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The Claims Process, Episode 1: Lawsuit defense

In this episode, our host, Tony Passalacqua welcomes Jim Boston of Boston & Hughes, PC, to discuss such questions as how does a lawsuit usually start? How do you stay ahead of an aggressive patient? What are some documentation best practices? And much more.

Also available on Apple and Spotify. A transcript of this podcast is found below.

Additional episodes in this series:

Episode 5: Impact of technology on your organization today
Episode 4: TMLT's Risk Management's Greatest Hits
Episode 3: Texas Medical Board defense
Episode 2: Five things that get physicians sued


Tony Passalacqua: Hello and welcome to this edition of TMLT's podcast, TrendsMD: Answers for Healthcare's Digital Trends. I'm your host, Tony Passalacqua, and today I have Jim Boston of Boston & Hughes. Jim has 40 years of experience as an attorney, defended medical liability cases, and representing healthcare professionals before licensing boards.

He is consistently listed among the best lawyers in America and Texas. We are very happy to welcome Jim Boston to our podcast today. Our topic today is Lawsuit Defense. So, Jim, what are some circumstances that may increase the chances of a claim? 

Jim Boston: Well, the obvious one is a bad outcome. So when patients experience an outcome that's not what they expect, uh, it's not uncommon for them to wonder whether the care was substandard or if a different approach could have resulted in a better outcome.

So that's the primary thing. I mean, obviously if a patient is happy with the outcome or happy with the way they were treated, they're less likely to sue then someone who's already dissatisfied, either because of the, the treatment or the attitude the doctor presents, or what they perceive to be a lack of attention or a lack of attentiveness.

Those kinds of things can motivate someone to sue if they feel as though they haven't been treated the way they want to be treated.  

In those different situations where patients are maybe having, uh, well, they feel like there's maybe some substandard care or an outcome that they, they didn't necessarily desire.

Tony Passalacqua: Is there any reason that a physician should possibly apologize or is an apology acceptable? 

Jim Boston: Well, sure. I mean, you can give an apology without admitting culpability. So, you know, interacting with someone on a very human level, I think, is a positive thing to do. Doctors always worry that what they say is going to be interpreted as an admission of liability or an admission of guilt, and sometimes it can be.

But if someone loses a child, for example, at a delivery, expressing your condolences because of the loss of that child is an appropriate thing to do, even if you don't believe anything you did contributed to the child's demise. If you have a surgery in which a common bile duct is transected, well, obviously, you have created an injury. That's known to occur within the procedure that you hoped we could avoid, but didn't. 

Sure. It's fine to go in there and say, “Hey, listen, this happened. We're going to take care of you. I'm going to send you to a tertiary care center where a biliary specialist can repair this duct. Uh, I'm very sorry this happened, but we're going to take care of you.” Et cetera, et cetera, et cetera.

You don't have to go in there and say, “Oh my God, I did the very thing I was trying so hard to avoid. I feel horrible about it. I think I've committed malpractice. Don't sue me, please.” No, nothing like that. Just a normal interaction between human beings about your compassion for them. I think patients appreciate that.

Now, can it be used against you if they decide to sue? Well, sure. Anything can be used against you if they decide to sue. I mean, there's, there's nothing that can't be misinterpreted or tweaked to suggest culpability, but that doesn't mean that you shouldn't express legitimate feelings of compassion for people if something happens.

Tony Passalacqua: If a physician would have just apologized for potentially an outcome that they may or may not have been involved in, do you think that kind of helps to create more of a human connection between the physician and the patient? 

Jim Boston: It probably does. Like I said, people worry about how that might be used against them, but I'll give you an example. So, I recently had a brain damaged baby case in which the physician involved in the initial part of the care that was most the focus of the lawsuit, after the baby was born, went to the mother and he apologized. He said, “Look, if anything that I did contributed to this outcome, I'm really sorry.” Okay. Was that used against him when the case was later tried or filed when he was deposed?

It certainly was because they tried to make it seem as though it was admission of culpability, but that doesn't mean that what he did was wrong. It was a situation in which a patient came to the hospital and the initial testing showed the baby to be compromised already. And so, the medical judgment part of that was, do we deliver the baby now, or do we try to mature the lungs with steroids before delivering? Because it was a premature delivery, 34 weeks. So, this is the judgment call. And his judgment was, let's try to mature the lungs. We know the baby is already compromised. Let's not risk compromising the baby further by a premature delivery before maturing those lungs with, with steroid administration over 48 hours if we can get it.

Alright, so the baby is born. The baby is severely compromised with what later turned out to be a significant learning disability and other brain damage. And, you know, the second guessing begins. What if they delivered the baby initially instead of waiting to administer those steroids? Alright, well he's going through his internal turmoil about that as well after the baby is delivered. And so, he goes to the mother and that's why he said if any of my decision making contributed to the outcome, to that extent I'm very I'm very sorry. Alright, was it wrong to do that? I don't think so. Was it used against him when he was taken when people were deposed? Of course, you know, but nothing you can do about that.

He could have phrased it better, I guess, but just going in there and, and expressing sympathy and empathy for someone who's had a problem with a delivery is not a bad thing to do. 

Tony Passalacqua: Some of the other items that I always think of that could potentially cause a lawsuit or increase the chances of a lawsuit or a claim is poor documentation. What's some advice that we could give to some of our physicians out there on maybe some better ways of doing documentation?  

Jim Boston: Well, if there's anything that's pertinent to you at the time, anything significant to you at the time you're providing care, you need to write it down. In almost every lawsuit, documentation is an issue. 

The better your documentation, the better impression you leave, the better your documentation, the more you have to refresh your memory about the care, the better documentation, the more objective, verifiable information you have written at the time that might support your decision making. It's always better to document.

And even if you're having to document something that you perceive to be a negative, I think that enhances your credibility as being someone who's an honest, caring physician. I mean, the fallback position on almost every question we're going to discuss today is what's in the patient's best interest.

Seriously, that's it. It's that simple. If what, if with whatever you're doing as a physician, if your goal is to do that which, in your opinion, is in the patient's best interest, you've done a lot toward improving the medical care, establishing a good relationship with the patient, and building a defense.

Because if what you've done can be rationally explained in a way that lay people can understand, why it was done and in what manner it was in the patient's best interest. Even if you get a bad outcome, you've gone a long way toward enhancing your defense. Even in a case where you're being sued, if a patient in the emergency room asks for you specifically and they happen to be a plaintiff in a lawsuit in which you have been sued, go to them and give the best medical care possible.

Number one, it looks good that they asked for you. It shows that they still have confidence in your abilities despite the ongoing lawsuit. And number two, you're doing the right thing. So always the fallback position is, what's in the patient's best interest and do that. Whether it's documentation, whether it's patient care, whether it's apologies, what's in their best interest?

Tony Passalacqua: A few years ago, for instance, if you had poor documentation and it was in a paper chart, the only way that a physician may necessarily identify if that chart was reviewed or if there was a request for records was a pretty good flag that there was something going on, right? But now, with the way that these patient portals work, sometimes these notes are released immediately.

Do you think there's any sort of additional things that maybe a physician should think of before they publish those notes? 

Jim Boston: Well, it depends on the software. So, some EMR software will allow you to make changes up to the point at which the note is signed.  And then you can't change the note anymore, you have to do an addendum.

So some physicians therefore document but don't sign until later, because it gives them the flexibility to go back and include more detail before the point at which it becomes unalterable. So, you know, there's, if my interpretation of your question is correct, it's what problems can be associated with this sort of thing.

And you know, there's several of them. So, you know, every time your charting is changed or, you have an addendum or something's modified, the other side is going to try to suggest that you were adding information or subtracting information in an effort to defend yourself from a bad circumstance if later sued.

That's not necessarily true. Um, your goal is accuracy and you just, you just need to be able to explain it that way. But let's just talk about the obvious for a minute. I mean, you've got this electronic software and some of the problems associated with it include that it repopulates information every time you open it up.

So, I've got a case right now where this is being challenged. The chart shows documentation consistent with what was done on two or three previous admissions as if it was done again at a later office visit. And it wasn't. It's just repopulating the same information. So, what they're accusing the doctor of doing is falsifying having done an exam he didn't do.

So, you have to watch out for that kind of stuff. I mean, it's even difficult reading the record sometimes, because you can't tell what's original information being charted on the date the exam is done, versus that which is being repopulated by the software system. So, there's all kinds of problems with electronic medical record software that you have to be mindful of.

And I'm not sure exactly the best way to go in there and deal with that, except to know your software well enough to determine how to distinguish within your own chart what is repopulation versus what is new so that these confusing issues don't arise if you're later sued. I mean, you can explain it away in your deposition or what have you, but it's better if the chart explains it just by its own review without you having to interpret it for someone.

Tony Passalacqua: There are sometimes aggressive patients out there that are essentially approaching physicians in a much more aggressive manner than what we've seen in the past. Is there any specific things that, uh, physicians can possibly do to stay ahead of aggressive patients? 

Jim Boston: Well, it's going to be circumstantial, but I mean, as a basic premise, do not respond in kind.

So, patients being aggressive with a physician or a physician's staff, don't take it personally. Personally, maybe they're having a bad day, maybe they're just an acrimonious type of personality that for whatever reason wants to take it out on the staff or on the doctor, but no matter what the reason for it, maintain a professional demeanor at all times.

I've got a situation now before the medical board wherein a patient is complaining that the staff was aggressive to her. But, fortunately for my client, he has video of the interaction showing that it was the patient who was the one who was the aggressor, and that the office staff was actually acting in accordance with their policy of being very understanding and calm in response to, uh, patient aggression.

So, that's going to work out well for him. The patient can say whatever they want. The patient can do whatever they want. Goes back to documentation. If the patient's being aggressive, do not respond aggressively in return, but you might want to make a note about it. I had a situation once where a patient complained about my physician to the medical board because she said he came on to her.

Well, fortunately, the patient and his nurse and his office manager had all separately documented without consulting one another about how that particular female patient was coming on to the doctor and how he very professionally dissuaded her from continuing in that effort. He did fine when the board reviewed that case.

So, all I'm saying is that we go back to the previous issue of documentation, we go back to just human interaction, always be professional, always be nice, always do what, that which is in the patient's best interest, even if they're not doing what's in yours, and just kind of deflect that aggression if possible, and deal with the issue at hand rather than the personalities involved. 

Tony Passalacqua: So how does a lawsuit usually start? 

Jim Boston: Well, so there's patient dissatisfaction. That's how it starts off. And one thing I meant to say earlier that you need to be mindful of is sometimes that dissatisfaction is born of a feeling of betrayal. So, if you're very close to a patient, maybe the patient is a family friend, maybe it's someone that over the years you've treated over and over and over again and, and you become close to them.

If things go badly for that patient, they sometimes feel betrayed because they've come to expect from you as their friend, perhaps better care, more attention, than they feel like they got. And so, the bad outcome for them is going to result in a lawsuit, even though you, you're surprised to be sued. But you know, it always starts out with the feeling of betrayal, the feeling that the bad outcome was because of something the doctor did or didn't do.

And then they hire a lawyer. The lawyer writes a letter, a notice of claim letter, sends it to the doctor or someone else who's going to be involved in the lawsuit. And following that, they file a petition.  So, if you're ever served with a petition, sometimes that's the first notice of a claim that you're going to get.

If you're fortunate enough to be the one who gets the notice of claim letter, you have some inkling that something's about to happen, but that's going to be it. I mean, sometimes a patient will telegraph their intentions by saying, “I'm going to sue you” because they're mad. Sometimes, you know, that the outcome is, is so untoward and the questions about the care such that you, you just have a feeling that you're going to get sued.

That happens. You don't know it, but when it happens, you're not surprised. But the first actual notice you're going to get is usually going to be a letter. 

Tony Passalacqua: So, what do you do if you get served? 

Jim Boston: So if you get served with a lawsuit, immediately turn it over to your medical liability insurance carrier. Do not try to deal with anything yourself.

You're not equipped to do that. Believe me. So, as soon as you get a notice of claim letter, turn it over to your medical liability insurance carrier. Thereafter, when you get served with the petitions, turn that immediately over to your insurance carrier. Your carrier will then engage a lawyer who will help you with the claim or with the lawsuit.

Tony Passalacqua: Are there any sort of statute of limitations when it comes to a medical malpractice lawsuit? 

Jim Boston: Well, there are. So, let's take a surgery case, for example. That's the easiest. Two years from the date of the surgery, if that's where the injury occurred, is the limit they have to file the lawsuit. Now that can be extended by 75 days if within that two years, they send a notice of claim letter.

So, basically, they have, there's a two-year statute of limitations in which to bring a case for medical malpractice - two years from the date of the malfeasance. But If you get a notice of claim letter within that two year period, you get an additional 75 days tacked on to that two years. If it's a minor, a child, well, they have two years after they reach their majority.

So, if a child is injured, let's say you've got a shoulder dystocia case or something where you've got a brachial plexopathy and some other injuries going on there, the child's cause of action endures until two years after their 18th birthday. 

Tony Passalacqua: I know, Jim, you've been defending physicians for about 40 years. How does it impact a physician?  

Jim Boston: Well, it depends on the guy or the woman involved. I mean, um, if they've been sued before, they've been through it. They recognize that it's not as bad as it seems. If it's their first lawsuit, it can be psychologically debilitating and, and scary.  So, I've got a case right now where a doctor has never been sued before. He's sued in this particular case. The damages are horrible. 

Patient goes in for a relatively innocuous procedure, experiences hypoxic brain damage, and dies. Okay. That's a bad outcome. Serious bad outcome. And it's his first lawsuit. And it's not his fault. That is, this bad outcome is not his fault. But he is psychologically just overwhelmed by the fact that he's been sued.

He's having a hard time dealing with the unknown. He naturally wonders, is this going to affect my license? Is it going to affect my personal finances? Is it going to affect my practice? You know, are my patients going to find out? Are they not going to see me anymore? I mean, all these questions run through a doctor's head when they've never previously been sued.

What's going to happen with the medical board? What's going to happen with the National Practitioner's Data Bank? What's going to happen with hospital privileges? Are the privileges going to be curtailed or revoked because of this? I mean, these are all things that run through their mind. And the answer to most of those questions is no, these are not things you really have to worry about.

Is it possible that a lawsuit with significant damages could result in an excess verdict that would affect your personal finances? Yes, it is possible. Is it likely to happen? No. I've had it occur once in my practice where a physician refused to listen to me when I told them they needed to give settlement consent.

Uh, it was a viral myocarditis case where a child died and it was in a bad venue. And I told her, you need to give consent. You need to let TMLT attempt at least to negotiate a resolution. She wouldn't do it. We tried the case. We almost won it, which made her, emboldened her even more, actually. We came within one vote of winning it before the judge called a mistrial.

So, we had to retry it two months later. I told her again to give TMLT consent to resolve it because I explained some differences in the second trial that I anticipated over when it occurred in the first one. She wouldn't do it, and we got, and we lost. And she got hit for way over her policy limits. But that's the only time that's ever occurred.

Did it affect their personal finances? Yes. I mean, we had a post-verdict mediation. We agreed on a different number than the verdict, but they still had to sell some recreational property in order to pay off that judgment. You don't, I think some doctors just don't realize how important listening to their lawyer can be.

But at any rate, it turned out okay. They did have to sell some property to satisfy that judgment. That's the only time though in 40 years that that's ever happened. It is not a likely occurrence. It's a possible occurrence, but it's unlikely. And as far as licensure is concerned, a lawsuit of itself doesn't affect your medical license.

That's going to be a state board matter that when you go before the state board, that's a license issue potentially. Getting on staff at hospitals, they look at it, but they're not going to exclude you from privileges there because you've had a lawsuit. No, you know, most of these things [that] doctors worry about are not going to happen to them just because they got sued. 

Tony Passalacqua: In smaller communities, do you think that sometimes these lawsuits could potentially cause a physician to, to quit their profession? 

Jim Boston: Well, it can. The doctor that I just talked to you about, the pediatrician who had the viral myocarditis patient who died, she and her husband were in practice together. And after we lost that case, she retired. She didn't go back to practice. That's the only time I've ever had that happen. She didn't have to quit. The state board didn't make her quit. But she was so disturbed by the outcome that she decided to retire. And so, you know, her husband's still in practice. She did not continue on, but that's the only time I've ever known that to occur.

Most of the time, a lawsuit is going to be resolved and you're going to go about your business and it's not going to affect your practice to any significant extent at all. That's the norm. 

Tony Passalacqua: When you're having a telemedicine visit, there's a few things that kind of change, but are there poor outcomes that you see that occur from a telemedicine perspective that physicians should be aware of? 

Jim Boston: Well, I would say dissatisfaction. So, in a case that I was thinking of, a patient was dissatisfied because during COVID she was given prescriptions for some of the more questionable treatments that had not become mainstream to address COVID. And it was done over a telemedicine visit. Those treatments didn't work for her, and she went into the hospital with a progression of her disease, and she thought the disease progressed because of the ineffective nature of the treatment based on her following this doctor's advice. All right, so that's a bad outcome based on advice and prescriptions given uh, over telemedicine. Um, that's the only case I've experienced where that's happened. 

But it did happen. Now in that situation, this patient was in Colorado. The doctor was in Texas and, uh, she made a medical board complaint. She did survive COVID, by the way, made a medical board complaint thereafter. And, uh, you know, the issue was not only whether he gave correct advice based on the knowledge existing at the time, but whether, uh, the medical board had jurisdiction to hear the complaint given the fact that his patient was in Colorado, and he was in Texas. Uh, in my own experience, I've only had the one situation in which a bad outcome was alleged because of information given via telemedicine. 

Tony Passalacqua: Do you think that the nature of apologies change, as we start moving away from this brick-and-mortar environment that we're used to, to more of the telemedicine?

Jim Boston: The nature of apologies? 

Tony Passalacqua: Yeah, so for instance, um, I always think about apologies in a brick-and-mortar location as feeling very personable, because you have complete access to an individual. You can see all the facial and body movements, so there's a lot. It's very rich in communication, versus a telemedicine visit, maybe where you only have access to someone's face.

Jim Boston: Well, it's obviously less personal. It's less intimate. Because you're not there to, you know, pat him on the back, perhaps. I mean, you know, physical touch is very important, especially in the context of an apology, where you're really trying to relate to someone who's been through a bad experience. And just being able to, to pat him on the back, or look him in the eye in a personal way is probably more meaningful than doing it over telemedicine.

I've never actually had a situation arise in which someone was offended by an effort to apologize over the internet, over telemedicine because of the telemedicine nature of the visit, but I can see what you're saying. I mean, it, it, um, it wouldn't have the same impact probably for sure.  

Tony Passalacqua: Poor documentation was another topic that we covered from a brick-and-mortar perspective. It's interesting, because that there are some potential differences that you would have, for instance, with the physical exam portion on a telemedicine visit. Do you think there's anything that physicians could do to maybe increase or show a physical examination on a telemedicine visit? 

Jim Boston: Well, yes, so the tendency is for doctors not to document as well when treating a patient over telemedicine. Um, I've run into this before, and I don't know why that is, but they do tend to be less thorough, and it may be that If they're seeing many patients in a row via telemedicine for whatever reason, like during COVID patients were scrambling to get care and doctors had patients backed up to try to give them the best advice possible under the circumstances and they weren't documenting everything that should have been documented.

And that was coming back to bite them if there was a complaint to the medical board or if the lawsuit was filed. But the approach should be that you treat your chart for a telemedicine patient just as thoroughly as you would for a patient who comes into your office. But for whatever reason, there does seem to be kind of a mental disconnect between the need to do that with an office visit and the need to do that with a telemedicine visit. I'm not sure why. But the documentation, and I've talked to the medical board about this, documentation needs to be just as thorough either way.  

Tony Passalacqua: So, we're talking a little bit about a notice of a claim, what to do if you get served, and statute of limitations. Thank you. I guess, as we're sitting down and we're talking about this telemedicine, uh, perspective, what happens if you start having patients from different states that you're maybe seeing on a telemedicine visit?

Jim Boston: Well, okay, so, um, I'm going to give you not so much a legal answer as what to me is a commonsense question. You know, I had a patient once who was brought before the medical board because he gave advice during COVID to a patient who resided in Colorado and, during the board hearing, the board attorney raised the question about whether they had jurisdiction to hear and ultimately dismiss the complaint given the fact that the patient involved was a Colorado resident.

And I explained to the panel at that point that the doctor didn't solicit the patient in Colorado. The Colorado patient solicited the doctor in Texas. And so, the doctor was acting within the scope of his Texas license, just as if she had traveled from Denver to Houston and sought medical care while there.

But it was an unanswerable question at the time, and so what they did was turn it over to the Colorado Medical Board, and I don't know what the Colorado Medical Board did with that. So this is an issue that's interesting, but I don't know the answer to it. There was a time during COVID, for example, where all restrictions were lifted so that these doctors in various states could meet the demands of COVID patients who needed immediate care and could get it over telemedicine, no matter where the doctor was located.

Um, the case I just referenced happened a week after all those liberalities were stopped. But yeah, seeing patients who contact you from different states does create an issue of whether you're acting outside the scope of your Texas license by treating a patient in Colorado or not. And I don't know the answer.

It seems to me like you'd be within your rights to treat someone who solicits your advice over the internet just as though they came to you in person, but I don't know the answer for sure.  

Tony Passalacqua: Are the statutes of limitation different for each state? 

Jim Boston: Well, they can be, but I don't know the laws of each state well enough to give you a definitive answer to that. In most states that I'm aware of, the statute of limitations for a medical liability case is two years. I don't know if all states give a 75-day extension based on a notice letter. But tort claims in general throughout the country have a two-year statute of limitations. So, and that includes medical malpractice.

Now, we know that libel cases, you have a one-year statute of limitations. Contract cases, you have a four-year statute of limitations. Real estate cases, uh, there are some situations for a real estate matter where the statute of limitations can be less. But in general, tort claims for personal injury, including medical malpractice, are two years.

I don't know if that's uniform throughout all 50 states, but it's The majority of states, I'm sure, have the same law. 

Tony Passalacqua: What about damages? I know, for instance, Texas fought really hard for its tort reform. But I don't think every state has that. Is that true? Are the damages different, potentially, for each state? Could you be, potentially, creating a more exposure, as you've seen residents in different states? 

Jim Boston: Not every state has tort reform. Not every state has damage limits. You know, New Mexico doesn't have tort reform. It's just the way Texas was back in the 80s. Same was true of several other states. I don't recall all of them by name, but not every state has damage caps.

Not every state has the same restrictions that help doctors, uh, with lawsuits that Texas has. So, the question is, if a patient from a state like New Mexico contacts a doctor in Texas and medical malpractice allegedly occurs, is that doctor going to be subject to the laws of New Mexico or subject to the laws of Texas.

And in general, what happens is that when you have a patient from another state who sues a Texas physician, you get into the federal court system because of diversity of citizenship. So it doesn't end up that you have a case in New Mexico State Court. It usually ends up that you have a case in federal court located in one of the districts of Texas. That's what typically happens. When there's diversity of citizenship, even if they were to sue the doctor in New Mexico, you could probably get that case removed to federal court so that you would, um, have the benefit of whatever laws, uh, are in existence, probably in Texas, given the fact that the care was, was administered here. 

Tony Passalacqua: When should a physician report a claim, especially with a telemedicine case? 

Jim Boston: Well, the same would be true, uh, as we discussed, If the patient was treated in person. I mean, when you get a claim letter, you know that a claim is likely to be filed, you report that immediately to your carrier. If a patient tells you they're going to sue you, you know, it's a little iffy because you don't know if they're just blowing off steam, you don't know if they really mean it.

Um, I think that's a judgment call on the part of the doctor as to whether that type of threat should be reported to the carrier or not. But clearly, when a notice of claim letter is received, clearly at that point, uh, you should report it to your carrier. I guess another circumstance could arise in which something happens at the hospital.

The hospital risk management department contacts the doctor. Maybe it goes into peer review. There could be some things that happen during that process that might motivate a doctor to inform his carrier about a potential claim without yet having received a claim notice letter. You have to remember that the 75-day statute of limitation extension applies if any defendant in the lawsuit gets a notice letter. It doesn't have to be the doctor. So, if the hospital gets one, uh, that 75-day extension to the statute applies to everybody in the case whether the doctor actually got one or not. So, if you become aware of something like that, then obviously it would be a good idea to report it to your carrier. So, for example, if the risk management committee or person comes to the doctor and says we got a notice of claim letter about this care that you provided. Did you get one? And maybe he did not get one. Well, based on the fact that the hospital did, I would still report that to the insurance company.  

Tony Passalacqua:
What's the one thing that you would like our listeners to leave with? 

Jim Boston: Okay, so, in defending a lawsuit, you're having to explain to lay people your medical judgment. And the analysis is, how can I do that? By making my decisions common sense to common people. You have to be able to let a jury, potentially, see the case from your perspective. They need to understand why what you chose to do, or chose not to do, was in the patient's best interest. If you act that way in practice, you have built a defense already.

As long as you can explain why your choices were in the patient's best interest. You are building a defense, even if the outcome is untoward or undesirable. That's the biggest issue, I think, that doctors need to take away from a general perspective. What's in the patient's best interest and how do I explain it in a way that makes common sense to common people? 

If you can do that, you've gone a long way toward defending yourself if you're ever sued. 

Tony Passalacqua:
Thank you, Jim, for your time. I appreciate it. And thank you for listening to this podcast. If you are a policyholder, please feel free to contact us with any questions by calling 1-800-580-8658 or check out our resources at and clicking on our Resource Hub.