The Misread Mark

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 again is Dr. Sally Miller. Dr. Miller, thank you for joining me. Thank you for your time today.  

Sally Miller: It is a pleasure.  

JA: Yes. It’s a pleasure for me to always have you listen to these stories.  

I got to tell you, this is one of the really fun things I like to do. You know, listen to these stories, because not only is it like, ‘Whoa, I can’t believe that happened!’ But, ‘Whoa, I learned a lot.’ And that’s really the goal of these podcasts. And I hope all of you listening are learning a lot too, and can apply this to your practice. 

Just as a reminder, Dr. Miller is a faculty member here with FHEA and an expert witness, so she actually serves as an expert witness on some medical malpractice cases that specifically involve NPs. So, we’re going to talk about different stories. Today we got a story for you and it’s where we break it apart, kind of walk through the timeline of events and think about where things kind of went a little off the rails, right. 

And maybe if we can identify different choices that could have had, potentially, maybe, different outcomes. But huge, big, big thing we want to always make sure to keep clear is that mistakes happen, right. So, this is not us passing judgment on anybody-on any clinician, any practitioner. We all work in healthcare in some capacity, and we are all very well aware that mistakes do happen. 

They will happen to any and every single one of us. And so, if we can learn and we can be better and do better and practice safer, we definitely want to take that opportunity for ourselves and to help you to do that too. Did I miss anything, Dr. Miller?   

SM: I don’t think so. I was just, you know, thinking when you were talking about when we talked about this in another episode that I hope everybody will watch. 

But yes, sometimes mistakes-I mean, it’s just a mistake. We are human, you know, and we’re imperfect, right. So, we do make mistakes sometimes. And then sometimes they’re not a mistake. And then sometimes what happens you really just can’t barely characterize it as a mistake. Sometimes it really is a deviation of standard of care. 

And I might have given away the farm here, but as we listen to this story, keep in mind that like, sometimes we have to, like, step back and revisit what is the standard of care because sometimes you can get caught up, especially nowadays, that there are so many healthcare organizations that are for profit organizations, and emphasis is on productivity. Getting the numbers through. 

I mean, you know, you hate to say it, but that’s just the way it is. It’s a business and it’s a capitalist society. And as somebody is getting reimbursed somehow, some way for the care, and if it’s clearly a for profit organization, there’s an emphasis on numbers. We like to think there’s an emphasis on quality, but getting people through. Lots of nurse practitioners, they are part of their salary is incentive-based or bonus-based. 

I mean, there are some of these very complex, bonus structures here. If you see X number of visits, you get this much more over and above your salary. And when that happens, when time is the issue and emphasis is on productivity, you see things over time get really skimmed down. And it’s not-I never think that anybody starts out this way or just tries to not do stuff, but over time, the longer you’re in an organization, you see your peers skim stuff down. 

You got to get home before 10:00 at night. And it’s like, so we’ll trim this down. And I think that might have something to do with what happened here. So, in this particular case, as I look at it, and I really look at these to the best very objective eyes that I can, recognizing none of us are objective. 

You know, that would have to be a machine. But I really try to be objective. And this is one of those ones where I don’t think that any of us could really characterize it as a mistake, a single omission or a single misinterpretation. There’s a real pattern here, but I can see how the culture of an organization can foster a very narrow approach to the patient, very limited timelines. 

And that’s how this kind of stuff can happen. So, looking at it through that lens, here is the story. Again, we’re going back some years here because those are the cases that I can share with you, those that have fully resolved. So, this actually goes over the span of 3 years. This is 3 years, so put on your seatbelt. Put on your seatbelt.  

This may take a little while. I try to be concise. All right. Starting off in April of year one, this is-I mean, this is the first time that there is any documentation of this patient and this provider at this practice. So, I don’t know if she came in from another practice or what happened. 

But starting off in April of year one, a patient comes in for what is documented to be an annual exam, pap and cultures. So, an annual women’s health exam, presumably annual exam, pap and cultures done. So, the charting is really very difficult. There’s very, very little here to read. And you know, in school you’re taught to document your chief complaint, your history of present illness, all your history, stuff like that. 

I mean, there’s a reason for that. And I’m a realist. I know that you don’t always have 5 hours to do these big, exhaustive histories, but especially for an annual exam, we really do try to have some attention to those major features of the visit. What is the chief complaint in the patient’s own words. You know, ‘annual exam, pap and cultures.’ Like that could serve as that. 

The next piece of the chief complaint here is culture of lesion at the introitus. So, she has a lesion. She’s got a vaginal lesion.  

JA: Yeah.  

SM: And she’s here for an annual exam and pap, okay. That’s our chief complaint. But there’s, like, virtually no history of present illness here at all. So, if you’re seeing a patient for a women’s health visit and the chief complaint includes a vaginal lesion-that’s what she’s got.  

In this first visit-there is, you know, how do you work up a lesion: how long has it been there? Has it grown? Has it changed character? Does it hurt? Does it burn? Does it bleed? Have you ever had it before? Does it come and go? Like there is a trajectory of how you evaluate a new onset lesion. And even if you don’t get all of it, we’d like to have some of it. 

There was no elucidation here on the lesion, just that it was cultured. So, it’s a pretty distinct deviation from standard of care. I’m not sure why. It might be that she collected some of this info and found it benign or negative or irrelevant and didn’t write it down. You know, again, I’m really not trying to critique the care here, but paper is what matters. 

Paper-like computer. But what’s on paper is what matters in a lawsuit. And there was nothing here about the history of present illness. It wasn’t asked about sexual activity. Is she monogamous? Is she asexual? Has she never had sex? Now, she was a 61-year-old woman. I identify with her, too. But that doesn’t mean like there are 61-year-old women out there that have not had sex, believe it or not. 

Or for those that haven’t had it in so many years as to be functionally irrelevant. But, it’s part of the history. It’s part of the history of a vaginal lesion. And none of that is there. There’s just nothing documented here. The only thing that’s put in the place for history of present illness, was that the patient used an antibiotic ointment. 

It doesn’t even say if it helped or it didn’t. There’s just really there’s nothing there. So, that’s that. So, that’s the history part of this exam that we don’t really have. Next, the physical examination, it just notes vaginal ulcer. That’s it. Vaginal ulcer.  

JA: Okay.  

SM: Nothing about even the specific location. The dimension or the character of the border, the depth, the presence or absence of drainage. 

The presence or absence of pain to the touch. Regional lymphadenopathy. And I’m again-I mean, I’m not suggesting that every patient we recite a perfect textbook regurgitation of everything we’re supposed to say or look for, but there was nothing there. I mean, she just noted vaginal ulcer and-well, any ulcer, there’s lots of things that can cause them. 

Some of them are self-limiting and benign. Some of them are really dangerous and cancer. And there just needs to be at least a minimal history and physical here. And it just wasn’t documented. There are a bunch of tests ordered. There’s a bunch of screenings for an STD, things like, you know, gonorrhea, chlamydia, stuff like that. 

And the patient is instructed to follow up in a year.  

JA: Okay.  

SM: So, it-I mean, follow up in a year does send a message that the ulcer is not a particular-  

JA: Yeah. It’s just fine. 

SM: I mean, it just gives a message. Again, patients hearing things through their filter. So, that was in April. Now, 2 months later in June the same year, the patient actually did come back to review her lab results. 

So, 2 months later, here she is to talk about the results of her, you know, all her labs, screening, her pap, and that kind of thing. The chief complaint is documented as “review labs, come in for a mammogram.” And that’s the chief complaint. There is no other documented history of present illness. There is no documented physical exam, including an exam of the lesion from last month. 

I mean, there’s no documented physical exam at all. Just-this is just like a ‘let’s go over the results of your labs.’ There is a diagnosis for this visit. The diagnosis is her herpetic ulceration of the vulva. She got a prescription for acyclovir with an order to follow up in 6 months. 

JA: Oh. So, that’s herpes. That’s what they’re saying?  

SM: Yeah. Okay. And so there are like, you know, just to be clear, there are times sometimes in a clinical setting where patients do come back in to follow up on a lab, and we don’t do a physical exam. Like if, you know, if you had a visit, you did your, you know, your annual lipids and you know, the hemoglobin A1C and whatever else we do, if they come back to review, we don’t necessarily do a physical. 

We just sit there and have a convo. In this circumstance, just because she was diagnosed with herpes, this is 2 months later, you know, like the first visit was April and this is June, and herpes outbreaks don’t last for 2 months.  

JA: Yeah.  

SM: Or I guess unless the patient is severely immunocompromised. But if it’s still there 2 months later, you know, you have to revisit that diagnosis. 

But there’s just no discussion of it. There’s no discussion with the patient about, ‘Is it there? Is it better? Is it worse? Are there more? Are there less?’ Or a physical examination. So, we just don’t know. So, she was told to follow up in 6 months. Not even, like if this improves or it doesn’t, you know, like, if she gets acyclovir, even assuming it’s herpes and she gets acyclovir, you would at the very least, advise her to return if it doesn’t clear up. 

JA: Right.  

SM: I mean, you know, again, in retrospect-so that’s that. So, we had April and June of year one. Patient isn’t seen again. Well, she’s seen several times over the next 2.5 years. She’s seen again in January. So, like, what, 6 months later? There is absolutely no reference to anything to do with that. 

She’s seen again two more times in February. Nothing. Nothing about that. She comes back in May. So, May is 11 months since the last time she was diagnosed with herpes and given acyclovir. And so, at this visit there is documentation of an outbreak of herpes for over 6 months, the bumps getting bigger, taking acyclovir with no improvement. 

JA: It doesn’t sound like herpes.  

SM: So that’s the history of present illness. Right. Okay. There is a brief and essentially useless exam of the genitalia documented. It’s not an internal like, speculum exam or a bimanual exam. There is an inspection of the genitalia and it documents normal external genitalia, but a genital wart now. 

So, now it’s calling the thing that was an ulcer a year ago a wart now. There-again, no size, no measurement, no character, no nothing. The patient was given a prescription for Aldara cream. So, it’s like, you know, to debride a wart, like, for HPV. So, that’s that. Follow up in 3 months if it’s no better-at least at this time, she was told to follow up ifno better. 

Now, the patient, I should probably also say, has diagnoses of multiple comorbidities. And isn’t the most adherent. Or perhaps I don’t know what’s the best word here. Maybe really doesn’t fully understand the implications of some of the things she’s told. Doesn’t follow up as aggressively as she’s necessarily told to. Things like that. You know, and again, that’s the patient, we’re the examiner, if we think something is really critical to evaluate, we have to be clear about that, as clear as we can and document that we were as clear as we can. 

And if the patient doesn’t follow up, then that’s on the patient. So, this is in May of year two. We have a 6-month outbreak of herpes with no improvement. Now it’s a wart. Now it gets Aldara cream. So, the patient comes back 3 months later. Wait, look at the timeframe here. That was May, June, July, August. Four months later-I’ve got to count on my fingers again, you know, like the academic that I am. 

Patient comes back 4 months later and the patient says she did not use the cream.  

JA: Okay.  

SM: The NP said, ‘Okay.’ Basically, there was no further, ‘Well, why not? Is it getting better?’ Because the patient has other issues and the patient’s here for like, you know, med refills and stuff like that. 

So, kind of in passing, apparently, you know, the NP asked, ‘Did you use it?’ The patient said no. And that that was that. There was no, ‘Well, is it getting better? Is it getting worse? Is it more of them?’ Like nothing else. That’s just it. That’s the end of that discussion. There is no exam of the lesion at this point. 

There’s no genital exam. Actually nothing now about facilitating further evaluation of this thing that now is almost 1.5 years old.  

JA: Jeez.  

SM: So, we have another totally unrelated visit the next month, you know, of some other physical ailment. No question or nothing. In February of year three. So, we had year one when it was first diagnosed as herpes. 

And then a few months later it was get acyclovir. And now we’re a year later. So, now we’re almost 2 years. Went from May of one year to February of two years later. The patient comes in for a physical exam, and the physical exam is very detailed except for the genitalia. 

There is no-now, it doesn’t know the patient. It doesn’t say that the patient mentions it either. But again, you know, as a professional, if we’re doing our annual exam, you typically follow up on existing or outstanding phenomenon. And there was no questioning of, ‘Hey, did it ever go away? Is it still bothering you?’ And there was no physical examination. 

And so, that was that. The patient comes back in October. So, this is a bit of a stretch here. We went from February to October. Now the patient comes back in October. Two years and what, 5 or 6 months, after the initial complaint complaining that the vaginal wart-we’re calling it a wart now-is still there and she’s developing boils on her inner thigh. 

JA: Oh, my goodness gracious.  

SM: So, now the reason for the visit is the vaginal wart and boils on her inner thigh. There is no history of present illness about this vaginal wart. Like, ‘Well, is this the one that was there 2 years ago, or is this another one?’ You know, ‘How long? Progression?’ Like, you know, again, nothing there. 

But more interestingly, there is no physical examination of the genitalia. Now, the reason for the complaint is the wart and boils on the inner thigh. And there is no physical exam documented of the genitalia, and there is no diagnosis related to the complaint. The outcome of this visit was a medication refill result for her chronicities. So, there’s a-I mean, again I’m just-the takeaway for anybody listening. 

Like, and you do learn this in school and then it’s easy to forget it. You know most of us it just becomes second nature. But a chart should read like anybody else ever read your chart from top to bottom. The chief complaint is why they’re there. That informs the history of present illness. The history of present illness is to evaluate the chief complaint, and then you get as much info from the history of present illness, and then you do a physical exam to further narrow down potential causes of your chief complaint. 

And then if you need to do labs, you do it. And then your diagnosis should derive from the history and the physical.  

JA: Right.  

SM: And we just don’t see that here. Like there is no diagnosis related to the complaint. There’s no plan related to the complaint. What this really turned out to be, it was treated as another chronic visit because there was dyslipidemia and hypertension and, you know, diabetes and that kind of stuff. 

And that’s ultimately the stuff that was addressed at this visit. So, that was in October. Two months later, the patient comes back. She is now complaining about the wart that is overly symptomatic. She says it’s getting really big, that it’s starting to hurt, that it’s starting to look different, and it’s starting to scare her, the patient. 

So, this time there is a history of present illness documented, but there’s no physical exam. Oh, there’s no exam. She doesn’t look at the vagina. The diagnosis for this visit is herpetic vulvovaginitis.  

JA: So, we’re back to that.  

SM: Herpetic vulvovaginitis. I’m not entirely sure. I mean, that might be a word. It might be ICD-10 code. 

I’m not entirely sure I know this. And some of your listeners might. I’ve never used that phrase. I mean, it’s, you know, because there’s herpetiform lesions that are not herpes. So, herpetic doesn’t necessarily mean herpes.  

JA: True. But is it herpes?  

SM: I don’t know. So, I don’t know. So-but she was diagnosed with herpetic vulvovaginitis and referred to dermatology which- 

JA: Derm?  

SM: Again-I mean derm typically handles skin things other than those of the genitals. I mean, I would think that you would refer this to GYN, but hey, at least it was a referral. Okay. That was in December of year three. So, this is like 2.5 years after the original presentation. 

So, that was December. For the next couple of months, the patient never goes back to this practice or this clinician, but she’s in and out of the emergency room because these boils that were reported and never examined or addressed. She finally went to the emergency room to have the boils on her inner thigh drained. And I mean, they were big and drained and packed and stuff. 

And then she had to go back to the emergency room. Yeah, like they were deep enough that they had to be packed after they were drained and irrigated. And then while she was in the emergency room and somebody was handling these boils, they apparently saw this enormous lesion of the vagina and called a GYN consult. And the GYN consult referred the patient for a surgical biopsy. 

So, we’ve got a period of time here, like the-you know, this is December  when that’s the last is and then over, you know December, January, February. The patient you know, it takes a while like you know, a few weeks later she goes to the ER and then she’s got these abscesses and then they drain them and pack them and tell her to do stuff. 

And then when she comes back and then somebody orders the GYN eval and GYN says, ‘Oh my goodness, you know, this needs to go for a surgical biopsy.’ So, then by the time the patient schedules the biopsy, we’re into March. So, it’s March now.  

JA: Oh my gosh.  

SM: The patient goes to have her biopsy-oh, by the way, when she finally she got the referral for the biopsy, the lesion was 5×4 centimeters. 

JA: Wow. That’s big.  

SM: You know. Whew. That 5×4, not millimeters, 5×4 centimeters.  

JA: Wow.  

SM: She had her biopsy and she was diagnosed with metastatic squamous cell carcinoma.  

JA: No way.  

SM: And she was referred to oncology. And while so, you know, she got under oncology care and while she was at the oncology office having a visit, she developed acute shortness of breath and symptoms- oh I’m going to sneeze. Bless me. 

Let me keep you on the edge of your seat, right. That was timed on purpose. While she was had her oncology visit, she developed acute symptoms and they called an ambulance and took her to the hospital where she died. In June. So, she died. Three months. March. April. May. June. She died 3 months later. And the death certificate noted the cause of death as metastatic squamous cell carcinoma of the vagina. 

JA: I have not ever heard something like this before.  

SM: So, I mean, I really- even still, I really do feel compelled to emphasize we’re not being judgy. I mean it’s easy to look at this and go, ‘Well, how did this happen? How did this not happen?’ But like I said, it’s almost like, you know, people always tell me I’m nuts when I say, I don’t think Bernie Madoff started off to have this billion dollar Ponzi scheme-like stuff- 

It is the nature of the human condition that you had small exposures and cut a few corners, and then it’s easier said the next time you cut a few more. This was probably a practice setting that really encouraged volume and turnover. And it wasn’t a women’s health setting. It was a general setting. But they did paps and pelvics, you know. 

So, but the genitalia wasn’t the focus of most of the business. It was her chronicities. And so, I mean, in retrospect, certainly there’s things that, you know, we like to think, ‘Well, going forward we’ll make sure that we don’t make some of these errors.’ But, you know, I just think it’s, you know, it starts out with your- 

Okay, so you’re here today for women’s health. We offer that here at this family practice, okay. So, we’re going to do this thing. Oh well you know I don’t know a lesion in the vagina is probably herpes like that. Like I could just see stuff going that way and then in follow up, well, if the patient doesn’t mention it, so the provider doesn’t mention it. 

And then like, again, there’s things that really were done here that probably could have been done differently. But I don’t think anybody starts out to be purposely, you know, purposely disregard and deviate from standards of care. But as we look at this story, there are certainly some big takeaways for all of us. I mean, and the most important, the thing that I think is consistently missing in all of these is just that trajectory of chief complaint leads to a history of present illness, which leads to physical exam, which leads to diagnosis. 

And I think, I mean, I think if that stuff had been done, it might have been evident much earlier on, but there was, you know, a problem here, like ulcers? Yeah, I could have vaginal ulcers be herpes.  

JA: Yes.  

SM: And then in a few days there’s going to be more ulcers and more and more. And then in a week or two they’re going to dry up and go away, you know. 

JA: Yeah.  

SM: And if it’s still there 6 months later, it is not herpes. If an ulcer is still there 6 months later-like squamous cell carcinoma anywhere in the body is like your leading differential.  

JA: Yeah.  

SM: You know for anybody anywhere in family practice. So, there’s definitely some things that we can learn from this.  

JA: Yeah. A ton. I really-this was a this was a doozy. And I agree we, like, we don’t want to be judged. 

We’re not-we don’t do that, right. But for sure, like listening to this Dr. Miller I mean, like, it’s not-dare I say, it’s not difficult to be objective in the sense of like, there was an actual problem almost literally staring you in the face that you didn’t address. You didn’t. You never addressed it. And what an awful outcome. What a terrible outcome. 

SM: It was a terrible, terrible outcome, and you know, preventable for sure. But I also-like I always try to get in the head of the NP when I see something like this. It’s like, ‘Oh my gosh, you know, things are often not what they seem.’ And I try to get into the head and I’m-not that it matters from a from a testimony perspective, but just trying to understand how this happens. 

Like, I can almost see a dialog where the NP says, ‘Look, this is out of my area of expertise. You need to go. Did you win?’ And the patient says, ‘No, I don’t want to, I can’t, I don’t like them. I don’t have any transportation.’ Like a 100 litany of reasons why I can’t go. And then maybe the NP says, ‘Well, look, I can’t manage this, you have to go. 

So I’m not going to examine it, and I’m not going to treat you.’ But didn’t write it down, you know. I mean, I don’t-I think there could be a whole combination of things going on here. We’re just seeing what’s on paper.  

JA: Right.  

SM: It doesn’t always necessarily tell the story, but clearly there are takeaways from this for all of us. 

And like, if nothing else, if that’s what happened, it needed to be documented. Yeah, 100% that that didn’t happen. It needs to be documented. To document herpes for 6 months-I mean, that definitely does demonstrate a knowledge deficit.  

JA: Yes.  

SM: About herpes. You know, that’s just not-yeah, that’s not the way herpes presents. To, you know, recognize that ulcerations, if they don’t resolve ulcerations, you have to consider squamous cell. So, there are several learning things going on here. 

JA: And then the acyclovir not working there. I forgot the name of the cream. Like not working all of those things.  

SM: Yeah. Aldara.  

JA: And still she’s having these symptoms happen. These lesions happen, like come on. That’s frustrating.  

SM: I’ll bet that this NP-she probably looks back at her chart and said, ‘Oh my gosh.’ I mean, I’ve looked back at my charts, thankfully not in the setting of a malpractice case, but I mean, I’ve looked back at some of my charts on a really busy day. I’ve looked kind of, ‘Oh my God, did I do that? 

Did I not write that like I did? Did I do that?’ I mean, I don’t think ever quite to this extent, but only because I’ve done so much of this work that at this stage of the game I really am on my documentation game. But I do-I mean, I just, I hope that we all can look at this and say, ‘Man, there’s so many things here.’ 

And I just-I think probably from the perspective of the NP, it’s not as dramatic as it sounds. It’s not as dramatic as the documentation, but there’s a lot of teaching points here. And that’s certainly one of them. 

JA: There’s a ton. My goodness. So, I’m gonna say, so far, I think I’m batting a really good average. 

I’m gonna say, you know, you were on the plaintiff’s side?  

SM: I don’t think that’s a tough read on this one. But yes.  

JA: Yeah. Wow. Yeah, how unfortunate. How unfortunate. But I mean there is a lot to learn on that one. I mean absolutely. And I think you make a really good point about like, you know, just really being mindful and being careful about documentation. 

You always bring it up. And that’s super important documentation. And in these cases and listening to these cases isn’t like enough proof to you that you’ve really got to be good about documentation. Like then we got to do more, right. And then yeah, being really careful about those shortcuts and while we can, I don’t know if we get comfortable to a fault. 

SM: If I had a nickel for every time a patient’s like, ‘Oh, I don’t want to do that, can I just do this or that? If I do that…’ And I say, ‘No, I’m sorry, I can’t support it. No, no. And if you want to transfer your care elsewhere, I would totally support that.’ Yeah. You know. 

JA: Yeah. Well, Dr. Miller, can you tell us what the outcome was for the NP in this case?  

SM: Yes.  

JA: Or like the case itself. Like, did it settle?  

SM: Yeah. No, there was a settlement there. This is a settlement. Yeah. And the NP got it. And they did settle this one. And, but the NP, you know, it remains out there. 

It remains practicing and stuff and. Yeah. And I don’t know, I don’t know if there were any, you know, I don’t know if there was any, required remediation or anything like that, but yeah. Yeah, but yeah, it settled on behalf of the family.  

JA: Wow. Oh my gosh, Dr. Miller, thank you so much for sharing this case and those takeaways. 

This was a lot. But that was-I mean a really good-like this is the reason why we do what we do and why we talk about this.  

SM: And it’s all fine until it’s not. You can go years and not have a problem and then all of a sudden it’s not fine, you know? 

JA: Yeah, you’re totally right. You’re totally right. Man. Wow. I appreciate your time, Dr. Miller. Thank you so much.  

SM: My pleasure.  

JA: And we hope you enjoyed listening to this and got some really good takeaways from these stories. All the stories that we talked about here in Scrubs and Subpoenas, hoping that you can take those. Let us know how you’re enjoying it. 

Check us out on FHEA.com for more of our episodes and more resources, and you can connect with us there if you have any requests for some more of these, bits and tricks, some of the things that we’ll talk about as well. In the meantime, hope you guys enjoy and 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 resources, visit FHEA.com. Join us again next time as we dissect more medical malpractice cases.