The Doctor’s Advocate | Second Quarter 2013
Texas Physician Advisory Board Update
The Doctors Company’s Texas Physician Advisory Board recently convened in Dallas. Board members represented a diverse group of physician specialties, including anesthesiology, cardiology, family practice, gastroenterology, hospitalist, internal medicine, neurology, pediatrics, and psychiatry. Two local defense attorneys and representatives from The Doctors Company also participated.
The meeting began with review of two cases and a discussion of the important lessons to be learned from them.
The first case involved a patient who suffered a traumatic perineal injury. Following examination and outpatient treatment, the patient was evaluated at a local emergency room and discharged. Subsequent surgical consultation revealed Fournier’s gangrene. The discussion focused on recognizing the potential for significant traumatic injury and the need for early surgical referral or consultation.
The second case involved a patient whose routine annual lab work revealed persistent transaminase elevation. Although the patient’s physician attributed the elevation to alcohol consumption, the physician neither documented the consumption nor advised the patient to limit alcohol intake. The patient was ultimately diagnosed with hemochromatosis complicated by cirrhosis and metastatic hepatocellular carcinoma. Board members discussed the need for proactive communication and detailed documentation—particularly when test results for longtime patients show a consistent pattern of change over time.
Litigation Process Overview
Following the case discussions, defense counsel led an interactive presentation on the litigation process. Counsel’s perspective was helpful to all board members, especially those who have never experienced a claim. The presentation began with advice on what to do if a claim or lawsuit is filed against you: notify The Doctors Company immediately, do not discuss the claim with other parties, and do not conduct your own investigation.
The presentation also included information about the investigation process: working with a claims specialist, developing defense strategies, and planning effective expert reviews. The discussion continued with an overview of the litigation process—from receipt of the complaint through deposition and discovery to trial and appeal. The presentation concluded with mock depositions featuring some of the board members acting as defendants. The exercise gave everyone an opportunity to experience the challenges of defending a malpractice claim and showed how to get the best possible outcome from a deposition.
Howard Marcus, MD, FACP, is a general internist in Austin and chairman of The Doctors Company’s Texas Physician Advisory Board. Dr. Marcus also chairs the Texas Alliance for Patient Access (TAPA), a consortium of healthcare institutions and stakeholders that includes The Doctors Company as a founding member. TAPA has worked with the Texas legislature and governor to create and maintain the landmark tort reform legislation since 2003.