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Medical Justice

Making healthcare safe for doctors


Medical Justice Blog

Need Spine Surgery? If You Work for Walmart, Talk to Your Travel Agent.

Most patients want to receive care close to where they live. Patients also want the option to travel to centers of excellence, if necessary. Walmart has flipped that model on its head for its employees. Effective January 2019, Walmart will mandate its employees travel to high-profile healthcare systems for spinal procedures…

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Training Medical Students to Perform Rectal and Pelvic Exams

When I was training, paid models served as teachers when we learned how to do a pelvic exam. They had done this before. They provided feedback. They knew what they were getting into. Fast forward to today –  an article in the journal Bioethics noted that educational pelvic exams are often performed on anesthetized women. What are the ethical (and legal) implications of  performing pelvic exams on anesthetized patients?

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Hell Hath No Fury Like Office of Civil Rights Scorned

A three doctor Allergy and Immunology practice in Connecticut just wrote the Department of Health and Human Services Office of Civil Rights a check for $125,000. Three Boston hospitals, Mass General, Brigham and Women’s and Boston Medical Center wrote a check for $1M. What was the common thread? They all disclosed a patient’s protected health information without the patient’s authorization.

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The Art of Being in “Two Places” at the Same Time

To the layman, a “concurrent” surgery and an “overlapping” surgery sound interchangeable. He says to-may-toe, she says to-mah-toe. But surgeons need to understand the difference. And most do. So for those of us who do know the difference, here’s a question – which type of surgery presents the patient (and doctor) with the least risk?

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“Grief as My Guide. How My Sister Made Me a Better Doctor.”

Dr. Joseph Stern, a neurosurgeon, wrote a moving piece published in the NY Times, about how his sister’s recent fight with cancer impacted him. The process of sitting by her bedside, sharing moments and comforting her, and his grief over her death made him a better doctor.

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O-Rings and Phone Numbers

Many practices use trackable phone numbers to measure the success of their marketing campaigns. If multiple campaigns are running consecutively, a practice may have many different phone numbers directing patients to the practice. These disposable phone numbers are essential when collecting success metrics. But – they are disposable. So, what happens when a patient in need calls a discontinued number and can’t get care?

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Demystifying EMTALA: Issues that Pop Up When You Are On-Call

ER physicians usually know EMTALA’s requirements and limitations very well. But physicians whose only interaction with the Emergency Department is an occasional call often do not, and so are at risk for inadvertently violating the law. These violations are costly – personal fines can go as high as $50,000. Let’s review some common questions that a doctor on-call may have about their obligations under EMTALA…

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The Difference Between Skydiving and the Practice of Medicine

Skydiving is dangerous. Most skydivers land safely. But, not all. And if your chute does not timely open (and properly), death or injury are likely. How is it skydiving facilities are rarely sued? And, if they are sued, the facility usually prevails. What about the practice of medicine? Can patients “assume the risk” for a treatment or procedure? Can the standard of care rise to “gross negligence” if the patient does assume the risk?

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Do You Want Your Kid to Be a Doctor?

I hear two stories from doctors. Some believe medicine is still a noble calling. A career in medicine delivers significant professional satisfaction. It pays well. And it comes with significant social stature. Others believe medicine hit its peak years ago and today is a formula for frustration and professional burnout. What do you think?

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A Report Card on Report Cards. Risks of Publicly Reported Surgical Outcomes

Skeptical Scalpel publishes an excellent blog. He recently tackled the topic of whether the public even understands how to interpret surgical complication rates and surgeon report cards. He graciously gave us permission to distribute his post. Read on…

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A Contingency Plan for Taking a Case on Contingency

Plaintiff’s attorneys frequently argue there is no way a seasoned attorney would take a meritless med mal case. They note that taking such cases to trail is expensive. They take such cases on contingency…

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Can You Patent a Medical Procedure? Well, Yes  and No

In the mid-1990s, Dr. Samuel Pallin patented a type of stitch-less cataract surgery procedure. He attempted to license the patient to other ophthalmologists. One such surgeon was Dr. Jack Singer… 

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Jail Time for the Wrong Pronoun

Most physicians defer to patients’ wishes as to how they want to be called. It’s a sign of deferential respect. There’s a brewing brouhaha in California related to Senate Bill 219 which was signed into law. Among other things, it could criminalize the act of deliberately referring to a patient by the wrong pronoun…

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Medical School for Free

NYU Medical School recently announced it will waive tuition for all medical students, now and going forward. One reason NYU made this commitment was because many medical students are saddled with crushing debt when they graduate. Not surprisingly, many people have opinions on whether NYU’s policy is the best way to help medical students…

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Why Doctors Don’t Like to Retire

An April 5, 2017 Time Magazine article broke down retirement rates by professions. They charted the percentage of workers still working after age 65. It seems that this is an accurate yardstick to measure the issue.  Although not near the top, physicians and surgeons were still in the top third at 8 percent. So why then do so many physicians resist retirement?  There are multiple reasons to consider…

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Crap, It’s Always Something…

We recently heard from a surgeon in Ohio. He was performing an office-based procedure. An employee was looking for the doctor. She quickly opened the door to the room where the surgeon was working. The surgeon was not expecting the intrusion.

His hand moved…

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FDA Warns Companies Against Marketing Benefits of Vaginal Rejuvenation

Medical practices often add new techniques and procedures to increase revenue. I’m not suggesting the only reason is revenue. Presumably it’s to serve the patient and make a living BY serving the patient. And, I’m not opposed to physicians expanding what they do from treating disease to promoting health.

But, I must admit, I did a double take when I saw the full court press on promoting vaginal rejuvenation at several recent meetings…

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Man Bites Dog. Doctor Sues Attorney and Wins $8M in Jury Verdict for Malicious Prosecution.

An account of this doctor’s odyssey reads like the Book of Job. There’s an ex-spouse involved. Bankruptcy proceedings. Complaints filed with the Board of Medicine. Documents both incriminating and vindicating. And the best part? The plaintiff wasn’t even sure why the doctor was being sued. So, how did this doctor win his “happy” ending?

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Physicians Interrupt Patients After 11 Seconds

A recent article evaluated 112 recorded clinical encounters. The rationale was testing of “shared decision-making tools.” I was confused by the findings and conclusions. The headline adopted by the media was that physicians interrupt patients quickly. It was not intended as praise.

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Some Attorneys Behave Like Jerks

Most of the time, when an attorney requests a copy of medical records for something like a personal injury case, auto accident, worker’s comp, they are professional, courteous, and offer to pay you the reasonable cost of copying the record. But sometimes they’re just a pain.

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Not All Threats Patients Make Are Equal

Patients may be unhappy with their doctor for a variety of reasons. Dialogue solves most of them. But, sometimes this angst escalates. It culminates in a threat. All threats are not equal in the eyes of the law.

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Is It Really Unprofessional to Write Prescriptions Outside the Office?

A famous US Supreme Court Justice Potter Stewart once opined on obscenity: “I know if when I see it.” The Maryland Board of Medicine weighed in on whether it was unprofessional to write a prescription for a patient at a restaurant / bar. Excerpts from the legal case tell the tale.

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Lions, Tigers, and Bears. Oh My. Therapy Animals in the Operating Room

First, let’s discuss the difference between a service animal and a therapy animal. According to the U.S. Department of Justice, service animals are…

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The Pros and Cons of Allowing Family into the Trauma Bay

Many years ago, the presence of family members during cardiopulmonary resuscitation was verboten. The reigning principles were two-fold. Family members would get in the way of allowing the team to save the loved one. And they would be emotionally scarred forever. Makes sense on paper. But is this really true?

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Looking for Deep Pockets

Ebola is making a comeback in Africa. Fortunately, the World Health Organization is on top of it. Further, vaccines are being distributed. Hopefully these vaccines will prove safe and efficacious. Which brings me to Coming Attractions Bride and Formal in Ohio…

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Ambulance Chasers on Mobile Phones

There are billboards of personal injury attorneys not too far from hospitals. But, you’d never see an ad for a personal injury attorney in the ER. Unless you own a phone…

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Arbitration for Med Mal – One Sentence You Must Include in Your Agreements

Imagine you received a request for records from a medical malpractice attorney. Not a good start to your day. But, the clock is ticking. The statute of limitations is about to run. If the clock runs out, you’re home free.  You are now one month BEYOND the statute of limitations. Then, you get a notice demanding arbitration…

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Using Alexa in the Operating Room

A client recently asked our thoughts on using Alexa in the operating room. Presumably, the tasks Alexa would be charged with doing would be basic. Turn the lights on. Turn the lights off. Make a call. And so on. Still, the OR demands a certain level of privacy. Do Alexa’s security risks outweigh her small conveniences?

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Pesky Little Details in Brain Death Determination

We have previously written about medico-legal challenges related to brain death determination. The American Academy of Neurology updated its guidelines in 2010 to create more uniform determination. Let’s review…

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The Curious Case of Cassandra

Not too long ago, the Connecticut Supreme Court ruled on a case that dealt with a mature minor; someone not quite 18, but close, and whether they are entitled to make their own medical decisions. If a child has been emancipated by the courts, they do not need parental consent for medical treatment. Let’s see this played out in the real world…

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British Hairdresser Sentenced to Life in Prison for Infecting Men with HIV

Daryll Rowe is a 27 year old hairdresser from Brighton. In court it was revealed he deliberately tried to infect at least 10 men with HIV. For that, he was handed a life sentence, and will have to serve a minimum of 12 years for the “determined, hateful campaign of sly violence.”

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Stuck by a Needle. Your Patient Refuses Consent for HIV Testing. Now What?

We recently blogged about a healthcare worker who was on the receiving end of a needlestick injury. The source patient agreed to be tested for HIV and hepatitis B and C. While the initial HIV test was positive, repeat testing was negative. Great news. But what would have happened if the patient refused testing?

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Spousal Consent for Vasectomy

I recently came across an informed consent form for a vasectomy. (Not mine. I was doing research.) The consent form included the expected items; risks, options, benefits, and so on. There was a signature line for the patient. There was a signature line for a witness. Just below was a paragraph of additional text and a signature line for the spouse…

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Is Death in the Eye of the Beholder?

It’s been said the only thing certain in life is death and taxes. Tax rates vary by state. And, what may come as a surprise to many doctors, the definition of death (or how someone is declared dead) is not uniform across all 50 states. A little background…

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Circumcision Wars

The topic of circumcision often stirs up spirited debate. More than other “body modification” procedures such as, say, cosmetic rhinoplasty in minors or piercing ears. Regardless, it might be hard to steady one’s hands to do a proper cutting if there were protestors outside the door…

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Beware of the Trojan Horse

The number of medico-legal landmines associated with running a practice is huge. Our cup runneth over. And most physicians are at least aware of these debacles. What most practices are blissfully unaware of: brouhahas caused by employees…

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Informed Consent and Facial Fillers: Risk versus Reward 

It’s easy to forget that cosmetic procedures are medical procedures; with risks and potential complications – some irreversible. Abide best practices. Inform your patients of the risks, keep your operating environment organized, and set the right expectations…

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Prescribing Over the Phone

Prescribing medication over the phone is convenient. But like most convenient things in medicine, tele-prescriptions can become legal headaches.

Here’s what you need to know before prescribing over the phone…

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Should You Have a Pre-Nup?

A harsh reality: the divorce rate for first marriages in the United States is almost 50 percent. When at least one spouse is a physician, the divorce rate for first marriages can be as high as 70 percent. That is why many physicians use pre-nuptial agreements. Not only to manage assets in a divorce, but to navigate other complicated marital issues.

So – should you have a pre-nup?

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Patients to Be Dinged by Insurance If ER Visit Not Emergent

Anthem rolled out a new policy holding patients directly responsible for the ER bill if it is later deemed non-emergent. And who will decide whether the visit was emergent or not? You guessed right…

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Iowa Board of Medicine Makes Love an Actionable Offense

Perhaps the headline should read “Iowa Board of Medicine Makes Making Love an Actionable Offense.” Boards of Medicine generally take action if a physician inappropriately propositions a patient for sex. Some boundary issues are obvious…

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Dodging a Bullet. The Occupational Hazards of Healthcare.

If you practice in an operating room, sooner or later you will get stuck with a needle. We all try to follow best practices. But, when you have sharp tools, on occasion, the unfortunate does happen. Last year, a scrub tech was pricked by a needle that had been exposed to a patient’s blood. The patient agreed to be tested for the usual. Her results  – HIV positive. Now what?

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Should a Doctor Change His Name? Witness Protection Lite.

Doctors occasionally change their name. They get married. They get divorced. Some keep their name. Some change their name. It happens all the time. But, that is a deliberate choice. Are there times doctors might want to change their name – against their will?

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Plaintiff Receives Nine Figure Personal Injury Settlement. Oh My.

In Illinois, a jury awarded a plaintiff $148 million. The state’s previous record was a $47 million medical malpractice settlement in 2017. The defendant, the Chicago Department of Aviation, was able to negotiate the verdict down to $115M. Whew. The plaintiff accepted to avoid the risk of an appeal. Now, about the case…

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Informed Consent? Sure. We’ve Got All the Time in the World…

The Supreme Court of Pennsylvania recently ruled a physician must obtain informed consent himself – he cannot delegate this task to a qualified assistant. If this ruling goes national, how will it change the operations of your practice?

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Professional Negligence Versus Ordinary Negligence in a Medical Office

Your medical office is a place of healing. It is also a place of business. This means that you are not just under a duty to diagnose and treat your patients properly but are also to provide safe environment for all who enter. No doctor wants to be charged with neglecting his patient. That’s why it is essential doctors understand the legal definition of negligence in all its forms…

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A Tale of Woe. A Bad Asset Protection Plan.

Doctors are at risk for being sued. Asset protection plans help mitigate the risk. Here’s an example of one asset protection plan, done on the cheap, that failed…

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Large Insurance Carrier Outs Patients With HIV

By now, doctors have been trained to think about the ramifications of patient privacy before taking action. We make sure that first name and last initial are on the operating room scheduling board. On hospital room doors – same thing. We ask for authorization before posting a patient’s picture on social media. It has not been easy adapting to this new world. That’s why I’m scratching my head on this…

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Surgeon Laser Etches His Initials into Liver in Transplant Patients

Let’s start at the end. You kind of know how this ends. Dr. Simon Bramhall, a liver transplant surgeon in the UK, pleaded guilty to two counts of assault by beating. He pleaded not guilty to the more serious charge of assault occasioning actual bodily harm. Prosecutors accepted his plea and he is scheduled for sentencing on January 12th

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Law Pushing for Cameras in the Operating Room

“Julie’s Law” is a Wisconsin bill named in honor of Julie Ayer. The patient had breast augmentation surgery in 2003. Sadly, the patient flatlined during the procedure. CPR was initiated, but too late.  Advocates suggest the addition of cameras will increase transparency. Opponents argue inserting cameras into the OR will turn an already high-pressure environment into a toxic one…

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Not Mastering the Art of Being in Two Places at One Time

A recent report in the New England Journal of Medicine highlighted a case of a patient who presented to the Emergency Department, unconscious, with a Do Not Resuscitate tattoo sprawled across his chest. The staff decided initially to not honor the DNR tattoo. The words Do Not Resuscitate were inked. With a replica of his signature. This was a serious tattoo…

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Doctors Flummoxed by DNR Tattoo

Dr. Reinaldo de los Heros was practicing as a psychiatrist in Maine. On August 31, Dr. de los Heros was evaluating a female patient – presumably in his office. During this evaluation, a male prison inmate called the woman…

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Necessary Action or Elder Abuse?

Dr. Konopka graduated from medical school in Poland in 1960. She moved to the U.S. soon thereafter and she has been a licensed physician in the .S. since 1968. She is currently 84. She will serve any patient who can pay her $50 in cash…

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The Migration from Third Party Insurance to Accepting Risk

My goal in writing this is to disseminate the strategies some are using to avoid paying stratospheric sums for plain vanilla health insurance on the individual market because they believe they have limited options.

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Who Bears Risk for Medical Decisions About Pacemakers at Risk of Being Hacked?

Thirty years ago, no one would have thought of this scenario. Hacking into a pacemaker to cause harm…

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Divorce is Politics By Other Means

Carl von Clausewitz was a Prussian general and military theorist who famously said: “War is a mere continuation of politics by other means,”. I leave the full parsing of its meaning to other military strategists. But, the quote serves as a useful segue to discuss how divorced parents sometimes use the medico-legal playing field to continue their battles.

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Cease and Desist

If you’re a surgeon, I have little doubt you have done a stellar job in selecting your patients. You’ve never made a mistake. Never overruled your staff when they detected “red flags.” Never talked yourself into accepting a patient for the operating room when you’ve had nagging doubts whether the patient had realistic expectations. If this characterizes your history over decades, you have a follow-up career in writing fiction.   

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Delivering Bad News – or Delayed Good News – to Patients

When a person is sick, they are stressed and anxious. No surprise. And it’s human nature to fill in the blanks with bad news. That’s why ambiguous information can be magnified into a worst case scenario…

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WTF is MACRA?

I sat in on a lecture about prospering with MACRA. I wanted to learn more. In the auditorium I saw a few physicians. While I believe the program is well-intentioned (who would be against quality or value; it’s like Mom and Apple Pie – everyone is for it), I’m skeptical the programs will deliver value or quality….

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Legal Issues in Physician Advertising

Many doctors advertise a lot. Some a little. A few not at all. Be careful of the creative marketeer you just hired. He may be an expert in persuading patients to see you. But, he is probably not an expert in regulations that bind physicians…

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Physicians Who Perform Surgery On Themselves

I know many surgeons who received a laceration of their torso or leg. They went into their office, pulled out some Lidocaine, and went to work. Sutures placed. Bandage on top. Back to the picnic. Now for the curious case of Leonid Rogozov. Don’t read further yet. Props to any trivia buffs who can identify his claim to fame…

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Why Are So Many Neurosurgeons in – or Potentially Headed to – Jail?

It’s been an active year for neurosurgeons and the criminal justice system. One doctor was sentenced to life in prison or knowingly and recklessly injuring patients. Two were killed. Two more were paralyzed…

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Lawyers Have Their Own “HIPAA” Issues – The Story of a Prostitute

Do not conclude I am equating an attorney to a prostitute. I’m not. Jerene Dildene started working as an escort when a divorce and cutback in work hours (teaching Spanish in area pubic school) created financial hardship. Initially she searched Craigslist for part time work. She became a bikini model. On one modeling job, the client apparently asked her if she would exchange sex for money…

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Being a Doctor and Playing Poker – The Overlap

Dr. Kelly McMasters, a surgical oncologist, graciously allowed us to republish the commencement address he delivered to the University of Louisville School of Medicine Class of 2017. His words of wisdom resonated far beyond the typical platitudes pushed onto graduates. Further, his personal experience as a father of an ill child delivered unasked-for-insights that, when practiced, can make all doctors even better. Heads up: it’s longer than our typical blog post. But, it’s worth the entire read. Make time to read it from top to bottom…

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 HIV Positive Man Charged With Murder After Mistress Dies from AIDS 

Robert Murdock was charged with murder in Ohio for not telling his mistress, Kimberly Klempner, he was HIV positive.  The indictment alleges that Murdock knew he was HIV +positive but failed to tell his mistress.

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Florida Takes a Step Backward

Let’s go down memory lane. As the new millennium dawned, Dade and Broward Counties were in the midst of a professional liability crisis. Insurance was not only unavailable. It was unaffordable. Neurosurgeons were being asked to pay $250k/yr in coverage. Many policies topped out at $250k in benefits…

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Freckles and Lawsuits

Virtually every physician knows that patient privacy is sacred. One needs a patient’s affirmative consent to disclose what is known as protected health information. This is covered by state and federal (HIPAA) privacy laws. If a doctor posts the medical record, that is disclosure of protected health information. If a doctor acknowledges a particular patient […]

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How Facebook Saved My Patient’s Life 

Sometimes you need a nugget of medical information – pronto. If your patient has been in a hospital, you likely have access to reams of data. Finding your nugget may take seconds, minutes, or hours. You may never find it.   A number of years ago, Dr. Kamal Thapar, a Wisconsin neurosurgeon, gave a talk on […]

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Upside-Down World – A Patient Sues You to Keep Taking Care of Them

Normally, when a patient sues a doctor, he is unhappy with the care. He wants money for damages the doctor allegedly caused. Most rational people do not continue to see the same doctor if they believe that doctor negligently harmed them  As Einstein once said: The definition of insanity is doing the same thing over […]

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Jewelry Store Owner’s Son has to Pay Competitor Because of Fake Review

The jury has spoken. Stephen Blumberg owns Stephen Leigh Jewelers in Massachusetts. Toodie’s Fine Jewelry is a competitor. Allegedly, Adam Jacobs, a Toodie’s employee, wrote a multi-paragraph negative Yelp review about Stephen Leigh Jewelers. The review said he was looking for a 1.5 karat engagement ring and he had a negative experience. He then advised […]

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The Tax Man and Med-Mal Settlements

First, the obvious. This is not to be construed as tax advice. Now for some interesting nuggets. When people sue one another (or even threaten litigation) and money changes hands, there are tax implications. A recent article by Robert Wood dives deeper. (A) Settlements and judgments are taxed similarly. Whether you come to a meetings […]

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Preventing a Lawsuit – Always Seek Consent Before Searching a Patient’s Anus: Part 2

Here’s follow-up from a blog we posted in 2013. It was titled “Preventing a Lawsuit – Always Seek Consent Before Searching a Patient’s Anus”. Now we know its full title should have included “Part 1.” Two doctors were among many defendants sued by the American Civil Liberties Union. To recap this madness, see below. The […]

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What NOT to do…

A Texas physician who performs aesthetic treatments recently agreed to disciplinary action by the Board of Medicine. In 2015, a patient underwent a series of non-invasive laser treatments with Dr. Tinuade Olugesugun-Gbadeham. Around May 27, 2015, the patient made a video testimonial on the results of these procedures. The patient gave consent to have photos […]

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Damn, that’s awkward…

Ars Technica and the Minneapolis Star Tribune recently reported that Mayo Clinic is considering prioritizing patient care with private insurance over those with Medicare and Medicaid. The Minnesota Department of Human Services (which oversees Minnesota Medicaid), stated: “Fundamentally, it’s our expectation at DHS that Mayo Clinic will serve our enrollees in public programs on an […]

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These Docs Behaved Badly, but Should They Have Been Sued?

Jeffrey Segal, MD, JD Published in Medscape: May 20, 2015 (reprinted with permission)  http://www.medscape.com/viewarticle/844251 Three Highly Unusual Lawsuits If you practice medicine, odds are that eventually you will be sued, face a medical board complaint, or experience some other legal headache. If you practice in a high-risk specialty such as neurosurgery, the likelihood that you will be […]

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Thorny Vignettes and Patient Abandonment

Most doctors understand that once you have agreed to treat a patient, and you are in the middle of a treatment plan, you must either complete the treatment or find an acceptable alternative to the patient. The reason is to avoid a charge of patient abandonment. Vignette #1: Doctor receives a consult from the emergency […]

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Political Correctness Over-reach in the Exam Room

  A general surgeon in Florida evaluated a patient for hernia repair. The patient confided he was HIV positive. The surgeon asked about the patient’s medication regimen. The patient explained that on the medication his viral titers were non-detectable. The surgeon stated that that was good for both of them. For the patient, of course. […]

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When Your Competitors Will Not Cross Cover for You

A neurosurgeon based in a large metro area in California used to be part of a large group. For a variety of reasons, he’s in solo practice now. He’s still busy. Doctors refer to him. Patients seek him out. He has a strong online presence. And he’s escaped petty intra-group politics. One problem, though. He […]

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Medicolegal Issues in Dealing with Aging Physicians

  We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not […]

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Why No Med-Mal Defendant Wants His Defense to Boil Down to “S**t Happens”

  Dr. Jha is a radiologist who also blogs. Virtually every one of his posts hit the mark on multiple levels. Plus, he’s a brilliant writer. He gave me permission to re-publish the following blog he posted on KevinMD.com on January 3rd.  Happy reading. Does lead-time bias have a place in court? SAURABH JHA|PHYSICIAN | JANUARY 3, […]

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How Language in an Operating Report Can Lead to a Trip to the Courtroom

Sometimes, the specific language in an op-report can lead to misunderstanding and litigation. I’m not talking about using words like “suddenly” or “to my unexpected surprise” in the document. I’m talking about how you label anatomic structures. Surgeons start with a clinical diagnosis. This diagnosis is often reinforced or guided by an imaging study. Then, […]

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Preparing for a Rotten Day – or Year – at Peer Review

  Guest Post by Dr. Michael Rosenblatt For many doctors, they will experience peer review as a benign process. Cases are presented. Lessons learned. The beat goes on. Some “unlucky” physicians experience a different reality. Over the years we have been “trained” to try to avoid malpractice suits. But “peer review emergencies” are no less […]

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Paid Reviews Cost Companies $175,000 Enforcement Action

Two companies have settled with the New York Attorney General’s Office after being accused of paying consumers for positive reviews by agreeing to increase their transparency and pay a total of $175,000. MedRite Care, LLC, a medical emergency care service, paid thousands of dollars to Internet advertising companies and freelance writers over a two-year period […]

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How to Keep Lawyers from Circling Your Practice: Lessons for New Doctors

  I am frequently invited to speak to medical students and residents. I’m often the first person to introduce them to the wonderful world of medico-legal headaches. It’s a topic they typically don’t think about while they’re studying and training. Why? It’s hard enough learning the Kreb’s cycle, the anatomy of the brachial plexus, and […]

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N=1. Congress Takes Action. Consumer Review Freedom Act

If pro is the opposite of con, what is the opposite of Progress? Congress. It’s an old joke, but, what exactly did Congress just do? By unanimous consent, it passed the Consumer Review Freedom Act (H.R. 5111). As of this writing at year end, it still needs to be signed by the President. But, there’s […]

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No Good Deed Goes Unpunished

  “No good deed goes unpunished” is an aphorism attributed to more than one origin -Oscar Wilde and Clare Booth Luce. The origin may be a mystery. Its meaning to an Iowa anesthesiologist is not. An obstetrician performed a C-section on a patient who was 35 weeks pregnant. The patient had persistent vaginal bleeding, so […]

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There’s a Fine Line Between Aggressive Questioning of a Witness and Being an A-Hole

The vast majority of doctors wake up every morning intending to do the best possible job for their patients. It’s in our DNA. If and when a patient experiences a complication, no one beats us up harder than we do ourselves. It gnaws at us. We’ll remember it. We hope never to repeat that outcome. […]

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When a Lawyer “Just Wants to Speak” to You

The office staff of Medical Justice member received an unexpected call the other day. A lawyer said he represented the estate of the practice’s recently deceased patient.  The lawyer just wanted to ask the doctor a few questions. No other context. Zip. Nada. First, a doctor cannot just speak with a lawyer who just happens […]

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Positive Change Regarding Medical License Renewals

Medical license renewals have morphed over time to be quite involved. The Board of Medicine is charged with keeping the public safe. This includes making sure that licensees have no medical or mental health conditions which, with or without treatment, could impact taking care of patients. In a prototypical renewal form, the following question was […]

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Your Patient Bolts in the Middle of a Treatment Plan. Now What?

Not all medical and dental procedures are completed in one setting. They are staged. A common example is a patient needs new teeth. Impressions are taken. Temporaries are placed. The lab fashions the new implants. They are placed down the road. Patients often pay upfront for the bundled procedures. And the work is front-loaded. The […]

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A Carrier Tells Its Insured Doctor He’s Not Covered. WTF?

The reasonable interpretation of language in an insurance policy dictates its coverage. Sometimes the definition of a word can cost a carrier or an insured millions, if not billions. When the World Trade Towers were destroyed in a terrorist attack in 2001, there were a number of insurers who covered the risk for damage to […]

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Death and Donuts

When I was a resident, we had a weekly Morbidity and Mortality Conference. That was the euphemism for what most called it, Death and Donuts. That moniker was not meant to be disrespectful. It was merely an acknowledgement that death did happen at the hospital. High risk procedures were indeed risky. And a normal part […]

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The Insanity Defense: Medical Versus Legal Issues

We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily […]

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The High Cost of Medications in Prison

A recent Wall Street Journal article reported that only 3% of patients with Hepatitis C in prisons are receiving the newest medications which have a cure rate over 90%. This means most are not receiving these medications. The reason is cost. Each treatment cost up to $1,000/day for a number of weeks. A commitment to […]

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Doc, What Would YOU Do?

As physicians, we learn we must inform the patient of their options. Each patient has a different tolerance for risk. Some want aggressive treatment. Some want conservative management. The patient decides what should be done. I always thought it awkward to merely present a smorgasbord of options and then stare at the patient asking – […]

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Whose Baby Was It, Anyways?

I spent some time over the weekend scanning physician responses to this ethical conundrum. An endocrinologist was caring for a man who spent years taking anabolic steroids. He developed hypogonadotropic hypogonadism with a low sperm count. He was now living clean and ready to start his family. The endocrinologist replaced the patient’s testosterone and achieved […]

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Medico-Legal Issues in Restraining Patients

  We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not […]

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Crazy Cases Against Doctors — and Inexplicable Settlements

Jeffrey Segal, MD, JD Published in Medscape: May 14, 2015 (reprinted with permission) http://www.medscape.com/viewarticle/844060 How Would You Have Handled Patients Like These? Being sued for malpractice is a traumatic experience. The odds of being sued at least once over one’s career are high.[1] Doctors typically have sufficient professional liability coverage to prevent financial loss. But not all […]

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Liability in Telemedicine: “Can you sue me now?”

Notes from a Plaintiff’s Attorney: Liability Issues in Telemedicine By Dr. JD, a plaintiff’s attorney, practicing in the Northeast We continue our series of articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a […]

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When a Doctor Becomes a Patient

Hundreds of articles have been published on the theme of a doctor becoming a patient.  I’d like to add one more to the literature.  But only to express my gratitude. Over the years, I’ve cataloged many of the headaches faced by professionals in health care.  This includes the countless challenges doctors face each and every […]

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Avoiding Liability When Dealing with Brain Death Cases

We continue with our series of articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily agree with […]

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Dealing with Medical Marijuana

We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily […]

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Those Damn Jackson-Pratt Drains

As Shakespeare once posited: “To drain or not to drain. That is this the question.” Perhaps it wasn’t him. Surgeon preference typically dictates whether a drain makes sense. Keeping a hematoma from forming means avoiding one additional nidus of infection. But, a drain (even a closed drain), can also serve as a nidus of infection. […]

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Plastic Surgeons as Psychiatrists.

Many years ago, a mentor taught me a surgeon spends an entire residency learning how to operate. Then the surgeon spends the rest of one’s career learning how NOT to operate. This includes when not to operate. A plastic surgeon called me recently, and described a recent patient visit. The woman, in her mid-40’s, confessed […]

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Simple Procedures: An Occasional Multi-Million Dollar Lawsuit

We often worry about complications from difficult procedures. What might happen if a patient has anesthesia for 12 hours. Or, operating on a redo-redo cervical spine. And we’re right to be cautious. But, even simple things can be fraught with hazards; hazards that are easily prevented.

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Credentialing and Answering Touchy Questions

I received a call from a general surgeon in California. He was re-credentialing for hospital privileges. He was re-credentialing for his in-network status with insurance companies. And, renewing his medical license was around the corner. Credentialing questions have gotten longer and more detailed.

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Suture Around the Ureter. Clip on the Common Bile Duct. Complication or Malpractice?

Over the years, I have seen many lawsuits where a specific operation ended in a complication. Two come to mind. An ob-gyn performs a hysterectomy or uterine repair and a ureter is sutured. A general surgeon performs a laparoscopic cholecystectomy and the common bile duct is clipped. Some of these cases turn into lawsuits. Some […]

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Doctors Strive to Avoid Being Labeled Outliers – Except When it Comes to Schedule II Drugs

Every month I receive a letter from my electric company. It shows how much power I am consuming relative to my peers – my neighbors. Studies have shown such data, when presented in a non-confrontational way – can impact behavior. In those studies, total energy consumption went down. In the letter I receive, no allowance […]

Posted in Healthcare Reform | 6 Comments |

NC Medical Board Disciplines Doctor for a Lease Dispute.

I can understand why a Medical Board investigates a practice for allegations related to patient safety. I get it when the Board responds to concerns a doctor may be taking advantage of patients sexually. The main purpose of the Medical Board is to protect the public. What I don’t understand is when a Medical Board […]

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HIPAA Conundrum. War of the Roses After Death.

Remember the movie War of the Roses.  Kathleen Turner and Michael Douglas play married characters. They hated each other. But, neither wanted to part with their opulent house. So, they stay put. No one moved. They continue to spew hate and back it up with hateful actions. Recently, a Medical Justice member said they cared […]

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Deporting Hospital Patients

Illegal immigration is now the buzz of the political ball. Candidates are talking about building a wall, rounding up and deporting undocumented immigrants, and its economic ramifications. What happens when undocumented workers are injured and need long term medical care? What must hospitals do? What do hospitals do?

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Two Counterintuitive HIPAA Scenarios

Scenario #1: Some doctors believe, incorrectly, that if a patient has already disclosed protected health information on the Internet, his doctor can “correct” the record online. In other words, if a patient slams a doctor online, and attaches his name or picture to the review, many doctors believe the toothpaste is out of the tube, […]

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If You’re Not a Psychiatrist, What Do You Do if Your Patient Threatens Suicide?

A few of our members are psychiatrists. Most are not. On rare occasion a surgeon will get a call or email from a patient suggesting they are considering suicide. Or they have a detailed plan to take their life. Or they’ve posted this nugget of info on Facebook or a doctor review site and you […]

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David versus Goliath. One Doctor’s Quest for Justice.

Physicians regularly renew their medical licenses. A typical question on the application reads: Since you last renewed have you become aware of any medical condition that impairs or limits, or could possibly impair or limit, your ability to practice medicine safely? (If you are an anonymous participant in the Physician Health Program and in compliance […]

Posted in Healthcare Reform | 14 Comments |

Avoiding Liability When Sending Specimens

Doesn’t happen often. But, when it does, expect a potential s*%#storm. Patient is anxious about the mole on his back. A dermatologist removes the mole and sends the specimen to the lab. Rule in or rule out melanoma. The lab says it never received the specimen. The dermatologist then does full excision. Then the doctor […]

Posted in Healthcare Reform | 3 Comments |

Why Not Bring The Entire Staff Into the Exam Room for My Prostate Exam?

I live in North Carolina. Each year I have a general physical exam. This includes the ritual known as the prostate exam. I don’t particularly look forward to it. But, it takes a few seconds and I’m reassured knowing that there are no lumps or bumps. My internist is male. And, in the exam room, […]

Posted in Healthcare Reform | 10 Comments |

Which Workplace Bathroom to Use?

The question is not so simple anymore. According to the UCLA School of Law’s Williams Institute, there are approximately 700,000 transgender individuals in the United States. In a recent Equal Employment Opportunity Commission ruling (Lusardi v. McHugh, EEOC, No. 0120133395, 4/1/15), the US government ruled that a government employee who transitioned from male to female […]

Posted in Healthcare Reform | 1 Comment |

Those Pesky Signatures

How many of us has received the dreaded notice that medical records are not complete; or worse, that records are complete but need to be signed. The absence of a “proper” signature gums up the works for getting paid. This following is what CMS considers to be a valid signed order/record. I won’t belabor the […]

Posted in Healthcare Reform | 1 Comment |

A Good Samaritan Saves the Day

We’ve heard plenty of horror stories where someone tried to do the right thing – and got screwed. Everyone knows the saying, “No Good Deed Goes Unpunished.” Still, my faith in humanity was renewed on January 10th.

Posted in Healthcare Reform | 12 Comments |

What Can Happen When Patient Consent Is Fuzzy? A Bizarre Odyssey…

Dr. Philip Taylor was employed by Spectrum Health Primary Care Partners. He practiced as an ob-gyn. His employment agreement with Spectrum defined how they could terminate the relationship. Summary Termination. If your employment … is terminated by its Board of Directors [the “Board”] for a serious, intentional violation of the standards of patient care (i.e., […]

Posted in Healthcare Reform | 4 Comments |

Is Pimping Really Abusive?

Yesterday, I read two articles in JAMA on pimping. (Yes, I still get JAMA.) The article suggested that pimping medical students and residents may be “old school.” Used inappropriately, it may serve more as a tool off abuse and humiliation as opposed to a pedagogical art. Duh.

Posted in Healthcare Reform | 23 Comments |

Easy New Year’s Resolutions for Cybersecurity.

Some say there are two types of online sites. Those that know they have been hacked. And those that have been hacked, but don’t know it. Sobering. Everyone is busy. The important question is what can be done to mitigate the downside of sites being hacked. You want two outcomes: (a) minimize the likelihood malicious […]

Posted in Healthcare Reform | 1 Comment |

⇨ Onward to Page 2


Latest News

How Facebook Saved My Patient’s Life 

June 6, 2017

Sometimes you need a nugget of medical information – pronto. If your patient has been in a hospital, you likely have access to reams of data. Finding your nugget may take seconds, minutes, or hours. You may never find it.   A number of years ago, Dr. Kamal Thapar, a Wisconsin neurosurgeon, gave a talk on […]

(more →)


Past News

May 26, 2017 Jewelry Store Owner’s Son has to Pay Competitor Because of Fake Review

The jury has spoken. Stephen Blumberg owns Stephen Leigh Jewelers in Massachusetts. Toodie’s Fine Jewelry is a competitor. Allegedly, Adam Jacobs, a Toodie’s employee, wrote a multi-paragraph negative Yelp review about Stephen Leigh Jewelers. The review said he was looking for a 1.5 karat engagement ring and he had a negative experience. He then advised […]… (more →)

October 10, 2012 Five-star practice, one-star reputation?

Fair or not, online reviews may be the first thing a potential patient sees about a dermatologist By John Carruthers, staff writer, Dermatology World, October 01, 2012… (more →)

April 5, 2012 HealthDay recently interviewed Medical Justice Founder and CEO, Jeff Segal, MD, JD, on the high costs of defending medical malpractice claims – win or lose

For doctors defending medical malpractice claims, costs vary widely across specialties and can run into the tens of thousands, even when a patient did not receive a payout, new research shows.

The upshot: Patients end up paying the price in the end, the researchers concluded in their letter published April 5 in the New England Journal of Medicine.… (more →)


November 10, 2011 Radio Health Journal recently interviewed Medical Justice Founder and CEO, Jeff Segal, MD, JD, FACS about the danger of “testimony for hire”.

Medical malpractice often boils down to a battle of expert witnesses. Frivolous cases are often fueled by inappropriate expert testimony.… (more →)

September 22, 2010 Preventing Frivolous Lawsuits and Frivolous Testimony

Every year, 8-10% of doctors will be sued for malpractice. Many physicians who have been sued or watched a colleague go through litigation respond with defensive medicine, which some recent studies estimate costs the healthcare system as much as $350 billion dollars a year. Most solutions to this problem would involve changes at the federal […]… (more →)