Doctors and Litigation: The L Word

In this episode we have a conversation with surgeon and longtime expert witness Dr. Stephen Cohen, who wants to tell you about common mistakes he's seen physician defendants make in their cases. Dr. Pensa and Dr. Cohen discuss real cases Dr. Cohen participated in as an expert, and their legal outcomes. We also emphasize the unfortunate reality that we (and licensing boards, and society)should not use adverse jury verdicts and legal outcomes alone to infer whether someone's medical care was reasonable. Learn more about Dr. Pensa at doctorsandlitigation.com.

Many of us have no idea who our medical malpractice insurance carrier is, let alone the details in our policy. But this ignorance can have huge consequences when it's time to face a claim, and it's better to go into that challenge with your eyes wide open. On this podcast, Dr. Pensa speaks with John Shufeldt, MD, JD, MBA about things that every doctor or other patient-facing clinician should know about their insurance coverage, which can vary tremendously from policy to policy, and from insurance company to insurance company. So before you take a new job, or before you face a claim: have a listen, and learn about the questions you've got to ask.

In this episode, Dr. Pensa discusses 'strategic communication' in litigation with expert Matt Abrahams. Matt teaches strategic communication at Stanford Graduate School of Business and hosts the podcast, "Think Fast, Talk Smart." He's also the author of the books "Think Faster, Talk Smarter" and "Speaking Out Without Freaking Out: 50 Techniques for Confident, Calm and Competent Presenting." We talk about the importance of communicating strategically in any setting, including the artificial settings of deposition and trial. We discuss, among other things, anxiety management, the importance of preparation and structure, and communicating with empathy, clarity, and brevity. More about Dr. Pensa and how to contact her: https://doctorsandlitigation.com/

The phrase "nuclear verdict" strikes fear into the heart of any defendant - and today we're going to tackle it head on. We welcome Dusty Otwell, JD, medical malpractice defense attorney and Chief Risk Officer of UCACS, to the podcast to discuss “nuclear," "runaway jury," or aberration verdicts. These are jury awards to the plaintiff, given at trial, that well exceed predictions. They tend to make headlines, create fear among doctors and other providers, and lead other parties to dream of giant jackpots. In this episode we discuss: Societal trends that may be fostering the increase in aberration verdicts How we can mitigate our fear around the possibility of an aberration verdict What happens after an aberration verdict: post-trial negotiations, and real-sizing the risk to your personal assets Why defendants should feel empowered to speak up, request preparation, and ask for 'financial risk estimates' The ‘reptile theory’ deployed at trial by plaintiff’s attorneys, and how tapping into the general anger in society fuels their persuasion Why and how defense teams need to evolve to combat these tactics Now, more than ever, preparation of the defendant should be paramount and start EARLY in the case. More about host Gita Pensa, MD, can be found at https://doctorsandlitigation.com/ Dusty Otwell is vice president for claims and risk management at US Acute Care Solutions. He also serves as Chief Operating Officer and Corporate Secretary for Clinician Assurance Risk Retention Group, the self-insurance carrier for USACS. Previously, he was associate general counsel and director of risk management for Emergency Service Partners, a founding partner of USACS; a senior risk management consultant for ProAssurance Corporation, staff attorney for Maynard, Cooper & Gale, P.C., and staff counsel for Medical Reimbursements of America, LLC.

Medical Boards (or state Departments of Licensure and Discipline) are charged with keeping the public safe from unskilled, impaired, or unscrupulous doctors (or other licensed clinicians, each of which has their own board). While this is an important and necessary role, it is also not uncommon for well-meaning or "innocent" doctors to become the subject of investigations due to complaints from patients, other doctors (including competitors), or from the Board itself. Malpractice litigation or adverse event reporting may also trigger Board investigations as well. This process is usually opaque, and clinicians have a poor understanding of how their Board works, who is on it, how those people are appointed, who they answer to, what happens when complaints are investigated, the possible ramifications of board decisions, and how to best prepare themselves in the case of a complaint. A naive physician can unwittingly worsen their situation, and an attorney is usually recommended to help in navigating the process. Depending on the complaint, your malpractice policy may help defray the cost of this. Important points to note: processes for Boards differ from state to state. Typically anyone can lodge a complaint against a physician with the Board, for nearly any reason, and every complaint needs to be addressed in some way. These complaints can be anonymous in some states, and can range from serious to trivial. There is generally no statute of limitations for these complaints. Consider this podcast an invitation to learn more details about your state's medical board and their processes. Board investigations and evaluations have been linked to physician suicide, and Dr. Pensa cites a study from 2014 in which nearly 5% of physicians referred to the Tennessee medical board for fitness-for-duty evaluations either seriously attempted or completed suicide. She also mentions a John Oliver 'Last Week Tonight' episode about state medical boards that paints a bleak picture of state medical boards' ability to root out dangerous doctors. The job of the medical board is indeed a difficult one, and Dr. Pensa makes the case for more transparency, accountability, and feedback mechanisms given their power and the wide-reaching impact of their decisions. Changes would need to be made at a legislative level, as the Board is typically a governmental/political organization. Dr. Gita Pensa gives an introduction to Medical Board investigations and complaints in this episode with Guillermo Beades, Esq. Mr. Beades teaches and publishes regularly in an effort to educate physicians and other clinicians about healthcare law. You can find an article of his about this topic here in Medical Economics. Guillermo J. Beades, Esq., is a Partner in Frier Levitt’s Healthcare Litigation Department and Co-Chairs the Firm’s Insurance Defense Group. He represents healthcare professionals in a broad range of administrative, civil and criminal healthcare matters. Mr. Beades has extensive litigation experience before state licensing authorities and Medical Boards (e.g., NJ BME, OPMC), federal healthcare agencies (e.g., OIG, CMS, DEA) and state healthcare agencies (e.g., NJ Medicaid Fraud Division, NY OMIG). He represents practices and healthcare professionals in matters concerning credentialing and denial of privileges, administrative discipline, Medicare audits, hospital fair hearings, post-payment demands and pre-payment audits.

In this first episode of Season 2, Dr. Pensa talks with attorney Saira Pasha, an EMR audit trail expert. What else besides the words in your chart does your electronic medical record track? Are 'secure messages' discoverable? (Spoiler: yes, they can be!) How can an audit trail help your case -- or hurt it? How does an audit trail expert 'read between the lines' of who's looking at what entries in the record, and when, and for how long? Take home points: The EMR creates a trail that tracks not only your substantive words on the chart, but evidence of all the people who were in a given chart, at what time, looking at what, for how many seconds or minutes, what they did next in the chart, whether a template or smart phrase was deployed. It tracks and times views, edits, additions, deletions, changes, and any printing or searches. These are not part of the initial requested 'medical record,' but can be obtained through the request of an EMR audit trail. The timing of changes to the record can imply that charting was slanted in a way to be defensive or misleading (or at least, a plaintiff’s attorney is going to try to do that, even if your intention was well-meaning.) Attorneys may infer the importance of a part of the record by seeing how many people were in a chart at a given time, and what they were all looking at, for how long. This information can act like a big red arrow pointing at a specific medication order or radiology result, for example, even if there is no explicit mention of it in anyone's notes. Secure messages, FYI's, Best Practice Advisories, and other prompts are all discoverable (with a little sleuthing) as part of an EMR audit within a few years of their appearance in the chart. If you cosign notes using a template that suggests you did a substantive review of another clinician's care (such as an APP or midwife), be mindful of the fact that the EMR tracks how long you spent in that note, or reviewing that patient's chart or imaging. Dr. Pensa references this 2021 case in which efforts to alter EMR records were exposed. More about Dr. Pensa and how to contact her can be found at doctorsandlitigation.com.

Although you might expect life to go back to 'normal' as soon as the litigation process is complete, it often doesn't work that way. Lingering distress, if left unaddressed, can lead to behaviors like over-documenting or over-testing, avoidance of certain procedures or case types, PTSD symptoms, disillusionment, burnout, and career abandonment. In part one of 'Life After Litigation', Dr. Gita Pensa speaks with Tracy Sanson MD, Stacia Dearmin MD, and Marge Paccione, PhD, about their insights.