I Was Sued for Malpractice and I Won
My office manager, Cathy, called my office and said, “There’s a man at the front desk who wants to see you. He says it’s important.”
Cathy’s call irritated me because I was busy, and I don’t like unpredicted interruptions. But I detected a tone in her voice that was different, so I went.
When I opened the door, a man I didn’t know stood at the desk. Several patients were in the reception room.
He asked, “Are you Loren Olson?”
“I am,” I answered.
“You’ve been served,” he said. He handed me a brown envelope. I wasn’t sure what had just happened.
I hadn’t seen her in years
I retreated to my office before opening the envelope. I don’t remember all that was on the paper but some things are unforgettable: I was being sued for malpractice. The patient was claiming kidney failure from improper management with lithium.
But wait, I haven’t seen her in several years.
That morning, before I was served, I had read in a newsletter from my malpractice carrier that the highest awards in psychiatric malpractice cases were for kidney failure from lithium toxicity. If what she claimed resulted in a judgment against me, we’re talking big bucks.
I’d changed practices since I saw her. I immediately notified my malpractice carrier. I explained the situation to the claims adjuster on the phone.
She said, “Oh, I don’t think your insurance covers you for that period of time. I’ll have to get back with you on this.” I was too frightened about this to discuss it with my family.
I could see the headlines in her local paper: Iowa Woman Awarded Millions Because Her Shitty Doctor Caused Her Kidneys to Fail and Now She Survives on Dialysis and he Survives on Food Stamps.
Her husband said, “She’s crazy”
The patient was a middle-aged woman I had seen for about fifteen years. Her diagnosis was a severe bipolar disorder. She had several lengthy hospitalizations.
During the last few years, she had been stable enough on her lithium to return to work. She had been so stable that she asked if her family doctor could manage her care. She had a two-hour trip from her hometown to Des Moines for her appointments.
I agreed to the transfer of care if her primary care doctor agreed to accept the transfer. I told her I would send a summary of her treatment to her family doctor with instructions. I said I’d remain available in consultation if necessary.
I never heard from him in the several years between the transfer and the time the malpractice suit was filed.
I was angry and depressed. Why didn’t he consult with me or send her back to me? How can I be responsible for someone who hasn’t been under my care for several years?
I was angry because I felt I had busted my ass for this woman and finally returned her to a stable albeit somewhat fragile recovery.
In the interim, I had seen her once. For twenty minutes. She came in to discuss whether she was stable enough to have children. That was all we discussed. But it was enough to name me in the lawsuit.
Something was off in that last visit. When I called her to come into my office, her husband sat with her. I could feel hate dripping from his eyes. While his wife was hospitalized in a manic episode, she had accused him of being physically abusive to her. After she stabilized, she denied it had happened.
Was she telling the truth or psychotic?
After she had revealed this during her hospitalization, I called her husband to come in. When we told him what she had said, he became livid.
“Don’t you know she’s fuckin’ crazy!” he screamed at me. As I recall, he never accompanied her to another appointment with me.
At her follow-up appointment, I questioned her again about the abuse. She grew agitated and grabbed my chart. She ripped out several pages and tried to destroy them before I stopped her.
You’d better get prepared
The insurance company called back. Whatever problems there had been between the two malpractice carriers had been resolved. They appointed an attorney for me.
I met with the attorney and he said it would be a difficult case. He explained the jury would be sympathetic toward her and not with me. He also said the attorney who was representing her was a very successful and aggressive malpractice attorney.
He advised, “Get prepared.”
Prepare I did
First, I had to get all of her records. I needed not only my records but the records from her primary care physician who had also been named in the lawsuit.
For nearly a year, I spent every Saturday at my office reviewing years of medical records. It was on my mind every moment, every day.
I created a chronological spreadsheet that showed fifteen years of inpatient and outpatient contacts. When did I see her? What were her symptoms? What meds was she on? Had there been any changes? Did the prescriptions and refills align with compliance? What labs were ordered and what were the results? Did the labs lead to any adjustments of treatment? Were there any unusual symptoms?
Then I began to research and cross-reference those findings with the medical literature. I needed to know if there were things I could have known? Should have known? Was my treatment at variance with the standard of care at the time I was seeing her?
Since I hadn’t seen her in several years, I couldn’t be held accountable for treatments that had not yet been approved. I needed to plot the available treatments in my spreadsheet as they related to my treatments. I could show, for example, that Divalproex had not become a standard treatment until well after I had actively treated her.
Every entry on my spreadsheet was labeled with a reference to my research.
Only her symptoms were difficult
Lithium was the gold standard, she’d responded well to it, and she had minimal side-effects.
I frequently instructed patients, You will have a bit of tremor, but call me if you find it difficult to write your name. Loose bowels are common, call me if you have explosive diarrhea, and definitely call me with any signs of confusion.
I taught them to use rating scales to review their symptoms with a reliable person. Call me if there is a significant change.
She was not a difficult patient; only her symptoms were difficult.
We had a good rapport. She kept her appointments. She followed my recommendations. She took her medications and got her labs drawn when ordered. But when she had a breakthrough in her symptoms, her mania was a 10 on a scale of 1–10.
One day, my preparation surged forward in quantum leaps. I discovered a treatment review article in a reputable journal written at the time I last saw her. It described the standard of care. It was written by her expert witness. It supported every aspect of my treatment.
When I was finally deposed by her attorney, I was ready. I had prepared as if I was preparing for board examinations in someone else’s specialty. The deposition lasted three hours. I was confident. I could see by my attorney’s expression that it was going well.
At the end of the deposition, her attorney said, “We’re going to release you from this case.” The only thing that ever exceeded that feeling was the birth of my children.
It’s never really over
Being charged with malpractice when you’re not guilty must feel something like being wrongfully accused of murder and you can’t prove your whereabouts. Although the law says, “presumed innocent,” the very act of being accused makes you suspect.
It is never over. Throughout the rest of your career, on every professional application you complete, you must answer, “Have you ever been sued for malpractice? If so, provide details.” I’ve watched eyebrows raise when I answer, “Yes, I have been sued.”
If I made any mistake in this case, it is not to have explored her husband’s enmity toward me. Had it been the patient’s choice, I believe it never would have happened.
The damages, if awarded, would have cost me everything I had.
But I still paid for that freedom with a year of Saturdays and countless sleepless nights.
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Loren A Olson MD - Medium
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