Steve Crandall BTK Audio-esv2-47p-bg-10p
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[00:00:00] Hi, all UBTK fans. It's Scott here and I'm super excited today. With us today is Steve Crandall, a former medical negligence defense lawyer who for reasons we're gonna get into a little bit switch sides and now actually represents the patient who's suing care providers. He's the founding partner of Crandall and Para Law and has also been ranked with.

Here in Cleveland as one of the top five lawyers in Cleveland and one of the top 10 best lawyers in Ohio for over the last 15 years. Steve, welcome to behind the Knife. Thank you very much, Dr. Steele. Look forward to talking to everybody today. So give us a little bit of background in terms of set the stage for us.

Your background. Where are you from? Where'd you train, and how did it come to the point where we're sitting here talking today? I'm originally from upstate New York, moved out to Ohio to go to law school. When I was in law school, I interviewed with a law firm that was exclusively medical malpractice defense.

Their [00:01:00] headquarters were in Cleveland and I got a job clerking there in 1991 and absolutely fell in love with medicine. They were very adept at teaching US medicine and having resources available. And actually I became at one point in time the youngest lawyer. To handle any defense cases for the Cleveland Clinic Foundation.

They were one of my biggest clients. Absolutely loved doing defense work. Tremendous amount of respect for care providers and physicians. In 2001, I switched sides to represent the patient, and we could certainly talk about reasons why I did that, but I have my own firm now. We're a very exclusive boutique firm that handles medical malpractice in Ohio and in Kentucky.

So, I just wanna first thank you for taking the opportunity to join. As, as you may know this is a surgical podcast, but we get you know, trainees all the way up to attendings, all sorts of medicine and everything. And I think this is one of the things that, to be honest with you, we don't talk a lot [00:02:00] about in medical education.

And we certainly don't have a lot of, what do I do until all of a sudden, God forbid, one day you come home and you have, as of. My aspect of it is you have a lawsuit that's staring at the face and it's, you know, pretty stressful. And so let's frame this episode. We're not here to talk about adversarial.

It's about understanding the legal side to hopefully improve patient care and, you know, and hopefully overall reduce litigation and have a better understanding of kind of the legal system of which many people have a giant. Black box that we don't know what data would go into. So let's start with some easy ones.

So, you mentioned it a little bit, gimme a little bit more in depth. What led you into medical malpractice law? When I first started to work for that law firm and I read medicine, there is just something about medicine in terms of reading the literature, understanding the principles. Of medicine. And then as you learn more about the body, some things would fit together.

You know, I'd have a cardiac case, then I'd have a neurosurgical case and they would fit [00:03:00] together. So I guess it was really the complexity of it and just the challenge intellectually that I loved about it. And then when I started to learn the legal side of it, in terms of. Representing physicians there are cases where the physicians did everything right and there was a bad outcome.

And certainly there was a tragic result and they would sue the doctor. And I took a lot of pride at making sure the jury understood the medicine, understood how the physician did everything he or she could do, and that the outcome was just a tragic one that no one could have prevented and was successful as a defense lawyer.

So that's originally why I enjoyed it so much and why I think I was drawn to it. So, you know, as as stated, we're here, we're behind the knife for a reason that knife has to do with surgery. And so, is there anything in particular about surgical cases which may make them maybe a little harder or on the other hand a little easier to [00:04:00] defend?

Yeah, I think there's several principles, first of all, and they're obvious ones, but they bear repeating the conversation that you have with a patient before a surgery is, is very important not only to establish rapport. But to make sure they understand that there are other options. If there are you should always encourage like, Hey, I could do it A, B, or C.

Let's talk it over and see which one works best for you. You obviously have to go through the informed consent process and document that. Once you're in surgery, I actually think surgical cases are pretty easy to defend. There are, there is a lot of literature out there on recognized complications. If things occur that are well studied and they're recognized complications, the physician should win those cases 10 times outta 10.

In fact, a good lawyer like me would look through a case like that and say, and I do very often. I say, listen, you know, they warned you of this risk. They can do this a hundred [00:05:00] times perfectly, the exactly the way they want it done. But 5% of the time, you're gonna get an infection or you're gonna have a nerve injury or whatever it is, and it's just not a case.

The last thing is if there is a complication, it is vitally important for you, not your pa, not your CN. For you to go to bedside or have an office appointment and explain everything that happened, why it happened, why it couldn't be prevented. One thing I wanna point out for surgeons and any care provider, there's a law in Ohio that indicates if you sit down and explain everything and apologize, nothing that's said in that conversation can be used in the court of law.

So, for example, if you did. Make a mistake. Or even if you were negligent and you explain it to them and say, listen, this has never happened to me before. This is what happened. You know, the clamp slipped. We didn't mean to have it slip, but it slipped, it injured an artery and your [00:06:00] husband bled out, and it's never happened to me before.

I'm sorry this happened. All of that does not come into court. But more importantly, all of that, most of the time we'll have someone go home and say, you know what? I'm not gonna sue that doctor. They took the time, they explained it to me, they apologized. They seemed very genuine. This is just one of those things that happen in life.

So those are some things that I think surgeons can do to protect themselves and avoid any brushes with a law. Steve, I feel a little bit ignorant in this next question, but I think it's important for a lot of us out there, no matter at what stage in life we're what leads to a lawsuit. Can you, can you talk a little bit about some common patterns that you've seen surgery or not surgery that kind of leads to a lawsuit?

Absolutely. I wanna say something that that's, I think one of the most important points I wanna make today. I've been doing this for 30 years. [00:07:00] I've been a plaintiff's lawyer now for 24 years. I have never seen such a extreme volume of cases coming to my law firm and particularly with huge, huge, tragic damages, you know, deaths, paralysis, brain injury.

I've never seen anything like this. I think the reason why is there's a crisis in the way medical care is delivered in the United States, and I wanna emphasize, I don't think care providers are in any way, shape, or form responsible for it. I believe that medical reimbursements have changed the landscape and they've made it so physicians have to have a lot of ancillary providers that they supervise in order to bill.

For patients really. And so that's kind of the start of where I see problems. I see PAs and CMPs in positions where in the past I always saw doctors [00:08:00] that would be in urgent cares, emergency rooms, postoperative visits discharge after a big surgery. And they're not adept at catching some of the vital signs that are subtle, but there.

And they don't coordinate it with lab work that has suddenly changed in the last 24 hours. So I'm seeing a lot of errors that way. The other way is I think EMRs have significantly changed the way practice and care is driven. Again, not care providers fault, but you come into a post-op visit, you may only get paid for 15 minutes of that visit.

You've got an EMR that's gonna take a while. What do you do? A lot of physicians. Care providers are relying on template notes, and that is getting a lot of physicians in trouble because whether they wanna admit it or not, if they have a prefab note, let's say in an urgent care. Are they trying, are they striving to write down per pertinent negatives?

Of course they are, [00:09:00] but over time it starts to dilute a little bit and the visits are shorter. The exams are shorter, they're not as thorough 'cause the note's already done. I just want everyone to know I can catch how long you spent with a patient in an audit trail that has to be provided to me. So when you put it together with a template note, I've had a lot of success in cases just showing the doctors and care providers aren't spending the time, they're not listening, and a lot of the note was already put down before that visit happened.

And so those are the areas that, that I'm seeing that are leading to a lot of cases nowadays. Steve, one to a hundred. One to a hundred, what percentage does poor communication influence a lawsuit? I think it's a hundred percent. I think basically if you take two cases and they both have merit for the patient, let's say okay, there was clear malpractice and those cases are out there [00:10:00] and the doctor for patient number one or a sits down and does everything I described earlier.

And then two or B doesn't, I think it's a near a hundred percent certainty. The second scenario is gonna result in them at least seeking out a lawyer. And in the first one, I think the percentages in the first one would be on favor of the physician of that person. Never calling an attorney like me to look at the case.

So if you've kind of break down, you said you spent 24 hours as a p, or 24 years as a plaintiff's attorney are most cases then about bad outcomes or bad processes, or bad? Fill in the blank. It starts with a bad outcome because, you know, I want everyone to know, care providers to know the laws in Ohio are favored to the care providers.

There's so many hurdles and hoops that I have to get through and over to get a case, you know, even to the courthouse steps. [00:11:00] So it's not like, I'm gonna take a case where there isn't devastating damages. That's where I start. And then when I look into it, there are so many causes as to what led to a valid malpractice case.

I think first and foremost is just a poor communication before the procedure and after. I think secondarily where I'm seeing the effects that I described earlier. You know, I think medical reimbursements have made it difficult on you, and I'm seeing a very tired and exhausted care provider system, and so I see mistakes made in the OR that are negligence that I didn't see before.

I see communication issues between subspecialties in the postoperative period. In other words, who's ordering the anticoagulation? Who's gonna check to make sure that it was provided? Who's gonna give the instructions at the end on what the patient's supposed to do for follow up when there's several subspecialties in a certain [00:12:00] admission, I see breakdowns in communication and basically all getting on the same page for what we're doing for this patient.

The other thing I see is less qualified, less experienced, and less trained nurses. They are the eyes and ears for the physicians and the physician extenders, and I'm seeing individuals who aren't smart enough to put together like, Hey, why does this patient have a high respiratory rate? You know, why is that we're four days post-op.

She's 28 to 30, let's say in breast per minute. Why is that? Let's not just slough that off. Let's order an A, B, G, let's. Ask for the physician consult, let's take a chest x-ray, let's take a CT scan. They just kind of accept it and turn that alarm off and go on. And then about 48 hours later, the person's coding, you know?

So I would say those are the areas that I see with communication really being the jump off [00:13:00] point. So I'm gonna ask you in the back of your mind to be thinking about a couple of studies and case questions that we're gonna walk through that kind of is stuck in your mind. But, but before we get there, what makes a case then compelling to take on huge damages?

I, I'm very careful who I would represent. You know, you need patients that were compliant. You need patients that were taking care of themselves before they got to the physician. I rarely, if ever take a case where someone didn't follow up on test results. I mean, MyChart, it's all right there for you.

And the clinic, obviously, and other care providers can see, you know, if you went into check your results. The quality of the client along with damages is, is a significant factor for me. In addition, I look up the physician. Or the care provider, I make sure that they have good, good credentials that they were you know, [00:14:00] certified, that they carry that ex extra certification for that specific surgery.

If I see that they bounced around a lot, I know there may be issues with their employment status. And then, to be honest with you, I have to have two feet in the white on the medicine. Like the medicine absolutely has to make sense. There was negligence. I want to have literature that backs me up. I talk to experts that are qualified and at the top of their field, and if they tell me like, Hey Steve, I don't like to do this, but this doctor was clearly negligent and I'm surprised this happened.

All of that together makes a really tough case to defend for the care provider. Fantastic. And so let's jump into maybe a, a, a case study. And I wanna frame this with a little bit about lessons learned. And so do you have a case that you can walk our audience through and let's anonymize it? You don't have to say the institution, you don't have to say the patient.

You can leave all that out. But maybe, maybe it stuck with you or maybe [00:15:00] has some learning or teaching points for the audience. I do. I have several. One that stands out to me, the headnote in the case is that it was a 4-year-old boy. Who did not have strep throat diagnosed, he ended up becoming septic, going into septic shock, and unfortunately he had all four limbs amputated.

He also suffered brain damage from the significant hypotension that occurred due to the septic shock. The reason why this case stands out to me beyond, you know, how horrifying those damages are, is that when I first looked at the case. The urgent care note, it was done by an ED doctor. So you know, that's good for the defense.

But that was the case that really announced to me the dangerousness of templates that we talked about earlier. That note, although it had some issues when I was a defense lawyer, I could have used that note and defended the case and won 10 times outta 10. Like he was pretty good. [00:16:00] And I remember talking to one of my experts and he is like, Hey Steve, this is gonna be a tough one.

But you know, there were three things that he missed. So I was like, okay, let's, let's file the case and I'll start taking depositions. What I learned once I got the audit trail was shocking and completely changed the case. I was able to deduce that the kid came in, my, my client came in, saw the triage nurse, and then the triage nurse had a conversation with that physician, and then the audit trail showed me before ever seeing this child and before ever having any testing come back.

He had already selected him for discharge and he had already pulled up discharge instructions for a, a viral stomach bug that he believed to be going around. Then I was able to prove that he was with the patient for only a minute, which corroborated what my, my client father had told me that he came in, he didn't even ask him to take his shirt off.

He took no vitals. He just asked the dad [00:17:00] questions from a distance of about six feet, and he left. So then we move on to the template. In the deposition, I marked the template and I gave the defendant a highlighter and I went through the note, but I asked him to highlight anything that he lifted from the template.

And surprisingly, he began to admit to me that even stuff like in the exam section that he lifted it from the template and he did not do that portion in the exam. So at the close of that deposition, I amended the complaint and I added claims for alterations of records. Okay. Because it was an altered record.

He wrote things in there that he didn't do an exam for, and that changed the case completely. I put that case to the hospital pre-suit. I told 'em I thought it was a bad case and we should settle it. They rejected that, you know, opportunity. And after the depositions began, the case [00:18:00] got way worse for them.

Just before trial we did mediate the case and it was a very, very significant settlement. It was $15 million. But that was a case that will always stick with me because of the callousness of the care. And because if someone didn't look closely, they would've never known, you know, how this child was treated in that urgent care that day.

So Steve, we're gonna go a little bit into consent and communication documentation a little bit later, but let's, let's break down a couple of things you said there because I know this is on a lot of physician mind and caregivers minds in terms of the role of templated notes we're asked to do more and more with less and less, and now with the electronic medical record and you know.

There is, as you duly pointed out in that case some potential pitfalls there. And on providers out here, you, you know, God I, I forgot that I, I forgot to go back. It wasn't negligence or I to use a legal term. [00:19:00] Maybe it is negligence, but I didn't willfully document inaccurately. I just forgot to erase that part.

I know I didn't do a, a, a. Panning of the liver or a, an anal rectal exam or something like that. I just forgot to decrease that 'cause you used templated notes or you get somebody that's in through triage and they pull up a note for you and maybe templated to kind of allow you to see more patients in a smaller time period.

So to what degree do these templated notes, if you will, what does the medical records reveal or fail to review? Yeah, great question because people need to know that the technology is available for me to request. To the degree that I can see exactly what sections of the template note you were in. And as a defense lawyer, I've always believed, and I think it was true when I, when I was there as a defense lawyer, if, if a physician has put in the effort, announced a plan, followed through on that plan, and there's a bad outcome, I'm gonna win that case.

And so it's kind of true about template notes. I can get [00:20:00] information from the, from the hospital, like the clinic of where you touched inside the template. And so obviously if in the exam section, which is a pretty important section, I mean, you're saying This is the result of my exam laying hands on this patient.

If you're in there, it's just gonna show that you're in there. And I can't say that you didn't do your job in that particular portion of the template. It's the same thing with other portions of the template. Note, if I see a footprint of the care provider in that template note. It's gonna be really hard for me to say the use of templates was done in a way that affected the evaluation of the case.

So I wouldn't worry so much, Hey, I've gotta use these notes. 'cause you do. But I think you really do have to touch 'em and use them. Last point is a question you said at the end there. What if I put something in there and I forgot to do it? That's okay. I would prep you as your lawyer to just say, listen, I wanna say it in advance.[00:21:00]

I know I put X, Y, Z, but in retrospect I did not do that and it was an error on my part and I apologize for that. And people are gonna accept that. It's when people try to hide it and get caught, that's what's really kind of a verdict accelerant for a case like that. Let's dive a little deeper into this documentation in consent communication aspect to it.

We, we talked a little bit before, but can you talk a little bit about maybe some documentation pitfalls that surgeons or trainees fall into that you've seen through the years? Yeah, it's interesting. Every institution handles informed consent differently. I've seen the Cleveland Clinic evolve through cases I've handled as well.

You know, at one point it was written. At one point, the idea was, let's not do it at all. Let's just say in the note, you know, that I did it. And then there's kind of an enlargement into documents that would have I guess the typical risk factors. So I don't think there's any one [00:22:00] answer. I just think the key is to make sure that you do it okay.

'cause a lot of times I talk to my clients, I'll be like, Hey, here it says. Questions answered, risk complications discussed, alternatives offered, and they will be like, that is a flat out lie. At no time did anyone talk to me about these things, and so you really have to do it. I wouldn't delegate it unless you have to.

It can be quick, but you wanna make sure you go through everything. I think the easiest thing to do is say, is there any questions you have on anything I went over? And if they say no, you can just document in your note that you went through all risk complications, alternatives. I asked if they had any questions at the end and they said no.

And that is giving some, I guess, depth, depth to that conversation so that you know, it's tough for me to look at that record and be like, oh, this. Didn't happen and my client wasn't fully informed, [00:23:00] you know? So that's really the way you do it. And I think it's, it's, I wanna, I wanna add one other point.

In my 21 years of being a plaintiff's lawyer, I have only had one successful informed consent case. Okay? One, it is a very, very rare claim. It is hard to prove juries don't like it. I really wouldn't worry about it too much if you do the right things as a physician. So along those lines, what makes a consent insufficient.

There is case law that we could talk about that lays out elements for lawyers, but I'd like to stick to the medical aspect of what makes good informed consent. And basically it's that you do not disclose significant complications or other alternatives. And if you, I guess, would pull 10 of your colleagues and you said, Hey, with this surgery, what are the main [00:24:00] complications?

And there's five of them, and you only told your patient three of them, there's gonna be trouble because that's what the standard is. I've gotta provide an expert that says These are the complications and alternatives that are well known in the standard of care, and this doctor did not provide them.

Then I have to prove that if given those options, the patient would've either declined surgery or done one of the alternatives. Now, practically speaking. You can guess what my client's gonna say, you know, on that one. So it's not really in the doctor's control, but those are the things really that lead to an informed consent case, and that's why it's so rare to see a successful one.

Steve, you spoke a lot about the EMR earlier and what the EMR could track and the level of detail and timing and iterations of the EMR. Walk me through this scenario. I am a doctor out there and. You hear about a bad outcome and oh my [00:25:00] God, I've been meaning, I, I, I saw that patient. I didn't chart on it and I, I, I need to go back in now after the complication and get in that ENR and I'm gonna, and I'm gonna write something.

Not, not something false, I just forgot about it. Is it, is that a good idea? Is there a way that you can do that safely? Or is that something to be avoided altogether? 'cause it looks suspicious. It's a great question, and it comes up in cases a lot. I just had a surgical case in Kentucky that we settled, where after the individual died, this physician went back into her chart and made about 10 to 12 changes.

Now, he termed those changes, addendum notes, but there was a policy at the hospital that spelled out what an addendum note was, and he did not meet that policy. In addition, he made significant substantive changes to conversations that occurred between he and this patient. So when you put all that together, that's not what to do.

Okay? The timing of it's important, [00:26:00] but I think you have to be clear in your note. Okay? So let's say you saw a patient in the postoperative period. They left the office, but a bad event has not occurred. You wanna go back in the chart to addend a note. Fine to do that. The audit trail will show you did it.

I would make sure I wrote the addendum that I wrote, the date and time I was doing it, and you have to give the reason why you're doing it. Okay? And it should be an objective reason. I'm going back to addendum note because I recall a conversation I had with this patient and I neglected to put the following information in the note and then you go ahead and put it in the note.

You're completely fine if a bad event occurs. So after that postoperative visit, they go home and they drop dead. Okay, and then an autopsy's done and it ties the cause of death. To that visit, let's say, I would be very, very careful of just that night, logging on at home [00:27:00] and doing an addendum note. I would seek counsel.

I would follow their advice on what to do at that, at that timeframe, because that is, that kind of fact pattern is going to lead to suspicion and it could actually alter the success of the case from a defense standpoint if they start to paint you out as someone who went into a chart to cover themselves and change things.

Steve, let's go into a little bit about some realities of litigation. You know, we talk about a lot of different terms that are thrown out there and everything, but how often do you feel are there frivolous lawsuits? Very infrequently. And I think what happens I'm sure there's a lot of care providers who are gonna smirk, you know, are laughing at themselves right now.

But honestly, think about a couple things. There are so many laws that I have to meet, and that's fine. It's my job, it's my obligation that I have to meet before I can even file a case. The hurdles are immense, okay? [00:28:00] I have to then find an expert who's willing to testify, okay? And it's gotta be someone good, or the case is not gonna be worth anything.

That's just the first part of it. Once the case is in litigation, care providers should feel comfortable because every law, every evidence rule, just about every Supreme Court ruling in the last 10 years has all been in favor of the care providers and against, against patients. It is extremely difficult.

To get a successful settlement or verdict in a medical malpractice case, care providers should rest easy. Now, let me address the second thing, the frivolous cases. Why do you hear about 'em? Okay, you hear about 'em so much because they're rare, and so when you have a frivolous case and it results in a crazy outcome, or it puts a doctor through the ringer for no reason, that is newsworthy.

It's put [00:29:00] out in the media and it spreads around social media and everyone is rightfully upset by it. But please understand that's less than 1% of the cases that that I've seen over the years. So you've been on both sides of it. And a defense lawyer. You've been a plaintiff's attorney. Can you talk just very briefly about kind of, if you will, the length emotional t control on this legal process for the doctors that you've represented or actually gone against as well as the patients that you represent?

Well, because of my audience, I'm gonna talk really mainly about the care providers and it is a very, very difficult thing to go through. I've been sued in my, in my legal practice. None of them resulted in anything, but the point is I know how they feel. And then when I defended them, I always got close to my clients if they would let me.

And I, I would see the pain on their faces and hear it in their voices, and I would understand that. I think the [00:30:00] important thing to do though is to realize that unfortunately this is our legal system and these things happen. What you need to do at that point is to get a trusted lawyer, someone that you like, someone who's experienced, and you need to trust them to do the right things for you.

You need to follow their advice. You need to reach out when appropriate, but not to a point where you're driving your lawyer crazy. You know? That can make them not really want to defend you. And then I think you gotta be prepared. Listen to their advice and let the process play out. I know it's hard. When you have a case and the defense lawyer reaches out to you, because let's say for example, you need your deposition taken, you're gonna spend the next few weeks intensively getting ready for that, then you're gonna do the deposition, and hopefully you're gonna do a great job after that.

You won't be needed for quite a while as the lawyer goes off to take other depositions and get into experts as best you possibly can. And I [00:31:00] know this isn't easy, you need to push that legal case outta your mind. Because what I've seen is doctors and other care providers obsess over it, and they drive themselves crazy, their family crazy.

The defense lawyer's crazy, and that ends up affecting their decision making when it's, Hey, should we settle this case or try this case? You know, they've exhausted themselves and everyone around them, and so I would really try to avoid that and just follow the advice and live in the present every day.

If that day doesn't include something on the case, push it outta your mind as best you can. Stevie, you mentioned a couple terms there. I'm just curious, do you have an overall general aspect into how often do you see cases settled versus going to court? Yeah, I think the large majority of cases that are with lawyers who exclusively do medical malpractice settle, and that is because we are mindful of all of the [00:32:00] defenses.

All the laws that are kind of stacked against the patient. We've seen things play out and how certain fact patterns play out, and so that causes us to be really, really careful about our case selection. And so generally speaking, if I'm going into trial, you know me, Steve Creel gonna trial. It's one of two reasons, okay?

One is there's a couple defendants and they're blaming each other and they can't agree on what percentage of fault that they have. Those are obviously great cases for me to try, and I have a blast with 'em. They never end well for the care provider. Okay? The second reason why I find myself going into trial is not good for me.

That means I selected a bad case and throughout the case, you know, maybe I selected a good case and it went bad and I didn't adjust. Now I'm two years into a case and maybe $200,000 into a case. And I got a client who understandably isn't gonna tolerate me [00:33:00] saying, you know, I think we're gonna lose this case.

I think we should dismiss it. You know, I try to do that. I try to talk them into it, but I can't abandon them, especially if the case is now beyond a time that I could dismiss it and refile it for them and get another lawyer. So in those instances, I mean, it happened few and far between, but I go into court and.

I certainly have a meritorious case. I have an expert behind me and I have a chance, but I'm probably gonna lose. And, and those are unfortunate cases to be a part of. So Steve, what do you say to the docs out there that basically they're maybe work in a hospital system and they think their care was outstanding and they're sued and maybe the defense attorney comes and says we need to settle.

What advice can you give to them? Let's take this with a physician who is outside the Cleveland Clinic Foundation at a traditional hospital. Maybe they're traditional in the sense that it's not a clinic-based practice like you guys have. Hospitals are still buying up [00:34:00] physician groups and so forth, but each individual physician has their own separate insurance policy.

Okay? So the hospital has one and the doctor has one. One of the safeguards for the physicians, if they believe strongly. The defensibility of their case is they have usually a consent provision. And so that means the insurance company is not allowed to settle the case regardless of what the defense lawyer says if they don't give consent to settle.

So in those situations, you can say, I don't wanna settle, but you gotta be careful because let's say you have a million dollar policy to protect yourself. What the insurance company's gonna do is say they're gonna send you a letter that says. Dear Dr. So-and-so, we've told you to settle. You do not want to consent to that settlement as a, as a reality.

Now, we're going to try this case, but if you are hit for a verdict in excess of the million dollars that is on your own, [00:35:00] that's gonna come outta your personal assets, and that's a significant factor for physicians if they have assets and they don't have a lot of coverage. So they, they, they really gotta think this through and, you know, potentially may want to listen to the advice of their defense lawyer.

Steve, as we wrap up here, there's a couple of things that I, I wanna kind of touch base on and curious as to your thoughts. So how, how do we work better together both sides of the house. What, what's, what's, you know, you mentioned a few of them, but what's the thing that surgeons can do if you day will to reduce their risk and maybe even the hospital system?

How do we go about this going forward? I feel really bad for care providers. I honestly do. You guys are getting squeezed at every angle. I don't know if anything's gonna change for everybody inside a hospital until, and unless, I guess as a group, would it be [00:36:00] care providers, physicians, hospitals get together to impress upon our government to make changes to how insurance reimbursement is.

You guys need to be the decision makers inside a hospital. If you think a patient needs X, Y, and Z, you they need it. I mean, you're not doing it for your own health, you're doing it for theirs. So until this gets changed around again to where you guys are leading the care, which you should be I don't know if there's much we can do to change.

I will say from my vantage point as a plaintiff's lawyer, one of the frustrating things and, and one of the other things I don't quite understand. Let's say I see a series of cases in spinal surgeries, let's say. Okay. And I was, I was seeing, you know, there's this acronym X-L-F-X-L-I-F. Okay. Extreme lateral inner body fusion.

And they're relatively new, but they're the placement of cages in between vertebrae to accomplish [00:37:00] decompression and also fusion. These. Surgeries are good for some people, but a whole host of surgeons was overselling them essentially. They, they would get a lot of money from 'em, and so they would do those instead of just a routine, you know, laminectomy or, or decompression.

I used that to explain, so I started getting in tons of cases and I started getting big settlements, and I started getting big verdicts on these cases. Okay. That should have changed the industry. The industry shouldn't say, oh, I hate Steve Crandall. Look at these lawyers preying on me. That should have led them to make a change, not only to avoid lawsuits, but to provide better care for patients.

And so I think there has to be an honest self-awareness and more importantly setting up some things to do to change medical care. So there aren't these bad [00:38:00] outcomes, and so there aren't these lawsuits. In many respects, it's not the lawyer's fault, we're just doing our jobs. I think it's the medical system's failure to turn into the issue and figure out a better way to do it.

They're an upside or a downside to a lot of physicians out there will get asked to be a plaintiff's expert or a defense expert. Any, any thoughts about that? Is that, is that something, is it just a money grab or are they looked at a different way or what are your thoughts about that? Yeah. I'm so glad you asked me this question because I have had a tremendous experience with experts over my 30 years, and I want everyone to understand something.

It is an incredibly unique position as an expert witness because you get to learn for yourself, both medically and from a legal risk standpoint. Doesn't matter if you're the plaintiff's expert or defense. You can see what happened in that case. Learn from it and you get paid very [00:39:00] lucratively for it.

I've had many experts that I've kept for 30 years. You know, started out when I was a defense lawyer, they became expert for, for me, when I was a plaintiff's lawyer. And they have made a tremendous amount of income being expert witnesses. Now they bill fairly, they call 'em fairly, you know, you gotta call balls and strikes.

You don't wanna extend yourself with an opinion, but I think it is amazing way to learn, make money, and I think better your practice. So I would encourage everyone to do it. So where can listeners learn more about risk management, legal resources, communication, training, anything like that? I mean, I certainly have a lot on my website to inform patients.

You know, the content we put on there isn't just. It's designed to capture cases and have people call us. I have an entire pregnancy and birth section that is helping first time moms navigate pregnancy. It has nothing to do with [00:40:00] lawsuits. So I do have things like that on my site. Other firms do, I'm sure there's other resources.

But I think that has to come from inside the hospital, from management care providers honestly asking like, Hey, why did this happen? How can we improve on it? Not, you know, darn it all, they filed a suit against us. Like what are we gonna do now? You know? I think that's the wrong way to react. And so, last question.

What is your advice? To next steps when you're a provider and you get that envelope that says that you were just named or even possibly named in a lawsuit, and then maybe even upstream from that, if you have an untoward outcome and you're like, whoa, this could be bad. What? What should they do? As we discussed earlier with the untoward outcome, you got, you've gotta get involved.

I cannot tell you how many times I see a bad [00:41:00] outcome. Forget whether there's negligence or not, and there's an avoidance of it okay. By that surgeon. And I know, I guess psychologically why that happens sometimes we wanna literally sweep things under the rug, but that's, that's the worst thing you can do.

You know, beyond that, if you get something in the mail that you were served with. Legally, you have to immediately report it. Do not delay, because if you delay, they can actually deny your insurance coverage. So you wanna reach out to your administrator if you have a lawyer that you know your insurance company, and let them know, and then demand that you get that lawyer out to your location within, I think 30 to 45 days is reasonable so you can have that initial meeting to discuss the facts of the case.

Give that lawyer your impressions on how to defend the case. I think those are the initial important steps for care providers. Well take it home for [00:42:00] us. Give us what are your, what are your final thoughts or key insights, wrap it up for us about this entire thought process between facing a lawsuit.

Absolutely. I, I will tell you something I heard one time. When I was in a meeting and I was a defense lawyer, okay? And it was a peer review meeting where doctors from that subspecialty were looking at the case and they said, you know, I'm sorry you, you were negligent. And this physician couldn't accept that.

And he came back for an appeal and they talked it through and explained to him again why he was negligent in the case. And I remember a physician, a very wise physician, saying to this other physician, it's tough to be human. And it is, we do things and sometimes, unfortunately, we're negligent in how we do them.

That has ramifications for me. It's always better to just take responsibility for it. If you have defenses, let's say, [00:43:00] on proximate cause or damages, make those. But I think it's better to step forward and be like, listen. You know, I was negligent in this case. Let's admit liability, but let's fight on proximate cause or damages, which you still can.

The other thing I'll leave us with, please don't ever take one case where you are negligent and, and really what it comes down to is paying money and don't let that ruin your career. How do you do that? You go back in the medical records and you alter things or you throw things away, or you go in and write.

A note that you shouldn't write. Those could be career changing actions by you. And I know in the heat of the moment when you get it, you're upset and emotions are running high. And maybe there are things going on in your day that make you short-tempered, but stop yourself and don't do those things that make the case 10 times worse and may make you unemployable in the future.

So those were, [00:44:00] those were probably my top bits of advice for care providers. Steve, on behalf of all of the listeners at BTK, just wanted to thank you. It what a fascinating exploration into this and something that is, you know, as I, as I as said in the opening, it's something that we don't haul a lot here about.

Thank you very much. I appreciate it. One parting thing I wanna say, I've had many, many clients who are physicians, so if there's any physicians out there. They've been, you know, they've had negligence occur to them. I specialize in representing physicians and would be glad to consult with anybody.

Thank you for walking us through it, and on behalf of all the listeners out there, dominate the day.