Relentlessly protecting physicians most

valuable asset – their reputation

www.medicaljustice.com

Jeffrey Segal, MD, JD

Founder & Chief Executive

Officer

Medical Justice Services

& Dental Justice

• Decade in practice

• Tort reform state

• A letter

One surgeon’s trajectory

• Ten years of data

• Programs:

– Deter and respond to frivolous suits

– Prevent online defamation; manage conflicts

One surgeon’s trajectory

• Lawsuits can be prevented:

• attention to key documents before treatment is rendered

• by communication

Setting the Stage

Escalation of Conflict

• Fixing problems sooner is better than later….

Nasty Letter

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Demand for Refund / Internet Rant

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Request for Records

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Intent to Sue

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Suit

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More Internet Rants

Frivolous Lawsuits

Does This Case Sound Familiar?

• Urologist performed vasectomy; post-op sperm count- negative

• Patient’s wife - pregnant one year later

• Surgeon was sued.

• 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?

• NEJM Study (2011) • Only 20% of lawsuits associated with

payment

Lawsuits: How Frequent?

Avoiding Frivolous Lawsuits

• Cases linger for years

• Nuisance settlements.

• Settlement for $1: Data Bank

• Some states report settlements on Internet.

Deter Frivolous Lawsuits 101

Deter Hired Gun Experts • Physician / Patient agreements: • Use experts within your specialty and in

good standing in your professional society

• Spine operation • Plaintiff’s expert’s testimony egregious

Hired Gun

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

• 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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Year Post-Op

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Sentinel Event

Time Versus Likelihood of Infection

Prevention / Treatment

• Upfront

• Agreement on who experts can be.

• Later

• Hold experts accountable

When Things Don’t Go Right

Art of Communication

• Surgeon intended to do liposuction • Performed abdominoplasty (tummy tuck) • Clinical result great. But- greater risk, longer

recovery period, bigger scar

Art of Communication

• Rx: • Apology • Root cause analysis • Explained what went wrong • Refunded money • Paid for help around house

Art of Communication

• Managing expectations • Money • Treatment • Outcomes

Deposits for Surgery

Deposits

• No deposit, 20%, 25%, 100%. • In writing, signed

•Options: re-schedule; be flexible… •Hobson's choice

• Unwanted surgery vs. forfeiting $$$

Small Claims Court

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.

Chargebacks

Chargebacks

• Credit cards, financing companies

• Best near term defenses:

• Signed receipts / treatment plans

• HIPAA allows divulging minimum necessary information to address “financial operations”

Demands for Refunds

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. ”

Demands for Refunds

If you refund? Do extra work?

GET A RELEASE

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.”

Demands for Refunds

• Sometimes, fine line between request for refund and extortion.

Demands for Refunds

• Sometimes, fine line between request for refund and extortion.

Online Reviews: Early Warning System

Doctor Review Sites

Landscape

• In 2012, 60 + sites

• No one site is perceived as go-to credible site

• Monitoring essential

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

Thank you…

Jeffrey Segal, MD, JD

Founder & Chief Executive Officer

Medical Justice Services

Greensboro, North Carolina

jsegal@medicaljustice.com