S2 EP 3: The Headache That Shouldn’t Have Happened

Narrator  [00:00]  Every minute someone’s life takes a terrifying detour, not down a dark alley but into the sterile bright halls of healing. They walk in seeking care and find themselves plunged into a nightmare. Most malpractice claims in hospitals are related to surgical errors, whereas most claims for outpatient care, which accounts for more than half of the paid malpractice claims, are related to missed or late diagnosis. Now before you raise a pitchfork at every white coat you see, let’s be clear. This isn’t an indictment, it’s a revelation. Because the truth is any provider any nurse any human being capable of brilliance is also capable of a mistake This is about understanding why and using that knowledge to build a safer future for every patient who walks through those doors Welcome to FHEA Scrubs and Subpoenas Tales from the witness stand a podcast where we’ll peel back the sterile sheets and delve into the real stories of medical malpractice practice. Each episode, a cautionary tale, a blueprint for change, a reminder that even in the darkest corners of human error, there’s a light. The light of knowledge, the light of empathy, the light of a future where healthcare becomes not a gamble, but a guarantee. So join us as we dissect the mistakes, illuminate the flaws, and ultimately learn to heal not just bodies, but the very system itself.

Dr. Sally Miller  [01:20]  Welcome to yet another episode of Scrubs and Subpoenas. My name is Dr. Sally Miller and one of the speakers, but for this podcast, I will introduce you to Dr. Wendy Wright, who is gonna share with us a malpractice scenario today. And of course, Dr. Wright can introduce herself, and then she’s going to share with us a case. Are you going to tell us if you were retained by the plaintiff or the defendant, or should we figure it out?

Dr. Wendy Wright  [01:43]  No, Sally, they’re gonna have to figure it out.

Dr. Sally Miller  [01:47]  I think we should start though, by our usual disclosure, right? That I’m not perfect.

Dr. Wendy Wright  [01:53]  I think you’re as close to perfect as they come.

Dr. Sally Miller  [01:55]  I think you say I am, but that’s beside the point. If I could just [inaudible] this modesty problem, everything would be perfect.

Dr. Wendy Wright  [02:02]  I know, but we want our listeners to know that we’re not here to cast any judgment, that we’re just bringing to the table issues that have occurred, and then we’re gonna let, hopefully people walk away from these and say, listen, I have a better understanding of maybe how I can prevent this from happening in the future. And I think that’s what I hope to bring to the table today. So anything you want to add to that or shall we jump right in?

Dr. Sally Miller  [02:28]  I guess times being what they are, I do want to be very clear that I don’t think I’m perfect. Sometimes humor can be misinterpreted and I am probably the furthest thing from perfect that there is. So that was really nice to just to joke between two colleagues, right? It is. It is very true that we all, I mean, I know I’m sure that you feel the same way. Anyone could look at some of my charts, especially the older ones and think, why did she do this? Why didn’t she do that? Oh, look, look at this, blah, blah, blah. I mean, for sure. The only reason that we do this is to try to help all of us go, not just the listeners, but for myself. Every time we do one of these, I have a few bells go off about, oh, in the future I want to be sure that I attest to this or document that or don’t do that or whatever. So, it really is just about trying to give all of us a framework for trying to maximize our documentation and approach to the patient so that we meet the best patient care expectations while simultaneously ensuring that we are protecting ourselves from litigation.

Dr. Wendy Wright  [03:36]  Absolutely. And I, from the beginning, from when I began to practice, I’ve always said the first time I’m sued is probably the last day I practice. And so it’s hard to be the recipient of one of these cases, but oh, but for the grace of God go I and I want people to learn from these. And so if there’s a takeaway point, you and I can have a conversation about it. So I’m going to jump right in and we’re going to talk about a case and I’m not going to tell you what side of this case I was on. As we go through, you can kind of listen and see what you think. But this was a 47-ish year old male. And I’m going to change up a little bit of the information just so it’s not identifiable. I think that’s really important. But this was a case that went on, I think it finally kind of came to fruition about two years ago, but it actually started in 2017. And this was a patient who presented to a nurse practitioner. And by the way, this NP had been caring for this family for decades in a rural community in the United States. And so he presented with a new onset of headaches, some nausea, and light sensitivity. He described it as a pulsating headache. It was associated with not feeling like he wanted to eat much at the time. But NSAIDs and acetaminophen offered him no benefit for that headache. And it had been going on at that point about seven days when he first saw the nurse practitioner. He had no past medical history of migraine, but there was a significant family history of migraine, but this patient reported he had never had them before. There was no trauma. NP did a really comprehensive history and did a really good neuro exam, and there was absolutely nothing identifiable on the neuro exam that was identified as being abnormal. But the patient’s blood pressures were in the high 140s and high 80s, which was different for him. He had never had that before, and this NP had the capacity to go back and take a look. And so the NP treated him with Toradol, I think it was 30 milligrams that the NP treated him with, and gave him an injection of Decadron and sent him on his way. And by the way, when she did that, she evaluated him after, did vital signs all through that total injection. And then his pain was 50% better when he left. And he was told, if anything worsens, you need to follow up here if it doesn’t go away. So he comes back in two days later because they had planned to follow up 48 hours later said my headaches had actually been a lot better until last night when they’ve worsened again. So at that point, his blood pressures were still elevated. And so the NP started him on lisinopril to treat his blood pressure. And at that point, there was nothing really else different except that the headaches just had not gone away. And I have some notes, so I want to make sure that I am not missing anything here. So, NP starts him on lisinopril, brings him back a week later for blood pressure recheck and the headaches are getting worse. And now he’s just not wanting to eat and he’s developed some pain in his neck. And so, again, neuro exam pretty unremarkable, but the NP orders up an MRI at that point and orders up a referral to neurology. Adjust his blood pressure med because his numbers are still staying high, but gets a referral going. He has an appointment actually with neurology in two weeks, ends up getting an MRI a couple of days later, so fairly quick MRI, and the MRI is unremarkable. There’s nothing showing on the MRI. And by the way, with that neck pain, there was no evidence of nuchal rigidity. And he put him through full range of motion, neuro exam was normal. Goes off to see neurology two weeks later, and neurology affirms that it’s migraine headaches, but writes in the note that if if it persists, consideration should be given for an LP. So he comes back to the NP in family practice about two weeks later and headaches are getting worse. And at this time the NP says, you know what, let’s get you to a different neurologist. He sees a different neurologist who evaluates him a couple weeks later, a neurologist diagnoses him with what sounds like Lyme related headaches and orders up some blood work. And then not getting any better comes back to see the NP again two weeks later. And the NP says, no, the wife says, I have a family friend who works in an ER. I think we should take him to the ER. So they take him to the ER, the ER evaluates him, doesn’t order any type of imaging there, some preliminary blood work and says these are non-worriesome headaches, comes back to see the NP and the NP says you need to go to a different ER, and sends him off. And he is admitted to the hospital about two months after the initial evaluation with the nurse practitioner ends up with a very rare form of encephalitis called crypto, we call it cryptoencephalitis, has a spinal tap and the rest is history. But at this point, MRI is grossly abnormal, grossly abnormal. And this man is now left in his 40s, pretty incapacitated, unable to work, unable to really feed himself, do much of anything at this point. So this is where we’re at and a lawsuit is filed. So thoughts about what we talked about?

Dr. Sally Miller  [09:33]  Well, just the one question at this point, what was the specific allegation? I mean, I’m assuming it was the nurse practitioner, playing it for defense, but the nurse practitioner’s care that you were called in? What was the assertion?

Dr. Wendy Wright  [09:47]  What was the assertion? But it was also the neurologists, which was a separate practice times two and the emergency department times one. All of those folks were named. My job was in relationship to the nurse practitioner. And basically what they said was, at the initial visit, blood work should have been done. Patients should have never been given Decadron as it’s an immunosuppressant. Patients should have never been given a pain medication such as ketorolac without knowing what the headache was that they were treating. And then it was just failure to diagnose and actually a delay in diagnosis. And what they alleged in the complaint was that the NP should have sent that patient to the emergency room immediately. And that that’s what delayed the care.

Dr. Sally Miller  [10:37]  And my other question is, do you know what the blood pressures were?

Dr. Wendy Wright  [10:40]  Yes, they were in the 140s and 80s and previously this patient had been in the 110s to 120s. You know, when I think about those blood pressures, yes, I know in some people, small amounts of elevated blood pressure can produce symptoms. I don’t usually think of a 140 as something that’s gonna create the headache. And I do think, Sally, that one of the things that comes up is as we’re thinking about primary headaches, which is what was originally diagnosed by not only the NP, but also the neurologist. When I think about primary headaches, we often say anything over the age of 50, it’s not a primary headache until you prove it otherwise. This comes in as mid 40s, but usually if you’re talking about a migraine, it usually declares itself in the younger years. You don’t usually have your first, in my opinion, you don’t usually have your first migraine in your 40s as a male, I don’t think. At least it’s not what I see.

Dr. Sally Miller  [11:38]  No, no, there actually are so many, there are so many interesting, isolated things that come up through this case. I mean, like the first one is yes, there is a, there’s a textbook description of primary headache presentation. There’s a textbook description.

Dr. Wendy Wright  [11:57]  Well, there’s real life.

Dr. Sally Miller  [11:58]  There’s real life. And there are, you know, patients rarely read the book and have the good grace to neatly present with a bunch of textbook signs and symptoms. And so, you know, a message for all of us is that I’ve had this experience with those circumstances that everybody’s not a textbook. And you know, especially the way NP education is now, we hang our hat so strongly on guidelines, guidelines, guidelines, you know, evidence-based care, etc., etc., that it’s easy to get kind stuck on something like that when in real life there’s such a wide deviation.

Dr. Wendy Wright  [12:34]  And technically you’re not supposed to diagnose migraine until there’s been five episodes. I mean that’s I think the International Headache Society’s diagnostic criteria is five episodes. Until that happens though we often will refer to it as migrainous but I think at that first visit I would say to you that there was nothing really that compelling. I mean, how many times do you see people that come in and have a pulsating headache but have absolutely nothing, afebrile other than an elevated blood pressure maybe because of a headache? So the question should become, should that patient have been sent to an emergency department? I mean, I, in reviewing the records, didn’t really see where there was a reason at that visit. Yeah, throbbing, yes, light sensitivity, but those can all be part of migraine. And the anorexia makes me a little nervous, but because who doesn’t usually want to eat, but migraine patients often don’t want to eat either. So, yeah. And then the question becomes, at what point do you then get someone to an ER? Do you refer them to neurology? I actually think honestly that a two week into a headache is not terrible for a referral to neurology and to be seen within four weeks of an onset of headaches in my community, you’re going to wait six months to see a neurologist. So getting that done quickly and getting the MRI, I probably would have gone to a CAT scan. That’s usually what I go to acutely. But again, the MRI is probably a better test. I just can’t get them quickly in my community. But there was nothing there. Nothing there.

Dr. Sally Miller  [14:23]  I lost my train of thought that this is my advanced Alzheimer’s onset here. I had something brilliant to say in that fast. Oh, I know what it was. Like another general concept here in this whole discussion is that we’re supposed in these cases, the bar is supposed to be standard of care. What would any nurse practitioner with the same or similar training, education, experience, licensure certification do in the same or similar circumstances? I mean, that’s what we’re supposed to be talking about here. I look at when I look at these cases and I know you do it. It’s what we look at, but it’s not what the juries look at sometimes and it’s darn sure not what the attorneys look at because to come back and say, oh, you should have sent them to an ER immediate, or you should have done bloodwork in the office, or you should have done X, Y, and Z. I guess when somebody is trying to make a case for their client, they’ll stretch to whatever. But what would almost every nurse practitioner you’ve ever worked with, known, taught, learned from, et cetera, what would almost any one of the 200,000 NPs in the United States do if somebody comes in with a headache of that nature and the exam as it’s presented, how many would order bloodwork? How many would send them anywhere else? Like nobody, especially the family history of migraines. You know, that’s really a sort of a scale tipper there. I mean, you know, appetite suppression. Well, you know, I get migraines, not as much now with my old age, but I mean, everything you’re describing there sounds very much like a migraine phenomenon. Unfortunately, it could be a lot of other things too, which is of course why Monday morning quarterbacking and hindsight are so crystal clear. But there’s a lot in that, even though the age is a bit on the high side, but when you’ve got a list of things that are supportive and statistical likelihood over here, and then one little textbook thing a little off over here, none of us would have gone nuts. And as I think of what would I have done, probably the same thing at that step.

Dr. Wendy Wright  [16:30]  We’ve talked about this, you and I before, repeated visits back, repeated phone calls to a clinic often signal like something worrisome or at least that anxiety is going up. But I don’t see in this case that there was ever a place that this NP didn’t escalate to the next level. Now in one of her visits, she wrote follow up, if anything worsens, there was nothing that said ED if anything worsens. But that, I mean, neurology times two, MRI out of the gate, ER times one, and they all affirmed what can an NP do different at that point?

Dr. Sally Miller  [17:18]  Can you order up an LP yourself? I can’t. Can you imagine me writing an order for an LP and having the patient take it to the ER and say, I want you to pay me.

Dr. Wendy Wright  [17:28]  One of the things that was alleged by the attorney is that the NP should have ordered up. Even when the patient saw two neurologists, the neurologist didn’t find it, that it needed to have an LP.

Dr. Sally Miller  [17:46]  That’s why it’s so frustrating that standard of care is what we’re supposed to be looking at and yet we find ourselves having to defend something much higher than standard of care.

Dr. Wendy Wright  [17:59]  Absolutely. Every conceivable thing.

Dr. Sally Miller  [18:02]  Possibility.

Dr. Wendy Wright  [18:03]  And we’re all taught, look for horses, not zebras. I want to ask you, how many cases of cryptoencephalitis have you seen in your lifetime, particularly in someone who’s not immunosuppressed? I mean, when I’ve read about that, it’s often someone who’s HIV positive or very severely immunocompromised. And so I think that by now, our listeners can probably figure out that I worked on the defense for this case, because I really believed that this NP didn’t give up, that this NP continued to step this guy’s care up. But shall we talk about the outcome?

Dr. Sally Miller  [18:43]  Yeah, yep, please.

Dr. Wendy Wright  [18:44]  What do you think?

Dr. Sally Miller  [18:45]  What do you think? What do you think? Like, so, well, what? I mean, did this go to a trial? Did it settle?

Dr. Wendy Wright  [18:54]  It did not go to a trial.

Dr. Sally Miller  [18:55]  I mean, a lot of times we’re not allowed to discuss the actual amounts, but the fact that it settled or?

Dr. Wendy Wright  [19:02]  It settled and the problem was is that each of these different defendants was a different organization. And so what happened was all of them around the nurse practitioner settled. And the NP did not want to settle. And I said to her, attorney, don’t settle. And the malpractice carrier felt like this was too high of an exposure case, because you’ve got a 40 plus year old man who will never work again, who’s the provider for the family. And so they felt compelled that they had to settle. And it was $2 million.

Dr. Sally Miller  [19:40]  I mean, have they all contributed to a two million settlement?

Dr. Wendy Wright  [19:45]  No.

Dr. Sally Miller  [19:46]  Each individual person?

Dr. Wendy Wright  [19:49]  I don’t know what the other parties paid. I just know that it was a $2 million settlement for the NP.

Dr. Sally Miller  [19:55]  Wow.

Dr. Wendy Wright  [19:56]  So, and I know that the NP was really, really angry. And I was angry for her. I really was. I felt like this case should not have settled. I actually talked to the attorney because I said, I want to know why you settled. And he said, we didn’t want to settle. We thought we had a really, really defensible case. But I work at the mercy of those malpractice insurers. And if they tell me you figure out a settlement, you figure out a settlement. And I think that, for lack of better words, I think that sucks.

Dr. Sally Miller  [20:28]  It does. I mean, it’s up to the carrier. It’s up to the carrier.

Dr. Wendy Wright  [20:31]  It is up to the carrier. They’re the ones that are going to pay this out. And so I feel this is one thing. So at the end of the day, what should we take away from this? I think we should take away a couple of things. One is rapid repeated visits, worsening, not getting better, escalate that up. I said this to one of my NPs, the newer NPs in my clinic when I was reviewing a note last week and I said I need discussed importance of seeking ED care. Adding a quick text into your quick text EHR that says ED if anything worsens or even saying sir I recommend you should go to an emergency department. If the patient refuses then you document refusal. There is a Z code called treatment refusal by patient and you can drop that into your plan and say discuss the importance of ED care. I mean, I would not have referred this patient early on to an ED, I just wouldn’t have. But at least putting a caveat in your note and saying that you referred if you did refer, but they refused to go, at least make that a Z code treatment refusal by patient. Those are the two takeaways or three takeaways that I have from this case. And sometimes you didn’t do, as I said to the NP, I don’t think you did anything bad. I think you were standard of care, but I think they felt like the jury would look at this and see this person sitting in a wheelchair who can’t ever work again and that the exposure could have been too high.

Dr. Sally Miller  [22:18]  Of course, I mean, it really isn’t about standard of care. And it should be because that’s the law, but it just often isn’t. It’s about trying to, you know, it’s about trying, they try to capitalize on sympathies of lay people that don’t understand the nuances and it’s, you know, all we can do as witnesses is try to convey that what we would do. But it’s hard when you have somebody who’s incapacitated and 40-something and can’t ever work again. It’s hard for lay people to understand the concept of, well, standard of care. This is a horrible thing. It’s a horrible outcome, but standard of care. But a couple of other thoughts that occurred to me that are good takeaways from this. It is standard of care, and it is very reasonable to assume that any specialist to whom you refer or to the emergency department that they do what they’re supposed to do, that they manage the way they’re supposed to. And I’m sure there are many that do. I’m being careful here because as we both know, snippets of these podcasts can get played for juries and chop out a little thing they like and not take the comment in context. So now, like now when we record these, I’m trying to keep that in mind so that none of my comments get taken out of context.

Dr. Wendy Wright  [23:39]  And I only hope that if one side shows a snippet of an episode, the other side can show the same episode. You know, that’s my hope. Have we set those comments up? Yes, because you know, we’ve talked about this. They showed me an image of me doing one of these podcasts in a trial. So, yes, and don’t give you a chance to respond or to set up why you said what you said. So, I agree with you.

Dr. Sally Miller  [24:04]  If they open a topic, then the opposing counsel is allowed to respond to that thing. And they’d be able to show the whole episode. So, that’s why I say, I’m sure, and I’m sure, legit for real, I’m sure there are plenty of specialists and plenty of EDs that do an excellent job. But maybe we see disproportionately the ones that don’t in doing this role. And I learned many, many years ago that even though I should be able to expect that a specialist and an ED did what they needed to do, it’s not a reasonable expectation. And so if you keep referring a thing out and it keeps coming back to you and it’s not solved or you get an explanation that you don’t really like but it was the specialist, the cardiologist, the neurologist, the pulmonologist, they said it was X, Y, or Z. If it really doesn’t seem right and you don’t feel good about it, don’t feel like you have to hold on to that. Refer out, refer back. And like in this case, I mean it is. In fact, when you were talking about this earlier, I said, well, if this is the case and the MRI is negative and it keeps going LP. The next step isn’t LP. And I appreciate the circumstances here but the next step isn’t LP. And so even though sometimes ER people don’t like it when you do this or specialists don’t like it when you do it, and it’s not a standard of care. It’s going above and beyond because in this day and age sometimes, unfortunately, we have to. But I have been known to send people to an ER with an instruction and even follow the ER. And sometimes they laugh and they tell me not to do whatever, but I send it and if they don’t do it, I make a report to the board of medical examiners. Because number one, having been a board investigator for three years, I know that nobody likes to be subject to a board investigation. Even the hint of a board investigation will make people rethink how they approach a patient sometimes. And there have been a couple of circumstances in my patient history where things were just really grossly, grossly missed in that kind of referral. So now, I mean, you know, not everybody likes me, but you know that not a lot of people don’t like me, but you know, that’s just not my priority. If I really think somebody needs something this specialist or an ED is pushing back, I will put it in writing and put it in my note in writing and and I mean, I don’t do it every day, but I have been known to make a complaint to protect the patient as much as to protect myself. And that’s something that you can do if you feel like you’re really trying get something done and the receiving end of your referral isn’t doing it, you can advise that.

Dr. Wendy Wright  [26:45]  And I think the hard part about this is, you know, we talk about the standard of care is what would you do Sally if you were in the room at the same time. It’s not Monday morning quarterbacking. Like all of us do when we know the outcome and that someone dies, it’s really easy to say I would have done that. That’s not what the standard of care is. would you have done what a reasonable nurse practitioner would have done with the same level of education sitting in the same spot you are in and at every turn that NP escalated at every turn and I think what she is the recipient of is a system that wanted to protect a high exposure. And I as I said to her you I do not believe you did anything wrong here at all and when there was something changing, you escalated it at every turn, but sometimes that doesn’t protect us, unfortunately.

Dr. Sally Miller  [27:47]  She didn’t do anything wrong. She did follow the standard of care, but the reason I make these other suggestions is, in the end, if I’ve had to settle a $2 million claim reassuring myself that I followed the standard of care, that’s not always enough. So some of these other things, they’re not standard of care. They’re over and above, And it’s just unfortunate that standard of care really often isn’t.

Dr. Wendy Wright  [28:11]  I think as we move forward that this is not going to be that unusual because there are high awards, higher than ever seen before. And these punitive awards that are 100 million meant to punish, don’t get paid by any of your malpractice insurances. And so I know I sit on the board of directors of a for a malpractice company who insures NPs and PAs and midwives, and they talk a lot about these what they’re calling nuclear verdicts that claims against NPs and physicians are not they’re not huge numbers of these cases like people would expect particularly against NPs, but when they are awarded, the amount of money tends to be high. And that’s what they’re calling nuclear verdicts. And that’s kind of the trend in the world of malpractice, unfortunately. It’s very scary. It’s just, it makes you really afraid. It makes me afraid.

Dr. Sally Miller  [29:21]  It makes me afraid as well.

Dr. Wendy Wright  [29:22]  I think healthy fear is always, I think a little healthy fear is important. Because I think when you don’t have it, you and I speak on a stage all the time. People say to me, do you still get nervous? I say I still have a little edge. And that edge makes me make sure I dotted my i’s and cross my T’s. I still to this day, 34 years in, fear being sued. I do. I fear it.

Dr. Sally Miller  [29:51]  You already are your hardest critic.

Dr. Wendy Wright  [29:53]  I’m my worst critic.

Dr. Sally Miller  [29:55]  My notes are fabulous. Like you write these notes, you only go when you go back at them and you look at them and you go, what the heck was I thinking? You try to do the best you can with what you have, but time there just is never enough time to spend hours on your documentation. Like the experts will years later.

Dr. Wendy Wright  [30:16]  Right.

Dr. Sally Miller  [30:17]  No, looking for every comma that you missed.

Dr. Wendy Wright  [30:21]  They brought this case. [Every] person was named, but this case did not settle for seven years, seven or eight years from the time it started. That’s not unusual. Five plus years is the average.

Dr. Sally Miller  [30:39]  At this stage of the game, knock on wood, knock on wood, I have managed to escape unscathed to this point in my career. So now, at this point, I want to do the right thing. I never want to be sued, but at this point, more importantly, I just want to do the right thing. Truth, I mean, I’m 63 years old. If I get served tomorrow with a complaint, it’s going to be a couple years before it ever even gets past all the initial reviews and the experts and negotiations and stuff like that. So at this point, I know that if I ever am sued and the case either settles or goes to a trial, I’m done. That’s it. That’s when I’ll pull the plug, I’ll be out. And that actually gives me a little bit of freedom. So if I were younger and had a 20 or 30 year career ahead of me, I would probably be much, much more frightened than I am now. That’s where you want to put every patient under every microscope and every lab test, which is the exact opposite of what we’re taught to do. What the opposite of… In the 80s and 90s, we did. We shotgun people. That’s what happened. came in and said, oh, you know, I have a little pain and all of a sudden you every lab and imaging and stuff like that. And then for the next 20 years, it’s like, no, it’s deductive reasoning. It’s systematic, you know, elimination, blah, blah, blah, don’t shotgun the patient. And then something like this happens and and you hear, well, why didn’t you do all these labs? And why didn’t you do x, y, and z? And it’s because that’s not the standard of care, but.

Dr. Wendy Wright  [32:03]  And one last trend, but because I know we have to wrap up this podcast. And this is what I also hear from malpractice insurers is that the times that we’re seeing NPs being sued are early in their career, first few years, and late in their career. First few years, you don’t know what you don’t know. You really don’t. That’s why for us, we have a mentorship program. Our seasoned NPs review these charts, say, hey, think about X, Y, and Z. But at the end of the career, you know, you’ve kind of done what you’ve done, and you kind of get, well, I’ve seen this a million times, but you know, it’s that one time that we get a little complacent. So you heard some big takeaways today. Thank you all so much for joining us. I hope that this was a healthy dialogue for all of you. Any last words before we wrap up this podcast?

Dr. Sally Miller  [32:57]  No last words.

Dr. Wendy Wright  [32:58]  No last words. Well, thank you all so much for joining us for this episode of Scrubs and Subpoenas and take care of yourself and we see you later, right?

Dr. Sally Miller  [33:08]  Goodbye for now.

Dr. Wendy Wright  [33:10]  Goodbye for now.

Narrator  [33:16]  Thank you for listening and learning with Scrubs and Subpoenas, Tales from the Witness Stand presented by Fitzgerald Health Education Associates. Please rate, review and subscribe to this podcast. And for more NP resources, visit FHEA.com. Join us again next time as we dissect more medical malpractice cases.