The Invisible Storm

Voiceover: 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’s 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. 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. 

Jannah Amiel: Hello and welcome to another episode of Scrubs and Subpoenas: Tales from the Witness Stand. I am your host, Jannah Amiel. And joining me is expert faculty and expert witness. Here is Dr. Sally Miller, my very cool co-host. Thank you for joining me again. 

SM: Always a pleasure.  

JA: Awesome. So, if you are just tuning in, hopefully you’re not just tuning in for the first time. 

This is a really fun podcast, really interesting podcast, and where we are going to listen in to real cases, real medical malpractice cases that Dr. Sally Miller has served as an expert witness on. And I should say, I think I forgot to say this, you can be an expert witness-I never think about this to be completely honest-on the plaintiff side. 

Right. Or the defendant side. So, I actually had the complete wrong assumption when we first started doing these podcasts that, naturally, you’re an NP, you’re always defending the NP. But that’s not always true, right? And that’s not always true for an expert witness. You don’t always get called on to defend the person that fits your role, right? That’s not true. 

Sally Miller: That is definitely not true. We can be contacted by either plaintiff or defense. And, you know, of course, serving as a plaintiff’s expert witness does not make us popular in the professional community because there is a school of thought about, you know, banding together or, you know, having that wall. And I guess, you know, being popular, thankfully, has never been my priority. 

But if there is a case where an NP has clearly deviated from the standard of care and it led to an adverse outcome for a patient, I don’t have any qualms at all about testifying about that because we all need to be held accountable. You know, we’ve fought for so long as a profession for autonomy and independence and prescriptive practice and, you know, analogous reimbursements, you know, that we still haven’t gotten yet. 

But we’re getting there. You know, we’ve been so long independent, independent, independent. We want to be respected as primary care providers. We want to be respected and acknowledged as independent providers. And that’s awesome. And we deserve that. But along with that is the responsibility for implementing that role appropriately. It’s kind of like, who was it? Is it Spider-Man? 

Let me quote a brilliant hero, Spider-Man, that said, “With great power comes great responsibility.”  

JA: Yes.  

SM: And the spider came out.  

JA: It was Parker’s uncle who said that. 

SM: Yeah, that’s right. It was his uncle who said that. But it’s so true. You know, we want this independence. We want to be freestanding primary care providers. Okay, but then we are accountable to a knowledge base that is appropriate to do the job, and we are accountable when we mess up. 

And so, I don’t like to see any case where anybody gets hurt and anybody messes up. But if it’s an NP who clearly deviates from the standard of care, I have no trouble at all testifying to that. And I also have no trouble telling an attorney, ‘I can’t support your position here.’ 

And believe me, it has happened on plenty of occasions where even attorneys with whom I have worked on other cases will come to me with a case and I’ll look at it and say, ‘No, I can’t.’ You know, that person didn’t do anything wrong. There’s no deviation there. I can’t support your position. There’s one attorney in particular who I really enjoy working with. 

He’s very smart, and in the scheme of plaintiffs’ attorneys, he’s actually very nice. I met him when he deposed me as a defense witness. And, you know, for a couple of hours, he was trying to, you know, just trying to elicit from me something that I never said because it didn’t happen. But after that case, he reached out to me to review one of his cases. 

And that, gosh, that was almost 10 years ago. And since then, there have been many cases and some I can support and there have been some where he clearly is representing a plaintiff who has been on the wrong side of a deviation of standard of care. And then, like I said, I have no problem holding anybody accountable. 

But if the NP didn’t deviate from standard of care, I will tell them that too. So, I think it gives us legitimacy if you are open to both kinds of cases. But by the same token, I have told defense attorneys I can’t support you because your client did, you know, deviate and is responsible for this outcome. So, it just seems like defense attorneys call me more often. 

I think insurance carriers, they give you know, they give names of people they’ve had successes with. But the last time I counted, because every time I am deposed one of the first questions the attorney asks is, ‘Do I always do this or do I always do that? What’s the ratio of plaintiff to defense?’ And the last time I looked, it was something like 35% plaintiff’s work and 65% defense work just because that’s who reaches out. 

And those are the cases that I can accept.  

JA: That’s interesting. And really well said, too, because, I mean, honestly, you’re not only advocating for the patient, right? The folks that are on one end of this, but for the profession. And you’re totally right. You’re absolutely right. And that’s important-just as important as advocating for the patient. 

So, with that said, I’m actually going to turn it over to you, Dr. Sally Miller, because we’re going to get into our next case. And so, Dr. Miller is going to walk us through this actual patient case; something that she served on. She hasn’t told us if it was plaintiff’s side or defendant’s side. It is quite interesting to listen along and try to figure out where she was as far as an expert witness, you know, serves on this case. 

But I’m ready when you are so let’s listen along and follow along and see what we learn here.  

SM: Well, okay. Well, this, too, is like most cases, this is about standard of care. Did the nurse practitioner deviate from standard of care? And for anyone who may not have listened to another Scrubs and Subpoenas podcast, I want to reiterate that standard of care is not a guideline or, you know, not, you know, the GINA guidelines for asthma or the American College of Cardiology guidelines for hypertension. 

You talk to an NP about standard of care and they will usually start quoting evidence and guidelines to you. But in the legal world, standard of care is what the person of a same license or certification, you know, the same type of practitioner with the same level of education, experience, and training would reasonably be expected to do in the same or similar circumstances. 

And the circumstances matter too, like just using the example of asthma. Yes, we have GINA guidelines and if you work in an allergy clinic that’s affiliated with a national asthma center or just, you know, a high-level specialty setting, you will manage asthma differently than if you are an NP in a primary care practice out in rural, rural America. 

You know, we will try to do the best that we can, but especially with an asthma exacerbation, the opportunity that you have available to you is certainly going to be different. So, the same or similar circumstances is an important part of that standard of care. So, this case is a case about a young woman. This was a 36-year-old female and she had been a patient of this practice. 

Yes, she was young. I know the older I get, the younger 36 sounds. But by anybody’s account, 36 is a young one. She was a patient of this practice, for at least, I want to say 4 years. Yeah, for at least 4 years going back from the date of the event. So, she was well-known to the practice. 

She was well-known to this NP, in fact, specifically asked to be seen by the NP typically when she would go in for care. At 36 she had no real medical history to speak of; the things that were documented in her chart. Apparently she had a persistent sinus problems. It was not unusual for a couple of times a year to come in complaining of sinus symptoms about 3 years prior to the events that are relevant now. 

Apparently she had some transient anxiety and she had over the course of 3 years, two or three different prescriptions for Xanax. But not long-term, you know, like maybe, you know what, like a 14-day supply or something, like maybe 14 or 28 pills, you know, 1 year and then a year or so later there was another one and like that. 

So, there appeared to be some sort of transient stressors or history in her world. She you could see she had small children. You could see the orders for prenatal vitamins and things like that. But other than that, she had no significant medical history to speak of. So, again, I’m going to be referring to the chart notes here, because I do want to be very literal in what I present to you and rather than my interpretation. 

So her medical history, recorded as headaches, which were presumably related to sinusitis. She had HSV-1 and she had a documented history of TMJ and the Xanax, the reason for it was never really clear. There were just brief notes about, you know, transient stressors or something like that, something to do with like work-life balance. 

Anyway, she appeared to be in good health. She was married. She had two young children at the time of these events. She had, I think it was a t2-year-old and a 5-year-old. And so the relevant piece of the story begins on we’ll say, the 26th of the month because it was the 26th of the month. 

I just want to give some time perspective here. She initially, that morning, early that morning according to the testimony of her husband in his deposition, they were up early somewhere between 8 and 8:15 a.m. And she was saying that her chest hurt and it was going up into her neck. Now, this wasn’t-there’s no recollection of what she said, but this is her husband in deposition testimony later on that she had chest pain or chest tightness and it was going up into her neck. 

He was very specific about the neck thing; he remembered that very clearly. They had been having breakfast, I guess, downstairs, and she was complaining about this discomfort. And then she went upstairs for something. And when she didn’t come back down, he went upstairs and found her on the floor. He said she had collapsed. She was awake. She was awake and responding to him. 

But he said she wasn’t quite right. And so he called 911. So emergency services came and took the patient and transported to her to the hospital, local hospital emergency room. By the time she got to the emergency room, she was fully lucid, awake, alert, and oriented and described for the people that, you know, emergency room staff that evaluated her this that she had been having these these pains or this tightness in her chest off and on. 

And even in the deposition, you could tell that the husband was gesticulating toward his chest when he was telling the story because the attorney said, “Did your wife make that gesture or did you make that gesture?” And he said, “My wife, when she was explaining it to the doctor, used the gesture.” So she was in the emergency room. 

She had an EKG, she had cardiac enzymes. She had, you know, a CBC, a metabolic panel, you know, the usual suspects when you work up something like that. And while she was there, she improved and the pain went away. Her EKG was read as normal. Her cardiac enzymes were negative and the rest of her studies were unremarkable. 

So she was discharged to home and in the discharge paperwork it said presumptive diagnoses: stress or gastrointestinal. So she was discharged to home with instructions to follow up with her primary care provider within 1 to 2 days, which is everybody is instructed you could stub your toe and go into the ER and they will say, ‘Follow up with your primary care provider.’ 

It’s like the standard line. Yeah. It’s sort of actually a joke. It’s like whether you’re in the hospital for 2 months or 5 minutes, the last thing somebody is going to tell you on the way out the door is to follow up your primary care provider. So, you know, she was advised to do that and but she was advised presumptive diagnoses as stress or gastrointestinal. 

So this family did appear to be really health conscious. You could tell by her records with this primary care physician over the years, you know, she had her general check-up, her well-woman exams and things like that. So she immediately-her husband took her home. He met her there like he had their 2-year-old. He she was in the ambulance and then he went to the ER and then they left together. 

And there was a lot of questioning in the deposition about was she in pain when she left? Was she still having pain or was it resolved? And it appears that by the time they left the emergency room, she was feeling better. She wasn’t having any more pain or radiation to her neck. So her husband took her home and then he dropped her off and he went to go shopping. 

He wanted to go shopping because, do you remember Hurricane Sandy, the stories about hurricane Sandy.  

JA: Right.  

SM: Well, this was-that storm was predicted for the next day or so. So of course, nobody knew how badly it was going to hit, but they knew a hurricane was coming. So he took her home and then he went shopping. 

She went home and immediately called the primary care office. This was a Friday and she immediately called the office and said she would like to come in that day if it was possible. So she got an appointment for later that afternoon. So her husband comes home and they decide that they’re going to go out and have lunch together before they go to the appointment. 

And I frame this in this way because it’s important to recognize that she felt well enough that he left her at home and then she felt well enough to go out to lunch before the appointment. You know. So they had lunch and then they went to the appointment in the primary care office. And while she was there, she sees her NP and this is the NP that being sued. While she’s in the office the NP documents the events. 

You know that she went to the hospital this morning, that she had chest tightness and chest discomfort radiating to her neck. The NP didn’t have an entire report yet. There was nothing that she could call the ER and get. But she did have the discharge paperwork that the patient had been given, most of which is it all those pages of instruction and, you know, education and all that stuff. 

Yeah, but she did have information that the 12-lead ECG was within normal limits. She didn’t have the graph, but she had the physician report that the ECG was within normal limits, that she was discharged with diagnoses of chest pain presumptively due to acute anxiety or GI, that a pulmonary nodule, I guess, was noted on on her X-ray and it did not appear emergent and follow up with that and that was it. 

That’s all that this NP knew that was available but the info that was available to her. So the NP advised the patient that she should be scheduled for a stress test and she had the option to either be referred to a cardiologist or to do the stress test in that office. Even though this was an internal medicine office, the physician but I know this physician from years and years ago, he’s very, what’s the word like? 

Just sort of, you know, all over things. He does a lot. He does a lot of his own care that some would refer to. And he did stress tests in the office. He was, you know, appropriately trained, etc, to do them. So the patient had the choice to clear the schedule, your stress test here, or we can send you to cardiology. 

And the patient chose to schedule the stress test there in the office. So this was Friday. The physician was not there that day. Of course, the physician is out playing golf, but the NP is doing the work on Friday, but they couldn’t do the stress test that day. And so they scheduled it for the next Tuesday. And the NP told the patient and documented in her note that if anything, if there was any recurrence of pain or discomfort in the interim to seek emergency care, she also gave the patient like a 5-day prescription for Xanax. 

So that was Friday afternoon. So the patient goes home. Let’s see. Alright. I’m doing I’m counting on my fingers again, like a good academic. That was the 26th. That was a Friday. You’re 27, 28, 29, 30 and 31. Alright. Friday, Saturday, Sunday, Monday, 26, 27, 29. The patient had no problem. 

The patient felt like there was no recurrence of symptoms, according to the husband, she was scheduled for her stress test on Tuesday. On Monday, she started to have some symptoms again. But then Hurricane Sandy hit full force and the stress test was canceled. The office was closed and the stress test was canceled. So, the 31st the Tuesday that she was supposed to have the stress test and the office was canceled. 

Apparently there are text messages that she sent her husband throughout the day about this pain in her chest. And, you know, she started getting it in the morning. It was coming and going and then it was becoming more constant. And the last text that they had was when she said, “This is constant now,” you know. And then she had three initials that sometimes we put on text when we’re trying to think, what the heck happened, you know, and that was the last thing was this constant. 

JA: Now, you know what? What the heck. I hate that you just said the last text.  

SM: Yeah. Yeah. So he, you know, husband went home. I don’t know why he wasn’t there, but he wasn’t there for some reason. And he went home and found her unresponsive and called an ambulance. And so she went, you know, she went to the same hospital where she had been a few days prior, and they immediately transferred her to the big city hospital. 

And she never regained consciousness. Actually, she was finally declared brain dead. And so what happened to her was that she, I know it’s really sad. You know, she had a 2-year-old and a 5-year-old. And as hard as I am, I fill up when I think like as I was going over my notes for this case yesterday, I was thinking, gosh, this is really-boy, this is a horrible read. 

She had a dissecting coronary artery, a coronary artery just dissected and basically- 

JA: Oh my gosh, is this the significance of the neck pain to you? My gosh. Okay. Whoa, whoa. We had an EKG, though.  

SM: Yes, we did.  

JA: I don’t understand. It’s not that I know that that shows up. But we did that. I don’t know. 

SM: But it was not an acute MI. It’s not an acute MI or it’s not ischemia. It’s a dissecting coronary artery. Yeah. I mean, if you look it up in a book somewhere, it might say, there might be you know, nonspecific ST-wave changes, which anything can be nonspecific changes. But yeah, no. So, herein of course lies the issue, you know.  
 
JA: Yeah. 

SM: Did anybody miss anything or is this just horrific, horrific bad luck. So, I was retained. Do you know yet who retained me? I was retained by the defense for the NP. And I mean, it’s a horrible story when you read the notes. I mean, it just really hammers at your heart when you read the husband’s deposition about finding her. 

And of course, part of any lawsuit is it’s what’s the law like, what’s the damages, what’s the loss? And so, he had to describe what the things that his wife did that he now like he needs to pay to have done or things that he doesn’t. And I mean it sound he the husband is an attorney. 

The husband was an attorney. But in this case, of course, he was just a you know, a husband. He was just a plaintiff in a brief time span. But when reading his deposition where he talked about, you know, his wife like she was the primary, you know, careperson for the baby, the kids and how she did everything. 

And he just went on and on about what a great mom she was. And I mean, yeah, you do. You read this. And I’m sitting there going, gosh, like, usually it’s only animals that can bring tears to my eyes. But as I was reading this, I really, really felt for the for the man and for the children, for a 2-year-old and 5-year-old. 

And it’s hard. It’s awful. It’s horrible. It’s awful and it’s horrible. But the question for me was, ‘Was there a deviation from the standard of care?’ That’s it. It shouldn’t matter how heart-wrenching it is. What matters is, did they not fail to do what any reasonable NP with the same or similar experience in the same or similar circumstances would have done? 

So, if you’re an NP in an internal medicine setting and a 36-year-old patient comes in that you have known for several years who has no known cardiac history and for that matter no known cardiac risk factors, no dyslipidemia, no hypertension, no diabetes, you know, nothing like that. And this practice tests for all of that even in young people. 

It is a very aggressive practice. Like I said, not only do I have the records in front of me, but I knew the physician because I used to live in that part of the country. And this patient didn’t have any risk factors for a coronary artery event. So the patient went to the emergency room complaining of the chest and the neck and was seen by an emergency room physician and had a 12-lead read as normal and didn’t have cardiac enzymes and didn’t apparently have any clear diagnostic indication. 

Now, she didn’t see all of that. The NP only knew the physician report. The NP knew that the physician read the 12-lead as normal, read that the enzymes were negative. She knew that the patient in the office in front of her was currently pain free, and she offered her the opportunity to schedule with cardiology or to come back. 

So, is that a deviation of standard of care?  

JA: Oh my gosh, that’s so tricky. So here we’ll hear my two questions, right? One: is not doing a diagnostic like imaging, is that a no-no in this type of case as far as, like, I wonder if that’s the deviation just in my nurse brain, right. You did these things. 

Should she have had some type of visual work-up and that and I don’t know why I’m so stuck on that Xanax that she got. Would that have masked any type of like additional symptoms or findings that would have been helpful? Oh my gosh. I can’t think of any because there’s no I mean, no like guide. 

SM: There’s no guidelines.  
 
JA: It says, like, if this and this and this shows up, you do that right?  

SM: I mean, it’s a great question about the imaging, but I mean, tthe standard of care, the typical approach to the primary care outpatient is if the patient is sitting in front of you and has just been discharged from the emergency room and is currently without complaint, you don’t do anything emergent. 

Nothing is urgent. I mean, even even if we tried to order a stat anything like I know I’ve ordered stat biopsies for cancer that didn’t get scheduled for 3 weeks because STAT in the outpatient world is not the same thing a STAT in a hospital. So the question really is this patient sitting here on a Friday afternoon who is just discharged from the ER, who is asymptomatic with no particular risk, does it warrant going back to the hospital? 

Because that’s the only way anything is getting done that day.  

JA: So that is a really good way of framing it up. And I can only just imagine saying no because everything seemed okay and normal in that moment.  
 
SM: It did. And so, you know, I hope that everybody that’s watching this has already watched some of our other podcasts, but we did one recently where the NP clearly did not deviate from standard of care, that they followed standard of care and the circumstance were not especially sympathetic. 

And so there was absolutely no, you know, no question there was no deviation there that the case never even made it to court. But if you asked me literally here at the base, the same basic premise, there is no deviation of standard of care. Now, remember, this NP doesn’t know how it turned out. I’m sure that once she found out how it turned out, she might have, or she probably thought like dissecting coronary artery. 

Should I have considered that? What did I miss? You know, should I have? So, for anybody who’s listening to us today, ask yourself, hey, how many times in your career have you had a patient with an acute dissection of a coronary artery? For me, it’s none. You know, 31 years as an NP and I worked in all settings. 

I worked in acute care for years. I’ve done internal med. I have never seen an acute coronary artery dissection. I mean, that’s not to say you might not happen across one every now and again, but they’re really, really rare and there really is not much of a predictor. I mean of course, after this and I was very prompted to investigate and learn what I could about a dissecting coronary arteries. 

Again, the statistic is like some ridiculous like less than 1% in the population. But when it happens and it’s very rare, but when it happens, it appears to happen in women more than men. And there appears to be a menopausal or like a theory, a postulate, about estrogen and female sex hormones because of the distribution of how these rare cases occur also. 

And God, I can’t believe I’m going to miss the word now: fibromuscular dysplasia. Fibromuscular dysplasia. Another most unusual phenomenon. But apparently that’s a risk for it as well. But I mean, NPs that are listening, how many of you know that I probably wouldn’t know it if I had reviewed this case and I teach physiology, for Heaven’s sake. 

I mean, I know kind of a lot about it, but this is just like such a one-off circumstance that, I mean, it’s a horrible story and it’s just so sad. And it really does bring tears to even like most hardened eyes. But the question is, did this NP on that day in that office, deviate from the standard of care? 

Did she fail to do what any other reasonable NP would have been expected to do in those circumstances? And I suggest strongly that the answer is she did not. Now, the plaintiff had an expert and of course, there was a plaintiff’s expert NP, who said that she should have considered that diagnosis and she should have required an emergent cardiac evaluation. 

And I just don’t buy it again. Again, how many NPs, when the patient was just sent home from the emergency room with a normal EKG and negative enzymes and really no acute finding at all, I would think to do that. But now, did the emergency room miss something? I mean, I am not an emergency room physician and I really don’t know the standard of care. 

I don’t know what their knowledge base is. And I’m sure they see that there’s a different distribution of the kinds of things they see. And maybe a New York physician has seen a dissecting coronary artery more than a primary care nurse practitioner. So, I don’t know if the ER physician I mean, it really is an unusual symptom complex: chest, neck, you know, chest, neck, chest, neck. 

I wouldn’t necessarily think anxiety for that?  
 
JA: Yeah. 

SM: So, I don’t know. I don’t know. But I can tell you that this one, there was an enormous settlement and this is public record so I’m allowed to say the amount the patient’s husband was awarded $2.5 million for this one, which, of course, you know, a significant chunk of that went to his attorneys and then a like reasonable chunks were set aside for trusts for both of their children and everything. 

And typically with something like that, when there’s multiple defendants in the suit, they contribute relative percentage of liability. You know, somebody I mean that this they all agree on this. The hospital was a defendant, the ER physician, and the company that he works for that staff the hospital, the NP, and no doubt the practice that she worked for. 

And they all contributed to the settlement. But yeah, the patient, which, you know, I mean, I certainly don’t begrudge them that. It’s a horrible, horrible, awful story. But I still, you know, I would assert firmly that it’s easy to Monday morning quarterback and a lot more NPs after watching this might be inclined to consider a dissecting coronary artery as a differential. 

You know it’s just so odd in that circumstance. I really did try to think about what would I do. I mean, the answer isn’t what I would do. The expert has to say what a reasonable NP would do in the same or similar circumstances, but just in trying to learn from it, which is hopefully what we all are doing. 

I like I was trying to sit back. What would I do in that circumstance where chest and neck, I mean that does kind of stick in my crawl. It’s hard to dismiss that as GI or anxiety. GI can be hugely painful, but it tends to be more, you know, substernal and even up into here and anxiety, I just don’t like that. 

That neck thing is kind of disturbing. But she had a history of TMJ and that can cause neck pain. So you know, it is easy. I mean, Monday morning quarterbacking is what we should be doing because that’s how we learn from it and hopefully don’t find ourselves in that position. But just trying to put myself in the position of that NP at that time. 

I think any reasonable NP that had an asymptomatic patient in front of them that just came out from having lunch out with their husband to kill the time that had this been discharged from the emergency room and essentially been given a clean cardiac bill of health. I don’t think that I don’t think there was any deviation and not immediately sending her off to an emergent cardiac evaluation, which was the only option that day. 

If you really feel like it’s an emergency, you need to go back to the ER. And if you don’t want to go to that one, go to another one. That’s the question. Did you expect that somebody should do that?  

JA: So, yes, rough, rough story. And, you know, terrible outcome. That was really that was really hard to hear. 

And, you know, it does make me think not at all to take away from the family and this this young lady losing her life. But one thing we don’t really talk about, we haven’t really is the outcomes for the like nurse practitioner. Right. Who was also part of this case and let’s say, you know-loss, I don’t know if that’s the right word, but you know, in that way. 

And how does that change you? Right. Like, I can only begin to imagine how that might change me as a provider and how I take care of my patients or I don’t. I mean, I think that those things can be really life-changing for everybody that’s involved when we have these type of huge, substantive outcomes like this that are really like terrible sentinel events that happen. 

SM: Now, for sure, I mean, I can’t speak to how it affected that NP, although I’m sure that the personal, emotional piece is much greater than-you know, if you have malpractice insurance and if you’re insurance determines that a settlement is appropriate, they pay off the settlement. It’s reported to the National Practitioner Databank. If there’s a judgment against you or a case is settled on your behalf, it is reported to a national clearinghouse. 

So that, like if you apply for another job, then whoever queries the databank will find that you contributed to a settlement. But there’s so much of that. I mean, there is so much settled litigation that settles only because it’s cheaper than actually going to court. So I don’t know how many cases people settle and they really shouldn’t have, but they do it because the insurer determines that, you know, the risk of-I don’t know if risk is the word-but they try to assess risk like so if we spend 2 years fighting this and finally get to court and the case is dismissed, but they have to pay attorneys to do all of that work, and sometimes they deduce that it’s just more financially efficient to pay into a settlement and not have to spend all that time.  

So for the insurance company, it’s just financial expediency. For the clinician, it is-I mean, I’m sure it has to be heart-wrenching. You always, of course, go back and what can I-I mean, you know, I’ve made I’ve made goofs in my career. 

I made a goof. I mean, I don’t even think this NP made a goof. I don’t think she did anything wrong. I think it’s just one of those examples where she did everything right and there was just a horrible outcome that who would ever even have anticipated it? But I know in my own history even have, having made a goof many, many years ago, and there was a pretty bad outcome. 

I mean, the patient did not die, but the patient had a rough course and it was something that I missed. But I mean, I didn’t get sued like there were no repercussions on my license or anything. But I still I mean, I still will never forget it. I actually went back to the church that I grew up in, the Baptist church in Collings Lake, New Jersey, and I knocked on the door of the minister’s house and like, I need to talk about this because I did this thing to this patient, you know, all this. 

JA: Wow. 

SM: And I didn’t even have a-there wasn’t even any any official sanction to me. So I can’t imagine dealing with the combination of the emotional abuse and recognizing that, you know, I mean, people contribute to settlements all the time. And it’s not unusual for a clinician to have an entry or more with the nurse practitioner or the National Practitioner Databank. 

But it still, you know, has to be like, dang, I wish that wasn’t there. Every time you get malpractice insurance or apply for a new job, you have to explain it. Every time you renew your license with the Board of Nursing one of the questions is, has there been a judgment against you? And then you have to address that. 

And so there was all of that, too.  

JA: My gosh. Wow. Well, I’m sorry that this didn’t have a better outcome, but I appreciate you sharing this story with us, Dr. Miller. And there was a lot to learn and process there. Thank you so much for your time. We hope you guys enjoyed-I don’t know if that’s the right word for this one.  

But, you know, listening to this, it was really interesting. There was a lot to learn. I think a lot of takeaways from for all of us, quite honestly. So, thank you for tuning in. And if you enjoy listening to these stories, check out some more that we got going on over here at Scrubs and Subpoenas. 

Goodbye for now.  

Voiceover: 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.