On the topic of PICA what are you guys experiences and opinions on them vs other malpractice carriers? Curious on how good they are when it comes to claims, responsiveness, and cost. They are supposedly touted as being the best at our conferences.Are there better carriers and if so why
All of the companies will settle.
That is my own exp and that of many surgical docs I have learned from or am buds with. It is rare to have any DPM who does weekly OR work and hasn't had at least one or two settlements. The large settlements or judgments are the only ones that are truly problematic (future rates, possible licensing or hospital troubles, etc), and that's because those basically flag that the doc was clearly in the wrong... found so by trial or large settlement basically indicates they very likely would've been.
I had one claim back near the start of my career (flatfoot/Lapidus... pt healed fine, re-lapsed into drugs after I'd left the practice... owner doc kicked her out for drug seeking... and she sued both of us). It was a frivolous case, settled for "nuisance" minimal value with no admission of wrongdoing. I would think the plaintiff attorney probably lost money with all of the expert and depo fees they paid. The plaintiff got probably half of the very small settlement, but she would have been embarrassed badly in court and likely received nothing (her own family was not on speaking terms with her, boyfriend into drug use, she was on video walking in flip flops post-op when she was supposedly having chronic pain, etc). I am glad it didn't go to court, even though 99% we would've won easily... time waste and honestly would've been sad to see someone I tried to help made to look pathetic and fraudulent in a courtroom.
Fortunately, I had good coaching from my attorney, my boss at the time, and my residency teachers during the case. Still stressful.
Essentially, if you get sued, it'll work like this: lawsuit starts (legit or not),
nothing happens fast. First, attorneys gather charts, both sides hire experts, both sides do depositions, both attorneys bill up many hours, plaintiff attorney aims to waste as much of DPM clinical time as they can. That goes on for many months or even years. Plaintiff attorney is often on % only, so they will try desperation stuff to coax a settlement if there is no real case. Defendant attorney is kinda indifferent as they get paid by malpractice company for whatever nonsense plaintiff attorney tries. Then, once both attorneys have billed up plenty of hours (or plaintiff attorney found a better case) and it's clear there is or is not a good case against the doc, settlement is reached.
If DPM wants to bring it to trial, they are told trial would cost much more than settlement if they didn't screw up (or told the trial judgment could be much more than settlement if settlement is sizable because they DID screw up). DPM is also told they would have to pay for trial and any judgment themselves if they wanted trial; malpractice company has recommended settlement and that's that. DPM gets to report such settlement for the rest of their career for hospitals, future insurance, etc. Fun times that nearly every surgical DPM/MD/DO has or will have.
...As mentioned, PICA is fine but way overpriced; they are owned by a much bigger company now (ProAssurance). My group right now uses it... they are pretty large, so who knows if they get discount for having many docs. It is a waste of many thousands per year if you're an entrepreneur or contractor or whatever... you're simply paying for their sponsoring conferences, extensive ads in podiatry journals etc, their corp partnerships, etc. It is not "podiatry focused" as it was 10+ years ago before the sellout. There are other options that will all get basically the same results (all simply hire a local malpractice attorney and local RRA cert DPM or other appropriate review expert if there is a claim). There are many adequate companies that will cost less than PICA (sometimes half in my exp), and if you are hospital/MSG employ, you probably don't have a choice of insurance company anyways.
Regardless of what company you pick,
tips for lower chance of having malpractice problems:
-communicate well with your patients
-document reasonable, esp on surgical or potential surgical pts... "pt declines X," "pt offered Y." Consent and op report and pre-op visit will be key docs (so ABFAS isn't
quite as crazy as we think when they dissect those for cert).
-pick surgical candidates well... avoid smokers, substance users, mood/psych med pts, obese/sick, etc
-realize there are some pts with unrealistic expectation, bad health, sketchy social situation, other problems... give them PT and orthotics until they go away... encourage them to go away if needed, discharge them if many red flags and documented non-compliance (esp non-compliance with diabetic DME or abx making ulcer/amp inevitable)
-build rapport with pts before doing surgery (this is why DM infect, trauma, and passed-on patients are much higher risk)
-test pt compliance with attending a few visits, using pads, filling Rx, using DME, going to PT, getting imaging, etc before scheduling surgery
-be empathetic if there is a complication and treat or punt it promptly
-do good work, both diagnostic and surgical (punt/consult fast and communicate well if you are in over your head)
-pass your surgical boards (ABFAS) if you want to do surgery... just makes things much easier in terms of privileging or explain your qual should you ever need to
In my case, we had RRA cert expert and me RRA qual at the time. We were able to largely disqualify the pathetic plaintiff "expert" since he was not even ABFAS, he was "retired" from toe surgery or whatever he once did, and the case was surgical in nature (basically invalidated his commentary on the surgery results, left with just his trite "orthotics would have cured the flat foot, pt did not need surgery" that he'd done in 30+ other cases - all plaintiff side - by stating "going to meetings" as his expertise on standards of care for surgery).
As to what I learned from it: don't try to be a hero. Good skill cannot make up for questionable pt selection. The pt had a history (many years prior) of drug use, and I should've just said no surgery. If I'd have done a few more visits, I might have pegged her as anxiety type. The owner had seen her and done insoles and pads with little help, she was turned over to me, and I figured severe HAV/planus shouldn't be punished just because she had partied many years prior... and I was probably wrong. She relapsed after the surgery healed and ended up kicked out of my former office as well as her PCP for drug seeking and probably mad at the world. Addicts are often great at lying and are happy to throw anyone under the bus to get their fix, money, etc. No good deed goes unpunished... tell the uber fatties, the substance users, the "CRPS-prone" anxiety types that they can find somewhere else to get their surgery done. Even if the trauma or deformity imaging screams "surgery," just put those types in a cast and tell them they can deal with the arthrosis or deformity later. Don't let the pt charm you into bending your common sense just for them.
Regardless, you can find many companies that'll settle the inevitable case here and there. They all settle after grinding down the settlement with evidence from charts and experts. Settlement's what is cheaper for them. The companies aren't dumb; they will all get you a competent med mal attorney and experts (or they'd risk HUGE settlements). How much you pay for that coverage is up to you - or your employer. You are basically paying many thousands per year for a service that just gives you a certificate to meet hospital/insurance reqs and hires attorney should you ever need one. Don't overthink it.
