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Why I decided to settle

Faced with a conflict between his religious beliefs and a pending malpractice trial, this physician chose to stop fighting.

By Samuel N. Grief, MD
Family Physician/Chicago

Every doctor has a malpractice odyssey, it seems. Mine came six years after my residency, when I was practicing in New Hampshire.

The plaintiff, whom I'll call Mr. T, was a 40-year old native of Pakistan who'd been living in the US for several years. I'd seen him only once, as an add-on to my usual busy schedule. He'd come into the office for a routine blood pressure check ordered by his regular doctor, a colleague in our thriving family practice group. The nurse had registered a blood pressure of 200/120, and he needed to be seen. After reviewing his medical record, I noticed that his BP had been difficult to control for almost seven years, as long as he'd been a patient in our group.

Over the years Mr. T had taken a variety of medications for his hypertension. His BP was baffling; it would intermittently rise and then fall back to near normal levels. After my brief evaluation that day, I ordered a lipid profile, urine dipstick, and IVP. I also referred him to a nutritionist for dietary counseling, which he'd never received. I then prescribed doxazosin, a new medication to lower his blood pressure. I started him on the lowest dose to avoid any orthostatic hypotension, and asked him to follow up with his primary care doctor in a few days.

The next morning, Mr. T called to report symptoms of blurry vision and dizziness. "Sounds like it might be a side effect of the new medicine," I told him. I added that he should try to take the medicine again that night and call back or come in over the weekend if he still didn't feel well. That was the last time I spoke with him.

As I learned later, the day after that call Mr. T apparently told his wife about feeling the same fleeting symptoms of dizziness and blurry vision, plus some difficulty speaking. Because of his fear of a recurrence, he stopped taking the medication.

The next day, Mr. T again felt the same transient symptoms, and went to the local emergency room. By the time he arrived, however, he was feeling fine. The ER attending, and a colleague of mine who was on call for the group, decided that Mr. T had been suffering from side effects of the doxazosin. They told him to stop taking it, and to report back to the ER if his symptoms returned. The next morning he did, this time the victim of a stroke.

Preparing for trial, facing the Day of Atonement

Fast forward 18 months, when I received my notice of the malpractice suit. I was listed as a co-defendant along with two colleagues and the ER doctor. My lawyer prepped me for the deposition as though I was going into a boxing match with the plaintiff's attorney. The deposition lasted only an hour, but I still recall nearly every detail.

The thought of being involved in a malpractice case preoccupied me. I read books on how to prepare for court and how to be a good witness. But I kept wondering how my best intentions to help someone I'd seen briefly only once could be perceived as anything other than competent and compassionate medical care?

By the time the case was finally put on the docket, it was more than two years since the day I'd received notification of the suit, and almost four years since my brief encounter with the plaintiff. Perhaps because of that passage of time, I no longer felt compelled to have my day in court. And I felt that Mr. T had already suffered enough.

The insurance company had already made an initial offer to settle the case on behalf of the hospital's ER physician. Now it was my turn: Was I willing to settle? Absolutely! Although I welcomed the prospect of explaining my side to a jury, I truly wanted to put this case behind me. When the issue of settlement came up, though, the plaintiff wanted much more than my insurer was willing to offer. So we were headed for trial.

Then the attorney assigned by my carrier called to tell me the trial date. It was scheduled to begin on Yom Kippur, the holiest day of the Jewish faith. I told him I simply couldn't be in court that day, and asked him to request a postponement. He did, but to our surprise, the request was denied. When I insisted that I couldn't attend the trial that day, the lawyer warned me that that would look bad. But I stood my ground. To go to court–let alone to work–on the Day of Atonement would be impossible.

Choosing peace of mind instead of a court battle

That's why I decided to settle. I called my insurer and spoke with the person in charge of making a decision about settlement. I told her of my desire to put the malpractice suit behind me and start the new Jewish year on a positive note. She said it was now out of her hands. I hung up, expecting the trial to start the following week, but still determined not to attend it.

The Friday before the Monday trial date, I was so busy caring for patients that I forgot to check my voice mail until after hours. That's when I heard the news: The malpractice case was settled! The plaintiff had accepted the insurance company's offer on behalf of all the doctors involved, so there would be no trial. I would be able to observe the Day of Atonement with peace of mind after all, and the hope of better things to come in the new year.

What are the lasting effects from this case? During the two years of discovery and depositions, I learned of the residual difficulties Mr. T continued to endure in his daily life. I still feel genuine sympathy for him, and I hope he harbors no lasting resentment towards the medical profession.

As for me, I don't believe that having my name in the National Practitioner Data Bank is a permanent smear on my medical record. With all the litigiousness in this country, it's unfortunately common for physicians to be sued, or to settle a case. It's too bad, however, that most physicians faced with a lawsuit take a defensive posture, and seek only full exoneration. The system here is based on laying blame for the injury, not working collaboratively to remedy the problems.

I now realize, too, that providing competent and compassionate care may not be enough to avert a lawsuit. I'm still glad I settled, because I felt it was the only way I could bring peace of mind to my former patient and to myself.

Samuel Grief. Why I decided to settle.

Medical Economics

2002;18:5.