Pearl McGuire[1], a 70-year-old retired nursing assistant with chronic back pain, scheduled an appointment to see orthopedic surgeon, Dr. Howard Glover, for evaluation of ongoing back issues. During her initial visit, Mrs. McGuire reported significant back pain, bilateral leg numbness, and difficulty wa...
The prospect of being sued is unnerving at best, terrifying at worst. Although I don’t know this from personal experience, I have talked to hundreds of our providers when they have called to report a lawsuit that has been filed against them. Thus, I know the range of emotions that most of the readers of...
A physician faced a medical malpractice lawsuit after administering injections that allegedly failed to alleviate a patient’s chronic pain. The patient, who sought relief from persistent discomfort, not only claimed the treatments were ineffective, but she also claimed the treatments were given simply s...
Most likely you have heard the song, “The Gambler,” written by Don Schlitz and famously sung by Kenny Rogers. The song depicts an interaction between the narrator and a seasoned gambler on an evening train. The gambler notices the narrator’s dejected facial expression and surmise...
It has been said that the bone that separates the brain from the ethmoid sinus cavity is as thin as a potato chip. In this case the plaintiff had an ongoing and worsening sinus condition and elected to undergo sinuplasty. Since the ethmoid bone was more deteriorated than expected, our insured otor...
The Beatles wrote a song entitled “The Long and Winding Road.” While it is doubtful the Beatles were talking about medical malpractice litigation, defendant health care providers are certainly justified in feeling as if their medical malpractice cases are long and winding roads, especially g...
“Communication breakdown, it's always the sameHavin' a nervous breakdown, drive me insane” – Lyrics from “Communication Breakdown” by Led Zeppelin The truism here is communication breakdowns, in a healthcare setting, will drive us all insane. But there are many ways breakdowns h...
Given the ever-increasing physician shortage and high demand for appointments, it is common for a patient to receive treatment from an advanced practice provider (APP) when seeking medical care. Appointments with an APP often give a patient the opportunity to be treated sooner for a problem. The continued pro...
A lawsuit is often described as a marathon, not a sprint. In some cases, that marathon takes longer and includes more hills to climb than expected. The COVID-19 pandemic certainly emphasized the challenges faced in litigation and created the perfect storm of repeatedly delaying a case ready to go to trial. In...
Do you remember playing the telephone game as a child? This is the game where the first player selects a word to whisper to the next player, and so on and so forth, until you see whether the final player ends up with the same word. The game challenges its players to listen carefully and make accur...
The patient was a 68-year-old female with a complicated medical history including significant cardiovascular disease and multiple previous surgeries. The events that are the subject of this case started in early 2014 when she was taken to surgery by Dr. Baker[i] for robotic salpingectomy, oophorectomy, transo...
Brandi North,[1] a 43-year-old stay-at-home mom, presented to a medical spa where she had received various cosmetic treatments over the last few years. The purpose of this particular visit was to discuss options that would help her achieve a smoother appearance of the fine lines on her chest and remove ...
“Tell the audience what you’re going to say, say it; then tell them what you’ve said.” This quote is attributable to Dale Carnegie, but it is also something that was impressed upon me by a supervising attorney early in my legal career regarding how to write effective and persuasive leg...
“The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw In real estate, it is often said that the most important thing is location, location, location. In healthcare often the most important thing is communication, communication, communication. T...
Several recent closed cyber claims involve a similar scenario: An employee[1] leaves the employment of a clinic, often on a voluntary basis. Several days or weeks later, the clinic receives reports from existing patients that the former employee is contacting the clinic’s patients and encour...
On a recent road trip to south Florida to move my daughter across the state, I took note of all the bad driving going on around me. It’s not that I haven’t seen a lot of bad driving in the past, and I am certain that other drivers could criticize my driving skills and behaviors from time to time. ...
A recurring theme in SVMIC policyholder education is the importance of effective communication between a healthcare provider and a patient. Another recurring theme is the issue of a healthcare provider following up with a patient after the patient has been advised to seek additional testing, treatment, ...
Readers of this article may be familiar with the medication error case that resulted in a fatality at Vanderbilt University Medical Center back in 2017. That medication error involved a nurse who gave the patient vecuronium, a muscle paralytic instead of Versed, a sedative, which resulted in the death of a pa...
“You’re a LIAR!” The plaintiff’s attorney passed close to the defendant physician as he leveled the accusation in front of the jury. The physician handled this charge as he did the entire trial: with grace and composure. The trial showcased two very different trial practice...
Appendicitis is a well-known medical condition. According to the National Institutes of Health, five to nine people out of every 100 will develop appendicitis during their lifetime.[1] It is most common in younger patients, teenagers, and individuals in their 20s, but appendicitis can happen to pa...
No doubt physicians are familiar with the concept of immunity in the medical context. However, there is another type of immunity with which physicians may not be familiar. Namely, immunity from legal liability. State legislatures have passed statutes granting immunity for a variety of activi...
There is not a day that goes by without an emergency or some type of accident. These scenarios are what make emergency medicine necessary. The American College of Emergency Physicians defines emergency medicine as “the medical specialty dedicated to the diagnosis and treatment of unforeseen illness and ...
Linda Powell[1], a 52-year-old woman, presented to the office of gynecologist Dr. Brenda Farmer for an annual exam in June. During the office visit, Ms. Powell complained of bloating and fluid retention associated with her menstrual cycle. For these complaints, Dr. Farmer prescribed Dyazide™, writing th...
As an avid sports fan, I routinely hear athletes mention that they need to “trust the process.” The origin of “trust the process,” as used ubiquitously in sports, apparently goes back to 2013 when the Philadelphia 76ers’ new general manager, Sam Hinkie, advocated an emphasis on p...
Growing up an avid sports fan I often heard the phrase, offense wins games but defense wins championships. The “defense wins championships” part of this maxim was first uttered by the legendary football coach Bear Bryant. Other legends of the sporting world such as Pat Summitt and Michael Jordan w...
When talking with physicians about the litigation process, a common concern is that a jury seated to hear their case will be comprised of individuals who do not and cannot understand the complexities of the practice of medicine. Many feel it is too risky to put their fate in the hands of individuals who...
Several months ago, a medical practice was unable to access its cloud based EHR system early on a Friday afternoon. A support ticket was submitted to the EHR vendor requesting assistance for the problem. In the meantime, the practice activated its emergency procedures protocol and records of the patient...
The recently licensed resident physician was “moonlighting” at a rural emergency department when the patient, a young male in his twenties with several small children, presented in the early morning hours with complaints of cough, congestion, nausea, vomiting, weakness, headache, and abdominal pai...
“The single biggest problem with communication is the illusion that it has taken place.” – George Bernard Shaw A recurring theme in SVMIC newsletters, seminars, etc. is the importance of effective communication. The emphasis is often centered around communicating with patients, but th...
Barbara Jones1, a 60-year-old female patient, presented to her local ER in Arkansas with acute onset abdominal pain and some distention. The history taken by the ER physician revealed a prior gastric bypass surgery and hernia repair surgery two years previously. A CT scan showed probable partial small bowel o...
Physicians receive a plethora of correspondence during the normal course of their medical practice. Occasionally, physicians receive pre-suit demand letters or lawsuits (i.e., Summonses and Complaints) from patients and their attorneys. These legal papers require special attention as they typicall...
Since the 1998 introduction of the “Sign Your Site” campaign by the American Academy of Orthopaedic Surgeons, much attention has been directed to preventing wrong site surgical procedures. What resulted was a paradigm shift in pre-operative processes, evolving into the pre-operative procedur...
This case is a good example of circumstances we sometimes encounter where the outcome is tragic, although the medical care by our insured physician was appropriate and caused no harm. The magnitude of the injury fuels the pursuit of the lawsuit. A case like this will garner great sympathy for the patient from...
Smart phones and other handheld devices are ubiquitous in our society. They are used in the medical community for professional and personal purposes continuously throughout the day. With the increasing use of these devices to communicate about patients, the line can be crossed not only as to liability concern...
To be human is to be connected. Since March of 2020 that concept has been stretched and strained to the point of breaking. These “trying times” we have been living though are trying the times of our healthcare providers and administrators in their relationships with patients. The stress and fear p...
Four out of five physicians say they are currently experiencing symptoms of burn out. [1] One of the biggest challenges for any working professional is finding a work-life balance. Given the current health care climate, providers are dealing with increased stressors ranging from the global pandemic, a decreas...
After arriving at the office on a Tuesday morning following a holiday weekend, a medical assistant at an ophthalmology practice* logged into her workstation to pull up the clinic schedule for the day. For an unknown reason, the assistant received an error message on her computer screen when she attempted to a...
When Dr. Fabian Starr[1] arrived for work that day in summer 2014, he was asked to examine Mr. Chet Stetson, a 58-year-old male who presented to the office to discuss liposuction. Dr. Starr, a plastic surgeon, worked at Fabulous New You, a free-standing office that advertises esthetic treatments and cosmetic ...
The rural surgeon took the patient to surgery around midnight. Her condition was miserable: relentless nausea, vomiting, and dry retching. The hour may have been late, but the patient was prepped and had been NPO after a previously done scope. The surgeon had placed the patient on several antiemet...
“Do a good turn daily.” – BSA Scout slogan The sky was filled with twinkling blue-white stars promising a fair day ahead when Dr. Able[1] climbed into his car to head for the hospital. A 70’s classics station played unnoticed in the background as Dr. Able mentally reviewed his schedul...
Martha Mae Randolph, an active 74-year-old female with a history of esophageal stricture, GERD, and hiatal hernia presented to the office of general surgeon, Dr. Cameron Smith.[1] Approximately one year earlier, Dr. Smith had performed a robotic Nissen fundoplication with hiatal hernia repair. Although Mrs. R...
“It’s the little details that are vital. Little things make big things happen.” - John Wooden “In the successful organization, no detail is too small to escape close attention.” - Lou Holtz These quotes are from two men who had very successful careers. John Wooden w...
Medical records are essential to the practice of medicine. Among several uses, medical records ensure continuity of care; facilitate effective communication among providers; serve as evidence of all pertinent facts related to the diagnosis and treatment of a patient; and serve as a basis for reimburseme...
While physicians are familiar with the concept of informed consent, they may not be familiar with the concept of informed refusal. Informed refusal is the flip side of informed consent and recognizes that competent patients have the right to refuse recommended treatment after receiving sufficient inform...
“I don’t want him to be the kind of boy lookin’ for fights, but I don’t want him to run from one when he’s in the right” – Sheriff Andy Taylor, The Andy Griffith Show, Opie and the Bully (1961) Once upon a time in the fictional hamlet of Mayberry, young Opie Tayl...
Kelly Johnson, a 45-year-old G0P0[1], presented to the office of gynecologist Dr. Belinda Smith after being referred for evaluation of chronic pelvic pain.[2] Mrs. Johnson had an extensive history of gynecological problems including endometriosis and ovarian cysts. Prior to her appointment with Dr. Smith, Mrs...
There are numerous stories in religious writings with the object lesson of “Things are not always what they appear,” but that lesson is fitting in the study of the sciences, and I submit as well as in the law. Take for example this scientific experiment: Fill a glass with tap water and drop a penn...
Rose Campbell[1], a generally healthy 74-year-old, had been a patient of family practice doctor, Dr. Morris, for more than ten years. Although she had tried to quit smoking many times, Rose was a life-long smoker. She had seen Dr. Morris in Spring 2014 for a checkup and had only minor complaints, including &l...
“If you can’t say anything nice, then just don’t say anything at all.” My mother gave me this advice – fairly frequently – during my childhood, when reprimanding me for arguing with my younger sister. My sister and I would raise our voices and yell ugly things at each other...
Medical offices routinely receive medical records requests, and medical offices should have established policies and procedures for the proper handling of medical records requests in order to promote patient care and to comply with state law and HIPAA. While such factors are important, a frequently overlooked...
The right to have “your day in court” is a highly cherished cornerstone of the American legal system. As a physician, defending your professional care is paramount. Whether to settle a case or defend it through trial is an important decision. Going to trial can have great consequences: losing can ...
In the practice of pediatric medicine, physicians care for arguably the most innocent and vulnerable subset of our population, children. When a child suffers an adverse outcome while under the care of a physician and other caregivers, it has a profound effect on the family, the medical providers, and, often, ...
On June 1, a 24-year-old obese female patient at 11 weeks gestation presented to the OB-GYN clinic to see Dr. Smith.[1] She had been treated at the clinic for her three prior pregnancies. At the patient’s visit on September 3, Dr. Smith scheduled the patient for a three-hour glucose tolerance test (GTT)...
In military communications parlance, your “net” is defined as several people on the same radio frequency channel as you. An axiom followed by leaders in the United States Army in order to win on the battlefield is, “Shoot, move, and communicate.” Timely and effective communication is t...
The Taylor1 family had a history of prostate cancer throughout the last couple of generations of their family tree. When Moses Taylor, age 63, received his prostate cancer diagnosis, he finally convinced his brother Malachi, age 59, and his son Martin, age 42, to see the local family medicine physician for a ...
Words matter. Words may matter even more in the medical profession. Health care providers work in glass houses. What is said, how it is said, and most importantly, how it is interpreted by the listener, can lead to serious and time-consuming consequences. You may think your words are benign or comforting, but...
"Shoulda, Coulda, Woulda. It's so easy in the past tense." - Sarah Dessen Contrary to popular belief, all medical negligence claims do not start and end with a physician or even a licensed healthcare provider. You may be thinking – “what are you talking about? Only a physician or healthcare provi...
The United States is the largest medical device market in the world, generating over $180 billion in annual revenue. [1] An area of growing concern for some in the healthcare community, but often unknown to patients, is the role of medical device sales representatives in patient care. Among these concerns are...
Bear with me, but I presume you are familiar with the colorful colloquial saying about what happens to us when we assume. (If not, just Google it. I will spare you the quote itself, in an effort to maintain some level of decorum.) Despite this “advice,” we make assumptions daily. We assume that ev...
Over the years, SVMIC has emphasized the importance of effective communication as it relates to providing medical care. The physician should attempt to effectively communicate with patients as well as with other healthcare providers. Patients sometimes claim after the fact that they didn’t really unders...
Physicians often feel anxious and fearful when faced with a medical malpractice lawsuit, even when they have rendered appropriate medical care and committed no medical mistake. This anxiety and fear likely stems from physicians’ belief that they have little or no control over the outcome of their case. ...
Tommy Waddell,* a 55 year-old truck driver, finally sought care from neurosurgeon Andrew Lewis when his back pain became disabling. Waddell’s history included spinal stenosis, prior disc surgery, DVTs (for which he took warfarin), diabetes, obesity, and other health issues. Physical therapy provided lit...
Lisa Owens was a sixty-year-old female.[1] By most standards, she had a good life. Mrs. Owens had a loving husband, adult-aged children and young grandchildren. Mrs. Owens and her husband were both at the twilight of their respective careers and were looking forward to retirement, which meant spending more ti...
Communication is one of the most important facets of human life and interaction. The ability to exchange information is a skill learned early on in our lives. Yet, despite our early introduction to communication and the vital role it continues to play in our lives as we mature, it is frequently underestimated...
Know your medical record. It’s an obvious statement. It’s a simple statement. On the face of it, it shouldn’t even be a necessary topic of discussion because it is presumed that we in fact do know our records. But that presumption is rebutted each and every day by reality. The reality of a s...
“It takes a lifetime to build a good reputation, but you can lose it in a minute.” - Will Rogers In general, physicians are widely respected. They are perceived as “healers” with good intentions. Physicians are members of society with remarkable abilities to help others. Statisti...
Most of the time, diagnosing a patient’s medical problem is a straightforward process. The patient’s symptoms are recognizable, and the solution becomes clear to the clinician after formulating a list of differential diagnoses. On rare occasions, a clinician will encounter a confounding constellat...
On a hot summer day in 2002, 55-year-old Mr. Adams[1] was working on his farm. When dismounting from the back of his truck, Mr. Adams fell and injured his left leg. He presented to the local ER later that day with complaints of left knee and ankle pain. Mr. Adams had a history of bilateral knee replacements. ...
Jim Logan,[1] a 54-year-old attorney and outdoorsman, had seen various providers over several years with occasional complaints of pain in one or both knees. In 2011, he injured his left knee while fishing. An MRI showed degenerative changes. Mr. Logan was initially treated with NSAIDS and pain medication. Six...
Tony Green[1], a 29-year-old construction worker, presented to the emergency department of a small, regional hospital complaining of lower and upper back pain over two days after lifting some flooring at a worksite. He described the pain as worsening with movement and radiating through to his chest. He was ab...
Our instincts of self-preservation and “common sense” protect us from many hazards. This article illustrates what can happen when those instincts are absent or ignored. The plaintiff, a middle-aged diabetic female, presented to a family practice physician for the primary purpose of obtainin...
Peggy Sue White* was a busy lady. At 73 years of age, she was described by her husband of 57 years as his “whole world.” They had seven children together, 19 grandchildren and 11 great-grandchildren. She took care of him due to his poor health, made his doctor appointments and attended the appoint...
This Tennessee case involved the alleged wrongful death of a 42-year-old male who presented to the ER in early 2008 complaining of lower abdominal pain, fever, nausea, diarrhea, anxiety and severe distress. The patient had a four- to five-year history of diverticulitis, which was managed by diet. Dr. Long[1] ...
“The single biggest problem in communication is the illusion that it has taken place.” - George Bernard Shaw SVMIC has written articles and given seminars over the years about the importance of communication as it relates to providing medical care to patients. This article focuses on a case...
“The memories of men are too frail a thread to hang history from.” John Still Paul Smith[1], a 52-year-old male, presented to the emergency room in a small community-based hospital with complaints of chest pain, shortness of breath, and nausea. Mr. Smith was quickly triaged and shortly thereafter...
“A time comes when silence is betrayal.” - Martin Luther King, Jr., The Time to Break Silence, 1967 We are bombarded with reminders of the importance of effective communication skills in our daily lives, whether the setting is professional or personal. The importance ...
Who is ultimately responsible for notifying the patient of important test results? If the ordering physician fails to do so, does any responsibility flow to the next provider in line, for example, the physician’s nurse practitioner? Does responsibility flow outward to other providers who wer...
All seemed well at a busy pediatric practice until a routine audit conducted by the Vaccine for Children program (VFC). When the VFC auditor reviewed the temperature log for the practice’s vaccine storage unit, numerous temperatures were noted to be out of conformity with guidelines. Non-conforming temp...
We are all familiar with Aesop’s fable wherein a lonely shepherd boy seeks attention by crying out wolf. This trick brings villagers rushing to his side to protect the flock of sheep from an attack. But there is no wolf the first few times the boy shouts out this false alarm. When a real wolf does appea...
In life, and certainly in documentation, there is a right and wrong way to do things. Order is everything. It is a well-known fact that a complete, accurate medical record will foster quality of care. Most importantly, it is the footprint that guides the course of the patient’s medical care and provide...
“Continuity of care.” We often think about this concept involving physicians in different specialties or groups, such as the doctor who treats the patient after us or the doctor who referred the patient to us. However, when stripped down, the concept of “continuity of care”...
Mary is a 60-year-old female who brought suit against a cardiologist alleging he failed to timely diagnose and treat her retroperitoneal hemorrhage following a cardiac catheterization. Unfortunately, for Mary, this alleged failure to diagnose and treat her resulted in a cascade of multiple medical/surgi...
Mr. Smith was 72, with a long history of various medical issues including coronary artery disease, carotid artery stenosis, chronic obstructive pulmonary disease, and peripheral vascular disease, when he was referred to cardiovascular surgeon, Dr. Jones. The referral to Dr. Jones was by Mr. Smith’...
Mr. Gamgee1 was a 70 year-old male who was a smoker and slightly overweight. He had a history of back pain and of a skin cancer removed 20 years before. His hypertension had been treated over many years with various medications but was not well controlled. He presented to the Emergency Depart...
Nathan Brown,[1] a 55 year-old man, fell from a 6 foot ladder outside his home while working on a home improvement project. Mr. Brown was able to get up and ambulate after the fall. The fall caused pain from his left shoulder blade down to his rib cage and coccyx. He took over-the-counter medication for pain....
Debbie[i], a woman in her fifties, presented to the emergency department on a Saturday with left chest pain, left arm numbness, shortness of breath, nausea and vomiting; she had been experiencing vomiting for two days. The ED physician, Dr. Smith, noticed that she had slightly elevated blood pressure an...
It was a warm day on a long July 4th holiday weekend when 39-year-old William[i], his wife, Carrie, and their two sons decided to go hiking on the family’s property where they intended to build a new home. The site was undeveloped and mostly flat except for a steep ravine on the rear side of the p...
Occasionally the sound of hoof beats should lead a medical provider to consider a zebra – instead of a horse – when evaluating a complex medical presentation. This obstetrical case involved a 24 year old female who was pregnant with her first child. Megan[1] had no previous medical problems and h...
Henry Jackson[1], a 50-year-old male patient, presented to the ER at a hospital near his home where he was seen for cold symptoms and progressively worsening headaches that were not responding to medication. The ER physician ordered a CT scan for Mr. Jackson. The scan showed sinusitis in the ethmo...
A physician, even if approaching a situation with the best of intentions, must be careful not to go outside the bounds of his/her training and expertise. Samantha Smith[1] had struggled with back pain and muscle spasms through her teenage years due to the development of extremely large breasts. This le...
As her gurney clattered toward the delivery room, Heather Carr[1] was excited about the birth of her second baby despite the need for a C-section. Her husband would be at her side during surgery, she was healthy, in a major hospital attended by her own obstetrician, and thus she had no fear. ...
The possibility of developing breast cancer is a haunting concern for most women. A perceived delay in diagnosis is one of the leading causes of malpractice litigation in the United States. Juries can be expected to sympathize with breast cancer victims, and these cases can be very challenging to defend. None...
The wise old saying “leave no stone unturned” is said to mean that one should do everything possible to find something or to solve a problem. Well, we will see in the following claim that is very wise advice. This case involved a 45-year-old male who underwent routine treatment for a ...
The crowd cheered, the football snapped, and helmets clashed as players piled onto the running back. A more ominous snap was heard, and 16-year-old running back, Jason[1], did not get up from the field. The teenager was admitted to orthopedics via the ED, where studies revealed a comminuted close...
The adage about “people who live in glass houses” still holds true. This claim involved an obese 45-year-old-male who presented to his general surgeon with a ventral hernia. History included multiple abdominal surgeries and known adhesive disease. The patient was admitted to the local hospital, a...
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