In Part Two of 'Experts and Testiliars' we continue to explore the world of unethical medical expert witnesses and their impact on defendants and the litigation system. You'll hear a presentation of Dr. Pensa's own malpractice case, as well as verbatim expert witness testimony from her second trial (acted out brilliantly by Dr. Anand Swaminathan as the plaintiff's expert). We also discuss what physicians can do to help attorneys identify and disempower 'testiliars' during litigation, what 'standard of care' actually means, and what recourse physicians can take after their case is completed if they feel they have been wronged by an unethical expert. 
Louise Andrew MD JD, Greg Henry MD, and Jeff Segal MD JD add their expertise. 
More about Dr. Pensa can be found at doctorsandlitigation.com.

Experts and Testiliars: Part Two

The majority of physicians will be sued during their career, yet the topic is largely taboo. This podcast for physicians discusses malpractice litigation and litigation stress, with the voices of doctors who have been through it. Music by @BenJamin Banger.
Learn more about creator Gita Pensa M.D. at doctorsandlitigation.com 

Also available on Apple Podcasts and Spotify

Medicine

Science & Medicine

Health & Fitness

Mental Health

Medical Boards (or state Departments of Licensure and Discipline) are charged with keeping the public safe from unskilled, impaired, or unscrupulous doctors (or other licensed clinicians, each of which has their own board). While this is an important and necessary role, it is also not uncommon for well-meaning or "innocent" doctors to become the subject of investigations due to complaints from patients, other doctors (including competitors), or from the Board itself. Malpractice litigation or adverse event reporting may also trigger Board investigations as well.
This process is usually opaque, and clinicians have a poor understanding of how their Board works, who is on it, how those people are appointed, who they answer to, what happens when complaints are investigated, the possible ramifications of board decisions, and how to best prepare themselves in the case of a complaint. A naive physician can unwittingly worsen their situation, and an attorney is usually recommended to help in navigating the process. Depending on the complaint, your malpractice policy may help defray the cost of this.
Important points to note: processes for Boards differ from state to state. Typically anyone can lodge a complaint against a physician with the Board, for nearly any reason, and every complaint needs to be addressed in some way. These complaints can be anonymous in some states, and can range from serious to trivial. There is generally no statute of limitations for these complaints. Consider this podcast an invitation to learn more details about your state's medical board and their processes. 
Board investigations and evaluations have been linked to physician suicide, and Dr. Pensa cites a study from 2014 in which nearly 5% of physicians referred to the Tennessee medical board for fitness-for-duty evaluations either seriously attempted or completed suicide. She also mentions a John Oliver 'Last Week Tonight' episode about state medical boards that paints a bleak picture of state medical boards' ability to root out dangerous doctors. The job of the medical board is indeed a difficult one, and Dr. Pensa makes the case for more transparency, accountability, and feedback mechanisms given their power and the wide-reaching impact of their decisions. Changes would need to be made at a legislative level, as the Board is typically a governmental/political organization.
Dr. Gita Pensa gives an introduction to Medical Board investigations and complaints in this episode with Guillermo Beades, Esq. Mr. Beades teaches and publishes regularly in an effort to educate physicians and other clinicians about healthcare law. 
You can find an article of his about this topic here in Medical Economics. 
Guillermo J. Beades, Esq., is a Partner in Frier Levitt’s Healthcare Litigation Department and Co-Chairs the Firm’s Insurance Defense Group. He represents healthcare professionals in a broad range of administrative, civil and criminal healthcare matters. Mr. Beades has extensive litigation experience before state licensing authorities and Medical Boards (e.g., NJ BME, OPMC), federal healthcare agencies (e.g., OIG, CMS, DEA) and state healthcare agencies (e.g., NJ Medicaid Fraud Division, NY OMIG). He represents practices and healthcare professionals in matters concerning credentialing and denial of privileges, administrative discipline, Medicare audits, hospital fair hearings, post-payment demands and pre-payment audits.

Medical Board Complaints and Investigations

This month, we're exploring the topic of 'help-resistance' in physicians. Why do we acknowledge the need to maintain and optimize the health of our bodies, but scoff at doing the same for our minds or mental well-being? Why do support programs flounder from lack of participation? Why is the notion of even 'self-help' so foreign and...icky?
In this 'listicast', Dr. Pensa explores the top ten(ish) reasons for help-resistance in physicians. This has practical implications as to why physicians often do not access support programs, and why they may resist external or even self-help instruction. 
These concepts are each briefly explored, with particular focus on the physician experience (though, of course, other clinicians and high achieving professionals may have similar experiences.)
Ten Reasons Behind 'Help-Resistance' in the Physician
1) Internal core beliefs and identity of the physician (and traits including exceptionalism and perfectionism)
2) External collective beliefs and medical culture 
3) Inability to recognize when help is indicated (or avoidance coping)
4) Lack of awareness of various modalities of 'help' (what does 'help' even mean?)
5) Family of origin (or culture of origin) taboos; expectations of the family high achiever
6) Absent help infrastructure (or a hush-hush help infrastructure)
7) Terminal uniqueness
8) Fear (of discovery, judgment, licensure/discipline threats)*
9) Friction
10) Change resistance and inflexible thinking (or dichotomous thinking)
 
*To learn more about Dr. Lorna Breen, the Dr. Lorna Breen Heroes Foundation, and their work addressing the origins of this fear, go to https://drlornabreen.org/
More about Dr. Pensa: https://doctorsandlitigation.com/about-gita-pensa
Disclaimer: Dr. Pensa is not a therapist or psychiatrist, and this discussion is not meant as treatment for any specific mental health disorder. This list is based on Dr. Pensa's personal and professional experience, and her coaching work with other physicians in the realm of litigation stress and burnout.

Help Resistance

In this first episode of Season 2, Dr. Pensa talks with attorney Saira Pasha, an EMR audit trail expert. What else besides the words in your chart does your electronic medical record track? Are 'secure messages' discoverable? (Spoiler: yes, they can be!) How can an audit trail help your case -- or hurt it? How does an audit trail expert 'read between the lines' of who's looking at what entries in the record, and when, and for how long?
Take home points: 
The EMR creates a trail that tracks not only your substantive words on the chart, but evidence of all the people who were in a given chart, at what time, looking at what, for how many seconds or minutes, what they did next in the chart, whether a template or smart phrase was deployed. It tracks and times views, edits, additions, deletions, changes, and any printing or searches. These are not part of the initial requested 'medical record,' but can be obtained through the request of an EMR audit trail. 
The timing of changes to the record can imply that charting was slanted in a way to be defensive or misleading (or at least, a plaintiff’s attorney is going to try to do that, even if your intention was well-meaning.)
Attorneys may infer the importance of a part of the record by seeing how many people were in a chart at a given time, and what they were all looking at, for how long. This information can act like a big red arrow pointing at a specific medication order or radiology result, for example, even if there is no explicit mention of it in anyone's notes. 
Secure messages, FYI's, Best Practice Advisories, and other prompts are all discoverable (with a little sleuthing) as part of an EMR audit within a few years of their appearance in the chart. 
If you cosign notes using a template that suggests you did a substantive review of another clinician's care (such as an APP or midwife), be mindful of the fact that the EMR tracks how long you spent in that note, or reviewing that patient's chart or imaging. 
Dr. Pensa references this 2021 case in which efforts to alter EMR records were exposed. 
More about Dr. Pensa and how to contact her can be found at doctorsandlitigation.com.

The EMR Audit Trail: Friend and Foe

Dr. Pensa tells the story of her own life after litigation in an interview with Dr. Mel Herbert.
This is the last episode of Season One.  But follow along -- a new season is in the works!  We'll talk about topics at the intersection of litigation, coaching, risk, and medicine -- and how to stay human through all of it.

Life After Litigation: Part Two

Although you might expect life to go back to 'normal' as soon as the litigation process is complete, it often doesn't work that way. Lingering distress, if left unaddressed, can lead to behaviors like over-documenting or over-testing, avoidance of certain procedures or case types, PTSD symptoms, disillusionment, burnout, and career abandonment. In part one of 'Life After Litigation', Dr. Gita Pensa speaks with Tracy Sanson MD, Stacia Dearmin MD, and Marge Paccione, PhD, about their insights.

Experts and Testiliars: Part Two

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