Anxiety and law suits

[Q1234]

I’ve been a PA for two years now working in an icu.  So far I haven’t been a part of a law suit but our patients are very sick and I feel I have been a part of some “sticky” situations.  I have so much anxiety involving it all that I am looking for another job.  At this point I kind of wish I never became a PA.  With that being said does anyone feel this way? Please share your stories.  

[Cideous]

Yes Yes and Yes.  It's a terrible feeling and I'd like to say it gets better, but for every provider I know says it doesn't.  The only thing I can say is to have great malpractice insurance, work for a supportive hospital/company (many places will treat you like you have the plague if you get tagged in a suit), and protect your assets.  

It's one of the good parts about living in Texas (and Florida), they simply can't take your house.  In many states though for example CA, they can and will take your house if the suit goes over your malpractice  limit.  They can also take your IRA not to mention all your liquid cash and stocks.  401k and most annuities are safe.

Basically I keep everything in my wife's name except one car.  That is risky as well, if she were to leave me I'd be screwed but there is little else one can do. I've looked into setting up a living trust as some have suggested in the past, but it is expensive and very restrictive.  It sucks...pure and simple.  The only thing that will help is aggressive TORT reform and a complete revamp of liability in our health care system which as you know...is not going to happen.

Probably the best advice I can give you is to make time once a week and talk to a therapist.

[mgriffiths]

One of the things that helped me was to look into the statistics of lawsuits.  How many get filed, and how many are successful? Of course that doesn't help those who lose, but helped me.

The other aspect is knowing what is the #1 way to prevent lawsuits.  Getting your patient's and their family to like you.  If they feel that you cared the likelihood you will be sued is tiny.  On the other hand, if you are a donkey then your risk increases significantly.

Caveat, I don't the stats for ICU, and I also don't know how well you are able to get to know patients and their family when you are treating them.

[Mayamom]

This is a subject I have spent hours thinking & reading about.  No matter what aspect of health care you work in there will always be "sticky" situations.  I have been named in 1 lawsuit.    It involved a coumadin case that involved nursing, myself

and the supervising physician.  After 5-6 years (not kidding) of litigation multiple meetings with attorneys, multiple papers to review & sign and finally a deposition the judge removed me from the case.  The case finally settled for a monetary amount which I was not privy too since I was not part of the case any longer.  It was a long and arduous process.   The attorneys for myself and the other parties where fantastic.  Very supportive very reassuring but not enough to curb my anxiety & many sleepless nights.  I finally managed to get out of patient contact last year because I don't think I could go through this process again.   You are not alone.  It s part of the job.  You need to be sure you have good full coverage.  I always purchase the most I can when it comes to premiums.    

[mgriffiths]

3 minutes ago, Cideous said:

Basically I keep everything in my wife's name except one car.

I have been told this before, but every lawyer I've asked says this does nothing.  Since you are married, her assets would be up for grabs as well.  Maybe another step where something could be missed, but doubtful.

[mgriffiths]

1 minute ago, Mayamom said:

I have been named in 1 lawsuit...the judge removed me from the case.

If you don't mind me asking, how did being named effect you moving forward in terms of employment?  For example, if you changed jobs did you find that this malpractice case led to further scrutiny and more difficulty finding a job?

 

2 minutes ago, Mayamom said:

I finally managed to get out of patient contact last year

I would LOVE to know what you are doing now.  My #1 regret about becoming a PA is the few directions to go beyond patient care.  I LOVE being a PA and have no current plans to leave patient care, but would like the option and would like to begin opening doors to do so.

[Mayamom]

 

As a single person how would I protect my house, retirement etc.  I have the Homestead act but that caps at $350,000.  My house is worth more than that.  Any suggestions appreciated. 

  

[Cideous]

Texas and Florida have unlimited homestead caps on liability claims.

On the asset name change....they can not touch my wife's IRA...and we dump everything into it and/or my 401k which is also safe.  That's here in Texas though, I know in states like California your IRA is up for grabs.   For years any excess liquidity I had went into annuities (also 100% protected) and cash...if they can't find it, it doesn't exist.  It's a damn shame that we have to live this way....in fear.  Lately my wife has been begging me to leave medicine altogether and anxiety from lawsuits is 100% why.

[Cideous]

8 hours ago, Mayamom said:

 

As a single person how would I protect my house, retirement etc.  I have the Homestead act but that caps at $350,000.  My house is worth more than that.  Any suggestions appreciated. 

  

It depends on the state you are in.  If you have say 1mil/3mil policy and you get tagged with a judgement for over 1mil....you are on the hook for everything over 1mil.  If your house is worth $500k but your homestead only covers $350k and the judgment against you is say 1.5mil, then you would have your house seized, sold and any excess profit after the $350k would go to them not to mention all the other liquid assets they find up until the claim is satisfied.

I worked with an ER doc that owned nothing, but one car.  Everything was in his wife's name exclusively and he would keep hundreds of thousands in cash in safes buried and hidden in different places.  I asked him one time where he would tell the prosecuting attorney all his money went?  He said, "I would tell them I have a gambling problem and lose it all in Vegas".  In fact, he would go to Vegas 4x/year just to have a track record in case it ever came to it.  It's having to deal with this kind of crap that makes this job so damn hard.

Edited February 9, 2020 by Cideous

[Cideous]

1 hour ago, mgriffiths said:

If you don't mind me asking, how did being named effect you moving forward in terms of employment?  For example, if you changed jobs did you find that this malpractice case led to further scrutiny and more difficulty finding a job?

 

It depends on the specialty, but in Urgent Care, when I did locums the very first question they would ask is, "Have you ever been named in a lawsuit because we can take NO ONE who has".  It would of immediately excluded me from working as a Locum.  Disgusting.  

[GetMeOuttaThisMess]

You can easily be named for having done nothing even remotely close to malpractice just because your name is on the chart. Had a patient in the 90's that came into the ED via EMS one night with an obvious tibial fracture from a soccer injury.  Went into room, got hx. from EMS, did a NV exam, ordered pain med/x-ray, and handed case to ED physician.  Early morning hours on floor pt. developed a compartment sx. not picked up on by floor nursing staff and even though pain med needs should've warranted some additional thought by the orthopod on call it was ignored.  On rounds next morning it was picked up by ortho, pt. taken to OR for a fasciotomy (where a vascular injury was missed), and pt. was sent back to floor.  Next day, foot/ankle guy picks up on issue and long story short, pt. becomes a BKA.  Guess who got invited to the party and later dropped?

Edited February 9, 2020 by GetMeOuttaThisMess

[rev ronin]

I seriously think that anyone who is concerned about being sued should look into sleep medicine: Reasonably compensated, day hours with no call, and CPAP never killed anyone. Sleep apnea is a killer, contributing to strokes, MI, obesity, DM II, drowsy driving, and more--the only downside to practicing sleep medicine is that it's boring.

[SedRate]

7 hours ago, Q1234 said:

I’ve been a PA for two years now working in an icu.  So far I haven’t been a part of a law suit but our patients are very sick and I feel I have been a part of some “sticky” situations.  I have so much anxiety involving it all that I am looking for another job.  At this point I kind of wish I never became a PA.  With that being said does anyone feel this way? Please share your stories.  

I am in a similar boat with my new job in CTS. And unfortunately, I am tied to the surgeons and their work so I don't have much in the way of protection except for what I do and chart. I hold myself to a high standard and being in these "sticky" situations doesn't align with my values, especially when the surgeons dismiss what I have to say. So, I'm actually looking for a new job. The pay and benefits are great, COL is low, and I'll owe money by leaving early, but my license and the headache aren't worth it.

Working in a low litigious field is one way to combat that as is trying to protect yourself as best you can by doing your best, covering your bases medically, be likeable to patients and family, charting to the best of your ability, etc. A good friend of mine used to work at a law firm doing medical chart review who now also works with insurance companies doing chart review, and the single-handedly best thing she said you can do to protect yourself is chart to the best of your ability and NOT just chart by exception, meaning chart pertinent positives and negatives. Interestingly enough, early in my career, she mentioned that she reviewed a chart of mine and said I did great. Haha. She wasn't able to tell me who or what it was regarding, of course. I always think of her whenever I'm charting and spend an extra minute or two checking to make sure I put everything I think I should have. I ask myself, "If I got sued, what all should I have here in my note?"

Unfortunately, anybody can sue for anything, so no matter how hard you try or how great of a job you do, it's always a possibility. This goes for other fields too. One of my parents is a cop and got sued by a criminal. It didn't go anywhere, but it drug on and the guy also tried to list my other parent and some other folks. How the hell were non-cops part of this case and able to be named?! One patient tried to sue one of my surgeons for lack of oversight on the pain medicine prescription they were discharged home on. Nevermind the fact that he had a terrible arm injury, had full recovery, and no history of drug use or narcotic abuse, but he tried to sue anyway. Oh, did I mention he represented himself and sent in his handwritten notice to not only the surgeon but the hospital, hospital CEO, county sheriff, and others from prison? 

All you can do is your best and nothing more. Work somewhere that supports you and continue to work on improving your skills and knowledge. If that's still not enough, try different fields or fields with lower patient contact/litigation. 

[SedRate]

2 hours ago, Cideous said:

It depends on the specialty, but in Urgent Care, when I did locums the very first question they would ask is, "Have you ever been named in a lawsuit because we can take NO ONE who has".  It would of immediately excluded me from working as a Locum.  Disgusting.  

Yep, I too have had a hospital system ask me if I've been named or if there is an active pending lawsuit.

[GetMeOuttaThisMess]

1 hour ago, rev ronin said:

I seriously think that anyone who is concerned about being sued should look into sleep medicine: Reasonably compensated, day hours with no call, and CPAP never killed anyone. Sleep apnea is a killer, contributing to strokes, MI, obesity, DM II, drowsy driving, and more--the only downside to practicing sleep medicine is that it's boring.

Except for the fungi that they inhale from not cleaning out the CPAP/replacing tubing.  Never a good thing when flowers are blooming out the end of the tubing.  

Edited February 9, 2020 by GetMeOuttaThisMess

[rev ronin]

12 minutes ago, GetMeOuttaThisMess said:

Except for the fungi that they inhale from not cleaning out the CPAP/replacing tubing.  Never a good thing when flowers are blooming out the end of the tubing.  

Perhaps, but I challenge you to find an instance of a sleep medicine provider getting sued for that, even unsuccessfully.

[Mayamom]

3 hours ago, Cideous said:

 If you have say 1mil/3mil policy

I purchase the 2mil/4mil policy.  If I could I would purchase more after having been through this once.  I did move onto another position.  I did not inform them of the pending litigation until after I was hired.  Private practice 2 DO; they were completely logical and had the attitude "not if you are sued but when".  But as you can see from above not everyone has this attitude.  I think its bizarre  UC  would have that policy they won't hire anybody with prior litigation.   I guess they must hire a lot of new grad

To answer above question I was a medical technologist before going to PA school.  I completely lucked out & managed to land a laboratory job last year.   I took a massive pay cut but I was ok with that and have not regretted my decision.  The docs I mentioned above keep asking me to come back but I just don't want to at this point of my life. 

[Cideous]

^^^   The local recruiters always told me the same thing, that their malpractice insurance that they would extend to us as locum‘s refused to take anyone who had ever been named in a lawsuit. I’m not sure if it was bullshit or not but I do know that they would’ve ended the phone call immediately had I said yes.

[trazodone]

Obviously for any provider this is a routine and major concern and as a reasonably new graduate, I have been trying to figure out things to help decrease my chances, first and foremost making sure that I create a good rapport with my patients, being kind and courteous, as well as documenting as best as I possibly can.

On the other hand, I've had significant recent major challenges with the remainder of the staff in our office who I feel do not adequately understand the liability we face as providers. More recently, I've had nursing staff make two significant errors/omissions that impacted patients in a negative light. Trying to explain to the nursing and front office staff that the decisions they do make actually impact patient care has been challenging. How would this work in a law suit? If a nurse makes a significant error of judgement or omission, does it come down on the provider? For example if a nurse discontinued a medication that was reasonably life sustaining for a patient, but did not notify the provider, how would that impact me? 

It's definitely a scary world for sure and even less than 5 years into practice and no previous court/law suit experience (Thank god and I'll keep praying every day), it has more than once made me consider leaving medicine. 

[Cideous]

^^^ If your name is on the chart...you will get named in it no matter who screwed up.  Period.  We call it the shotgun method.  They fire a shotgun and hope to hit as many people as possible.  You will need to retain a lawyer in an effort to get you dropped off the suit.  Which may happen, but as mentioned above can take years.

 

Honestly, it's one part effort (be nice, don't screw up, choose a low liability specialty as Rev mentions) and another part luck.  Pure unadulterated luck.  Praying helps.

[Reality Check 2]

My saga was lamented in multiple other threads. 

Being on call with an ortho doc who was not my CP - and had the personality of an IRS agent - got me named in a suit that dragged on for SEVEN AND A HALF YEARS - made my question myself, my integrity, my career, my desires and I learned every lawyer joke ever told.

My attorneys - yes multiple - were AMAZING and supportive and logical and not ambulance chasers. 

I too was removed from the case quite literally 7 minutes before trial began. Judge worded a document that says I cannot ever, for time immortal, be named by this guy ever again. I have the document.

It was agony. My character was assassinated and I felt anger, humiliation, injustice and a bunch of other things.

Bottom line - this dude sued because the doc I was on call with was a jerk. He named everyone including the cleaning staff and dining staff of the hospital. His lawyer was a true schmuck, a complete toad. 

Found out the guy has been hiding money from IRS for a long time and there are videos of him doing every single thing he says he can't do because of his surgery/complication. Not an honest person and not truly injured by medical practice. 

It comes with the job. 

Do good work, be honest, be nice as possible and have witnesses. 

There are always trolls in the world looking for a deep pocket and big win.

Karma is watching and most of the time the good guys win.

 

[Cideous]

^^^. Gawd, what a nightmare.  

[ohiovolffemtp]

I was sued once.  I do EM.  Took about 2 1/2 years but I was dropped from the suit along with all the other defendants except for my supervising doc on the patient.  Several months later she and the entire suit was dropped when the plaintiff realized they didn't have a case.  My medmal company had absolutely wonderful lawyers.

During and after that suit I've been hired by 2 new employers - each with their own medmal company, credentialed at 2 new hospitals and licensed in 1 new state.  All it required was brief explanations, most was about 1 paragraph, about the circumstances of the case and the fact that the suit was dropped by the plaintiff, on each set of paperwork.  Keep track of the patient name, plaintiff name, case number, and which court system heard the case.

Only real hassle I had was applying for a construction loan for building a new house.  Their application asked if I was a defendant in a lawsuit and paid no attention to the letter from my attorneys who documented the 1M/3M medmal coverage and the likelihood that the suit would fail.  They gave me a hard time and would only give me a short term adjustable rate loan.  I ultimately replaced them with a much better lender.

The key is having a medmal company that hires good lawyers to protect their money.  That causes them to protect you.  Having good documentation, e.g. key pertinent negatives, what time you paged and later spoke with consultants, what data you gave them and their recommendations, etc. does a lot to make it easy for the lawyers to defend you.

[BrianR]

Just goes with the territory.  It's all well and good to be nice, have patients like you, and don't miss obvious pathology, but people can and do sue for anything with nary a care in the world about the effect it has on us.  As someone else pointed out, you can be sued simply for coming to work that day.  Patients/families expect 100% accuracy, nothing short of perfection is acceptable.  God help you if you miss anything, no matter how trivial.  For certain segments of the US population, it's like buying a lottery ticket - little cost, no risk, and a potential big reward.  And there's no shortage of slime ball attorneys who will take nebulous cases in a heartbeat.

It's a big reason I left EM after 30 years.  Most of that was spent in single-coverage critical access EDs, and as the only provider seeing the patient, it presented a ready target for a windfall-seeking plaintiff.  I was named in a few lawsuits over the years; a couple were settled for relatively small amounts, others were dismissed.  The most infuriating case was a chronically-ill elderly patient who arrived already near-dead and the family actually said, before she was even transferred to the ED stretcher, "If she dies, we will sue you."  She did and they did.  The case was reviewed by multiple experts, who could find little about my care to criticize.  The insurer settled the case, on the eve of trial, without my consent, which for several complex reasons, they actually didn't need.  Although it was many years ago, it still makes my blood boil every time I think of this case, because I did absolutely nothing wrong, yet still lost.  You just have to have the best malpractice insurance you can afford, and accept the fact that's what the premiums are for, and it's all about money.  Nothing else..

Not that every lawsuit didn't cause significant stress, anxiety, and anger, and the cases usually drag on forever, but I eventually came to view lawsuits as virtually inevitable for anyone who practices long enough in a higher-risk specialty like EM.  Nearly all of my EM colleagues, both PAs and physicians, who have been practicing for more than a few years, and are seeing sick patients, have been sued at least once.  Interesting that the OP fears lawsuits as an ICU PA, since that's what I'm now doing, and I think it's far less risk than EM.  The difference is that the patients I care for now in a tertiary ICU have so many people involved in their care, and generally have longer length of stays, that even if there's a bad outcome, it's tough for the families or the lawyers to narrow down whom to blame.  It's also why I enjoy my other specialty of forensic medicine so much; dead people don't sue.

As for the employers who won't even consider you if you've ever been named in a lawsuit, good luck finding experienced clinicians.  As someone else said, sounds like a place that hires a lot of new grads.  I did have one hospital tell me years ago that was their position, but they had other issues.  Other than that, most employers, including my current one, just ask for a brief explanation of the case details, and seem to accept that it happens to good clinicians.

[Cideous]

5 hours ago, BrianR said:

Just goes with the territory.  It's all well and good to be nice, have patients like you, and don't miss obvious pathology, but people can and do sue for anything with nary a care in the world about the effect it has on us.  As someone else pointed out, you can be sued simply for coming to work that day.  Patients/families expect 100% accuracy, nothing short of perfection is acceptable.  God help you if you miss anything, no matter how trivial.  For certain segments of the US population, it's like buying a lottery ticket - little cost, no risk, and a potential big reward.  And there's no shortage of slime ball attorneys who will take nebulous cases in a heartbeat.

It's a big reason I left EM after 30 years.  Most of that was spent in single-coverage critical access EDs, and as the only provider seeing the patient, it presented a ready target for a windfall-seeking plaintiff.  I was named in a few lawsuits over the years; a couple were settled for relatively small amounts, others were dismissed.  The most infuriating case was a chronically-ill elderly patient who arrived already near-dead and the family actually said, before she was even transferred to the ED stretcher, "If she dies, we will sue you."  She did and they did.  The case was reviewed by multiple experts, who could find little about my care to criticize.  The insurer settled the case, on the eve of trial, without my consent, which for several complex reasons, they actually didn't need.  Although it was many years ago, it still makes my blood boil every time I think of this case, because I did absolutely nothing wrong, yet still lost.  You just have to have the best malpractice insurance you can afford, and accept the fact that's what the premiums are for, and it's all about money.  Nothing else..

Not that every lawsuit didn't cause significant stress, anxiety, and anger, and the cases usually drag on forever, but I eventually came to view lawsuits as virtually inevitable for anyone who practices long enough in a higher-risk specialty like EM.  Nearly all of my EM colleagues, both PAs and physicians, who have been practicing for more than a few years, and are seeing sick patients, have been sued at least once.  Interesting that the OP fears lawsuits as an ICU PA, since that's what I'm now doing, and I think it's far less risk than EM.  The difference is that the patients I care for now in a tertiary ICU have so many people involved in their care, and generally have longer length of stays, that even if there's a bad outcome, it's tough for the families or the lawyers to narrow down whom to blame.  It's also why I enjoy my other specialty of forensic medicine so much; dead people don't sue.

As for the employers who won't even consider you if you've ever been named in a lawsuit, good luck finding experienced clinicians.  As someone else said, sounds like a place that hires a lot of new grads.  I did have one hospital tell me years ago that was their position, but they had other issues.  Other than that, most employers, including my current one, just ask for a brief explanation of the case details, and seem to accept that it happens to good clinicians.

 

Your mentality is what we should all have, but don't.  I often tell people asking about the profession...If you have any form of anxiety or anxiety disorder, medicine is not for you.  You will kill yourself over the stress of being perfect, and then eventually being sued.  The providers who last the longest are those that at the end of the day, shrug their shoulders and just say F-it.  I'm not going to worry about it. I often wish I could do that.