Association of Liability Lawyers in Medical Defense

The Doctors Company has put together a checklist for reopening your practice during COVID-19. You can download it here: As officials relax some COVID-19 restrictions and you begin to reopen your practice, be mindful that transitions may occur in phases. If there is a resurgence of the virus, you will need to reassess the process and adapt. If disease transmission slows further, authorities may lift additional restrictions. The following checklist is provided as part of our commitment to serving you as you care for all of us. Lists are categorized by administrative (both office and personnel), environment of care, patient management, and elective surgery considerations. Since there is no one-size-fits-all approach to reopening any practice, we encourage you to adapt this tool to your practice’s needs. If you have any questions about your malpractice insurance during the COVID-19 pandemic, please reach out to us here.

BY DR. HERBERT KEATING | SPECIAL TO THE COURANT http://www.courant.com Being “on call” nights and weekends is part of every physician’s life. Mandatory during the training stages of residency and fellowship, call responsibilities continue for the full-fledged doctor, some disciplines requiring more (e.g. cardiology) than others (e.g. pathology). Predictable emotions are part of the “on call” experience. For example, when approaching a weekend on call, a doctor invariably experiences a peculiar amorphous sense of pessimism. Especially true for younger trainees or physicians newly in practice, this pessimism can approach out-and-out dread, particularly if an unseasoned doc is placed in a situation that seems beyond his or her capabilities. In my internship, I was on call every third night which means I spent every third night in the hospital. But because my butt was always covered by a more experienced resident, this call was not accompanied by the dread that occurred when I later became a second-year resident, responsible, for example, for all uninsured patients admitted to the hospital from the emergency department. As the years pass, “on call” becomes easier as a physician acquires more experience. However, as time goes on, there is a natural tendency – what I call a cumulative toxicity – that results in an unbecoming, smoldering but perfectly understandable resentment of taking calls. This seems especially true for physicians in private practice, most of whom are pressed to meet the expenses of running an office and meeting a payroll. “Why should I be forced to field phone calls from strangers who might sue me, and give out hundreds of dollars in free advice?” some doctors ask aloud. And for many of them a second sentiment follows, as night follows day: “Couldn’t get a lawyer to give out free advice.” But, really, in the era of increasing co-pays and frantically busy lives, who could blame a patient for calling to get his bronchitis treated over the phone rather than cough up the $30 co-pay for an office visit? And then call day arrives. The weekdays of dread lead to the Friday of the call weekend itself. And the calls start coming in around 5 p.m. The first calls are routine. One patient wants to know what to do with his stool sample now that the lab is closed for the weekend. Two pharmacies call for medication clarification. But then a disturbing call comes from a young man. He wants something to help calm down. Twenty-three, his girlfriend has just broken up with him, and he feels upset. “Just give me something, you know, doc, like Xanax or something.” “Are you depressed?” I ask him. “No,” he says. “Do you have any thoughts of hurting yourself?” “No,” he says. “Do you have any thoughts of hurting anyone else?” “No,” he says. “So, let me understand,” I continue. “You want me to give you a drug to make you feel less pained from breaking up with your girlfriend?” “Yeah,” he answers. “I don’t feel comfortable doing that,” I say, and he says, “Oh, OK.” “But if you get worse, like have any of those thoughts I mentioned, don’t hesitate to call back. Or you could go to the ER.” He says “Oh, OK” again. (When I tell my wife about this call, she says to me that I should have told him to go for a long walk. “As in, take I hike?” I ask her, and she says, “Precisely.”) But then things improve. I get to be a real doctor. I get useful. A pleasant woman in her late 50s calls. She is worried that symptoms of numbness and tingling around her mouth and in her fingers and toes mean that she has multiple sclerosis. She has gone online and is convinced. But her symptoms sound like the hyperventilation syndrome, brought on by a stressful life and over-breathing. This has changed the acid-base balance in her body. My advice makes her symptoms go away, and she feels relieved. A worried mom calls about her beloved 16-year-old daughter who is having cramping abdominal pain. After a few minutes of questioning, I figure out that the teenager has “irritable bowel” which has been worsened by an antibiotic (erythromycin) prescribed the previous Thursday for sore throat. And I set in motion ways to make her feel better. I feel like a fencer or a chess player or a preacher. On the playing field of the patient’s body, demon disease’s thrusts or sorties are deftly met and I deliver decisive counter-blows. Nausea is knocked out and people can rest. I can hear airways plugged by asthma and I help people breathe again. Incipient heart attacks – disguised as acid-indigestion – are detected and an ambulance is summoned; heart muscle may be saved. And then the predictable happens. Call – as everything else must – passes. Monday arrives. As every survivor does, I feel privileged. Dr. Herbert Keating practices and teaches internal and geriatric medicine at Prohealth Physicians in Bloomfield and is clinical professor of medicine at the University of Connecticut. His columns include real stories, but names are changed to protect patient confidentiality. His website is FearLessAging.net. see original

BY DR. JAY GROSSMAN Special To The Miami Herald http://www.miamiherald.com Re: ”My view: Future of med-mal caps in doubt,” by Hector Lombana Mr. Lombana would love to go back to the halcyon days when attorneys made big bucks by milking the medical malpractice cow for all it was worth. Fortunately for physicians who practice here in South Florida, Mr. Lombana’s point of view as well as his facts are just plain wrong. I do a fair amount of expert witness testimony in this community, and as a practicing physician I’ve seen both sides of this debate. Florida and South Florida, especially, are the most litigious areas in the country to practice medicine. There are more lawsuits filed here than anywhere else. Five years ago it was virtually impossible for physicians to obtain malpractice insurance at anything close to a reasonable premium. Why? Because there were so many bogus lawsuits and such high costs to defend these suits, malpractice carriers were cutting their loses and leaving the state. Insurance companies, just like Mr. Lombana, are in the business of making money. The dirty little secret that the trial lawyers don’t want you to know about is the expert witness problem. The real crux of the medical malpractice issue has nothing whatever to do with insurance companies or the legislation; it has to do with professional expert witnesses. To file a malpractice suit, the lawyer has to find a doctor willing to say that the treating physician fell below the standard of care in the community. Where do you find these people? It’s easy; they’re all over the Internet, just like the escort services — but more lucrative. In 2006, Debra Henley, the deputy executive of the Academy of Florida Trial Lawyers, wrote that expert witness reform is ”cockamamie” and ”another diabolical attempt by the Florida Medical Association to cut down on medical malpractice cases.” Why? Because they know that over the years they’ve gotten away with flagrant and malicious misuse of the tort system by getting virtually anyone with a medical license to testify. I have personally seen many cases where the same ”expert” is a professional witness testifying all over the state. Trial lawyers will do anything to make sure no one deprives them of these prostitutes who make their living on the backs of innocent doctors. They have been united in opposing any reform of the expert witness system because that is, of course, the weakest link in the chain. What’s the answer? There must be a radical change in the way medical malpractice lawsuits are allowed to proceed. First, all people calling themselves expert witnesses should have to register with the State. All suits they are involved in should be posted. This will provide transparency in the process and the immediate ability to see if they are prostituting or real practicing physicians rendering objective opinions. A panel of acknowledged medical experts in the field should review the case and decide if it has merit. These people should be blinded to the names of all parties involved. If there was negligence, then the suit should be allowed to proceed. If not, then it’s up to the attorney whether to proceed or not. I doubt Mr. Lombana or his cronies are interested in these real reforms because they would provide the kind of transparency that threatens the ”business as usual” attitude that has long plagued the practice of medicine in Florida. Dr. Jay Grossman is an assistant professor of clinical anesthesiology at the University of Miami Miller School of Medicine and director of Cardiothoracic Anesthesia at the University of Miami Hospital. see original