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Thursday Jul 09, 2015

Reflections on Surviving a Malpractice Case

I was sitting in the middle of the living room in the now-empty house, the last boxes having been loaded onto a truck. It had been a busy few weeks, with graduation from residency and moving into a new home in a new community to start a new practice. We were studying for our board exams and preparing to leave on our wedding cruise to Alaska.  

The mailman knocked on the door and handed me a certified letter. I didn’t think much of it and told him that if he had been 10 minutes later, he would have missed me. When I opened the outer envelope I saw the inner envelope had a law firm as the return address, and my heart sank. I opened it, and what I had feared was confirmed. I was named as part of a malpractice suit. 

I sat back down on the floor and called to my fiancé to tell him the news. I didn’t know what the process would look like, but I knew that it was going to be long and painful.

Many physicians are pulled into lawsuits regarding cases that their colleagues aren't familiar with, but not so in my case. The case in question involved a prolonged hospital course with consults from multiple services and an outcome that no one wanted. At least 10 of my fellow residents were associated with the case during the weeks the patient was hospitalized because they were rotating on various services.  

The hospital had had everyone who was intimately involved with the initial incident come together for a debriefing and a careful evaluation of process, but that had been almost two years before this letter arrived. The hospital's legal counsel told me the case likely would go to court, but I had put it mostly out of my mind as time marched on. No legal notice had come. The statute of limitations was a few days from being up, but here was the letter.  

I felt blessed in an important way, however. I had been through the case inside and out by myself, with my attending physicians and with hospital risk management staff, and I knew that the outcome could not have been prevented. I knew I had done absolutely everything I could, and that the patient had the best specialist and intensivist team anyone could ask for. This knowledge would make the years of the process to come easier.

I wasn’t prepared for how slowly everything moved, and how time-consuming the process could be. The monthly updates and discussions with my lawyer, depositions to prep for and give (five weeks after delivering my daughter, no less), expert testimony to review and mediation to attend.

Reading what the opposing side’s expert witnesses write about you is heartbreaking. You know you were doing the best you could and feel confident in your medical decisions, but here is someone listing your alleged incompetence. Prepping for mediation is grueling, and having someone ask the same questions in a slightly different way over several hours -- to see if you will stumble and answer in a way favorable to the plaintiff -- is mentally and physically exhausting (even without a 5-week-old infant across the hall that you have to breastfeed every few hours).

I understood that the outcome was extremely painful for the patient’s family, and it was painful for the providers, too. I just couldn’t wrap my mind around how that unpreventable outcome meant that I, two other physicians and the hospital should be sued as if we had neglected our duty.

And through it all, life went on. Aside from close family and friends, no one knew what I was going through. Patients still needed to be cared for, and I still went to work. There was still much to enjoy, but the shadow of the case loomed. It made me question myself more than usual, and it was an unwelcome specter in the first years of our practice. Being a new physician on your own for the first time already is challenging, but carrying the weight of a lawsuit with you makes it even more difficult.  

The case involved obstetrics, and it made me question whether I wanted to integrate OB into my practice, but the joy of that part of my job always won out when doubt tried to creep in. I was blessed to have supporting physicians around me, wonderful family and friends, and most of all, an amazing husband who was my rock.

Our situation was different from many other malpractice suits because my husband was one of my fellow residents. He was also not just my partner in life, but in our practice. Reading the words of the expert witnesses was difficult for me, but almost impossible for him. My husband really loved delivering babies, but since my lawsuit, he has allowed that part of his training to fade.

I think those around us often are overlooked when dealing with lawsuits. It doesn’t affect just us, but those around us as well. So I asked him to share some of his thoughts.

"I always knew lawsuits were possible," Michael said. "It’s practically the first lecture in medical school. What the lecture didn’t tell me is how to prepare for the onslaught of harmful statements from medical experts."

As my husband read each of the plaintiff's medical expert testimonies, he was naturally defensive, but a much deeper emotion that emerged was a sort of hollow fortitude.

"I have been evaluated by my peers, and I have evaluated my peers," he said, "and even when standards of care have not been met, there has always been an objectivity to the process that is overlooked in malpractice suits because no one cares about true improvement. The opposing side only cares about winning. As promised, life has gone on. We are now almost two years on the other side and, for the most part, unscathed."    

Together, we learned the importance of finding people to talk to when a physician faces something this difficult. Find a therapist, a partner who has been through it or your lawyer, and talk about what you are going through.  

Internalizing the struggle in an attempt to be strong and spare others will drown you, and little by little erode your love of what you do. Know that you are not alone and that many have walked this path before you, and many will come behind. Know that at the end you will come out a stronger person, though carrying some scars you didn’t have before. And know that you are still a good physician, spouse, friend and person.

Beth Oller, M.D., practices full-scope family medicine with her husband, Michael Oller, M.D., in Stockton, Kan.

Posted at 11:25AM Jul 09, 2015 by Beth Oller, M.D.

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