The Trial of a WhiteCoat

Foreword

Medical malpractice is a process where neither side wins. Patients suffer bad outcomes – some due to medical negligence, some not. Even an accusation of medical malpractice cuts to the soul of any medical provider. As malpractice litigation drags on, both sides are forced to repeatedly relive bad memories as strangers pick through the issues and question their every action. Often it isn’t a matter of who wins a medical malpractice lawsuit, it’s a matter of who loses least.

The death of a patient is especially troubling because many people, physicians included, fail to remember that death is a part of life. Death can happen at any time and in any place. An unexpected death does not necessarily mean that someone else is to blame.

This story was written for every healthcare professional who has received a summons for a lawsuit and doesn’t know what to feel or where to turn. You aren’t a bad person, and you aren’t a bad doctor. Even if you made an error, you’re human. Sometimes I wish everyone could understand that more.

The Trial of a WhiteCoat is great reading. You should bundle it all together, expand it, and publish it. You could be the John Grisham of the medical set.

This was just one of hundreds of comments I received after publishing a series of posts about my medical malpractice trial many years ago. The series became quite popular and garnered more than 1 million total views. Comments to the posts resulted in many discussions between attorneys, doctors, and patients. Some questioned the propriety of discussing a patient’s medical care online (for the record, facts and demographics about the patient were changed). Others described how much they enjoyed the suspense and how much they learned from my experiences.

It is my sincere hope that this book helps to demystify medical malpractice lawsuits and encourages discussion about how to make medical malpractice litigation more equitable and less intimidating for all involved.

Dedication

To my amazing wife and children. You are the foundation upon which my life is built. Each of you is a source of endless support and pride for me every moment of every day. My love for you has no bounds.

To readers who made this blog series so popular. My sincere gratitude for your encouraging comments and support. I’m not sure I could have completed this series without your encouragement.

The Trial of a WhiteCoat

CHAPTER 1 – An Unwelcome Surprise

I was in the middle of writing admission orders for a patient when the secretary told me that someone needed to see me in the front.

I headed toward the triage desk when a security guard ran up, grabbed my arm, and stepped in my path. What the hell is going on? I thought to myself. He told me that the person who wanted to see me up front was a process server. He said that he could keep her from coming back and that I could sneak out the back door after my shift if I wanted.

I thought about it for a few seconds and realized that it would only delay the inevitable. I thanked him for looking out for me and walked out to see the woman. When she saw me, she fiddled with her briefcase for a moment, finally got the latch undone, opened the briefcase, and handed me some ruffled papers. I asked her if she wanted me to sign for them. She raised her eyebrows, making it seem as if my offer was not something ordinarily done. She handed me another piece of paper. I scribbled my signature on it and walked away.

The first page of the stack of papers was a summons commanding me to appear in court. I turned the page and saw the name of a Plaintiff as the executor of the estate of another person. Not a good sign. If there is an executor and an estate, it meant that the patient died. Below that was my name, the name of the hospital where I had previously worked, the names of a few other doctors, and the names of a couple of nurses. As I paged through the complaint, I had no idea who the patient was. All I knew was that everyone allegedly delayed diagnosis of a surgical problem in the hospital emergency department and that the patient walked into the hospital … but didn’t walk out.

The rest of my shift that day sucked. I looked at patients as adversaries rather than as people needing help. I ordered more tests than I probably needed to. It wasn’t for defensive medicine purposes or anything like that. Everyone knows that defensive medicine doesn’t exist. Maybe it helped me feel better about not missing anything. Maybe I didn’t want to get named in another lawsuit a few years from now. My head just wasn’t in the game at that point. My brain was full, and I wanted to go home. The shift that day couldn’t end quickly enough.

When I got home, I wasn’t myself, but I didn’t say anything about the lawsuit to my wife. I still hadn’t gotten over the shock and I didn’t want my wife worrying about me. Didn’t get much sleep that night.

The next day was a day off, so I canceled plans to take my kids to the park and went to my old hospital to review the patient’s chart. Had some important business suddenly pop up, I told my wife. I could see the concern on her face, but I just wanted to be alone, so I gave her a peck on the cheek and took off. Tooling down the highway with Motown blasting on the car stereo helped me take my mind off things for a little while. I even caught myself singing a couple of the songs.

Since I no longer worked at the hospital, I couldn’t log onto the computer to review the chart. The medical records department had to get special approval from the legal department to unlock the chart so it could be reviewed. I was only able to review the chart with a member of the medical records department standing over me. Like I’m going to write extra notes in it or delete some pages. The attorneys already have copies of the chart, anyway. Otherwise, they wouldn’t have been able to tell what had happened with the patient. Changes to the records after the fact are a sure way to ruin your defense. Plus, electronic medical records have metadata that shows when a record was accessed and what records were changed. Do I look that dumb to make a change to the chart now? The staff member looked around at the walls and paced in the room as I scrolled through the chart.

The patient had come by ambulance with a nonspecific complaint. Soon after he arrived, he began to complain of severe back pain. He got a couple of doses of pain medication while we were waiting for his tests to come back. Then his blood pressure dropped. We reversed the pain medication with Narcan, but his blood pressure remained low. His blood pressure didn’t respond to fluids. We started him on medications to raise his blood pressure. While treating his shock, we also looked for the cause of his nonspecific complaint which ended up being a very uncommon medical issue. It took several hours, but we finally made the correct diagnosis in the emergency department. Unfortunately, the patient’s disease had progressed too far. He died from sepsis the next day.

After reading through the chart, I remembered the patient. Nice older fellow who was laughing and joking with the staff when he first came in. I also remembered the patient’s daughter. She was confrontational. As soon as she arrived, she began questioning everything we did and everything I ordered. I remember at one point asking her if she had any suggestions for her father’s care. She had called her father’s primary care physician and wanted him transferred to a hospital about 30 miles away. Unfortunately, by the time she made that request, her father was already in shock and was too unstable to transfer.

Fortunately, I documented that chart very well.

I asked the lady in the medical records department for a copy of the patient’s chart. Nope. Cannot be copied and can only be provided to authorized parties. What was she talking about? I used to work at the hospital, and I was being sued for care that took place at the hospital. Doesn’t matter, she said, you’ll need to get approval from the legal department. You have a lovely day, too, ma’am.

I wanted to brush up on my knowledge of the patient’s medical issues. I wanted to make sure I knew all the signs, symptoms, and laboratory findings typically seen in the disease, but I also felt the need to validate the care I provided. I spent the rest of the day in the medical library reading through all the articles and book chapters I could find about the patient’s diagnosis and management of patients in shock. The more I read, the more I could see that my care was entirely appropriate. Then I got angry. If I missed something, that’s one thing. But we diagnosed a very obscure problem and I thought everyone involved provided excellent care. I couldn’t wait to see what the plaintiff’s expert said that I should have done differently.

I notified the group I was working for at the time, and they notified the medical malpractice insurance company.

The following day, I got a call telling me that I had been assigned a malpractice attorney.

CHAPTER 2 – Vinny Takes the Case

I checked the attorney out online. I also had a couple of friends who are lawyers get some information about him. He had a particularly good reputation. That’s good news. One friend told me that he was the go-to guy that the insurance company used to handle complex cases. That worried me. I know that I’m looking at the care I provided from my own skewed perspective, but I thought that everyone did a great job treating this patient. Why did the insurers want a big gun for this case?

I called Vinny and we talked on the phone for a while. I liked him almost immediately. Very down to earth. Knows his stuff. He did seem a little high-strung at times. I could hear the tenor in his voice go up when he told me things to do and things not to do from that point forward.

"Don’t talk about this case with anyone but me – the plaintiff’s attorney will grill you about it during your deposition and you’ll drag other people into the case who may