Healthcare Reform - Medical Justice

The Economics of Brain Death

August 15, 2024January 10, 2014 by Jeffrey Segal, MD, JD

Jahi McMath was declared brain dead following complications related to tonsil / sleep apnea surgery at Children’s Hospital in Oakland California. Jahi developed post-op bleeding and went into cardiac arrest. Several doctors examined her and declared she satisfied criteria for brain death. And she was indeed declared dead. Under California law, brain death equals death.

The hospital wanted to remove Jahi from the ventilator. The patient’s family filed a court action arguing that the hospital should not have the power to do so. Removing the ventilator would cause cardiopulmonary arrest. The family believed it was premature to make that call.

One more item on HIPAA to do list

August 15, 2024January 3, 2014 by Jeffrey Segal, MD, JD

We encrypt laptops and cell phones. We get business associate agreements to make sure our vendors protect our patient’s confidentiality. We have data breach policies in place. That’s already a load. There’s always something else to do. On August 14, 2013, Dept. Health and Human Services settled with Affinity Health Plan, a non-profit managed care … Read more

Are you liable when you do IMEs or insurance exams?

August 15, 2024December 27, 2013 by Jeffrey Segal, MD, JD

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 100% of the details of every article, I think the messages are salient, on target, and fully relevant. Please give us your feedback – and let us know if you find the series helpful.

I am scaling back my orthopedic surgery practice because I am moving towards retirement. I supplement my income by doing independent medical examinations (IMEs) for defense firms and insurers in personal injury cases.

One of the reasons that was appealing is because it seemed a low risk endeavor. Now that I am so close to retiring, I wanted to keep my risk of being sued as low as I can. The problem is that I am now actually being sued for malpractice over an examination that I performed on someone I examined who was suing her landlord over a fall.

She claims I injured her back by asking her to bend and twist so that I could evaluate the area of a spinal fusion she received after a car accident several years ago. She also claims to have re-injured her back in the fall.

What’s going on here? She knew that I was working for the defense and she even signed a form that said that she understood my seeing her for the IME did not constitute a doctor-patient relationship. How can she sue me if I am not technically her doctor?

When a patient prefers care that is NOT the gold standard of care?

August 15, 2024December 20, 2013 by Jeffrey Segal, MD, JD

You are a surgeon and were just called to the ER to see a new patient. He’s a nurse practitioner who walked in describing abdominal pain and a low-grade fever. You determine he is in the early stages of acute appendicitis. You recommend an immediate appendectomy.

He explains he just started his job at a clinic and his health insurance coverage has not been initiated. Oh, crap.

Notes from a Plaintiff’s Attorney: Using the medical record to sue a competitor for defamation

August 15, 2024December 13, 2013 by Jeffrey Segal, MD, JD

I am a surgeon in a small community hospital.

I performed an endoscopic carpal tunnel release on a patient. I have performed hundreds, if not thousands, of such procedures. I am fully experienced in performing that procedure.

After surgery, the patient described some residual complaints. I believed these would resolve with time. Rather than wait and see me for follow-up, the patient went to my competitor for a second opinion.

This competitor told the patient I performed the surgery ineptly. He said that he needed to re-operate. I tried to dissuade my patient but he explained he now had little faith in my opinion. The patient transferred his care to my competitor. The second surgery was consummated.

Your Patient Demands You to Pay for HIS WIFE’S treatment. WTF!

August 15, 2024December 6, 2013 by Jeffrey Segal, MD, JD

Recently, a doctor treated his patient for erectile dysfunction and decreased sexual drive. The patient had multiple reasons explaining these two conditions. He was on a SSRI. He had a history of alcohol abuse. And several other medical issues. What was also clear was that he had low free testosterone levels for his age cohort; and he had clinical hypogonadism.

The doctor discussed treatment with exogenous testosterone. They discussed the risks, benefits, and options – including low sperm count and fertility issues. The patient said he understood and gave his blessing to proceed.

What Makes a Great Surgeon?

August 15, 2024November 29, 2013 by Jeffrey Segal, MD, JD

An article recently published in New England Journal of Medicine studied video submissions of 20 experienced Michigan bariatric surgeons performing laparoscopic gastric bypass surgeries. The videos were rated in a blinded fashion according to surgical skill. The authors then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients.

The authors concluded that skill – as measured on videotape – varied widely. “Greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department.” In other words, the better the technical prowess, the better the outcome.

Asking a Patient for Feedback. What NOT to do.

August 15, 2024November 22, 2013 by Jeffrey Segal, MD, JD

Bear with me. This introduction is not about a doctor-patient interaction. But, it will illustrate a core principle on “best practices” in asking patients for feedback or reviews. Actually, it will illustrate “worst practices.

I went to upgrade a phone with my carrier; a carrier that shall not be named – but it rhymes with lint. I had interacted with this customer service rep previously; an interaction that ending in my spending two hours on the phone with customer support addressing charges that never should have been billed. What a time-waster.

Notes from a Plaintiff’s Attorney: Should I Apologize?

August 15, 2024November 15, 2013 by Jeffrey Segal, MD, JD

You made a mistake; not a harmless mistake. You are, of course, obligated to reveal that clinical fact to the patient.

Frankly, you also feel terrible about it because you are a good doctor and care about your patients.

You now face the question of whether to actually offer an apology to your patient.

File This Under No Good Deed Goes Unpunished…

August 15, 2024November 8, 2013 by Jeffrey Segal, MD, JD

Many years ago, I treated a patient for neck and arm pain. I removed his cervical disc. The procedure was uneventful, and by all measures, he should have returned back to work quickly. (Many years later, a surgeon removed a cervical disc fragment from me and I went back to work part-time the following day). The patient, a postal worker, did not go back to work quickly. In fact he never went back to work at all. He said he was too weak to even lift a cup of coffee to his lips. He had zero objective neurologic deficits – and I was skeptical he was disabled.

Unbeknownst to me, this postal worker bragged to a fellow employee how he was scamming the system and would soon be collecting permanent disability paychecks — all courtesy of Uncle Sam. Did this new confidante succumb to envy? Hell no. He was a bigger person than that. He called his boss and a sting operation was birthed.

+ More