VA malpractice lawsuit?

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I am thinking about looking for a VA position. I thought that malpractice lawsuit risk would be lower because of sovereign immunity. However my colleague tells me that it is equally stressful. Although we do not have to pay out of our own malpractice insurance, we still have to prepare to defend as any other lawsuits. In the end, it will reported to NPDB. And VA patients may sue even if you have good relationship with them, as they are suing the government. Everyone wants to get some free money. Is it really so?

 

[Apollyon]

The VA is covered by the Federal Torts Claims Act (FTCA) - IF you are an employee. This means, if you are sued, it is actually the US government being sued, so you get defended by the Department of Justice/underlings of the Attorney General. However, if you are an independent contractor, they will not defend you. As EM, though, the bar is pretty easy to meet to show that you weren't really an IC (such as being told where to work, when, and using their equipment).

I am not a lawyer (thank heavens), and I have never been sued (again, thank heavens), even when I was covered by the FTCA.

 

[erdoc00]

In the future everyone will be on the npdb.

my understanding with the VA is that you are not personally liable for payments and therefore can't be sued beyond "limits" . I also believe that the VA has a peer review system that determines if there is merit to the claim.

 

[Vandalia]

In a significant fraction of "malpractice cases" against the government, a suit is never filed. This applies for the military, the VA, the PHS, Indian health, etc.

First, the person who alleges injury must make an administrative claim against the government, then if the claim is rejected, they may file suit in federal district court. If it is a legitimate claim, then the government usually grants the claim and avoids trial. So technically, there was never any "malpractice suit." If the claim is rejected, it is less likely that the malpractice attorney will be willing to continue to trial. This is because the claim must be made in federal court, and plaintiff's generally hate federal court They would much prefer to spend their time on a potentially more lucrative state-court malpractice claim.

So if you actually do commit malpractice, it is likely to never result in an "official" malpractice suit. And because the case is defended by the US Justice Department in federal court, malpractice attorneys are generally less willing to take a 50/50 case on a contingency basis.

 

[EMIM2011]

Would you get an entry in the NPDB? My understanding of sovereign immunity systems (VA, some states) is that your name never ending up in there is one of the "perks" so to speak...

 

[Vandalia]

Would you get an entry in the NPDB? My understanding of sovereign immunity systems (VA, some states) is that your name never ending up in there is one of the "perks" so to speak...

An interesting question. I believe the official requirements are something like, any payment made on the basis of a written claim of malpractice. So this would tend to indicate it would be reported. However, it then goes on to speak of the "malpractice insurers" duty to report. So maybe not. If you are involved in this type of thing, you would need to check with the agency lawyers and/or the NPDB itself.

However, for the younger folk, I think it is important to point out that no one cares about malpractice claims when it comes to hiring. I have been on hiring committees/credentialing for well over a decade, and I cannot recall a single case where malpractice settlements/verdicts alone caused a negative evaluation/decision. People I know who do the same job report the same thing. Everyone knows the system is broken, and as a result no one pays that much attention to it. Now, if you manage to have 90 judgement against you spread evenly over 3 years, that would be a problem. (Even that wouldn't necessarily be a problem if you had a good explanation - like a nurse stealing the narcotics and infecting everyone.) It is also possible that if there is correlation with other factors - such as substance abuse - someone with a ton of judgement wouldn't be hired, but it is due to the underlying problem, not the malpractice cases.

If you are in a specialty with a lot of elective cases and a highly educated population bases - plastic surgery, for example - then a number of malpractice cases might be a bigger issue. But in EM, if you have one - or five - judgement against you, no one will bat an eye. So don't worry that your only career option would be "a pediatrician in a woman's prison." (Kudos to anyone who gets that reference. You have to be a real fan.)