Patient lawsuits

[docB]

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I'm not saying that anybody "deserves to be sued". I'm saying that there is no such thing as an acceptable rate of mistake (technical complication) under the law. The law isn't about blame as much as shifting burdens. It has been deemed that where someone does something that deviates from the standard of care, which, for example, is considered the case when putting in a chest tube causes a pneumothorax, according to medical experts, then he bears the burden and it is deemed negligent. This is not the same as the OBGYN case where some percentage of babies will be born imperfect even without medical intervention. Causing a pneumothorax isn't just something that happens X% of the time so tough luck for the patient. It is something where the X is going to be variable based on the physician, and thus the physician bears the cost of that X. That is so whether it happens 1/100 times or 1/2 times. You lessen your liability if you lessen the rate of complications, but the law doesn't allow for you to throw up your hands and be less concerned/careful because there is an "acceptable risk" for a given procedure. Because patient's aren't bargaining for acceptable risk. They are bargaining for you to fix what ails them, and if there are complications along the way, the question becomes whether you deviated from the standard of care. So it turns on whether an expert deems you erred. And if you cause a PTX putting in a line, you erred even if the best hands will err 1% of the time. That isn't saying you are bad, it's saying you did the procedure so you shoulder the cost (as opposed to the patient shouldering the cost).

As for losing your career due to a case or two of alleged negligence, it doesn't really happen. Most physicians will be sued at least once in their career, many in surgical fields and OB will be sued multiple times. They carry insurance and don't lose their careers.

Then our only alternative is to stop doing procedures. We don't operate under the "getting sued is just a cost of doing business" model that the lawyers try to force upon us. Getting sued is such a high stress, life altering, cost prohibitive situation that the risk is not worth bearing. It does end careers, marriages and force unwanted job changes, demotions and grief. If that will be the result of being unlucky and having a known and unpreventable complication occur then that risk is too high.

I do not accept your argument that the legal system is sufficiently self policed and all of the problems that led us to the current med mal crisis are due to the apathy of medicine. Medicine, outcomes and the "system" we work under is controlled by the rules of biology which are poorly understood and often unpredictable. We do our best to cope but to held to the standard of perfection is unreasonable. Law functions under the rules of men. It is fallable and gets changed when it suits the needs and whims of its masters, the lawyer class. When trying to apply law to medicine it will invaribly be unfair to one party or the other.

Perfection is just not possible and we should not be punished for our humanity. It is only reasonable for this abomination of a system to punish us when we fall outside the lines of good intent and competence.

 

[dragonfly99]

lawdoc
I just want to say that your assertion that a pneumothorax during central line placement is always negligent and there never can be an acceptable rate of complications is completely wrong. That is untrue. There are some patients who are just very high risk (i.e. already on a vent, have had many previous lines so have venous stenoses, scars, etc.) and no matter how skilled the person doing the procedure there will be some rate of complications. That doesn't mean we shouldn't strive to reduce the rates of complications, but every adverse outcome or complication does NOT equal negligence nor a breach of the standard of care. It just doesn't. We are dealing with biological systems and multiple variables, and a bad outcome does not always equal negligence or malpractice. Some patients have a >> risk of death than others in the OR, and much of that is unrelated to who is doing the surgery or anesthesia.

The crazy lawsuit mania has DEFINITELY decreased the number of med students wanting to do OB, and I believe has decreased the quality of those going into OB, though OB residencies can still fill (so far). 150-200k/year malpractice insurance is NOT reasonable, and I believe it is unacceptable and also undoubtedly drives up the cost of OB/gyn care, which affects the public negatively.

 

[BADMD]

IA line related PTX occurs due to negligence. Sure, doctors are only human and with even the best skillset some small percent of chest tubes will cause one. But that doesn't make it not negligent. I understand that folks don't like the idea of being held to a standard of perfection, but being able to put in a central line without causing a PTX happens to be the standard of care. This standard was created by other doctors, not lawyers.

This is simply incorrect.

A pneumothorax is not caused by "lack of ordinary care." There are a number of reasons why even with the most careful and practiced approach a pneumothorax may occur.

If any physician actually testified that a pneumothorax equals negligence I would happily report them to their professional society and see if their were other remedies available, as that physician would be lying. I'd love to see them scramble for evidence to support that assertion. It is certainly not a standard created by doctors...or at least not doctors in clinical practice.

The only way to avoid absolutely avoid a pneumothorax from a central line is to do a femoral line (risks include retroperitoneal hematoma, higher rate of infection, femoral artery thrombosis, plus) or not do the line. I can't wait until someone gets sued for not doing Early Goal Directed Therapy for a patient in septic shock because they couldn't, with 100% certainty, avoid a pneumothorax and didn't want to be "negligent."

Frankly, patients, often driven by lawyers don't understand that "bad outcome" or even complication doesn't mean "negligence." Everything can be done right and there will be a complication. A complication is not "res ipsita loquitur."

 

[deltamed]

law2doc:

You may have gone to law school but your understanding of medicine is woefully inadequate at this point. This is obvious to me based on your outlandish views on PTX complications, as pointed out by previous posters.

Just because the current medmal system shifts the burden from some injured patients to some negligent docs does not make it a good system. Just because its the law does not make it good - you should know that.

In fact it does a HORRIBLE job in both compensating victims and increasing costs for everyone. Most victims dont get compensation, as you noted. I actually agree with you that cases where the plaintiff wins IN COURT the doc was probably negligent. All those cases that are settled out of court because of the incredible costs of litigation and risk to various interests being sued PLUS all the defensive medicine is the real problem. Current estimates of defensive medicine are WRONG I can tell you and way too small. That is because several generations of doctors have been trained to practice defensive medicine and the costs boggle my mind. So many unneccesary procedures and interventions are now "standard of care." As a doc if someone is having chest pain are you going to even THINK of using your clinical judgement if you have a 0.1% chance of missing an MI or subdural? NO - you do the full workup, costing everyone LOTS of money.

Second, how much money is being drained by the lawyers that could go into healthcare? How much money is being spent by doctors doing documentation instead of patient care? I know I spend 90% of my time doing paperwork and 10% of my time with acutal patients and that is NORMAL in our system. Its all because we have a HORRIBLE medmal sysyem.

Sure you have some good points - we should curtail expert witnesses. Sure we should strive for less complications and police our own better. But you are sadly mistaken if you think these are the major problems in our profession and that current medmal is a good system.

 

[Law2Doc]

...

If any physician actually testified that a pneumothorax equals negligence I would happily report them to their professional society and see if their were other remedies available, as that physician would be lying. I'd love to see them scramble for evidence to support that assertion. It is certainly not a standard created by doctors...or at least not doctors in clinical practice.
...

Then report them already, and see what happens. My argument throughout this thread is that there are few, if any, teeth on the self policing of physician expert witnesses, and this is exactly the kind of testimony you see in courts regularly, and exactly the kind of self policing what could forestall a lot of this litigation, if implemented.

As for the rest of this post, regarding "bad outcomes" versus negligence, I would suggest that a lot of what is defined as negligence doesn't have to be unexpected or realistically avoidable. The 1/100 event can be negligent even if you keep your ratios that low and that single event in 100 was unavoidable. Much of negligence law isn't about pointing fingers and asserting blame, it's about shifting risks/cost. The law wants to shift the cost to the doctor doing the action from the poor patient on whom the action is performed. This is a concept that is several hundred years old. So the fact that something is rare or that it simply happens once every 100 times regardless of the skill involved isn't that important. What is important is where the law/society wants to put the cost.

 

[Law2Doc]

... But you are sadly mistaken if you think these are the major problems in our profession and that current medmal is a good system.

Well, a "good system" depends on what you are comparing it to, and whether any revision still meets the goals it was set up to deal with in the first place. The point of medmal is to compensate those patients who were debilitated, maimed or harmed by negligent acts. It was also meant to shift the costs from the actor to the victim. Physicians in turn insured themselves and effectively made premiums a cost of doing business. The insurance companies imposed paperwork and expectations on physicians which basically led to the growth of defensive medicine. It is unclear what the real costs are here, but very clear that a lot of myths abound with respect to what percentage of cases are "frivolous" (a recent Harvard Med study suggests very few), and how fields like OBGYN are going to be driven out of the market (notwithstanding that they have been making these claims since the early 1980s and there hasn't been the OBGYN crunch people feared). Is it a good system? Not great -- and I never once said it was. But it does serve its goals of compensating harmed plaintiffs to a large degree. Can and should it be improved? Absolutely.

Tort reform is not the answer, because, while it helps physicians and negligent actors, it does so at the expense of the actually harmed plaintiffs. Other possible paths such as an "expert jury", (or even no jury and instead a medically trained judge) probably would be ideal, but there are constitutional problems when you try to disallow plaintiffs a "jury of their peers". Sanctioning lawyers for frivolous and absurd cases already exists, but hasn't gotten to the heart of the issue.

So I submit that the most fruitful area at which to attack the problem is in-house. If you (1) continue to strive to reduce errors, (2) communicate better and longer to patients so they are less likely to sue you, and (3) impede outlandish claims of medical experts by professional conduct rules, you can make a huge dent in the problem.

 

[Hayduke]

. Other possible paths such as an "expert jury", (or even no jury and instead a medically trained judge) probably would be ideal, but there are constitutional problems when you try to disallow plaintiffs a "jury of their peers".

Great discussion. L2D, I appreciate your input here, and wonder what your impression of medmal will be in a few years when you progress in your training.

One technical point...there is no constitutional guarantee of a 'jury of one's peers'.
Physicians have been the victims of this error for decades. Who are our peers? Plaintiffs have always benefited from this erroneous inclusion.

 

[Law2Doc]

Great discussion. L2D, I appreciate your input here, and wonder what your impression of medmal will be in a few years when you progress in your training.

One technical point...there is no constitutional guarantee of a 'jury of one's peers'.
Physicians have been the victims of this error for decades. Who are our peers? Plaintiffs have always benefited from this erroneous inclusion.

You don't get professional peers under our constitution, you get peers in the sense that they are a dozen fellow citizens who weren't able to get excused from jury duty. That's what the founding fathers imagined. Fellow members of the public, not the intellectual elite.

My viewpoint isn't likely to change much throughout my training, as I have already worked in another profession subject to malpractice suits, dealt with insurance and plaintiffs as a result, and have also worked on behalf of physicians in a variety of contexts (but not medmal). So it's not exactly like I'm pontificating from the sidelines without ever being in the trenches. I do think I bring a bigger picture viewpoint having not been locked into the premed to med school to physician route my whole life, as I think folks start taking an "us against them" view of the world which makes it harder to appreciate solutions that actually address the issues of the injured plaintiff rather than simply focusing on what helps/hurts physicians (and therefore supposedly impacts healthcare costs). There are definitely people on SDN who seem to believe that tort law is merely a hindrance to the medical profession and that things would work wonderfully without it. But I would suggest that if you research this issue you would find that most of the cases that prevail in court involve real negligence (or at least a deviation of a standard of care as asserted by the plaintiff's medical expert), and that it isn't unreasonable for society to expect the physicians involved to bear the costs. The notions of frivolous lawsuits and lottery size judgements tend to be overblown -- they are exceptions that tend to be noticed because when they happen they are so outlandish, but they really don't represent a significant percentage of such suits.

 

[dragonfly99]

My viewpoint isn't likely to change much throughout my training,

We'll see...

 

[yaah]

In regards to doctors not providing shoddy or untruthful testimony in medmal cases, I saw an interesting website on this recently. The guy who started it, Bernard Ackerman (a dermatologist/dermatopathologist) recently died and it was mentioned in his obit.

It is a fascinating read to go through some of the cases if you have time. Dr Ackerman was a defendant in one case in which he admitted fault (an error in diagnosis) but the plaintiff's attorneys were going overboard in their claims of what harm came to the patient as a result. I got sucked in for over a couple of hours when I first visited. It is at http://truthfultestimony.org/

 

[deltamed]

Well, a "good system" depends on what you are comparing it to, and whether any revision still meets the goals it was set up to deal with in the first place. The point of medmal is to compensate those patients who were debilitated, maimed or harmed by negligent acts. .

Law2Doc - the system does NOT do this. The majority of people who are hurt in our system are not compensated.

It was also meant to shift the costs from the actor to the victim. Physicians in turn insured themselves and effectively made premiums a cost of doing business. The insurance companies imposed paperwork and expectations on physicians which basically led to the growth of defensive medicine. It is unclear what the real costs are here.

I would like you to directly address my problem with defensive medicine. The costs are shifted but in the end they are shifted back to taxpayers and people who purchase healthcare, not doctors. Why do we spend twice as much healthcare money than any other developed nation with similar or worse outcomes? Its because we order more tests, more procedures, more invasive interventions. And that is becuase we've trained a generation of doctors to act STUPIDLY because of the threat of medmal.

Is it a good system? Not great -- and I never once said it was. But it does serve its goals of compensating harmed plaintiffs to a large degree. Can and should it be improved? Absolutely.

Again wrong. It does NOT serve its goals and it's not just a "not great" system, its the most horrible system I could possibly think of. We compensate less than 1% of injured patients, we make these patients "blame" and "punish" doctors in order to get any money for their harms, and we shift ENORMOUS real costs to society, enrich lawyers and psychologically harm our healthcare providers. I could not think of a worse system.

And the sad thing is there are systems that work well - look at sweden for example with no-fault arbitration and compensation. Hell even socialist countries like cuba do better in terms of medmal.

Tort reform is not the answer - I agree. We need to completely throw away the system and start from scratch.

You think your experirence in law school has broadened your perspective. I would argue that you have bought the trial lawyer's argument hook line and sinker. I can't beilive some one so clearly intelligent can be convinced that a system which is completely RUINING our healthcare system should be defended.

 

[Law2Doc]

Law2Doc - the system does NOT do this. The majority of people who are hurt in our system are not compensated.



I would like you to directly address my problem with defensive medicine. The costs are shifted but in the end they are shifted back to taxpayers and people who purchase healthcare, not doctors. Why do we spend twice as much healthcare money than any other developed nation with similar or worse outcomes? Its because we order more tests, more procedures, more invasive interventions. And that is becuase we've trained a generation of doctors to act STUPIDLY because of the threat of medmal.



Again wrong. It does NOT serve its goals and it's not just a "not great" system, its the most horrible system I could possibly think of. We compensate less than 1% of injured patients, we make these patients "blame" and "punish" doctors in order to get any money for their harms, and we shift ENORMOUS real costs to society, enrich lawyers and psychologically harm our healthcare providers. I could not think of a worse system.

And the sad thing is there are systems that work well - look at sweden for example with no-fault arbitration and compensation. Hell even socialist countries like cuba do better in terms of medmal.

Tort reform is not the answer - I agree. We need to completely throw away the system and start from scratch.

You think your experirence in law school has broadened your perspective. I would argue that you have bought the trial lawyer's argument hook line and sinker. I can't beilive some one so clearly intelligent can be convinced that a system which is completely RUINING our healthcare system should be defended.

I don't know where you got your 1% figure, but can assure you it's not even close to accurate. It isn't useful to compare tort law to countries with socialised medicine, because there's a prevailing notion that you are getting what the system chooses to pay for -- we look for things under our system that other countries might not.

 

[deltamed]

And what are these things that you refer to? 50 million uninsured? Vaccination rates that are horrible? The highest rate of CT scans per capita? People on welfare who have 8 babies by in vitro and are rewarded for it?

Open your eyes. Next time you order a CT head that you are 99.9 percent sure will be negative just remember we could have insured someone, provided vaccines etc for a year for that cost. And then I dare You to stop ordering them. Its standard of care now despite the cost to society and radiation to 999/1000 other patients.

Your views on negligence are so black and white. Consider a 25 yo woman with 2 kids coming in for leg cellulitis. Since Mrsa is high in your community you prescribe bactrim. Oh crap she has an anaphalactic reaction or gets stevens johnsons and dies. No way you could have forseen this and in our system you are probably NOT negligent (despite what you think) and the family gets nothing. Instead some 30 yo alcoholic driving drunk in an MVA gets a mill cause you missed a spinal fx when he was too drunk for a good physical exam. Oh his lawyer gets 500k too. That's real fair. Don't think this isn't common too (look up most common cause of ER physician lawsuits).

Again you have no answer to the defensive medicine effects or the compensation for victims injured by doctors who are NOT negligent (the vast majority)

 

[NotAProgDirector]

The intersection of the US legal and medical systems does not have many positives. It's very inefficient -- lots of money spent that doesn't help patients or doctors. Long delays from the time that patients are injured until they are compensated, and many injured patients never get anything.

However, I think Law2Doc has some interesting points.

The US medical system does a really crappy job of policing itself. We LET others police us like crazy -- hospital credentialing, licensing, etc. But we almost never reign in ourselves. As mentioned, it would be relatively straightforward for any Board of Medicine to decide to drop the license of a doc who gives expert witness testimony of questionable validity -- without a license, seems like their "expert" classification would be in jeopardy.

Law2Doc seems to have a different, legal, definition of the term "negligence". Every physician I know defines negligence as "a mistake by a physician that should have been avoided if they were a better doctor". Law2Doc is defining it as "a poor outcome for a patient that might have been avoided if another physician had provided the same service". These are very different definitions.

One important aspect of this discussion is the concept of "acceptable adverse outcomes". As physicians, we often use this excuse when something bad happens. We become complacent. A great example is line infections. What is the "acceptable" rate of central line infections? 1%? 5%? 10%?

It's an interesting question, one my institution decided to address. A certain unit in the hospital had a spike in line infections. The person in charge decided to investigate. In the end, they made the following decision -- all central lines were to be put in under full sterile conditions. Docs scrubbed, gowned, and masked. Full sterile drapes. Assisting nurses were to stop docs who obviously contaminated themselves or the field. Guess what happened? The line infection rate fell to absolutely zero for a period of 9 months. Point is this -- we are often too ready to accept a complication as a simple cost of "doing business". We laugh about docs in the past who didn't know about bacteria, infected and killed their patients. What fools, we think. Perhaps we are the fools that our future colleagues will be laughing at. Perhaps complication rates should be much, much lower than they are.

Much of negligence law isn't about pointing fingers and asserting blame, it's about shifting risks/cost. The law wants to shift the cost to the doctor doing the action from the poor patient on whom the action is performed.

Lets say patient X comes to be seen. He is diagnosed with "cancer". He gets chemo. Studies show that of those that get chemo, 50% of people get better and are healed, the other 50% die. He dies, leaving behind several young children.

Under the above theory, the patient should be compensated? We should shift the cost (loss of patient income) to someone else?

 

[Law2Doc]

...Your views on negligence are so black and white. ... That's real fair. ...

The law is black and white. You either have sufficient evidence for a prima facie case to get yourself into court, or you don't. Once you are in court, it may turn on how sympathetic a jury finds the plaintiff, but in most cases, the evidence is weighed reasonably, and there is a judge to adjust and police things if they go off track.

And it's not about fairness. Fairness is not a component of the law. The law is about a formulation of rules to govern actions, and a shifting of costs based on missteps while doing those actions. If you upheld the standard of care, the costs don't get shifted -- you did no misstep. Doesn't matter how "fair" that is, and doesn't turn on how pathetic the victim is, or how deserving the plaintiff is. If someone is a victim of negligence, they will be able to prevail and get a judgement and if a person was unquestionably given the standard of care they generally will not prevail. So yes, it's black and white and not about fairness, justice or other nebulous concepts that don't actually come into play under our legal system. Folks who haven't been lawyers may not appreciate this, but the system was written for specific risk allocation purposes, and fairness was never one of them.

 

[Law2Doc]

...

Law2Doc seems to have a different, legal, definition of the term "negligence". Every physician I know defines negligence as "a mistake by a physician that should have been avoided if they were a better doctor". Law2Doc is defining it as "a poor outcome for a patient that might have been avoided if another physician had provided the same service". These are very different definitions.

One important aspect of this discussion is the concept of "acceptable adverse outcomes". As physicians, we often use this excuse when something bad happens. We become complacent. A great example is line infections. What is the "acceptable" rate of central line infections? 1%? 5%? 10%?

It's an interesting question, one my institution decided to address. A certain unit in the hospital had a spike in line infections. The person in charge decided to investigate. In the end, they made the following decision -- all central lines were to be put in under full sterile conditions. Docs scrubbed, gowned, and masked. Full sterile drapes. Assisting nurses were to stop docs who obviously contaminated themselves or the field. Guess what happened? The line infection rate fell to absolutely zero for a period of 9 months. Point is this -- we are often too ready to accept a complication as a simple cost of "doing business". We laugh about docs in the past who didn't know about bacteria, infected and killed their patients. What fools, we think. Perhaps we are the fools that our future colleagues will be laughing at. Perhaps complication rates should be much, much lower than they are.



Lets say patient X comes to be seen. He is diagnosed with "cancer". He gets chemo. Studies show that of those that get chemo, 50% of people get better and are healed, the other 50% die. He dies, leaving behind several young children.

Under the above theory, the patient should be compensated? We should shift the cost (loss of patient income) to someone else?

I'm not sure I'm being paraphrased exactly in the top paragraph. Negligence isn't about being a "better doctor", nor is it about different doctors doing the procedure. It is about living up to a "standard of care". This standard of care is going to be defined by other doctors, usually by expert witnesses in court. So you are absolutely having to live up to the expectations of others, and if other doctors in the community would have done X, or checked Y and you didn't, and a bad result ensued as a direct consequence, you are likely to be deemed negligent.

As for the acceptable adverse outcomes, the law gets more complicated. You are still held to the standard of care, and if you comply with that you are probably fine even if your outcomes are far worse than what many would deem acceptable. But if you deviate from that standard of care, even to the extent of prescribing things off label that perhaps in a given case may improve your percentages, you might be stepping off into the abyss. Again, the law isn't about fairness, or compensating folks with adverse consequences (although if it gets to a jury, thanks to a medical expert's questionable testimony, that is undoubtedly what happens), it's about shifting costs where one party deviated from an expected norm.

Any fix in medmal has to leave intact the notion that deviation of standard of care creates liability for the person who takes that step, and shifts the costs to such person. That is the part of medmal that actually makes sense, works, and has historical roots. So the obvious fixes still are to address the expert witness issue, to decrease the number of deviations from the standard of care, etc.

 

[BADMD]

Much of negligence law isn't about pointing fingers and asserting blame, it's about shifting risks/cost.

Seems kind of odd. Every malpractice suit I've ever had the pleasure to read seemed all about finger pointing and assigning blame.

The law wants to shift the cost to the doctor doing the action from the poor patient on whom the action is performed. This is a concept that is several hundred years old. So the fact that something is rare or that it simply happens once every 100 times regardless of the skill involved isn't that important. What is important is where the law/society wants to put the cost.

I thought negligence was about failing to devote ordinary care to a task, resulting in damages. I'm having a very difficult time with the idea that the result is what defines the negligence and not if the was preventable and resulted from a lack of ordinary care...especially if reason the line is being placed is to help avoid morbidity or mortality from an underlying medical condition. It isn't like doctors are rolling up on healthy people and shoving in central lines.

Part of the problem is that you are pre-supposing that there is a tort involved. There isn't. The law also recognizes that stuff happens. There are lots of cases in medicine where everything was done absolutely right, but the patient still has a bad outcome. That doesn't mean there is negligence.

A central pays the physician about $95 in professional fees. So if 1 in 100 results in litigation and that litigation results in more that $95,000 worth of headaches (actually significantly less), then doctor will stop placing them. Hope no patient actually needs one to aid in their resuscitation efforts. Of course, then not placing one could also be considered negligent....

 

[Law2Doc]

Seems kind of odd. Every malpractice suit I've ever had the pleasure to read seemed all about finger pointing and assigning blame.
.

That comes more from your own viewpoint than what happens. It's very hard for folks in medicine to look at these cases objectively and from the same kind of impartial purposeful perspective that the law does. You see finger pointing, but an impartial person sees dispute resolution based on fairly black and white parameters.

 

[Law2Doc]

...
Part of the problem is that you are pre-supposing that there is a tort involved. There isn't. The law also recognizes that stuff happens. There are lots of cases in medicine where everything was done absolutely right, but the patient still has a bad outcome. That doesn't mean there is negligence. ...

I'm a bit confused -- you are echoing a lot of what I said earlier and saying I'm presupposing the opposite. Negligence is based on a deviation from the standard of care, and exists in the law as a concept of who should bear the risk of loss. Those aren't mutually exclusively applicable concepts -- if you don't have negligence, you don't get to apportion the risk, but if you do, the law seeks to do this. So your post above seems to have only focused on half of what I am saying. Sorry if I wasn't clear.

I don't disagree that where the standard of care is not deviated from but the outcome is still bad then there isn't a case. I would argue that this never gets to court, but for a dishonest expert witness because most courts require a plaintiff to substantiate a deviation of the standard of care to get the case before the court. Meaning physicians are the only ones who get these bad outcome cases into court, the law itself would otherwise throw them out. I

 

[dragonfly99]

lawdoc, you seem to imply up above in one of your comments that a patient getting a pneumothorax during a central line placement is malpractice. Is that what you believe?

 

[Law2Doc]

lawdoc, you seem to imply up above in one of your comments that a patient getting a pneumothorax during a central line placement is malpractice. Is that what you believe?

I've personally seen several central line placements resulting in PTX that I would suggest a lawyer could easily find a physician expert who would proclaim negligence and get the case to trial, had the patients had a bad outcome. I don't dispute the comment made earlier that there are patients with such so damaged tissue that a PTX will be unavoidable even if the standard of care is upheld, and so I won't say it is de facto malpractice in every case; just that in many of the routine cases it would be.

 

[dragonfly99]

I've personally seen several central line placements resulting in PTX that I would suggest a lawyer could easily find a physician expert who would proclaim negligence and get the case to trial, had the patients had a bad outcome. I don't dispute the comment made earlier that there are patients with such so damaged tissue that a PTX will be unavoidable even if the standard of care is upheld, and so I won't say it is de facto malpractice in every case; just that in many of the routine cases it would be.

Why would you say it's malpractice if there is a known/documented/published rate of these happening even with proper technique? And it's not just patients with damaged tissue who can be hard sticks...if the patient is already on the vent, and/or is small/thin, or the patient isn't absolutely still (like in some semicode type situations where patient is in extremis)...there are many cases where this is true. The logic you are applying is like that of Medicare which has decided it will never pay for bladder infections due to indwelling urinary catheters in hospitalized patients. That sounds good, until you realize that there are sometimes good reasons why a patient still needs the catheter, and taking it out too early can also have bad consequences (urinary obstruction, etc.). I think the law of unintended consequences definitely applies to the current lawsuit mania afflicting our society - everyone wants life to be perfect and hunky-dory, and if it isn't it must be someone else's fault and someone must pay...

 

[docB]

I disagree with Law2Doc that the legal system is black and white. There are so many man made variables that go into it and all introduce unfairness (I'll address "fairness" later). The patient with the bad outcome may or may not decide to sue on reasons that are totally arbitrary to whether good maedicine was practiced. Their lawyer may or may not take their case based on their assessment of the possible value of their expected cash reward. How the judge handles the case and whether he makes rulings favorable to the plaintiff or to the defense are totally dependent on the judge. And, as stipulated, once a jury gets involved no one knows what might happen.

While lawyers may see the legal system as a mechanism to redistribute risk the public does see it is a system that is there to (attempt to) ensure justice and fairness. If the legal system truly has no place for justice or fairness then I reiterate my call to get rid of it and start over.

I would also point out that a glaring problem of the system is that it does not seek to compensate in a rational way. Take the previously mentioned line placement complication of a pneumo (which I continue to assert does not equate to negligence). If someone were to be compensated for that I would suggest that the bills for the chest tube, its care and the extra hospital days should be paid. The current system however routinely seeks huge amounts of money in compensation for these suits.

I have trained and worked under the current system and I practice defensive medicine as we all do. The "standard of care" incorporates this defensiveness. If we are actually under the dictates of a system that works as presented here we should become more defensive. A pneumo can be directly linked to my line placement. A femoral line's infection will be more difficult to prove direct fault. Fem lines it will be.

 

[BADMD]

I would argue that this never gets to court...

Great. It doesn't get to court. It is the years of crap that comes before court that most doctors want to avoid. If I recall correctly, less than 5% of cases ever actually see a court room.

... dishonest expert witness because most courts require a plaintiff to substantiate a deviation of the standard of care to get the case before the court.

Except that it is often more economically efficient to settle, rather than litigate. And I often ****le at the term "Standard of Care." It is a very fluid term that live more in the minds of lawyers, then in the reality of being a doctor and treating patients. The "standard of care" actually differs between regions and hospitals.

F.e. I know of one case that went to trial where the expert testified that "The Standard of Care" was to see all patients who arrive in the ED with in 20 minutes. This was the standard in his small regional facility. Definitely not the standard at a large urban tertiary facility.

Frankly the only real "Standard of Care" is when guidelines have been issued by professional organizations. Even then, the guidelines don't fit every patient.

And don't forget the lawyer who shops for an expert who will say what they want or just plain shotguns the plaintiffs. Lawyers have a duty, under both the rules of professional responsibility and under federal/state rules of procedure, to fully investigate the claims that they are filing, yet rarely is there an effective mechanism to sanction them. Ohio has some of the most lenient laws for wronged physicians to use, and even in egregious cases, the wronged physicians recovered a miniscule fraction of their out of pocket costs.

You can't blame this one on a bunch of bad physicians.

 

[Law2Doc]

Why would you say it's malpractice if there is a known/documented/published rate of these happening even with proper technique? And it's not just patients with damaged tissue who can be hard sticks...if the patient is already on the vent, and/or is small/thin, or the patient isn't absolutely still (like in some semicode type situations where patient is in extremis)...there are many cases where this is true. The logic you are applying is like that of Medicare which has decided it will never pay for bladder infections due to indwelling urinary catheters in hospitalized patients. That sounds good, until you realize that there are sometimes good reasons why a patient still needs the catheter, and taking it out too early can also have bad consequences (urinary obstruction, etc.). I think the law of unintended consequences definitely applies to the current lawsuit mania afflicting our society - everyone wants life to be perfect and hunky-dory, and if it isn't it must be someone else's fault and someone must pay...

Don't tell it to me. Tell it to the physician who goes into court and testifies that this isn't the standard of care. I submit that this is an easy fix but the profession chooses not to. Which is why yes, it is going to be medmal, not because I deem it so, but because there is a standard of care out there and because negligence isn't something you get to wave away because it happens X% of the time. Eg. There is an acceptable increase in rate of automobile accidents when you raise the speed limit each 10 mph (eg the recent rise from 55 to 65 mph), but that doesn't mean that each accident can't be looked at for negligence.

 

[Smurfette]

If you place a line using techniques following the standard of care, a PTX is not negligence (unless the PTX is not treated with the standard of care). Frankly, things that involve negligence with line placements would be: losing the guidewire in the patient, placing line in carotid (or SC) artery, using central line before position is verified (and line clearly not intravascular), popping the ETT balloon with the needlestick, etc....all of which I've seen happen with bad outcomes. A chest tube for PTX for 24-48hrs after a pt has a central line placed is probably NOT going to have an extended stay (i.e. if they are getting a line, they are probably going to be there more than a couple days anyhow) or long term disability from the PTX.

 

[deltamed]

Don't tell it to me. Tell it to the physician who goes into court and testifies that this isn't the standard of care. I submit that this is an easy fix but the profession chooses not to. Which is why yes, it is going to be medmal, not because I deem it so, but because there is a standard of care out there and because negligence isn't something you get to wave away because it happens X% of the time. Eg. There is an acceptable increase in rate of automobile accidents when you raise the speed limit each 10 mph (eg the recent rise from 55 to 65 mph), but that doesn't mean that each accident can't be looked at for negligence.

Law2Doc, so you are telling me that a competent, good doctor who always diligently tries to follow standard of care SHOULD and WILL be sued multiple times because he is human and some rate of errors happen?

I submit, while this might be the current enviornment it DOES NOT correctly serve it's purpose. From what I understand the PURPOSE of the system should be
1. Deter doctors from doing sloppy work by penalizing those that do
2. Make it expensive for the party who made the mistake - ie shift costs from the harmed party to the negligent party
3. Encourage systems and individuals to implement saftey mechanisms that will lower costs and increase safety

Instead, we have a system that:
1. Encourages doctors to order every test they can think of because they don't want to miss anything. You are rarely negligent for ordering an extra test, even if its thousands of dollars.
2. Encourges doctors and insurance to settle cases left and right because DAMN those lawyers are expensive. Even if they *probably* wont win at trial we may as well drop a measly 30 or 40k to get rid of this lawsuit.
3. Does not help compensate the majority of patients who are harmed if standard of care WAS followed.
4. Makes doctors spend 90% of their time on documentation and 10% actually taking care of patients - SUPER EFFICIENT!!!
5. Compensate victims based on things like "economic earning power" and age. Children, old folk and disabled folk are worth less inherently and probably wont even see the inside of a lawyers office.

You support this? Wow.

 

[J-Rad]

I think he's saying a few things: 1. One of the most powerful weapons at our disposal would be self regulation-in the profession of medicine-of so-called expert witnesses who ***** themselves out for a buck. The enemy from within is more dangerous than the enemy from without. But, as a rule, physicians are limp-d***ed P*****s when it comes to true self policing because most physicians are passive aggressive versus aggressively confrontational in scenarios that call for difficult-but just-action (OK, the last bit of editorializing is from me, but when Law2 gets into residency and practice, my bet is he'll agree with me) 2. The courtroom does not function like the hospital. It isn't about biostatistics and evidence. Law books do not function like medical books and interpretation of law does not function like interpretation of tests. I think Law2 has fairly eloquently explained this, and one of his most important points IMHO is that the law is not about "fairness"-even though our guts tell us it should be. Ours is a flawed system, with plenty of room for improvement, but if we don't take some action within our own ranks, how can we whine and cry foul that "Those Damn Lawyers" haven't fixed it for us. Truthfully, everything Law2 said (at least on page 2 which I read) makes sense to me. Everybody is talking medicine and he/she is talking law.

 

[deltamed]

I think he's saying a few things: 1. One of the most powerful weapons at our disposal would be self regulation-in the profession of medicine-of so-called expert witnesses who ***** themselves out for a buck. The enemy from within is more dangerous than the enemy from without. But, as a rule, physicians are limp-d***ed P*****s when it comes to true self policing because most physicians are passive aggressive versus aggressively confrontational in scenarios that call for difficult-but just-action (OK, the last bit of editorializing is from me, but when Law2 gets into residency and practice, my bet is he'll agree with me) 2. The courtroom does not function like the hospital. It isn't about biostatistics and evidence. Law books do not function like medical books and interpretation of law does not function like interpretation of tests. I think Law2 has fairly eloquently explained this, and one of his most important points IMHO is that the law is not about "fairness"-even though our guts tell us it should be. Ours is a flawed system, with plenty of room for improvement, but if we don't take some action within our own ranks, how can we whine and cry foul that "Those Damn Lawyers" haven't fixed it for us. Truthfully, everything Law2 said (at least on page 2 which I read) makes sense to me. Everybody is talking medicine and he/she is talking law.

In terms of what we can actually do, I think you are right- law2doc has a great idea and we should heed his words- regulate the expert witnesses, take their licences away if what they are saying isn't 100% medically sound and their definition of "standard of care" is widely agreed upon. In terms of his defense of medmal law I could not disagree more.

The problem is, people like law2doc are those that BECOME the expert witnesses. He would be the one testifying against a doctor who caused an PTX from a central line placement because he sees things in the black-and-white world imparted by his law training. I would never testify as an expert witness because the system is fundamentally flawed and I would be causing more waste and further sending our healthcare system into the sewers.

One thing is certain, and law2doc is right about this - we have to police our own cause the lawyers are doing it now for us on their terms and they are making a huge mess of it.

 

[finished]

Unfortunately, we live in a litigious society. I don't think it is merely a "bad outcome" that affects a patient's decision to sue, however. Other factors are involved. One important factor is the kind of rapport you had with the patient. If you showed the patient kindness and respect and a professional demeanor, you are less likely to get sued in the event of a bad outcome. If you were arrogant or condescending to the patient, or did not listen to their concerns, they will remember this and may be more "blood thirsty".
Same is true with your office staff. If they were unfriendly or unprofessional, this can be a liability for the doctor.
Also, the willingness to apologize when a mistake is made can prevent a suit as well.

Should it be this way? I don't know. Professionalism can go a long way though in preventing a suit.

 

[KluverB]

Bottom line... "standard of care" presented in a lawsuit is easy to define in black-and-white when it is done by an expert, even if he is acting honestly, with 20/20 hindsight. What most people fail to appreciate is that the "standard of care" is applied by the 95.4% (arbitrarily using median +/- 2 s.d.) of physicians practicing good medicine every single day, as most do. "Standard of care" should not be defined by experts (ie. those in the top 2.3%, they're called "experts" for a reason), and with the 20/20 hindsight.

Unfortunately, most cases do get settled before such an argument can be made in court. And who of you has the ba11s to do it? 😳

 

[edmadison]

I waited along time to wade again into this discussion. As an attorney-physician, I hope I'm not too swayed by my biases. A couple of things come to mind.

I agree with L2D that the legal profession does a much better job of policing itself. It doesn't appear that way because many of the ethical standards seem immoral to some people. As an attorney, I have an obligations to my client that often result in a larger harm. The reason? There is overall good in protecting the legal system as a whole. There are certainly many attorneys who use the legal system as tool for personal gain instead of truly representing their clients. Don't even get me started on class-action suits. However, this isn't unethical.

In terms of keeping or tossing the system. I do have a problem with the current system. A tort system has two main purposes: compensate the victims, and give those in the system an incentive to do the right thing (e.g. comply with the standard of care).

The system does a wretched job with the first item. Far too many patient's injured by negligence never seek compensation and a small, but not insignificant, number of non-injured (or injured, but not via negligence) win. This number is larger than reported because studies examining the legitimacy of suits don't look at cases that were settled and in most cases everybody wants to settle except the doc. The second half of this equation is the incentive. Do we really comply with the standard of care because of fear of lawsuits? And by practicing defensive medicine, aren't we really being negligent? Yes, but just not in a way we can easily be sued. Will the concussion patient who developed brain cancer 20 years later really come back and sue me because I ordered a CT scan I shouldn't have?

Thus, the system really doesn't meet these aims, thus it is flawed. The question is, would it be better or worse if we changed it?

Ed

 

[docB]

Thus, the system really doesn't meet these aims, thus it is flawed. The question is, would it be better or worse if we changed it?

Ed

I don’t think the system could be worse. Therefore most changes would be a benefit. At this point the amount of resources being wasted on the current system would provide for huge benefits if redirected. Just salvaging the waste created by defensive medicine alone would avert the impending financial death spiral of the medical system for a decade or more.

The current system is so entrenched due to the fact that the vast majority of legislators are lawyers. However it is my hope that the attractiveness of crafting a working system out of the huge amount of resources currently being wasted would compel us toward something better.

I again suggest splitting the punishment and compensations functions. Here’s what I would do:

We immunize doctors from civil suits for malpractice. Instead of malpractice insurance premiums doctors pay into a trust that patients with bad outcomes can apply to for compensation. This is not a new idea but it has only been used for niche applications such as vaccines. Once we apply all of this money to such a trust we do away with all of the overhead including shareholders of insurance companies, some administration and the money paid to lawyers. Compensation would be limited to real damages. No more “pain and suffering.” Applications would be made to the fund which would only be interested in verifying the situation rather than assigning blame. Note that the “bad outcomes” that merit compensation would require definition. I would expect usual progressions such as having an MI and winding up with CHF would not be compensated while the pneumothorax from a line placement would.

For punishment we would use the existing BOMs and create the self policing the lack of which Law2Doc has frequently decried. Patients who feel they have been wronged, as well as other health care personnel would file complaints which would be investigated. Interdisciplinary committees would evaluate complaints and mete out punishment. Fines, sanctions against privileges, remediation and suspension or revocation of licensure would all be available. It would be important for the fines to be directed into the state general funds rather than into the BOM budget.

This system would fail to satisfy two groups: lawyers who make their living off of the current system and patients with an axe to grind against a doc and are not satisfied with a complaint to the BOM. I wager that most of us would be willing to leave these groups unsatisfied.

 

[Apollyon]

A complication is not "res ipsita loquitur."

Latin nerd alert: "Res ipsa loquitur".

 

[Trifling Jester]

You can do everything right and still get a pneumo off a central line. I don't think that anyone who's actually been through residency would disagree with this.

-The Trifling Jester

 

[NotAProgDirector]

I don’t think the system could be worse. Therefore most changes would be a benefit.

The system could always be worse. Changes might not help. Usually, changes create winners and losers -- some people gain and some lose. Whether the new system is better depends on your perspective.

Instead of malpractice insurance premiums doctors pay into a trust that patients with bad outcomes can apply to for compensation. This is not a new idea but it has only been used for niche applications such as vaccines.

Don't get me started. The vaccine injury/reimbursement system has it's own problems, as people try to get money out of it for any perceived harm. In a system like this, there will be a slow slide towards including more and more "bad outcomes" that "need" to be compensated. A whole industry will sprout up around this. They will charge some fraction of the monetary compensation obtained. Sound familiar?

 

[docB]

The system could always be worse. Changes might not help. Usually, changes create winners and losers -- some people gain and some lose. Whether the new system is better depends on your perspective.

True. I should have said that the current system is so bad that just about any change would be better. Even if we just awarded 10 grand to everyone who files a complaint it would still be cheaper than the current debacle.

Don't get me started. The vaccine injury/reimbursement system has it's own problems, as people try to get money out of it for any perceived harm. In a system like this, there will be a slow slide towards including more and more "bad outcomes" that "need" to be compensated. A whole industry will sprout up around this. They will charge some fraction of the monetary compensation obtained. Sound familiar?

But this would still remove us from the current game of "pin the blame on the doctor" nightmare that is strangling medicine. If the fund turns into a quagmire it will only be until we socialize and everyone gets paid to consume medical care anyway.

 

[OTD]

So what Law2Doc is telling us is this.

A PTX is negligent under the law, because according to people that extort money (lawyers) it's perfectly acceptable to redistribute wealth and extort money from a physician if a patient has a bad outcome. It doesn't matter that there was no actual deviation from the standard of care, and no matter if that injury was inevitable because according to the people have never practiced medicine there is no acceptable complication rate. It's just the cost of doing business.

I can tell he has never placed a line in a combative trauma patient, emaciated cancer patient, etc etc etc etc. and I do hope the two times he stated chest tubes caused PTX were typos.

Basically, according to the extortionists, all patients with a bad outcome, no matter how inevitable, deserve to steal money from the one person that actually helped them, the doctor, and at the lawyer that helped him steal that money deserves a cut.😱😱

 

[BADMD]

Latin nerd alert: "Res ipsa loquitur".

Yeah, that was just a typo and not my usual bad grammEr and speeling.

 

[BADMD]

]The vaccine injury/reimbursement system has it's own problems, as people try to get money out of it for any perceived harm.

You ever read the Neurodiversity Weblog? She posts some of the opinion of the vaccine courts on the fees paid for the litigation (paid for by the US taxpayer, BTW). They are scary and we pay for it.

 

[edmadison]

True. I should have said that the current system is so bad that just about any change would be better. Even if we just awarded 10 grand to everyone who files a complaint it would still be cheaper than the current debacle.


But this would still remove us from the current game of "pin the blame on the doctor" nightmare that is strangling medicine. If the fund turns into a quagmire it will only be until we socialize and everyone gets paid to consume medical care anyway.

Maybe I'm just a huge cynic. You are essentially proposing a no-fault system. Ask people who live in a no-fault auto insurance state if they like their insurance. It's great if you're a lousy driver. On the other hand, I certainly do think there is room for improvement. I think we can fix the system with a few changes. First, switch to the English rule for attorney's fees. That will get rid of many of the marginal (but not truly frivolous suits). Insurance companies will have more of an incentive to defend than to settle. Second, the majority of punitive damages should always go to the state, not to the plaintiff or his attorney. This prevents some, but not all of the jackpot hunting. Finally, adopt a rule from the French system (I can't believe I'm advocating anything french other than something edible): the court appoints it's own expert. The jury is told that this is the unbiased expert. Both sides are still permitted to hire and present expert testimony.

Ed

 

[docB]

Maybe I'm just a huge cynic. You are essentially proposing a no-fault system. Ask people who live in a no-fault auto insurance state if they like their insurance. It's great if you're a lousy driver. On the other hand, I certainly do think there is room for improvement. I think we can fix the system with a few changes. First, switch to the English rule for attorney's fees. That will get rid of many of the marginal (but not truly frivolous suits). Insurance companies will have more of an incentive to defend than to settle. Second, the majority of punitive damages should always go to the state, not to the plaintiff or his attorney. This prevents some, but not all of the jackpot hunting. Finally, adopt a rule from the French system (I can't believe I'm advocating anything french other than something edible): the court appoints it's own expert. The jury is told that this is the unbiased expert. Both sides are still permitted to hire and present expert testimony.

Ed

I'd go for those reforms. How do you address the problem of awards (and therefore settlements) disproportionately favoring "sympathetic" patients?

 

[edmadison]

I'd go for those reforms. How do you address the problem of awards (and therefore settlements) disproportionately favoring "sympathetic" patients?

Well, here is where I agree with L2D again. Juries actually favor doctors more than you might expect. I believe the last stat I saw was that 70% of docs win malpractice cases versus about 50% for most tort victims. Changing to a loser pay rule will get rid of many marginal cases. It will also make the plaintiffs think twice about suing if they stand to lose 100K in fees. Insurance companies would be much more aggressive about defending cases under this rule and thus there would be fewer settlements. In terms of jackpot verdicts, those are very unusual and very very frequently are reduced by the court or on appeal.

Ed

 

[LADoc00]

What kind of impact does a lawsuit filed by a patient have on doctors? Now I obviously cannot talk about the case, but I believe it is being filed for negligence due to a bad outcome (which I do not think negligence is the case here; and which I am one of many defendants). But regardless of what I think, I was an intern while taking care of this patient, I am just wondering what is the worst that can happen if the plaintiff somehow won this case? (I AM covered under the malpractice insurance under my program).

Thanks

the impact is huge, the consequences though I feel are very unfamiliar to residents.

See you cant usually get on a medical staff with a pending lawsuit or the very least it is difficult to get through a credentialing process in the midst of that.

The problem that leaves for residents is they end up being in limbo for a period of time after training if this issue isnt rapidly resolved. I have seen personally residents/fellows jobless for several months when they should be getting settled in a new group because of a pending suit.

Beware.

 

[maceo]

That's just wrong. Some level of risk for bad outcome and for technical limitations has to be accepted by the patient. It is not the standard of care to never cause a pneumo. The known rate is ~1/100 (and is dropping with US but does and will always exist). To say that any technical complication equals negligance and that any doc who has such a complication deserves to be sued is just so disturbing to me I can't even express my dismay.

Losing a case can end your career. If your assertion that any complication = negligence and should = losing a suit we'll all just be transient actors in thei field. I would be gone. It would only serve to enhance the already disposable nature of doctors in the current system.

what are you talking about? there are plenty of docs out there who dont practice anymore because insurance companies jacked up their malpractice rates astronomically that itforced them out of business. . And the premiums were jacked up because of a few lawsuits. This happens especially to surgeons.. vascular, orthopods, and general surgeons. The vascular surgeons have it bad especially because a bad outcome is the rule in that population because of their co morbidities.. maybe not the rule but you catch my drift.. The medical liability insurance companies arent stupid. They are money makers. You just gave them a reason to raise you rates... Voila.. more money in their pockets

 

[peerie]

The law is black and white.

The law is not 'black and white,' it is often mostly 'gray.' This is why we have so many courts and a final "supreme court." And, the decisions of that final supreme court are often based on who is sitting on its bench.

So, I respectfully disagree with my esteemed colleague and say that it is not the law that is black and white but perhaps it is the given people who are interpreting the law in that particular circumstance. 😉

 

[satori47]

Thanks to everyone who responded.

Honestly I am a bit concerned. I see a few varying answers, but I want to know what is the worst scenario that COULD happen to me as a resident, theoretically if they did find me guilty of incurring some negligence as an intern (though they are suing the hospital as a whole and not me per se); would I still be able to practice? would I lose my license? would I have to fish money out of pocket though I am covered under by program's malprac? can such things happen even though I was supposedly being supervised by a senior resident?

Honest answers appreciated

the impact is huge, the consequences though I feel are very unfamiliar to residents.

See you cant usually get on a medical staff with a pending lawsuit or the very least it is difficult to get through a credentialing process in the midst of that.

The problem that leaves for residents is they end up being in limbo for a period of time after training if this issue isnt rapidly resolved. I have seen personally residents/fellows jobless for several months when they should be getting settled in a new group because of a pending suit.

Beware.

 

[3dtp]

Sued, as intern, thought about leaving medicine...case dismissed with prejudice. Had to report to licensing board, credentialing board, medmal carriers, so far, no impact on licensing or credentialing. Big deal at the time, emotional toll was high, even though records were clear that nothing untoward was done or not done that should have been done, bad outcome completely unrelated to medical care.

Unless you did great badness (please no details, w/o talking to your lawyer who will tell you no details at all), you will probably be fine. One less OB in the world as I switched specialties. The statute of limitations has run on all deliveries.

 

[docB]

I have been thinking about this thread a lot lately. It's probably because I live every day and see every patient under the threat of lawsuit. I lose sleep, raise blood pressure and generally have a lower quality of life because of this horrible system we have. This is compounded by the fact that I am greatly disturbed by the attitude among lawyers that the system is fine and that doctors should just view their predatory tactics as "the cost of doing business." This underscores the reason that medicine and law will continue to be at odds. We recognize the current med mal system as causing life altering events for physicians. Without even any understanding of this by lawyers we have no choice but to fight as hard as we can for reform.

That said I think it is contradictory to argue that the current system is valid because it is just the will of society to use it as a tool to redistribute costs while at the same time arguing against tort reform. If the eveloution of the current system was the will of the people then the current will of the people to change that system must be equally valid. The current, successful efforts at reform mean that public opinion and voter opinion have recognized that the pendulum has swung too far. These efforts to reverse that are called for and legitimet.

 

[dragonfly99]

Sued, as intern, thought about leaving medicine...case dismissed with prejudice. Had to report to licensing board, credentialing board, medmal carriers, so far, no impact on licensing or credentialing. Big deal at the time, emotional toll was high, even though records were clear that nothing untoward was done or not done that should have been done, bad outcome completely unrelated to medical care.

Unless you did great badness (please no details, w/o talking to your lawyer who will tell you no details at all), you will probably be fine. One less OB in the world as I switched specialties. The statute of limitations has run on all deliveries.

Can someone explain what "dismissed with prejudice" means?
Also, 3dtp, sorry that you got sued as an intern...that would have been horrible on top of the normal intern experiences/stress.

Also, those med students on here need to realize that being sued is something you have to mention on every job application and medical license application, whether or not you lost the suit, etc. Also, insurance companies often like to settle (cheaper for them) but that ends up on the doc's record as something bad/adverse and I believe this is also recorded in the "National Provider Databank" which is basically a nationwide record of all doctors.

I do think we need reforms, and should consider reforms to our entire tort system, not just medical liability reform. We don't want to keep poor people who have a complaint/problem that is legit. from being able to bring a lawsuit, and I don't think we want to go to a totally no-fault system unless there is some built-in mechanism to help weed out the few bad/actually negligent docs, but I don't think our current system is sustainable long term for our society, nor is it really just. Unfortunately, a lot of this I think comes down to the entitled mentality that a lot of people have in our society...I don't imagine tort law has changed a lot since the 1950's, yet we have people who will sue for any possible thing, just because they are hoping to hit the jackpot.