relentlessly protecting physicians mostattainfertilitycenters.com/cops/ppt/jeffrey segal - medical...
TRANSCRIPT
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Relentlessly protecting physicians most
valuable asset – their reputation
www.medicaljustice.com
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Jeffrey Segal, MD, JD
Founder & Chief Executive
Officer
Medical Justice Services
& Dental Justice
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• Decade in practice
• Tort reform state
• A letter
One surgeon’s trajectory
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• Ten years of data
• Programs:
– Deter and respond to frivolous suits
– Prevent online defamation; manage conflicts
One surgeon’s trajectory
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• Lawsuits can be prevented:
• attention to key documents before treatment is rendered
• by communication
Setting the Stage
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Escalation of Conflict
• Fixing problems sooner is better than later….
Nasty Letter
▼
Demand for Refund / Internet Rant
▼
Request for Records
▼
Intent to Sue
▼
Suit
▼
More Internet Rants
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Frivolous Lawsuits
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Does This Case Sound Familiar?
• Urologist performed vasectomy; post-op sperm count- negative
• Patient’s wife - pregnant one year later
• Surgeon was sued.
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• NEJM Study (2011) • 7.5% of all doctors sued each year
• High risk specialists:
• Up to 19% per year • Lifetime risk: 99%
• “Low risk” specialists
• Lifetime risk 80%
Lawsuits: How Frequent?
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• NEJM Study (2011) • Only 20% of lawsuits associated with
payment
Lawsuits: How Frequent?
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Avoiding Frivolous Lawsuits
• Cases linger for years
• Nuisance settlements.
• Settlement for $1: Data Bank
• Some states report settlements on Internet.
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Deter Frivolous Lawsuits 101
Deter Hired Gun Experts • Physician / Patient agreements: • Use experts within your specialty and in
good standing in your professional society
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• Spine operation • Plaintiff’s expert’s testimony egregious
Hired Gun
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Hired Gun
>130 medical malpractice cases; for defense only 3 times
•Jones v. Sugar VERDICT $2,786,000
•Leon v. Billings VERDICT $1,250,000
•Skaggs v. Tupper SETTLED $1,750,000
•Conwell v. English VERDICT $1,016,306
•Smith v. Quality SETTLED $5,000,000
•Terry v. Lindell VERDICT $10,000,909
Action…… Expert CENSURED - misrepresenting evidence
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• Case CL: Pre-existing case : Ohio surgeon sued for lap-cholecystectomy.
• Plaintiff’s expert:
• 7 year story
• 9 year story
Frivolous Lawsuits
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0
10
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60
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100
1 2 3 4 5 6 7 8 9
Year Post-Op
Lik
elih
oo
d In
fec
tio
n
N=1
Sentinel Event
Time Versus Likelihood of Infection
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Prevention / Treatment
• Upfront
• Agreement on who experts can be.
• Later
• Hold experts accountable
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When Things Don’t Go Right
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Art of Communication
• Surgeon intended to do liposuction • Performed abdominoplasty (tummy tuck) • Clinical result great. But- greater risk, longer
recovery period, bigger scar
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Art of Communication
• Rx: • Apology • Root cause analysis • Explained what went wrong • Refunded money • Paid for help around house
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Art of Communication
• Managing expectations • Money • Treatment • Outcomes
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Deposits for Surgery
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Deposits
• No deposit, 20%, 25%, 100%. • In writing, signed
•Options: re-schedule; be flexible… •Hobson's choice
• Unwanted surgery vs. forfeiting $$$
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Small Claims Court
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Small Claims Court
• Mostly about money
• Must show up (or staff)
• If about money, deliver signed receipts / treatment plans
• If about outcome, explain experts must adjudicate.
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Chargebacks
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Chargebacks
• Credit cards, financing companies
• Best near term defenses:
• Signed receipts / treatment plans
• HIPAA allows divulging minimum necessary information to address “financial operations”
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Demands for Refunds
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Demands for Refunds
“I really appreciate the effort you made. It was such a big expense for me. I’m just not happy with my result. ”
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Demands for Refunds
If you refund? Do extra work?
GET A RELEASE
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Demands for Refunds
“If I do not receive $5000 refund within ten days, I will notify the ...State Board of Medicine, and ten physician ratings sites.”
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Demands for Refunds
• Sometimes, fine line between request for refund and extortion.
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Demands for Refunds
• Sometimes, fine line between request for refund and extortion.
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Online Reviews: Early Warning System
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Doctor Review Sites
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Landscape
• In 2012, 60 + sites
• No one site is perceived as go-to credible site
• Monitoring essential
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All You Need To Know
• Plan upfront; paperwork will save you
• Communicate with finesse when things don’t go well
• See what you’re patients are saying on the Internet
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Thank you…
Jeffrey Segal, MD, JD
Founder & Chief Executive Officer
Medical Justice Services
Greensboro, North Carolina