It's a Legal Playbook episode covering why defensible malpractice cases still settle — walks through insurer economics and expected value calculations, consent-to-settle and hammer clauses in malpractice policies, the nuclear verdict shadow driving settlement pressure, and the NPDB reporting implications that follow a physician after settlement. Status shows published already.

A middle-aged man presents with breathing problems, gets diagnosed with pneumonia and discharged, then returns a week later in worse condition. Over twenty lab tests come back negative as clinicians allegedly delay the diagnosis of the “great pretender.” The episode walks through the diagnostic challenge and the science behind causative organism.

The season finale puts you in the courtroom. The plaintiff's hematology expert says warfarin was the gold standard and the switch to rivaroxaban was unjustified. The defense experts say the evidence was unsettled and the decision fell within reasonable medical judgment. Same papers, opposite conclusions. We reconstruct both sides of the expert testimony, examine how courts handle gray-zone medicine, and close with practical lessons on documentation, shared decision-making, and what your chart note actually needs to say when you depart from the mainstream standard.

Warfarin had been the standard for APS for decades. Then DOACs hit the market — convenient, no blood draws, no dietary restrictions. But for patients with Antiphospholipid Syndrome, convenience came at a cost. This episode breaks down the pharmacology of warfarin versus DOACs, explains what the TRAPS trial would eventually prove, walks through the patient's prolonged hospitalization and devastating clinical decline, and introduces the legal concepts — proximate cause and preponderance of evidence — that will frame everything that follows.On the Record is a deep-dive series from The Charted Defense that takes a real medical malpractice case apart — from the patient's first presentation through the courtroom. Each season follows one case across multiple episodes, walking through the medical records, the clinical decision-making, the legal filings, and the expert testimony on both sides. The goal isn't to pick winners — it's to find the moments where something could have gone differently and turn them into lessons for the next shift.

A young mother develops pulmonary emboli — then a thrombophilia workup reveals a dangerous combination of inherited and acquired clotting disorders, including suspected Antiphospholipid Syndrome. As her care fragments across multiple providers and health systems, the stage is set for a critical anticoagulation decision that will define the rest of her life — and this entire case.

A young mother survives bilateral pulmonary emboli, only to be diagnosed with a clotting disorder. When her anticoagulation was allegedly switched, the case alleges that a chain of events was set in motion that led to her death. Her family filed a medical malpractice lawsuit. The case survived summary judgment when the court found that competing expert opinions — on whether the prescribing decision departed from the standard of care and whether it caused her death — were a question for a jury, not a judge. Season 2 breaks down the medicine, the litigation, and the decision points where the outcome might have been different and goes into the medical experts and their opinions.

A practical, physician-focused deep dive into the documentation habits that can either narrow or expand malpractice exposure. Using a concurring appellate opinion as the framework, this episode examines three recurring process-of-care vulnerabilities—stale risk assessments, orders without documented reasoning, and chart gaps that leave care indefensible—and translates them into concrete next-shift documentation strategies. The core message is straightforward: in modern malpractice litigation, the chart is not just a record of what happened; it is the evidence of whether your clinical judgment can be defended.

SOURCES

* Candello/CRICO. “For the Record: The Effect of Documentation on Defensibility and Patient Safety.” Benchmarking Report. November 2024.

* Kusumoto FM, Ross J, Wright D, Chazal R, Anderson RE. “Analysis of Closed Claims Among All Medical Specialties.” Risk Management and Healthcare Policy. 2024;17:411-422.

* Padula W, et al. “Value of hospital resources for effective pressure injury prevention.” BMJ Quality & Safety. 2018;28:132-141.

* Lorente-Granados G, et al. “Hospital-Acquired Pressure Injuries: Application of Preventive and Reactive Measures in Real Practice.” J Adv Nurs. 2025.

* Pascall E, et al. “Litigation associated with ICU treatment in England.” Br J Anaesth. 2015;115(4):601-7.

* Corum L. “Medical Malpractice in Wound Care: A Multiple Case Series.” J WOCN. 2025;52(5):417-420.

* Ghaith S, et al. “Charting Practices to Protect Against Malpractice.” Western Journal of Emergency Medicine. 2022;23(3):412-417.

* Sharma S, McKenna MK, Brenner MJ. “The Evolving Legal Standard for Medical Malpractice.” Otolaryngology–Head and Neck Surgery. 2025;173:1028-1030.

* American Law Institute. Restatement of Torts — Medical Malpractice. Approved 2024, published February 2025.

* ProAssurance Risk Management Case Study: Documentation and Prevention Protocols.

* VerdictSearch database analysis: 141 pressure ulcer malpractice cases. Published in Adv Skin Wound Care.

* CMS F-686: Treatment/Services to Prevent/Heal Pressure Injuries.

* NPIAP. Unavoidable Pressure Injury White Paper.

DISCLAIMER

This podcast is produced for educational purposes only and does not constitute legal or medical advice. The content reflects publicly available case information, published medical literature, and general legal principles. Laws vary by jurisdiction. Clinical decisions should be based on individual patient circumstances and current evidence-based guidelines. If you are facing a malpractice claim, consult a qualified attorney in your jurisdiction.

The Charted Defense Newsletter | Michael Coleman MD

A malpractice case involving a young child illustrates how recognition and response failures—rather than the initial prescribing decision—can drive catastrophic outcomes and large verdicts. In 2016, while being treated for Burkitt lymphoma at Children’s Hospital the child was started on allopurinol for tumor lysis syndrome prophylaxis, a routine therapy. Within days he developed progressive skin sloughing, a hallmark of Stevens-Johnson syndrome (SJS), yet multiple clinicians documented the worsening rash over approximately nine days without discontinuing the drug or obtaining a dermatology consult. When another physician finally recognized the likely diagnosis and stopped allopurinol, roughly 30% of the child’s body surface area was involved; he died the next day. In 2024 a jury returned a reported $35 million verdict against the University System Board of Regents. The case highlights recurring malpractice patterns: documented warning signs without action, diffusion of responsibility in team-based care, delayed escalation, and inadequate documentation of clinical reasoning. The broader lesson for physicians is that litigation risk often arises not from the initial treatment decision but from failures in monitoring, recognizing complications, and clearly documenting risk assessment, escalation plans, and response when warning signs appear.

Sources

Case Sources

* The Augusta Press (May 8, 2024). “Augusta jury awards $35 million verdict.” https://theaugustapress.com/augusta-jury-awards-35-million-verdict/

* GeorgiaMalpractice.com (Scott McMillen). “10 of the Largest Medical Malpractice Verdicts in Georgia History.” https://georgiamalpractice.com/10-of-the-largest-medical-malpractice-verdicts-in-georgia-history/

* Childers, Schlueter & Smith, LLC. SJS Practice Area. https://cssfirm.com/practice-areas/personal-injury/medical-malpractice/stevens-johnson-syndrome/

* AboutLawsuits.com: $6M California allopurinol-SJS verdict; $21M Bartlett v. Mutual Pharmaceutical SJS verdict.

Legal Sources

* Georgia Tort Claims Act, O.C.G.A. § 50-21-23 et seq. https://law.justia.com/codes/georgia/2020/title-50/chapter-21/article-2/section-50-21-23/

* Mutual Pharmaceutical Co. v. Bartlett, 570 U.S. 472 (2013).

Medical Literature

* Yang CY et al. “Allopurinol Use and Risk of Fatal Hypersensitivity Reactions.” JAMA Intern Med. 2015;175(9):1550-7.

* Ko T et al. “A prospective study of HLA-B*5801 genotyping in preventing allopurinol-induced severe cutaneous adverse reactions.” Clin Transl Allergy. 2014;4:O4.

* Cairo MS et al. “A Clinical and Economic Comparison of Rasburicase and Allopurinol.” Clin Lymphoma Myeloma Leuk. 2017;17(3):173-178.

* Cheung CMT et al. “SJS and TEN in Hong Kong.” Hong Kong Med J. 2024;30(2):102-109.

* Huang YS et al. “Drug-induced liver injury associated with severe cutaneous adverse drug reactions.” Liver Int. 2021;41(11):2671-2680.

* Bathini L et al. “Initiation Dose of Allopurinol and the Risk of Severe Cutaneous Reactions.” Am J Kidney Dis. 2022;80(6):730-739.

* Noe MH, Micheletti RG. “Diagnosis and management of SJS/TEN.” Clin Dermatol. 2020;38(6):607-612.

* Hasegawa A, Abe R. “Recent advances in managing SJS and TEN.” F1000Research. 2020;9:612.

* Chang CJ et al. “Pharmacogenetic Testing for Prevention of SCAR.” Front Pharmacol. 2020;11.

Regulatory Sources

* NCBI Medical Genetics Summary: Allopurinol Therapy and HLA-B*58:01 Genotype. https://www.ncbi.nlm.nih.gov/books/NBK127547/

* CPIC Guideline for Allopurinol and HLA-B (2013/2015). Hershfield MS et al. Clin Pharmacol Ther. 2013;93(2):153-158. Saito Y et al. Clin Pharmacol Ther. 2016;99(1):36-37.

* Allopurinol: Pediatric drug information. UpToDate (2026).

* Allopurinol: ClinicalKey AI clinical summary. Elsevier ClinicalKey (2026).

The Charted Defense provides educational content for physicians. Nothing in this newsletter constitutes legal advice, patient-specific medical advice, or a definitive statement of adjudicated findings. Case details are drawn from publicly available reporting with attribution. Where court-primary documents have not been obtained, this limitation is noted. Laws vary by jurisdiction. Discuss specific legal questions with qualified counsel. Discuss specific clinical questions with qualified colleagues.

Michael Coleman, MD is a practicing hospitalist, Hospital Medicine Program Director at US Acute Care Solutions (South Division), based at Highlands Medical Center in Scottsboro, Alabama. He is currently pursuing a Juris Doctor degree to deepen his expertise at the intersection of medicine and law. Michael has personally been named as a defendant in a medical malpractice lawsuit — an experience that profoundly shaped his understanding of how litigation impacts physicians.

Where medicine meets the law — an MD’s journey to JD.