Jeffrey Segal, MD, JD - Medical Justice

Patience is the Hunter’s Greatest Weapon

August 15, 2024November 2, 2010 by Jeffrey Segal, MD, JD

by Joseph Horton, MD

I was raised by a pair of criminal lawyers in New Orleans. Being raised by wolves is not intrinsically pleasant, but it does give one a certain sense of being invulnerable to specious attacks—like while being on a witness stand. The inevitable education about courtroom and trial procedure doesn’t hurt either.

Of the two, my mother was the litigator. Tiny in size (I’m 5’3” tall and I dwarfed her), in court she stood, oh, about 11 feet tall, breathed fire, and was bulletproof. It was not a good idea to cross her there—or anywhere else, come to think of it.* One of the things that she drilled into my head was the First and Second Laws of cross-examination.** The First Law is never to ask an opposing witness a question you don’t know how he’s going to answer. The Second Law covers what to do on the very rare instances when it is OK to ask a question you don’t know how they’re going to answer: refer to the First Law.

It always amazes me how many opposing attorneys missed that lecture. Probably half the time I’ve been to trial as an expert witness, I get asked a question that there is no way they can know how I’ll answer. My best guess is that they believe that, since I really am physically small (and gray and nebbish-looking), I can’t possibly help anyone’s case but theirs. Best bet is to look as unassuming as you can, and wait for the opening. (Remember that patience thing?) Then overwhelming force usually stops the attack.

A couple examples:

Curbside Consults are Kosher: A Breath of Fresh Air

August 15, 2024October 29, 2010 by Jeffrey Segal, MD, JD

How often are we told as doctors? You can’t do this. Don’t do that.

We are sometimes made to feel as if we are two-year-olds.

Now for the good news. An article published by Victor Cotton, MD, JD* pushes the opposite position. Curbside consults. If you follow the basics, you’re on safe ground. A breath of fresh air.

As a neurosurgical resident, we were cautioned to avoid curbside consults. Attending physicians admonished us to get the formal consult. At Ben Taub County Hospital, our service was busy. The internal medicine service was busy. Everyone was busy. The one commodity we did not have was time.

I was forced to use the following strategy to coax an internist to see my patient – one suffering from a head injury, in the Neuro-ICU, with a gazillion lines penetrating his skin and a blood sugar of 450.

“I know you are really busy and I hate to bother you. I have a patient with severe head injury and a blood sugar of 450. Do you give one amp or two amps of insulin?”

“What! Don’t do anything. We’ll see your patient in a matter of moments.”

Mission accomplished. The more stupid I sounded, the easier it was to get a consultant to the patient’s bedside.

That made no sense to me then. It makes no sense to me today.

Recent Case Highlights the Importance of Protecting Your On-Line Reputation

August 15, 2024October 28, 2010 by Jeffrey Segal, MD, JD

Michael J. Sacopulos, Esq. Last month, a trial was conducted in Queens, NY. The facts of the case are not particularly unique and it was the type of trial that could be conducted in most courtrooms across our country on any given day. The judge instructed the jurors before the start of the civil trial … Read more

Tort Reform Is Dead. Now What?

August 15, 2024October 26, 2010 by Jeffrey Segal, MD, JD

More than a few state Supreme Courts have overturned tort reform laws in the past year. The concept is that everyone is entitled to a trial by jury, and that the courts, not legislature, should decide how much is enough. Oddly enough, the legislative branches are often opposed to tort reform as well. Whether we agree or not is irrelevant. Enough Supreme Courts have spoken that we concur that tort reform certainly in jeopardy.

What’s the next step? Do we just “stay the course,” continue the trend towards increasingly extensive defensive medicine? That is a waste of the physician’s resources as well as the patient’s time and money. The insurance companies can’t care very much for it either, since raising rates to compensate for such costs is easier said than done these days.

Other Concealed Faults of the New HCR; The Case For Universal Healthcare

August 15, 2024October 21, 2010 by Jeffrey Segal, MD, JD

When the new health care reform legislation was presented to the American people, one of the pushing points was that one could keep dependent children on one’s policy until they turn 26. But guess what? Not really. If your son or daughter’s employer offers health care of any kind, s/he MUST take it from the employer. It doesn’t matter if that coverage is horribly inadequate. It doesn’t matter if it costs an arm and a leg and still doesn’t actually cover anything. Yep, s/he still has to take it from the employer, and you cannot cover your child on your policy any more. That’s right, it is forbidden. So your young adult dependent MUST take the inferior coverage at the higher price. Think it’s not happening? All over the nation, companies are being sold similarly overrated policies as employers scramble to lower costs. Some do it because of economic conditions, some because they’re about to shoulder costs they didn’t have before the law, and some because reducing costs is what corporations do. Regardless, if an employer offers it, you’re stuck with it, no matter how inadequate it may be.

Be Careful What You Say to a Patient’s Family Members

August 15, 2024October 19, 2010 by Jeffrey Segal, MD, JD

by Michael J. Sacopulos, Esq.

A recent case from Missouri highlights the importance of keeping patient’s medical information confidential — even from that patient’s family members. A 23 year old female sustained injuries to her right arm. While being treated for these injuries, a patient alleges that a nurse informed the patient’s brother and aunt of her being HIV-positive. The patient went on to state that the same nurse announced her HIV status in a hospital corridor while transporting her from the surgical recovery room to her hospital room.

The case ultimately went to trial.

Some Hidden Gems in the Patient Protection and Affordable Care Act

August 15, 2024October 18, 2010 by Jeffrey Segal, MD, JD

Given the wordiness of the Patient Protection and Affordable Care Act, it is no surprise that some surprises lurk deep within. A few selected pearls: Providers must return any Medicare overpayment within 60 days after identifying such an overpayment. An overpayment not returned during the 60 day period can be deemed a violation of the … Read more

Report Expects Medical Malpractice Costs To Rise

August 15, 2024October 15, 2010 by Jeffrey Segal, MD, JD

This week a new report was released, indicating that medical malpractice liability costs are likely to rise for both physicians and hospitals. The study, performed by Aon Risk Solutions, cites both claim frequency against hospitals and increased claim severity as the two driving forces behind the anticipated increases in premiums. From their release:

U.S.-based hospitals are expected to face more than 44,000 claims arising from incidents occurring in 2009, according to the report, “Hospital Professional Liability and Physician Liability Benchmark Analysis,” which Aon Risk Solutions put together with the American Society for Healthcare Risk Management.

Read more

Win the Battle; Lose the War

August 15, 2024October 12, 2010 by Jeffrey Segal, MD, JD

We heard of a doctor who performed a routine injection on his patient. No written consent. Should have been plain-vanilla and without consequence. Until he dropped her lung. The patient was sent to the ER, had a chest tube placed, and was out of the hospital in a couple of days. The doctor never visited … Read more

The Most Outrageous HIPAA Release – from Angie’s List

August 15, 2024October 12, 2010 by Jeffrey Segal, MD, JD

Most of you know Angie’s List as a consumer rating site. They launched as a web portal, rating assorted service providers such as roofers and plumbers. Believing that the practice of medicine is little different than roofing and plumbing, they dipped a toe into rating doctors.

One of our beefs with their system is that doctors are foreclosed from responding to outrageous posts. The reason: federal and state privacy laws. Whereas roofers and plumbers can tell their side of the story, doctors cannot.

Angie’s List has doubled down by offering a service to resolve complaints patients may have with their doctors. This is where the most outrageous HIPAA Release emerges. In an effort “to be fair,” Angie’s List appears to require the full medical record to make its determination. Do you think they have experts from the specialty in question deliberating over the material?

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