Workplace Disaster

Voiceover: Every minute someone’s life takes a terrifying detour not down the 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. I am your host, Jannah Amiel, and joining me is my co-host, our expert witness, and amazing faculty member here at FHEA, Dr. Sally Miller. Dr. Miller, how are you?  

Sally Miller: I’m well, thank you. And you?  

JA: Good, good. Thank you for asking. Now, again, I love doing these podcasts. If anyone is just listening in for the first time, then you are in for some exciting minutes with us. 

Really. We are going to be working through listening. Right? Stories of real cases that Dr. Miller has served as an expert witness on. So, these are real medical malpractice cases, real patients, real events that had taken place. And this is a real opportunity for us to not just kind of listen and ‘Oh my goodness!’ Right. 

But to take the opportunity to learn because these are really good learning opportunities for us as providers, as nurses, as clinicians, as just folks in the healthcare arena. To really encourage us, right, to remember, there is such thing as best practice sometimes, right, that it does matter what we do and what we don’t do. And bigger than that, every single one of us can make a mistake because every single one of us are humans, right? 

And it does happen. And this is a really good reminder of just how we can continue to do the best that we can, not just for ourselves, right, as the provider, not just for our profession, but for our patients. Right. And everyone that’s attached to them. Because we know sometimes things go wrong and they go really, really wrong. 

So, with that said Dr. Miller, I’m going to turn it to you, and we are ready to get into the first story that you got for us.  

SM: Okay. Well, so this one, I’m going to pull my notes up here so I make sure I am literal and accurate. So, this is a case of a young man. This man, I believe, I should only say 22 years old. 

JA: Oh yeah. 

SM: And I guess I should have had that directly in front of me. So, 20, 22 or so. In early 20s for sure. So, this is a relatively short story actually. So, this is a gentleman that I should probably point out has a history of opioid use disorder. He had a heroin addiction that he had recovered from. 

He was in recovery for 3 years. So, he was on methadone maintenance. Methadone maintenance programs, you know, they’re not as conventionally popular anymore. Like if you talk about opioid use disorder and medication-assisted therapy, most people will say, ‘Well, what about buprenorphine or Suboxone? Isn’t that the way it’s supposed to be? Isn’t that what we’re doing?’ 

That’s the more contemporary approach. And there’s advantages to Suboxone that you don’t have with methadone. So, there’s this misconception that methadone is something we don’t use anymore, which is totally not true. Now, number one, this case of course, happened several years ago because we can only present cases here that have either, you know, been settled or closed or adjudicated. 

And it takes that long for things to go through the system. So, this case is about 8 years old. I mean, even 8 years ago, Suboxone was still certainly available. And methadone has this stigma of not being as safe and not being as good. And I don’t mean to sound like a methadone commercial, but methadone also has certain advantages. 

It requires greater supervision, you know? Methadone is administered by SAMHSA-approved centers. You know, you can’t give somebody a prescription for methadone for opioid use disorder and say, ‘We’ll see you again in 2 weeks.’ So anyways, what’s really-I’m going off on a bit of a divergent tangent here, but what is important to know for the history is that he does have an acknowledged history of opioid use disorder. 

He has been sober from his opioid disorder for 3 years, and he has maintained on methadone, and he’s maintained on a lot of methadone. This gentleman was on 95 milligrams (mg) of methadone a day. If you know anything about methadone, we really, really like to keep it under 20, which is almost impossible. So, we really, really shoot to keep it under 40, which is even still a bit of a challenge. 

But when you get above that, you know the concerns about it, the safety issues become a little bit more compelling. Anyway, bottom line is he was on 95 mg a day, which is a pretty hefty dose of methadone. So, keep that in the back in your back pocket, because that’s the history that was available to every provider that was involved in this story. 

So, we have this young man, he is 3 years sober from his opioid use disorder being managed with methadone, and he has a job at a grocery store at a big, you know, supermarket kind of place. So, what happened to him was on the 14th of the month, he was unloading a truck at work, and he was pulling a milk dolly. 

You know, one of those big things, you know, you move around.  

JA: Oh, yeah.  

SM: So, it was toward the end of his shift and he was unloading milk from the truck, and he was pulling the dolly. And it managed to like, what they said in his notes, was run over the back of his left foot. 

He somehow managed to get himself in the back of the left foot with it. So, he said in his reported history that this occurred about 10 minutes prior to the end of his shift. So, he just finished his shift. He didn’t take any action. He didn’t report it to anybody. He thought it was, you know, minor and that he would walk it off and it would be fine, which is reasonable. 

I mean, any one of us, if we’re doing something at work and we accidentally bang something into our foot, it’d be like, ‘Oh, yeah, that hurts.’ But, you know, do you think to make a report of it and if you do then you’re going to have to go have an evaluation and you know, so I can see why he didn’t, didn’t seem like any big deal. 

That was on the 14th of the month. Two days later, he presented to his local emergency room complaining of left foot pain and pain with weight bearing. So, it hurt and it hurt more when he put weight on it. The symptoms were reported as a few days of duration following an incident at work, during which a milk truck rolled over his foot. 

If you read it, it sounds like the entire truck drove over, but-that would cause a problem-but I mean, that’s the way it was recorded, but we know it was the milk dolly. During this emergency room visit, the dorsalis pedis pulse is documented as normal. The musculoskeletal assessment of the affected foot reveals full range of motion. 

There is no noted edema. There’s a notation that edema is absent. There’s normal capillary refill, and he has intact sensation in this distal extremity. He reports the pain as at an intensity of ten on a scale of 1 to 10. At that time, his vital signs- 

JA: That’s bad.  

SM: What? Yeah. Ten on a scale of 1 to 10 is as bad as it gets. 

His vital signs were recorded as a temporal temperature, right, of 98.5 F, pulse was 88, respiratory rate 16, and a blood pressure of 143/90. So, a little higher than you expect on a young man. But that was the only a significant vital sign. The history of present illness revealed, specifically, posterior heel pain at the insertion of the Achilles tendon, that the pain was provoked by push off-you know stepping off the foot and weight bearing. 

There was a small amount of swelling, point tenderness, and faint hyperemia noted at the area. Deformity, ankle pain, mid and distal foot pain were specifically recorded as absent, so as pertinent negatives. You know, we know that at that time he denied that kind of pain. He had a 3-view radiograph of the left foot. There was no fracture, dislocation, etc. The soft tissues were unremarkable. 

The impression the diagnosis for this ER visit was recorded as unremarkable left foot radiographs. The patient was discharged with diagnoses of contusion of the left ankle and tendonitis. He was prescribed ibuprofen and Ultram for pain. This was back when we thought ultrasound was so safe, which, you know, I mean, it’s a fairly recent phenomenon that Ultram also has sort of evolved into a we don’t use it as much. 

Anyway, he was given ibuprofen and Ultram. He was provided a work release for the next 3 days and given discharge instructions for non-pharmacologic management and circumstances for which he should return to care. So that was 2 days after the initial injury. The injury’s on the 14th. On the 16th he goes to the ER with ten out of ten scale pain. 

That was the evaluation. There was a rather detailed physical examination and the X-ray was negative. That was on the 16th. On the 18th of the month the patient went to another emergency room in the same general area, but, you know, another emergency room. And he told them that his foot was run over 2 days ago by a milk cart. 

‘I was seen in this other ER and they told me it was a contusion or tendonitis, but the pain is unbearable. It has me in tears and I cannot put weight on it.’ At that time, the emergency room assessment documented normal dorsalis pedis pulse, redness and bruising to the right heel. Interestingly because the left foot was-you know, again, pay attention to documentation folks. Right there: documenting the right heel. 

But the left foot is the problem. So obviously, you know, this is just a booboo on somebody’s click and pick. So, there was redness and bruising at the right heel and the Achilles tendon area. That’s the way it was documented. Swelling present in the affected area. Normal capillary refill. The vital signs at that time were recorded as a temp of 98.7, a pulse of 92, respiratory rate of 18, and a blood pressure 131/84. 

Physical exam reports tenderness at the left calcaneus, increased pain with dorsiflexion. This patient again had radiographs in this emergency room and it was reported as unremarkable. The soft tissue was specifically noted as unremarkable because, you know, with sprain or strain you would expect to see some soft tissue injury or, you know, some soft tissue findings on the radiograph. 

The patient was discharged with a diagnosis of plantar fasciitis. His work release was extended for another 3 days. He was given NSAIDs and how to manage his foot: heat, cold, etc. So now that’s the history that the NP is aware of. The next visit is to the NP that we’re interested in. So, remember the original injury was on the 14th. 

Didn’t do anything about it until the first ER visit on the 16th. Two days later it was no better. So, he went to another ER and said, ‘The first doctor told me it was tendinitis, but I don’t think so.’ They discharge him with plantar fasciitis which if you know, for any of our listeners who know anything about plantar fasciitis, it’s not usually triggered by running a milk truck over your foot. 

But, you know, I guess there might be some similarities, but with pain, with push off, etc. Anyway, that was a discharge diagnosis on the 18th. Now on the 19th, less than 24 hours after his second emergency room visit, the patient went to yet another emergency room in the region. So, in this 20-mile radius, there’s a couple of different emergency room. 

This is the third emergency room visit and the third emergency room, and this one is less than 24 hours later. So, he comes in and he told, you know, told the staff that were evaluating him all of the same information that had been documented previously about the left heel. And that he ran over it with the milk truck dolly. 

He reported that he had been to those other two emergency rooms. And what they told him-he was told that his radiographs were negative, but he said he’s still having severe pain. And this is why he’s at the third emergency room. His vital signs on this visit were recorded as a temporal temperature of 37.8 Centigrade, which calculates to like 100.4 Fahrenheit. 

He had a pulse of 84, respirations of 16, and blood pressure 131/70. The patient was evaluated by the APRN. The APRN noted the history as provided, noted that the patient had been to two other emergency rooms in the last couple of days. And you know what the findings were that were reported and documented the injury as recorded as a twisting and blunt trauma, that the symptoms were unremitting for 5 days, that the location was left lateral foot, but there was pain and swelling. 

The degree present was noted as minimal and exacerbating factors as weight bearing. So, you know, I mean, really, nothing’s changing here. The patient is telling the same story.  

JA: Yeah. Okay.  

SM: The physical examination documents an intact Achilles tendon, no pain with extension, no flexion deformities, tenderness, swelling, ecchymosis, or range of motion restricted by pain. So, these are all negatives, right? 

No flexion deformities, no tenderness, no swelling, etc. Another ankle radiograph is done. Is that like three doses of beams right. The radiograph was reported as normal. The patient was treated for an ankle sprain and ACE wrap and splint were applied. He was given instructions and a written handout for non-pharmacologic strategies, and was instructed to follow up with primary care and an orthopedist within 2 days. 

So, like, because this is the visit that matters, I actually did pull up directly the visit to refer to here, but I don’t think I missed anything at all that, you know, the documentation was that this was an essentially normal inspection, but that the patient was in unremitting pain. It does note his history of opioid use disorder. 

His current treatment with methadone and that’s it. There really isn’t anything else that I didn’t mention. The vital signs we commented on physical examination. Let’s see. Ankle, left foot, Achilles tendon intact. No pain with extension, no flexion deficit. No Achilles tendon, no deformity. Okay. So, he’s sent home with instructions and contact information for a primary care provider and an orthopedist and instructed to contact them within 2 days. 

So, guess what? He didn’t.  

JA: Oh, gosh.  

SM: He didn’t contact anybody in 2 days. The next time anyone hears from this gentleman is 4 days later. Four days later, he goes back to the same emergency room. Well, the second emergency room. Not the first one. Not the one for the NP, the one in the middle. He goes back by way of EMS and he is complaining of left foot pain, redness, swelling, calf pain, shortness of breath, and redness extending over the left lower extremity. 

The physical exam is significant for a swollen left foot, a 4 centimeter hematoma to the heel. The extremity was cellulitic to the distal leg, with lymphangitis streaking all the way to the groin, right from foot to groin. He’s got lymphangitis. During the history of present illness, there is a note that the patient in the interim, like after the last ER visit but before now, developed a blood-based blister on the back of his heel and it burst. 

And that’s when the whole foot and ankle got swollen and hot and painful, and he started developing temperatures and trouble breathing. And that’s why he is now here in the emergency room. On this day, on the 23rd, a white blood cell differential was consistent with sepsis. The patient was admitted for treatment. His hospital course was complicated by a variety of factors, and ultimately his condition resulted in a left below the knee amputation. 

JA: No, I didn’t see that coming.  

SM: And so, the amputation, of course, there was a whole lot of time in rehab and adjusting to a whole different life. You know, like, I know that the rehab and then the, you know, later on, the prosthesis and PT and all of that kind of stuff. So, yeah, he was 22 when this happened. 

So, the 22-year-old man who, you know, had been 3 years sober from his opioid use disorder, and now essentially his life has changed. So, I was retained. I don’t know if you know by who yet. I was retained by the defense attorney defending the NP for that-the last emergency room visit before the patient wound up septic. 

And of course, the assertion was standard of care. Did he deviate from standard of care? So, I would ask your listeners again, I wish we had this music we could play even Jeopardy music in the background. Did he deviate from the standard of care? You know, there are a couple of ways to look at this. 

There’s always more than one way to evaluate a set of circumstances. One school of thought would say he was young. There was there was no apparent, you know, no apparent indication of sepsis. Now, what became a really important bone of contention was that temporal temperature.  

JA: Yeah.  

SM: Remember I said it was like 37 point something. It converts to 100.4 degrees Fahrenheit. 

JA: Yeah.  

SM: So, I mean, this was a hotly contested point. Was that the thing that should have prompted this nurse practitioner to evaluate the patient and to have a more comprehensive evaluation? And it even gets down to things like, nobody, you know, there are some literature that doesn’t even consider a temperature elevation significant until after it’s 100.5 and we’re at 100.4. 

JA: Oh, jeez, talk about splitting hairs.  

SM: I mean, sometimes that’s what it comes down to. And then the other thing is how sensitive is the temporal temperature? Like there is literature that suggests it’s not a direct correlation to the oral temperature-that it might be off, so that a temporal temperature of 100.4 is really like an oral temperature of 101.4. 

JA: Oh my gosh.  

SM: And then others say it’s not. And that really is what-this is really where it came down to for this NP. Was that temperature-should that have prompted him to consider something other than musculoskeletal injury? So, if, you know, I again I asked the listeners to really give this one some thought and not in terms of like-it always drives me bananas when I tell people these stories and they say, ‘Well, I of course would work this up for something. Of course, I would have thought that.’  

I mean, well, you know, God bless you for being perfect. The rest of us are not. But did he deviate from standard of care is the question here. So, what it really comes down to is he’s in emergency room and he sees this patient who has had these last emergency room visits. 

We had one me an injury on the 14th, a visit on the 16th, and a visit on the 18th. Here he is again on the 19th. So should you, would you say, well look, he’s been worked up. He’s had X-rays, they’re negative. The physical examination is unremarkable. And one of the confounding issues here is the history of opioid use disorder, not just about is he drug seeking. 

That’s another conversation to have in a minute. But people that are on long-term opioids, there is absolutely an association with hyperalgesia, like a heightened responsiveness to pain, sometimes, paradoxically, over a long-term, high-dose opioid use, people actually have a heightened response to pain. Then they’re non-opioid using counterpoints. So, even though he was in recovery, yeah, he’s on 95 mg of methadone a day and it’s really all about how your how your threshold of these neurons resets after perpetual exposure to an opioid. 

And so yeah, that’s really one of the big arguments for getting people off of opioids is if you’re on them too long, it can actually, paradoxically exacerbate your pain experience. And so, it’s very reasonable to believe that he might genuinely be feeling ten on ten scale pain due to an ankle sprain, whereas you or I might not feel it that painfully because of the long-term opioid use. 

Now, nobody documented that, by the way. But that’s just when it gets introduced-two sides trying to duke it out here. I mean, we have an adversarial legal system. There are two sides, and each side tries to find the way to prove their position. And for this, this patient, that’s what it came down to. And so, one school of thought says, ‘Well, okay, he’s had X-rays. 

They’re negative. The physical examination is unremarkable. There’s no particular risk factor for sepsis in an otherwise healthy 22-year-old man. And it didn’t look infected and he wasn’t complaining of infection. His pulse was like, what, 80-something, his blood pressure was normal. His respirations were 16. Do you take a temp of 100.4 and call it a sepsis? 

And then of course, the other school of thought is-and I really am not entirely sure when I look back at this and really tease that apart, I really think that it’s not clear cut. Because the other thing to keep in mind is that a couple of things from the psych perspective in the world here, like if you were thinking he was drug seeking, because it may have been that some of these ER providers thought he was drug seeking and didn’t necessarily write it down. 

And I’m just hypothesizing here. In the legal case, it doesn’t matter what somebody was thinking. What matters is what’s written down. But I can imagine that perhaps some of the ER providers were thinking he might be drug seeking. Yeah, but this is not the behavior of a drug seeker. Like number one. Now, drug seekers do have their whole own-there’s a whole subculture like you can find a whole blogs on it and stuff like that.  

You know how to go to emergency rooms and get drugs. It’s harder now than it used to be, because there’s a much greater awareness of, you know, the opioid phenomenon. But one thing they don’t do is admit that they were in other emergency rooms yesterday, like if someone is going to an emergency room with a fictitious complaint trying to get an opioid prescription, they don’t tell you that , ‘I went to another one yesterday with the same complaint, and this is what they said.’ 

JA: Right.  
 
SM: Like that’s exactly what they don’t do. They do go from ER to ER to ER, but they don’t tell anybody that they were at the other one, you know. So, it didn’t make sense. Just, you know, from a purely academic perspective, I wouldn’t think drug seeking here because he was freely acknowledging everywhere he went that he was at an ER a day or two before and had the same complaint and they told him it was negative, you know. 

So, from that I wouldn’t think drug seeking here. And then, you know, even though it’s hard for the population that doesn’t work with opioid use disorder, but people really do recover. And 3 years worth of methadone, you can bet that he would not have been able to stay with a methadone clinic for 3 years if he was using on the side, you know, they’d know it, they’d figure it out. 

So just on the face of it, I don’t see drug seeking here. I do think it’s likely that his pain experience was exacerbated or exaggerated is probably a better word by being on high-dose opioids. But the other thing, just from a general approach to the patient perspective, is when you see somebody who repeatedly comes in with the same complaint and nobody can figure out what it is, there’s probably something there, and we just haven’t figured it out yet. 

Whereas, you know, malingering or, you know, Munchausen is an old term, but that kind of thing, like people that are just preoccupied with health or coming in, like wanting attention or whatever the case may be for them, it’s usually something different all the time. Are these vague, nonspecific things like, I have pain everywhere, you know, arms and legs hurt or, today it’s my stomach, tomorrow it’s pain. 

You know, the next day it’s a headache that’s much more consistent with a psychiatric etiology of pain. But when you see somebody coming in with very specific complaints, you know, like one visit after the other, after the other, a very same specific discussion. There’s probably something there. And so, the first visit to the emergency room, totally reasonable to think that it was, you know, sprains, strain or whatever. Totally reasonable based on everything. 

By the time you get to that third visit then it is time to start broadening your differential a little bit and going, ‘Okay, hey, well, he’s not responding at all to these treatments and there’s no soft tissue swelling.’ Like even if his pain response is exaggerated, if there’s enough there to cause any pain, you might expect some soft tissue swelling on the radiograph. 

Yeah, but the fact that it’s the third visit. Now, I don’t know if you figured this one out, but I was retained by the defense. I wasn’t retained by the plaintiff. I was retained by the defense. But it’s our job to look at it like, you don’t look at it from a defense perspective or from a plaintiff’s perspective. 

You’re supposed to look at the case in front of you and make the best judgment call based on the information that you have. And this is truly one where there’s things to support his actions, there’s things to support a standard of care approach. And then there are pieces that didn’t uniformly support it. And so, you know, again, in the end, this was a sympathetic case with, you know, a fairly catastrophic outcome. 

I mean, it wasn’t death, but it was fairly catastrophic. And there was also a settlement here. I don’t know the amount, but there was a settlement here as well. And so, I think the interesting things for all of us are, well, you know, I was there. I mean, I do genuinely believe that when you see a young person in front of you and they just had an injury like that. 

Just got hit with something and the x-rays are negative and the physical exam you know, I mean there definitely was some pain with push off and things like that. And musculoskeletal cause is a very reasonable interpretation. And the exaggerated pain is consistent with long-term high-dose opioid use. So, I was very comfortable making those assertions. 

I was also very comfortable supporting the notion that a temp of 100.4 is not typically a temperature that we start thinking systemic infection, especially when there’s no apparent infection at the site; especially younger people. Younger people get fevers just like that. Now, if it’s somebody who’s 80 and has a temp of 100.4, just because the older adult has a lesser physiologic response to any stimulus, 100.4 might be a little bit more significant. 

But in a 22-year-old, a temp of 100.4, I mean, I would you know, I wouldn’t think much of that. These are the young people. They’re the ones that get these 102, 103s, which of course he did a couple of days later because, you know, recall there was 4 days between those two visits. 

It was the 23rd when he came back and he was overtly septic. So, you know, it is-you do wonder why. And I know like I said, I learned from every case and I am very aware now of not falling into that anchored perspective, not having tunnel vision here because of what seemed most likely right off the bat. 

After a few visits for the same complaint, it is time to think out the box a little bit.  

JA: Yeah, that is such a bummer that’s for sure. I will say that’s one thing I have learned from you is, you know, patients coming in, same thing going on over and over again, especially doing these podcasts, you’ve got to think about something different. 

And it’s true also, even in practice, especially being in the ER, these are things that when you keep seeing a patient coming in all the time for that same thing, you’re thinking like, ‘We’re missing something because why are you back again for that?’ And it is really a bummer, you know, and they’re not saying this is what happened. 

But it’s a bummer when we, you know, we have patients that we know have a history of, you know, opioid abuse, drug abuse in that way. And the reality is sometimes they are just dismissed as you were here because you’re trying to get some drugs, you know, and like there’s not a lot of deep thought into truly like what they’re experiencing and why they really, really are here. 

So that is a bummer. And I got to say, Dr. Miller, the way that sepsis has showed up in just these podcast is different. Different ways that sepsis has showed up is kind of wild because I wanted to think sepsis, as you were saying this, but I thought, ‘Well, no, because it didn’t seem like you had a gross ankle’ or like it didn’t seem like there’s anything like funky going on there. 

So clearly you would see that. But I mean, it just always challenges what I think.  

SM: I know. And again, it doesn’t it- I mean, I’m not hard and fast on something was really blown here. I mean, it’s really, you know-like in retrospect having hindsight, we can look back and say, ‘Oh, didn’t look at this, didn’t think about that.’ 

But yeah, like some cases I think it’s really that something was missed that shouldn’t have been.  

JA: Yeah.  

SM: In this case I do believe there’s a bit of Monday morning quarterbacking here. Like now that we know how it came out, we can, you know, look back at this. But just the things that do jump out at me later on are the repeated visits for the same thing. 

SM: And those are those darn ten. Always makes me nuts when people’s vital signs are just a little bit off. You know, if you’re going to have a temp, have a 102.5, give us something unambiguous to work with here. But that’s a temp that nobody gets excited about. So, you know, again, a learning activity for all of us. 

JA: Yeah, absolutely. That was a lot to learn from this one. I appreciate you sharing this story, Dr. Miller, and I appreciate your time as always. These are so insightful. They’re hard to hear sometimes, let’s be quite honest. But every single time there’s something new that I’ve learned and something I will say that comes back to me that we have learned before. 

And it’s one of those things we’re like, ‘Oh yeah, that’s why we do that.’ So, we know, you know, having this type of outcome. So, I really appreciate that. I appreciate your time. And we hope everyone who’s listened and really enjoyed this story, enjoyed listening to the lots of stories that we have, really, because it is such a great opportunity to listen in, to learn, to follow along, and see how does this actually apply, you know, to the practice that you’re doing. 

So, I appreciate you all for joining us. And if you did enjoy it, check out more podcasts that we’ve got going on over here at FHEA, and we hope to see you next time. 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.  

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