Stories Behind the Statistics

Given the testing that she had undergone required the use of a contrast dye that can temporarily exacerbate creatinine levels, it was recommended that she be discharged for a few weeks in order to allow her creatinine levels to recover. Against the insured's recommendation, she booked her surgery sooner than recommended. However, after seeing multiple consultants, she was hemodynamically optimized before undergoing cardiac surgery. The surgery was successful. However, post-operatively, the patient experienced a mild stroke and developed renal failure, a known complication of this surgery, given her pre-existing condition. Thereafter, the patient required dialysis treatment until her death a few years later.

Allegation: Initially, the plaintiff (patient's husband) alleged that our insured was negligent for allowing his wife to undergo two high-load radiographic dye studies in light of her renal condition. However, the focus of his claim then shifted, eventually alleging the insured was negligent for failing to obtain a pre-operative nephrology consultation and failing to properly evaluate and treat pre-operative anemia. The case was filed both as a medical malpractice survivor action as well as a wrongful death action.

Argument: In court, the plaintiff's experts were not particularly impressive and rather boastful. After multiple continuances, the case was tried once to a hung jury (four votes for defense and two for the plaintiff). After multiple attempts at a second trial, something unexpected occurred. The plaintiff's daughter (along with other family members) came forward with information against her father that, in more than ten years of discovery in this case, had never surfaced. The new evidence strongly contradicted his prior testimony. The dishonesty and sensationalism of the contradiction resulted in the case being dismissed by the court.

Result: MedPro incurred more than $360,000 in fees and expenses defending our insured in this case. The claim was, indeed, unusual since the testimony that would directly lead to the plaintiff's dishonesty (and ultimate dismissal of the claim) did not become apparent until the second trial. However, because of MedPro's persistence, patience and willingness to go great lengths to clear our insured – as well as the defense team's persuasiveness and dogged determination to seek all appropriate evidence – the insured's reputation was protected and the case dismissed.

With MedPro, our financial stability and longevity give us the ability to spend the money required to protect your future with a defense verdict or a dismissal. We don't take the easy way out to reduce costs. The attorneys we retain for our insureds have the experience, resources and marching orders to leave no stone unturned. You can be certain that MedPro is prepared for any claim you may experience.

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The following morning, an exploratory laparotomy was performed. Our insured CRNA induced the patient according to normal protocol. The patient, however, immediately began vomiting and aspirating gastric contents. The CRNA suctioned the contents and summoned an on-call anesthesiologist for help. The patient was then stabilized, and surgery moved forward. A small bowel obstruction caused by an internal hernia was located and repaired.

The patient sustained a hypoxic ischemic brain injury after the induction procedure. As a result, she developed Adult Respiratory Distress Syndrome and acute renal failure. After further treatment, she developed a sudden cardiopulmonary arrest and died shortly thereafter. Both the anesthesiologist and the employed CRNA were sued.

Allegation: The plaintiff claimed the anesthesiology team should have placed a nasogastric (NG) tube into the patient's stomach prior to induction to reduce the probability of vomiting, which ultimately led to her death.

Argument: Following the plaintiff's logic could involve significant risk including rupturing the staples from the gastric bypass, leading to catastrophic complications. In addition, there was a standing order at this hospital that NG tubes not be employed in this type of gastric case. During trial, MedPro's eminently-qualified defense experts opined that the insureds were, in fact, in no way at fault in their standard of care and that the proper protocol had been observed.

Result: The anesthesiologist was cleared by the jury. However, a surprise verdict found the CRNA negligent and liable for $1,150,000 in damages. Making matters worse, this verdict exceeded the MedPro coverage for the CRNA. The claimant's untimely death had left several children to the care of their grandmother, a sad story for a jury to consider. However, MedPro stood behind the CRNA and fought the verdict, citing many errors in the presentation of information to the jury. Amazingly, no expert had ever stated that the CRNA had not delivered the proper standard of care.

Not only was the judgment against the CRNA reversed by the state Supreme Court, the Court actually found the plaintiff's evidence so lacking that—rather than send the case back for a new trial—judgment was entered in favor of the CRNA, thus ending the case. Besides the lack of expert evidence demonstrating a breach in the standard of care, the jury instructions were, likewise, so prejudicial that the Court felt compelled to set the judgment aside.

MedPro's expertise, in partnership with battle-tested defense counsel, allowed us to appeal the verdict in an effective way and to stand by the insured even though the financial exposure was high. The defense team diligently broke down the plaintiff's case and concisely identified errors in the trial, all of which resulted in allowing the CRNA to continue his profession with confidence and peace of mind.

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MedPro's insured was the anesthesiologist who attended the C-section. MedPro also insured the anesthesia group for which the doctor worked. The surgery was uneventful and resulted in the delivery of a 2 lb, 2 oz. baby. However, upon closing the surgical incision, the patient began to complain to her obstetrician of difficulty breathing. Her blood pressure and pulse dropped sharply; a code was called.

The anesthesiologist began to administer oxygen, and CPR was performed. Furthermore, medications were administered, and the patient was intubated. The claimant was resuscitated; however, she did sustain an anoxic brain injury. After the episode, she spent three weeks in the hospital and then five weeks in a specialty center where she made significant progress in spite of long-term effects that the injury would have on her daily life (i.e. disorientation, mild verbal and written language impairment, episodes of incontinence and ambulation issues).

Allegation: The plaintiff alleged the insured failed to discover the patient's history of asthma and that, as a result, she was not intubated in a timely manner. The plaintiff argued this knowledge would have led to administering anti-bronchospastic agents and calling for additional help more quickly. Complicating the case further, the infant died days after the event. The verdict ranges were estimated to reach $5,000,000 since the quality of life was significantly diminished for the patient. Both the group and the doctor were named as defendants.

Argument: MedPro's defense was that the claimant had an amniotic fluid embolism (AFE), which is an exceedingly rare event. Even with impressive testimony from the insured, our team was able to bring two pieces of evidence to the forefront—things that made an influential impact on the jury. For one, the husband checked 'no' for asthma on the pre-anesthesia evaluation. Further, the insured did not think the patient had an asthma attack. Evidence indicated no wheezing and that she did not respond favorably to the use of Albuterol.

Second, multiple credible anesthesiology experts were highly supportive that the standard of care was met. Most importantly, however, was that one of our experts was someone with specialized experience in AFEs. He supported the insured's case that the claimant did, indeed, experience an AFE, which directly resulted in his inability to restore her breathing function sooner.

Result: These key points were hammered home to the jury by a highly reputed, 35-plus year experienced medmal defense attorney, who thoroughly and diligently prepped the insured and our experts so their testimony during trial was viewed by the jury as extremely convincing. It was so effective, in fact, that the jury required less than an hour to find for the insured.

MedPro's strong defense team and presentation of key witnesses, one with extensive experience relevant to this rare situation, led to a verdict for the defense. MedPro knows there is nothing like having access to the right people at the right time. Our insureds can be confident that we have the best resources available, and that we work tirelessly to locate additional experts to address the unexpected cases evolving from a changing healthcare industry.

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Nearly ten years passed until our insureds–an anesthesiologist and dentist–entered the picture. The patient had developed severe dental caries and severe pain from tooth decay and poor oral hygiene. He was referred to our insured dentist. The patient's mother implored him to help.

After extensive research and discussions with medical professors about the extreme complexity of this case, the dentist proposed a surgical procedure under general anesthesia, for which the patient obtained medical clearance from his internist and neurosurgeon.

It is critical to note here that other doctors refused to get involved with this ‘higher risk' surgery. Our insureds contacted us to inquire about proceeding with this special case. We confirmed their coverage based on: (1) the amount of research that was conducted to make sure the surgery was safe, and (2) all parties involved were on board with every aspect of the procedure. The due diligence had been completed; they had asked the proper and mindful questions about techniques and medications. All they wanted to do was give this young man a proper quality of life, which he did not have in his current state.

On the day of the procedure, the dentist performed multiple dental repairs to more than 20 teeth during a nearly five-hour procedure with general anesthesia performed by our insured anesthesiologist. The surgery was uneventful.

Postoperatively, the patient remained lethargic and unresponsive. After admission to the hospital he developed severe hypertension, rhabdomyolosis and metabolic problems. Five days later, a CT scan revealed multiple small areas of hemorrhage in his brain consistent with infarcts (likely caused by his severe hypertension). He never regained responsiveness and is now in a persistent vegetative state.

Allegation: The plaintiff's theory of liability was that the defendants failed (1) to properly prepare for this surgery, (2) conducted too long of a surgery, (3) failed to recognize and treat the patient's hypertension and tachycardia, (4) failed to recognize and initiate treatment for malignant hyperthermia or neuroleptic malignant syndrome and (5) improperly stopped the patient's Levodopa abruptly and failed to restart it timely. Boiled down, the plaintiff's case was that the anesthesia itself or the Levodopa withdrawal, or both, led to further brain damage that left the patient in the persistent vegetative state.

Argument: During trial it was determined that both the dentist and anesthesiologist met the standard of care. The patient's injuries were caused by his progressive neurological disease and the stress of surgery. It was proven that the surgery was necessary due to his dental condition. Without it, he would have developed sepsis and died. Another key point in court was that, even if the patient's final condition was caused by failure to treat post-operative high blood pressure or mitochondrial disease, the insured anesthesiologist was not notified of the problem by the hospital staff. Finally, experts for the plaintiff were not credible.

Result: The defense team had to deal with both the dental and anesthesia sides of this case, and the exposure in this case was considerable (potentially $10 million). MedPro had two highly skilled and experienced law firms collaboratively working on the collective defense. MedPro even went one step further. We hired two additional trial specialists in the region to assist an already outstanding trial team. We wanted to make sure that we were prepared to handle the witnesses and proactively deal with any challenges.

The litigation costs ($625,000) were secondary to getting a defense verdict for two insureds who had a lot to lose, including their reputations and personal assets. Having more experience in this region than any other carrier allowed MedPro to assemble the best defense team possible. Furthermore, our financial strength allowed our claims and defense teams to persevere. Equally important is that MedPro's experience put the insureds in a position of confidence, which is critical on the witness stand. All these attributes laid a foundation for an excellent presentation at trial, one that was instrumental in this outcome.

When we can defend healthcare providers with such a high level of compassion for patients, it makes all of the hard work even more meaningful.

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A year before his death, the patient was admitted to a hospital for pneumonia. The insured examined the patient and located a pulmonary nodule in the mid-lung, visible on X-rays. CT and PET scans further confirmed the lesion. The doctor saw the patient again a month later. The natural next step – obtaining a biopsy – could not be performed due to the location of the lesion and the extent of the patient's bullous disease. Based on symptoms, the patient's severe medical complications and social history, the doctor diagnosed malignancy.

The insured performed an upper lung lobectomy. Pathological analysis found no cancer but revealed a mass-calcified cavitary lesion. The plaintiff died of post-operative complications.

Allegation: The patient's wife alleged that the insured was negligent in failing to appropriately diagnose and treat her husband, citing the incorrect preoperative and postoperative diagnoses that led to an unnecessary surgery, which ultimately led to his death. She further alleged that the insured should have obtained results from a peri-operative biopsy and ordered discontinuance of the patient's use of Plavix prior to surgery. The plaintiff also felt that other post-operative results – including hemorrhage, severe dehydration, acute pneumonia and sepsis – all led directly to the outcome. The plaintiff alleged that these results could have been prevented by an appropriate front-end diagnosis.

Argument: This case was tried once, resulting in a hung jury. This is where MedPro's experience and persistence came into play. When a reasonable settlement could not be reached, the case was tried a second time to a defense verdict using the information gleaned from the first trial. The defense repeatedly emphasized (through six highly trained experts and other testimony) that the patient had such severe medical issues that the standard of care was not breached. Moreover, the experts emphasized that the diagnostic results were in line with the diagnosis of malignancy and that a biopsy was not an option based on the risk involved with that procedure. They also testified that, ultimately, the patient's demise was a result of being a long-term smoker and the advanced stages of his many maladies.

Result: This case illustrates the exceptional skill of MedPro's defense teams. First, the experienced claims staff and counsel were able to leverage the information gained from the first trial into a changed strategy for the second trial that resulted in a defense verdict. Second, as part of that strategy, the defense recommended that the trial be moved to a different courthouse location in the same jurisdiction. After trial, the defense team felt this strategy influenced the jury selection to yield the positive result.

This case shows how MedPro's strategy of long-term persistence pays off for our insureds. When it comes to your professional future, you can rest assured that we make deliberate and mindful decisions that have a significant effect on trial outcomes.

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The pediatrician — our insured — carefully examined the child and concluded that she had severe infections in both ears. The insured prescribed an oral antibiotic and Tylenol. During the examination, the pediatrician indicated the child was alert and in no way lethargic, and the doctor cancelled surgery, in lieu of her recommended treatment. She asked the mother to bring the child back if she did not improve.

Overnight, the child was cranky and slept poorly; her temperature had not improved dramatically, all while still vomiting and remaining "very lethargic." The following day, the mother took the child back to the insured. The pediatrician examined her again, and explained that the prescribed treatment should continue, along with a focus on hydration. The pediatrician noted that the child was, again, alert and demonstrated no other symptomology.

The following day, the child had improved dramatically. Her temperature decreased significantly, she had more strength and ate without incident. In fact, the mother was so encouraged by the improvement that she went to work that day, leaving the child in someone else's care.

The child did well until the afternoon when her fever acutely spiked, and the caregiver had difficulty waking her up. The mother immediately came home to find the child physically limp and difficult to arouse from sleep. She cared for the child the rest of the day. Upon returning from a trip, her husband grew concerned and insisted they call the doctor. They were instructed to go to a local children's hospital.

Upon arrival at the emergency room, the emergency physician saw a completely different child than the one who had presented to the insured on two occasions. This was a child who was completely unarousable, had a highly elevated temperature and looked quite toxic. As a result, a lumbar puncture was performed, revealing a very rare, virulent antibiotic-resistant bacterial meningitis. The patient was given intravenous antibiotics and remained hospitalized for more than a month. She suffered from hydrocephalous, resulting in a lifelong shunt to drain the fluid down into her abdomen.

Allegation: The parents argued the pediatrician did not place adequate urgency on the child's condition and symptoms, and that this negligence led to a life of diminished capacity.

Argument: This case was tried twice with two appeals. At both trials, the insured denied the mother informed her that the patient was "very lethargic" and that the patient was having a hard time sleeping on her back.

All doctors who testified at trial indicated the patient had survived the meningitis against all odds and did not develop any cognitive impairment or physical impairment but had only sustained the need for the shunt. In fact, later in life, she was clearly a very capable adult who was leading a rich life and overachieving in her educational pursuits.

The trial was most contentious and aggressive toward the defendant. It was a stressful environment, particularly for the insured. However, our defense attorney was so clearly committed to the case that he spent considerable time throughout this ordeal with the insured and her husband, calming nerves and reassuring them both.

Result: MedPro dedicated 20 years to this case! The defense team spent inordinate amounts of time and effort with the insured and her family to stand behind her because they knew she was not negligent. The case took two trips to the Court of Appeals and one trip to the state Supreme Court. Both juries returned 8-0 verdicts for the defense in less than two hours. The stellar defense team helped the doctor navigate all of the trial pitfalls because they knew she was a good doctor who did nothing wrong.

The doctor was not interested in settling. MedPro agreed. Because of our strong financial position, MedPro spent over $485,000 in attorney fees and expenses so our doctor could secure two defense verdicts.

MedPro doesn't just do its job; it does the right thing with unwavering passion and perseverance. Extraordinary loyalty is doing what we must to appropriately, completely and skillfully defend physicians.

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