From the
PRESIDENT
JOHN L . ROBERTS , MD GLMS President | john . roberts @ glms . org
BLESSED ARE YOU WHO HAVE NOT BEEN SUED
Blessed are you who have not been sued ! I have been sued four times in my 40-year career , probably not bad for a high-risk specialty such as neonatology . Like pediatrics and obstetrics , patient care decisions I make involving a newborn put me at malpractice risk for 18 + years .
The first suit occurred shortly after I had finished training . One Saturday , as I was going out to get the morning paper , a sheriff ’ s car pulled up beside me and the sheriff said , “ Mr . Roberts , you are hereby duly served !” and handed me an envelope containing a hand-written pro se pleading . “ Pro se ” means the person was representing himself and a “ pleading ” is a one-page legal form that identifies the complaint and makes the request for a trial to settle the matter . Over a cup of coffee , I read the following : “ I , Mr . X , do hearby sue you , John Roberts , for performing a bad circumcision . I want $ 20 million dollars . I want $ 10 million for my son who had the bad circumcision , $ 5 million for his mother and $ 5 million for me , for pain and suffering , and all that stuff .” This was all very curious as , at that time , I had never performed a circumcision . I called my insurance company who reassured me that they would take care of it . About two weeks later I received a phone call at home . It was Mr . X . “ Mr . Roberts , sir , I understand you have talked to a lawyer about my case . Now Mr . Roberts , I am sure two reasonable men could sit down and come to some agreement without involving lawyers .” I replied that I have malpractice insurance so that attorneys can take care of such matters for me . Six months later the courts threw out the case . No one could get in touch with Mr . X .
The second case involved a 26-week gestation baby born in 1989 , when the survival of such small babies was less than 50 percent and most survivors had significant developmental disabilities . The baby developed hyperkalemia while on parenteral nutrition and had a cardiac arrest , was successfully resuscitated , but died at three months of age while still ventilator dependent and with hydrocephalus from an intraventricular hemorrhage . The mother wished to withdraw care . Six months later , the suit was filed ; after two years of expert testimony and depositions , the case was settled for $ 25,000 . I expect the plaintiff ’ s attorney got most of it . I think of this case every time I write for IVs with potassium ; certainly , I might order far more blood chemistries than necessary .
My third suit involved the death of a baby within 48 hours of discharge . The baby had been born four weeks early , but two weeks later the baby was feeding well , gaining weight and was sent home with her teenage mother . I had arranged for a home health nurse to visit the family the next morning . Two days later , the baby was dead on arrival in the ER ; this was attributed to SIDS . The malpractice suit was filed a few months later and the case remained active for two years . Multiple experts on my side gave testimony regarding SIDS and overlaying and the standard of care relating to the discharge of premature babies to home . The plaintiff contended that I sent the baby home too soon . The home health nurse ’ s documentation showed that she tried to see the baby at home multiple times the morning after discharge , but no one answered the door . The mother swore under oath that the nurse must have gone to the wrong apartment and that she and baby were home . The case ended when the baby ’ s maternal grandmother finally testified that her daughter had actually been at the baby ’ s father ’ s house , against her own mother ’ s advice .
Finally , there was the very , very sick premature infant at whose bedside I literally stayed at all night . The baby required ventilation , blood volume expansion and vasopressors for days . I have had few babies so sick as this one . We made it through the night and three weeks of hospitalization . The baby was breast feeding and had breast milk jaundice . I had stopped checking the bilirubin levels . But on the weekend prior to the anticipated discharge , the baby became acutely jaundiced and quite ill . He looked septic , and was given antibiotics . The baby improved and went home . Pleading papers came four years later . The baby had delayed motor development and findings consistent with kernicterus . After two years of depositions and expert testimonies the case was settled ; my part was $ 200,000 , which I do not begrudge . The child will have a difficult life .
These suits , and fear of others , have affected how I practice medicine . They have taken a toll on my psychological wellbeing . The KMA is again working to reform the tort laws . Our legislators need to hear these stories and others like them . They need to know that the fear of malpractice suits causes us to order unnecessary tests and to keep patients in hospitals longer . Frivolous suits shade our feelings toward our patients and make our careers less satisfying and often shorter . The fear of malpractice , and the cost of malpractice insurance , dissuades family physicians from delivering babies , worsening rural access to obstetric care . Contact your legislators and tell them your stories . If you have not been sued , count your blessings and then contact your legislators .
Dr . Roberts is a neonatologist with the University of Louisville Physicians and the Vice Dean for Graduate Medical Education and Continuing Medical Education at the University of Louisville School of Medicine .
MARCH 2017 5