Doctors' Writing Contest
Runner-up Winner

My malpractice case was literally a trial by fire

A lawsuit was bad enough. A sorehead with a Molotov cocktail was what made the author's malpractice trial really memorable—and this article the runner-up winner in our Doctors' Writing Contest.

By Allan E. File, MD
Family Physician/Urbana, IL

Colleagues had warned me that a malpractice suit can really take a toll on a physician. I never suspected that it might nearly take my life as well.

Four years have passed since my infamous day in court. The depositions, yellow legal pads, and newspaper clippings from that time are all filed in the oak cabinet my wife and I once bought at an auction. As I thumb through the contents, I pull out a picture of myself from the Chicago Tribune. Another clip from the St. Louis Post-Dispatch depicts a charred courtroom. A local newspaper article is headlined, "People in courtroom all ran for their lives."

As the flaming bottle-bomb whizzed past me, my first thoughts were a swirl of panic, disbelief, and self-preservation. I slammed my jaw against a hard edge as I dived under the courtroom table and braced for the impending explosion. I could taste the bitter tang of blood in my mouth and hear the screams of jurors stampeding by me. My mind registered a feeble protest: Wait a minute! I'm just an ordinary guy. These things don't happen to people like me. But I, the jurors, litigants, attorneys, and spectators in the courtroom were just in the wrong place at the wrong time.

How did we get there? The strange saga began in February 1993 in the family practice office of the Carle Clinic, where I've worked for the past 14 years. A nurse practitioner on the ob/gyn side of the clinic asked me to examine a post-cesarean patient scheduled to have her abdominal staples removed two weeks following surgery. Her attending obstetrician, Jane Reilly (not her real name), wasn't available.

When I walked into the room, I was struck by the patient's morbid obesity. A short woman, she weighed more than 250 pounds. I don't remember much of our conversation beyond my inquiries as to whether she was having any discomfort. It seemed like a straightforward case. I noted four separate, small areas of wound separation, the largest of which was 2 centimeters in diameter. Most of the staples were halfway out. The remaining stapled areas appeared to have some redness at the skin margin. There was no evidence of fluid or drainage.

"Let's take them all out to prevent possible infection, and we'll continue with the same wound care that Dr. Reilly ordered," I said, reminding her of a scheduled follow-up appointment in a few days.

The patient left with a relative—and proceeded to eviscerate about 90 minutes later following a coughing attack at a local fast food restaurant. Not a pretty scene. Following a gush of fluid, her greater omentum and some of her small intestine came through. She evidently grabbed some napkins and used them to hold things together until she reached the hospital, where the wound was repaired surgically. I was, of course, disturbed when I heard about her trauma. Had I missed something obvious?

Her history was complicated, I later learned, by the fact that she smoked heavily, which contributed to chronic bronchitis and fitful coughing. In reviewing her case, I concluded there was no way I could have anticipated what had happened. I wasn't at fault, and neither was Dr. Reilly, a great physician who had delivered my own children.

The patient recovered and moved out of state. She returned a couple of years later, armed with a lawsuit, naming Dr. Reilly and me for providing substandard care. The suit alleged that Reilly shouldn't have done the C-section at all, but since she did, she should have used a different suture technique. And I should have known that the patient would eviscerate, it added.

We went to trial in April 1997 on the third floor of the 96-year-old Champaign County courthouse. The dark wood paneled room contained about 25 people. The jury was seated up on a staged area across from me, with the opposing counsel to my left and the judge to my right.

My codefendant, Jane Reilly, was the first witness, and I hastily scribbled down the question-and-answer exchanges. Suddenly I became conscious of a disturbance, a murmuring sound from the jury. As I looked up, I saw in my left peripheral vision the outline of a man in a hooded sweatshirt standing just a few feet from me. There were gasps and shrieks as I saw him pull out an object from under his sweatshirt, fuss with a lighter, ignite what looked like a wick of some kind, and then hurl the flaming projectile past my head.

I plunged under the table as I heard the pandemonium of chairs scraping and people screaming and running. All I could do in that moment was cover my head and brace for the explosion and flying debris. In that eerie vacuum of expectant doom, I heard only the receding sounds of stampeding hysteria and the faint crackling sound of fire. I had expected a "boom" of some kind. Was I now alone in this incendiary room with an armed lunatic who would happily blow me away the second I tried to break free?

Slowly I eased my frozen body forward so I could dare a craning view past the table legs and floor area around me. As I crawled away, I could smell gasoline and see flames hungrily lapping up the wall behind where the judge had been seated. Halfway between my table and the door to freedom, a quick glance backward revealed the bloody, staggering form of the stately 69-year-old judge.

I stood up, praying the bomber was gone, and hurried back to the dazed man. A huge laceration crossed his forehead, and blood was running down his face on to his robe. Grabbing his arm, I said, "We've got to get out of here!" I worried that the bomber might also have a gun and that we would be shot. I hustled the judge through the back door, past his inner chamber, and down a back hallway. A bathroom door was open, and I could see a paper towel dispenser. I steered him inside and pulled out a handful of folded towels to apply to his wound. Thank goodness he was ambulatory.

We hurried down the hallway, and I furtively glanced back at the courtroom door. Through the upper glassed section I could see the silhouette of the raging fire. The back wall was completely engulfed now, and a canopy of flames was forming over where the jury had sat just minutes ago. All we had to do was get down those three flights of stairs and outside. Others were running past us yelling, "Bomb! Fire!"

Once we got to the street, I examined the judge more thoroughly, and found nothing besides his laceration. He wasn't sure if the bottle had hit him or if he'd cut his head on the table as he ducked. In a few minutes, the ambulance arrived.

When we arrived at the ER, I received a page from my wife. She had been standing in line at a clothing store, waiting to pay for a tie she wanted me to wear in court the next day, when she picked up on the clerk's comments to a customer just in front of her: "You never expect something like this to happen in a community of our size."

"What are you talking about?" my wife asked.

"We just heard on the radio that the courthouse has been bombed."

Images of Oklahoma City, rubble, and destruction seared her panic-stricken thoughts. "The Champaign County courthouse? My husband is involved in a trial there this morning! What did the radio report say?"

"That people were pouring out of the building, and that there were ambulances and fire trucks everywhere."

Four years have passed since that day. The judge recovered with only a scar, and retired soon afterward. Three other people suffered minor injuries. The courthouse didn't burn down, but Courtroom B was described in a newspaper article as a "charred, blackened scene of destruction." All our notes, laptops, and various articles of clothing were destroyed, including one of my co-defendant's high-heeled shoes, which she lost while bailing out of the witness stand.

Who threw the bomb, and why? The unstable 37-year-old man was apprehended a few days later. He didn't know anything about me or my malpractice case. His target was the judge, who had earlier dismissed a frivolous slip-and-fall case the man had filed against a supermarket. He remains in custody—I hope!

My malpractice case was later retried in a different courtroom with a different judge. It took the jury less than two hours to decide that we weren't at fault.

Not long ago, I was called for jury duty. Whereas security was virtually nonexistent the day of the bombing, it was noticeable this time. There was only one entrance, and it was monitored by security personnel who required everyone to walk through a metal detector. The trial I was assigned to took place in that same courtroom upstairs, now remodeled with generic white walls and modern furnishings. As I walked down that same hallway, I paused at the bathroom door and reflected upon my last brief visit and the irony of being there again.

I like to think that I've closed the file on this past experience. We get on with life. Doctors are trained to do that. I don't feel any palpable evidence of trauma. I'm in good emotional shape and consider myself to be reasonably secure and well-adjusted. So what's the problem?

I run in my sleep—literally. Not Olympian strides, but a series of panicky, spastic, flailing movements that wake my wife. She in turn jabs me awake with the same goofy, sarcastic question, "Where are we going tonight?" Most of the time we're going nowhere. It's the usual variation on a theme where I'm being attacked and have to escape by running for my life. I've been "running" for about three years now. I haven't lost much weight, but I've worn a hole in the bottom sheet of our bed, right down there where my feet are supposed to be resting.

Hmmm. Could it be that I have a few little wound separations of my own? It all looks just fine on the surface. Maybe I'll leave a few of those staples in this time, just in case.

 

Allan File. My malpractice case was literally a trial by fire. Medical Economics 2001;6:57.