PERC negative PE death leads to $10M verdict

[BoardingDoc]

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Yeah, of course. My point is more that it's entering that crap to begin with. That means I need to proofread my chart in detail. If I have to read the chart in that degree of detail, it certainly isn't saving me time as compared to dictating.

 

[Brigade4Radiant]

People still want their pound of flesh when they're pi$$ed. If they can't get anything via the civil route, they may go after you with criminal charges. That's much worse as far as I am concerned.

Criminal charges aren’t an option because a prosecutor has to prosecute them. It’s not something a plaintiff can just decide. Also burden of proof becomes way higher in criminal cases like you actively have to try to harm the person

Also, if it becomes criminal charges, there will be a big blowback in that state and watch as doctors flea.

Keep in mind, the VA has sovereign immunity also insurance companies have sovereign immunity

 

[VA Hopeful Dr]

Criminal charges aren’t an option because a prosecutor has to prosecute them. It’s not something a plaintiff can just decide. Also burden of proof becomes way higher in criminal cases like you actively have to try to harm the person

Also, if it becomes criminal charges, there will be a big blowback in that state and watch as doctors flea.

Keep in mind, the VA has sovereign immunity also insurance companies have sovereign immunity

I work for a county hospital and it's similar here.

 

[Backpack234]

Was this in florida? This feels like Florida

 

[TysonCook]

...glad I read the case. At work, one my partners had a young female patient presenting with syncope and nothing else. Flipped T's in III and V1... and ended up finding multiple PE's. I'm not sure I would've picked it up without reading this thread

 

[Jabbed]

...glad I read the case. At work, one my partners had a young female patient presenting with syncope and nothing else. Flipped T's in III and V1... and ended up finding multiple PE's. I'm not sure I would've picked it up without reading this thread

Can you post the EKG? I see this all the time and chalk it up to juvenile pattern and normal variant as long as they’re shallow and asymmetric. Now this thread has me paranoid 😬

 

[mmmnmmm]

...glad I read the case. At work, one my partners had a young female patient presenting with syncope and nothing else. Flipped T's in III and V1... and ended up finding multiple PE's. I'm not sure I would've picked it up without reading this thread

Are those the only TWI? T wave inversion in V1 is normal and III is a normal variant. EKG in this case showed more extensive inferior and anterior precordial TWI.

 

[southerndoc]

Q&A with the jury foreperson:

Q&A with Jury Foreperson from PE Case

Within a few hours of publishing the Death After ED Visit for COVID case, I received this message in my inbox:

expertwitness.substack.com

 

[JacobMcCandles]

Q&A with the jury foreperson:

Q&A with Jury Foreperson from PE Case

Within a few hours of publishing the Death After ED Visit for COVID case, I received this message in my inbox:

expertwitness.substack.com

There’s a few unfortunate things:

1.) He commented on the computer read of the EKG.

2.) I disagree on his first take away. If we tell a patient they should follow up then they should follow up. Just because everyone is told that doesn’t absolve them from taking charge of their own care. Any patient who thinks they’re having an emergency, especially shortness of breath, chest pain, etc., should follow up after being discharged from the ED anyway.

 

[thegenius]

Q&A with the jury foreperson:

Q&A with Jury Foreperson from PE Case

Within a few hours of publishing the Death After ED Visit for COVID case, I received this message in my inbox:

expertwitness.substack.com

I breezed through it (read about 50-75%) and my takeaways are
1) documentation really doesn't matter all that much
2) there will be a spike in CT Chest Angios for PE over the next 6 months.
3) the legal system sucks. It is deranged that they will get Hematology to be an expert witness in an ER case.

lastly

There is so much nuance in medicine and Emergency medicine and I do question what is "the standard of care". I often tell that to patients. I come up with an analogy like the following: "If 100 ER doctors came in here and evaluated you, 70 might want labs, 25 might want labs and a CT, and 5 would attempt just symptom control. It's not totally clear what to do. It depends on your risk tolerance, desire to have more testing, maybe some of it invasive, and etc. My job is to advise you as best as possible about." Patients seemingly get that, but I never truly know what they are thinking.

 

[anonperson]

Q&A with the jury foreperson:

Q&A with Jury Foreperson from PE Case

Within a few hours of publishing the Death After ED Visit for COVID case, I received this message in my inbox:

expertwitness.substack.com

Damn. I read the jury foreperson interview.

What a travesty.

The juror sounded insufferable and like some pseudo intellectual who thinks they understand medicine while in reality they are completely clueless.

Ladies and gentlemen, this dbag is deciding your fate and can completely wreck you financially.

He mentions his wife is a medical provider. That probably means a half competent nurse practitioner or PA.

First, please don't think that just telling someone that leaves the ER to follow-up with someone in two days is going to do anything useful (or protect you legally).

So basically, patients are too stupid to follow even basic instructions. The jury has made it so there can be no bad outcomes whatsoever.

Put another way, part of being a good physician is connecting with your patient and getting them to do what you think they should do.

Gee. How the h#ll does someone connect with a patient you've just met? What kind of insane thinking is this? Sounds like some dopey Patch Adams line.

The damages are some arbitrary number they completely pull out of their collective a$$es. That in of itself is comical.

My main question is, how can you even prove the patient had a PE at the ED visit? You can't. Guy didn't die until much later. What if he died 3 weeks later? 4 weeks? 8 weeks? How long are you going to keep that doc from the initial ED visit on the hook?

Any physician who read this case is thoroughly disgusted. The end result is only going to be more CTs for everyone because no bad outcome is acceptable in this system. Cost and cancer risk be damned.

This only reinforces the idea that all that matters is the result. If you have a bad outcome, you are at risk even if you did everything right and by the book. No one will save you.

I'm not ED but am in a highly litigious specialty myself (OB). I laugh when the MFM administrator complains that we order too many US or NSTs or do too many c sections. F that. I'm not going to throw away my life because of some bogus outcome and dummy jury.

And to anyone who thinks CYA medicine doesn't increase health care costs, please get your head out of your @$$. I know so many times that I don't need to get imaging but do so just to minimize my litigation risk.

 

[Apollyon]

Btw, I've heard (such is hearsay) that Hunter "Patch" Adams MD has a huge ego and a short temper.

 

[watermanMD]

Q&A with the jury foreperson:

Q&A with Jury Foreperson from PE Case

Within a few hours of publishing the Death After ED Visit for COVID case, I received this message in my inbox:

expertwitness.substack.com

This person is very confident in himself and assessment of the complexities and nuance of medicine. Non-medical people wading through pretest probability, heuristics, cognitive errors and diagnostic mistakes and deciding your fate. Terrifying. **** this ****.

 

[CliveStaples]

"Clear from the beginning the plaintiff was going to win."

And this is the fundamental problem. It was clear to the juror because a 19 year old died who had been seen in the ED a week prior, there must have been negligence. There was no need to fully understand or engage with the decision making, nor was there any assumption that this could reasonably happen without fault being applied.

There was nothing the ED physician could do to avoid this except to have tested this person for a PE, regardless of whether or not it was the right thing to do, or the common thing to do.

If I told you that 50% of ED physicians also would have applied PERC to this patient despite the EKG findings, does that mean that 50% of ED physicians are practicing negligent medicine? If so, what even defines negligence any more?

 

[Jabbed]

Damn. I read the jury foreperson interview.

What a travesty.

The juror sounded insufferable and like some pseudo intellectual who thinks they understand medicine while in reality they are completely clueless.

Ladies and gentlemen, this dbag is deciding your fate and can completely wreck you financially.

He mentions his wife is a medical provider. That probably means a half competent nurse practitioner or PA.



So basically, patients are too stupid to follow even basic instructions. The jury has made it so there can be no bad outcomes whatsoever.



Gee. How the h#ll does someone connect with a patient you've just met? What kind of insane thinking is this? Sounds like some dopey Patch Adams line.

The damages are some arbitrary number they completely pull out of their collective a$$es. That in of itself is comical.

My main question is, how can you even prove the patient had a PE at the ED visit? You can't. Guy didn't die until much later. What if he died 3 weeks later? 4 weeks? 8 weeks? How long are you going to keep that doc from the initial ED visit on the hook?

Any physician who read this case is thoroughly disgusted. The end result is only going to be more CTs for everyone because no bad outcome is acceptable in this system. Cost and cancer risk be damned.

This only reinforces the idea that all that matters is the result. If you have a bad outcome, you are at risk even if you did everything right and by the book. No one will save you.

I'm not ED but am in a highly litigious specialty myself (OB). I laugh when the MFM administrator complains that we order too many US or NSTs or do too many c sections. F that. I'm not going to throw away my life because of some bogus outcome and dummy jury.

And to anyone who thinks CYA medicine doesn't increase health care costs, please get your head out of your @$$. I know so many times that I don't need to get imaging but do so just to minimize my litigation risk.

My main takeaway from this case was this excerpt:

10. Do you think Dr. L might have won if he had documented that he told the patient instructions that were specific to his care like "return if your chest pain gets worse, if your breathing worsens, if you pass out, or if any other new unexpected symptoms arise"?

I think this would have significantly improved his chances of winning and, if true, likely that the patient would still be alive. I viewed the packet of papers of discharge instructions as insufficient since they are often generic and rarely read by patients.

The juror’s main narrative is that this kid was diagnosed with Covid twice and was under the impression that he should just “tough it out”. Ie, when he had his external syncopal episode which we all clearly believe was his submassive PE, he declined to go back to the ED since ‘it was just the Covid’.

He mentions multiple times that if it was documented that the patient should follow up with someone specifically for his abnormal EKG or if better return precautions (come back if chest pain or shortness of breath worsens or any exertional symptoms), it might have changed the verdict and the clinical outcome. Specific return precautions and follow up is a frequent topic in medmal charting.

Notably, the ED physician was found to be “40% at fault” and his financial penalty is 4 M, which will probably be knocked on appeal. A lot of the juror’s perception of the case comes down to his impression of the expert witnesses (‘defense hematologist was condescending’) and defendant (‘kept trying to dismiss EKG findings’).

Similar to Diddy, I don’t think that I would take the stand. It seems to have worked out better for him than it did for our doc.

 

[TooMuchResearch]

Damn. I read the jury foreperson interview.

What a travesty.

The juror sounded insufferable and like some pseudo intellectual who thinks they understand medicine while in reality they are completely clueless.

Ladies and gentlemen, this dbag is deciding your fate and can completely wreck you financially.

He mentions his wife is a medical provider. That probably means a half competent nurse practitioner or PA.



So basically, patients are too stupid to follow even basic instructions. The jury has made it so there can be no bad outcomes whatsoever.



Gee. How the h#ll does someone connect with a patient you've just met? What kind of insane thinking is this? Sounds like some dopey Patch Adams line.

The damages are some arbitrary number they completely pull out of their collective a$$es. That in of itself is comical.

My main question is, how can you even prove the patient had a PE at the ED visit? You can't. Guy didn't die until much later. What if he died 3 weeks later? 4 weeks? 8 weeks? How long are you going to keep that doc from the initial ED visit on the hook?

Any physician who read this case is thoroughly disgusted. The end result is only going to be more CTs for everyone because no bad outcome is acceptable in this system. Cost and cancer risk be damned.

This only reinforces the idea that all that matters is the result. If you have a bad outcome, you are at risk even if you did everything right and by the book. No one will save you.

I'm not ED but am in a highly litigious specialty myself (OB). I laugh when the MFM administrator complains that we order too many US or NSTs or do too many c sections. F that. I'm not going to throw away my life because of some bogus outcome and dummy jury.

And to anyone who thinks CYA medicine doesn't increase health care costs, please get your head out of your @$$. I know so many times that I don't need to get imaging but do so just to minimize my litigation risk.

It's okay. They make us go through CT PE study MIPS hoops under threat of dropping our Medicare reimbursement. Time to find workarounds...

 

[Major]

Instead of metal detectors EDs need walk through CT scanners for PEs.

 

[Emapp20177]

So basically, patients are too stupid to follow even basic instructions. The jury has made it so there can be no bad outcomes whatsoever.

This part stood out to me, too.

"You need to find more clear and direct ways to encourage people to seek follow-up if you truly think it's necessary."

What?

"Return to ER for any problems"

Syncope is a problem in my book. Why else would you call an ambulance if there's no problem?

What a joke.

 

[thegenius]

If I told you that 50% of ED physicians also would have applied PERC to this patient despite the EKG findings, does that mean that 50% of ED physicians are practicing negligent medicine? If so, what even defines negligence any more?

That's the problem and challenge as it's hard to define what's the standard of care for most patients in the ER. I'd say 60% of patients would receive different care if 100 ER doctors all saw that same pt. I wrote that above.

Also have a big problem with expert testimony, as experts are always right when looking at the retrospectroscope. Not necessarily true when they are actually working. A hematologist wouldn't know the first thing on how to treat someone with chest pain in the ED.

 

[MechEDoc]

Also, while I agree that there was no standard of care breach, who the hell is documenting “short of breath with exertion” and then discharging a patient with just an EKG?

If I’m already planning to discharge that patient, that phrase is not getting anywhere near my chart regardless of whether it came out of the patient’s mouth. That’s like documenting “tearing chest pain radiating to my back” and discharging with just an EKG”, or discharging “rebound abdominal tenderness” with just a KUB, or “worst headache of my life” with just a migraine cocktail.

Either ignore the comment, or work it up, but your charts shouldn’t be court transcriptions of what patients complain of.

Totally agree. I doesn't hurt me to get labs (and a CXR or CT) at all and I catch some odd presentations of PEs and pericarditis / myocarditis every few years.

 

[hoot504]

Two questions asked and not answered in this thread... 1.) What state? 2.) What is the doc financially likely on the hook for? bonus points if you can ELI5 what having your assets in a trust in a situation like this would do for you.

 

[JacobMcCandles]

Two questions asked and not answered in this thread... 1.) What state? 2.) What is the doc financially likely on the hook for? bonus points if you can ELI5 what having your assets in a trust in a situation like this would do for you.

The doc will likely only be on the hook for policy limits when it’s all said and done.

 

[Pudortu]

The doc will likely only be on the hook for policy limits when it’s all said and done.

Most likely yes. But this is also the reason I am looking for ways to protect my assets from these scumbags. Just look at the chiropractor case too. More and more cases above policy limits.

 

[WhatJobDoIPick]

EM is trash tier.

I can tell you from experience the chance of suit has nothing to do w documentation and everything to do with outcome.

People are just looking for a lottery win.

Get out ASAP.

 

[WhatJobDoIPick]

Most likely yes. But this is also the reason I am looking for ways to protect my assets from these scumbags. Just look at the chiropractor case too. More and more cases above policy limits.

Trust won't help you unless it's irrevocable which you don't want.

 

[Pudortu]

Trust won't help you unless it's irrevocable which you don't want.

I realize you lose control with the irrevocable trust...but as long as you trust your wife why not?
Also I'm looking more into Cash Balance Plans now to protect myself.

 

[WhatJobDoIPick]

I realize you lose control with the irrevocable trust...but as long as you trust your wife why not?
Also I'm looking more into Cash Balance Plans now to protect myself.

You're trying to insure against risk that doesn't exist.

 

[hoot504]

You're trying to insure against risk that doesn't exist.

Explain

 

[JacobMcCandles]

Explain

It's incredibly, incredibly rare that a malpractice judgement is going to actually go above your malpractice limits and come after your personal assets. It's actually kind of humorous the lengths some people go to prevent this yet don't try to do anything to prevent something that is much more likely to impact their personal assets such as divorce or getting appropriate umbrella insurance.

 

[Pudortu]

It's incredibly, incredibly rare that a malpractice judgement is going to actually go above your malpractice limits and come after your personal assets. It's actually kind of humorous the lengths some people go to prevent this yet don't try to do anything to prevent something that is much more likely to impact their personal assets such as divorce or getting appropriate umbrella insurance.

“So you’re telling me there’s a chance”

 

[Brigade4Radiant]

Oklahoma was the state this disasterous verdict was placed