A 20-Minute Visit Changed the Way I Practice
Merli, Geno J., Medical Economics
Back in 1985, I first saw a woman I'll call Helen Thompson for deep-vein thrombosis, caused by birth control pills. I admitted her to rule out pulmonary embolism and treated her with heparin. I next saw Helen three years later, six weeks before the birth of her first child. She'd come for my reassurance that her OBG specialist was using subcutaneous heparin appropriately.
Not surprisingly, Helen's legs were proportionately larger in diameter than three years previously, and again the right leg was a bit larger than the left. She reported some bilateral cramping and said her right leg hurt when she was on her feet for long stretches of time.
After the visit, Helen had weekly exams by her obstetricians, who kept her on heparin until her delivery. Her labor lasted 17 hours and ended with a cesarean section and a healthy baby boy. Ten hours later, Helen suffered a massive pulmonary embolism and died. An autopsy confirmed the cause of death.
I called Helen's husband and also wrote him to express my condolences. But he later filed a wrongful-death suit against all the physicians involved in his wife's care, including me. I assumed I'd be dismissed from the case, since I was sure the OBG specialist would be the main target.
My complacency seemed justified when several years passed with no work from the husband's lawyer. Then came a brief deposition. Last year, my defense lawyer informed me that the plaintiff's attorney had dropped the OBG specialists from the suit and was focusing on me. The trial was set for last summer.
I was furious and terrified at the prospect of the trial: the stigma of being sued, the questions about my ability as a physician, the effect on my family and reputation, the entry in the National Practitioner Data Bank.
"I only saw her for 20 minutes," I protested to my lawyer, "and that was six weeks before her due date. It's ludicrous to think that a clot was silently present in her leg that long before delivery."
My lawyer said to calm down and help prepare for the trial. "If we're going to win, you've got to teach me everything you know about thrombosis and pregnancy," she said.
For weeks before the trial, I couldn't think of anything else. Although the media didn't mention the case, most of our friends and neighbors knew about it. Many asked me how I was coping and offered their support.
The trial wasn't at all as I had imagined from watching "Matlock" and "Perry Mason." First, the plaintiff's attorney displayed poster-sized documents and pictures of Helen and her husband and of Helen and her newborn son. Both husband and son, now aged 6, were in the courtroom, along with her parents and brother. All of them, I assumed, saw me as the terrible doctor who had caused the untimely death of their loved one. As her family testified to her character and their sense of loss, their words were so moving that even I began to feel I was somehow guilty.
When my lawyer cross-examined Helen's family and co-workers, she got them to admit that Helen hadn't complained of leg pain during the last six weeks of her pregnancy.
Then came the plaintiff's expert witnesses, neither of whom was very persuasive. The first was an internist who had retired six years earlier. He was led through the blowups of my office records. At each step, he stated emphatically that within a reasonable degree of medical certainty, I hadn't met the standard of care. He insisted that all pregnant women with leg cramping, swelling, or pain at any time must have a venogram. Though I was incensed by his comments, my lawyer cautioned me to remain calm.
The second plaintiff's expert was an emergency physician who testified that I should have performed non-invasive testing. By then, I feared that the jurors were convinced that an attractive, loving mother and wife had died because of my negligence.
Based on the testimony of an actuary on Helen's lost future income, the plaintiff's lawyer came up with an estimate of $500,000 for economic damages. …