Deposition of Critical Care Doctor
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- Опубликовано: 15 сен 2024
- This is part 2 of 3 of the deposition of an ICU doctor who was the primary defendant in this wrongful death malpractice case in Baltimore City. The claim was for his treatment at the University of Maryland Medical Systems, who was also a defendant.
This is Part 1 of the deposition: • Deposition of Critical...
This is Part 3 of the deposition: • Deposition of Critical...
The case ended in a $10 million verdict for the plaintiff.
Our clients were gracious enough to allow us to share materials related to the case to help educate other attorneys.
You can find our closing statement in this case here:
www.millerandz...
This is the Baltimore Sun article on this case:
www.baltimores...
I am a board certified nephrologist this lawyer has NO IDEA WHAT HE IS TALKING ABOUT> Put sign out notes in the chart. This guy is a bit green but well trained. Only the better MD's get into to Pulm /Crit. I have contacted this Doctor and told him to ask for sanctions for publishing this deposition online. Any Rn or MD would know that the questions he is asking are inappropriate and lack a fundamental knowledge in the treatment of hyperkalemia. When we tell patients "you could die" and they literally do after being difficult or refusing we are serious. The case went nowhere that's why you dont see a deposition of a nephrologist.
Exactly
Not intending to be argumentative, but the case clearly did not go “nowhere”. It resulted in a jury verdict and a $10M judgement against the medical center.
@@MattyBEightyThree a jury did true. i think he had bad representation. Its sad. Only nephrologists can order dialysis to characterize it otherwise is misconduct. Juries are not professional . Its a battle of experts. Just by the questions getting passed during the deposition shows that. It was against the "medical center" Juries often when they see a aggrieved often try to "make things right". The jury was in baltimore which is known for this.
The hospital didnt pay for any good experts.
I showed this to a few medical residents and it did provide a service. To sear into their brains when a patient is uncooperative and compromising care, document you discussed this with them and designated proxies. If they are admitted for hyperkalemia and prevent blood draws it makes treating them difficult.
Most juries know that physicians classically behave in good faith. Bad outcomes can happen. The lawyer painted a narrative that " if he just had dialysis he would be alive." Patients also this sick also die on dialysis .
@@MattyBEightyThree That amount was deemed to be excessive and sent back. Not sure if the lawyers will accept the suggested settlement but it will be far less than 10 million.
Got a kick out of that. Does this doctor order dialysis??? I'd love to see those HD orders. Making me angry listening to this! Like always, Lawyer clueless.
Doesn't sound like this dr did anything wrong
this case never should have gone to court
Wouldn't have needed a case at all had these professionals treated him like they would their own family or themselves.
His care was substandard and they deserved to be sued.
@@juliecrane9647 How was his care substandard?
This is a prime example of why lawyers are called ambulance chasers. No one should be sued over a bad outcome involving a geriatric patient. In this case, the patient was terminally ill. ESRD is a terminal illness. 🤦🏻
No one should ever get sued when treating a geriatric patient? Wait what?
Sounds to me like here we have a case of Mr. Allen who was literally on his death bed and regardless of medical expertise Mr. Allen was going to die in a matter of hours!! Mr. Allen’s body was shutting down, I picture a very elderly man who probably smoked 3 packs a day for 40 years who had diabetes and congenital heart disease who was admitted to the hospital in dire straits. I’ve seen the same thing over and over and the family wasn’t ready to let pawpaw go and when he passed away they just couldn’t believe it was possible so they hired an attorney to go after the hospital and the person trying to save what little bit of time he had left!! I seriously hope this case was thrown out if I’m correct in my assessment of Mr. Allen!! Now if Mr. Allen is a healthy 20 year old man I may have other views but I highly doubt that’s the case!!
Thanks for the comment, Ryan. I can't say we share your sentiment here. But you are right there is no question this was an issue. Causation is often an issue in medical malpractice cases. Maybe he would have died. I think the one thing everyone agreed with in this trial is that he was a great man. I think when there is negligence, a jury will and should give the benefit of the doubt by believing that a victim of negligence would have lived. Certainly, a man who lived his life like this man deserved that chance.
@Deplorable Centrist and OJ Simpson isn't a murderer.
@Deplorable Centrist well, genius, technically I said, "OJ isn't a murderer," Einstein. - professor Shelly Shell
Hi Ryan, I tried to read the article in the Baltimore Sun to find out more information on the case but, unfortunately, I am in the UK and blocked from their website! You indicate you know how old this gentleman was and wonder if you could let me know please? I suspect that your assessment is correct (don't want to prejudge as I don't know all the facts!) and I find it sickening that decent human beings like Dr Burk who dedicate their lives to caring for often very ill people get professionally annihiliated, and probably emotionally too, by a litigious system that plays on people's greed and vanity and just perpetuates and spreads further injustice in society.
@@Millerandzois ... Being a "great man" is a subjective opinion and has nothing to do with facts and evidence, it is wholly irrelevant! I don't know why you would even mention this in relation to a legal case!
unfortunately this patient would have died anyway within a very short amount of time. This doctor seems like a genuine, honest, and caring doctor. His patients are lucky to have him.
I agree.
Neeewaaaaw neeenaaaww z.....Hey guys you better go I think you've got an ambulance to chase!
Chloe, that is unfair. That sounds like a European siren. We were not trained to chase those.
@@Millerandzois 😂 checks out I'm in Europe are sirens are a little fruity! Sounds like it's time for your firm to take up long distance running !!!
All in good fun !
@37:40 NOW they’re speaking my lingo as a PICC nurse… this lawyer asking questions is making me mad at implying they should have waited for CVC access to adm the CaCl urgently. He is ill informed at best, taking a cheap shot at worst. I believe the latter. When HE gets sick, let the nurses delay his care while they make his vascular access situation ideal from HIS own legal standpoint. Maybe he’ll survive… grrrr
I thought it was standard knowledge that CaCl should not be administered through peripheral IV due to risk of necrosis?
Isn’t that why crash carts contain Calcium Gluconate and not Calcium Chloride?
I know mistakes happen - I don’t want to beat the guy up. Just curious.
This doctor really knows his stuff, it seems to me. None know everything, none make perfect decisions, or perfect compromises almost all of the time. Patients are individuals and a "crystal ball" is not within this or any physician's treatment kit. I would trust him to care for me or my family. I do not know all the specifics of this case, but it seems like the care was reasonable, and the Dr. was on top of the patient's condition. I don't know why the jury decided on a $10M verdict for the plaintiffs. I am very sorry for their loss. Clearly Mr. Allen was well loved.
Feel so bad for this doctor.
He seems so sad.
Btw, can I add that this doctor did not administer the kayexalate himself?? It’s bugging the crap out of me when the dude keeps saying “when you administered”.
Awesome catch, I noticed this as well.
If it’s not documented, it didn’t happen. Period. I know we can become complacent at times because patient documentation can be extremely tedious and time consuming. And I’m emergency situations we usually can’t document immediately but my God keep track of what you did and document as soon as the emergency is over.
So it is how well you are in making up stories.
We need tort reform! No wonder our health care is so expensive,the doctor's are doing the best they can! He did what he thought was best for the elderly man. You wonder why young people want to go to school for a decade and hundreds of thousands in debt to keep up alive,even lawyers.
So what, every doctor gets a pass because they did more school? What about the incompetent but arrogant ones that profile and dismiss? And life altering injuries happen? Just let it slide?
I'm guessing doctors do not make mistakes? Next time call your lawyer when you're needing life saving treatments! Lawyers who make more money than people who helps keeping our species alive is not good! We're devolving as a species!
Good & educated comment. Thanks Doc.
When I was a medical ward clerk, ALL verbal orders were documented in the patient's chart, especially medicines...
Yes, i also find that to be very suspicious.
Wow pt1 was a slow roll but pt 2 is great the explanations of the how and why are fascinating i love the questions
Even if the calcium chloride wasn’t a written order or documented in the MAR, the pharmacy or the pyxis should have some record of dispensing the medication unless it was in crash cart ?!
If CaCl was taken and used from the crash cart, there would be no computerized documentation of it being dispensed (it would be written later in the patient's chart). But since the Dr was calling the pharmacy for the C₁₂H₂₂CaO₁₄ and told to substitute w/ CaCl, the nurses either obtained it from the pharmacy or from the nursing floor stock (which if they weren't located in the ICU, the nurses would not have it in stock).
If I was the defendant in a medical malpractice suit I would not want a jury trial. I would prefer a judge decide. He would be less likely to let sympathy for the "victim" effect his decision.
You would be surprised actually. For the most part juries tend to have more reverence for doctors and are often very reluctant to hold them responsible no matter how sympathetic they feel for the plaintiff. Judges often have much less reverence for doctors because they understand that they are human and make mistakes like everyone else.
@@Millerandzois I guess I probably would be weeded out during voir dire in a medical malpractice suit..As I tell friends, "incompetence, negligence, and apathy is rampant in healthcare" :(
@@johninjersey Me too JJ. Worked in healthcare 40 plus yrs. Still there.
They make it difficult for their coworkers who treat every pt with dignity and respect, who never factor in the"fault" of the pt and give our BEST care every time without judging pt.
I report all caregivers guilty of subpar care. I do one on one 1st.
No improvement ?
Let it go in their file.
I encourage them to give me the same if warranted.
These "professionals" embarrass me.
I was taught to treat every pt as tho they are family or myself.
That is my code of ethics.
It serves me well every time.
@@johninjersey Yet every year except 9-11 nurses are voted by the public to be the most trusted profession,
who keeps saying objection and why does the doc keep talking after said objection?
As a former RN, I feel bad for this doctor. Given the circumstances of this patient and the reality of starting hemodialysis immediately in most hospitals, I feel his decision to implement the Kayexalate order set was a prudent and logical option. I feel most doctors would have done the same thing.
Yep. He caught the negative jackpot of a 1/10000 adverse effect, something that's frankly not even taught to physicians or APPs. Everyone give kayex for hyperK
The current way of ducumentation is not suitabe for busy medical practice.
Going crazy here. Immediate dialysis requires a special IV line which is placed in order for dialysis can begin. This is placed either at the bedside, or in radiology, the bedside being the quickest way, but this takes time. Stat hemodialysis sound good, but stat dialysis without an access for dialysis won't happen stat. Lawyer asking questions a nephrologist should be answering. This guy might be smart, but knowing how fast a Potassium will drop after initiating dialysis, is a nephrologist question.
The patient had no functional kidneys. Did he have dialysis vascular access or was the potassium allowed to pile up in his blood until he became unstable? It sounds like his condition was already a part of medical history and now throwing this doctor under the bus. I don't know his true history, but no functional bowels, no functional kidneys, what do you expect this doctor to do?
I would still trust this doctor to care for me or my kid. I don't feel bad for big hospitals who have to pay life-changing money to grieving families. It's a shame that good doctors get their names dragged though.
Sorry, there is no way a pharmacist is going to release a medication without an authorisation.
Listening to this is excruciating but fascinating. I think one important part that is missing is that the doctor is not able to get the specialist to come within any given time frame. He had to do the best he could in a dire situation. Why can't he administer the dialysis?
The lawyer as they do often trivializes dialysis. Dialysis takes training to administer. A nurse, vascular access for the procedure. Dialysis can be dangerous and can cause a unstable patient to die. You have to be trained to administer it. Unfortunately it was made as if this doctor just chose not too.
@@NyRenalMD Exactly! I can’t count the number of code blues that have been called from the dialysis unit. These are relatively stable patients, not counting the dialysis at the bedside in ICU who are too unstable to transport to the dialysis unit. This physician was not at fault.
The nephrologist initiates dialysis. Requires special orders, donor only by the nephrologist!
I'd like to have an update on the cases. Always interesting how these things turn out.
Agreed - I read in the baltimore sun article that UMMC would appeal the decision. I'm wondering if that happened and what the result was, or if it's pending.
@@phakeAccount Obviously on appeal an order of Remittitur was granted reducing the judgment to statutory level of $906250.00, not sure if Plaintiff's appealed that. Do Miller & Zois agree with this assessment?
As a a Doctor how do you not know the risks of a medication. I read every medication that is prescribed to me for what the medication is for, the risks and side effects.
Yes, I'm sure you know every post-marketing report of every pill you've ever taken. GTFOH
There are several warnings and potential problems with this medication that he did not explain
This is exactly why medical costs are so ridiculously high!
Of course says the nurse. Noooo bias there whatsoever
Never answer hyper-theatricals. Just so you know, you'll only need to answer what your experience and knowledge are about this if you don't mind. The same expertise was given for ages, "not documented, not done!"
Nurses don't routinely use a dialysis catheter unless ok'd by the nephrologist. Only in an emergency. We're taught not to use them.
sad. Documentation and Informed consent would have been helpful here.
Very hard to go forward with a medical malpractice case.
I would love to have insight into the chart. All labs, meds, EKG. So many thing go into treating a patient with the severity of this illness. Interesting comment when lawyer asked why doctors shred handoff notes. Seriously? Wonder if any nurse was also deposed in this case.
Objective form, asked and answered move on!
There are many causes of Hyperkalemia, which is sometimes very hard to reverse in a similar patient in hospital setting.
As long as the doctor followed standard of care patients dies in hours.
BS case that was taken to court.
Document document and document even if patient say the F word and sneezed.
Even Without calcium chloride he would have dies anyway.
Was the physician held responsible? Or just the hospital?
My wife a nurse tells me they use kayexylate all the time and rarely get ekg before as important to get k down. She says k high doesnt mean there is always an abnormal ekg.
That is correct!
Dr. crumbles under questioning and his lawyer stinks. Excellent job by patient's atty. I particularly enjoyed mark 48:48ish when atty states "okayyy" in a way that may imply he is absolutely getting doc to spill and happy with the doc's stumbling. ✌🏻
Sadly his lack of experience didn't lead him to act to prevent increased K+ from causing altered heart rhythm. He seemed to have waited until the abnormality "showed up". He should have gotten hold of those labs as soon as he started his morning shift. A problem with a big medical center is one has to be aggressive to get the other departments to act. At times, an RN can be counted on to get action from the lab. Where was the RN in all of this? Having had an overall view of the patient's other health problems, leading to poor perfusion of the bowel, he could have been more reluctant to give the K. The system doesn't allow for thought and contemplation. Experience can not be replaced. After all this is a teaching hospital. I'm sorry he got caught up in this. It could happen to anyone.
I want to jump up and scream!
the lawyer got the doc hung up on kayex the doc should have said i refer you to manufacturers prescribers guidelines - he gave more information than lawyer asked for he ment well but he got roped in piece meal
Annoying how a lawyer objects to every question where the answer reveals what happened.Objecting to the truth being told. :(
There are good reasons to object to a question which may go against law and/or the rights of the person being asked.
Patient was 63 years old.
That ain't old these days.
With the medical issues he presented with his body was much older
He sounds like he’s making up the ca chloride...🤔
Surprisingly, the doctor doesn’t know if the calcium chloride was given IV push or over an infusion.
Too much “teaching” by this doctor.
I don't think so. Doctors need to put medical lingo in layman's terms so a jury can understand the details and make an informed decision. I'm sure he was briefed on how he should answer. If he didn't teach then he'd be seen as combative and I don't think that would help anything.
Jon Smith This is a deposition not a trial. Big difference. Answer only the question asked… Period.