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MEDICAL EDUCATOR
VOL 4, No 2, April 2002 Residents glimpse legal side of health care '. . the truth, . . . and nothing but the truth'Residents, faculty and students were munching on sandwiches in the 2-West Amphitheater one recent Friday afternoon, but the real entrees were John Blumer and Megan Baker.The two residents participated in a reenactment of a deposition in a South Carolina medical malpractice case involving two Midlands physicians and a patient who was given a toxic dosage of a prescription for a thyroid condition. Blumer, a family medicine resident, and Baker, a surgery resident, assumed the roles of the physicians who were defendants in the malpractice case and, under oath, answered questions from the two attorneys involved in the actual case. The program was the second in a series sponsored by University Risk Management, Graduate Medical Education and the South Carolina Insurance Reserve Fund to introduce residents to the legal side of the medical profession. “You need to understand right now that as a resident, as a licensed professional, you’re subject to the same rules and have the same responsibilities as private practitioners,” Franklin Medio, Ph.D., associate dean for graduate medical education, told the audience. “You can be deposed now for cases involving patients you are treating today or you may be deposed after you leave MUSC for a patient you treated while you were a resident here.” Wayne Brannan, director of University Risk Management, told the audience that, statistically, one in five South Carolina physicians will be involved in a deposition. He also noted that South Carolina is not immune from high malpractice awards. One lawsuit in the Upstate resulted in a $17 million verdict in 2000, he said. Strom Johnston, manager of professional liability for the South Carolina Insurance Reserve Fund, gave some chilling statistics about medical malpractice cases in the state: In 1995, the median jury award in malpractice cases was $500,000; five years later, it had doubled to $1 million. Johnston said changes in public attitude towards health care was one reason behind the increase in jury awards. “The public expects perfect medicine and perfect results,” he said. “The system will get better, but it will never be the same as before.” Johnston had three words of advice for residents and veterans alike. “Document, document, document, this is one of the tools of (malpractice litigation) prevention,” he said. “It’s one of the best defenses.” The majority of the two-hour session was presided over by attorneys Fayrell Furr Jr. and James Parham Jr., the two lawyers who handled the malpractice claim involving the two Midlands physicians. Both addressed the audience about malpractice law before taking part in the deposition reenactment. Furr, who got the first multi-million-dollar award in South Carolina ($6 million) for a medical malpractice case, said his office screens approximately 1,500 medical malpractice complaints a year, accepting an average of 50. He takes cases which he believes are valid, he said, because it costs him “$50,000 to $100,000 to put a case together.” The deposition, which is sworn testimony by participants in the case in the discovery phase of the lawsuit, focuses on the fundamental facts of the case, the “who, what, when, where and why” of the complaint. Many cases, he added, were based on miscommunications between a physician and the patient or the patient’s family. “The doctor doesn’t sit down with the family and explain why someone dies,” Furr explained. Parham, who defends health care providers in malpractice lawsuits, advised the audience not to underestimate the importance of the deposition. “You cannot win a case in deposition,” he said, “but you can lose it. “We are in a huge crisis,” Parham continued. “Unfortunately, you are coming out (into professional practice) at the wrong time. Medical malpractice cases can consume massive amounts of your time, and it may depend on whether a jury likes or doesn't like you.” Above all else, Parham said, “be yourself—treat a deposition like the jury’s there, and present a good bedside manner. I’ve represented a lot of (physicians) that I wouldn’t want to treat my dog, but they can fake a good bedside manner.” More emphasis is going into pretrial preparation in order to present litigants in the best possible light, Parham said, using videotaped depositions and focus groups to watch and evaluate the witnesses. Furr told the residents, however, that “there is some bad medicine being practiced. It’s 10 percent of the doctors who are causing most of the malpractice, but you have to pay for it.” According to the information from the mock deposition, the patient, an elderly woman, had a thyroid condition and complained to her family physician of weakness and aches. The physician called in a prescription to a retail pharmacy for .033 milligrams of Synthroid. As it turned out, the medication doesn’t come in that specific dosage, so, for reasons unexplained, the pharmacy filled the prescription as .3 milligrams, 10 times the prescribed dose. A week later, the patient was admitted to a Columbia hospital after her condition had not improved. There she was accepted as a patient of the surgeon, who asked her physician to provide a courtesy consult. The family physician visited her on the first day of her admittance, noted the discrepancy in the prescription and put a note in her chart to that effect. The prescription was never changed, however, and the two physicians who controlled the woman’s care never had direct contact with each other. Following a six-day hospital stay, the woman was discharged, but after several days she was readmitted. She remained in the hospital briefly and was again discharged. Baker, testifying as the hospital surgeon, said she intended to have the family physician follow the patient during the initial hospital stay, and thought the other physician had changed the prescription. She admitted, however, that she never called the other physician and never called the pharmacy about the mistake. Despite the seriousness of the matter, there was one humorous moment when Baker’s pager went off as she was answering questions from Furr. Baker indicated she could wait to answer the page when Furr volunteered to suspend the deposition. “I don’t want to endanger any patients,” he said, prompting laughter from the audience. The deposition continued, and at its conclusion, the attorneys explained that the situation eventually was resolved and the woman suffered no permanent harm. Furr said he appreciated Blumer’s and Baker’s candidness during the questioning. “Just tell me you messed up and admit it. I can understand that,” he told the audience. “When you try to bull me, you just get in worse and worse shape the more you do it.” Holding up a folder full of documents, he added, “I know everything you’ve written in this record, probably more than the witness does. If you mess up and tell me you’ve messed up, that makes me want to get the case settled.” Parham cautioned the residents to keep meticulous—and legible—records.
He added, however, that everyone makes mistakes, and not all mistakes lead to lawsuits. “A mistake is not always malpractice,” Parham said. “You can admit to a mistake, but not below the standard of care. We all make mistakes.” From her perspective, Baker found the experience useful. “The litigious nature of our profession necessitates that we learn how to properly conduct ourselves in a legal environment so that both the true issue at hand and our actions are best represented,” she said. “More significantly, however, the sessions emphasized the importance of developing and maintaining an honest, candid and trusting patient-physician relationship.” For Blumer, the experience was an “enlightening” one. “I have never been deposed nor attended a deposition,” he said. “My only experience was watching scenes on TV. Being sworn in made the experience seem real. Being under the scrutiny of a 100 or so of my peers was also nerve-wracking.” MUSC tops pass rate for Step 1College of Medicine students achieved a significant feat recently—surpassed the national mean and pass rate on the United States Medical Licensing Examination’s Step 1.One hundred and thirty MUSC students participated in the event which included more than 17,000 examinees from medical schools in the U.S. and Canada. Of that number, 121 passed, for a 93 percent success rate, compared to 90 percent for the rest of the U.S. and Canada. “They did an outstanding job,” said Amy Blue, Ph.D., associate dean for curriculum. “Step 1 is the first exam that must be taken as part of the licensure process for all medical students. It represents the first hurdle they have to cross to continue through medical school. These scores are also important because these are the students who went through the first years of the curriculum change.” Blue attributed the good showing to the curriculum change, which better prepared the students for the exam, and the fact that this class came in with higher MCAT scores. The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. It is designed to assess a physician's ability to apply knowledge, concepts, and principles that are important in health and disease and that constitute the basis of safe and effective patient care. Results of the USMLE are reported to medical licensing authorities in the United States for their use in granting the initial license to practice medicine. Step 1 consists of multiple-choice questions prepared by committees of faculty members, teachers, clinicians and researchers considered experts in their respective fields. The exam measures basic science knowledge, with the majority of questions requiring the student to interpret graphic and tabular material, identify gross and microscopic pathologic and normal specimens and solve problems using basic science principles. Continuing Medical EducationThe following conferences are sponsored by MUSC. All conferences are to be held in Charleston unless otherwise noted.May
16 - 19
23 - 25
24 - 27
May 29 - June 1
May 31 - June 1
June
10 - 15
July
August
September
23 - 28
Teaching TipsSix Traps in the Evaluation Process from George Arana, M.D., and Franklin Medio, Ph.D.1. Reviewing Another Person’s Performance
from an Autobiographical Perspective
2. Being the Target of “Responsibility Ricochet”
3. Basing Judgment on “Extraneous” Factors
Don't miss thisSecond Annual Charleston Connections Conference:“Innovations in Higher Education,” Friday May 31, at The Citadel's campus. Early registration by May 3. For details go to the conference Web site at http://www.musc.edu/connections Apple Tree Society Brown Bag
This session will include viewing a discussion from three administrators invited by the Chronicle of Higher Education to talk about how technology is changing the duties of faculty members, followed by a discussion by Brown Bag attendees about the issues raised. The Chronicle article can be viewed at: http://chronicle.com/free/2002/02/2002020701t.htm Feel free to bring your lunch and come prepared to learn more
about the role of technology in education!
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