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Surviving a malpractice suit
SURVIVING A MALPRACTICE SUIT Personal Experience and General Information
Ch:‘.stine Kuhlman,
CNM,
MPH
ABSTRACT Few CNMs to date have been sued and fewer yet have been through the !i-auma of a malpractice SW The fokaving article Is a syno,,sis of the malpractice piocess from sunrnons through trial. lnterspewd throughout are ,monal recollecttons and rerpanres of one CNM who endured a two-week hial.
I WQS awakened on a Saturday morning in 1985 at 9:00 A.M. bv a telephone call from a man idektifying himself as a syndicated reporter. He wanted to ask me how I felt abol’+ that morning’s headline in my state’s largest paper regarding my being named in a lawsuit with a local physician for $4.8 million. I didn’t know what to say since it was mv first information that I was beins sued! It was later that week that Irewived a surnrnons from a sheriff, formally notifying me of the lawsuit. This article will track the malpractice process from surmnons through trial and personal experiences will be interspersed throughout. SUMMONS AND COMPLAIM The sutnmons is notification from a courtthat you are sued, and the complaint contains the ailegations agaimt you It may also contain the dollar amount the daintiff would like to collect, but in’eome states, now including my own, this is not an allowable procedure. At the time, however, in my case the plaintiff was claiming $4.8 million in damages.
betrig
The amount claimed is generally srosslv inflated. Few juries would award the amount asked for, although in a few cases, they have awardedgreater amounts than asked for by the plaintiffs attorney. After being notified of a summons, do not discuss the case with colleagues or codefendants. The need for support is great, but you should not relate swcifics of the case. Later. you will beasked if you have spoken with anyone about your case; those you have spoken with may also be deposed. Immediately after receiving the s”nlmo”s, notify your insurance carder about its contents. They will appoint a defense attorney for you enough the imoortance of your involvern&t with &or attorney. It’s your job to educate the attor& to the &dtcal information necessary for hlm or her to understand the case and adequately defend you. This may mean many hours of chart reviews, reviewing of licensing requirements, nati&l standards, hospital or birlh center protocols and privileges, literature review of SimXar cases and sftcations. the beet texts, journals, and articler. e:c. Early on, it is advisableto ask your
cannot stress
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attorney his or her professional record and knowledge of medical malpractice cases. If ihe attorney’s remrd is too new for your comfort or too many of his cases have won plaintlff’s verdicts, it is certainly within your rights to ask the insurance carder for another attorney. I was never quite happy with my attorney but didn’t know at the time that I could do this. Most defense attorneys already have a gad worktng knowledge af the field but need specifics and details necessary to defend your specific case. It is important to suggzst some gocd expert WitnesseP These lndlvtduals don’t need to be nationally known, but can be lwally or regionally recognized es gad rxectitioners. Sometimes a juy will deal better with a local expert. someone closer to home. someone they might go to themselves, than with a national figure who may or may not even practice. It is generally not a good idea to suggest a “Mend” or a a backup CNM or MD in the cornmunity. A jury may we this individual as too potentially biased in vow favor. If the dollar amount for which you are beins sued exceeds the limits of
ties provide $1 million per suit), you
the case. It includes interrogatories.
first
may want
which
mental
to hire e prtvate lawyer.
are a series of v&ten
qua-
child
wee showing
marked
deficiency et that time. He
He or she will be working exclusively
tions composed, in the defendant’s
had not been ew-&e of thtt and prepared
ic your interest and not aleo for the
case, by the plaintiffs
interest of the irnumnce carrier. Your
vice versa;
personal
orel answers
ptimay
COUnS4or
wiii notiFs
defense attorney
insurance
ranter
your
and your
that, if the case is
Iwyer
depositions. to further
the opposition’s
and
which
are
westions
of
lawyer:
and docu-
questions
ihroughout
regarding
the discovery
this
process
end et the &al. I felt it was one of the significant
issues
in my defenre-
ment oroducnon and validation. The
there wes no lack of bust shown with
lost for greater than your cowrage,
defenbant must respond to the inter-
the second pregnancy.
then
be
rogatories in uniting within a time pe-
was advised to
riod of usually 30 days After the an-
quertion
swers have been compwzd.
have no wrsonal
the insurance
I certainly
held liable.
carter
will
do this in my case. It is vey calm
important
when
5”lnroO”S.
first
to by to stay notified
of
a
k’s easy to get angry or
you will
swear to their accuracy in the presence of a notay rogetory
public. The
is an attempt
inter-
to disclose
hostile, to have self-doubts regarding
more of the facts, relevant mateliats,
your care and knowledge,
and potential
or to wony
staff members, will
think
to panic.
what other colleagues, friends,
of you.
and family
Remember,
a
witnesses.
which
can
It is also .pamtssible with
I had before attending the plaintiff’s labor. It was nine years after the fact that the case was first
complaint
ledion but oko stated what the call
The
interrogatory
usually
star&
system was nine years before to !$Je
does not mea” you were
with questions regarding age. educa-
them
at fault
in
tion.
sleep pattern
anv WV.
Most suits are brousht
to
gresses
and work into
history,
the actual
and proallegation.
an idea of how might
The
femilu or individual
taken lightly. Answers even this early
most situations,
in the dtscovey
to the discovey
aged &ild,
es was the situation in my
interrogatory
should
not
be
process can be used
at the deposition
and trial.
Don’t
regular
can take
the place of oml d-tins,
but, in
bath are necessey process
for both
sides.
speculate in aonuering any question. You should have a copy of the patient’s full chart (clinic and hospital as
DwosmoN
needed, newborn chart as applicable
Thts
assistance in caring for their reterded
to the ceee. etc.) to work from. Ide-
i5 usualiy taken in the attorney’s
daughter and saw malpra6ice
ally, these charts should th the or&-
Xce in the presence
in&.
court
ablv didn’t
have anv ill will toward
me-but were d%per&
for financial litiga-
tion as a means to an end. To day. three years after my biel,
this
I still
my
have been. In
some cases. interrogatoties
re;over~money sufftcient to aid the
case. I was told from the stat not to t& il personally. The family prob-
I ob-
and stated I had no personal recol-
or necessarily
in carins for the
filed.
viously bed no wey Qf remembering.
shed light on the allegations iz the
negligent
outcome, e.g., a b&n-dam-
that you
recoUection. I was
asked, for instance. how much sleep
suounons
adwse
to answer a
a statement
You have sufficient time to re-
search articles that till
initially
assist
is oral testanony
asked
stenographer. questions
under oath. It of-
of a licensed You
will
be
by the plaintiff’s
you and will also be useful throaghout your defense, If they are com-
lawpr US& yw!wyer present Depositions are taken of all the expert
cent pawns in n system that some-
pleted, you may also be able to wad
,vitoesses for both sides and any CD
how has gone awry.
the
h&e trouble accepting this explenaSon. It’s too easy to feel we ere inno-
is the process
by which
both sides learn the complete facts of
Chris Kuhlmw has bsen o nursemidwile in ~riuote pmctke since 1976 In Con&d &pit4 Concord, New Hampshire and in on ou!.o/-hospital birth center. She holds an M.P.H. from John Hopkins School ojHyg!ene and Public H.&h. She is (I member of the Pm@alond Liability Committee 01 the ACNM and is organtztng o molpmtice suppott network for the College
.,oumel ofNurre.Mtd.lfery
interrogatories
and
those of any codefendantIs). It is vey important to work with
INTERROGATORY Mscovey
plaintiffs
your your
attorney in prop& phrasing responses before committing
defendants
es well es rhe platotiffs
theoE&eS
It
is e less dgtd process than the written interroqatories. The way a certefn question is answered IPSWS morn for the attorney to pose other
them to writing. Hopefully, before the receipt of the interrogatories.
questions.
you’ve
one. The debtton
alread!
carefu!ly
spent
going ir~er
a long time the case with
Thts
process is a clittcel itself can bst for
hours; mine lasted for six hours with
your attorney.
onlv a brief lunch break This can be
You can also assist your attorney in phrasing questions for the plaintiffs tnterrogatortes and their expert
a truly exhausnng experience, as you
wttoesses.
ough and clear knowledge
I informed
that the plaintiffs
my attorney
had allowed me to
are the only one to answer all the questtons. You must have e thorof your
case. Know the chart inside and out.
care for them in their second preg-
Including monitor
nancy and deliver this child even though they swere aware that their
records as needed, and depositions and interrogetodes of codefendanh
. Vol. 35, No. 3. Ma~Nune 1990
tracfngs. newborn
167
if there are any, of your expert witnesses.and of the plaintiff 2nd their experts It is ideal, if not absolutely necessery, to spend time with your attorney practicing for your deposition. He or she can take the place of the FleiIIttff-S attorney in asking question< in the manner you can anticipate. Remember that, as with the interrogatory. d the information gathered at the deposition is admissible at the 5me of t&J. You must be prepared for the repetitiveness of the quesnons. This is a direct &tempt to make you frustrated end angy and perhaps even defensive enough to change your arlswers a Uffle. You cannot say, for example. to refer to your previous answer or that you’ve sufftc~entlvanwered that q&&on. You &also expect i&w questions like, “Isn’t it & that .” x “Wou!dn’t vou agree that.. questions ere a favolite, asking you to assume the factsin a certain way. If the hypothetical situation presented is unltke your case, you can state that you do not know how it relates to your case If it is like your case, answer the hypothetical in a manner consistent with anwers you may have already given to direct questions about your case. Again, there wUU!x con:ten* attexpts to tick you into saying something that can be used against you in kial or force the case into settlement. At both the deposition and the trial, the plaint& attorney will ty to establish whetiva you conformed to professional “Standards of Care.” Know the ACNM and ACOG stew dards well before this time. Remember, these are no* absoklte rules but “guidelines.” Deviation from the standards is acceptable if you can defend clearly why you ma: have done so while showing a clear understanding of the &mdar&. k can be very appropriate to remind the plaintiff’s attorney that medicine andlor mtdwtfew is an “art” and not an e~ci sctence.Each situation must be considered individually, and de-
.” Hypothetical
163
viations from the standards often occw. You may be &ad here, as well as at the bial. to agree with a certein authority 0: text h’s wise not to agree with any author or text in its entirety. It’s better to ask the attorney to be specific as IO a c*tn article or to a certatn chapter or paragreph in a text or journal. It is atso all right to be honest if you don’! agree with a certain author or text if you can explain why. A good example is the famous Friedman curve. Often, depending on the case. of course, the opwsl”g attorney will ask you if you r&g&i Friedman’s curve to be nationally recognized and accepted as a “standard of care.” When I was asked this because of a question of a pmlonge 1 second stage- in my law&i*, I answered thet I certainly recognized the principle oi the Friedman curve and knew of Dr. Friedmen 1 alvl stated that Dr. Friedman never meant his cuwe to be taken so literally, that he did not regard any deviation from it as a breach of quality care, and that he recogntzed the need for individual “ari.siion. was as a guide, not an absolute. It is also acceptable to state that you are not famtliar with a certain medical authority or text. You will not be expected to know about everyone and thetr writings in the field; however, any authors, texts, or journals that you have Usted in your intetmgatodes as being used es a reference in care of your patients will probably be referred to in their quations. Take time to answer a question. It does not mean that you’re not knowledgeable, just cautious in phrasing your words. It’s vey difficult, I’ve found, not to get angy or answer patIonjdngly to sane of the more absurd questions. It’s critical to stay calm. Anot& favorite hick oi the pleinws ettomey is to get you to say too much. The more infomtion in en answer, the more he or she he to use to ask you more questionso, to trick you with. Remember, you
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are not there to show how extensive your knowledge 1s.These questions are not board exam questions. The best advice is to answer as succinctly es you can and stay to the point. Agatn, found this Lcredibly difficult. and, if had no* been prepared by my lauyer, I would’ve felt compelled to explain in great detail. Don’t guess at en answer. If you don’t know something, say so. You will only be cross-examined by your attorney at the kiat. He or she, however, can perk&ally object to e question from the plaintiffs attorney. Wait a moment when this Is done before answeting the question, as you do have to answer it. Your attorney’s objection wiU be recorded by the stenographer and can be brought up again at the hial. He or she may also be hying to warn you about cettein phrasing, etc; in other words, be vey cautious in answering that palncular questto”. You may also ask to refer to the records at the deposltior. or at the trial. You’ll often be asked if you have an independent recoUec5onof a certain went or decision. It is okay to state you do not without consulting the record. The child was 10 years old before my lawsuit came to deposition. There was no way I could recollect basically anything without direct referral to records, standards of that time. hospital prltileges, call schedule. etc. After the deposition. you will receive 3 copy to read and sign as correct. Remember, it is probably the most important process in the discovey poriion of a lawsuit. Read it wry thoroughly. These can be terribly long. Mine was 99 pages. Your attorney will ask you to make any conections on a s%parate plow of paper, You cannot change ideas or full sentences, although you may wish you could. The corrections wUI be minor ones only, such as Ming in a blank whore the stenographer either missed a word or didn’t hear correctly or to change spelling aron. Once the final copy is approved by you, you sign it before a notary
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Joumat d NurseMtdwtfey . Vol. 35, No. 3, May/dune 1990
public and copies are dlstdbuted to both slws in the lawuit SETTLEMENT Only one lawsuit in ten will lead to a court hearing or trtal in medicalmalpmtic~- cases. Most casesare settled or dropped before trial. ff your ettomey agrees to settle without a trial, it is very difflcul! not to feel that sanehow it is an admitix oi msilt on your part. k’s difficult to rt?alize that your attorney might know best when your pride and reputation are at stake. A settlement is not a judgment for the plaintiff against the defendant, and there is usually a written clause in the settlement stating such. You can also ask that the amount of the settlement not be disclosed to the media. If you do not agree with the idea of settlement and feel that your case is t& defeil&&, it is imporiani io state that to your attorney and alx, ask if X’s hi or her legal opinion that settlement is necessary or if it is the insurance cardefs wish. Reasons for settlement can be that the amount asked for is less than the cost of defending the case; that, in the discovery process. there were noted to be missing records or key witnesses uho are not available;that the seriousness of the injury or the amzarance of the plaintiff may !sad excessive a&d becauseof tbe “svnmathv factor?that there may be r&l &aknesscs in your case;orihat a codefendant’s testimony may be demaglng to you You must try to remain realistic and objective about settlement, perhaps the most dlfflcult thing to do, when you may want to scream at the injustice of it We knew that my case might risk an excessive award because the 10.year-old girl was profoundly retarded, with a working vccebulay of 2C words and the ablllty to perform only a few basic tasks
toin
TRW Most malpracticecasesare jury trials. becauseone or both sides feel a jury
will help their caw. The pLaintiffs etare on the witnessstand or not It is tomey anactpaes playing to a juy’s cdticalnot to show emotions such as sympathy. The plainnff s anorney anger, surpdse, or hostility by your may also want a jury becausejudges fadal expraion or b.zdliy p&we. hear molly sad cases and become told, when I was seated at somewhai h,,mune to the “symthe attorney’s table, to sit pathy factor;” because the fudge with two feet on the floor. with nw may be more obwtlve than a ,u-y ha: C fofded In front of me, lea& can b-z and becausea judge 1smore slightly foward in a posture of p&e expedenced in hearing testimony attention. My trial lasted two full and evaluating it for exaggerations weeks. and to malntein tt;is postw from the truly “professional” witand demeanor con&tendy was very “_. difficult !t was most difficult when The defense attorney may want a the plaintiffs mother, my patient, iuw ti if you make a wad witness ws on the stand. She told the iw andmanner of howcmelandmeanIwastoh&in handling yourselt w&r the wun of labor. During her entire testimony, the pla%Xs attorney. He & she she literally glared at me. At one may be banking on your honesty point, my mouth droppedopen, and and knowledge to counter the effect I y-d in dtsbekef. 1 hadn’t even of the “sympathy factor.” Also. with realized I was doing it until my lawyer ldcked me under the table a jury, you have an averageof 6 to 12 people who musi agreeby a macouldn’t believe she’d say such unjox#y. This can be better than the true things about me. She was affronting my senGbtfi~ as a caring oolnion of one judge who way be human being, not just as a midwife. known to be biased. A iuw decides ThepkJntiffu4listertwithhisoT the verdict, and if it Is lo;the plaintiff, !hey also decide the percenta~ of her opening statement. This is the Ilability assigned and the dol!ar usualiy an elabaaon on the intual amount of the damageawarded. ChergiKin the sumlnons. Then, your attorney will gtve an opening stateIf there h a trial, it is important to ment presenting an ove&w of why b-epresent evey day, even though thii is time-consumingand emotionthe charg25 are Invalid. The plainelly difficult It tells the juy that you tiffs calls the wiare concerned end helps offset the for hi or her dde. After eachwitness presence of the plaintiff and his OT is questioned by the plaintiff’s ather family. If you are persistently torney. the defense attorney cm+ exemines the wttne?s. witnesses for present. you will also help your atthe defense are then called and torney to interpret medical lnformation. apzclalk, that of the opposing questioned In the same f&on. You will be questioned bv the expert witnesses, information that pfaintiffs attome; fimt Rem&ber, may help in your attorney’s nowaxhls fee Is on a mntlnaew basis If amination. he loses, he gets &thins for his Your personal appeamnceI5 way work; your defenselawyer. however, Imoortant. Most IUIOE will have a pr&oncelaed Id& about the appear. Is pald by the insurance canier regardless of the outcome. So, the ante of a “health professional.” It Is suggested to dress in clothes you plalntift-s attomey Is $&g to be aggresslve In his or her questlonlng, might wear to a lob intetiew, such more so than at your depositton, as a suit, nice blouse and skirt or even to the point of being theatrical dress Your nonverbal commwdcattonis at times. He or she wifl by a@n. as in your deposition, to make you lose as critical as your verbal. (t’s Impayour temper, which would makeyou tent to remember you are always a Iwk bed In the juror’s eyes. it’s Imfocus of attention by the ;urcv and patent not to answer a questton R a the plaintiffs attorney, whether you
1was defendant
in,ur appearance
Journal of NurspMldwUer$ l Vol. 35. No. 3, MaylJurw 1990
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attorney then
169
pahon’ktng manner. Always by to look at the jury and speak diictJy to them when you’re explaininga decision-making process or procedure. Explain and teach them as you would your patients. Be in command of you&f and your knowledge. I was asked to explain the mechanisms of !abcr by the plaintiff’s lawyer. There was a large artist’s type chat on a stand in the courtroom I asked the attorney if 1 could draw as I explained, ee that would make it more understandable.I positioned the pad so that It wes facing tbc jxy so I coold telk directly to them. I guess I did a particularly good job here, becausethe plaintiffs attorney was obviously frustrated wher. ! finished. The only difficulty in explaioinganything to tie joy is that yoii get no feedback, cxept to assess their level of interest by their ettention to you, So you have no diret! wzy !o meke sure they’ve UPderstood. Know your deposition cold. Don’t equivocate or change your enters at the trial when the same questions come up. Ty not to be intimidated by information from an expert witness or by having a leadingauthonly quoted to you. You do not have to be an outstanding academidan,just ~racticinq accordinq to reasonable &end& oi care. The olaintiff’s attornev will often try to &mmarize your Correct him or her if he or she is incowat. but do so politely wch as, “I am very sorry, &.iMs. So-and-So, but 1 think you misunderstood me. I said not .” Sections from texts and journals are often quoted during the trial by the plaintiff’s attorney. The joy will hear him or her refer to the source as a” expert or leading reference. It’s up to you to interpret the information br them. Ask to see the context in which it was written before you anwer whether you agree with it or
kements
.,
not
When the opposing attorney held up a copy of ACOG’s Stnndards of Care and asked me if recognizedit
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and, if so, if 1 agreed with is 1 raid 1 did but asked to see it. He seemed surprised then opened it to the inside cover and read to the joy the statement that basicallysaid that the Sendards were to be &d as guidelines for acceptablepractice, not as rigid ales for &ti&. I then handed it back to the attorney. I believe that helped me to set the stage for any questions about my deviation from the ACOG stand&.. Agaln 1 was able to surprise and throw the lawyer off guard a little. got the diinct imore&on that, as a CNM and not an tiD. he felt that I would be easy to discredit Try to make SIXE that you are judged by standards current to the time of the case. I was asked if the monitor strip in my care didn’t show “stress” on the baby’s part told the plaintiffs attorney and the joy that the ten” “stress.” which I defined for them, was not used in 1976 at the time of the case. Onlv “distress.” again defined, wes &d, and that I fe:: xre there was no distress shown on the monitor strip. If you have a codefendant(sl, txy not to criticize that per&o”(s) from the beginning of the discovey prccess through the trial, but don’t “ecessarily defend him or her, either. At my trial, questioned by tie piaintiffs attorney regarding a statement that the patient said I made after decidedthat she xcded to be delivered by forceps by my backup MD. She had sworn that I had told her that mv backor, would deliver her child r&r he fikihed eating his breakfast Obviouslv. denied this. as I would “ever t;il anexhausted and somewhat frightened patient thii information-even if perhaps it could be hue in a “onemergency situation. When it is your turn to t&ify, your nonverbal communication on the witness stand will say much to the urv and to the daidffs lawwr. If ;o; sit with your’legs crossed,-It can be interpreted that you’re not cooperative; if you sit with your arme folded ecross your chest, that you’re
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I was
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defensive and ho&e. Agaln, ifs tmpatent to sit with a straight back, leaning slightly forward, with two feet on the floor and with “our arms relaxed at your sides or ii front of vou. As CNMs. w’re trained to oick the nonverbal communiicatio; of our patients. We cannot underestimate our nonverbal communication to others, either. Aft&wards, your defense attorney will cross-examine you. Hi or her job is to clmify paints in your favor or give you the chance to explain an answer in more detail than the slaintiff’s attorney had. He or she wili also bring up favorableinformation about your background,elaborate on your education, etc. 1 had asked my ettorney to give me ample time to explain what a CNM was to a joy. because I felt fairly sure that they wouldn’t be knowledgeable regarding the education, mining, and expertise “ecessay to our field. In my case, it turned out that, with one exception, all 12 jurors were SO years or older. Indeed, few would have used a CNM for their childbirths or those of their partners. The final process in the ti is the closing arguments of both sides. Again the plaintiffs attorney will go first, your defense attorney second, and then the plaintiffs anomey can briefly have the opportunity to rebut any of the last statements made by the defense. The judge till advise the jury a” how to come to a verdict, i.e.. that the olainiiff must “rove his or her case’by “the pr&“dera”ce of the evidence.” In civil cases. that Is 51% assurance that the charges against the defendant are valid. While in criminal cases, the defendant must be found guilty “beyond any reasonable doubt,” in civil cases the scales need only to Up slightly in favor of one side over the other. The judge will also inform the joy, es he did :ir ray lawsuIt, not to decide in favor of the plaintiff just because of the severitv of the outcome. The jurors are not allowed to take any printed testimony of either side when
;p
Joereef of Neree.Midwifery . Vol. 35. No. 3. Mey/Ju”e1993
they are deciding the verdict. but must make a judgnenent on their recall of the events of the tial. In my lawsuit, the jw wee out four hours before they rendered a defendant’s verdict vindicating me and my codefendant physidan. The whole process was the most harrowing emotional experience of my profe.Ssionel caeer. It wee extremely difRcult to remain calm and not show emotion. Even after and my codefendant received defendant’s verdicts. felt like it wee a hollow victory. sad that there was no way to nuly help the child who would forever be mentally retarded and that her family faced a llfelong sttuggle from the emotional and financial standpoints. I was angry about the system that gave m;no way to “deaf mv name. ewedally in the media, @i&e the alleged damages had made front peg@ new. I also subsequently lost hvo OB pattents who read about the trial. Although I
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told them t5at I’d wan the verdict, the” felt tbev could no longer tnst my-care. I was extremely frutreted at the economic loss es weU. I lost Income from being out of my of& for two weeks for the trial alone, to say nothing of the pre~mtion time and $4,ooO in legel fees that I had to pay for my personal lawyer whom I reUned because of the huge financial s&n for which I was being sued. One of the most important factors. which is most difftcult to @S@SSor quantify, is the degree of stressand strain on vou DersonallY.your partner, you faily, and coworkers. I felt es if I were !unctionins in a void from the start of the dis&@ly process through the trial. During this time un&! at least six months later, I over-questioned every decision I made and had a great deal of difficulty trusting my knowledge and intuition. There are few ot us m our p:ofe.+ sion who have been sued to date,
Journal of Nuree.Mldwtfery . Vol. 35, No. 3. May/June 1990
even fewer who have gone @ii the wey through this henowing expoience. If the melpmctice at.+ and the natronelly accepted attitude to srsign blame to others isn’t changed @con, w? can only exgect more CNMs to be sued, perhep~ even with the frequency of the OB-GYii5. We must be prepared to eonrive lewsuia and to support each other emotionally. SUGGESTELI READINGS
Alton WG: Malpractice-a trial lawyer’s advice for phyricians,hw to avoid,how towin). B&on, l.ltt!+Brown 1977. Robber% JA, ShaneJA, R&c& ML, (edil: Confrowlg Le mdpracr‘ci!ClisiS -guidelines for the Obstemden-Gynecolo& Kansascity. EaglePlw. 1985. TareshanJM: L& guide fo: phys’. cianr. New York. Matthew Bender. 1987.
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Ch:‘.stine Kuhlman,
CNM,
MPH
ABSTRACT Few CNMs to date have been sued and fewer yet have been through the !i-auma of a malpractice SW The fokaving article Is a syno,,sis of the malpractice piocess from sunrnons through trial. lnterspewd throughout are ,monal recollecttons and rerpanres of one CNM who endured a two-week hial.
I WQS awakened on a Saturday morning in 1985 at 9:00 A.M. bv a telephone call from a man idektifying himself as a syndicated reporter. He wanted to ask me how I felt abol’+ that morning’s headline in my state’s largest paper regarding my being named in a lawsuit with a local physician for $4.8 million. I didn’t know what to say since it was mv first information that I was beins sued! It was later that week that Irewived a surnrnons from a sheriff, formally notifying me of the lawsuit. This article will track the malpractice process from surmnons through trial and personal experiences will be interspersed throughout. SUMMONS AND COMPLAIM The sutnmons is notification from a courtthat you are sued, and the complaint contains the ailegations agaimt you It may also contain the dollar amount the daintiff would like to collect, but in’eome states, now including my own, this is not an allowable procedure. At the time, however, in my case the plaintiff was claiming $4.8 million in damages.
betrig
The amount claimed is generally srosslv inflated. Few juries would award the amount asked for, although in a few cases, they have awardedgreater amounts than asked for by the plaintiffs attorney. After being notified of a summons, do not discuss the case with colleagues or codefendants. The need for support is great, but you should not relate swcifics of the case. Later. you will beasked if you have spoken with anyone about your case; those you have spoken with may also be deposed. Immediately after receiving the s”nlmo”s, notify your insurance carder about its contents. They will appoint a defense attorney for you enough the imoortance of your involvern&t with &or attorney. It’s your job to educate the attor& to the &dtcal information necessary for hlm or her to understand the case and adequately defend you. This may mean many hours of chart reviews, reviewing of licensing requirements, nati&l standards, hospital or birlh center protocols and privileges, literature review of SimXar cases and sftcations. the beet texts, journals, and articler. e:c. Early on, it is advisableto ask your
cannot stress
I
attorney his or her professional record and knowledge of medical malpractice cases. If ihe attorney’s remrd is too new for your comfort or too many of his cases have won plaintlff’s verdicts, it is certainly within your rights to ask the insurance carder for another attorney. I was never quite happy with my attorney but didn’t know at the time that I could do this. Most defense attorneys already have a gad worktng knowledge af the field but need specifics and details necessary to defend your specific case. It is important to suggzst some gocd expert WitnesseP These lndlvtduals don’t need to be nationally known, but can be lwally or regionally recognized es gad rxectitioners. Sometimes a juy will deal better with a local expert. someone closer to home. someone they might go to themselves, than with a national figure who may or may not even practice. It is generally not a good idea to suggest a “Mend” or a a backup CNM or MD in the cornmunity. A jury may we this individual as too potentially biased in vow favor. If the dollar amount for which you are beins sued exceeds the limits of
ties provide $1 million per suit), you
the case. It includes interrogatories.
first
may want
which
mental
to hire e prtvate lawyer.
are a series of v&ten
qua-
child
wee showing
marked
deficiency et that time. He
He or she will be working exclusively
tions composed, in the defendant’s
had not been ew-&e of thtt and prepared
ic your interest and not aleo for the
case, by the plaintiffs
interest of the irnumnce carrier. Your
vice versa;
personal
orel answers
ptimay
COUnS4or
wiii notiFs
defense attorney
insurance
ranter
your
and your
that, if the case is
Iwyer
depositions. to further
the opposition’s
and
which
are
westions
of
lawyer:
and docu-
questions
ihroughout
regarding
the discovery
this
process
end et the &al. I felt it was one of the significant
issues
in my defenre-
ment oroducnon and validation. The
there wes no lack of bust shown with
lost for greater than your cowrage,
defenbant must respond to the inter-
the second pregnancy.
then
be
rogatories in uniting within a time pe-
was advised to
riod of usually 30 days After the an-
quertion
swers have been compwzd.
have no wrsonal
the insurance
I certainly
held liable.
carter
will
do this in my case. It is vey calm
important
when
5”lnroO”S.
first
to by to stay notified
of
a
k’s easy to get angry or
you will
swear to their accuracy in the presence of a notay rogetory
public. The
is an attempt
inter-
to disclose
hostile, to have self-doubts regarding
more of the facts, relevant mateliats,
your care and knowledge,
and potential
or to wony
staff members, will
think
to panic.
what other colleagues, friends,
of you.
and family
Remember,
a
witnesses.
which
can
It is also .pamtssible with
I had before attending the plaintiff’s labor. It was nine years after the fact that the case was first
complaint
ledion but oko stated what the call
The
interrogatory
usually
star&
system was nine years before to !$Je
does not mea” you were
with questions regarding age. educa-
them
at fault
in
tion.
sleep pattern
anv WV.
Most suits are brousht
to
gresses
and work into
history,
the actual
and proallegation.
an idea of how might
The
femilu or individual
taken lightly. Answers even this early
most situations,
in the dtscovey
to the discovey
aged &ild,
es was the situation in my
interrogatory
should
not
be
process can be used
at the deposition
and trial.
Don’t
regular
can take
the place of oml d-tins,
but, in
bath are necessey process
for both
sides.
speculate in aonuering any question. You should have a copy of the patient’s full chart (clinic and hospital as
DwosmoN
needed, newborn chart as applicable
Thts
assistance in caring for their reterded
to the ceee. etc.) to work from. Ide-
i5 usualiy taken in the attorney’s
daughter and saw malpra6ice
ally, these charts should th the or&-
Xce in the presence
in&.
court
ablv didn’t
have anv ill will toward
me-but were d%per&
for financial litiga-
tion as a means to an end. To day. three years after my biel,
this
I still
my
have been. In
some cases. interrogatoties
re;over~money sufftcient to aid the
case. I was told from the stat not to t& il personally. The family prob-
I ob-
and stated I had no personal recol-
or necessarily
in carins for the
filed.
viously bed no wey Qf remembering.
shed light on the allegations iz the
negligent
outcome, e.g., a b&n-dam-
that you
recoUection. I was
asked, for instance. how much sleep
suounons
adwse
to answer a
a statement
You have sufficient time to re-
search articles that till
initially
assist
is oral testanony
asked
stenographer. questions
under oath. It of-
of a licensed You
will
be
by the plaintiff’s
you and will also be useful throaghout your defense, If they are com-
lawpr US& yw!wyer present Depositions are taken of all the expert
cent pawns in n system that some-
pleted, you may also be able to wad
,vitoesses for both sides and any CD
how has gone awry.
the
h&e trouble accepting this explenaSon. It’s too easy to feel we ere inno-
is the process
by which
both sides learn the complete facts of
Chris Kuhlmw has bsen o nursemidwile in ~riuote pmctke since 1976 In Con&d &pit4 Concord, New Hampshire and in on ou!.o/-hospital birth center. She holds an M.P.H. from John Hopkins School ojHyg!ene and Public H.&h. She is (I member of the Pm@alond Liability Committee 01 the ACNM and is organtztng o molpmtice suppott network for the College
.,oumel ofNurre.Mtd.lfery
interrogatories
and
those of any codefendantIs). It is vey important to work with
INTERROGATORY Mscovey
plaintiffs
your your
attorney in prop& phrasing responses before committing
defendants
es well es rhe platotiffs
theoE&eS
It
is e less dgtd process than the written interroqatories. The way a certefn question is answered IPSWS morn for the attorney to pose other
them to writing. Hopefully, before the receipt of the interrogatories.
questions.
you’ve
one. The debtton
alread!
carefu!ly
spent
going ir~er
a long time the case with
Thts
process is a clittcel itself can bst for
hours; mine lasted for six hours with
your attorney.
onlv a brief lunch break This can be
You can also assist your attorney in phrasing questions for the plaintiffs tnterrogatortes and their expert
a truly exhausnng experience, as you
wttoesses.
ough and clear knowledge
I informed
that the plaintiffs
my attorney
had allowed me to
are the only one to answer all the questtons. You must have e thorof your
case. Know the chart inside and out.
care for them in their second preg-
Including monitor
nancy and deliver this child even though they swere aware that their
records as needed, and depositions and interrogetodes of codefendanh
. Vol. 35, No. 3. Ma~Nune 1990
tracfngs. newborn
167
if there are any, of your expert witnesses.and of the plaintiff 2nd their experts It is ideal, if not absolutely necessery, to spend time with your attorney practicing for your deposition. He or she can take the place of the FleiIIttff-S attorney in asking question< in the manner you can anticipate. Remember that, as with the interrogatory. d the information gathered at the deposition is admissible at the 5me of t&J. You must be prepared for the repetitiveness of the quesnons. This is a direct &tempt to make you frustrated end angy and perhaps even defensive enough to change your arlswers a Uffle. You cannot say, for example. to refer to your previous answer or that you’ve sufftc~entlvanwered that q&&on. You &also expect i&w questions like, “Isn’t it & that .” x “Wou!dn’t vou agree that.. questions ere a favolite, asking you to assume the factsin a certain way. If the hypothetical situation presented is unltke your case, you can state that you do not know how it relates to your case If it is like your case, answer the hypothetical in a manner consistent with anwers you may have already given to direct questions about your case. Again, there wUU!x con:ten* attexpts to tick you into saying something that can be used against you in kial or force the case into settlement. At both the deposition and the trial, the plaint& attorney will ty to establish whetiva you conformed to professional “Standards of Care.” Know the ACNM and ACOG stew dards well before this time. Remember, these are no* absoklte rules but “guidelines.” Deviation from the standards is acceptable if you can defend clearly why you ma: have done so while showing a clear understanding of the &mdar&. k can be very appropriate to remind the plaintiff’s attorney that medicine andlor mtdwtfew is an “art” and not an e~ci sctence.Each situation must be considered individually, and de-
.” Hypothetical
163
viations from the standards often occw. You may be &ad here, as well as at the bial. to agree with a certein authority 0: text h’s wise not to agree with any author or text in its entirety. It’s better to ask the attorney to be specific as IO a c*tn article or to a certatn chapter or paragreph in a text or journal. It is atso all right to be honest if you don’! agree with a certain author or text if you can explain why. A good example is the famous Friedman curve. Often, depending on the case. of course, the opwsl”g attorney will ask you if you r&g&i Friedman’s curve to be nationally recognized and accepted as a “standard of care.” When I was asked this because of a question of a pmlonge 1 second stage- in my law&i*, I answered thet I certainly recognized the principle oi the Friedman curve and knew of Dr. Friedmen 1 alvl stated that Dr. Friedman never meant his cuwe to be taken so literally, that he did not regard any deviation from it as a breach of quality care, and that he recogntzed the need for individual “ari.siion. was as a guide, not an absolute. It is also acceptable to state that you are not famtliar with a certain medical authority or text. You will not be expected to know about everyone and thetr writings in the field; however, any authors, texts, or journals that you have Usted in your intetmgatodes as being used es a reference in care of your patients will probably be referred to in their quations. Take time to answer a question. It does not mean that you’re not knowledgeable, just cautious in phrasing your words. It’s vey difficult, I’ve found, not to get angy or answer patIonjdngly to sane of the more absurd questions. It’s critical to stay calm. Anot& favorite hick oi the pleinws ettomey is to get you to say too much. The more infomtion in en answer, the more he or she he to use to ask you more questionso, to trick you with. Remember, you
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are not there to show how extensive your knowledge 1s.These questions are not board exam questions. The best advice is to answer as succinctly es you can and stay to the point. Agatn, found this Lcredibly difficult. and, if had no* been prepared by my lauyer, I would’ve felt compelled to explain in great detail. Don’t guess at en answer. If you don’t know something, say so. You will only be cross-examined by your attorney at the kiat. He or she, however, can perk&ally object to e question from the plaintiffs attorney. Wait a moment when this Is done before answeting the question, as you do have to answer it. Your attorney’s objection wiU be recorded by the stenographer and can be brought up again at the hial. He or she may also be hying to warn you about cettein phrasing, etc; in other words, be vey cautious in answering that palncular questto”. You may also ask to refer to the records at the deposltior. or at the trial. You’ll often be asked if you have an independent recoUec5onof a certain went or decision. It is okay to state you do not without consulting the record. The child was 10 years old before my lawsuit came to deposition. There was no way I could recollect basically anything without direct referral to records, standards of that time. hospital prltileges, call schedule. etc. After the deposition. you will receive 3 copy to read and sign as correct. Remember, it is probably the most important process in the discovey poriion of a lawsuit. Read it wry thoroughly. These can be terribly long. Mine was 99 pages. Your attorney will ask you to make any conections on a s%parate plow of paper, You cannot change ideas or full sentences, although you may wish you could. The corrections wUI be minor ones only, such as Ming in a blank whore the stenographer either missed a word or didn’t hear correctly or to change spelling aron. Once the final copy is approved by you, you sign it before a notary
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Joumat d NurseMtdwtfey . Vol. 35, No. 3, May/dune 1990
public and copies are dlstdbuted to both slws in the lawuit SETTLEMENT Only one lawsuit in ten will lead to a court hearing or trtal in medicalmalpmtic~- cases. Most casesare settled or dropped before trial. ff your ettomey agrees to settle without a trial, it is very difflcul! not to feel that sanehow it is an admitix oi msilt on your part. k’s difficult to rt?alize that your attorney might know best when your pride and reputation are at stake. A settlement is not a judgment for the plaintiff against the defendant, and there is usually a written clause in the settlement stating such. You can also ask that the amount of the settlement not be disclosed to the media. If you do not agree with the idea of settlement and feel that your case is t& defeil&&, it is imporiani io state that to your attorney and alx, ask if X’s hi or her legal opinion that settlement is necessary or if it is the insurance cardefs wish. Reasons for settlement can be that the amount asked for is less than the cost of defending the case; that, in the discovery process. there were noted to be missing records or key witnesses uho are not available;that the seriousness of the injury or the amzarance of the plaintiff may !sad excessive a&d becauseof tbe “svnmathv factor?that there may be r&l &aknesscs in your case;orihat a codefendant’s testimony may be demaglng to you You must try to remain realistic and objective about settlement, perhaps the most dlfflcult thing to do, when you may want to scream at the injustice of it We knew that my case might risk an excessive award because the 10.year-old girl was profoundly retarded, with a working vccebulay of 2C words and the ablllty to perform only a few basic tasks
toin
TRW Most malpracticecasesare jury trials. becauseone or both sides feel a jury
will help their caw. The pLaintiffs etare on the witnessstand or not It is tomey anactpaes playing to a juy’s cdticalnot to show emotions such as sympathy. The plainnff s anorney anger, surpdse, or hostility by your may also want a jury becausejudges fadal expraion or b.zdliy p&we. hear molly sad cases and become told, when I was seated at somewhai h,,mune to the “symthe attorney’s table, to sit pathy factor;” because the fudge with two feet on the floor. with nw may be more obwtlve than a ,u-y ha: C fofded In front of me, lea& can b-z and becausea judge 1smore slightly foward in a posture of p&e expedenced in hearing testimony attention. My trial lasted two full and evaluating it for exaggerations weeks. and to malntein tt;is postw from the truly “professional” witand demeanor con&tendy was very “_. difficult !t was most difficult when The defense attorney may want a the plaintiffs mother, my patient, iuw ti if you make a wad witness ws on the stand. She told the iw andmanner of howcmelandmeanIwastoh&in handling yourselt w&r the wun of labor. During her entire testimony, the pla%Xs attorney. He & she she literally glared at me. At one may be banking on your honesty point, my mouth droppedopen, and and knowledge to counter the effect I y-d in dtsbekef. 1 hadn’t even of the “sympathy factor.” Also. with realized I was doing it until my lawyer ldcked me under the table a jury, you have an averageof 6 to 12 people who musi agreeby a macouldn’t believe she’d say such unjox#y. This can be better than the true things about me. She was affronting my senGbtfi~ as a caring oolnion of one judge who way be human being, not just as a midwife. known to be biased. A iuw decides ThepkJntiffu4listertwithhisoT the verdict, and if it Is lo;the plaintiff, !hey also decide the percenta~ of her opening statement. This is the Ilability assigned and the dol!ar usualiy an elabaaon on the intual amount of the damageawarded. ChergiKin the sumlnons. Then, your attorney will gtve an opening stateIf there h a trial, it is important to ment presenting an ove&w of why b-epresent evey day, even though thii is time-consumingand emotionthe charg25 are Invalid. The plainelly difficult It tells the juy that you tiffs calls the wiare concerned end helps offset the for hi or her dde. After eachwitness presence of the plaintiff and his OT is questioned by the plaintiff’s ather family. If you are persistently torney. the defense attorney cm+ exemines the wttne?s. witnesses for present. you will also help your atthe defense are then called and torney to interpret medical lnformation. apzclalk, that of the opposing questioned In the same f&on. You will be questioned bv the expert witnesses, information that pfaintiffs attome; fimt Rem&ber, may help in your attorney’s nowaxhls fee Is on a mntlnaew basis If amination. he loses, he gets &thins for his Your personal appeamnceI5 way work; your defenselawyer. however, Imoortant. Most IUIOE will have a pr&oncelaed Id& about the appear. Is pald by the insurance canier regardless of the outcome. So, the ante of a “health professional.” It Is suggested to dress in clothes you plalntift-s attomey Is $&g to be aggresslve In his or her questlonlng, might wear to a lob intetiew, such more so than at your depositton, as a suit, nice blouse and skirt or even to the point of being theatrical dress Your nonverbal commwdcattonis at times. He or she wifl by a@n. as in your deposition, to make you lose as critical as your verbal. (t’s Impayour temper, which would makeyou tent to remember you are always a Iwk bed In the juror’s eyes. it’s Imfocus of attention by the ;urcv and patent not to answer a questton R a the plaintiffs attorney, whether you
1was defendant
in,ur appearance
Journal of NurspMldwUer$ l Vol. 35. No. 3, MaylJurw 1990
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attorney then
169
pahon’ktng manner. Always by to look at the jury and speak diictJy to them when you’re explaininga decision-making process or procedure. Explain and teach them as you would your patients. Be in command of you&f and your knowledge. I was asked to explain the mechanisms of !abcr by the plaintiff’s lawyer. There was a large artist’s type chat on a stand in the courtroom I asked the attorney if 1 could draw as I explained, ee that would make it more understandable.I positioned the pad so that It wes facing tbc jxy so I coold telk directly to them. I guess I did a particularly good job here, becausethe plaintiffs attorney was obviously frustrated wher. ! finished. The only difficulty in explaioinganything to tie joy is that yoii get no feedback, cxept to assess their level of interest by their ettention to you, So you have no diret! wzy !o meke sure they’ve UPderstood. Know your deposition cold. Don’t equivocate or change your enters at the trial when the same questions come up. Ty not to be intimidated by information from an expert witness or by having a leadingauthonly quoted to you. You do not have to be an outstanding academidan,just ~racticinq accordinq to reasonable &end& oi care. The olaintiff’s attornev will often try to &mmarize your Correct him or her if he or she is incowat. but do so politely wch as, “I am very sorry, &.iMs. So-and-So, but 1 think you misunderstood me. I said not .” Sections from texts and journals are often quoted during the trial by the plaintiff’s attorney. The joy will hear him or her refer to the source as a” expert or leading reference. It’s up to you to interpret the information br them. Ask to see the context in which it was written before you anwer whether you agree with it or
kements
.,
not
When the opposing attorney held up a copy of ACOG’s Stnndards of Care and asked me if recognizedit
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and, if so, if 1 agreed with is 1 raid 1 did but asked to see it. He seemed surprised then opened it to the inside cover and read to the joy the statement that basicallysaid that the Sendards were to be &d as guidelines for acceptablepractice, not as rigid ales for &ti&. I then handed it back to the attorney. I believe that helped me to set the stage for any questions about my deviation from the ACOG stand&.. Agaln 1 was able to surprise and throw the lawyer off guard a little. got the diinct imore&on that, as a CNM and not an tiD. he felt that I would be easy to discredit Try to make SIXE that you are judged by standards current to the time of the case. I was asked if the monitor strip in my care didn’t show “stress” on the baby’s part told the plaintiffs attorney and the joy that the ten” “stress.” which I defined for them, was not used in 1976 at the time of the case. Onlv “distress.” again defined, wes &d, and that I fe:: xre there was no distress shown on the monitor strip. If you have a codefendant(sl, txy not to criticize that per&o”(s) from the beginning of the discovey prccess through the trial, but don’t “ecessarily defend him or her, either. At my trial, questioned by tie piaintiffs attorney regarding a statement that the patient said I made after decidedthat she xcded to be delivered by forceps by my backup MD. She had sworn that I had told her that mv backor, would deliver her child r&r he fikihed eating his breakfast Obviouslv. denied this. as I would “ever t;il anexhausted and somewhat frightened patient thii information-even if perhaps it could be hue in a “onemergency situation. When it is your turn to t&ify, your nonverbal communication on the witness stand will say much to the urv and to the daidffs lawwr. If ;o; sit with your’legs crossed,-It can be interpreted that you’re not cooperative; if you sit with your arme folded ecross your chest, that you’re
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I was
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defensive and ho&e. Agaln, ifs tmpatent to sit with a straight back, leaning slightly forward, with two feet on the floor and with “our arms relaxed at your sides or ii front of vou. As CNMs. w’re trained to oick the nonverbal communiicatio; of our patients. We cannot underestimate our nonverbal communication to others, either. Aft&wards, your defense attorney will cross-examine you. Hi or her job is to clmify paints in your favor or give you the chance to explain an answer in more detail than the slaintiff’s attorney had. He or she wili also bring up favorableinformation about your background,elaborate on your education, etc. 1 had asked my ettorney to give me ample time to explain what a CNM was to a joy. because I felt fairly sure that they wouldn’t be knowledgeable regarding the education, mining, and expertise “ecessay to our field. In my case, it turned out that, with one exception, all 12 jurors were SO years or older. Indeed, few would have used a CNM for their childbirths or those of their partners. The final process in the ti is the closing arguments of both sides. Again the plaintiffs attorney will go first, your defense attorney second, and then the plaintiffs anomey can briefly have the opportunity to rebut any of the last statements made by the defense. The judge till advise the jury a” how to come to a verdict, i.e.. that the olainiiff must “rove his or her case’by “the pr&“dera”ce of the evidence.” In civil cases. that Is 51% assurance that the charges against the defendant are valid. While in criminal cases, the defendant must be found guilty “beyond any reasonable doubt,” in civil cases the scales need only to Up slightly in favor of one side over the other. The judge will also inform the joy, es he did :ir ray lawsuIt, not to decide in favor of the plaintiff just because of the severitv of the outcome. The jurors are not allowed to take any printed testimony of either side when
;p
Joereef of Neree.Midwifery . Vol. 35. No. 3. Mey/Ju”e1993
they are deciding the verdict. but must make a judgnenent on their recall of the events of the tial. In my lawsuit, the jw wee out four hours before they rendered a defendant’s verdict vindicating me and my codefendant physidan. The whole process was the most harrowing emotional experience of my profe.Ssionel caeer. It wee extremely difRcult to remain calm and not show emotion. Even after and my codefendant received defendant’s verdicts. felt like it wee a hollow victory. sad that there was no way to nuly help the child who would forever be mentally retarded and that her family faced a llfelong sttuggle from the emotional and financial standpoints. I was angry about the system that gave m;no way to “deaf mv name. ewedally in the media, @i&e the alleged damages had made front peg@ new. I also subsequently lost hvo OB pattents who read about the trial. Although I
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told them t5at I’d wan the verdict, the” felt tbev could no longer tnst my-care. I was extremely frutreted at the economic loss es weU. I lost Income from being out of my of& for two weeks for the trial alone, to say nothing of the pre~mtion time and $4,ooO in legel fees that I had to pay for my personal lawyer whom I reUned because of the huge financial s&n for which I was being sued. One of the most important factors. which is most difftcult to @S@SSor quantify, is the degree of stressand strain on vou DersonallY.your partner, you faily, and coworkers. I felt es if I were !unctionins in a void from the start of the dis&@ly process through the trial. During this time un&! at least six months later, I over-questioned every decision I made and had a great deal of difficulty trusting my knowledge and intuition. There are few ot us m our p:ofe.+ sion who have been sued to date,
Journal of Nuree.Mldwtfery . Vol. 35, No. 3. May/June 1990
even fewer who have gone @ii the wey through this henowing expoience. If the melpmctice at.+ and the natronelly accepted attitude to srsign blame to others isn’t changed @con, w? can only exgect more CNMs to be sued, perhep~ even with the frequency of the OB-GYii5. We must be prepared to eonrive lewsuia and to support each other emotionally. SUGGESTELI READINGS
Alton WG: Malpractice-a trial lawyer’s advice for phyricians,hw to avoid,how towin). B&on, l.ltt!+Brown 1977. Robber% JA, ShaneJA, R&c& ML, (edil: Confrowlg Le mdpracr‘ci!ClisiS -guidelines for the Obstemden-Gynecolo& Kansascity. EaglePlw. 1985. TareshanJM: L& guide fo: phys’. cianr. New York. Matthew Bender. 1987.
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