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I recently started a new job and had an outing with some of my colleagues. A family member of theirs, a PA, was there and he opened up to me about all kinds of things.

 

He's been practicing for about 14 years now. For the past 3, he's been engaged in a lawsuit with the family of a patient that died while in his care. He's a pain management PA. He refilled a patient's pain medicine. This patient decided to take the entire bottle and successfully killed themselves.

 

The family is suing. His lawyer is trying to convince him to settle, but he is unwilling to do that and is trying to push it to trial since he feels that he did nothing wrong.

 

What are all of your thoughts on this? Would you settle just to get it over with? Or would you fight it?

 

I never really thought of pain management as being a high risk specialty, but it certainly seems so after hearing his story.

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Ugh, no, please don't do this. I'm nothing more than an armchair legal enthusiast, and I know that these are incredibly hard to even bring, much less win. You would have to show that you had specific

How do you stop a lawyer from drowning? Take your foot off his head....   POLITICALLY INCORRECT WARNING ------- Why do lawyers wear neckties? So the foreskin won't roll up....   Sorry - had to

So the elements of a tort are basically duty of care (check), breach of standard of care (?), harm (?), and causality--that the breach caused the harm. What's the alleged harm and what's the alleged b

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I recently started a new job and had an outing with some of my colleagues. A family member of theirs, a PA, was there and he opened up to me about all kinds of things.

 

He's been practicing for about 14 years now. For the past 3, he's been engaged in a lawsuit with the family of a patient that died while in his care. He's a pain management PA. He refilled a patient's pain medicine. This patient decided to take the entire bottle and successfully killed themselves.

 

The family is suing. His lawyer is trying to convince him to settle, but he is unwilling to do that and is trying to push it to trial since he feels that he did nothing wrong.

 

What are all of your thoughts on this? Would you settle just to get it over with? Or would you fight it?

 

I never really thought of pain management as being a high risk specialty, but it certainly seems so after hearing his story.

 

Without knowing the specifics of a case because I'm not the primary PA, it all depends on the details, so hard to say what I'd do.  

 

There will be more of these types of lawsuits in the future- the pendulum is turning in regards to how we treat pain given the actual dependency patients develop on these medications.  And while this is anecdotal, I see a very strong correlation between psychiatric issues and the need for chronic pain medication- and again anecdotally, these patients may be more likely to attempt self-harm.  I would very much be in favor of some sort of mandatory psychiatric evaluation before someone is placed on long-term opioid pain medication.

 

And let's not forget that for the first time, a doctor in California was actually convicted of murder earlier this year for overprescribing: http://www.cnn.com/2016/02/05/health/california-overdose-doctor-murder-sentencing/

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My experience is people sue more often because of anger and greed with a soupcon (which I probably didn't spell right) of stupidity and ignorance. I have done some medical legal reviews for law suits and there is often a failure of some kind in the care provided that (and this is very general) didn't really effect the outcome. People get  angry, consult someone who makes their living off the misery, and suits get filed.

Defense lawyers often recommend settlement because it is cheaper than a long drawn out case with an uncertain outcome. The truth rarely is a factor in the decision process and the reputation and feelings of the provider never is a factor.

I recall one malpractice policy that stated, in effect, if the insurance company wants to settle and the provider refuses and then loses the provider was responsible for the legal costs and the court directed settlement above what the settlement would have been.

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My experience is people sue more often because of anger and greed with a soupcon (which I probably didn't spell right) of stupidity and ignorance. I have done some medical legal reviews for law suits and there is often a failure of some kind in the care provided that (and this is very general) didn't really effect the outcome. People get  angry, consult someone who makes their living off the misery, and suits get filed.

Defense lawyers often recommend settlement because it is cheaper than a long drawn out case with an uncertain outcome. The truth rarely is a factor in the decision process and the reputation and feelings of the provider never is a factor.

I recall one malpractice policy that stated, in effect, if the insurance company wants to settle and the provider refuses and then loses the provider was responsible for the legal costs and the court directed settlement above what the settlement would have been.

 

I've heard that, in other countries, the loser of the lawsuit has to pay for the winner's legal expenses. I'm sure that this would decrease malpractice suits significantly. Unfortunately, the people most capable of putting these laws into place (lawyers and politicians) are the ones that profit off of frivolous lawsuits.

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I've heard that, in other countries, the loser of the lawsuit has to pay for the winner's legal expenses. I'm sure that this would decrease malpractice suits significantly. Unfortunately, the people most capable of putting these laws into place (lawyers and politicians) are the ones that profit off of frivolous lawsuits.

A lawsuit isn't necessarily frivolous just because the plaintiff lost it. In America, you can still countersue your opponent for legal expenses if their lawsuit proves to be frivolous. I hope your colleague takes this route. I tend to be sympathetic toward grieving people, but this isn't grief. It's greed.

 

Believe it or not, a lot of our legal system is built on limiting lawsuits and proceedings to keep the courts from getting clogged up. I knew a guy who found out he had a daughter by an ex-girlfriend who waited until said daughter was five years old before telling him. He tried to sue for paternity but was told the law won't allow him to have it since he failed to sue before the girl's third birthday (back when he didn't even know she existed). The way his lawyers explained it, a lot of people don't figure out paternity issues until the child gets older and starts to resemble the milkman, and they don't want the father or the milkman to be creating more burden for the system.

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I am stuck in legal limbo hell for the past 4 years.

 

I was named in a suit with a surgeon I was on call with for one stupid weekend. 

 

It is a long and ultimately not interesting story. But, my life and career is still in limbo waiting for this damn suit.

 

Surgery in 2010. Filed suit 2012 at end of statute of limitations. Served me papers the week of Christmas.

 

Since that time - NOTHING.

 

The plaintiff's attorneys have filed extension after extension and dropped people from the case and re-added them and asked the judge for interim rulings on thousand year old cases of no consequence.

 

I have not been deposed. I have never seen the plaintiff's attorneys.

 

I have met with my group's attorneys 3 times. Been briefed, reviewed medical records.

 

THREE experts show me to be absolutely 100% clear and one MD/JD labeled me "bulletproof". Still, I am named in the case.

 

No trial date, no depositions, nothing - absolutely nothing.

 

Yet, I have to fill out on every single form known to medical man that a claim has been filed against me and it has..... no outcome. I attach a letter I made the attorney write saying that things have been done on my part and the case is just pending.

 

It is pure and absolute hell. I have spent 4 years waiting to clear this up. Hardly remember the patient. Saw him twice. Did NOT assist on his operation.

 

I could be cited, I could be cleared. I could magically be dismissed. But ------- when?

 

So, plaintiffs should have a limit on how long it takes their shirk attorney to get his crap together and present the case.

 

My only answer to any questions at this point are "I do not recall. Please refer to my hospital notes" 

 

Because - in all honesty - that is all that I know about this anymore.

 

I hate it and resent it

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I am stuck in legal limbo hell for the past 4 years.

 

I was named in a suit with a surgeon I was on call with for one stupid weekend. 

 

It is a long and ultimately not interesting story. But, my life and career is still in limbo waiting for this damn suit.

 

Surgery in 2010. Filed suit 2012 at end of statute of limitations. Served me papers the week of Christmas.

 

Since that time - NOTHING.

 

The plaintiff's attorneys have filed extension after extension and dropped people from the case and re-added them and asked the judge for interim rulings on thousand year old cases of no consequence.

 

I have not been deposed. I have never seen the plaintiff's attorneys.

 

I have met with my group's attorneys 3 times. Been briefed, reviewed medical records.

 

THREE experts show me to be absolutely 100% clear and one MD/JD labeled me "bulletproof". Still, I am named in the case.

 

No trial date, no depositions, nothing - absolutely nothing.

 

Yet, I have to fill out on every single form known to medical man that a claim has been filed against me and it has..... no outcome. I attach a letter I made the attorney write saying that things have been done on my part and the case is just pending.

 

It is pure and absolute hell. I have spent 4 years waiting to clear this up. Hardly remember the patient. Saw him twice. Did NOT assist on his operation.

 

I could be cited, I could be cleared. I could magically be dismissed. But ------- when?

 

So, plaintiffs should have a limit on how long it takes their shirk attorney to get his crap together and present the case.

 

My only answer to any questions at this point are "I do not recall. Please refer to my hospital notes" 

 

Because - in all honesty - that is all that I know about this anymore.

 

I hate it and resent it

 

Do you have any advice for new grads to avoid lawsuits? Does it hurt you professionally if you are named in one? Do we personally have to pay if we lose?

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The family is suing. His lawyer is trying to convince him to settle, but he is unwilling to do that and is trying to push it to trial since he feels that he did nothing wrong.

 

What are all of your thoughts on this? Would you settle just to get it over with? Or would you fight it?

 

 

What does it mean to "settle"? Does malpractice typically cover it?

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It is a royal pain in the arse, even when you are deposed but not even a named litigant.  I've been deposed on several occasions and while I never felt like I got walked all over it was still not a pleasurable experience.  I looked at it kind of like PANRE, can we just get it done and over with?  With regard to avoiding lawsuits, in some respects it's just a game of musical chairs and you just happened to have your name on the chart (only time I've been named, but then dropped after depo).  In other scenarios, document, document, document, and if you don't know the diagnosis I like to use symptoms/PE findings as my diagnosis, i.e.-"N/V", not gastroenteritis; "abdominal pain", "febrile illness", "chest discomfort" w/ a negative w/u.  Kids are great.  Red ear?  Otitis.  Uncertain about otitis media or otitis with effusion?  Just otitis.  Sore throat with post-nasal drainage induced injection from the acidic snot?  Pharyngitis.  A real gem from one of my ED docs back in the early 90's; make sure the PE matches the hx., or in other words address each c/o you documented on the PE.  Edit:  double negative was driving me nuts.

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A variety of factors came into play on my case:

 

Angry patient with very bad ortho injury of his own doing - poor protoplasm put together poorly combined with a poor choice of activity most likely fueled at least partially by alcohol

A very bad ortho injury known for complications and post op limitations

Poor choices of friends of said patient who pushed to sue because his leg "just isn't right"

 

Shirk lawyer with a big billboard and lots of big empty promises, less than scrupulous tactics and vocabulary

 

Being on call with a surgeon whose bedside manner led angry patient to be more angry

Not my normal surgeon and not my choice to be in that position at that time

 

Everyone is named in the suit - I think even the folks who clean the hospital room and deliver food - not kidding

 

So, know who you work with and avoid situations that will implicate you as a potential bad guy - personality and bedside manner cause more complaints than anything

I would have paid someone to take that call weekend for me

Some fields of practice are just more likely to have bad outcomes not based on skill - based on injury or medical condition

Document document document - document like someone is going to paint a picture with your words and use professional language without inflammatory words no matter how angry, rude, condescending or inappropriate the patient is - or the surgeon is

Try not to take it personally, but you will. In the end it is usually about money

 

Long ago, a thoracic surgeon I trained with actually performed an ER thoracotomy and the guy lived. The guy sued over the scar on his chest and the pain from broken ribs. The jerk lived from trauma that he put himself in line to receive - when you deal drugs in a crap neighborhood, people often shoot at you. The surgeon was overwhelmed. He thought he saved the guy's life. The suit almost broke his spirit.

 

Another doc I worked with got sued by a patient whose mole came back with the wrong pathology report. Didn't die but ended up with an advanced melanoma treatment. Told the doctor he had to sue because he needed money - "nothing personal doc, but I gotta pay bills."

 

Documentation saved my whole office - an elderly female with huge cardiovascular risks had an MI - not a surprise. However, we had 3 years and pages of documentation from multiple providers about her saying that every statin made her hurt or gave her a headache or made her feel funny. Even low dose aspirin made her gums bleed according to her report. We tried niacin, fibrates, question - you name it - we offered it, sampled it, prescribed it. We sent her to cardiologists every six months - they stress tested her, echo'ed and may have even cath'ed her at some point. Her husband was furious that she had an MI and her post op EF was in the 30s.  He went to a lawyer who looked at all our records and thankfully told the husband that bad things just happen sometimes and we appeared to have done absolutely everything in our power to educate her, test her and monitor her. He told the husband that there was no case.

 

Any way you cut it - it sucks. It feels personal and it feels like violation and character assassination. You second guess yourself and then you feel guilty if you find blame in someone else. People do make mistakes. 

 

Try to avoid them, be nice, stay professional and try not to get too cynical too early.

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I'm still in school but I have a professor who harp on how to not get sued

 

1) Rule out everything that will kill the patient

 

2) Never write gastroenteritis or constipation, you are wrong

 

3) Docuement conversations with colleagues. When the neurosurgeon tells you to hold a drug because they are on there way, document and time stamp. They will try to drag you down with them if they don't show up or something happens.

 

4) Always document follow up instructions. Especially for the indigent and drug/alcohol abusers, they will not follow your instructions but their families will sue you if your documentation isn't perfect.

 

5) Public figures always get the full work up, don't leave anything to chance, even a hang nail.

 

6) Hands, feet and penises are "tiger country", proceed with great caution. Lawyers will eat you alive here if you are not careful.

 

6) Take the pants off, that is where the diagnosis is.

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Wow. A lawyer that convinced a patient NOT to sue? Never thought I'd hear that.

 


 

He went to a lawyer who looked at all our records and thankfully told the husband that bad things just happen sometimes and we appeared to have done absolutely everything in our power to educate her, test her and monitor her. He told the husband that there was no case.
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I'm still in school but I have a professor who harp on how to not get sued

 

1) Rule out everything that will kill the patient

 

2) Never write gastroenteritis or constipation, you are wrong

 

3) Docuement conversations with colleagues. When the neurosurgeon tells you to hold a drug because they are on there way, document and time stamp. They will try to drag you down with them if they don't show up or something happens.

 

4) Always document follow up instructions. Especially for the indigent and drug/alcohol abusers, they will not follow your instructions but their families will sue you if your documentation isn't perfect.

 

5) Public figures always get the full work up, don't leave anything to chance, even a hang nail.

 

6) Hands, feet and penises are "tiger country", proceed with great caution. Lawyers will eat you alive here if you are not careful.

 

6) Take the pants off, that is where the diagnosis is.

Agree with all....except for the "NEVER" write gastroenteritis or constipation.  If it started with vomiting, then mild epigastric pain from vomiting, then turned into nonbloody diarrhea....then it's probably gastroenteritis.  And constipation is, well, it's constipation.  

 

I do absolutely agree that BEFORE you write gastroenteritis or constipation you need to stop and think about it....any red flags for the gastroenteritis, and what's the cause of the constipation.  

 

And I'll add one more to the list, especially in the ED.  D/c instructions give time specific and action specific follow up instructions.  ie:  F/u with primary care physician in 2-3 days if not significantly improved.  Return to the ED immediately if you experience <worse case scenario symptoms>, <symptoms of worsening of their disease>, or with any other new or concerning symptoms.

 

That puts some of the responsibility back on them, or their PCM.  

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Agree with all....except for the "NEVER" write gastroenteritis or constipation.  If it started with vomiting, then mild epigastric pain from vomiting, then turned into nonbloody diarrhea....then it's probably gastroenteritis.  And constipation is, well, it's constipation.  

 

I do absolutely agree that BEFORE you write gastroenteritis or constipation you need to stop and think about it....any red flags for the gastroenteritis, and what's the cause of the constipation.  

 

And I'll add one more to the list, especially in the ED.  D/c instructions give time specific and action specific follow up instructions.  ie:  F/u with primary care physician in 2-3 days if not significantly improved.  Return to the ED immediately if you experience <worse case scenario symptoms>, <symptoms of worsening of their disease>, or with any other new or concerning symptoms.

 

That puts some of the responsibility back on them, or their PCM.  

 

As an addendum to the discharge instructions, always note that these instructions were given BOTH verbally and in writing (assuming written instructions are provided) and if pt. does so, note their acknowledgement of understanding.  Share the responsibility with them!

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My question is if a patient does NOT take the pain medications as prescribed and takes the entire bottle, then how is provider at fault? How can anybody even have an iota of evidence against that? I don't know the details of this case and without knowing them, I don't want to judge, but it just sounds like another person trying to take advantage of the loophole in the system.

 

I work in a primary care clinic as a MA and I have noticed that people on long term Opioids tend to develop dependency and psychological issues so my question is how and why are these people getting on these medications for so long? I have seen 30 and 40 year old healthy patients who take Oxycodone and Methadone everyday. Reason: LBP or knee pain. Why can't they try other options such as PT, exercise, or even chiropractor? Surgery is also an option. A patient who have been in MVA and injured his shoulder needs a surgery, but instead he chose to get on pain meds. Why? Are providers not pushing for these options?

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Wow. A lawyer that convinced a patient NOT to sue? Never thought I'd hear that.

 

 

 

My wife worked in worker's comp/personal injury for several years. It happens a lot. Attorneys are not going to waste time and money on cases they know they can't win.

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My question is if a patient does NOT take the pain medications as prescribed and takes the entire bottle, then how is provider at fault? How can anybody even have an iota of evidence against that? I don't know the details of this case and without knowing them, I don't want to judge, but it just sounds like another person trying to take advantage of the loophole in the system.

 

I work in a primary care clinic as a MA and I have noticed that people on long term Opioids tend to develop dependency and psychological issues so my question is how and why are these people getting on these medications for so long? I have seen 30 and 40 year old healthy patients who take Oxycodone and Methadone everyday. Reason: LBP or knee pain. Why can't they try other options such as PT, exercise, or even chiropractor? Surgery is also an option. A patient who have been in MVA and injured his shoulder needs a surgery, but instead he chose to get on pain meds. Why? Are providers not pushing for these options?

I think for the most part, most of these people have chronic back pain. I believe the general consensus is not surgery unless causing weakness or cauda equina because I would say at least 50% of the time the surgery does not help with the pain. Then people get on opoids which rewires the brain. I tell people opoids treat acute pain but i believe its a cause chronic pain.

 

Sent from my SAMSUNG-SM-N920A using Tapatalk

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I spoke with a PA at my new job today. She's been practicing for almost 20 years. She told me that you don't even need to do anything wrong to get sued. She said that even if you refer to a specialist, if a patient doesn't go, it's still the provider's fault.

 

She told me that she has never been sued and attributes that more to luck than anything else.

 

The practice that I'm in looks to be expecting me to see 20-30+ patients per day. This is similar to the last place that I just go out of (though that was supposedly part-time and I didn't have a lunch hour).

 

Apparently, this is the norm for my area. I'm very happy that I'm moving out of here in a few months. I can't imagine spending significant time here and not getting into trouble.

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One of our docs got sued because she ordered an immunization and when the patient received it she passed out and was injured.  Doc didn't even give the shot.  How scary is that?

Makes me wonder how anybody is even practicing anymore.

 

Did the doc lose?

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I spoke with a PA at my new job today. She's been practicing for almost 20 years. She told me that you don't even need to do anything wrong to get sued. She said that even if you refer to a specialist, if a patient doesn't go, it's still the provider's fault.

 

She told me that she has never been sued and attributes that more to luck than anything else.

 

The practice that I'm in looks to be expecting me to see 20-30+ patients per day. This is similar to the last place that I just go out of (though that was supposedly part-time and I didn't have a lunch hour).

 

Apparently, this is the norm for my area. I'm very happy that I'm moving out of here in a few months. I can't imagine spending significant time here and not getting into trouble.

 

 

I think the biggest protection to getting sued is being nice.  and practicing at least ok medicine

 

 

You can practice perfect medicine (what ever that is) but if you are a PIA and rude  - you will likely get sued

 

You can be a clueless NICE provider and your panel will be full - especially if you have an MD after your name

 

 

 

my goal is to make it through my career with out being sued -- my newest job is in corrections, so I am not sure that is reasonable as they are suit happy....

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