The Ulcerated Truth

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 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 health care 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. Like this. Remind me, Sally, I didn’t get the thunder sound. I have to ask for the thunder sound. Next time. Next time we’ll do that. How are you? Thanks for joining me again, Dr. Miller.  

Sally Miller: I’m well, and you? 

JA: Good, good, good. It’s the beginning of the week, so off to the races. 

We go after the race.  

SM: Indeed, yes.  

JA: And off to more stories about real medical malpractice cases that Dr. Sally Miller has served on and shares with us so we can learn. We can be a little bit frightened in a good way. And, you know, we can understand how sometimes mistakes happen, right? Sometimes things happen because we’re human and we know that we are not exempt or immune from that in any type of way. 

So, these stories and listening to these and dissecting them together really is an awesome way to bring together full pictures and think about how we can apply that to what we do and practice in our own lives with our patients. Just to be a little bit more better, right? Any way that we can, any way that we can get better, we want to do that and we want to learn. 

So, with that said, I will stop babbling and I am very ready for your story.  

SM: Dissecting is actually a good word because that’s exactly what happens to your notes when someone sues you.  

JA: Yeah.  

SM: That they are dissected every little-I mean, every little thing, every comma, which could change the meaning of a sentence, etc. So, we may dissect a little bit here too. 

So, this morning we are talking about a patient who for most of her relationship with the nurse practitioner, was a resident in an assisted living facility. Gosh, I think she was there for 3 or 4 years before advancing. So anyway, this was a lady in her early 80s and she moved into assisted living with like a concerted conversation with her family because they were worried about her safety. 

She used to live alone in an apartment in New York City.  

JA: Oh wow.  

SM: And, you know, the picture being kind of trendy and cool, right? And not wanting to like, you know, probably had something rent-controlled that, you know, she was there. It sounds like all of her adult life, she was a single woman, I think. 

Or was it her? It was a child or a niece. And I have a sense that she was single, but the her niece really like was the role of the daughter. Anyway, all of that was really irrelevant. It was a concerted conversation that it was time for her to go to assisted living because she they were worried about her falling. 

She was having a lot of falls. So, this lady lived in this residential section of the assisted living facility for, oh gosh, the first year it was just like purely assisted living, where you do almost everything yourself, you know, you have just some resources for like meals and things like that. And then the next year she moved to the memory care unit, reportedly, not because they were worried about neurocognitive decline, but that they just wanted her to have an increased level of supervision. 

So, she didn’t have a neurocognitive disorder, what we used to call dementia or dementing disorders. But they really were just worried about the falling. And so anyway, she moved to a higher level of care. The family wanted somebody checking on her more frequently, that kind of thing. So, the first year she goes from assisted living to like, this is like, what do you call these, like a continuum of care, you know? 

Do you know what I’m talking about? Like, you buy in and then you live at the lowest level of supervision you need or as you need to escalate, you could just move through the continuum. And there’s different names for all of those steps along the way. Anyway, then she goes-so she was in the memory care unit for 3 years and as a resident of the memory care unit over those 3 years. 

And now again, she’s like advancing into her 80s. But over those 3 years her cognition and her physical health began to decline. Finally by like mid of the third year, going on into the fourth year-like that last fourth year that she was there-there were numerous documented events where the staff found this patient, confused, found her like out of her room, out in the facility, nude or inappropriately dressed like, was really having significant cognitive deterioration. 

JA: Yeah.  

SM: By the same token, her physical capabilities had started to decline. She stopped participating in physical therapy. She stopped going to social activities and slowed down her meals. So, we’ve got this period of several years where there is a clear, slow, steady deterioration, both physically and cognitively. But it looks like it really started to become an issue-we will just say, like in the middle of year X in the middle of the fourth year.  

So, there was started to be some concern that she wasn’t eating enough. There was some concern about her weight. Finally, in November of what would be her last year at the facility and then again March the next year, she wound up hospitalized. 

She had urinary tract infections, which is a, you know, change of mental status often in the older adult. Finally, the family decided to relocate her to a skilled nursing facility. And so, she moved out of this place, like, to an entirely different organization.  

JA: Yeah.  

SM: And to a skilled nursing facility. And she died there- 

JA: Oh no. 

SM: So she died like a year later. 

All right. So, after she died, she had been gone from this facility and this healthcare system already for-she’d been out of that facility. at least 6 months, at least 6 months, if not a little bit longer. So, she was completely in the care of another, a whole other system and service for 6 months. And then she died. 

And when she died, the assertion basically was that the poor quality of care that she got in the place where she was, where she came in 3 years.  

JA: Where she came from? Oh my gosh.  

SM: Yeah, that set the stage for-and now again, like when it’s-when somebody dies and there’s going to be a lawsuit like everybody gets named, you know. 

JA: Yeah.  

SM: They just take these charts and literally sue John Doe, Jane Doe, John Doe, Jane Doe, this facility, that facility. And then somebody sorts it all out, like after all the respondents are served, then somebody sorts out who it really was and who really matters and who deviated from standard and who didn’t and that kind of stuff. 

So, but yeah, everybody was served at this stage of the game. So, this nurse practitioner, specifically the nurse practitioner that I was called to be part of this case, was not an employee of any facility. She was an employee of a physician practice. And the physician, just a regular outpatient physician practice who contracted with the first facility to provide home care visits there. 

JA: Okay.  

SM: Just like any home, like any home care nurse practitioner, you know, you see patients in their home, you do their annual stuff, you might do monthly or quarterly or whatever it takes. If there’s an acute complaint that doesn’t require transfer to a hospital, you might go out and do it. But the NP worked for the physician group, not the facility. 

And that does become important when you start teasing this out and what went wrong, if anything, and who’s responsible if anyone is the reporting lines of authority here and the lines of responsibility can really get blurred pretty quickly. And so, you know, again, I want to be clear that the lady lived in a continuum of care, but I can’t remember the name of it. 

There’s a term for that and it’s escaping me. But she lived there in a couple of different levels for almost 4 years; in the last two-her last months there, on two different occasions, she wound up acutely ill, went to the hospital and after the last hospitalization, the family said, we want her to go somewhere else. So, they put her somewhere else in a SNF, and then she died in the SNF, and then they went back to sue everybody. 

So, everybody’s known for being evaluated. And this nurse practitioner is the one that we’re interested in. And again, she wasn’t an employee of the facility. She was an employee of the physician practice. And so, she did home visits even though it was in an assisted living facility. It’s considered a home visit. And she did home visits for this patient for a period of 4 years. 

Actually, to be precise, it was 3 years and 11 months.  

JA: Okay, wow. 

SM: And 3 years and 11 months. And then the patient left her care going to this other place. And then 5 months later died.  

JA: Yeah.  

SM: So, in retrospect, the family unit asserts that the employee allowed the patient to sustain and suffer multiple pressure ulcers, including rotting and infected stage three and stage four decubitus to her sacrum, her buttocks, her heel, that the NP failed to provide treatment, recommendations and orders and oversight. Didn’t oversight and manage these decubitus and allowed her medical health to deteriorate to a point at which she was susceptible to developing these decubitus. So, for everybody who’s listening, how long, you know, think about how long it takes to develop that, keep it as ulcer. 

And for it to deteriorate. And so, if these decubitus ulcers got to the point where they led to the patient’s sepsis and death, 5 months outside of this nurse practitioner’s care-what you know, you have to ask yourself what’s the culpability of whoever was doing the job in those 5 months.  

JA: Yeah. Seriously.  

SM: And how-what like what was going on? 

How bad were they before then? How bad were they in the years preceding that? So, I just sort of stood out at me because 5 months is a long time. You can go from no decube to fatal decube in a 5-month period. You go from nothing to fatal in a 5-week period. I’m sure the worst. 

JA: Those stages are very bad and really advanced.  

SM: Yep. Absolutely. So, the like-the complaint really is that she allowed the patient’s medical condition to deteriorate to the point where she was susceptible to developing all these ulcers, and then that these ulcers caused her death. The specific complaint about how she was negligent and how she allowed things to deteriorate to this point were a little bit less ill-defined. 

But the specific allegations from the plaintiff’s witness were that the NP failed to put orders in place to help prevent weight loss and manage the patient’s nutritional needs, that the NP should have ordered the patient a strict monitoring schedule for weight, intake/output, a protein supplement, and she gave some examples to aid wound healing. The expert says the NP noted on like-in that last year, when all of the things really started to happen, she noted a weight loss of 7.2 pounds and didn’t do anything about it. And that the NP failed to explore other reasons why the patient wasn’t eating and helped the staff overcome the patient’s refusal.  

JA: Wow.  

SM: That’s really the primary. 

That is the-and then complaining that she didn’t appropriately assess, intervene, and manage early decubitus ulcers that began to develop before the patient went to the hospital and then ultimately transferred to another to another care facility. And so again, when- 

JA: Those are like in the notes. Right? I mean, those are things you can go back and look at notes for to see how people cared for the wounds. Right?  

SM: And imagine that. And we did look back. She did look back. So, remember that the first assertion was that she didn’t do anything about this weight loss that she noticed that the patient had lost 7 pounds and didn’t do anything about it. Well, you know, also remember that I said she was managing this patient for 3 years and 11 months. 

Yeah, she had her care for 3 years and 11 months before the patient was transferred out. So, for 3 years and 11 months she was seeing the patient on a regular schedule. It looks like monthly home visits, actually. And for those for the overwhelming majority of those years, the patient didn’t have any problems with weight, didn’t have any problems with skin. 

Really didn’t have any problems outside of, you know, the usual suspects. So, I’m looking at my document at my review in the documentation here so that I can be very clear and not just infusing my opinion here. For the first 3 years at the residence and the assisted living facility, wellness staff and the registered dietitian had repeatedly documented that the patient’s weight was stable. 

So again, think about like the lines of responsibility and authority here. The lady is in a facility. It’s assisted living. She’s largely, you know, really fairly independent, but she’s in an assisted living facility. And that facility has a staff, and they have a kitchen and they have a dietitian, and they have PT and OT, and they have activities and recreation and all sorts of therapy and things like that. 

The NP is the healthcare provider from the physician’s office. It’s like her primary care provider making a home visit.  

JA: Right.  

SM: And so yes, while she certainly does avail herself of information that’s provided by the facility, she’s not credentialed there. Well, no, she must have been empaneled, but she had no direct authority. Nobody reported to her. 

And so just, you know, keeping that in mind, she’s seeing the patient for a period of years. She sees that the wellness staff and the dietitian repeatedly document that the patient’s weight is stable. There was a predictable fluctuation, both up and down from her admitting weight and her identified goal weight. So, the patient’s identified goal weight was 120 pounds. 

And for the first 3 years-I’m going to give them to you specifically here. The patient’s goal weight was 120. And for the first 3 plus years of her stay there, the fluctuations like on either side of that, were a bowel movement. You know, like any of us, you know, up and down.  

JA: Right.  

SM: In that last year, as she started to decline both physically and cognitively, then there was evidence of a weight loss. 

And at that point, the NP actually became as aggressive as she could be. And I have these numbers out so that you’re not just taking my word for it. Okay, here we go. So remember, she was there for 3 years when all was well.  

JA: Yeah.  

SM: And then halfway through the fourth year, that’s when things started to- 

So, her weight, the patient’s weight at admission was 120 pounds. And that was identified by wellness staff as her goal weight. A year later, her weight was 123 pounds. And it had been measured in the interim, but it was documented as being stable through the year and a year later is 123.  

JA: Okay.  

SM: Then the next year it was 119 and stable, and then like 6 months later, there is a note that she is maintaining her weight the way it was recorded, but a note that she was maintaining it and then the next year or so, like we have year one, two, three, and four weights like admission and then one year in. 

Two years in and in three years in, her weight is documented as stable, fluctuating between 119 and 123. Okay, okay. So just a little bit of a difference. Everybody listening can decide if I’m saying this is the difference between being constipated, taking a laxative difference.  

JA: Right.  

SM: This is a colonoscopy prep you know. So, then at the first point at which there begins to be any articulated concern, like anywhere are, you know, the records from the facility and the record from the nurse practitioner in that, like so I know I’m confusing people by saying year three and four, we have weight on admission and then year one, two, three, right. 

Everything up to that point is stable and there’s no concerns. After that, there begins to be a concern. So, like a few months after that third year, the weight is documented as being down to 114. And this is noted as a 7-pound weight loss and a weight loss that was identified as requiring intervention. 

So, the dietician documented the weight loss and notified the NP that there was a significant weight loss that required intervention. From the time that the NP was notified that there was a weight loss requiring intervention, she from then until the very end, consistently-immediately at that of notification and then consistently ordered weekly weights were ordered and reordered at each visit. 

There was an order. And this is also typical in long-term care or assisted living. Encourage intake at meals, which might sound very vague and ill-defined. But in many, you know, in most cases of the patient needs to find their meal is given to them and the person leaves, is delivered by dietary and they leave, or they go to the dining room and they leave. 

But when you see the order, encourage intake at meals. This is when then somebody will be there to help the patient like to make sure to encourage or maybe or doesn’t need to be cut up, broken up. Like do they need help with it and they’re just encouraged to eat so that the orders for that began at this same point and a psychiatric evaluation was ordered, because there was concern that maybe she was becoming depressed and that’s why she wasn’t eating. Over the remaining 10 months that this patient was in this facility, the NP evaluated her in person on 15 separate occasions in 10 months, 15 occasions, and at every one ordered continuation of weekly weights.  

Encourage meals, and then started writing more specifically things like encouraging foods that the patient likes, which again, we don’t-we might not think about it. Or if you come from a different place in healthcare, you don’t think about, oh, well, you know, make sure the patient likes their food, you know, in a hospital, you know, it goes they bring your tray if you like to eat, if you don’t like, you don’t. 

JA: Yeah.  

SM: You know, then you’re gone hopefully in a few days. And end of story. If you’re just otherwise healthy and you’re assisted living and you go down to the dining room, you don’t like what they have that night, well, they don’t eat it, you know, maybe a candy bar or something, but so in this sort of environment it is appropriate. 

And it is an evidence-based, documented intervention to make available and encourage foods that the patient likes. And so you can change dietary orders, you know, whether it’s, liberalize fats or liberalize carbohydrates or double portions or, you know, that kind of thing. Don’t, you know, like, don’t-things that they don’t like, don’t put it like, you don’t write the order that way, but you talk to the patient, you find out their food preferences, and then you can order a diet that’s more consistent with their food preferences. 

You can order double portions. You can order a bedtime snack. Like these are all the things that went on for this patient. Fifteen visits in 10 months. The last 10 months there, the NP consistently ordered these things. Now she can’t force the facility to do them, right. It appears that some of her orders weren’t implemented as intended or as ordered. 

And one of the criticisms was that she should have ensured that they did. And so, you know, again, anybody listening, depending on where your practice and what your practice experiences are, what can you do, what should you do? What is the standard of care when you do a home visit, which is what these essentially are, you do a home visit and you give orders. 

You make a prescription for the patient, liberalize this snack, double portions, all of those things. You make those recommendations, right? Like when you write an order, it’s really like a recommendation because we don’t have authority in that facility. But what power do you have to make the person do it? Like there’s no-it’s just not realistic to think that she can insert herself into the administrative functioning of the facility to make sure that the things she orders are there. 

She can ask every time she goes, she can reinforce it. She actually encouraged the family who really, in that circumstance, actually has more power to make sure things get done. But-well, and there’s a lot of course, there’s a lot that’s not documented. So, there’s a lot we don’t know. But we do know that in 10 months, in 15 separate visits over 10 months, we know that she was notified that there was a concerning weight loss and that she consistently ordered everything that was available to her to order. 

You know, as this time went on and the patient continues to lose weight, not only was she ordering weekly waits, and first it was encourage the patient to eat. And then the order started to include make available the food to the patient likes to eat. And then she started to order the you know like not Ensure by name. 

But for those getting those high-calorie, supplemental drinks.  

JA: Yeah.  

SM: She ordered a psych consult. We couldn’t find the psych consult in the chart, but the patient was started on Remeron. And Remeron is an antidepressant, but it’s commonly used in the older population because it’s an appetite stimulant.  

JA: Oh, it’s used to stimulate appetite? I didn’t know that. 

SM: Yeah. 

We also use it like in people with eating disorders and stuff. You know that anorexia nervosa.  

JA: Yeah.  

SM: I mean, virtually all antidepressants have this feature of putting weight on you.  

JA: Yeah.  

SM: Remeron specifically is associated with that. And it is used as an appetite stimulant.  

JA: Okay.  

SM: And it’s also an anti-anxiety properties and can help you sleep. And so, I don’t know where the recommendation for that order came from, but she was put on Remeron as well. 

So, 15 visits over 10 months consistently monitoring weight, progressively encouraging foods, making more foods available and making foods the patient likes more available, ordering a psychiatric consult and then we don’t know where it went, but we know she wound up on Remeron. And then we see the orders for the supplementation TID. Like there is clearly a persistent progressive acknowledgment of the concerns about weight and interventions as best they are ordered to do it. 

And like there were prescriptions for Ensure on one, two, three, four, or five-six separate occasions. Then as these 10 months went on, then orders were started to feed the patient. Not encourage, not make stuff available. But at one point, finally, there was order to feed the patient. 

I mean, you can’t tie down and force feed her, but to actually help her put the food in her mouth.  

JA: Yeah.  

SM: She documented, as after they started the insurer and after they started feeding the patient, there is a note that the patient had gained 3 pounds. And then 6 weeks later, she was again flagged for a weight loss. 

So, a complete laboratory assessment was ordered to look for underlying, like metabolic impairment, things that could make the payer a patient, hypercatabolic, etc. And then the patient developed a UTI and went out of the facility to the hospital. And after her hospitalization, she was transferred elsewhere. It sounds like she addressed it-does show that I’m not and I’m not giving you everything. 

I also see, as I scroll through my own notes here, that she also ordered a speech pathology consult. Not for speech per se, but for swallowing, you know, with her problem chewing and swallowing and things like that. So again, keeping in mind she didn’t work for the facility, she has no administrative authority with the facility. She has nothing to do with the facility processes and staffing, and everybody knows how this goes. 

Facilities have staff and priorities and we can order whatever we want. But it’s really analogous to doing a home visit and saying in the patient’s home visit, okay, patient do this, this and this.  

JA: Yeah.  

SM: And sometimes they do and sometimes they don’t. And in this case it’s sometimes the facility does and sometimes they don’t. 

And none of that is really very well documented. I mean recordkeeping, there are just so many things that they have to do from an accreditation perspective like that. Those kind of facilities have an enormous amount of paperwork for accreditation. And so, the actual real documentation of patient care, the thing that’s not required, oddly enough, is often limited. 

So, there’s probably lots of things that happen that we don’t know. But all we do know is that poor nutrition is an enormous risk factor for the development of decubitus ulcers. And the patient developed decubes and they made her septic and she died. And the assertion against this nurse practitioner was that her care was substandard. And deviated from standard of care to the extent that the patient was at enormous risk for developing a decubitus ulcer. 

And the primary highlight there was that the weight loss and not doing anything about it. So, we don’t know for sure everything that was or wasn’t done and we don’t know. And I know the facility, but we do have documentation that for the first 3 years that this patient’s weight was measured, it was stable. And as soon as it became unstable the first time there’s a recording of that 7 pound weight loss, the NP was notified. 

And from that point forward, we have clear documentation that on numerous occasions, more than one a month, she went through the progression. Liberalize the diet, encourage the patient to eat, include foods the patient likes, assist the patient, get a psych consult, start Ensure TID, start feeding the patient, speech evaluation and a laboratory assessment for underlying contributors to a hypercatabolic state. 

JA: There’s a lot of interventions directly for that.  

SM: I just don’t know. I don’t know what else you could do except a PEG tube, which is, you know, if your goal weight is 120 and the concerning weight is 114, like this is not feeding tube territory, you know, you’re not even there. And that’s really the gist of it. 

I mean, the whole-but she did begin to develop her decube before that last hospitalization. And so, again, this is a home-this is a home care. And when a home care employee is, she doesn’t-we don’t strip people naked for every visit. No assisted living. But we do rely on the staff or the family or the staff or somebody to let us know when there’s a particular concern. 

And when she was first notified of the first appearance of a decubitus ulcer, she immediately consulted the local visiting nurse association. Because the visiting nurse association is like, that’s who has the wound care nurse and they come out and do a good wound care assessment, and then they prescribe treatments. And there is a whole series of charting about when she was notified that there was a decube-she consulted the visiting nurse, visiting nurses came out and they made this assessment and they ordered things. 

And the criticism that the NP didn’t manage that decube. Well, again, you know, I would ask anybody who’s listening at what point do you trust the staff that are that specialize in an area to do a job, that they’re doing it and that you trust that they will let you know if there’s a deterioration or if there’s something that needs to be further addressed or if things aren’t responding. 

And as it happened, there were over a period of about a month or so, there were different recommendations, and wound care was just getting started. And, you know, there’s all sorts of different gels and things and types of dressings and repositioning and, you know, foam cushioned support, like, what’s the word I’m looking for here to reduce weight bearing in that kind of thing. 

And all of this was done, but it was the visiting nurse association and the room care nurse that was making the assessments and making their recommendations. And then when she needed orders for things, she advised the NP who did implement the orders. So I mean, I guess I’m looking at my clock going, I know our time is winding down here and I don’t want to read the entire 4000 page chart to you, but the weight and the nutritional support is the thing that was really very directly asserted that this NP did not manage. 

And so, I share with you that was and what else do you think she could do?  

JA: I mean, she did all of the things just short of honestly and for my opinion, hovering over the staff and watching them deliver the interventions that she asked for. I mean, there isn’t another thing that I can even think of, and I think too like the fact the couple of months that that patient was in the SNF, that’s a that’s a long time. 

And that’s-I mean, that’s a lot of time to make a difference one way or another. And ulcers like that- 

SM: We don’t know what happened there. Like, I don’t, you know, since like they pay me a lot of the hour to read this stuff.  

JA: Yes.  

SM: I’m only given what’s relevant. Yes, to my decision-making. And so, what matters to me is it was the condition she was in when she left this facility for the last time. 

So, that was everything I saw. And I don’t know. I know that when she left the facility, went to the hospital, she didn’t go because of an infected decube. She went to the hospital for a UTI. She did have a decube, but they weren’t they weren’t documented to any extent. And then who knows what happened in the hospital too, right? 

JA: Right.  

SM: And I think I have like 3 or 4 would be like something big and flagged on a chart. If that was a very first time you saw something that bad. And if they were, if there were grade three and four decubes when she went into the hospital, it’s hard to imagine she would have survived.  

JA: Yeah, that’s true. 

SM: Once you know it’s true. I mean, I know what it was though.  

JA: Yeah. Wow. Well you know, it sounds-honestly this-I mean I hate to say it comes back to like we could sue for anything but we can kind of sue for anything because it really-I’m sad to hear the outcome of course for the patient, but it sounds like that NP did all of the things that you would do to address it directly. Address the weight, address nutrition and address, you know, all the factors that are going to increase her risk of developing this, to humanize. 

And she did that. I don’t know what else you do aside from honestly just delivering it yourself, which is not the-  

SM: I mean, sometimes we do everything right and it’s just we don’t have good outcomes, and which is why we don’t all live forever.  

JA: Yeah, we know, that’s a podcast for another.  

SM: I know, but I mean, in this case, it does show you the value of really being aggressive with your documentation because like I said, the facility, there was a lot of stuff missing from their reporting. 

I understand why it’s really hard to keep up with requirements, but whatever else, whatever else was going on this NP, it is indisputable. So you can see the clear, frequent, regular and escalating trajectory of her interventions as the patient failed to respond to more conservative ones.  

JA: So how did this play out for the NP in this case? Was it like go to trial? 

Was this a settle type of thing?  

SM: No, it did not go to trial. I believe that this NP wound up contributing to a settlement. I see-she really-I mean, it’s not up to her. Of course, at that point it’s just all up to the insurance company and the attorneys. But that there was a settlement for the family unit and several different players contributed to it. 

And I believe there was-it was small, but there was still a settlement.  

JA: Wow. There’s still a contribution to the settlement? 

SM: Yeah.  

JA: Well, normally I would end by saying document, document, document. This is the big lesson. But there was documents in there.  

SM: There was I guarantee you this is like this is just one of those times where completely independent of the nurse practitioner or the quality of care, sometimes the insurance company just makes the deduction that it’s less expensive for them in the long run to give a little bit of money as opposed to actually trying to defend the case. 

It’s totally not about right and wrong. That’s one of the things, one of the things about the law, I still think we have a better system of juries, prudence, than anyone else in the world. I mean, I’d rather live under our system than any others, but one of the interesting features of it is that it really isn’t about what’s right or wrong. 

It’s about the law and precedent and previous rulings and statutes and money. I mean, money is a big player there too. And so anyways, even though she-her attorney contributed to the settlement or her insurance company contributed the settlement and there it will be entered into the practitioner databank. It’s a pain, you know, when you go to apply for a new job. 

They it’s always queried you’re asked and you renew your licenses. You’re asked if you’ve ever been, you know, party to a suit, if you’ve been sued or settled, then you have to disclose that. But when it’s something like this, I can tell you it’s not a real like-I’ve been in that position when I was the APRN investigator for the Board of Nursing in Nevada, one of the things that was my job was when somebody submitted a license renewal, if they reported that they were subject to a malpractice action, they asked had to submit whatever documentation about it they had. 

And it was my job to go through it and make a judgment call about whether or not it was anything for which we should be cautious about licensing or renewing a license. And the vast majority of the time the answer was now, oh no, it’s fine.  

JA: Reassuring. That’s reassuring. Wow. Thank you, Dr. Miller, for this story. I appreciate that. 

This is-this was an interesting document. And, also cross your fingers.  

SM: Well, I’ll tell you what. If she had not documented well, it could have been very different.  

JA: True. Yeah, absolutely.  

SM: So, we still advocate for that.  

JA: Well, this was a different twist. Appreciate that. We hope you guys enjoyed this episode. And you know, find us at FHEA.com or anywhere you like to listen to your podcast to check out some more of our Scrubs and Subpoenas episodes. 

And until then, 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.