Anatomy of a Lawsuit

1. Anatomy of a Lawsuit James Fitko, MD, MPH,FACOEM

2. Civil Procedure • Federal Rules of Civil Procedure • State rules

3. The Complaint • Relatively easy to file • Statute of limitations • Caption • Alleged facts • Numbered paragraphs • Prayer for relief • Pleadings

4. Process serving • Various methods • You can run, but you can’t hide • Contact your insurer immediately • Must answer in 20 days • Don’t discuss any specifics with others

5. Motions to dismiss • Lack of jurisdiction • Subject matter • The person • Improper venue

6. The Answer • Limited time to avoid a default judgment • Responses to allegations in the complaint • Affirmative defenses

7. Necessary elements for a claim • Duty • Physician-patient relationship • Standard of care • Breach • Injury • Proximate cause • (Informed consent)

8. Defendant Suits • Counterclaims • Cross-Claims • Third-Party Actions

9. Motions • To dismiss • Directed verdict • Continuance • Summary judgment • In limine

10. Discovery • Scope • Interrogatories • Requests for Production of Documents • Subpoenas duces tecum • Depositions • Independent Medical Exams (IMEs)

11. Discovery - Scope • Broad based • Personal questions • Privilege • Attorney-client • Physician-patient • Husband-wife • Attorney work product

12. Discovery - Interrogatories • Written questions • Under oath

13. Requests for production of documents • Parties to the suit • 30 day time limit

14. Subpoenas duces tecum • Require the provision of documents • Not parties to the suit • Protective orders

15. Electronic Health Record • Technical problems with the software • More details than a paper record • Signatures • Boilerplate and checkboxes

16. IMEs • Independent medical exams

17. Depositions • Purpose • Preparation • Location • The transcript • Advice for the deponent • Videotape • Abuse

18. Depositions-Purpose • The deponent is under oath • Gather information • Determine facts • Evaluate you as a witness • Lock you down • Intimidation

19. Depositions-Preparation • Very important • Settlement • >90% settle without trial • Meet with counsel • “A reasonable degree of medical certainty” • Study all case material • Medical record • Expert reports • Review the literature

20. Depositions-Time and Location • Don’t box yourself in on time constraints • Not in your office

21. Depositions-Transcript • Don’t waive right to read and sign • Changes in form or substance • Must be explained

22. Depositions-Advice • Listen to the question carefully • Take your time • Don’t lie • You don’t know • You don’t remember • Don't guess or assume • Take breaks

23. Depositions-Advice • Don’t get angry • Don’t joke • Don’t volunteer any information • “Off the record” • Don’t form “instant opinions” • Don’t say that a text is “authoritative” • “Hypothetical” situations

24. Depositions-Advice • Inventive assumption • I cannot answer the question as asked • I don’t agree with the assumption • Don’t use the other side’s words • Never say never (or always) • Don’t use absolutes

25. Depositions-Advice • Repetitive questioning • Don’t elaborate • Don’t volunteer information • Take all the time you need to review documents

26. Depositions-Videotape • Dress appropriately • Look at the camera • Body language • Don’t get angry or combative • Don’t appear nervous or evasive • Don’t eat, drink, chew, etc.

27. The Trial • Bench trial/Jury trial • Finder of fact • Level of sophistication • Opening statements • Theories of the case and previews of evidence • Burden of proof • Preponderance of evidence • 51% • A reasonable degree of medical certainty

28. The Trial • Evidence • Witnesses • Plaintiff goes first • Closing arguments • Jury deliberates • Verdict

29. Evidence • Federal Rules of Evidence • Relevant evidence

30. Experts • Qualified by • Knowledge • Skill • Experience • Training • Education • Reports • Express opinions • Compare to lay witnesses

31. Daubert • Federal Rule of Evidence 702 • Expert by knowledge, skill, experience, training, or education • Daubert v. Merrell Dow Pharmaceuticals • The theory or technique can be tested • Peer review • Rate of error and standards • General acceptance • Did the theory exist before the litigation? • Motion in limine

32. Remedies • The judgment • Damages • General—pain & suffering • Special—lost wages, medical bills • Punitive • Court orders

33. The Appeal • Decide questions of law, not fact • An appeal is not a retrial • New trial • Reverse verdict

34. Implications for Medical Personnel • Record keeping and documentation • How will experts view your actions? • Red face test • Prepare thoroughly for depositions

35. “Defensive” Medicine • Limit injury if a mistake is made • Consultations • Recommend further treatment and follow-up • Notify the patient or family • Answer questions • Notify your malpractice insurer • Write down everything you remember • Apologize?

36. The Adverse Event • Whose “fault”? • Was a mistake made? • How serious is the result? • Could/should something have been done differently?

37. Possible Motivations • Justice • Money • Revenge • Effect a Change • Prevent Future Recurrence

38. Dealing with a Lawsuit • Don’t take it personally • It’s business • It’s a chess game • 89% of ObGyns have been sued • 70% result in no judgment against the physician • Physicians win 80% of cases that go to trial

39. Thank You