Med mal case question

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PabsMD

PabsMD

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I have just settled a medical malpractice lawsuit (ischemic stroke, not a tPA candidate, bad outcome after mechanical thrombectomy) for 200k. Per my lawyer, the next step is a Department of Health investigation.

Does anyone have experience with this? Not sure what to expect.

Any advice would be appreciated. Thanks!
 
Dept of Health investigation? What state are you in? In Tx, these have nothing to do with the Dept of Health.

Typically, you settle, it goes on your Board records, and you explain it every time you get credentialed. That's the end of it.
 
PabsMD said:
In Florida. It’s described here: DOH Practitioner Investigation What to Expect - Self-Insurance Programs
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I'm not familiar with the process in Florida, but that sounds like the medical board. I'm not sure if that's routine in Florida after any settlement or judgement, or not. Hopefully some Florida docs can chime in on this.

But I'd ask your lawyer, "Is this routine after all suits in Florida? If not, why is this being referred to the DOH? Do I need to worry about actions against my license?" etc.

My wild guess is that it's exceedingly unlikely you would lose your license over something that you were able to settle for $200,000, which in med mal terms isn't a tiny amount, but wouldn't be considered a very large amount either. I know people that have lost suits in the millions and they're still practicing away.
 
How is a bad outcome from a thrombectomy your fault?

I did hear that Florida has awful malpractice laws and just having a bad outcome means someone has to pay.
 
Brigade4Radiant said:
How is a bad outcome from a thrombectomy your fault?

I did hear that Florida has awful malpractice laws and just having a bad outcome means someone has to pay.
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Pretty much.

Add to that the fact that 99% of your patients are turbo old, have multiple advanced comorbidities, and have the boomer attitude where they think they can do whatever they want without health consequences and live forever and it's not a fun environment.

I'm involved in one of these cases now.

I'm outta here soon.

The "three strikes" law thing is bogus.
That law has been on the books for decades now, and something like 2 "strikes" have been handed out. In total. Across all docs. A "strike" requires much much higher suspicion of negligence.
 
As RustedFox stated, it’s automatic in Florida for settled cases (although I didn’t know the threshold was >100k).

The patient came in by EMS as a stroke alert, had an MCA sign on CT head without contrast. He was not a tPA candidate and the family perceived that there was a delay in the patient going for thrombectomy (as well as some mud slinging in the chart) and all involved were sued. Never mind that this was his 3rd ischemic stroke, he had a fib and was non-compliant with his blood thinner and CCB per family. The effects of his stroke were debilitating and he required total care until his death several years later.
 
My attorney explained that this investigation will happen, although no one knows when. I could receive the certified letter today or years from now. He said that in 95% of cases, nothing happens in terms of disciplinary action. Other cases may involve CME, fines in the 2-5k range that malpractice insurance doesn’t cover or even suspension/loss of license.

The malpractice climate in Florida is very unfriendly and I’m constantly in fear of another lawsuit.
 
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PabsMD said:
My attorney explained that this investigation will happen, although no one knows when. I could receive the certified letter today or years from now. He said that in 95% of cases, nothing happens in terms of disciplinary action. Other cases may involve CME, fines in the 2-5k range that malpractice insurance doesn’t cover or even suspension/loss of license.

The malpractice climate in Florida is very unfriendly and I’m constantly in fear of another lawsuit.
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If they're reviewing everything over $100K, it's unlikely anything serious will come of a medical board looking at a case slightly over that limit. Florida is a huge state. That board must be absolutely overwhelmed with reviews if these are mandatory. I'm sure they're more worried about cases $1,000,000 and up. Attention getting outliers are going to get the bulk of their wrath. I wouldn't worry too much about it based on what you've posted. Unfortunately we have a terrible system and this is a part of it. Keep in mind, these boards are usually made up of doctors and they're generally overwhelmed and underfunded.
 
PabsMD said:
I have just settled a medical malpractice lawsuit (ischemic stroke, not a tPA candidate, bad outcome after mechanical thrombectomy) for 200k. Per my lawyer, the next step is a Department of Health investigation.

Does anyone have experience with this? Not sure what to expect.

Any advice would be appreciated. Thanks!
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As someone who is a peer reviewer for my state's medical board, this is probably a no cause for you.

This varies by state, but in Georgia any malpractice settlement with the amount you paid obligates you to report it to the state medical board. It is then assigned to a peer reviewer within your specialty to see if you are grossly negligent in your treatment, documentation, etc. If so, then an investigator with the state medical board will look into it and see if it should be referred to the AG's office for fines and/or other charges (sometimes criminal if it's grossly negligent and you were criminally negligent).

In my many years doing this, I've had one case that a physician was fined (sent someone home before their troponin came back, came back markedly elevated and the physician didn't call the patient back -- he under oath said it was lab error; patient died from an MI 6 hours later). I've had another case where a physician was criminally charged for doing something that was not only grossly negligent, but intentionally caused harm to a patient because the physician could not contain his anger. That physician lost his license and is currently serving time in jail.

For the case you are referring, more than likely you were not negligent at all. Sounds like the patient had a bad outcome from a procedure that you had no control over. It will probably be marked as acceptable standard of care and dismissed.
 
Kryptocoin said:
Never heard of dept of health investigation for a med mal case. Also why are you on the hook for mechanical thrombectomy??
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Nearly every state does an investigation for any malpractice settlement or judgement above a certain amount.

99% of the docs that have a malpractice case against them never knew that the medical board investigated them. It's common practice. See my post above.
 
PabsMD said:
I’m constantly in fear of another lawsuit.
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I understand this fear. But there's no reason to "fear" another malpractice suit. It happens to all of us. It's normal for good doctors to be sued. Its abnormal to not ever be sued. There's no reason to live in fear, because lawyers will fight each other to take an insurance company's money. That's all our malpractice system is. You should view it no other way.

On the other hand, board investigations are much more painful than malpractice suits, in my opinion. That's because medical board investigations are not about getting your money. They're about trying to ruin your life.

I've been through both. I came through both. I followed the standard of care each time. I was cleared. Work goes on. Life goes on.

You'll get through this, too.
 
southerndoc said:
I've had another case where a physician was criminally charged for doing something that was not only grossly negligent, but intentionally caused harm to a patient because the physician could not contain his anger. That physician lost his license and is currently serving time in jail.
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Is there any way for you to anonymize that story enough to give a "he basically did this" explanation?

Like, the doc intentionally didn't give the whiny patient antibiotics because... reasons? The doc got into an argument with someone in the ED, doc was in the wrong but ordered haldol for the patient who subsequently had malignant hyperthermia? The doc didn't bring a flexortenosynovitis to the OR because it looked like the patient was giving him the finger?

Story time!
 
BoardingDoc said:
Is there any way for you to anonymize that story enough to give a "he basically did this" explanation?
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If he was tried, let alone convicted, then the information would already be available to the public.
 
Vandalia said:
If he was tried, let alone convicted, then the information would already be available to the public.
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I know, but we don't have a name or details so at present we can't really look it up terribly easily. I feel like we can maintain anonymity while still getting a gist of the degree of what was going on.
 
BoardingDoc said:
I know, but we don't have a name or details so at present we can't really look it up terribly easily. I feel like we can maintain anonymity while still getting a gist of the degree of what was going on.
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My point was that since the case is already in the public record, there is no need for or requirement for anonymity.
 
I can't imagine a scenario where an Ed physician could be found negligent for a bad outcome from a mechanical thrombectomy unless patient languished in the ED for 10 hours without a neuro consult, admitted to floor without neuro consult or consideration of transfer? Wish we can have details so I can avoid this. Our department currently discourages us from doing CTAs and most ppl I work with dont know what stroke VAN is or know indications for thrombectomy or that is exists 🙁 I have worked in departments that perform stroke VAN assessments and activate code stroke up to 12 hours for mechanical thrombectomy transfers...in these cases, I guess the standard of care changes, right?
 
For the purpose of discussion, if you venture outside of gross negligence and intentionally cause harm (i.e., you willfully cause harm to a patient by either hitting the patient, injecting medications that are done so with intention to cause harm [high-dose potassium, a medication they are allergic to, etc.], or if you do something as wanton as purposefully perform rapid sequence induction and intubate someone with paralytics while they remain awake [i.e., you gave succinylcholine without a sedative because you thought the patient was an a-hole, and then followed that up with some vecuronium without sedation], then rest assured you will be investigated and possibly charged criminally despite the high-five you might get from the nurses for your tough love stance. Just don't do it.

Keep in mind that some criminal records can be sealed by a judge if it's a first offense and circumstances show it won't be a repeat problem, it hinders a person's ability to get a job, etc. A record can be expunged and sealed.
 
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southerndoc said:
As someone who is a peer reviewer for my state's medical board, this is probably a no cause for you.

This varies by state, but in Georgia any malpractice settlement with the amount you paid obligates you to report it to the state medical board. It is then assigned to a peer reviewer within your specialty to see if you are grossly negligent in your treatment, documentation, etc. If so, then an investigator with the state medical board will look into it and see if it should be referred to the AG's office for fines and/or other charges (sometimes criminal if it's grossly negligent and you were criminally negligent).

In my many years doing this, I've had one case that a physician was fined (sent someone home before their troponin came back, came back markedly elevated and the physician didn't call the patient back -- he under oath said it was lab error; patient died from an MI 6 hours later). I've had another case where a physician was criminally charged for doing something that was not only grossly negligent, but intentionally caused harm to a patient because the physician could not contain his anger. That physician lost his license and is currently serving time in jail.

For the case you are referring, more than likely you were not negligent at all. Sounds like the patient had a bad outcome from a procedure that you had no control over. It will probably be marked as acceptable standard of care and dismissed.
Click to expand...

Thanks, this is both helpful and comforting to hear. Appreciate your input.
 
CoffeeGourmand said:
I can't imagine a scenario where an Ed physician could be found negligent for a bad outcome from a mechanical thrombectomy unless patient languished in the ED for 10 hours without a neuro consult, admitted to floor without neuro consult or consideration of transfer? Wish we can have details so I can avoid this. Our department currently discourages us from doing CTAs and most ppl I work with dont know what stroke VAN is or know indications for thrombectomy or that is exists 🙁 I have worked in departments that perform stroke VAN assessments and activate code stroke up to 12 hours for mechanical thrombectomy transfers...in these cases, I guess the standard of care changes, right?
Click to expand...
Even in retrospect, I wouldn’t change my care. The patient was seen immediately and stroke alerted. Our stroke protocol was to order CT/CTA/CTP (all performed at once after RN performed bedside POC creatinine) and then they would be seen by the stroke neurologist. The patient‘s creatinine was 2.4 so by radiology department protocol, the CTA/CTP was cancelled by the tech. There was an MCA sign on the CT without contrast, the patient was not a tPA candidate and had aphasia and hemiparesis on exam (So he obviously needed thrombectomy even without the CTA).

It seems that there was some difficulty getting ahold of the neurosurgeon (done by stroke neurologist per protocol at this hospital) as this case occurred overnight and then the neurosurgeon blamed everyone else for the "delay" in front of the family and in the chart stating that they were waiting for the CTA and CTP results and that I should have notified them that they were cancelled by radiology. Ultimately, the patient received the thrombectomy within 3 hours of arrival (so it is within the standard of care) but had a poor outcome as a very large clot was removed from the MCA and he had no collateral blood flow. The plaintiff had no quality of life due to his debilitating stroke and the family was very angry and sued everyone involved in his care. A debilitated plaintiff is very sympathetic so we settled without going to trial.
 
PabsMD said:
Even in retrospect, I wouldn’t change my care. The patient was seen immediately and stroke alerted. Our stroke protocol was to order CT/CTA/CTP (all performed at once after RN performed bedside POC creatinine) and then they would be seen by the stroke neurologist. The patient‘s creatinine was 2.4 so by radiology department protocol, the CTA/CTP was cancelled by the tech. There was an MCA sign on the CT without contrast, the patient was not a tPA candidate and had aphasia and hemiparesis on exam (So he obviously needed thrombectomy even without the CTA).

It seems that there was some difficulty getting ahold of the neurosurgeon (done by stroke neurologist per protocol at this hospital) as this case occurred overnight and then the neurosurgeon blamed everyone else for the "delay" in front of the family and in the chart stating that they were waiting for the CTA and CTP results and that I should have notified them that they were cancelled by radiology. Ultimately, the patient received the thrombectomy within 3 hours of arrival (so it is within the standard of care) but had a poor outcome as a very large clot was removed from the MCA and he had no collateral blood flow. The plaintiff had no quality of life due to his debilitating stroke and the family was very angry and sued everyone involved in his care. A debilitated plaintiff is very sympathetic so we settled without going to trial.
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thanks for those details. wow, sorry this occurred to you. i will keep this in mind and continue doing CTAs and will probably ignore my dept in the meantime until they catch on...maybe they will see the value of it or not...who knows...i did catch a gnarly basilar artery near occlusion with it...so definitely very helpful study...thanks!

fyi, ive done CTAs recently on Cr 2+ and to my surprise, their Cr actually improved. i do have radiology background and remember renal functions deteriorating w/ IV contrast but I guess that new EMRAP podcast is right that it may not be as a big a deal.
 
PabsMD said:
Even in retrospect, I wouldn’t change my care. The patient was seen immediately and stroke alerted. Our stroke protocol was to order CT/CTA/CTP (all performed at once after RN performed bedside POC creatinine) and then they would be seen by the stroke neurologist. The patient‘s creatinine was 2.4 so by radiology department protocol, the CTA/CTP was cancelled by the tech. There was an MCA sign on the CT without contrast, the patient was not a tPA candidate and had aphasia and hemiparesis on exam (So he obviously needed thrombectomy even without the CTA).

It seems that there was some difficulty getting ahold of the neurosurgeon (done by stroke neurologist per protocol at this hospital) as this case occurred overnight and then the neurosurgeon blamed everyone else for the "delay" in front of the family and in the chart stating that they were waiting for the CTA and CTP results and that I should have notified them that they were cancelled by radiology. Ultimately, the patient received the thrombectomy within 3 hours of arrival (so it is within the standard of care) but had a poor outcome as a very large clot was removed from the MCA and he had no collateral blood flow. The plaintiff had no quality of life due to his debilitating stroke and the family was very angry and sued everyone involved in his care. A debilitated plaintiff is very sympathetic so we settled without going to trial.
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I'm so sorry this happened to you. It all sounds so needlessly stressful.

As an aside, I get a little cranky with technicians who cancel emergent contrast studies based on the creatinine. This is because contrast-induced nephropathy probably doesn't exist, the purported effect size is so small that it probably doesn't matter, and if a patient needs a scan, they need a scan. The amount of concern is so disproportionately intense to the actual risk that all reason goes out the window.

Our local stroke protocol makes very clear to never wait for the creatinine.

emcrit.org

Contrast Nephropathy, myth thereof

CONTENTS Venous injection of contrast (e.g. for CT scan) The birth of the contrast nephropathy myth Current lack of evidence regarding contrast nephropathy Weighing the risks vs. benefits of using contrast (Renalism) The attention given to contrast nephropathy is insane Intra-arterial contrast...
emcrit.org emcrit.org
 
CoffeeGourmand said:
thanks for those details. wow, sorry this occurred to you. i will keep this in mind and continue doing CTAs and will probably ignore my dept in the meantime until they catch on...maybe they will see the value of it or not...who knows...i did catch a gnarly basilar artery near occlusion with it...so definitely very helpful study...thanks!

fyi, ive done CTAs recently on Cr 2+ and to my surprise, their Cr actually improved. i do have radiology background and remember renal functions deteriorating w/ IV contrast but I guess that new EMRAP podcast is right that it may not be as a big a deal.
Click to expand...
CIN doesn't really exist according to the literature. If the benefit outweighs the risk, do it. I personally would rather be on dialysis 3 times/week instead of being fed through a G tube because I'm debilitated.
 
CoffeeGourmand said:
I can't imagine a scenario where an Ed physician could be found negligent for a bad outcome from a mechanical thrombectomy unless patient languished in the ED for 10 hours without a neuro consult, admitted to floor without neuro consult or consideration of transfer? Wish we can have details so I can avoid this. Our department currently discourages us from doing CTAs and most ppl I work with dont know what stroke VAN is or know indications for thrombectomy or that is exists 🙁 I have worked in departments that perform stroke VAN assessments and activate code stroke up to 12 hours for mechanical thrombectomy transfers...in these cases, I guess the standard of care changes, right?
CoffeeGourmand said:
thanks for those details. wow, sorry this occurred to you. i will keep this in mind and continue doing CTAs and will probably ignore my dept in the meantime until they catch on...maybe they will see the value of it or not...who knows...i did catch a gnarly basilar artery near occlusion with it...so definitely very helpful study...thanks!

fyi, ive done CTAs recently on Cr 2+ and to my surprise, their Cr actually improved. i do have radiology background and remember renal functions deteriorating w/ IV contrast but I guess that new EMRAP podcast is right that it may not be as a big a deal.
Click to expand...
Thanks all for the comments and support. I agree that contrast-induced nephropathy isn’t evidence-based but this incident occurred in 2015 and has dragged on until last week. This case did teach me the importance of good documentation with time stamps and that my colleagues will not hesitate to throw me under the bus to save face (and subsequently get themselves and everyone else sued).
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southerndoc said:
CIN doesn't really exist according to the literature. If the benefit outweighs the risk, do it. I personally would rather be on dialysis 3 times/week instead of being fed through a G tube because I'm debilitated.
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This doesn't seem to make sense, to me. If CIN doesn't exist, why would you be on dialysis? I mean, I saw it happen when I was a resident - cards would do the ventriculogram, which would be a big dollop of contrast, and that was adios kidneys. The literature says it doesn't happen, but I saw repeated anecdotes. I'm going to say right here that I am not closely familiar with whatever studies there are.

Or, is it, the amount of contrast from a CT isn't enough to injure you, but, the contrast volume used in cardiology is?
 
Apollyon said:
This doesn't seem to make sense, to me. If CIN doesn't exist, why would you be on dialysis? I mean, I saw it happen when I was a resident - cards would do the ventriculogram, which would be a big dollop of contrast, and that was adios kidneys. The literature says it doesn't happen, but I saw repeated anecdotes. I'm going to say right here that I am not closely familiar with whatever studies there are.

Or, is it, the amount of contrast from a CT isn't enough to injure you, but, the contrast volume used in cardiology is?
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Yes there does seem to be a significant difference the the type/amount/load given in certain cath-based contrast uses and the modern use in CT scans…
 
PabsMD said:
Even in retrospect, I wouldn’t change my care. The patient was seen immediately and stroke alerted. Our stroke protocol was to order CT/CTA/CTP (all performed at once after RN performed bedside POC creatinine) and then they would be seen by the stroke neurologist. The patient‘s creatinine was 2.4 so by radiology department protocol, the CTA/CTP was cancelled by the tech. There was an MCA sign on the CT without contrast, the patient was not a tPA candidate and had aphasia and hemiparesis on exam (So he obviously needed thrombectomy even without the CTA).

It seems that there was some difficulty getting ahold of the neurosurgeon (done by stroke neurologist per protocol at this hospital) as this case occurred overnight and then the neurosurgeon blamed everyone else for the "delay" in front of the family and in the chart stating that they were waiting for the CTA and CTP results and that I should have notified them that they were cancelled by radiology. Ultimately, the patient received the thrombectomy within 3 hours of arrival (so it is within the standard of care) but had a poor outcome as a very large clot was removed from the MCA and he had no collateral blood flow. The plaintiff had no quality of life due to his debilitating stroke and the family was very angry and sued everyone involved in his care. A debilitated plaintiff is very sympathetic so we settled without going to trial.
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Based on this story (and the fact that neurointervention was performed within 3 hours which is hardly a delay), I'd guess that the patient likely had a large infarct core with very little salvageable penumbra tissue, and therefore would have been a poor thrombectomy candidate anyway. A CTP would probably have shown that (although CTP for a large vessel obstruction within the first 6 hours is not considered necessary). In which case, the thrombectomy didn't help, but also likely didn't hurt. So this would not have been "bad outcome after thrombectomy" but rather "poor candidate for thrombectomy who unsurprisingly didn't get better after thrombectomy". If the CTP had actually been performed, perhaps there would have been no lawsuit at all, since the fact that this was a poor thrombectomy candidate, not a bad outcome, would have been demonstrated. All speculation at this point, of course. But as others have said, I don't see where anyone dropped the ball here, or patient care suffered.

You say "he had no collateral blood flow", how do you know that without a CTA or CTP?
 
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OP, thanks for sharing this case and generating discussion. I created a similar one a few years back after noticing that nobody ever really talked about malpractice cases on here and I just assumed that nobody had been sued. It's a lonely feeling going through your first malpractice suit and not really having a community or close colleagues that you can talk about it. It lends to a great deal of self doubt, obsessive compulsive rumination over the encounter, perceived guilt, depression and anxiety. Surprisingly, we've had a few threads since then where people seem more comfortable sharing their malpractice history and I think it's been great for people (especially new docs) to see it and know that it's not as uncommon as they might have thought and they most definitely are not alone.

What I don't like to see are a million questions about all the nitty gritty details followed by posters criticizing you for any perceived errors in your management or what they would/would not have done "in your shoes". I don't particularly think that's helpful. I also don't think it encourages people to come forward later and share their own experiences. If anyone has ever been through a suit, you become your own medical and legal expert on the subject matter by the time its all over. Hours upon hours of reading and/or prep for depositions, discussions with your lawyer, etc..

Kudos for sharing and asking for advice. Regarding your original question, I did go through a state investigation regarding an EMTALA case awhile back but it was fairly straightforward and involved me speaking to an investigator on the telephone and that was it. From what you've shared, I don't think I would worry that much about it, especially if every case over 100K is automatically investigated.

In the future, I might suggest getting out of Florida altogether. I have a list of states that I won't consider jobs in d/t malpractice environment, regardless of how nice they might be, proximity to family, etc.. Florida is one of my anathema states, as I call them.

In case anyone is curious, my malpractice history:
Sued twice, settled one for below state reporting limits ~60K. I was dropped from the other.
 
Phantom Spike said:
Based on this story (and the fact that neurointervention was performed within 3 hours which is hardly a delay), I'd guess that the patient likely had a large infarct core with very little salvageable penumbra tissue, and therefore would have been a poor thrombectomy candidate anyway. A CTP would probably have shown that (although CTP for a large vessel infact within the first 6 hours is not considered necessary). In which case, the thrombectomy didn't help, but also likely didn't hurt. So this would not have been "bad outcome after thrombectomy" but rather "poor candidate for thrombectomy who unsurprisingly didn't get better after thrombectomy". If the CTP had actually been performed, perhaps there would have been no lawsuit at all, since the fact that this was a poor thrombectomy candidate, not a bad outcome, would have been demonstrated. All speculation at this point, of course. But as others have said, I don't see where anyone dropped the ball here, or patient care suffered.

You say "he had no collateral blood flow", how do you know that without a CTA or CTP?
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Good point; he was likely not a good candidate for thrombectomy. I’ve never really considered that a CTP (which was part of the routine ischemic stroke alert at that time) may have prevented the suit in that he may not have gone for the procedure and therefore he would not have "experienced a delay in treatment" since the plaintiff’s case was based upon potentially increased disability due to the delay (the "time is brain" argument). If there was no issue of salvageable brain tissue, time/delay becomes irrelevant. The hospital was doing a thrombectomy trial at the time (2015) and they were very aggressive about performing the procedure.

The lack of collateral flow was based upon the neurosurgeon‘s statement during his deposition.

I think that if this case was tried amongst a jury of my peers (ie physicians), it would be clear that there wasn’t a direct dereliction of duty on my part leading to damages and therefore this was not malpractice on my part but that’s not the way the system works. Also… Florida.
 
PabsMD said:
The lack of collateral flow was based upon the neurosurgeon‘s statement during his deposition.
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There's no way he could really claim that for certain without a CTP/CTA (although it is most likely true given the way things turned out), but regardless, in a fair world, that one statement alone should have been enough to throw out the lawsuit ... if there were "no collaterals" there was never anything to salvage with thrombectomy. But insurance companies, of course, rush to settle even when they could win.
 
BoardingDoc said:
Is there any way for you to anonymize that story enough to give a "he basically did this" explanation?

Like, the doc intentionally didn't give the whiny patient antibiotics because... reasons? The doc got into an argument with someone in the ED, doc was in the wrong but ordered haldol for the patient who subsequently had malignant hyperthermia? The doc didn't bring a flexortenosynovitis to the OR because it looked like the patient was giving him the finger?

Story time!
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Neuroleptic malignant syndrome?

And yeah op sounds like you got hosed. Just got caught holding the bag when the music stopped. It's absurd that noncompliant patients can sue after a self inflicted negative outcome and actually win.
 
Groove said:
OP, thanks for sharing this case and generating discussion. I created a similar one a few years back after noticing that nobody ever really talked about malpractice cases on here and I just assumed that nobody had been sued. It's a lonely feeling going through your first malpractice suit and not really having a community or close colleagues that you can talk about it. It lends to a great deal of self doubt, obsessive compulsive rumination over the encounter, perceived guilt, depression and anxiety. Surprisingly, we've had a few threads since then where people seem more comfortable sharing their malpractice history and I think it's been great for people (especially new docs) to see it and know that it's not as uncommon as they might have thought and they most definitely are not alone.

What I don't like to see are a million questions about all the nitty gritty details followed by posters criticizing you for any perceived errors in your management or what they would/would not have done "in your shoes". I don't particularly think that's helpful. I also don't think it encourages people to come forward later and share their own experiences. If anyone has ever been through a suit, you become your own medical and legal expert on the subject matter by the time its all over. Hours upon hours of reading and/or prep for depositions, discussions with your lawyer, etc..

Kudos for sharing and asking for advice. Regarding your original question, I did go through a state investigation regarding an EMTALA case awhile back but it was fairly straightforward and involved me speaking to an investigator on the telephone and that was it. From what you've shared, I don't think I would worry that much about it, especially if every case over 100K is automatically investigated.

In the future, I might suggest getting out of Florida altogether. I have a list of states that I won't consider jobs in d/t malpractice environment, regardless of how nice they might be, proximity to family, etc.. Florida is one of my anathema states, as I call them.

In case anyone is curious, my malpractice history:
Sued twice, settled one for below state reporting limits ~60K. I was dropped from the other.
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Thank you so much for your words of encouragement. I’m happy to share and I definitely echo the feelings of being alone and depressed. To this day, I still have PTSD with stroke cases.

I highly recommend the podcast Doctors and Litigation: The L Word. It’s an excellent series that goes through the anatomy of a lawsuit, what to expect, and made me feel less alone. Also, it’s important to seek help/therapy if needed during these events. Physician depression and suicide is so rampant and the more isolated we are, the worse things will be.

ETA: unfortunately my spouse’s career will keep us in Florida for the foreseeable future. I’m working on saving for early retirement (>50% of my income) and hope to be done within the next 7 years.
 
GassYous said:
Neuroleptic malignant syndrome?

And yeah op sounds like you got hosed. Just got caught holding the bag when the music stopped. It's absurd that noncompliant patients can sue after a self inflicted negative outcome and actually win.
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I agree and am working to not be so bitter while navigating this broken system.
 
Were the neurologist and neurosurgeon also sued? Did their insurance companies settle?
You mention that there was difficulty getting hold of the neurosurgeon; was that documented?
If you informed the neurologist as per protocol, and the neurologist consulted the neurosurgeon, and the delay was in getting hold of the neurosurgeon, why would you (or the neurologist) even be considered at fault? Especially since there does not really appear to have been a delay at all.
 
PabsMD said:
Thank you so much for your words of encouragement. I’m happy to share and I definitely echo the feelings of being alone and depressed. To this day, I still have PTSD with stroke cases.

I highly recommend the podcast Doctors and Litigation: The L Word. It’s an excellent series that goes through the anatomy of a lawsuit, what to expect, and made me feel less alone. Also, it’s important to seek help/therapy if needed during these events. Physician depression and suicide is so rampant and the more isolated we are, the worse things will be.

ETA: unfortunately my spouse’s career will keep us in Florida for the foreseeable future. I’m working on saving for early retirement (>50% of my income) and hope to be done within the next 7 years.
Click to expand...

Good tips. An option worth considering would be to do locums in a more malpractice friendly state. Doing a couple short stretches or one long one and then flying home each month might not be so bad. Florida sounds like an absolutely miserable place to practice.
 
@Groove is right. Thanks for sharing. We all need more of a support network. The majority of EP's get sued at least once. I've been through litigation twice. The first I was dropped after my deposition and the second is ongoing. Hopefully it gets resolved soon because I would love to share the details. I'm sure most will be like me -- in total disbelief that this actually led to litigation against me. Maybe I'm wrong and people will say otherwise, but will have to wait to divulge the details later (if I can -- some things become sealed). Thankfully my insurer is not settling and plans to take it to trial.

On another note, I recently found that Georgia has moved from #6 to #3 in the country for the number of claims paid in excess of $10 million. We now surpass Chicago for the number of high dollar claims. WTH?!? We have a gross negligence clause, but that doesn't always apply. The whole malpractice environment is scary at times.
 
Groove said:
OP, thanks for sharing this case and generating discussion. I created a similar one a few years back after noticing that nobody ever really talked about malpractice cases on here and I just assumed that nobody had been sued.
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I've posted about this subject many times. I'm sorry you missed them, because I agree 100%.

This article was originally a thread and post here on SDN, but I can find it with the search engine. Maybe I deleted it, but EP Monthly agreed to publish it online and so did Kevin MD (with a different title). But here's my take on my first lawsuit (in which I was totally innocent, did nothing wrong and followed the standard of care):

It Didn't Feel Like A Win
 
Phantom Spike said:
Were the neurologist and neurosurgeon also sued? Did their insurance companies settle?
You mention that there was difficulty getting hold of the neurosurgeon; was that documented?
If you informed the neurologist as per protocol, and the neurologist consulted the neurosurgeon, and the delay was in getting hold of the neurosurgeon, why would you (or the neurologist) even be considered at fault? Especially since there does not really appear to have been a delay at all.
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The real question is, does that matter for a lawsuit and the cost of settlement vs potential cost of litigation?

We're talking about a world where a mother didn't get prenatal care, went into preterm labor, and successfully sued an ambulance service because they transported her after the EM physician's assessment was that she was too early in labor to give birth.

Everyone else: Malpractice limits.
Ambulance company: $10 million.

www.orlandosentinel.com

Jury awards $10 million in ambulance birth

DeLAND – A Volusia jury has awarded $10 million to a Volusia County woman, finding EVAC Ambulance service at fault for the injuries her son received during his premature birth in 2003. After …
www.orlandosentinel.com www.orlandosentinel.com
 
Birdstrike said:
I've posted about this subject many times. I'm sorry you missed them, because I agree 100%.

This article was originally a thread and post here on SDN, but I can find it with the search engine. Maybe I deleted it, but EP Monthly agreed to publish it online and so did Kevin MD (with a different title). But here's my take on my first lawsuit (in which I was totally innocent, did nothing wrong and followed the standard of care):

It Didn't Feel Like A Win
Click to expand...
Actually Bird, that's the first article that I can remember reading on here regarding EP lawsuits and was great. I read it a couple years after you wrote it when I was going through mine and it was very helpful at the time.
 
Ugh. That sounds miserable. Obviously egregious lawsuit that gets settled out of expediency. The problem with medmal is the constant stress of knowing that an unpreventable or unpredictable random bad outcome or event can have this type of effect on your career. Even when you know that it won't have any direct monetary cost to you is unlikely to affect your career in any meaningful way, it's still in the back of your mind, constantly nipping at your heels. Plus, the fact that the causative factors are almost always systematic in nature, yet we're held personally responsible.

WilcoWorld said:
Hence the lawsuit.

If nursing facility care wasn't so astronomically expensive we'd have less med mal nonsense.
Click to expand...
This country really does need a non-fault system to compensate real victims of medical error (as well as much smaller fault-based system to punish or remediate the far smaller number of true malpractice cases). However, I'd estimate that the OP's case wasn't one of those, it was just a stroke.
 
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