medmalreviewer @medmalreviewer Twitter profile

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medmalreviewer

3 years

Medical malpractice cases from nearly every specialty with real-life expert witness opinions used in the lawsuit. Check it out:

The Expert Witness Newsletter | Med Mal Reviewer | Substack

Expert witness opinions for medical malpractice lawsuits. Click to read The Expert Witness Newsletter, by Med Mal Reviewer, a Substack publication with tens of thousands of subscribers.

expertwitness.substack.com

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medmalreviewer

@medmalreviewer

1 year

Hands down, this is absolutely the wildest post I’ve ever seen on Reddit. Really, really, really hoping this person does not have rabies.

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@medmalreviewer

1 year

@ScholerinED Hoping it’s just someone trolling

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@medmalreviewer

1 year

Also, pop quiz… where do you need to biopsy this patient?

In the wound

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Oral swab

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@medmalreviewer

2 months

Really incredible article about an insurance company disciplining a doctor for following the standard of care. Looks like their “experts” are just as bad as some of the most crooked plaintiff experts I see.

Insurance Corrective Action Poses Danger to EBM and... : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

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medmalreviewer

@medmalreviewer

4 months

Just read through the Halyna Hutchins autopsy (Alec Baldwin shooting on Rust) and it strongly suggests substandard prehospital trauma care. 1. Esophageal intubation 2. Needle decompression didn’t actually make it into the chest

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@medmalreviewer

1 year

@jkantor_MD Antemortem rabies testing including biopsy of a particular skin location:

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@medmalreviewer

3 years

Tomorrow's case centers on this:

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@medmalreviewer

9 months

When I was a med student on a transplant surgery rotation, the trauma surgeon held up the donor kidney, looked at me, asked “what would we do if I dropped this kidney on the ground right now?” “Cancel the operation and wait for a new kidney?” “No. Pick it up, wash it off, and

Oren Gottfried, MD

@OGdukeneurosurg

9 months

My worst nightmare! Man accidentally drops a donor heart on the ground. Luckily, it wasn’t damaged or contaminated.

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@medmalreviewer

1 year

Something I've seen dozens of times: NP accused of malpractice. Plaintiffs hire a physician expert witness. Lawsuit dismissed because a physician is not qualified to criticize an NP in many jurisdictions (they don't have "similar training").

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@medmalreviewer

4 years

I’ve seen a lot of malpractice cases, but I’ve never seen one for sending asymptomatic hypertension home still hypertensive.

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@medmalreviewer

1 year

If a patient comes back from CT and the radiologist calls and says "ascending aortic aneurysm, ruptured, active extrav, mediastinal hematoma", then the patient codes in front of you, are you starting chest compressions?

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@medmalreviewer

1 year

Found a malpractice lawsuit stating that it was negligent to admit a TIA patient (symptoms resolved), and that he should have been discharged. Why? Patient has a stroke overnight in the hospital. Neurologist didn't trust the nurse's neuro assessments, so they said no last

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medmalreviewer

@medmalreviewer

25 days

Some of the wildest med mal cases I read are from big prestigious medical centers. Some of the worst experts work at the fanciest academic hospitals.

Siyab Panhwar, MD

@DrSiyabMD

25 days

Truly very sorry for your loss. I hope there is some sort of investigation to make sure this doesn’t happen again. But bad care can happen anywhere, including at large fancy ivory tower academic medical centers, and in red and blue states. It is unfair to paint an *entire

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@medmalreviewer

7 months

I worry a bit about the documentation habits of new EM grads. The pendulum has swung from documenting almost nothing to documenting massive walls of text with multiple paragraphs. Its not going to stop you from being sued.

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@medmalreviewer

9 months

Interesting lawsuit... Lady with complicated surgical history presents with RUQ pain. US shows multiple gallstones. Surgeon goes in to take the gallbladder out... No gallbladder. It was actually someone else's ultrasound, mislabeled.

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medmalreviewer

@medmalreviewer

3 years

What are the top 5 drug interactions an EM doctor should know?

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@medmalreviewer

1 year

A 37-year-old woman (herself a physician) at 17 weeks gestation presented to the ED with a fever of 102.8 and heart rate of 120bpm. She was sent to L&D, where fetal demise was diagnosed on US. She was diagnosed with a septic abortion. There was a delay in starting antibiotics.

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medmalreviewer

@medmalreviewer

3 years

Well. Found the entire text of the lawsuit forcing a hospital to give the horse paste to a patient. It’s…. pretty crazy. Going to publish it but might have to paywall it to protect from litigious, uninformed people.

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@medmalreviewer

9 months

Stress test decision-making gone wrong

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@medmalreviewer

8 months

The most recent case from my newsletter ⬇️

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@medmalreviewer

2 months

Well here’s a wild case: Guy goes in for a stress test. Rad tech helps him up on the table. Patient (very obese) says… you sure this will hold me? Tech says yeah, it’s held people plenty bigger! Table collapses. Patient suffers horrific series of complications including

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@medmalreviewer

1 year

I’ve seen an expert witness have their credibility destroyed and the lawsuit was thrown out due to this exact issue. Expert forgot to make the payment. Opposing counsel asked ABIM to confirm their MoC. ABIM says nope, they didn’t pay and lapsed.

Dr. Glaucomflecken

@DGlaucomflecken

1 year

Do I have this right? - ABIM requires yearly fees from physicians who are already cert to “maintain certification” - no evidence that MOC helps pt care - ABIM will report you as “not certified” if you don’t pay - hospitals require certification Idk kinda sounds like extortion

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@medmalreviewer

11 months

Not gonna lie, pretty pleased with myself for this opening paragraph:

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@medmalreviewer

7 months

You can choose a career to help those in need, or a career in which you try to tear down the helpers. The choice is yours.

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medmalreviewer

@medmalreviewer

4 years

When you notice an uptick in attorneys subscribing to your content but you’re just a doctor who does elementary legal research via Wikipedia and kind of wings the law part of it.

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@medmalreviewer

1 year

I’m begging all EM residents, please actually figure out what the retirement benefits are when you interview for a job. They’re not all the same, and some can be *very discreetly* worth millions of dollars. It pains me how overlooked this is.

Attending Jobs | The Most Underrated Job Benefit for Employed Physicians

attendingjobs.com

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medmalreviewer

@medmalreviewer

6 months

My goal for the year is to release a stroke CME class. Going to consist of 3 stroke cases that arose from ED decision-making with a *very* deep dive on the records: full medical chart, depositions, expert opinions, arguing about tPA and thrombectomy, legal maneuvers, etc… I’m

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@medmalreviewer

1 year

A patient bounces back to the ED with bilateral leg weakness to the point that they can't walk. They were seen 3 days ago with back pain and severe leg cramping. They had a normal lumbar/thoracic MRI and a normal CK. What's the diagnosis?

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@medmalreviewer

1 year

Every ER doctor (or rotating shift worker) needs to have at least one unemployed friend.

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@medmalreviewer

1 year

If an ER doctor pages an on-call specialist, asks a specific clinical question about a specific patient (and gives the pt name, location, and DOB) is that a consult?

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@medmalreviewer

1 year

A big malpractice case was filed a few days ago: EMS accidentally gave 500mg IV ketamine (instead of pain dose) to a lady entrapped in a car. Pulse ox undetectable for ~10 min before they got her out and bagged her up (she didn't code). Got her to the hospital.

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@medmalreviewer

4 years

Imagine having to explain this on every single job application under "Have you ever been sued before?"

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@medmalreviewer

6 months

Would anyone like to read a brand new med mal newsletter that consists solely of lawsuits against surgeons (of numerous specialties) who are sued for injuring people's ureters? I have so many of these I can't even count them. They all read the exact same way and if I published

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medmalreviewer

@medmalreviewer

3 years

Just published a tragic case of a 12-year-old boy’s death. Seen by NPs with consulting physicians over several visits. Multiple expert witnesses. 7-figure verdict.

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@medmalreviewer

4 years

My overarching opinion on clinical documentation: HPI, ROS, exam should be done as fast as possible, clicking buttons, pre-populated text. It’s just for billing. The MDM should be done in narrative form, 1-3 paragraphs, no automated text. Write down what you were thinking.

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@medmalreviewer

1 year

Home BP cuffs cause more unnecessary ED visits than any other cause. Hypertension on home BP cuff —> Anxiety —> Psychosomatic symptoms, which essentially mandate (in our medicolegal climate) large ED workups.

Howdoyousaythat, BBQ

@TriageNurseMD

1 year

My Political beliefs? Abolish all home blood pressure cuffs Burn them. Throw them away. Drag them out of the clutches of the elderly.

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@medmalreviewer

9 months

Re: ED visits for chest pain Now that there is broad adoption of high sensitivity troponins, I see way more lawsuits from missed aortic dissections and PEs than I do for missed MIs.

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@medmalreviewer

1 year

For every *interesting* med mal case I find, I have to sort through 50 cases against nursing homes in which a debilitated/frail elderly person slowly dwindled, got pressure ulcers, had multiple falls, and died without a super clear cause of death.

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medmalreviewer

@medmalreviewer

5 years

Reviewing lawsuits on mefloquine (malaria prophylaxis): One lawsuit because the patient suffered severe psychosis as a side effect. Another lawsuit because the patient was warned about side effects and therefore placed on an alternative, and ended up getting malaria.

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@medmalreviewer

1 year

I've never seen a lawsuit in which a chest pain patient had 2 negative high sensitivity troponins and was sent home.

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@medmalreviewer

1 year

When I realized that I wanted to do an atypical side project that involved publishing people's medical records online. And wanted to monetize it. Also when I realized that most published research has no impact and is read by almost nobody. Blogs and newsletters more well read.

DocMcCafferty (She/Hers)🌊🏄‍♀️⚽️🏐🏀🩰🤸🏼‍♀️

@DocMcCafferty

1 year

When and how did you realize that academic medicine might not be your cup of tea? #MedTwitter

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@medmalreviewer

4 months

Yes, *another* anticoagulation med mal case:

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@medmalreviewer

3 years

@MattWhite_95 @jmugele If there are system issues that limit you from providing care a patient needs, I would document it. Obviously has to be done professionally.

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medmalreviewer

@medmalreviewer

4 months

Sometimes ET tubes get dislodged during transport and during chest compressions (which you probably shouldn’t be doing for penetrating trauma anyway). But if it was placed in the esophagus originally, it took this injury from a small chance of survival to zero chance of

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@medmalreviewer

1 year

A pt is admitted to the hospital for chest pain rule out. Cardiologist recommends echo: - normal EF - moderate pericardial effusion - moderate aortic regurg - ascending aorta 5cm in diameter Cards: follow-up in 2 weeks for repeat echo What test should the hospitalist order?

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@medmalreviewer

3 years

Truly one of the worst expert witness I’ve ever seen.

Case #44 [Terrible Expert Opinion]

A 42-year-old woman presented to the ED with right lower quadrant abdominal pain. A CT scan revealed “uncomplicated appendicitis”. A general surgeon was consulted and took her to the operating room...

expertwitness.substack.com

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medmalreviewer

@medmalreviewer

7 months

It’s good to document your thought process, and will come in handy when you’re defending yourself in a lawsuit. But don’t go overboard. You’ll burn yourself out and may be giving the other side too much rope to try to hang you.

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@medmalreviewer

3 years

Today’s #medmal tidbit: A doctor gets sued for malpractice. Insurance says don’t settle, you’ll win. ... doctor loses.... ... $3.45 million verdict.... ... her policy limit is only $1 million... So now she’s suing her insurance company bc she’s on the hook for $2.45 million.

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@medmalreviewer

1 year

When insurance companies fight massive, private equity-fueled contract management groups, it’s hard to know who to cheer against. Both actively trying to leach every dollar possible from doctors AND patients.

Ben White, MD

@benwhitemd

1 year

Bombshell lawsuit against Radiology Partners from United Healthcare: United claims that RP funneled the work of multiple groups across Texas through its most lucrative contract held by a small group in Houston.

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@medmalreviewer

3 years

When you see a child with a painful hip, just know that 100% of children have had a fall the day before. You can mentally write it off as a hip contusion if you want, but if you’re wrong it’ll be terrible for everyone.

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@medmalreviewer

4 months

The autopsy also described tension physiology. The needle never actually decompressed her chest. It never made it through the chest wall. This is a very common issue and a good reason why many strongly advocate for finger thoracostomy now.

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@medmalreviewer

11 months

A patient develops shortness of breath. Echo shows a large pericardial effusion, no tamponade. They get a pericardial window and feel better. 8 wks later symptoms are back, now w/ pleural effusions and ascites. What's the diagnosis? (this is a pattern you must recognize)

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@medmalreviewer

6 months

I now have found good malpractice cases about frostbite management after a snowmobile mishap, and hyperthermia management after a search/rescue of a stranded motorist in the desert. Just need a 3rd case to round it out and I think I can create a very interesting online CME

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@medmalreviewer

1 year

A 68-year-old man had a stress test. Results showed "evidence of anteroapical and septal MI" Unfortunately no one bothered to follow-up with him about these results. He had a cardiac arrest and died. I publish cases like these every week via email, link is in bio to sign up.

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@medmalreviewer

7 months

This may be unpopular, but it’s always been a charade that non-ophthalmologists can accurately identify these findings. Standard should be non-mydriatic retinal cameras with interpretation by ophtho.

Andrew Micieli

@MicieliA_MD

7 months

@ClementLeeMD *Correctly identifying the findings on fundoscopic exam In this study 0% were correctly identified in the ED.

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@medmalreviewer

1 year

Sometimes I feel relieved because it was a ridiculous lawsuit (plaintiffs bar thinks they only take good cases. False. They take an unpredictable mix of good cases and bad cases). Sometimes its frustrating because there was clear malpractice.

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@medmalreviewer

7 months

Don’t forget the thiamine!

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@medmalreviewer

4 months

She got a clamshell thoracotomy when she got to the ER, but she was aleady in asystole when she arrived. She was dead before getting there. I don’t know if she would have survived with a tracheal intubation and actual decompression of her chest, but she certainly would have had

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@medmalreviewer

4 months

Also, someone took the time to place a central line during a penetrating trauma arrest, when they already had IO access, which is a bit odd. Might be ok if you have an entire academic trauma team around, but is more likely to distract from doing the things that could actually

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@medmalreviewer

2 years

Imagine going in for a couple’s colonoscopy (might as well get them done the same day I guess), and 3 months later you both develop jaundice and… … get diagnosed with hepatitis C.

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@medmalreviewer

11 months

You know why independent groups of ER doctors won’t ever take over any of the significant APP contracts? Because USACS has an army of “business development” professionals and expert negotiators who have been working 80+ hours/week ever since whispers of an APP bankruptcy began

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medmalreviewer

@medmalreviewer

3 years

And here's the case:

Ivermectin [Emergency Injunction]

This week’s case is not a malpractice lawsuit. It’s a legal proceeding brought by a patient’s wife, demanding that a hospital give ivermectin to her husband. He has COVID and is near death. The...

expertwitness.substack.com

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medmalreviewer

@medmalreviewer

9 months

Alleged ortho malpractice:

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@medmalreviewer

1 year

(and I'm not even touching the "does tPA actually do anything useful for stroke patients" argument.... although I will note that making it standard of care absolutely helps plaintiffs attorneys extract millions of dollars from hospitals and doctors)

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@medmalreviewer

3 months

Tough case without tons of clinical details, but it spurred some really great discussion of the physiology of cardiogenic shock, the challenges of identifying sick kids, and transport issues.

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@medmalreviewer

2 years

On Monday I’ll publish a 3rd malpractice case involving fatal cardiac tamponade. 1 misdiagnosed as anaphylaxis. 1 completely missed until autopsy. 1 tried to delay pericardial window until the morning and they coded.

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@medmalreviewer

1 year

New EM Job Listing in Baltimore! I’m not looking for a job right now but this looks like it could be a great job for the right person.

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@medmalreviewer

10 months

@thats_bone As with most things, I suspect it’s multifactorial. Anecdotally the biggest contributor is the fact that all stroke alerts now get CTAs. Less than 10 years ago strokes only needed a plain head CT, then decision about tPA. CTAs/MRs were ordered upstairs the next day. Now that’s

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medmalreviewer

@medmalreviewer

1 year

A 40-year-old woman had cosmetic surgery on her neck. She went to a free standing ED several days later with an expanding hematoma. Multiple intubation attempts occurred, it was briefly secured, then lost again. I publish new cases every week via email, link in bio.

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@medmalreviewer

9 months

Guy who paid actual money for Twitter and still missed the window to edit “trauma” to “transplant” 😩

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@medmalreviewer

1 year

@RussellSterrett That's the conundrum... almost everyone would do compressions, but doesn't it seem like that would make the underlying root case even worse?

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@medmalreviewer

1 year

Fascinating tidbit from the Envision bankruptcy filing: Their 2nd largest unsecured creditor is a $4,000,000 verdict it appears they lost related to a medical malpractice issue in Texas.

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@medmalreviewer

3 years

I'd love to publish these cases if insurance companies are getting sued due to bad patient outcomes. If you've seen a lawsuit like this, send it my way.

Harrison

@HARRlS0N_

3 years

Honest question, if an insurance company error causes a patient to be off anticoagulation and this causes a blood clot, can that insurance company be sued? I’m looking at you @UHC 👀

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@medmalreviewer

3 years

Does the iPhone 12 contain magnets that inactivate ICDs? Looks like it might be true... High risk #EM and #Cardiology

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@medmalreviewer

9 months

Patient develop peritonitis from bowel perforation. Surgeons, enlighten me, it seems extremely odd that you just take a look and realize there's no gallbladder, and still somehow perforate the bowel?

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@medmalreviewer

2 months

@ScottTruhlar I’m a night owl anyway, so clearing 500-750k range and only working 18 weeks per year sounds like a dream job.

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@medmalreviewer

2 years

Found another MD expert witness who put his social security number on his expert report, which was promptly uploaded to a public legal database. Free tip for experts: Don't put your SS# on your report. Free tip for attorneys: Redact your expert witness' SS#.

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@medmalreviewer

1 year

Monday's case: 58-year-old with PKD and CAD calls his PCP: "I'm short of breath". PCP (IM-trained MD): prescribes Z-pak 2 days later calls back: "still short of breath" PCP: switches to levofloxacin

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@medmalreviewer

11 months

Interesting, ChatGPT-4 makes the diagnosis when several real-life physicians missed it (and most of the Twitter guessers) and got sued for it.

𝗥𝗲𝘀𝘂𝘀𝗠𝗲𝗱

@ResusMed

11 months

@medmalreviewer ChatGPT-4: Given the information you provided, the patient may be suffering from Constrictive Pericarditis. This is a condition in which the pericardium (the sac-like covering around the heart) becomes thickened and rigid, constricting the heart and interfering with its normal

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@medmalreviewer

9 months

All the missed MIs I see now are cases without chest pain, in which no one even thinks to check a trop. Upper back pain or shoulder pain (without any chest pain or SOB) are the most common missed-MI symptoms I see.

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@medmalreviewer

1 year

Something I realized recently while reviewing med mal cases. Every iatrogenic opioid overdose that was fatal, was caused by Dilaudid. Never seen morphine, fentanyl, or anything else cause one.

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@medmalreviewer

9 months

They also sued the PCP who did the pre-surgical risk stratification, because the PCP should have known the patient's surgical history.

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@medmalreviewer

1 year

Patient can't walk, numbness in his legs. You go to the trouble to get a lumbar MRI. Radiology read is below. Now what… discharge them home?

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@medmalreviewer

1 year

@YichengB Friends with "normal" jobs are never free to hang out when you're free to hang out.

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@medmalreviewer

1 year

If you catch yourself thinking... I'd like to order an MRI, but I'd also like to order a CK, you should probably do both of those things. Then when they're negative, do the LP. MRI + CK = LP

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@medmalreviewer

1 year

I've found that most "learning pearls" from medical malpractice cases are actually "reinforcement pearls". We already know the lessons, but for some reasons we didn't realize we had to apply them in a given scenario. Approaching them with this mindset helps keep you humble.

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@medmalreviewer

3 years

@zjepsonmd Hope so! Its a bit bizarre because its an evolving situation pitting a single doc who never saw the patient against an entire hospital who is taking care of him.

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@medmalreviewer

4 years

61-year-old woman on ski vacation. Anticoagulated. Crashes and hits head on the ground. Not many surprises here but worth a read:

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@medmalreviewer

4 years

@EM_RESUS @Twitter Giving false medical opinions without any evidence? Sounds like good fodder for a case I could publish.

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@medmalreviewer

4 months

Resisting the urge to hijack every medtwitter thread with a malpractice case vaguely related to the topic at hand.

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@medmalreviewer

1 year

Terrible. One of the most bizarre and absurd obstacles to getting elderly people into the care they need.

Robert Oubre, MD | The Doctor of Documentation

@Dr_Oubre

1 year

The 3 midnight rule is back. You may be 3 years into your career without knowing this rule bc it was put on hold for covid. Here's what it means: Your patient must stay 3 consecutive midnights of INPATIENT care in an acute hospital setting for Medicare to cover SNF services

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@medmalreviewer

2 years

Interesting med mal case going out today for subscribers… PA placed an NG in the ICU. Spoiler: it was in the lung, and caused numerous complications. Plaintiff sued the PA… but NOT the supervising ICU doc. Also sued 2 radiologists who read subsequent chest X-rays.

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medmalreviewer

@medmalreviewer

3 years

Found the transcript of a trauma surgeon refusing a transfer. She had already been warned by the hospital about refusing (fearing EMRALA violation). Hospital fired her. She sued the hospital for firing her. Not med mal but it’s going to make a fabulous and unique case report

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@medmalreviewer

3 years

Tomorrow's case will make the radiologists mad. Patient evaluated for knee replacement. Ortho says PCP must do risk stratification. PCP orders a chest x-ray. Radiologist says there's a weird 3cm density under a rib. Guess what?

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@medmalreviewer

1 year

The first-ever medmalreviewer case! (Going to have to re-edit this at some point.) 31-year-old man with shortness of breath. Too big for CT scanner. Doc says forget it and discharges him home. See the outcome:

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@medmalreviewer

2 years

Btw, given all the criticism EM has gotten the last few days from the press and misinformed armchair “experts” from within the house of medicine, none of these were EM related.

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@medmalreviewer

2 years

@dr_prevent @AshleyGWinter Thanks! Wrote it up yesterday with some more info that that article has: Also I always redact names even when published elsewhere.

Locked-In Syndrome [Chiropractor Adjusts Neck]

Case #131

expertwitness.substack.com

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medmalreviewer

@medmalreviewer

1 year

Patient comes to ED 2 weeks after Roux-en-Y bypass with abd pain. CT results show below. Consult the surgeon, who says "Hey don't worry, we'll see her in the office later".

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medmalreviewer

@medmalreviewer

11 months

Update: crisis averted!

medmalreviewer

@medmalreviewer

1 year

Hands down, this is absolutely the wildest post I’ve ever seen on Reddit. Really, really, really hoping this person does not have rabies.

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medmalreviewer

@medmalreviewer

14 days

I found a med mal case centered on this exact issue. Family (one parent a physician) was told their baby has Down syndrome. They chose to abort. If I remember correctly, testing afterward revealed mosaicism. Family sued. (Happened at Ivy League institution)

Lyman Stone 石來民 🦬🦬🦬

@lymanstoneky

15 days

Because there are still people who don't understand how abysmally bad prenatal testing is, I want to give you the regular reminder that even tests for extremely-recognizable conditions like Down's Syndrome are mostly wrong.

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