So, we're not going to talk about Rosen getting sanctioned? Okay. Seems legit.

[Birdstrike]

The guy on our EM-Bible gets sanctioned for ethical violations & violating expert witness guidelines, and we're going to avoid talking about it, like the hairy wart on Grandma's chin, and what happens after we eat gas station sushi ever, let alone again.

Yeah. Seems about right....


"Peter Rosen...violation of ACEP’s Expert Witness Guidelines...and the Code of Ethics"



http://www.acepnow.com/article/acep-issues-public-censure/

---

Members don't see this ad.

 

[Arcan57]

We're going to talk about it

Soon

Patience....

Wait for it....

They don't post info other than he's censured. Lack of info makes it seem less effective than a scathing public explanation.

 

[Birdstrike]

Any ACEP member can write to ACEP's General Counsel Leslie Moore ([email protected]) to get more information about it.

 

[Arcan57]

Any ACEP member can write to ACEP's General Counsel Leslie Moore ([email protected]) to get more information about it.

But if it's a public censure that you have to write an email to a specific person to find out about it's not all that public.

 

[Birdstrike]

Meh...forget this thread. I'm bored. I think I'll read this article again.

http://epmonthly.com/article/gross-negligence-a-slippery-slope-for-dubious-expert-testimony/

 

[RustedFox]

I'll talk about it.

Here's what I wanna know:

1. I want to read this letter that ACEP has written, so I can hear what they have to say.
2. I want to know what punishment Rosen receives. The link provided outlines what can happen, but I want to know what happened.
3. I want to know what impact (if any) this has on the case/verdict.

 

[RustedFox]

Seriously, somebody contact ACEP - see what is "public" about public censure. If there isn't much to find out - then we have reason to be even more critical of ACEP that we already are.

 

[deleted77919]

…

 

[TooMuchResearch]

Seriously, somebody contact ACEP - see what is "public" about public censure. If there isn't much to find out - then we have reason to be even more critical of ACEP that we already are.

More reason to be critical of ACEP?

Isn't the new president elect another EMCare higher power? There's a reason.

 

[RustedFox]

More reason to be critical of ACEP?

Isn't the new president elect another EMCare higher power? There's a reason.

Correct. More reason. Just like I said.

 

[thorg12]

AAEM renamed Peter Rosen award after "the" testimony. Now it's called the Robert McNamara award

 

[wholeheartedly]

Yeah, pretty BS they didn't make the details publuc for a public censure. Of course maybe they just thought it was self evident...

 

[em1234]

Independent of what verbiage is ultimately used by ACEP, I think it is awesome that they are finally taking the step to police these mercenary bags of feces, that are eviscerating the tort reform standards that EPs have fought so hard to attain and are central to us thriving as a profession.

Just imagine his future as an expert witness.
Rosen: As the world's foremost emergency physician, having written numerous text books, chair of this, super amazing at that, I can say without question that this physician totally screwed up.
Defense attorney: Dr. Rosen have you ever been censured by your specialty's governing body for violating ethical standards as it relates to giving inappropriate expert witness testimony?
Rosen: Uh, yeah...once...but...
Defense Attorney: Thanks Dr. Rosen, no further questions.

Like others have expressed, ACEP is mostly an organization that seems to have its priorities centered on representing the interests of CMGs, but sometimes, they throw the regular doc a bone and this seems to be one of those times. This would be an opportunity to be proud of ACEP. They went after one of their own, one of the most prestigious names in the business, and hit him right in the reputation, which at this point in his career is primarily what he has left.

Good on ya, ACEP

 

[gro2001]

Independent of what verbiage is ultimately used by ACEP, I think it is awesome that they are finally taking the step to police these mercenary bags of feces, that are eviscerating the tort reform standards that EPs have fought so hard to attain and are central to us thriving as a profession.

Just imagine his future as an expert witness.
Rosen: As the world's foremost emergency physician, having written numerous text books, chair of this, super amazing at that, I can say without question that this physician totally screwed up.
Defense attorney: Dr. Rosen have you ever been censured by your specialty's governing body for violating ethical standards as it relates to giving inappropriate expert witness testimony?
Rosen: Uh, yeah...once...but...
Defense Attorney: Thanks Dr. Rosen, no further questions.

Like others have expressed, ACEP is mostly an organization that seems to have its priorities centered on representing the interests of CMGs, but sometimes, they throw the regular doc a bone and this seems to be one of those times. This would be an opportunity to be proud of ACEP. They went after one of their own, one of the most prestigious names in the business, and hit him right in the reputation, which at this point in his career is primarily what he has left.

Good on ya, ACEP

Yeah, I think we are lucky that on this issue the interests of EPs and CMGs are convergent. Although the issue of ridiculous expert witness testimony is not as sharply felt by them, I am sure they also don't like being sued like that.

 

[RustedFox]

Lets not get carried away. Until we know for sure that ACEP has some concrete punishment that has an impact, I'm not counting this as V-R(osen) Day.

 

[southerndoc]

Lets not get carried away. Until we know for sure that ACEP has some concrete punishment that has an impact, I'm not counting this as V-R(osen) Day.

Any public sanction is embarassing, makes credentialing a headache, and pretty much ends your career as an expert witness. The defense can easily use it as an argument that the expert's testimony has been unethical in the past so their current testimony can't be trusted.

 

[Birdstrike]

Take home points:

1-Don't be greedy and give sh---y testimony for cash, no matter how much cash. It's not worth the blow to your reputation. Plus, there's plenty of expert witness money to be made defending docs, as opposed to funding the malpractice plaintiff's attorneys 401k's.

2-Don't throw fellow doctors, let alone fellow EPs, under the bus. The lawyers do a good enough job. They don't need our help.

3-If you are going to testify against a fellow EP hopefully for something criminally egregious (and not out of arrogance or greed) make absolutely sure you know what you're talking about (can't do this without doing #4 first) and that your testimony and facts are flawless.

4-Ego, ego, ego. Get it under control. This applies to life in general, as well as how we treat colleagues. We're all going to one common use, regardless of how important we think we are: worm food.

"Pride precedes destruction; an arrogant spirit appears before a fall"- Proverbs 16:18

5-For ----'s sake, save your money. Do this so you can retire before you're 90+ yrs old, and so you don't have to work into your 90s and embarrass yourself. At that point you should be on a beach enjoying life (or rockin' the bingo/shuffleboard circuit, shopping for those bangin' dentures you've had your eye on, dating around the assisted-living wing, or whatever else is your bag) but you should not be spending your golden years in a courtroom! let alone working in any other capacity whatsoever, if you've played your cards right.

6-Finally, remember that honor and reputation take a lifetime to build, but can be pissed away in the blink of an eye, with a single poor choice, one failure of judgement, one epic display of arrogance, stupidity, or mistreatment of one's fellow man. When in doubt, follow the Golden Rule.

 

[RustedFox]

Any public sanction is embarassing, makes credentialing a headache, and pretty much ends your career as an expert witness. The defense can easily use it as an argument that the expert's testimony has been unethical in the past so their current testimony can't be trusted.

That's great and all; but some justice needs to be done by the doc in question. I feel (and I can be wrong) that retrospectively, the court has an obligation to consider that the testimony heard was deemed unethical, and to review the impact that this may have had on the outcome of the case.

 

[Birdstrike]

That's great and all; but some justice needs to be done by the doc in question. I feel (and I can be wrong) that retrospectively, the court has an obligation to consider that the testimony heard was deemed unethical, and to review the impact that this may have had on the outcome of the case.

Seems like excellent grounds for an appeal that might have legs.

 

[southerndoc]

Seems like excellent grounds for an appeal that might have legs.

Exactly, but only if there is still time to appeal. The time limit may have already passed.

 

[MSmentor018]

so even if rosen gets expulsed from acep for 5 yrs, what does that really mean? sure his rep is shot, book sales may drop but he'll still practice medicine? I always thought "ethics" violation has to go a state medical board. kinda like unprofessional conduct, anger mgt issues....etc

 

[southerndoc]

so even if rosen gets expulsed from acep for 5 yrs, what does that really mean? sure his rep is shot, book sales may drop but he'll still practice medicine? I always thought "ethics" violation has to go a state medical board. kinda like unprofessional conduct, anger mgt issues....etc

Depends on the board. Some states require you to notify them.

 

[Vandalia]

Exactly, but only if there is still time to appeal. The time limit may have already passed.

Plus appellate courts only very rarely look at the actual evidence. The legal system will say that it is the jury's responsibility to determine who is telling the truth, and that the defense should have put on evidence to prove that Rosen's opinion was wrong. While you can sometimes get a case reopened (but then only very short time limits) for new evidence, it has to be new evidence. Something that challenges the credibility of a witness is generally not considered "new evidence." Even then there are usually fairly strict time limits, such as one year after the verdict becomes final (i.e., appeals are over.)

It is much easier to get a verdict overturned on appeal if the judge made a mistake of law.

 

[FoughtFyr]

There is a lot of misinformation in this thread. Full disclosure, I am an active ACEP member, I'm on the ACEPNow Editorial Board, but I'm answering as an individual.

First of all, a public censure is a HUGE deal. It is reported to state boards and the NPDB. It will prevent any future work as an expert witness, and can make (re)credentialing difficult. A State Medical Board can take independent punitive action based on the censure. It is a very rare step to take, one that has monstrous legal implications, and lawsuits by recipients of censure actions are not uncommon. I can't remember the last such action by ACEP, so being cautious in reporting is reasonable.

Second, as for not taking action sooner or against more people, currently ACEP can not censure non-members. There have been resolutions within the ACEP Council to attempt to do that, but given the legal implications, it is difficult at best. Members agree to abide by a professional body's standards, non-members don't. So if a non ACEP member offers egregious testimony, there is really nothing we can do.

Third, there is no nefarious plot between ACEP and the various CMGs. A large percentage of EPs work for CMGs, so there will be a large percentage of ACEP leaders who do. The path to ACEP board membership and presidency is long and elections are based on service to the organization. The rules in place to assure fair elections are extraordinary and there are many in leadership, at every level, who are not involved with CMGs. There are others who work for CMGs, but are not in leadership positions with those companies. On the other hand, AAEM has literally become a CMG - http://www.aaemphysiciangroup.com and they hired Intermedix (a huge management entity) to help with management issues. How is that independent? Because they promise to be nice or treat their people better? That's the same claim every CMG makes... I don't understand how they are still considered a professional organization. How can I pay dues to a CMG I don't work for? Even if you accept some contorted explanation of how this is a good thing or isn't a conflict of interest or principle, advocacy is, in part, based on size and influence. In comparison to ACEP, AAEM has neither.

I would invite anyone who wants to be involved with the future of the specialty to come to ACEP. Learn about what they do. They are suing CMS for transparency in billing on your behalf (http://newsroom.acep.org/2016-05-19-ACEP-Sues-Federal-Government), they run a huge government advocacy program aimed at improving your ability to do your job (https://www.acep.org/advocacy/), they sponsor research (https://www.emfoundation.org) and run the preeminent journal for EM (http://www.annemergmed.com), they have an active and involved young physicians section (https://www.acep.org/content.aspx?id=30290) that has produced many of the leaders of the College, they host residency fairs, leadership academies, and regional meetings to educate and provide networking opportunities, and no professional organization puts on a better CME conference (https://www.acep.org/acep16/about/). SAEM, CORD, and EMRA all have seats on the ACEP Council and ACEP works directly with just about every relevant government and regulatory agency. In short, they have your back.

Now as I said at the start, I'm biased. But having "peeked behind the curtain" for 8 years on the ACEP Council, I promise you, ACEP is filled with EPs of all ages, putting forth tons of work on your behalf to better our profession.

 

[thorg12]

I will preface this with I am an AAEM member.
I agree with the importance of the censore and it is reassuring that ACEP do action on this testimony; especially considering his high profile.
This is off topic but need to clarify what was previously
I just want to clarify that AAEM physician group is nothing like the CMG
From the website

• Be part of a practice where physicians take care of each other and you have an equal voice
• Be part of a practice that is run by the local physicians for the physicians
• Be one of the few EM physicians who see what is billed and paid in their name

The biggest point being seeing what is being billed and paid in your name. No CMG does this.

 

[FoughtFyr]

I will preface this with I am an AAEM member.
I agree with the importance of the censore and it is reassuring that ACEP do action on this testimony; especially considering his high profile.
This is off topic but need to clarify what was previously
I just want to clarify that AAEM physician group is nothing like the CMG
From the website

• Be part of a practice where physicians take care of each other and you have an equal voice
• Be part of a practice that is run by the local physicians for the physicians
• Be one of the few EM physicians who see what is billed and paid in their name

The biggest point being seeing what is being billed and paid in your name. No CMG does this.

The first two points are lifted nearly completely from the old EMP materials. I have worked for two CMGs where, on request, a physician could see what was billed in our name. No one did. That issue is much more of a problem with hospital employed physicians than CMG ones. Even EmCare used to allow this (I don't work there anymore, so I can't speak to things now). But I still don't understand how AAEM can function as both a CMG and a professional organization. How can they represent the interests of physicians they are competing with?

 

[FoughtFyr]

Yeah, pretty BS they didn't make the details publuc for a public censure. Of course maybe they just thought it was self evident...

"Public" means you can find out the details (as opposed to the details of closed meetings of an organization). It doesn't mean published. Depositions are public, but no place publishes them. But this is a HUGE punishment, reported to state medical boards and the NPDB.

 

[GeneralVeers]

I don't bother asking for what was billed in my name. Legally they are probably required to provide this. The primary question is what would I do about it? Is it worth causing a fight with the CMG over it?

 

[thorg12]

This may be a little off topic but feel the need to defend the Aaem physician group a little.
the physician group bears the aaem name; meaning it adheres to its principals the biggest being seeing what's billed and paid in your name. And as a parnter you see where all the money is going. The physician group name ensures these democratic groups as they grow do not develop the "senior parnters," not equal voices etc.
for example a hospital employee group has trouble staffing. Instead of emcare coming in, the docs contact aaem physician group and they will run the numbers about them becoming a private group and the total overhead cost, etc. this is where the Managment company comes in.

Believe me emcare has no interest in showing how much money they are making off you bc physicians would quickly walk

Of note I am not part of aaem physician group but know people who put a lot of work into developing

 

[deleted109597]

I don't bother asking for what was billed in my name. Legally they are probably required to provide this. The primary question is what would I do about it? Is it worth causing a fight with the CMG over it?

Back when I used to get RVUs it was. They literally were "losing" between 10-20% of my charts every month. It was a constant battle. So instead of paying correctly, they got rid of RVUs.

 

[GeneralVeers]

Back when I used to get RVUs it was. They literally were "losing" between 10-20% of my charts every month. It was a constant battle. So instead of paying correctly, they got rid of RVUs.

I just look at the bottom-line $$$/hour. There are so many ways they can game charts, and RVUS. There's a $$$ floor I won't go below. Stop paying me that and I'm out.

 

[Birdstrike]

In my opinion:

-Testifying that ordering an EKG was useless care, is reprehensible.

-Saying that d-dimers are not elevated in postsurgical patients, is false and equally appalling.

-Saying that PEs are present in 2-3% of all pediatric ED visits is ludicrous, and also reprehensible.

-Opining on the age of a clot, is also equally ludicrous.

 

[Birdstrike]

Arrogance as a weapon against the humble, is indefensible.

 

[Old_Mil]

Step two in this process...everyone get on Amazon and give the text a one star review and mention the author was censured by ACEP.

 

[The White Coat Investor]

Third, there is no nefarious plot between ACEP and the various CMGs. A large percentage of EPs work for CMGs, so there will be a large percentage of ACEP leaders who do. The path to ACEP board membership and presidency is long and elections are based on service to the organization. The rules in place to assure fair elections are extraordinary and there are many in leadership, at every level, who are not involved with CMGs. There are others who work for CMGs, but are not in leadership positions with those companies. On the other hand, AAEM has literally become a CMG - http://www.aaemphysiciangroup.com and they hired Intermedix (a huge management entity) to help with management issues.

Intermedix is hardly a CMG. They do our billing. We pay them a fee. They send the bills. They collect the money. They take their cut at the transparent rate we negotiated with them and send us the rest. Bizarre to somehow equate AAEM or intermedix with a CMG.

As to whether CMGs are interested in having their officers as high up in ACEP leadership as possible, don't be naive. Doesn't mean anything personally about any of them or that someone who isn't a CMG officer cannot be elected, but it is useful to remember what the two largest CMGs are. They are publicly traded corporations whose primary duty to maximize shareholder return.

 

[The White Coat Investor]

Lets not get carried away. Until we know for sure that ACEP has some concrete punishment that has an impact, I'm not counting this as V-R(osen) Day.

A censure is a big deal and about the most you can hope for. It should stop Rosen from giving any more crap testimony and that's the point. Good on ACEP for doing this. Could be too little too late but at least it's something.

 

[southerndoc]

Now if more people would turn witnesses in for reviews.

The supporting documentation seems vague in their instructions. Do you turn in transcripts, expert witness statements, patient charts, etc.? Not sure how much of this even becomes public record when a suit is filed.