Medical Justice Blog

The information presented on this site is for general educational purposes only. It is not specific medical or legal advice. Nothing on this site should be construed as establishing a doctor-patient or attorney-client relationship. 

Raleigh ENT Doctor Accused in $46 Million Medicare Fraud Scheme

Dr. Anita Louise Jackson is an ENT specialist. Dr. Jackson runs several ear, nose, and throat clinics in the Raleigh, NC area. She helped several of her local health departments respond to the COVID-19 pandemic. She’s also named in a $46-million Medicare fraud scheme. 

We’ve summarized the 20+ counts – which include the recycling of “single-use” balloon sinuplasty devices. What can we learn? Our blog has the details…

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$13 Million “Rapey Juan” Verdict Shatters California Med-Mal Cap

Aurora Vista del Mar is a psychiatric hospital in Ventura, California. Three of Aurora’s former patients sued the hospital in 2015 for sexual assault, emotional distress, and failure to protect them under the Elder Abuse Act.

The allegations: The rapist you hired raped us.

The damages awarded: You read the headline, didn’t you?

The case is a roller coaster. Let’s start with the perpetrator, known to his coworkers as “Rapey Juan.” Our blog has the details…

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Brain Surgeon versus Rocket Scientist? Has the Question Been Answered?

The British Medical Journal just published a piece called: “It’s not rocket science” and “It’s not brain surgery” — “It’s a walk in the park.” The authors included neurosurgical residents – a group with a stake in the outcome.

The objective: Compare cognitive testing scores in neurosurgeons and aerospace engineers to settle the age-old argument of which phrase is most deserved — “It’s not brain surgery” or “It’s not rocket science”. What were the results? Place your bets. Our blog has the details…

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“As goes California, so goes the rest of the nation…”

California’s Silenced No More Act takes effect in 2022. Many doctors are already taking notice. Here’s why you should, too.

It’s likely the law will make it harder for doctors to prevent their employees from disclosing information related to what they believe are acts of discrimination or harassment. It does not matter if the employee’s claims are meritless.

How will this impact doctors in California – and potentially the rest of the nation, if this spreads? Our blog has the details…

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Your Patient Just Submitted a Chargeback. Now What?

The world has changed. Once upon a time, you performed a service for a patient, perhaps surgery, and you were paid. You might be paid by personal check. By credit card. Or even cash. And that would be that.

Now, much more frequently than in days past, some patients feel entirely comfortable initiating a chargeback from their credit card company. Even if objectively the result was good – even excellent.

This is maddening. What to do? Our blog has the details…

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“I’ll Trade You.” Embryo Mix-Up Prompts Parents to Swap Babies.

A fertility clinic in California is being sued by one patient for medical malpractice, breach of contract, and fraud. Another patient is likely to file their own lawsuits in the coming weeks. The origin of the conflict warrants discussion.

If you monitor medical news outlets, you’re likely familiar with this story already; if you’ve missed it, we’ll fill you in. Our blog has the details…

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Surgeon Sues Patient for Defamation and Wins. $30,000 Payout.

We often advise doctors against suing patients for defamation – especially if the defamatory content originates online. Why? It’s hard to win a defamation case. It takes a long time. It’s expensive. And frequently the publicity of the lawsuit brings even worse attention to the business. You must also prove the review has damaged your business. Procuring this evidence is difficult and often not possible.

A plastic surgeon in Canada broke the mold. He sued his patient for defamation. And won. How’d he do it? Let’s meet our cast…

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Why So Many Doctors Self-Destruct During Their Depositions – and How to Nail Your Own (Part 2)

Many medical malpractice cases never reach trial. But almost all defendants are deposed. Critically, the defendant must ace their deposition. A deposition is the plaintiff’s chance to make his/her case as strong as possible; and the defense’s chance to see how the doctor performs when pressured.

Let’s examine several real-world vignettes to see where the traps may hide – and how doctors must sidestep them. Our blog has the details…

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Bad News, Wrong Man. Patient’s Prostate Removed by Mistake.

Eric Spang underwent a routine prostate examination in late-2020. His blood test revealed elevated levels of a prostate-specific antigen (PSA). This sometimes indicates the presence of prostate cancer. He underwent a biopsy to confirm. When his biopsy came back positive, Mr. Spang and his wife discussed his options with his doctor. After seeking a second opinion with another doctor in the practice, surgeons removed Mr. Spang’s prostate, believing the procedure would save his life. It wasn’t until the procedure concluded that the surgeons realized the mistake. Mr. Spang did not have prostate cancer. Our blog has the details…

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When a Doctor Has an Abnormal Blood Test

Two years ago, I fractured my left fibula. It was treated with 8 weeks of bracing. When I took the brace off, my calf was enormous. A doppler venous flow study showed extensive deep venous thrombosis. I did 12 weeks of Xarelto. I started wearing compression hose. All was well.

Ten days ago, I went cycling. We rode for 60 miles at a blistering pace. When we finished, my right calf was sore. No surprise. I figured it was a sore muscle and it would get better on its own. It didn’t. It was still sore 5 days later. And tender. This couldn’t be a DVT, could it? I ordered a D-Dimer test, fully expecting it to be negative. It was a DVT.In one sense, we all live on borrowed time. How hard should we look for ticking time bombs? And when we find one, what should we do? Here’s the story…

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Vaccine Wars

Most agree that COVID will simmer in the population unless and until we reach herd immunity. And, yes, if SARS-COV-2 mutates “enough”, it will linger even longer, perhaps annually, because herd immunity will not have been achieved for the mutation in circulation.  As vaccines become accessible, employers large and small weigh the costs of vaccine mandates. Is there a solution that satisfies everyone? Or is this a pipe dream? Our blog has the details…

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Doctor Pleads Guilty to Selling “Misbranded Medication.” Who Pays Retail?

What practice doesn’t want to save money? That said, there’s a line that should not be crossed. In a Department of Justice News Release, Dr. James Heroman is identified as a physician who should have shopped locally. He just pled guilty to ordering and receiving “a misbranded medication.” This is a criminal offense with criminal penalties.

The charge of receiving and delivering a misbranded medication carries a maximum penalty of a year in prison and a $1,000 fine.

Dr. Heroman and his corporate entity also agreed to pay $450k to resolve they violated the False Claims Act.

Our blog has the details…

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Doctors Accidentally Start Fire During Open Heart Surgery

The patient was undergoing emergency surgery to address a torn aorta. The patient also had an “enlarged” lung, a symptom of the patient’s pulmonary disease. The patient’s lung was fixed to his sternum, and the surgeons needed to crack his sternum to access his heart. In doing so, they punctured a bulla within the lung.

The anesthesiologist responded by increasing the amount of oxygen in the patient’s anesthetic inhalant. You can guess what happened next. But what were the outcomes? Our blog has the details…

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Murder, He Spoke. Different Confidentiality Standards for Doctors and Lawyers.

In 1969, a University of California student told his psychologist that he intended to murder his ex-girlfriend. The psychologist wrote to campus police.

The student was detained but released as his mental state appeared improved. The ex-girlfriend received no warning. When she returned to campus, the ex-boyfriend befriended her brother. They even moved in together. Seriously. Not long after, the young woman was murdered.

In the resulting landmark case, the state Supreme Court held that mental health professionals have a duty to protect people who are threatened with bodily harm by their patients. It is critical doctors of all specialties study this case. Our blog has the details…

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How a 21st Century Answering Service Immunizes Practices from a Surprisingly Common Source of Litigation. The After-Hours “He-Said She-Said.”

We cannot count the number of times a doctor has called us and said: “If I only had a recording of my conversation with the patient, my case would have been dropped instantly.” During a medico-legal crisis, solid evidence can save a doctor from a disruptive, expensive, drag-out knock-down lawsuit.

We spoke at length with Dr. Michael Nusbaum, co-founder of MedXCom. MedXCom provides doctors with a simple, reliable, HIPAA-compliant way of storing and retrieving conversations with their patients for 23 years. The technology makes patient-to-doctor communication easier, more secure, and lower-risk. MedXCom is more than just an automated answering service – if you are sued, its technology can save you.

Our podcast has the details. Here’s what doctors need to know…

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Why So Many Doctors Self-Destruct During Their Depositions – and How to Ace Yours

Many medical malpractice cases never reach trial. But almost all defendants are deposed. Critically, the defendant must ace their deposition. A deposition is the plaintiff’s chance to make his/her case as strong as possible; and the defense’s chance to see how the doctor performs when pressured.

Let’s examine several real-world vignettes to see where the traps may hide – and how doctors must sidestep them. Our blog has the details…

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What Were They Thinking? Chapter 952.

Yes, it’s true, in the United States criminal justice system, one is presumed innocent until proven guilty beyond a reasonable doubt.

If the allegations in a recent US Department of Justice press release are true, two physicians will have a hard time staying out of prison.

What was the alleged scheme? It entailed insurance fraud, staged accidents, and the exploitation of the homeless, the poor, and the drug-addicted. Our blog has the details…

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Operating Room Shenanigans Lead to Lawsuit. Amazingly, the Hospital Prevailed.

In January 2020, Michael Sonnier, a charge nurse, underwent hernia surgery. He experienced no complications. Then he woke up and the “fun” started. Michael awoke to find himself wearing a diaper, despite the fact that most patients recovering from hernia surgery do not require diapers.

He then discovered someone had taped a plastic baggie containing mixed nuts to the diaper and written, “These nuts!” on the baggie. While he was unconscious, someone painted his fingernails and toenails scarlet. And that’s just the tip of the iceberg. Our blog has the details…

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Video Cameras in the Operating Room, Gangnam Style.

You think medical politics is contentious in the US? Let’s step over to South Korea for a moment. As I write, a legislative bill is about to be passed allowing for surgical procedures to be videotaped. The Korean Medical Association warned it will take legal action to prevent the passing or implementation of this bill.

What started this debate?

In 2014, medical workers at a famous plastic surgery clinic in Gangnam, Seoul were celebrating a birthday in the operating room, eating cake and playing with the implants. Our blog has the details…

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The Texas Heartbeat Act and M.C. Escher.

The Texas Heartbeat Act just took effect. It creates a private cause of action if a patient obtains an abortion in Texas after six weeks – when a fetal heartbeat can be identified. The private cause of action (meaning money) accrues to ANY citizen. In the past, state laws restricting abortion were pre-empted by litigation. Here, there is no public official serving as the enforcement arm. Such a public official would otherwise become a “defendant” in a lawsuit for an injunction to pre-empt the law taking effect. No public official defendant. No injunction. The law is ready to roll.

The law is clever on its face. Still, I’m going to take a crack at the gaping loopholes in the law. Please note, I’m only addressing the mechanics of the law and not taking a position on the pro-life versus pro-choice debate. If you want to debate the politics of pro-life versus pro-choice, please do it elsewhere.

Let’s discuss the gaping loopholes. Our blog has the details…

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Is It Worth Keeping a Medical License in More Than One State?

Last month I met two physicians with more than one medical license – actually each had over 40 medical licenses. They were both active in telemedicine and had a staff to assist with applying for and maintaining those licenses. Physicians who work locums and travel frequently also carry double-digit numbers of licenses. For these two groups, they use their licenses. They use these documents to earn a living. To them, it’s the cost of doing business.

What about the rest of us? Is it worth keeping a medical license in more than one state? Here’s what doctors need to know…

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Yelp Now Allows Businesses to Highlight Their Vaccine Policies. Review Bombing Follows.

This August, Yelp added two new features businesses can list on their profiles. A business can publicize that its staff is fully vaccinated against COVID-19. It can also indicate if it requires customers to provide proof of vaccination to receive services.

As of August 23, 26k businesses listed at least one of these two vaccine “badges” on their profiles. What does this mean for doctors and their practices?

Here’s what doctors need to know…

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Can You Mandate YOUR Patients be Vaccinated to be Seen?

Recently, a dentist asked us our thoughts on whether she can mandate her patients be vaccinated for COVID-19 as a condition to be seen/treated. The gist of the question was whether there were legal or regulatory prohibitions against pulling the trigger. It is important professionals of all specialties understand the medico-legal implications in play – this is a question you’ll have to address eventually. Here’s what you need to know…

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It’s All in the Delivery: Breaking Bad News to Patients – How To Do It (Part 2)

No one likes delivering bad news. But delivering bad news is a reality many doctors must navigate every day. Doctors who learn to do it well can carry patients through the most difficult days of their lives. Doctors who do it poorly wreak havoc. Dr. Anthony Orsini, an experienced neonatologist and creator of The Orsini Way, has mastered the art of delivering bad news. We spoke to Dr. Orsini at length. His insights are invaluable. Learn how he does it. Listen to our two-part podcast.

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It’s All in the Delivery: Breaking Bad News to Patients – How To Do It (Part 1)

No one likes delivering bad news. But delivering bad news is a reality many doctors must navigate every day. Doctors who learn to do it well can carry patients through the most difficult days of their lives. Doctors who do it poorly wreak havoc. Dr. Anthony Orsini, an experienced neonatologist and creator of The Orsini Way, has mastered the art of delivering bad news. We spoke to Dr. Orsini at length. His insights are invaluable. Learn how he does it. Listen to our two-part podcast.

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Someone Dropped the Ball. Thoughts on Wrong-Sided Groin Surgery.

On September 10, 2019, a patient was scheduled to have a left testicle varicocelectomy. This procedure addresses enlarged veins around the testicle, in this case, on the left side. Varicocelectomy is often performed to address male infertility, though there may be other reasons.

After speaking with the patient, the surgeon, a Tampa urologist, marked the right testicle just before the procedure. During the procedure, the urologist realized the patient had actually consented to a left-sided procedure.

Rut roh!

Here’s what happened next…

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How to Fire a Patient WITHOUT Getting Burned Yourself

Can a doctor fire a patient? Absolutely. And sometimes ending the doctor-patient relationship is the best path for both the doctor and the patient. Is firing a patient an easy, risk-free solution to a distracting patient conflict? Absolutely not. But there are ways a doctor can fire a patient while minimizing the risk of a bad outcome – such as an abandonment charge or a frivolous medical malpractice lawsuit.

Here’s what doctors need to know…

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Vaxed or Axed. So Wrote Dr. Ezekiel Emanuel.

In an opinion piece published on STAT, lead author Dr. Ezekiel Emanuel urged a vaccine mandate for all healthcare workers.

For healthcare organizations, the ostensible concerns persuading them to use carrots instead of sticks are employee retention and litigation. No healthcare organization wants to lose a significant portion of its staff en masse. And no healthcare organization wants to be sued.

But I expect more and more patients will ask doctors about their vaccination status.

Here’s what doctors need to know…

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Neutralizing Violent Conflicts in Your Practice: Life Lessons from the FBI

Most encounters with patients are conflict-free. That’s the good news. But not all patient interactions are conflict-free. Some can be deadly. Doctors must understand how to prevent violence in the medical practice – and what must be done when violence cannot be avoided. Many of these best practices come directly from two former FBI agents – it is critical doctors of all specialties internalize these techniques. They may save your life.

Here’s what doctors need to know…

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How to Survive Patients from Hell. Every Doctor Has at Least One – Including You.

Most patients love their doctors. And most doctors like (even love) their patients. Understanding how to de-escalate the outliers is critical. Medico-legal threats are frequently propelled by difficult patients. Applying this knowledge successfully can save you from an expensive and disruptive lawsuit, a meritless Board complaint, or worse.

Here’s what doctors need to know…

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Biological Parents of Child Born Via Surrogate Forced to Adopt Their Own Baby

Surrogate pregnancies are guided by state law. Each state is different. Michigan does not automatically recognize babies born to surrogates as the legal children of their biological parents.

That posed a problem for Jordan and Tammy Myers of Grand Rapid Michigan. Each provided the genetic material to produce an embryo; an embryo which was implanted in a surrogate.

When born, Michigan incorrectly labeled the surrogate (Lauren Vermilye) and HER husband as the legal parents of the twins. Note, the surrogate and her husband even filed a legal affidavit stating the Myers were the real parents.

What to do? Here’s what doctors need to know…

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Here We Go Again. United Health to Deny Some Emergency Department Claims.

United HealthCare, the largest private health insurer in the country, is playing Monday morning quarterback and denying some claims for what they deem to be non-emergencies in the emergency department.

Due to massive blowback from this ill-advised policy, United HealthCare is delaying the policy’s rollout.

Make no mistake. Winter is coming. And this comes on the heels of a year when EDs were underused for almost everything other than COVID-19. Here’s what doctors need to know…

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Avoiding Liability with Patient Photographs (Part 2)

We continue the discussion we started last week. Photography has been a part of medicine since, well, the advent of photography. However, with the dissemination of the smartphone camera, anyone can grab and disseminate an image with barely two screen taps.

In this setting, it is essential that physicians, who are fiduciaries for their patients’ medical information, including its confidentiality, be aware of the limitations that they need to follow to avoid not just a privacy breach but an ethical one.

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Avoiding Liability with Patient Photographs (Part 1)

Photography has been a part of medicine since, well, the advent of photography. However, with the dissemination of the smartphone camera, anyone can grab and disseminate an image with barely two screen taps.

In this setting, it is essential that physicians, who are fiduciaries for their patients’ medical information, including its confidentiality, be aware of the limitations that they need to follow to avoid not just a privacy breach but an ethical one.

There’s a lot to unpack here, so we’re addressing the major issues in two parts. With that said, let’s dive in. 

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Lawyer in Sizzling Water Over Courtroom Zoom Fracas

The list of Zoom courtroom challenges keeps growing. Most recently, a med mal plaintiff’s attorney was fined $3,000 and referred for further discipline after raising his middle finger to opposing counsel during an oral argument. The court was hearing a heated discussion about a challenge to the statute of limitations. The debate over stature of limitations will always ruffle some feathers. Here’s what happened…

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You Want a “Consent to Settle” Liability Insurance Policy. Here’s Why. (Part 2)

We continue the discussion we started last week. When reviewing your professional liability coverage, there are few elements as critical as the “consent to settle” clause. Why is the consent to settle clause so valuable to doctors?

Here’s what doctors need to know…

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You Want a “Consent to Settle” Liability Insurance Policy. Here’s Why. (Part 1)

Imagine you are sued for malpractice. You’re prepared to do everything necessary to defend your professional reputation. Based on the facts, you feel confident in prevailing. All you must do is speak up. But you can’t. This sounds like a nightmare. But if your professional liability policy is missing a “consent to settle” clause, that nightmare could become your reality.

When reviewing your professional liability coverage, there are few elements as critical as the “consent to settle” clause. Why is the consent to settle clause so valuable to doctors?

Here’s what doctors need to know…

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Employment Law and Your Office. A Thicket.

If you run a practice or evaluate candidates for your group, you know that there are interview questions under EEOC regulations and related laws that you cannot ask.

You want to avoid discrimination and implicit bias. But you cannot hire blindly. If the candidate is a bad fit (or a great fit), you need to know. The question: How far can you go? Where is the line between gathering relevant information and impermissible questioning?

Our blog has the answers. Here’s what doctors need to know…

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Prior Acts as Evidence in a Medical Malpractice Case

When the defense in the Derek Chauvin trial was permitted to introduce a video of George Floyd being arrested in 2019 (a year before he lost his life during a subsequent arrest) many doctors were confused. Physicians are generally told by their defense counsel that a basic rule in a medical malpractice action is what you did with another patient cannot serve as evidence in a current case.

They are correct – as a general rule. This is suited to medical malpractice actions because the issue is whether the defendant adhered to the standard of care. But the standard of care varies with circumstance. Each patient and each case is different. Here’s what doctors need to know…

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Manslaughter Versus Malpractice

A handful of recent cases, including a non-medical case, have doctors concerned that a medical claim could develop into criminal liability. All of these cases were charged as types of manslaughter, which is an unintentional killing. The charges were based on “reckless” conduct.  Of course, none of the defendants planned (intended) to kill. However, they all engaged in “reckless” conduct that carried a risk of serious harm to another. So, their conduct rose to potential criminal liability. Here’s what doctors need to know…

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21st Century Cures Act and Open Notes – Your Cheat Sheet

The 21st Century Cures Act was signed into law in December 2016. It was designed to help accelerate medical product development and bring new innovations to patients faster. It included modernizing clinical trial designs, expedited options for regenerative medicine therapies, and a “breakthrough devices” program. 21st Century. What’s not to like? It’s like Mom and apple pie.

Well, there’s a provision related to “information blocking” that took effect on April 5, 2021. It’s popularly referred to as the Open Notes Rule. If you’re a doctor who creates or uses medical records (that would include all practicing doctors)  here’s what you need to know now…

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It’s Not Discrimination to Tell a Patient “No.”

Man, the country has gotten so sensitive…

Patients are lashing out online, stating medical practices are “this phobic” and “that phobic.” Racist. Ageist. Ableist. Other “ists.” Some patients have filed lawsuits alleging discrimination. Oh dear. Let’s start with the basics. Here’s what doctors need to know…

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Patient Allegedly Woke Up in Body Bag. Hospital is Sued.

In 2017, a 99-year-old woman was declared dead at Olympic Medical Center in Washington state. Her daughter said her mother’s blood-stained sheets and apparent broken nose indicated she was alive up to two days after being declared dead. The mortuary noted the blood-stained sheets and the broken nose but stated there was no corresponding note from the hospital. This indicated a suffocating patient was trapped in a metaphorical coffin clawing to get out. A horrific image. Here’s what doctors need to know…

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Bullet-Proofing Your Medical Practice Against Unexpected In-Office Emergencies (Part 2)

We continue the discussion that started last week. Doctors are no strangers to emergencies – there’s a reason many of us specialize in “emergency care.” But not all emergencies are confined to the ER. Doctors of ALL specialties MUST have a plan for addressing unexpected in-office emergencies. And it’s not enough that doctors know how to act – we must train our staff as well.

A plan of action can save lives and absolve a doctor’s liability in the event of an in-office emergency. Here’s what doctors need to know…

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Bullet-Proofing Your Medical Practice Against Unexpected In-Office Emergencies (Part 1)

Doctors are no strangers to emergencies – there’s a reason many of us specialize in “emergency care.” But not all emergencies are confined to the ER. Doctors of ALL specialties MUST have a plan for addressing unexpected in-office emergencies. And it’s not enough that doctors know how to act – we must train our staff as well.

A plan of action can save lives and absolve a doctor’s liability in the event of an in-office emergency. Here’s what doctors need to know…

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How to Avoid a Report to the Data Bank (Part 2) 

Most doctors fear the destructive effect of a report to the National Practitioner Data Bank (NPDB). That concern is well-placed. A physician involved in such a situation must do the following: First, seek expert counsel. And second, seek education. Informed clients will get the most out of their representation.

Let’s examine what your lawyer must do to either prevent a report entirely or to blunt its impact. Here’s what doctors need to know…

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Black Doctor Asked to Speak About Racism. Fired Shortly After.

Dr. Aysha Khoury taught internal medicine at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, CA. Dr. Khoury is black. During one of her classes, Dr. Khoury and her students discussed the Tuskegee syphilis study. Khoury also discussed several first-hand experiences as a woman of color in medicine.

Less than a day later, Dr. Khoury was suspended from her teaching role at the medical school. Four days later, she learned she was also suspended from her appointment at a Kaiser Permanente clinic. Why was Dr. Khoury canceled? Here are the details…

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The Surgeon Who Appeared in Traffic Court by Zoom During Surgery. Hear the Real Story. FROM HIM.

Dr. Scott Green is a talented plastic surgeon trapped in a 21st-century media storm. Dr. Green received a traffic ticket. Because of COVID restrictions, he appeared in traffic court via Zoom after successfully completing the salient portion of his patient’s surgery. His fellow was closing. A faulty Zoom connection created a false narrative that Dr. Green was careless and cavalier. This judgment is both false and unfair.

How do we know? We spoke to Dr. Green ourselves. Every doctor needs to hear his side of the story. Why? What happened to him could happen to any of us. Listen to his story…

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How to Avoid a Report to the Data Bank (Part 1)

Most doctors fear the destructive effect of a report to the National Practitioner Data Bank (NPDB). That concern is well-placed. A physician involved in such a situation must do the following: First, seek expert counsel. And second, seek education. Informed clients will get the most out of their representation.

Let’s examine what your lawyer must do to either prevent a report entirely or to blunt its impact. Here’s what doctors need to know…

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Criminalizing Normal Doctor Behavior Must Stop! Now!

Dr. Hasan Gokal is a physician who worked for the Harris County Public Health department in Houston. He helped give COVID-19 vaccinations. He injected his 47-year-old wife with a vaccine, technically allowing her to “cut in line.” 47-year-old individuals living at home were not in the queue.

Dr. Gokal was fired. The district attorney filed criminal charges. A mug shot was taken. The world labeled him a bad person. In my estimation, Dr. Gokal did nothing wrong. He just practiced good medicine.

Details matter. So, here they are…

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Healthcare Execs Go to Jail. Good.

Henry McInnis was convicted by a federal jury of conspiracy to commit healthcare fraud and money laundering, obstruction of justice, as well as six counts of healthcare fraud in November 2019. He was sentenced to 15 years in prison. McInnis’ partner in the scheme, Rodney Mesquias, was also convicted in the November 2019 trial and was sentenced to 20 years in prison in December 2020. Two other co-conspirators have pleaded guilty and are awaiting sentencing.

Who were these people, and what did they do? Here’s what doctors need to know…

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Disabled “Hitmen” Setting Up Doctors for Disability Lawsuits

The Americans with Disabilities Act mandates reasonable accommodations to level the playing field for those with disabilities. The law was well-intended. While businesses often need a gentle nudge to come into compliance, some with disabilities (and their lawyers) are turning this gentle nudge into a cash cow. Doctors are among their targets.

Some attorneys are paying disabled “testers” to visit businesses – including medical practices. If the practice is not ADA compliant, the practice is sued. One firm in Georgia has filed hundreds of these federal lawsuits. Here’s what doctors need to know…

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Dude, Those Are MY Patient’s Photos on YOUR Website…

It’s Friday afternoon. You check your mail before calling it quits for the weekend. There’s a note from an attorney. It’s a cease and desist letter. Plus, a demand for money. Lots of money. The lawyer alleges your website and social media accounts are peppered with unlicensed pictures of patients from a practice he represents. He claims your practice committed copyright infringement, false advertising, and more. This is not how a restful weekend begins. Now what? Here’s what doctors must know…

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When Patients Go to War with Doctors Over “Failed” Procedures, Here’s How Doctors Win…

A classic example is a plastic surgeon who performs a facelift. The outcome is good. Is it perfect? No. But it was done at or above the standard of care. Yet the patient is dissatisfied. The surgeon says he’s happy to do a revision where he waives his professional fee. The patient says, “No dice.” She wants her money back. How to resolve? Here’s what doctors must know…

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Runaway Patients. Medicolegal Issues When Patients Leave AMA.

“Doctor, the pneumonia patient in cubicle 4 is trying to get up and leave!” Now what?

Forcing unwanted care on the competent patient might actually constitute battery, but in medico-legal reality there are quite a few layers in that simple answer. Let’s take a look at those. Here’s what doctors must know…

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Doctors Slapped by Anti-SLAPP Legislation. Why Suing Some Patients for Defamation Doesn’t Pay.

We understand the impulse. Someone said something ugly about you. It might be a patient. Another doctor, perhaps. They said it publicly. Online. You want to even the score. Sue them. Teach them a lesson.

There is no shortage of attorneys willing to take your cash to help you in your mission. Before jumping off the cliff, ask your attorney this one question. “Can I be burned under anti-SLAPP?” If your attorney answers, “What’s that?” or “Huh?”, don’t walk away. Run.

We’ll answer that question for you. Here’s what doctors must know…

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When the DEA Comes Knocking

“Doctor, there is a DEA agent at the front desk. He wants to speak with you.” What now? We got a call from a member doctor not long ago that sounded just like that. It raised an important point: What should doctors do when the DEA visits their practices?

The DEA is empowered to perform unannounced site inspections. However, that does not mean that these visitors can have immediate unfettered access to your office. Knowing your own rights is the most effective way to avoid being pulled into a more serious problem. Here’s what doctors must know…

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Doctors Who Purchase Fake Online Reviews from Bangladesh

Kathryn Dean is the creator of and its eponymous YouTube channel. She’s exposed a large international marketplace for purchasing and posting fake reviews. She’s also discovered a domestic marketplace for trading reviews between businesses. One such review trader teaches law and ethics at a major US university. And physicians are participating. Here’s what doctors must know…

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Surgeon Slammed by NFL Star. When Celebrity Patients Sue Doctors.

An orthopedic surgeon operated on an NFL star athlete. When the athlete experienced a bad outcome, he blamed the surgeon for prematurely ending his career. When a patient’s lost earning potential can be measured in the tens of millions, how can doctors protect themselves from catastrophic settlements?

Most doctors would jump at the chance to operate on someone famous. But star-power can cut.

Here’s what doctors must keep in mind when caring for celebrity patients…

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Doctor Screwed by Med Mal Carrier: How to Prevent It From Happening to You.

You know what’s a bummer? Getting sued for med mal. You know what’s a double bummer? Having your carrier deny the claim. This nightmare became one doctor’s reality. Overlooking small (but critical) details in your policy can land you in the same boat. Here’s how one doctor got screwed by his med mal carrier – and how to prevent it from happening to you…

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C-Section. No Anesthesia. $5.75 Million in Damages. Ouch.

In 2018, an interesting medical malpractice lawsuit was filed in California. Well, interesting if you are not the defendant. The plaintiff delivered a healthy baby girl. The allegation is that her C-section was performed without anesthesia forcing her to suffer horrific pain.

The new mom was 41 weeks pregnant and was rushed to Tri-City Hospital in Oceanside, California for a C-section. The anesthesiologist allegedly did not arrive to administer anesthesia after several pages were sent.

But what actually happened here? Here’s what doctors must know…

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Sued for Leaving Cancer Patients High and Dry.

St. Peter’s Health is a healthcare system in Helena, Montana. If you can’t get timely cancer care in Helena, you’re driving. Far. Dr. Tom Weiner was one of four oncologists employed by St. Peter’s Health. Dr. Weiner was unexpectedly shown the door. Patients were not warned of his impending departure.

At least 96 cancer patients left in the lurch by his unexpected departure are suing St. Peter’s Health. How did this happen? And could this happen to your practice? Here’s what doctors must know…

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Dealing with Non-Maskers in Your Office

As COVID-19 cases increase across the United States, there has been great focus on mask mandates by governmental authorities, but not much attention on how individual businesses, including medical practices, can respond.

The basic rule is simple: A private business must conform to a regulation on masking set by a governmental authority, but if there is no such regulation, or if it is weak, that business can set up its own policy.

A medical practice is unique in several ways. Here’s what doctors need to know about dealing with non-maskers in the office…

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Doctor Prevails in Sham Peer Review: How He Did It.

Not infrequently peer review is parried as a sword to attack doctors. These confrontations often stem from disagreements between doctors and leadership governing a large hospital. This was the position an anonymous doctor found himself navigating. Ultimately, this doctor prevailed – but it wasn’t easy. We’ve distilled the highlights.

Here’s what doctors must know about sham peer review…

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Surviving a $1.5 Million (or More) Medical Records Breach

Here’s what doctors must know: Medical records are breached more often than you think. It’s not a matter of if, but when. Penalties are steep and go beyond cash payouts. If 500+ patients are affected by the breach, you are required by law to inform patients and the media.

It’s critical that sensitive information is kept under an impregnable lock and key. Here’s what doctors must do to protect themselves from a breach…

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Lessons from a Neurosurgeon-Attorney-CEO with Jeff Segal, MD, JD

Dave Mandell, partner at OJM Group and host of the Wealth Management for the Modern Physician podcast, discusses, business, medicine, and wealth management with Medical Justice Founder and CEO, Jeff Segal, MD, JD.

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How Doctors Risk Becoming Casualties of Casual Care…and Solutions

What is casual care? Broadly, it refers to informally consulting with an individual who is not your patient. A neighbor, a family member, a co-worker, etc. Many well-intentioned doctors are catapulted into court over an informal consult with a neighbor. They say no good deed goes unpunished. Let’s discuss how doctors can do a good deed without getting punished…

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Unauthorized Penis Surgery Spawns $9M Judgment. Careful Where You Cut!

A patient was suffering from a small scrotal mass. While operating, the surgeon discovered the mass extended into the patient’s penis. The surgeon believed leaving the mass unchecked endangered the patient long-term.

Because the patient was under anesthesia, the surgeon did not obtain additional consent from the patient. The surgeon also did not obtain consent from the patient’s designated healthcare power of attorney – his ex-wife. You read that right.

We won’t spoil the rest. Read on…

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Yelp Will Now Adjudicate Claims of Racism.

On October 8th, Yelp released “New Consumer Alert on Yelp Takes Stance Against Racism.” In short, Yelp appointed itself judge, jury, and executioner by placing warnings on the pages of businesses alleged to be associated with overtly racist actions. What could go wrong?

Adjudicating race relations can be tricky. Can Yelp be trusted to manage a delicate dance on such a volatile issue? Here’s how doctors will be impacted…

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Abortion, Physicians, and Changing Jurisprudence. Fasten Your Seatbelts.

The makeup of the Supreme Court is changing. Abortion jurisprudence is also likely to change and the issue may revert to the states. If so, what does this mean for physicians who never performed the procedure and never will?

This post takes no position on the Supreme Court’s judgment, now, or in the future. But physicians may get sucked into the drama.

Let me explain…

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Sex with Patients, Opioids, and Vaccine Waivers. Riling Up the Board.

A “love letter” from the Board of Medicine can kick-start a very stressful experience. Board complaints have evolved over the years. The primary purpose of the Board is to protect the public from unsafe doctors. That role has evolved to address “undesirable” behaviors, which may or may not impact patient outcomes. Board priorities often reflect what’s making the news. These are the issues catching doctors off-guard…

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Hoverboarding Dentist Sentenced to 12 Years. Lessons on What Not to Do. 

An Alaska dentist was sentenced to 12 years of prison for 46 charges including Medicaid fraud, embezzlement, reckless endangerment and unlawful dental acts. His prior claim to fame? Extracting a tooth while on a Hoverboard. Illegal? No. A bad idea? Yes.

Back to the big charges. He supposedly fraudulently billed Medicaid $1.8M and stole approximately $250k from his partners.

How was he caught? We’re unpacking it all. Here’s what doctors can learn…

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A Storm is Brewing in the Med-Mal World

And one of the best professionals to educate us on the gathering clouds is Teddy Gillen. Teddy is a principal at EPIC Insurance Brokers & Consultants. He’s been in the med-mal space his entire career.

He has a gift for turning medical malpractice insurance, a subject most perceive as dry and dreary, into a whirlwind narrative that is fascinating and informative. Doctors frequently call us after a crisis has hit. If you spend even a modest amount of time with us today, you’ll walk away with wisdom that will help guard you against the worst med-mal outcomes.

The malpractice landscape is changing. Here’s what docs must know…

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No Good Deed Goes Unpunished – When Docs Are Bitten by Curbside Consults

An ER doc was treating a patient suffering from chest pain. The ER doc phoned a colleague (a cardiologist) for advice. The cardiologist was happy to lend a hand – only to become embroiled in litigation a short time later.

Collaboration is a critical (and inevitable) component of medicine. And  collaboration often benefits both doctors and patients. But what many doctors don’t know is how easily a “curbside consultation” can catapult them into litigation.

Can doctors really “curbside” safely? It’s possible. Here’s how you do it…

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Nailing Your Med Mal Deposition – So You Don’t Get Nailed in Court

Many medical malpractice cases don’t go to trial. But most defendants (doctors) are deposed. Knowing how to comport yourself during a deposition is critical.

A strong deposition often deters an opposing attorney from proceeding onward. A poor deposition will give your opponents an edge in the event your case is tried. Here’s what you need to know to nail a med mal deposition – so you don’t get nailed in court…

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Surviving Medical Board Investigations from Hell

A Board complaint can feel like a bolt of lightning. But there is one key difference: Medical Board complaints don’t fall from the heavens. They seem to rise from the depths of hell.

And doctors fear Board complaints for good reason. They have the power to permanently alter the trajectory of our careers, and frequently for the worst. Here’s what you need to know survive a board complaint from hell…

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Can Doctors Be Fined for Buying Online Reviews?

Your practice is running a promotion. Patients are entered into a small sweepstakes if they write a review for your practice. The winners (chosen at random) receive a gift card. The amount is modest. And the gambit is a success. New patient revenue increases as a result. All seems well. Until the Federal Trade Commission knocks on your door. Can doctors really be fined by a regulatory body for buying online reviews? Absolutely. And the fines can be steep. Here’s what you need to know…

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No Bulls**t. America’s Leading Voice on COVID Speaks from the Frontline.

Dr. Roger Seheult is arguably America’s leading voice on COVID-19.  He is a pulmonary and critical care doctor treating COVID-19 patients on a daily basis. His website, MedCram, has released over 100 videos on COVID-19. His YouTube channel has over 800,000 subscribers. MedCram’s content has been cited regularly as one of the most credible and accurate sources of COVID information available.

We spoke with Dr. Seheult about his experiences caring for patients on the frontline. And we discuss it all – victories, setbacks, emerging vaccine candidates, and potential treatment options.

His insights are invaluable.

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Bikinis and Unprofessional Doctors. 

The fastest way to piss off doctors is to call them unprofessional. Case in point: Several surgeons recently authored a paper in the Journal of Vascular Surgery. The authors researched how young doctors use social media. Their goal was to identify bad habits and help their younger colleagues “course correct” before their careers got off the ground.

What put the authors in a vat of boiling water was their loose definition of unprofessional conduct. What was the problem with their definition? We have the details of the firestorm…

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E.R. Doc Sued After Dousing Patient’s Laceration with Pesticide. Who’s to Blame?

A patient was rushed to the E.R. after a lawnmower lacerated his forearm. Sitting on the counter was a product called CaviCide. What’s CaviCide? An industrial strength pesticide. Absolutely not for human use. Which, of course, is precisely why the attending physician and his nurse sprayed it repeatedly into the patient’s gaping wound.

How did this happen? Why was an industrial strength pesticide present in the treatment room? And why did the jury deliver a defense verdict? It’s a complicated case. Let’s dive in…

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The Enemy of Good is Better. The Case for $1/Day COVID Test.

Michael Mina, a Harvard public health expert, recently explained why a daily rapid home-based test for COVID-19 will tame the pandemic. He argues the test sensitivity only needs to be surveillance grade. And the estimated cost? A dollar a day. Has he hit the jackpot? Let’s assess his assessment…

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Cutting Your Losses. Staged Procedures and Patients from Hell.

Not all patients love you. Or some love you today; not so much tomorrow. In most elective situations, you do not have to accept an ogre into your practice.

But what happens if you plan a staged course of treatments over time and the doctor-patient relationship sours in the middle? What are your options? Here’s the deal…

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Doctor or Bomb Squad? Defusing Patient Conflict Before It’s Too Late

“I expected you to make me better. You made me worse. I’m thinking about speaking to an attorney. Also, I want the whole world to know so they can be forewarned.” Yikes.

Doctors want to treat as many patients as reasonably possible. But if you practice long enough, you’ll treat them. Who? Angry patients. It sucks, but it’s an inevitable part of the job.

The “good” news: Doctors can do a lot to de-escalate conflict with an angry patient. The “even better” news: This article shares general tips and will set you on the right track. Here’s what you need to know…

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To Mask or Not to Mask. That is the Question.

For decades, surgeons have performed elaborate rituals to minimize risk of infection to patients. We wash our hands. We don gloves and gowns. We cover our hair. We avoid reaching over our heads or below our waist. And it works.

I cannot recall a single surgeon ever making a libertarian argument that it’s his choice whether to adhere to these rituals. But that was not always so. Ever heard of Dr. Ignaz Semmelweis? Here’s a history lesson…

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Missiles in the OR. Patient’s Eyeball Pierced by Flying Needle. Who’s to Blame?

A 30-gauge needle pierced a patient’s eyeball during an elective procedure. The patient was advised all was well and sent home. She returned a short time later with rapidly deteriorating vision. She was ultimately rendered blind. Was the surgeon at fault? Or was his scrub tech to blame? It’s a complex case. Here’s what happened…

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Carrier Threatens Doctor with Discipline for Ordering Too FEW Tests

How many of us have received a letter from a carrier asking us to justify the medical necessity of our decisions? Assuming you have been in practice for more than one day, your answer, based on probability, is predictable. Insurance carriers generally demand doctors order fewer tests. One doctor was “beaten up” by a carrier for NOT ordering more tests. Here’s what happened…

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Impostors: Dealing with Medical Identity Theft

Doctors are targets for identity thieves. Our patients are also targets. And the interconnected nature of the cyber-world makes the threat of identity theft omnipresent. As more doctors move into telemedicine, the risk of becoming a victim of medical identity theft increases. How can doctors deal with medical identity theft? Here’s what you need to know…

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Revoking Her License? That Seems Harsh.

A male patient was referred to a female oncologist. The oncologist ordered bone marrow testing and diagnosed the patient with cancer. As the patient’s treatment developed, so did his relationship with his doctor. Eventually, the oncologist gave the patient her personal contact information. One thing led to another. A blossoming romance. Not long after, their romance soured. If you’ve read the title of this piece, you can guess what happened next.

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Every State Determines Brain Death Differently. Really.

What does it mean to be dead? You’d think the answer to that question is binary. You are, or you are not dead. But the fact is every state in the US determines death differently. And the subtle differences can have major consequences for doctors and their patients.

On this episode of the Medical Liability Minute, we discuss brain death with Thaddeus Pope, JD, PhD. Professor Pope is one of the world’s leading experts on medical law and clinical ethics. We are privileged to have Professor Pope as our guest on this episode of the Medical Liability Minute.

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The Ethics of Vaccine Efficacy Trials Using Prisoners Challenged with SARS-CoV-2

The race is on to create and distribute a safe and effective vaccine against SARS-CoV-2 for the world. A thought experiment.

What if the FDA learns the best vaccine candidate was tested overseas using prisoners challenged with SARS-CoV-2 exposure? Assume the safety profile and evidence of efficacy are excellent. Should the FDA allow the compound to be marketed and distributed in the US? This week’s blog weighs the implications…

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Your Colleague’s Keeper: Vicarious Liability

In the midst of COVID-19, some states are starting to loosen up. Before long, many practices will have clearance to return to work. But the universe in which we’ll all be working will look different. As we’ve discussed in past blogs, plaintiff’s attorneys are gearing up for a COVID specific litigation tsunami.

Understanding under what circumstances you may be held liable for a colleague’s error will help you take action to prevent those errors – which protects everyone at your practice against frivolous COVID litigation…

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Trial Bar’s Bonanza: COVID-19

Here’s a formula for the trial bar’s wet dream.

A high frequency, high severity condition where no consensus standards are fully accepted or in place.

High frequency means the “triggering event” is common. COVID-19: Check.

High severity means the damages are significant. COVID-19: Check.

A pandemic causing hospitalization, disability and death satisfies both conditions. Two big double checks. So, what does this mean for doctors?

Two words: Litigation tsunami. Medical Justice will help you prepare…

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A Deal is a Deal

Senator Ron Johnson’s April 23rd op-ed was a buzzkill. Even if it has zero chance of being implemented into law.

Unless you’ve been living under a rock for the past two months, the federal government launched the largest economic stimulus package in history (CARES). Included in that behemoth was the Paycheck Protection Program (PPP), a godsend to small businesses.

Many healthcare practices took advantage of the offer. Candidly, with the pandemic still in gear, the PPP (rounds one and two) may not be enough. But the program was popular and well-intended.

So – what’s the problem?

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Doctors, Divorce, and COVID-19

Dr. Theresa Greene is an ER physician in Miami.

Greene and her ex-husband have been divorced for two years. They have a daughter and split time with her evenly.

Her ex-husband challenged the custody order and the court ruled the child should stay with her father to limit the risk of exposure to coronavirus. Dr. Greene is appealing the emergency order granting full custody to her ex-husband.

The court stated it based its decision on the welfare of the child.

Did it? Or is this just a grab for power? It’s complicated…

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COVID-19: Want to Help Via Telemedicine? You’re Immune

I’ve received a number of calls from doctors whose offices have slowed down. These same doctors have years of experience. They want to help screen and inform patients about COVID-19. These same doctors have asked how to help and not be sued. No good deed goes unpunished.

In helping our brothers and sisters on the front line, we don’t want to be a plaintiff’s lawyer’s next meal. Well, you’re immune.

Not from COVID. But from litigation. Mostly. Here’s the deal…

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Asset Protection and Wealth Creation for Doctors – Protecting Your Nest Egg from COVID-19

The COVID-19 pandemic has turned our world on its head – both in terms of our health and our finances. To help our audience thrive, we are speaking with David Mandell, JD, MBA, partner at the OJM Group, a multi-disciplinary wealth management firm.

What distinguishes the OJM Group? Their focus on physicians.

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The Nation’s Largest Clinical Trial Ever. Let’s Roll.

Coronavirus is a tough opponent. It spreads easily and aggressively. Our brothers and sisters providing healthcare around the world are working tirelessly to deliver care, preparing for the worst, and staying true to the Hippocratic oath. Those in non-clinical fields are researching paths to treatment and prevention.

Everyone has a role to play. As a population, can we do more? Yes – we should embark on the largest clinical trial ever.

But first, some background…

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Pandemic, Elective Care, Urgent Care, and Informed Consent

As I write this, we are reading in the news about potential quarantines and lockdowns. In addition, there’s talk about canceling all elective surgical cases, leaving hospital operating rooms empty so beds will be available to take care of those affected by COVID-19.

Have all elective cases been canceled across the US? Well, no.

Weirdly enough, while most people are hunkered down, there is a sizeable cohort who are capitalizing on their time off…

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Complacency or Crisis?

In America, we seem to operate under two modes – complacency or crisis. Not much in between. With the COVID-19 pandemic in the background, we see the juxtaposition of Spring Break revelers on Florida beaches contrasted with geographic hot spots in full quarantine.

I’m of two minds on the coronavirus…

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No Good Deed Goes Unpunished – Chapter 10 to the 82nd Power: Adventures with TCPA

There are reportedly 1082 atoms in the universe. I have no idea how that estimate was made. To me, there are an equal number of stories of people/entities who try to do the right thing, only to later get burned.

Like CVS Pharmacy. What do we mean? Our blog has the details…

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Yale Refuses to Respect Its Older Physicians. EEOC Whacks Yale.

The Bible provides sage advice on honoring the elderly.

Wisdom is with the aged, and understanding in length of days. Do not rebuke an older man, but encourage him as you would a father, younger men as brothers.

And, of course, honor your father and mother. Not sure Yale New Haven Hospital got the memo…

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Family Practitioner Treats Patient for Depression While Sleeping with His Wife on the Side

It is not uncommon for patients to develop romantic feelings for their caregivers. Managing these emotions is critical. When these emotions are mismanaged, bad outcomes result.

A family practice doctor was treating a husband and his wife. To make a long story short – the patient’s wife (who was also the doctor’s patient) fell in love with him.

Did this development resolve professionally? If it did, we wouldn’t be discussing it. What can we learn?

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Medicolegal Issues When Dealing with Separated and Divorced Parents of Minor Patients?

Marital breakups are an common fact of life, and their effects on the medical care of minors are matters that all doctors who treat children and adolescents should understand.

Let’s look at some FAQs about this important topic…

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Is Sex with a Patient ALWAYS Unprofessional Conduct?

Most Boards of Medicine take a draconian view towards sex with patients. If a complaint is filed, and the sexual relationship began in the middle of a doctor-patient relationship, discipline likely will ensue. The interpretation is absolute.

That said – are there any exceptions?

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Seemed Like a Good Idea at the Time

Recently, a dental practice in Pennsylvania sent a letter to select families. I’ll be generous for the moment and assume it was a friendly reminder to bring their kids in to be seen.

Here’s the problem: The tone of the letter was accusatory. The accusation? Because these families had not scheduled a check-up for their child, the practice implied they were at risk of being reported for child neglect…

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A Prescription for Humanity in Medicine

Neurosurgeons (and surgeons in general) have a reputation for being cold. Deserved or not, the stereotype has stuck. Dr. Joseph Stern argues embracing humanity in medicine is the key to combating burnout and improving patient outcomes. He speaks from his own experiences and makes compelling arguments.

We are privileged to have him as our guest on this episode of the Medical Liability Minute…

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The Slippery Descent of Someone with Little Grip on Reality

Michael Arnstein ran a gemstone and jewelry business in Manhattan. He was irked by a number of negative online reviews. So, what did he do? He fired up Photoshop. Between 2014 and 2017, Arnstein forged over ten court orders that he submitted to Google to de-index pages with unsavory comments of his business.

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Paying Some Patients to Stay Away from Your Practice

I spoke with a fellow surgeon not long ago. He confided in me he recently encountered a patient that, in hindsight, he wished never walked through his door. Had he known how troublesome this patient would eventually become, he’d have paid a premium to make her go away…

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A Universe of Unavoidable Errors

A colleague, Robert Yoho, M.D., is writing a book about the practice of medicine. It included reflections on medical errors. I am sharing with his permission verbatim: “I had drinks with a sixty-year-old attorney who said he had never made a mistake with a client. I tried to be polite for a few minutes and asked him to expand on his statement…”

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No Good Deed Goes Unpunished – Chapter Gazillion

Dr. Kenneth Woliner is a physician in Florida. The Board of Medicine revoked his license. The Board used a surreptitious tape recording from a family member to render its judgment.

The 11th Circuit Appellate Court just ruled against the Board– opining “not so fast.”

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Combating Sexual Harassment in Healthcare: Protecting Your Employees, Your Patients, and Yourself

It is critical doctors take steps to protect their staff, their patients, and themselves from sexual harassment. These cases often rear their heads without warning. Many doctors have the power to do more than they realize. Those caught unaware pay a high price.

On this episode of the Medical Liability Minute, Medical Justice Founder and CEO, Jeff Segal, MD, JD, and Medical Justice General Counsel, Mike Sacopulos, JD, discuss key measures doctors can take to protect their employees, their patients, and themselves from sexual harassment.

They do this by dissecting a real sexual harassment case from Tennessee…

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Is Fish Oil, the Supplement, Now an FDA Felon? 

Let me start with the regulatory status of CBD (right, not fish oil). CBD, the non-psychoactive ingredient of marijuana or industrial hemp, supposedly treats everything under the sun now. Putting aside any claims of efficacy, what is its regulatory status? And why does the FDA have a beef with it?

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Consent Forms Fail to Meet 8th Grade Reading Level

In the US, we have never had so many college graduates. Presumably, they can read. And I get that consent forms used by physicians and hospitals need to be readable for all patients. So, a recent study grabbed my attention. Summarized – many consent forms are too challenging for patients to comprehend…

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A Hospital Dings a Doctor’s Reputation. Doctor Sues. Collects $6M Award.

Normally, when a doctor is subjected to peer review over safety concerns, it is a cage fight. If the doctor loses, his career will be on life support. His reputation damaged. Reports made to licensing boards and National Practitioner Data Bank. He will wander in the desert for 40 years.

Dr. Miguel Gomez never received THAT memo…

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How to Have Your Day in Court and Keep Your Nest Egg | Top Med-Mal Defense Measures with Super Lawyer Chris Schulte, JD

Let’s pretend you’re on trial for malpractice. The jury delivers a runaway verdict – a 5 million dollar judgement. You have a 1 million dollar malpractice policy. You could be on the hook for the 4 million dollar difference – but because you and the plaintiff agreed to invoke a certain kind of agreement, your nest egg is untouched. And you get to keep your house.

What is this agreement? And what other key strategies can doctors invoke to protect their interests before, during, and after a trial?

Listen to this episode of the Medical Liability Minute to find out…

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Dealing with Medical Board Complaints: Part II

In Part One, published last week, we went over high-level issues related to board complaints. Now, let’s look at specific scenarios…

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Dealing with Medical Board Complaints: Part I

Ask doctors what they fear the most and almost all will say being sued for malpractice, but another challenge poses no less a risk to their careers: a complaint to a state medical board. Understanding the process and being appropriately insured against a board complaint are vital for any practicing physician. Let’s discuss…

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In Pennsylvania, Supreme Court Decides It’s Possible to Sue Doctor Decade(s) Later for Med-Mal

This development reinforces a point we express to our member physicians every day. In the medico-legal space, you must expect the unexpected. And you can be certain aggressive plaintiff attorneys will use this legislation to resurrect meritless claims long thought dead. Before diving in, here’s a little history and background…

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What Doctors Get Wrong About Med-Mal Litigation | A Deep Dive with Florida Super Lawyer Chris Schulte

On this episode of the Medical Liability Minute, Medical Justice Founder and CEO, Jeff Segal, MD, JD, and Florida Super Lawyer, Chris Schulte, JD, discuss what most doctors get wrong about medical malpractice litigation – and what they can do to increase the chances they’ll get their case dismissed or prevail in court. Chris Schulte, JD, is a seasoned medical malpractice defense attorney from Tampa, Florida. We are privileged to have him as our guest on this episode of the Medical Liability Minute…

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Helpful Hint to Plaintiff’s Attorneys

I’m already detecting the venting some physicians are channeling. Some are saying, “Segal, what are you doing? Why are you making it easier for a plaintiff’s attorney to collect cash?” Let me explain – there is a method to this perceived madness. And this hint benefits doctors as well…

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Forcing a Patient to Take One for the Team. Ethics Takes a Dive.

We have all heard of some doctors refusing to care for the sickest patients because embracing such a risk could impact their outcome statistics. Colloquially known as cherry-picking. Risk adjustment should address that concern. Yet, it still happens. Here’s a new one – keeping a patient alive much longer than the family would accept to keep the transplant program on safe footing and away from federal scrutiny…

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Dental Practice Fined $10k for Improperly Responding to Online Reviews

Elite Dental Associates, a Dallas dental practice, just wrote a check for $10,000 to the Office of Civil Rights (OCR) for Dept. Health and Human Services. The reason. A HIPAA violation. What “egregious” act did the practice commit? Responding to negative reviews on Yelp…

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Do Health Insurance Carriers Have to Pay for Injuries Caused by DUIs?

In the news. Patrick Conway, the president and CEO of Blue Cross Blue Shield of North Carolina was arrested and faces charges of driving while impaired and reckless driving after an alleged alcohol-related automobile accident in summer, 2019. In additional, because two minor children were in the car with him, he also faces charges of misdemeanor child abuse. My point is not to pile on – but use the example to analyze what happens to the average Joe with a fender bender, a DUI, and an injury. And a giant hospital bill.

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“Doctor, I Need You to See This Patient”

When a nurse beckons, and says she’s worried, you should listen. A recent paper supports this assertion. The title is self-explanatory: The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours. The article concluded that nurses’ pattern recognition and sense of worry provides important information for detecting acute physiologic deterioration. How did our Nostradamuses do for 3,000+ patients?

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Cyber-stalker Criminally Indicted for Defaming Physician 

In Texas, there’s a law which makes it a felony to use the name or persona of another person to create a web page or post on a social networking site if the action is taken to harm, threaten, defraud or intimidate the other person. A patient in Austin had a beef with his ophthalmologist. This patient supposedly posted over 100 reviews from 20 different aliases. The origin of the dispute lies in a $45 check. What was his beef? And how did the ophthalmologist overcome him?

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A Doctor Attempts to Murder an Attorney

Everyone knows we have an opioid crisis. Now we have an opioid treating doctor with his own crisis. Dr. Daniel Schwartz is a pain management physician in Ohio. He was charged with conspiracy, attempt to possess, and attempt to distribute a controlled substance. The conspiracy charge is not a typical physician indictment. Particularly since his attorney described Dr. Schwartz as a “wonderful, gentle guy.” What happened?

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A Doctor’s Greatest Nightmare. Indictment. Prison. Then the Road to Redemption.

Dr. Roy Shelburne was, by all accounts, living the dream. He was leading a successful dental practice. He was providing high-quality care to patients who otherwise would’ve gone without. And he was serving a community of friends and family.

In 2003, the FBI kicked down his door. Over the next few years, his every word was scrutinized. A few years later, he was indicted and found guilty of healthcare fraud, racketeering, money laundering, etc. Now he teaches others how to avoid fatal mistakes. It is our privilege to have him as our guest on today’s episode of the Medical Liability Minute.

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What Do You Want to Get from this Visit?

“What do you hope to get from this visit?” This was the introductory question a physician asked me when I first met him. I prioritized my goals and started a brief narrative. And away we went to the races. The more I thought about this simple question, the more brilliant I thought it. First, it sets a tone that my priorities are important, and a successful visit will be my determination, not the doctor’s. So, find out what matters the most to me.

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Getting Sued Even When You Never Saw the Patient

Medical bulletin boards and blogging sites caught fire about a recently decided case in Minnesota, Warren v. DinterThis glaring headline noted that the essential law underpinning a medical negligence claim – that a doctor-patient relationship must exist for a plaintiff to prevail – was overturned. Doctors are understandably very concerned over this. The implications for medical practice if that were true would be devastating – any doctor could actually be liable to any patient for, well, anything…

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A Severely Mentally Ill Patient Sues You. Now What? 

A Medical Justice member was served with a summons of a case filed in federal court and signed by the clerk of the court. The patient filed pro se – so no lawyer was involved. The surgeon has a limited window of time to respond. Absent a timely response, this patient could receive a default judgment in her favor. This patient appears to exhibit some of the hallmarks of schizophrenia. The summons reads like word salad. There’s no template for events like this – so, here’s what happened…

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The Man Who Told Yelp to Buzz Off. He Succeeded Beyond His Wildest Imagination.

Heard of Botto Bistro? It’s a pizzeria in the Bay Area. Chef Davide Cerrentini, who emigrated to the US in the 90s, opened the restaurant’s doors in 2009. Cerrentini is famous for asking happy diners to give him a one star Yelp review. That’s right. One star. But here’s the thing – he is enormously successful…

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Making Primary Care Cool Again with Dr. Josh Umbehr and Atlas MD

Dr. Josh Umbehr is a leader in the DPC (Direct Primary Care) movement. Briefly defined – it is prepaid primary care. And it is revolutionizing primary care across the country. This week, the Medical Justice Blog features a new episode of our podcast – the Medical Liability Minute. On this episode of the Medical Liability Minute, Dr. Umbehr and Dr. Segal discuss multiple topics: the DPC movement’s history, its impact on patient outcomes, and what doctors can do to participate….

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Patient Feedback: A Goldmine for Your Practice – in 4 Steps

Patient feedback presents doctors with a chance to look at themselves from the public’s perspective. While this perspective is not always accurate, you shouldn’t discard it. You risk throwing away information that could be used to refine your quality of care (outcomes, safety, and patient experience). This piece will teach you how to make the most of that feedback in four steps…

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A Century of Brutal Call Schedules. The Libby Zion Case. And Cocaine. 3 Converging Stories.

Dr. William Halsted is known as the Father of Modern Surgery. There’s a reason for this – objectively speaking, he was a supremely talented surgeon. The techniques he invented saved lives. But his work-life balance was nonexistent. The man did not sleep. And that lack of sleep shaped the behavior patterns of physicians-in-training for decades…

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Physicians and Gallows Humor. Is It Unprofessional?

Gallows humor is defined as grim and ironic humor in a desperate and hopeless situation. Physicians frequently use gallows humor. They do it to blow off steam. To head off compassion fatigue. Is it unprofessional?

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Defeating Internet Defamation: How Doctors Crush Lies Online

Platforms like Google, Healthgrades, Vitals, and Yelp present the public with information. Information about their health, information about their potential physicians, and information about their local healthcare systems. These platforms exist to educate the public. Overall, they succeed. Unfortunately, their popularity has increased the frequency physicians and dentists are defamed online. Fortunately, solutions exist…

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When Can You Refuse to Treat a Patient?

As you have likely heard, the relationship between a doctor and a patient is a contract. The patient consents to be treated and the doctor consents to treat.  In that purely legal sense, the doctor would therefore have an unfettered right to refuse their role. Of course, that is not actually so. There are critical limitations on when a doctor may refuse to care for a patient…

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New Patient Comes in For Dental Exam. Surprise. He’s 450 Pounds. Is Americans with Disabilities Act Triggered?

We received a call from a dentist in the Midwest. A week earlier someone called for an appointment. He wanted a run of the mill check-up. First available appointment was Friday at 4PM. Just before closing. In the waiting room, the patient appeared morbidly obese… 

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FDA and Drugs Used in Executing the Death Penalty

For years, the FDA took the position that it did not have authority to regulate drugs used for executions – or in the alternative – it had discretion to avoid review. If the intended use is death, it’s hard to argue that a drug is safe and effective for death. Of course, you can make the argument, but saying something is safe for death doesn’t jive with our traditional notions of safety – namely the mitigation or avoidance of harm or death…

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5 More Golden Rules Physicians Should Follow When Responding to Patient Reviews

In February, we published two articles related to patient reviews. One piece was published online. The second was made available for download. Both remain available, and we encourage our readers to study them. Considering the overwhelmingly positive reception both pieces received, we decided to return to the topic and discuss five more golden rules physicians should follow when responding to online reviews. Read the full article to learn how you could win one free HIPAA compliant response to a patient review of your choice…

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Man Bites Dog

If a dog bites a man, that is not newsworthy. When a man bites a dog, it makes news. A patient sues a doctor. Not newsworthy. Doctor sues a patient. That’s a headline. Dr. Leonard Hochstein, star of the reality TV series “The Real Housewives of Miami” is suing two patients, Nicole George and Kristen LaPointe. The two wrote negative online reviews about the practice. As one might expect, an emotionally-charged reaction followed…

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A Good Deed Ends in Arrest

Casey Smitherman is superintendent of a small school district in the Midwest. The town, Elwood, Indiana, has 8,500 people and struggles with serious poverty. Many of its students do not have adequate resources. Ms. Smitherman took a specific student to a medical facility and checked him in for evaluation using her son’s name…

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A Serial Malpracticer

I had never heard of the phrase “serial malpracticer.” It seems to apply to Dr. Spyros Panos, an orthopaedic surgeon who surrendered his medical license six years ago. An arbitrator awarded $140 million to resolve 255 medical malpractice lawsuits in New York. Dr. Panos refused consent to settle. What is shocking is how long it took for this practitioner to be ousted…

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5 Golden Rules for Responding to Negative Patient Reviews | Featuring 4 Real Life Examples

Negative patient reviews are a fact of life. You can’t avoid them, and you shouldn’t ignore them. Instead, deal with them by leveraging the techniques you’ve honed as a physician – diagnose the problem, synthesize a cure, and administer treatment. Today, we are sharing the essentials ingredients with the public – addressing reviews from anonymous patients slamming doctors online.

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Perfecting the Patient Dismissal Letter – How to Avoid Patient Abandonment and Other Medicolegal Complications When Terminating the Doctor-Patient Relationship

At Medical Justice, we’ve co-authored hundreds of patient dismissal letters with our clients. The objective of these letters is simple: Help our clients (and indirectly, their patients) formally end the doctor-patient relationship. The purpose of this article is to teach the public how to distinguish a competent patient dismissal letter from an incompetent one.

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How Doctors Are Using (And Abusing) Facebook to Market Their Practices

Facebook has been with us for fifteen years. In three years, it will old enough to vote. What an invigorating thought. In those fifteen years, Facebook has distinguished itself as one of the most powerful advertising platforms on the planet. It has also made a name for itself as a regulatory compliance hazard.

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Press Ganey Scores and Unicorns

A unicorn is a mythical creature. It does not exist. Which brings me to Press Ganey scores. For those of you entirely immune to the numeric patient satisfaction benchmarks, Press Ganey is eponymous with HCAHPS scores mandated by CMS. HCAHPS was initially rolled out to allow comparisons between institutions providing inpatient care. The usefulness of these scores is subject to debate…

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Why Do Doctors Take Med-Mal Lawsuits So Personally?

Here’s a question that perplexes many plaintiff’s attorneys. I hear it all the time. Why do doctors take medical malpractice so personally?

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47 Tips to Keep You Away from My ER

Recently, we published a piece by Dr. Rada Jones on the 68 Laws of the ER. She returns now for prescient and timely advice to patients on how to stay out of the ER. The best way to do her post justice is to present it as is without editorial or comment. Enjoy!

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Doc, How Long Do I Have to Live?

When a patient has a difficult diagnosis, they want answers. They want to know how to structure the time they have left. It’s also a question that determines whether a patient qualifies for government funding for hospice. A case is currently marinating in the 11th US Circuit Court of Appeals which addresses civil and potential criminal liability based on the medical judgment of whether a patient will last beyond 6 months…

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Board of Medicine Gives Reprieve Enabling Sexual Predator to Practice for 18 Years. Justice Finally Served.

Dr. Johnnie Barto pleaded guilty in December 2018 to sexually abusing two family members. He also pleaded no contest to sexually assaulting 31 children, most of them patients. Dr. Barto is 71 years old. He appeared before the Pennsylvania Board of Medicine in 2000 on administrative charges he molested two young girls in the 1990s. And yet – the charges were dismissed. How did this happen? And what finally brought him to justice?

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Federal Government Considering Plunge into Regulating Stool

C. difficile is a thorny problem for hospitalized patients because physicians have generously prescribed progressively stronger broad spectrum antibiotics, killing off good bacteria, making it easier for the bad bacteria to proliferate.

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Before and After Photos. Do You Own Them? Or Not?

Many aesthetic surgeons and dentists use before and after photos on their web site to market their practices. They are demonstrating to the public at large what they can reasonably expect if they select their practice. Presumably, the patients depicted have given you permission to showcase them. But do you own the photos? The answer is more complex than many practitioners realize…

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Medspa Slammed with Class Action Lawsuit for Violating TCPA

Ever heard of TCPA? Most people haven’t. It stands for Telephone Consumer Protection Act. And it’s the second most frequent federal lawsuit after employment law claims. And now a medspa is on the receiving end…

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Nursing Home Sues Law Firm Over Ads

A friend and colleague, Doug Wojcieszak, recently posted an article on his blog, Sorry Works, about responding to criticism in health care.  Actually, it was more than just criticism. A law firm ran ads soliciting plaintiffs against a nursing home. The nursing home sued the law firm. The story and Doug’s response are worth reading.

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Who’s Your Daddy?

I may not be clairvoyant. But I know one family that will receive a gigantic check soon. A 29-year-old woman had been in a persistent vegetative state for about ten years. She was involved in a near drowning incident. Unbeknownst to the staff at Hacienda Healthcare, a long-term care facility, the patient was pregnant. She started to moan and gave birth on December 29th.

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Can NC Physicians Legally Prescribe Meds to Suffering Terminally Ill Patients to Precipitate a Peaceful Death?

One role of the physician is to relieve suffering. Adult patients, who are mentally competent and terminally ill, sometimes implore their physicians to help them achieve a more peaceful death to alleviate either actual or impending suffering. Broadly, what risk might a physician face engaged in such prescribing?

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68 Laws of the ER

Every now and then you read a piece about life in the medical trenches that fully hits the mark. Dr. Rada Jones is an Emergency Physician who did precisely that. She penned the 68 Laws of the ER. The best way for me to do it justice is to present it as is without editorial or comment. Enjoy!

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Fire Her and Yank Her License

Is practicing medicine a right or a privilege? Most physicians treat it as a privilege. They appreciate being given the responsibility of earning a patient’s trust and caring for them.  The vast majority of physicians conform to established norms. It doesn’t mean we are all saints. And not all patients are loveable or even likeable. Which brings me to the case of Cleveland Clinic resident, Lara Kollab. She engaged in anti-semitic invective on Twitter.

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Is Facebook Engaged in the Practice of Medicine?

Facebook is watching us. And if it senses one of its users is contemplating suicide, it will flag his posts and attempt to intervene. Mason Marks, MD, JD, recently posted an article that asks the following question. Should this practice be regulated?

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The Most Frivolous Lawsuit Contest Redux: Part II

Medical Justice takes aim squarely at deterring frivolous litigation. And we provide remedies for those unjustly sucked into such lawsuits. Ten years ago, we ran a contest for the Most Frivolous Lawsuit. The “winning” defendant received a free year of membership in Medical / Dental Justice. Recently, we decided to hold that contest again. We highlighted two of our winners last week; the other two follow – read on…

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The Most Frivolous Lawsuit Contest Redux: Part I

Medical Justice takes aim squarely at deterring frivolous litigation. And we provide remedies for those unjustly sucked into such lawsuits. Ten years ago, we ran a contest for the Most Frivolous Lawsuit. The “winning” defendant received a free year of membership in Medical / Dental Justice. Recently, we decided to hold that contest again. Today, we’re ready to announce two of our “winners” from our most recent contest…

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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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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 meeting […]

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

Here’s a 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) 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 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 sitting. They are staged. A common example is a patient who 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 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 acknowledgment 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 of over 90%. This means most are not receiving these medications. The reason is cost. Each treatment costs 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, Anyway?

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) 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 […]

Posted in Healthcare Reform | 12 Comments |

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 […]

Posted in Healthcare Reform | 5 Comments |

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 […]

Posted in Healthcare Reform | 5 Comments |

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 […]

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Avoiding Liability When Sending Specimens

Doesn’t happen often. But, when it does, expect a potential s*%#storm. The 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 have 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. The 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 of malicious […]

Posted in Healthcare Reform | 1 Comment |

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