DoctorsKnowUs.com: Helping Doctors Blacklist Patients

[DSeid]

luc,

Ralph stated that “you (as a litigant) don’t directly bear any of these costs” and you responded that “To prosecute a malpractice lawsuit, you need to spend thousands of dollars hiring experts, taking depositions, etc. It also takes a lot of attorney time.” Seemed to me like he was making the point that the plaintiff has no costs unless they win, and you were saying that they do. Perhaps one of us misunderstood Ralph’s point, perhaps it was me, but I don’t think so.

I am familiar with medical mal. Perhaps more than you, since you don’t do any and my brother does (makes for fun family gatherings, I can tell you). I have been sued, my freinds have been sued, almost every doctor has been or will be sued at least once. I stand by my assertions. (BTW, lots of medical mal lawyers are multimillionaires. My brother, who is selective with his cases but bemoans the many of his collegues who are not, does quite well. I drive a Civic; he drives a Lexus. Need I say more?)

Interestingly you don’t address most of my points. Medical mal lawyers may even believe that they are performing a public service, but what a surprise that those whose very comfortable incomes are based on skimming a third off of any jackpot awards scream over protecting the consumer by preserving those jackpots while the practice leads to poorer healthcare practices and poorer healthcare availability.

Let me make this clear: I have made mistakes. Good faith errors that I can recognize in hindsight. Some stupid mistakes. I admit it. No one is mistake free and I too am human, a good caring doctor, not as smart as some, smarter than many, but very human. Usually my mistakes cause no harm because we have systems in place to prevent most errors from causing harm. Sometimes harm has occurred. I have been sued. But not in the cases that I made mistakes. The times I have been named have had to do with the prospect of a jackpot and that alone. When harm has occured the appropriate action isn’t to punish me for being human, but to find another way to compensate the injured and to figure out how the system can work a little better to prevent unavoidable human errors from causing harm in the future. The lawsuit system prevents that.

[MsRobyn]

@lucwarm

I’m getting a little confused here – Based on the earlier comments, I thought that these women were previously seeing local general practictioners, not obstetricians.

GPs can catch babies and can manage most delivery complications, but they’re no substitute for an obstetrician.

Robin

[Qadgop_the_Mercotan]

@MsRobyn

GPs can catch babies and can manage most delivery complications, but they’re no substitute for an obstetrician. Robin

Amen! A family doc who delivers babies needs good and fast OB backup if a crash C-section is necessary. One of the reasons I stopped delivering years ago was because I wasn’t comfortable with the possibility of catastrophic outcomes which I wouldn’t be able to handle and the fear that my covering OB wouldn’t be there in time.

Otherwise, I totally agree with Dseid and artemis.

[lucwarm]

@DSeid

luc,

Ralph stated that “you (as a litigant) don’t directly bear any of these costs” and you responded that "To prosecute a malpractice lawsuit, you need to spend thousands of dollars hiring experts, taking depositions, etc.

Ummm, you’ve mischaracterized the exchange:

Here’s the ACTUAL exchange:

Ralph: One big reason for the stupendous increase in the number of lawsuits is the fact that filing such malpractice lawsuits is essentially free!**

lucwarm: This is essentially false. To prosecute a malpractice lawsuit, you need to spend thousands of dollars hiring experts, taking depositions, etc. It also takes a lot of attorney time.

I did not respond to his next sentence, that “you (as a litigant) don’t directly bear any of these costs.”

As far as I can tell, he was NOT talking about the distinction between attorney and client. He was talking about the costs of running the judicial system, which, as he correctly points out, are largely borne by taxpayers.

---

In any event, l’ll give you the benefit of the doubt and assume that the point you are making is that plaintiffs have no disincentive to filing frivolous lawsuits because their attorneys bear the expenses of litigation and not them.

Your position is invalid because a gung-ho plaintiff must still find an attorney who is willing to invest substantial time and money in the case.

I am familiar with medical mal. Perhaps more than you, since you don’t do any and my brother does (makes for fun family gatherings, I can tell you). I have been sued, my freinds have been sued, almost every doctor has been or will be sued at least once. I stand by my assertions. (BTW, lots of medical mal lawyers are multimillionaires. My brother, who is selective with his cases but bemoans the many of his collegues who are not, does quite well. I drive a Civic; he drives a Lexus. Need I say more?)

It’s possible to make lots of money suing people. But you need decent cases.

Interestingly you don’t address most of my points.

What point did I ignore?

Medical mal lawyers may even believe that they are performing a public service, but what a surprise that those whose very comfortable incomes are based on skimming a third off of any jackpot awards scream over protecting the consumer by preserving those jackpots while the practice leads to poorer healthcare practices and poorer healthcare availability.

The question of whether the possibility of large damage awards leads to better or worse healthcare is open to debate IMHO.

I just had a case yesterday involving a hospital tech who was fired because she repeatedly failed to include a sterility indicator in trays she was preparing. It seems to me that hospitals (properly) take these sorts of lapses very seriously in part because of the possibility of getting hammered by a jury. It would be nice to think that hospitals (and their insurers) would take these things seriously out of the goodness of their hearts. But the reality is that in our society, money talks.

In any event, I noticed that you did not answer my question:

If a defense verdict means the case has no merit, do you believe that a plaintiff’s verdict for X dollars means that the case does have merit and is worth X dollars?

When harm has occured the appropriate action isn’t to punish me for being human, but to find another way to compensate the injured and to figure out how the system can work a little better to prevent unavoidable human errors from causing harm in the future. The lawsuit system prevents that.

I’m not sure what your point is – what sort of system would you propose for resolving disputes over whether health care providers had done their job properly; whether patients have suffered as a result; and what the appropriate measure of damages would be?

[lucwarm]

@MsRobyn

GPs can catch babies and can manage most delivery complications, but they’re no substitute for an obstetrician.

Robin

Well, here’s what was said on the previous page:

The example I gave is easy to understand. In sparsely populated rural areas, the patient density won’t suppport a full-time OB-GYN; the routine obstetrics care is performed by a family practice physician. It’s only a minor part of what he does, but it exposes him to a disproportionate risk of litigation and accounts for a huge percentage of his malpractice premium. When the litigation risk and the cost of the premiums rises high enough, it makes sense for the clinician to simply close the obstetrics part of his practice and refer his pregnant patients to an out-of-town OB. Result = no local obsetrical care, even for extremely low-risk pregnancies, is available in that area anymore.

So perhaps you applaud the (apparent) fact that women are being channeled away from (rural) family practice phsycians towards big city OB-GYN’s.

[Metacom]

@Paul in Saudi

Punishment is what the criminal courts and other disciplinary measures are for.

I think this is one of the problems: the criminal courts “and other disciplinary measures” just aren’t there. For many different things, the civil courts have become, in a sense, criminal courts because they’re the sole entity that will actually punish wrongdoers. There was a great series of articles in the LA Times a few months ago about OSHA’s unwillingness to file criminal charges unless it was a double-plus egregious case involving a repeat offender who sacrified cute puppies to the dark lord.

I guess that leads to a question: Are the (non civil-court related) organizations that police the medical field up to the job?

[Metacom]

As a sidenote: Thanks to lucwarm, Artemis, DSeid, and Qadgop for chiming in! This thread got way more interesting when people directly involved with the issue spoke.

[Jackmannii]

@lucwarm

Hopefully they won’t slip on all the straw from your strawman.

They have good lawyers.

But really - a strawman accusation from you?

You complain that other posters want to make doctors less accountable for errors. When it’s pointed out to you that no one has suggested that, you wait until Shodan subsequently expresses support for a cap on non-economic damages, then allege that he’s proposing to make doctors less accountable.
So you obviously feel accountability is tied to keeping such awards unlimited.

You need to keep tabs on what you’re posting.

[lucwarm]

@Jackmannii

You complain that other posters want to make doctors less accountable for errors.

Here’s what I actually said:

For what it’s worth, I’m skeptical that making doctors LESS accountable will improve the quality of patient care.

It was a specific response to one person’s post. Granted, that poster did not make any specific proposals in the paragraph I was responding to, he merely made a vague statement that the system wasn’t working and I assumed he was in favor of the limits proposed elsewhere.

None of this changes the fact that folks in this thread have proposed changes to the system that would make doctors less accountable.

When it’s pointed out to you that no one has suggested that,

Folks DID propose various limits on liability previously. Your statement is flat out wrong. But in a vain attempt to avoid a meta-debate over what was actually being said, I invited people to share their positions.

Shodan subsequently expresses support for a cap on non-economic damages, then allege that he’s proposing to make doctors less accountable.

So you obviously feel accountability is tied to keeping such awards unlimited.

I “obviously” feel that limiting damage awards is one way to make doctors less accountable.

Nowhere did I “equate” “accountability” with “monster jury awards” as you claim.

You need to keep tabs on what you’re posting.

I’m perfectly aware of what I have posted. You need to respond to what I actually post, as opposed to your straw men.

[Fish]

It’s easy to agree that something has to change. Capping the unmeasurable “pain and suffering” rewards would only be one way to do so—one I can somewhat agree with, because being compensated for “pain and suffering” doesn’t mean you are legally entitled to live a lifestyle of a hundred or a thousand times your previous prosperity. A person making $50,000/year before his medical incident is entitled to $50,000,000? Jeez, without that cool fifty million he must have been really suffering before; to prevent such abject suffering we should just give everyone fifty million dollars on general principles.

Punitive awards? Cost-of-care awards? Yes, I can understand those. Sometimes medical foulups can cause associated costs: wheelchair rental/purchase, additional surgery, unnecessary hospital stay, home care, and so on. The patient sometimes only incurs these by medical error; therefore, I think they should be covered. The only valid punishment for deliberate harm is removal from practice and criminal proceedings; simple mistakes and incompetence should result in fines and training for the doc (not expulsion from the field).

But those are easy compared to real reform. Part of the reason why it’s difficult to decide how many lawsuits are “frivolous” is because we haven’t even defined what a “bad outcome” is.

In a local radio discussion of this topic, a physician spoke of one particular suit that had been filed against his practice. The patient had been in a single-car rollover accident that resulted in severe spinal trauma and he was taken to the ER. The doctors were concerned that he may never have walked again. For whatever reason, the outcome was wildly better than the doctors expected: the patient was able to walk with a cane.

He still sued. Apparently he felt that getting into an accident he had himself caused and having better-than-average and better-than-expected results was not enough. He felt he should be paid because the doctors couldn’t miraculously fix his broken back to perfection.

Or consider a patient whose post-operative instructions involve no heavy lifting. What about a diabetic who is told to keep away from sugary foods and eats them anyway? What about a person who is given 3-a-day pills for 10 days and stops taking them after three? Or someone on oxygen who continues to smoke cigarettes and manages to torch a lung lighting a cigarette in the presence of her 0[sub]2[/sub] tank? Medically, these people are non-compliant. Should they expect or deserve complete 100% medical fix-ups for their own behaviors?

So if we’re going to talk about “bad outcomes” and “frivolous lawsuits,” I think the the place to start is to figure out what the hell one is. Is it simply that the patient leaves the hospital in worse condition than he started? Or is it that his care was less good than expected? Or is it that a jury feels that the outcome ought to have been better? Or is it that a medical review shows that the patient had the right to expect better care for his complaint? Or what?

[Jackmannii]

Let’s see, lucwarm - here’s the “vague” statement you don’t like and your response:

“I want to see patients who’ve suffered potentially preventable medical injuries be compensated for their pain and suffering. I want to see incompetent physicians removed from practice. But our current system doesn’t do either task well, and it’s really hurting the quality of patient care in this country.”

For what it’s worth, I’m skeptical that making doctors LESS accountable will improve the quality of patient care.

When artemis says that under the current system quality control suffers because the medical community is scared away from open discussion of mistakes, you, instead of responding to that, ask if she wants to completely shield MDs from any liability for errors. And Shodan’s proposal for non-economic award caps is met by you with a flat-out statement that he wants docs to be less accountable.

Instead of continually making pejorative assumptions about what other posters want, try responding to their arguments and proposals.

Unlimited awards, “monster” awards, take your pick. It’s clear you don’t want any changes made here.

[DSeid]

Metacom,

What is the goal? The prime goal is to improve patient care. Most mistakes are not criminal, they are human. Foster systems analysis and honest appraisal of what went wrong where and how to improve upon that in the future. There are proposals out on how to do that that I can find for you later but the current system hamstrings the process. A very few mistakes are bad docs who do not care and/or are incompentent. Sometimes they are prosecuted when the offense is criminal. Our ability to police our own is not as strong as it should be however. Most docs will be sued however and most docs are not bad people.

Luc asks

If a defense verdict means the case has no merit, do you believe that a plaintiff’s verdict for X dollars means that the case does have merit and is worth X dollars?

Actually, I think that jury verdicts are only loosely associated with the merits of the case either way. They are prone to being very influenced by the likability of the players: a doctor who comes off arrogant; a sympathetic plaintiff; a down home lawyer; a professional witness (the oldest profession?) who sounds as convincing as real experts on the other side; so on. However I do think that most juries are prone to side with what they percieve as the little guy who really is in need of money versus the “rich doctor” whose judgement is likely to be covered by the insurance anyway. Nature of the beast. Jurors can see themselves as the plaintiff and can’t see themselves as the defendent.

Hospitals (and I assume docs) wouldn’t care about sterile instruments unless there was the threat of huge lawsuits? Well here we differ quite a bit. Anyway Shodan’s proposal doesn’t get rid of lawsuits or even large punitive awards. Instead it recognizes that no amount of money can replace a leg, an eye, a child’s life, and gives some reasonable guidance to limiting the huge settlement as jurors try to come as close to infinity as they can. (The harm to all from such an attempts I have tried to make clear) It keeps huge punitive settlements for egregious offenses by bad people as a disincentive but doesn’t use it to reward the lawyer or the plaintiff - it puts it to use to prevent others from suffering in the future.

[lucwarm]

@Jackmannii

Let’s see, lucwarm - here’s the “vague” statement you don’t like and your response:

---

I gather that you now concede that (1) I never “equated” “accountability” with “monster jury awards” as you claimed earlier; and (2) your statement that nobody had proposed reducing doctors’ accountability was incorrect.

Shodan’s proposal for non-economic award caps is met by you with a flat-out statement that he wants docs to be less accountable.

Don’t confuse the issues – I never responded to his statement at all. I simply used it as an example to show that your earlier claim was incorrect.

If I find the time, I’ll be happy to debate the merits of the actual proposal though.

When artemis says that under the current system quality control suffers because the medical community is scared away from open discussion of mistakes, you, instead of responding to that, ask if she wants to completely shield MDs from any liability for errors.

Here’s what I ACTUALLY said:

I’m not sure what your point is here . . . are you suggesting that doctors be completely shielded from liability for their mistakes? That we should go to some sort of no-fault system? Because those are the only ways I can see to get rid of the incentive you describe.

And I stand behind that – I didn’t understand what point artemis was trying to make. If artemis wants to get a little more specific, I’ll certainly consider what he or she is saying.

[lucwarm]

@DSeid

Actually, I think that jury verdicts are only loosely associated with the merits of the case either way.

Well, when you said the following:

most malpractice cases that get to trial are found to be without merit.

what did you mean? Who is finding these cases to be without merit?

Hospitals (and I assume docs) wouldn’t care about sterile instruments unless there was the threat of huge lawsuits? Well here we differ quite a bit.

I think it’s an overstatement to say that they “wouldn’t care.” Would they take things as seriously though? I doubt it. Let me ask you this: Have you ever seen someone in a hospital punished or reprimanded for violating a safety rule? On any of those occasions, was the possibility of lawsuits thought about or mentioned? Be honest.

Anyway Shodan’s proposal doesn’t get rid of lawsuits or even large punitive awards.

My comment was addressed to your various comments about “jackpots.” I haven’t responded to Shodan’s proposal yet.

[DSeid]

The statement is merely the legal fact: the jury is finding the charge to be without merit. They could be right, they could be wrong. Obviously we have no definitive metric for the percentage of suits brought without merit, I have ample anectdotal experience but nothing scientifically verifiable, nor do you, so this is the best we have to go on.

Have you ever seen someone in a hospital punished or reprimanded for violating a safety rule? On any of those occasions, was the possibility of lawsuits thought about or mentioned?

Honestly, lawsuits aren’t mentioned. OSHA and Joint Commissions are the boogeymen there. Fear of lawsuits is mentioned as the reason to order the extra test or procedure that the doctor doesn’t really feel is medically necessary, as the reason for the radiologist to hedge their call and for the doc to then order an extra MRI just because the radiologist hedged. But not for safety protocols. (And even in our QA/UM meetings, lawsuits are rarely mentioned, other than any case that has resulted in a suit is automatically brought for review as is every patient complaint. Really.)

And sorry, I thought that when you said

Shodan is proposing to make doctors less accountable by limiting the extent of their civil liability for their wrongs.

and then continued to defend jackpot awards, that you were commenting on Shodan’s proposals. Must be my bad. :rolleyes:

[lucwarm]

@DSeid

The statement is merely the legal fact: the jury is finding the charge to be without merit. They could be right, they could be wrong. Obviously we have no definitive metric for the percentage of suits brought without merit, I have ample anectdotal experience but nothing scientifically verifiable, nor do you, so this is the best we have to go on.

Well, it seems to me that you have a double-standard. When a jury returns a defense verdict, in your mind it means that the case has no merit. When a jury returns a plaintiff verdict, the case might have merit, or the system might not be working.

Honestly, lawsuits aren’t mentioned.

If you say so. You’re certainly willing to concede that the threat of liability affects peoples’ behaviour in a negative way. Why is it so hard to believe that the threat of liability might affect peoples’ (and institutions’) behaviour in a positive way?

I know that in my case, there has been such an effect. For example, my malpractice insurer requires me to keep a dual calendar system. Yes it was a pain in the *ss at first, but it’s a benefit to my clients. And I’m confident that my insurer is concerned mainly with minimizing the total amount of claims it pays out.

And sorry, I thought that when you saidand then continued to defend jackpot awards, that you were commenting on Shodan’s proposals. Must be my bad.

No problem, just read more carefully next time.

[Jackmannii]

@lucwarm

Don’t confuse the issues – I never responded to his (Shodan’s)statement at all. I simply used it as an example to show that your earlier claim was incorrect.

I’ll have to second DSeid’s :rolleyes: and raise him one then, because you (or someone posting under your identity) said:

Jackmanjii, you have your answer. Shodan is proposing to make doctors less accountable by limiting the extent of their civil liability for their wrongs.

You can keep repeating this silliness from now till doomsday (is this your standard courtroom technique?), but no one here has suggested doctors should be held less accountable or be immune from penalty for malpractice. That’s how you have chosen to interpret suggestions or comments from posters with whom you disagree.

If I find the time, I’ll be happy to debate the merits of the actual proposal though.

That would be a hellacious improvement over your attempts at demonization.

[lucwarm]

@Jackmannii

no one here has suggested doctors should be held less accountable or be immune from penalty for malpractice.

Errr, how does limiting a person’s liability NOT make him or her less accountable?

That would be a hellacious improvement over your attempts at demonization.

Attempts at demonization? Kindly show me where I attempted to demonize something.

[Typo_Negative]

@lucwarm

As I said on the previous page, I don’t file suit on well over 90% of the calls I get. If it were possible to extract even $3000 on a typical nuisance claim, I’d be a multi-millionaire. I’m not.

Since you’ve mentioned it a couple of times, I feel I need to ask a couple of questions. Possibly because I’ve misunderstood what you meant…

I want to ask about the 90%. I presume that you mean that those are folks who you feel have no real case, or least, no chance of proving their case. I’m guessing that at least a couple of those folks would want to file what you would consider frivolous suits. you seem to suggest that your turning them away was a kind of check that keeps the system more honest.

Now the 90% in general that you have turned away, how many of them do think found lawyers that were willing to take their cases? The validity of their cases not withstanding.

Lastly, of those 90%, were there ever times where you thought you could get a quick settlement, but turned it down for ethical reasons? (Meaning it was possible to bully someone into paying you to go away)

[lucwarm]

@spooje

I want to ask about the 90%. I presume that you mean that those are folks who you feel have no real case, or least, no chance of proving their case. I’m guessing that at least a couple of those folks would want to file what you would consider frivolous suits. you seem to suggest that your turning them away was a kind of check that keeps the system more honest.

Well, my main point is that the notion that you can generally extract a nuisance settlement by filing or threatening to file a frivolous suit is wrong in my experience.

Now the 90% in general that you have turned away, how many of them do think found lawyers that were willing to take their cases? The validity of their cases not withstanding.

I would guess that 2 or 3 out of 100 found a lawyer who would be willing to take their case. However, I would guess that most of the time, that “willing lawyer” wanted a 5 or 10 thousand dollar non-refundable retainer and that the client decided not to bother.

Lastly, of those 90%, were there ever times where you thought you could get a quick settlement, but turned it down for ethical reasons? (Meaning it was possible to bully someone into paying you to go away)

No, that issue hasn’t come up. It’s just so freaking hard to get a quick settlement – even with a strong case. I did get one guy who essentially wanted to blackmail his former employer, and I told him I didn’t want to get involved.