Doctors and Litigation: The L Word

Litigation affects the majority of physicians during their career -- in other words, good doctors often get sued. Yet the topic is largely a taboo one among physicians. In this first episode, Dr. Gita Pensa introduces the topic of litigation stress, interviews physicians who have been sued about what makes the experience difficult, and talks to Louise Andrew, MD JD about why this topic needs to be addressed. Dr. Pensa successfully defended a multi-million dollar malpractice case spanning twelve years, including two jury trials. She speaks nationally on the topic of litigation and litigation stress, and has been a practicing physician for nearly 20 years. She is currently academic faculty at the Alpert Medical School of Brown University. However, these opinions are her own, and this podcast does not express the views of Brown University, her employers, or any affiliated hospital systems. More about Dr. Pensa: doctorsandlitigation.com Also available here on Apple podcasts. Theme music by BenJamin Banger (Instagram: @BenJaminBanger) _____________________ Check out Dr. Pensa's recent appearance on The Pitt Podcast -- the HBO Max companion podcast to the Emmy-winning hit show, The Pitt! Gita Pensa was thrilled to be a consultant for the hit drama The Pitt for the 2nd and (upcoming) 3rd seasons, bringing her expertise in malpractice litigation stress to help the show's writers understand what clinicians carry behind the scenes. She speaks about it more in Episode 10 of the HBO Max companion podcast. Watch here now: https://youtu.be/phwbzDMCuUc?si=DUymrA6dE9xYYVx_&t=2070 _______________________ Take the LEAP! Be litigation-ready. Learn from Dr. Pensa's attorney-vetted Litigation Education and Performance for Clinicians course. Up to 16 hours of AMA Category 1 CME/CNE credits available in this self-paced video course that will teach you about the skills and mindset required to face medical litigation with integrity and know how. Learn many of the techniques Dr. Pensa uses with her own 1:1 coaching clients. START HERE: https://www.doctorsandlitigation.com/LEAP/signup _______________________ Attorneys, Risk, Claims, and Medical Leadership: Learn about "Defense LEAP" and partnering with Dr. Pensa to ensure your medical defendants are supported and prepared from the very beginning. Contact Dr. Pensa through her website to learn more: https://www.doctorsandlitigation.com/contact ________________________ WATCH: The Emmy-nominated 30-minute documentary, "A World of Hurt: How Medical Malpractice Fails Everyone," featuring host Dr. Pensa. PBS: https://watch.ripbs.org/video/a-world-of-hurt-how-medical-malpractice-fails-everyone-uklpuo/ YouTube: https://www.youtube.com/watch?v=09IVcL6pACU

In this third episode, you'll hear the story of one tragic medical case and its legal aftermath, involving a physician who did everything right -- and yet winds up as a defendant in a high-stakes malpractice trial. More about author Dr. Pensa: doctorsandlitigation.com

In follow up to the fourth episode, which tells the story of Dr. J, a physician who died by suicide during medical malpractice litigation, this mini session highlights National Physician Suicide Awareness Day (NPSA Day) which falls on September 17th. This is during Suicide Prevention Month, and one week after World Suicide Prevention Day. Physicians have an increased risk of suicide over the general population; over 300 physicians die by suicide each year. I speak with Dr. Loice Swisher, co-founder of NPSA Day, tells us about its origins and ways that you can get involved. Follow hashtags #NPSADay, #DocsTalkSuicide, and for general suicide prevention, #BeTheOne or #BeTheOneTo. The fifth regular episode on the deposition will be out later this month.

In part one of this look at medical experts in malpractice litigation, we hear the story of Dr. M, a physician embroiled in a dramatic legal battle after the death of a patient, and his efforts to bring the medical expert in his case to justice. We speak more with Dr. Louise Andrew, MD JD, about the necessity and ethics of medical expert testimony, and hear the voices of physicians who have been defendants, plaintiffs, and experts themselves. And we examine the psychological impact that unethical, exaggerated, or misleading expert testimony has on defendant physicians, including the story of a physician who died by suicide after being accused of witness tampering. More about Dr. Pensa can be found at www.doctorsandlitigation.com.

"Every member of the family is involved in a lawsuit." -Dr Greg Henry Litigation often has a spillover effect on spouses/partners and families, whether or not the defendant physician acknowledges it. In this episode, I interview Dr. Claire Nicogossian, PsyD, a psychologist and clinical instructor in the Department of Psychiatry and Human Behavior at Brown University (www.MomsWellBeing.com) We discuss common struggles that couples and families face during litigation, how to stay connected and communicative, and how to speak with children about litigation. Dr. Nicogossian describes some of the Gottman Institute's longitudinal research on couples, including the 'Four Horsemen of the Apocalypse' in relationships that predict divorce/relationship failure (Criticism, Contempt, Stonewalling, and Defensiveness). She offers some practical advice, reassurance, and insight. Drs. Paccione, Andrew, and Henry, introduced in previous episodes, continue to offer their added insights. More about Dr. Pensa can be found at doctorsandlitigation.com.

Many listeners have sent in questions about litigation in this new era of COVID-19. They are infuriated after seeing advertisements from plaintiff's attorney firms already soliciting COVID-19 cases, while physicians and other front line health care providers risk our lives and the health of our families in an unprecedented crisis --when litigation should be the last thing we have to worry about. Physicians now wonder how protected will they be if their usual practice is disrupted, and there are delays in diagnosis or treatment. Or what if we send a patient with suspected COVID-19 home when they are stable, but they later worsen or die due to the unpredictability of this horrible virus? What if we are forced to ration ventilators or other scarce resources? Or if we are asked to practice outside our usual scope -- if an OB-Gyn is now working on the medicine floors, or a general internist is now working in the ICU, and there is an adverse event in that setting? In this episode, Dr Pensa speaks with two malpractice defense attorneys about some general principles, and gets some reassurance. Some states are adopting emergency measures that provide practitioners with additional protection, changing the standard for civil cases to 'gross negligence or willful misconduct'. But this does not mean the provider has blanket immunity from being sued at all. Lawsuits might still be filed that will need to be defended, even with this new standard (though likely fewer cases will be brought forth, because they will be much harder for plaintiffs to prevail). Because lawsuits can still be filed, and there are large costs associated with defending them from the start, it is imperative that you are properly insured for however your practice changes in this pandemic. We discuss considerations for retirees and volunteers, physicians who are changing the manner in which they see patients, and the importance of documenting circumstances in general. More about Dr. Pensa: 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.

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.