Organized Medicine Is a Real Trip,  Always Bashing the Clinician

Sending this letter. 


November 29, 2013

Chairman, Education Committee
Pennsylvania Psychiatric Society
777 East Park Drive
Harrisburg, PA 17111
1-800-422-2900 PH
717-558-7841 FX

        Re: Patient Safety and Risk Management 2013

Dear Doctor:
I am adding some missing commentary to the program. I hope you will share these comments with all faculty and attendees. The program was overly harsh,  negative, and unfair to the clinicians described, thus misleading. If you decide to provide your own corrections, let me know.

Internet.
All patients have access to the internet. This makes the process of informed consent automatic, and all patients now have a duty to Google. They may get as much information as any psychiatrist may have. They may look up information they cannot understand. So all claims about lack of informed consent are now frivolous, and should be automatically dismissed by the court.

There could also develop a duty to Friend, since patients will often communicate an intent to harm themselves and others on social media, and not tell the clinician until later, or never. The paranoid schizophrenic who shot people at a Batman movie in Colorado did so. The categorical prohibition of Friending patients as boundary crossing comes from silly transference concepts in psychoanalysis. The latter is a form of quackery, and psychiatric rules should not be based on such inferior conceptualizations. If a clinician harms a patient via social media, then boundary crossing has taken place.

Until the antiquated thinking of organized medicine has changed, it is a good idea to ask patients to Friend members of the family, as part of safety planning. This is similar in intent to the suggestion of informing family of urges o harm self or others, and to cooperate with eyesight supervision, as an effective alternative to hospitalization.

Safety Issues in Prescribing Hypnotics
1) A patient has an accident, and blood is taken. If it contains a benzodiazepine but no alcohol, the patient will get treated like a drunk driver. Patients need this warning.

While there is habituation of the brain to opiates and to benzodiazepines, the breathing center (http://en.wikipedia.org/wiki/Control_of_respiration) habituates to opiates but not to benzodiazepines. So the lethal dose of these drugs is the same as before the patient ever took any, with wide individual variability, and an unknown amount. See the death of Whitney Houston ( http://www.thedailybeast.com/articles/2012/02/13/whitney-houston-s-death-xanax-and-alcohol-deadly-duo.html). See the review in Postgrad Med. 2013 Jul;125(4):115-30.

Elements of a Med Mal Lawsuit

Four elements are listed. A fifth one is missing. It is of essential importance in cases of suicide. Its application should end almost all cases of malpractice for suicide of a patient.

5. Legal Causation. The fourth is Direct Causation: the patient’s damage is the direct result of the doctor’s negligence. Legal causation requires Direct Causation plus the total absence of “An Unforeseen Intervening Cause.” The definition is, An intervening act or event which overwhelms a defendant's antecedent negligence and prevents him/her from being liable. In every single case of suicide there is an intervening cause. In half the cases, the victim is intoxicated on alcohol or drugs. In the overwhelming majority of suicides, there are no prescription psychotropics in the blood, implying non-adherence with treatment. Treatment of ordinary psychiatric disorder is the single most powerful way to prevent suicide. Most victims have relationship problems driving their urges to kill themselves. Here is a long list of unforeseen intervening causes, covering 99% of suicides, http://www.suicide.org/suicide-causes.html. Each case should be analyzed for such, and no suicide case should prevail. Only cases of assisted suicide in states prohibiting it are justified. Even then one may make the case that treatment resistant depression is as bad as metastatic cancer, and that suicide may be a humane alternative.

Determining the Standard of Care. All listed items represent garbage science, and should not be allowed to be introduced. If they are, the defendant should file a cross claim against the authors, their publisher, and their supervisors in academia. Only an expert in the same field, and with the same credentials may describe the standard of care. There are no authoritative texts because any written advice is cookbook medicine, lacking the individualization of care required to meet any standard of care. The use of rating scales as part of any standard is also garbage science.

Unfortunae Truth. If you have not been sued, you will be.

Doctors should stop being crybabies. If a practice grosses $5 million a year, and has 4 lawsuits, doctors will get upset. A welding business or a store, or a service business grossing $5 million will have 400 lawsuits all the time. Walmart has 10,000 at any one time. Lawsuits are part of business in this county. The alternatives are much worse. One is a violent vendetta for 100 years. The other is government regulation. Only the tiniest fraction of malpractice acts are ever pursued in court, because they are not lucrative enough for lawyers, or the patient has undesirable personal characteristics, especially a mental illness. So things can only get worse wi th any change.  Even in judicial hellholes for defendants such as Philadelphia, physicians win two thirds of cases (http://www.pacourts.us/assets/files/setting-771/file-2715.pdf?cb=bd9d58).

Better Coping: Counterattack the plaintiff lawyer, to drive them from the business. Just about all behavior in a case has legal immunity. However, there is recourse inside the trial and from the court. Seek e-discovery on the plaintiff lawyer’s and on the plaintiff’s personal and work computers, seeking an improper motive for the suit, such as animus toward doctors. Any purpose other than money compensation for damages is an improper purpose. For example, “It’s not for the money.” “So it does not happen to others.” “Psychiatry is quackery.”

Look for any misstatement of fact by plaintiff witnesses and experts. Opinion is immunized by the First Amendment and by the litigation privilege. One may not lie about a fact, for example, I read this report, when the expert has not. A motion for a mistrial and for all legal costs to the assets of the witness should be filed. The judge may sanction perjured testimony from the bench at trial. This has been done.

This has not been done yet. The defense of Outcome Bias (http://en.wikipedia.org/wiki/Outcome_bias), an error made in evaluating the quality of a decision when the outcome of that decision is already known. Even defense experts cast blame when the outcome of a theoretical case is bad, and not when outcome is good, despite the fact that all procedures described are exactly identical. It is one of many established and well studied errors in critical thinking. The list should be reviewed for other biasing effects. (http://en.wikipedia.org/wiki/List_of_cognitive_biases)

The defense  lawyers who are supposed to be on the side of the doctor were overly harsh in their opinions, and insufficiently supportive of the doctor. Doctors must think of all out resistance as an investment in the future of clinical care. Lawyers learn from experience in court. If they win they come back over and over. The limp attitude of these lawyers was personally threatening to me, since they would encourage malpractice claim against others. Doctors should be encouraged to hire a personal attorney to manage and bully the insurance company lawyer. First, he paid very little, and must go to trial to make any profit. Second, he has failed to disclose that he gets his job, not from the client but from the plaintiff lawyer. So he will never hurt, scare, or deter the plaintiff lawyer, however much the client is screaming for more aggressive tactics. However, if the doctor asserts any demand, it will be laughed off. A lawyer malpractice specialist demanding zealous representation will not be laughed off.

Carefully Documenting. There is no correlation between quality of record and medical outcomes. Good records do not mean good care, nor do terrible records mean substandard care. As to electronic medical records, they should be resisted to the utmost because they force docors to become typists destroying productiveity, slowing all encounters, and slashing physician income.

No malpractice claim arising from a suicide has ever had any merit. Even in a Supermax prison, no one has enough control over the body to prevent suicide. There is no duty to commit involuntarily, and suicide is mostly caused by bad relationships, especially with the family scape goating the physician for their own guilt in the suicide.

Kidney Damage from Lithium. In this case, addiction was rewarded with a settlement. It should be general policy to never do that. No permanent damage. No relationship between testing and damage, stemming from alcohol abuse. Get rid of experts, and shun them in the future. Damage was minimal. Standards for monitoring of medication are garbage science. This is unproven speculation. Real malpractice was entirely missed. Making a diagnosis of a mood disorder in an ongoing alcoholic. Proposed process will take many hours, and have no basis in any evidence.  Informed consent is a rolling process of experience and education. Patients now get package inserts, and have a duty to Google. All patients are non-adherent, especially if patient is an expert doctor in the field. Entire population would be terminated. Alternative is to persistently work with the patient.

Patient suicide. No case should be settled short of assisted suicide where illegal. Family far more to blame for the suicide. They should be mercilessly torn apart in deposition, to protect clinical care from scape goating.

Duty to Warn. There are 1000's of threats for every murder. Duty to warn based on garbage science.

Patient Suicide. Plaintiff expert promulgating garbage science. Seek a statement of a false fact under oath, then demand prosecution for perjury. File ethics charges against plaintiff expert. Move for a mistrial if found, with all costs to the assets of the expert. There is a duty to clinical care to deter fatuous, academic, purveyors of garbage science.

Metabolic Syndrome. Seen in those patients in the 1920's, caused by the disease, not the medication. Massive testing represents massive fraud against the federal government. For example, a surgeon puts a stent into every patient who has chest pain, would constitue fraud under the False Claims Act. The occurrence of metabolic syndrome is elevated in patients on these medications, 1 in 500, up from 1 in 1500. You will test 499 people to find one positive patient. This is fraud under the False Claim Act. The subject is not scientifically settled. The courts are not competent to rule on the subject. Medical controversy should not be settled in the court.

Never Events in Psychiatry.

Failure to adequately treat pain is illegal and patient abuse.

Expressing anger to patient can be appropriate sometimes.

Insider tips in the public domain are legal. “Pfizer is rolling out Viagra in three months. Time to buy. “

Sexual relationship with current patient allowed by Pennsylvania court, and affirmed at the Superior Court level. Such relationships may be protected by Lawrence v. Texas. I strongly opposed such relationship because our business is about the body, and we should remain trustworthy with it. The Judges slapped down the 3000 year old Hippocratic Oath prohibiting sex even with slaves who might be patients.

Self Disclosure is insane and unAmerican. It is an old trick. Confess to the Inquisition. Self criticize yourself to the Communist party of Stalin. Go to the stake or get shot. Silence is the best policy to protect clinical care from the lawyer predators besetting it.  We are at war with the lawyer profession, making their job easier is betrayal of clinical care. Joint Commission and AMA are total adversaries of the ordinary clinician. They are fully in collaboration with the lawyer profession.

I would never use the APA recommended insurer if these lawyers are setting policy. They are too pessimistic and dismissive of clincian interest. They will not be aggressive, nor ever counterattack the other side. Why? They owe their jobs to the other side and not to the doctor. They will never deter the other side.

I was personally sued for causing tardive dyskinesia in a child. The claim came after a half dozen successful lawsuits in New Jersey and Pennsylvania. Wach was for $5 million. I had to handle the total resistance. They lost. The plaintiff experts never testified again. The lawyer went out of the TD business. A patient with horrible TD said, no lawyer will consider my case up to 150 miles away. The resistance is an investment in the future of clinical care.        

I hope that if you plan to present the same namby pamby, half hearted review of the legal aspects of care, you let me know. I do not want to attend without the presentation of a lengthy rebuttal of your lawyers. However, they are telling only part of the story.

Sincerely Yours,




David Behar, MD

Alternatives to "Life After a Lawsuit"

The AMA is a trip. This article describes helplessness and victimhood. It says nothing about another side of being sued for malpractice. That is the duty to protect clinical care from the vicious predators coming at it from all sides, including hate filled, scapegoating, entitled, greedy plaintiffs, who are real scum.

Some Perspectives

Doctors are Spoiled and Nearly Immune from Tort Liability

1) Say a practice makes $5 million a year. It gets all upset if it has four lawsuits of any kind. If it were a $5 million welding business, it would have 400 lawsuits all the time, permanently, as long as in business.  A large business, such a s Walmart, has 10,000 lawsuits at all times. This predatory practice is a huge heavy anchor on our economy, where a criminal cult enterprise, the lawyer profession, has total control of government, and uses it to enrich and empower itself by plundering all productive entities. This criminal cult knows doctors are crazy and violent once angered, so they stay away, mostly. (See Al Qaida, the Cuban Revolution, Ethnic Cleansing in Serbia,  for examples of doctors getting angry.) Doctors are a privileged group, almost immune.

2) When a lawsuit is filed, it fails at a rate of 80% at every stage of litigation. So, the smallest fraction of claims ever reach trial. Once at trial, jurors like doctors and give them the benefit of the doubt. Even in judicial hellholes, the verdicts favor doctors 75% of the time.

3) When spectacular losses make the newspaper, they are misleading. Baby makes $58 million, the headline may say. Baby really makes almost nothing is the reality. They baby will get the limit of insurance, such as $2 million. After the lawyer has taken out expenses and contingency fees, only a pittance is left for the baby. Greedy, low life parents are often shocked by this principle of no "Blood Money."

The Doctor has No Friend in Court Save the Jury

1) The defense lawyer is a traitor working only for himself. He will always want to get to trial because that is the only way to make a profit on a medical malpractice defense. He will allow his client to go through the wringer in a frivolous case to generate the profits from the rial. He does not need the client. He will never do anything that might scare, deter, or even inconvenience the plaintiff bar. He will never go after a biased judge. These are all duties to the client.

2) The doctor must hire, at his own expense,  a legal malpractice specialist to terrorize the insurance provided defense lawyer, looking out only for himself, and always orchestrating the case so a trial happens to enrich himself. There should be no pity shown this traitor. The malpractice lawyer must force the defense lawyer to file for motions to dismiss, for motions to disqualify  the lawyers, the judges, and the experts. Try to destroy the case as early as possible.

3) The process of discovery must brutalize all the enemies of clinical care, including the pro-lawyer biased judge, a hack, only slightly more morally upright than the felons passing thorugh his court. The judge is scum, and must not be spared any pain possible. Judges must come to pee their pants whenever a doctor enters the court, rather than the other way around. The judges are base cult criminals, sworn enemies to clinical care, scum who allow frivolous cases to proceed and refuse to punish irresponsible plaintiff lawyers. Demand all out e-discovery on the plaintiff, his entire family, the plaintiff lawyer for an improper motive, on all the named experts, and on the judge for his anti-doctor bias or pro-litigation bias. A full search for content in social networks should be done for all the adversaries.

This is  a proper motive for the tort claim: to make the plaintiff whole with money damages. Period. Every other utterance should result in a motion to dismiss, or to disqualify. For example, "It is not for the money." An improper motive. To prevent this from happening to others. To find out what happened. To send a message to the health care system. Any utterance indicating frustration or hate for the doctor. All improper motives. Use all appearances in the media as evidence of improper motive, since these are to get attention and notoriety, to embarrass the defendant into offering a settlement. All depositions should be relentless in their search for these case ending statements.

No Courtesies Nor Civility During the Trial

1) The malpractice lawyer must second guess every move or failure to make a move by the defense lawyer.

2) Ask the judge to question the jury in mid trial, whether any has used any electronic means to independently research any aspect of the parties or of the case. This is irresistible. It will be true at nearly every trial. Demand a mistrial and legal costs.

3) Use every utterance of every adversary, including those of the judge as a basis for many ethics complaints, using a specific Rule of Conduct from the applicable law covering professional ethics. This may generate dozens of complaints against the plaintiff lawyer, the experts, the judge. Generate dozens of investigations against each, so they all live in uncertainty, and not just the defendant, as in this article cited above. These investigations may have to be carried out for months after the end of the case. They have driven the targets from the field.

4) File cross claims against all other defendants. If one decides to settle, he will need your consent. You would not let anyone out unless they paid you or your wanted to. People will settle, and leave to suffer a trial alone. Do not allow that without thinking hard about it.

5) A doctor in the article sued the plaintiff and the lawyer for misuse of a civil procedure. This measure after the trial is a waste of time. The legal system is rigged airtight to encourage litigation and lawyer employment. One must possess proof in the form of a writing or recording of the lawyer confessing that the case was filed with knowledge of its lack of merit or confessing an improper motive. Impossible.

Alternative to the Misuse of a Civil Procedure after the Trial

The sole remedy to the frivolous claim must be found in the trial. The trial judge has limitless powers to punish the attorneys with costs, jail time, and seizure of personal assets, even dismissal of the case for misconduct (generating a legal malpractice case by the client). Make the defense lawyer traitor demand sanctions against the expert for any misstatement of facts (opinion is immune), against the plaintiff lawyer for misconduct (the doctor defendant should study the Rules of Civil Procedure to make informed demands of the defense lawyer.

6) The tort defendant has  procedural due process rights, the Supreme Court affirmed in reversing excessive punitive damages against an insurance company. One such right under is a right to a fair hearing. The defendant should take this list of biases, use it as a checklist, and see if any apply to the case, and demand a motion to dismiss if found (as early in the case as possible). Here is the list of biases.  The most important in medical malpractice are hindsight bias and outcome bias. The defendant may even blame himself and harbor an outcome bias against himself. This bias can be demonstrated to exist in defense experts. These are no more acceptable than other biases such as those against minorities.An argument using cognitive bias has never been made, let alone tested in a medical malpractice case, so the defense lawyer will resist it as having no precedent.

Deter the enemies of clinical care. Personal destruction has good moral validity. It is indeed a duty of the doctor defendant, to protect clinical care from its relentless enemies.

Many Medical Malpractice Claims Motivated by Anger. This is an Improper Motive

What the doctor is trying to say is the evidence points to personal animus as motivating most malpractice claims. Such a motive is an improper motive and represent lawyer malpractice if it is the real reason for the lawsuit, and the alleged deviation from standards of care and its alleged harm is just a legal pretext. The filing of such a retaliatory claim is an improper use of a civil procedure and itself a tort. The subject of anger should be deeply explored in any patient and family deposition. Then the doctor should file a countersuit against the lawyer, the plaintiff and any family member who encouraged the claim. An attempt should be made to get an injunction from a higher court against any judge allowing such venomous claims to proceed beyond first pleading to dismiss.

The overwhelming majority, perhaps up to 80%, of medmal claims are weak claims. They fail at every stage of litigation. The innocent doctor should not settle, and should consider countersuing the lawyer predator. To deter.

Because there is a first duty to survive and to stay open, the cover up is the most common response of any health entity to medical error. All investigational material will be subject to discovery and may ruin the health entity. One may conclude that these weak, hate filled, retaliatory lawsuits result in the shut down of investigations into systemic improvements that would eliminate medical errors. Every preventable medical error may therefore be caused by the medical malpractice lawyer, with no exceptions.

AMA Study: Medical Malpractice Ubiquitous and Has Big Impact on Clinical Care

The solution is to allow the adverse third party to sue the lawyer for legal malpractice. It appears 90% of claims are weak, and the filing of a weal claim is legal malpractice. The lawyer will argue, the lawyer cannot have a duty to the adverse party. It would make his job impossible. This is not true. The lawyer has dozens of duties to the adverse third party, enumerated in the Rules of Civil Procedure, of Evidence, of Conduct, in hundreds of precedent setting case decisions.

From Medscape Medical News

Malpractice Threat to Physicians Pervasive, AMA Study Finds

Mark Crane

August 5, 2010 — More than 42% of physicians have been sued for medical malpractice at some point in their careers, and more than 20% were sued at least twice, according to a new American Medical Association (AMA) report.
An average of 95 claims were filed for every 100 physicians — almost 1 per physician — the AMA's Physician Practice Information survey of 5825 physicians, fielded in 2007 and 2008, found.
Despite the pervasive threat of litigation across 42 different specialties surveyed, two thirds of claims are dropped or dismissed, and physicians prevail 90% of the time in cases that go to trial, the study found. Still, the costs to physicians in terms of malpractice premiums and to the entire healthcare system resulting from the practice of defensive medicine are quite high. Average defense costs per claim range from a low of $22,000 among claims that are dropped or dismissed to a high of more than $100,000 for cases that go to trial.
"Even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine," AMA Immediate Past-President J. James Rohack, MD, told Medscape Medical News. "This litigious climate hurts patients' access to physician care at a time when the nation is working to reduce unnecessary healthcare costs.
"Unfortunately, there are no real surprises in this study for us," said Dr. Rohack, a cardiologist in Temple, Texas. "It reconfirms the need for a solution to our current tort system. If the nation is ever going to control the rise in healthcare costs, we have to eliminate wasteful defensive medicine spending."
Other highlights in the report include:

• Nearly 61% of physicians aged 55 years and older have been sued.
• There is wide variation in the effect of liability claims between specialties. The number of claims per 100 physicians was more than 5 times greater for general surgeons and obstetricians/gynecologists than it was for pediatricians and psychiatrists.
• Before they reach the age of 40 years, more than 50% of obstetricians/gynecologists have already been sued.
• Ninety percent of general surgeons aged 55 years and older have been sued.

Attack on Locality Rule Unwarranted

The letter above was to rebut this article.

The Locality Rule

The locality rule is the progenitor of the debates over the proper specialty qualifications for an expert witness. The locality rule evolved before the standardization of medical training and certification. During this period, there was a tremendous gulf between the skills and abilities of university-trained physicians and the graduates of the unregulated diploma mills. In many parts of the country, parochialism and necessity combined to create the rule that a physician's competence would be determined by comparison with the other physicians in the community, or at least in similar neighboring communities. The strictest form of the locality rule required the expert to be from the same or a similar community. This made it nearly impossible for injured patients to find experts to support their cases, effectively preventing most medical malpractice litigation.

The underpinnings of the locality rule are diametrically opposed to contemporary specialty training and certification. There is no longer a justification for a rule that shelters substandard medical decision making on the sole excuse that it is the norm for a given community. Many states have explicitly abolished the locality rule for physicians who hold themselves out as certified specialists. Unfortunately, the locality rule is being reinvigorated in some states as a tort reform measure. This resurgence is driven by the problem of access to care and facilities in rural areas.

Proponents of the locality rule often confuse access to facilities with physician competence. A national standard of care implies that the rural physician will have the same training and exercise the same level of judgment and diligence as an urban practitioner. It does not require that the rural physician have the same medical facilities available. If the community does not have facilities for an emergency cesarean section, the physician cannot be found negligent for failing to do this surgery within the 15 minutes that might be the standard in a well-equipped urban hospital.

Under a national standard, however, the physician must inform the patient of the limitations of the available facilities and recommend prompt transfer if indicated. This allows patients to balance the convenience of local care against the risks of inadequate facilities. The protection of a national standard is especially important as rural hospitals attempt to market or retain lucrative medical services that their facilities are not properly equipped to handle.

Court Overturns Certificate of Merit Requirement for Medmal Claim

The certificate of merit requirement is an absolute shield for the plaintiff lawyer against subsequent misuse of a civil procedure counterclaim or against an ethics complaint with the Disciplinary Counsel for filing a frivolous lawsuit. Striking it down is striking down a lawyer immunity.

Every doctor should put away $10,000 to fund lawsuits and administrative complaints holding plaintiffs, experts, and lawyers accountable.

Medical Malpractice Litigation Stress: What No One Will Tell the Doctor Victim of Lawsuit Abuse

There is an inherent conflict of interest of all parties in a case, save that of the jury. The jury is the sole friend of the innocent doctor. All others are backstabbing mortal enemies. The standard advice in this article is wrongheaded. The innocent defendant doctor has a moral duty to attack and to utterly destroy the other side, and to totally intimidate the insurance company and its running dog, the insurance defense lawyer. This is to protect clinical care from plunder by all sides. It is strongly recommended that the defendant doctor hire a private attorney to defend his interest against the insurance company and the defense lawyer it has hired on the cheap. The private attorney should get the instruction to show no mercy to the enemy.

Insurance Company. Even if doctor owned, its interests lay in churning litigation. The doctor officers get high salaries when lots of premiums are collected. They will oppose any measures that will deter the filing of weak claims.

Insurance Defense Attorney. This defense lawyer gets paid a tiny amount. It is impossible that it even covers overhead. The doctor will learn what it feels like to be an HMO patient, when he gets minimal legal care from this defense lawyer. The latter will always try to get to trial to just break even. He will refuse to file motions to dismiss. He will refuse to seek sanctions against the other side for their misconduct. He will refuse to go after a biased judge. That is where the private attorney comes in. If the doctor complains, he will be dismissed, as not knowing any law. If the private attorney, preferably specializing in legal malpractice speaks, the defense lawyer will take notice, and be less dismissive. The private attorney should repeatedly threaten to sue the defense lawyer in writing every time he refuses to be more aggressive in getting rid of the case.

Plaintiff Attorney. The doctor should read the Rules of Conduct of the state, covering the licensed lawyer. Every utterance that in the least hints at a violation should be reported to the Disciplinary Counsel. If he is licensed in multiple states, file one complaint a month. Prolong the period of investigation. If kept confidential, the complaints have legal immunity. They may be shared with the personal lawyer. Demand total e-discovery of the plaintiff lawyer, including all social network sites back to kindergarten. Try to get a hold of the personal and work computers. The justification is to search for an improper motive for the lawsuit. If child porn, any other shady activity, or prejudiced utterance is found, put into the public record. Report all child porn to the FBI. Try to destroy the life of the plaintiff attorney, just as he doing to the doctor.

Plaintiff. Demand total e-discovery, and deep background checks on the plaintiff and its family.

Plaintiffs are always boohooing on TV. It is unclear if adverse information about the plaintiff and the plaintiff lawyer should not be trumpeted in public. The lawyers say they advise against that because all statements will be used against the defendant at trial. That is an open question.

Plaintiff Experts. There is no recourse outside of the trial against the false testimony of the plaintiff expert. The defense lawyer will accept this person as it comes. No. The defendant is an expert himself, and that should be used. The defendant should read every word the plaintiff expert has ever uttered, in articles, in depositions. If the expert has little experience to offer, the private lawyer must force the insurance company defense lawyer to move to disqualify. If that cannot be done, read every word for contradictory statements to impeach the expert on the stand. The Golden Fleece of research on the plaintiff expert is the utterance of a false fact. Opinion cannot be verified nor contradicted, and is protected by the Free Speech Clause, and several Supreme Court decisions. The assertion of a false fact in any submitted document or testimony is perjury and a crime. Once found, a motion to declare a mistrial should be made, and all legal costs should be assessed to the private assets of the lying witness.

Here.

This article advises the standard advice of taking it in the rear quietly.


"Plaintiffs bringing medical liability cases commonly contend they have experienced pain and suffering. Many physicians could say the same about being dragged into the litigation process.

Karen Kohatsu, MD, a San Diego-area obstetrician-gynecologist, was confident she would prevail when she was sued a couple of years ago, but isolation and sleepless nights still reigned throughout the process. The suit was eventually dismissed.

"Self-doubting occurs when you read the summons and depositions from the other side," she said. "The other side makes it sound like you are a terrible person for missing a diagnosis. You feel really alone and have to turn everything inward because you don't have anyone to talk to about it."

Dr. Kohatsu is not alone.

Experts say litigation stress syndrome is a real phenomenon, and one that has a significant impact on physicians. Various emotions, including anger and depression, can strike, along with an inability to concentrate.

When physicians are counseled by their lawyers not to talk about the case, most take that to mean they can't talk about the experience at all, experts said. But increasingly liability insurers and professional medical societies are instituting programs designed to help physicians deal with the emotional rigors of litigation stress.

"In the big picture, we want to normalize the experience of litigation," said Ronald L. Hofeldt, MD, a psychiatrist in Salem, Ore. He serves as a consultant to medical liability insurers and other organizations, helping design retreats and wellness programs that give doctors a venue to air their litigation concerns and help them develop coping skills."