaintiff lawyer will go through very basic questions such as name, education, etc.
Then they will slowly get into the details of the case.
One thing they perseverated on was the fact that my progress note was done a few hours after I saw/examined the patient. And it wasn't due to laziness but just because of being so busy. There was nothing wrong with the note but they try to claim something was wrong because a note was completed a few hours later. Very stupid stuff.
I was eventually dropped from the case as it was clear I did nothing wrong. From what I understand, the OB settled for a $1 million.
Some tips:
Don't guess or make up answers
If you don't know or recall, just say so
Sometimes I just read the statement of my note in response to a question
The lawyer will often ask basically the same question several times looking for you to alter your answer hoping for a gotcha moment and to attack your credibility.
"As I previously stated" then repeated my response...
Be calm
Don't take it personally. Easier said than done.
Lawyers in general are dirtbags
-------------------------------------------
Lawsuits unfortunately are a reality
I don't like to call them malpractice lawsuits. What they are in reality is bad outcomes lawsuits.
You can do everything perfectly and have a bad outcome or you can screw things up and have a great outcome. Guess who will be sued?
I don't do much obstetrics at this point. I see some patients in the office and do maybe 12 c sections a year.
I do urogynecology mainly and have done numerous challenging cases including fistula repairs, complex hysterectomy, ureteral reimplant for some of the local gynecologists when they tagged a ureter and urology refused to come in. Even with all that stuff, never been sued for that.
Just obstetrics.
And people wonder why there is a shortage of OBs. I know several who have given up doing deliveries and they are young too. They don't even care about a potentially decreased income, the stress and liability wasn't worth it.
