{"id":330,"date":"2016-09-10T14:03:53","date_gmt":"2016-09-10T18:03:53","guid":{"rendered":"http:\/\/www.herbheineman.com\/?page_id=330"},"modified":"2024-07-26T09:46:32","modified_gmt":"2024-07-26T13:46:32","slug":"chapter-32","status":"publish","type":"page","link":"https:\/\/herbheineman.com\/Eden\/edensgarden\/chapter-32\/","title":{"rendered":"Chapter 32: Plans are Laid"},"content":{"rendered":"\t\t
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PART III<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\u201cI ran into Homer.\u201d Alan froze at Gordon\u2019s words. \u201cHe thought you\u2019d want to know, but he didn\u2019t feel comfortable coming to you directly.\u201d<\/p>

\u201cI\u2019m surprised he\u2019s allowed to talk to anybody, with all that legal paranoia.\u201d<\/p>

\u201cI didn\u2019t ask for the cause of death, just what he found in the heart. No vegetations, just slight retraction of the aortic valve. Beginning mitral stenosis too. Postmortem blood culture grew out Staph aureus, same as when she came in.\u201d<\/p>

\u201cNo endocarditis.\u201d\u00a0 Alan breathed a sigh of relief. \u201cI wouldn\u2019t have had the nerve to ask.\u201d<\/p>

Gordon looked at him. What a strange reaction, he thought, recalling the conversation at the FLYNT. The girl\u2019s dead and he\u2019s relieved the valve wasn\u2019t infected. Lord, he was even afraid to ask! What difference did it make? Eden had been practically in shock. It was an emergency if ever there was one. The valve was a long-term worry \u2015 if she survived the crisis, which she didn\u2019t. And why was Alan relieved? Why not upset that she died with a condition less serious than he\u2019d feared? Didn\u2019t that make her death all the more tragic?<\/p>

But Alan had another worry. \u201cKaren\u2019s on my back to file a lawsuit. Between you and me, I\u2019m not disputing the negligence. But suing my own hospital\u2019s a different matter. Win or lose, I\u2019d get kicked off the staff. And even if I didn\u2019t, nobody\u2019d want to associate with me.\u201d<\/p>

\u201cYou wouldn\u2019t get kicked off this partnership; that I can promise. And nothing in the by-laws says you can kick a doctor off staff for filing a lawsuit. Maybe that\u2019s academic if they\u2019re going to ostracize you. . . . It just isn\u2019t fair to make a man choose between his legal rights and his career, especially after a loss like yours.\u201d<\/p>

\u201cWhat would you do in my shoes?\u201d\u00a0 Alan asked.<\/p>

Gordon didn\u2019t hesitate. \u201cI\u2019d sue. They\u2019d settle, and there wouldn\u2019t be any publicity. If you wanted to protect Rick you could just name the hospital. That\u2019s where the liability is anyway. I also think the medical staff would be sympathetic. All they have to do is imagine a child of theirs being treated like that. Remember, your house staff is their house staff too.\u201d He put a piece of candy in his mouth. \u201cYou\u2019re not running much risk. Especially if you leave Rick out.\u201d<\/p>

Protect Rick? Leave him out? OK, Rick was entitled to rely on the house staff. But then, why was he being so evasive? Was Alan really supposed to buy that story about being out of town, an excuse delivered with such perfunctory regret? No, Rick was hiding. But then, Alan didn\u2019t want to be driven by the wrong motive. He\u2019d give Rick the benefit of old friendship. Let him stew in his own recriminations. And let the hospital involve him as co-defendant in the suit if they wanted; it wouldn\u2019t be his doing.<\/p>

\u201cDo you really think they\u2019d settle?\u201d<\/p>

\u201cI would if I were the one being<\/em> sued. But I\u2019m not a lawyer.\u201d<\/p>

\u201cI have no intention of going on the witness stand,\u201d Alan said.<\/p>

\u201cYou might get more from a jury. They\u2019d identify, especially if they have children.\u201d<\/p>

~~~~~~~~~~<\/p>

\u201cLooks like Gordon\u2019s on your side.\u201d They had just finished dinner.<\/p>

\u201cHow do you mean?\u201d\u00a0 Karen asked.<\/p>

\u201cAbout suing. He thought, one, that the hospital was liable\u2014\u201d<\/p>

\u201cOf course,\u201d Karen interrupted. \u201cThey\u2019re all hospital employees \u2015 except Rick.\u201d<\/p>

\u201c\u2014 Two, we could leave Rick out if we wanted. Three, the staff would be sympathetic. Four, the hospital would settle. Five,\u2014\u201d<\/p>

\u201cLet me guess. A jury would award at least five times what they\u2019d be willing to settle for.\u201d<\/p>

\u201cHe didn\u2019t give numbers.\u201d<\/p>

Karen smiled. \u201cHe\u2019s probably been around lawyers a bit. Has he ever been sued?\u201d<\/p>

\u201cI don\u2019t know where he gets his information, but you think he\u2019s right, don\u2019t you?\u201d<\/p>

\u201cAbsolutely. I\u2019ve been wanting to ask if you\u2019d had any more thoughts, but I\u2019m just as glad you brought it up. If you ask me, the only way we can lose is to accept a cheap settlement.\u201d<\/p>

Alan\u2019s look cautioned her not to go too far. \u201cEven if I do agree to a lawsuit, and I haven\u2019t yet, we\u2019ll take the best settlement your lawyers can get and leave it at that.\u201d<\/p>

\u201cAlan,\u201d she said quietly, \u201cyou\u2019re the bereaved father. No defense lawyer\u2019s going to antagonize the jury by giving you a hard time on the stand. I have no hesitation.\u201d<\/p>

\u201cI won\u2019t. That\u2019s all there is to it.\u201d<\/p>

His intransigence irked her, but she kept an amiable tone. \u201cBetter not let them know, else they won\u2019t even settle. Without at least the threat of a trial we have nothing.\u201d<\/p>

\u201cI wasn\u2019t planning to tell them. I\u2019m telling you.\u201d<\/p>

\u201cIt\u2019s OK, then, to ask for the chart?\u201d she asked. \u201cYou\u2019ll sign the release?\u201d<\/p>

\u201cI don\u2019t want you to think I condone their actions, I just detest the process.\u201d<\/p>

Karen couldn\u2019t help herself. \u201c\u2018The process\u2019 \u2015 that\u2019s my career. Lawyers don\u2019t have it in for the medical profession, and there\u2019s no need for doctors to have it in for us. We serve the same patients they do \u2015 or claim to.\u201d<\/p>

Her hand went to her mouth, too late. He waved her off. \u201cOK, OK. Just review the chart.\u201d<\/p>

~~~~~~~~~~<\/p>

\u201cHere it is,\u201d Frank said, holding up Eden\u2019s chart. \u2018Diagnoses: 1. Anaphylaxis. 2. Drug allergy, oxacillin. 3. Staphylococcal bacteremia. 4. Infected abrasion, right knee. 5. Rheumatic heart disease, aortic insufficiency, mitral stenosis.\u2019 I want to send this off to Nancy Olson.\u201d<\/p>

\u201cGood. She\u2019s my age \u2015 probably has teenage kids. She\u2019d be good on the witness stand.\u201d<\/p>

Frank smiled. \u201cIf it ever goes that far.\u201d<\/p>

\u201cI don\u2019t think we should settle for less than a couple million,\u201d Karen said.<\/p>

\u201cI don\u2019t want to close any doors this soon. We\u2019ll decide on strategy as we go.\u201d<\/p>

Nancy Olson was unequivocal.\u00a0 \u201cHe should\u2019ve known. Interesting, he wrote his note after she died. He could\u2019ve said \u2018Denies allergies\u2019 without fear of being contradicted, but he didn\u2019t. Either too honest or too stressed out. Describes her as alert, cooperative, oriented times three, meaning she knew the date, where she was, and who she was. No way he could claim she was too out of it to tell him. Did you know she was in last year with an anaphylactic reaction to Bicillin? She\u2019d be bound to tell him that. I\u2019m surprised. New interns usually write pages and pages of history, like they\u2019re afraid of missing the most trivial detail, and look what he missed.\u201d<\/p>

\u201cWasn\u2019t he supposed to be supervised?\u201d\u00a0 Frank asked.<\/p>

\u201cAbsolutely. And I don\u2019t see a supervisor\u2019s signature, or a resident\u2019s admission note, anywhere. What\u2019s more, without it the nurse shouldn\u2019t have carried out the orders. An intern isn\u2019t licensed to prescribe.\u201d<\/p>

\u201cI may have to depose that nurse, or her supervisor. Write it up for me, please.\u201d<\/p>

A week later Olson\u2019s letter arrived. It contained the following summary:<\/p>

This patient died from an anaphylactic reaction to oxacillin, a member of the penicillin family. Less than a year earlier she had been admitted to Cresheim Valley Hospital with a similar though less severe reaction to benzathine penicillin G (Bicillin), a related antibiotic. Her penicillin allergy was a matter of record. Furthermore, this information was certainly known to the patient and to the patient\u2019s mother, either of whom could have told the admitting doctor if he had asked. Because of this history, administration of any penicillin drug was absolutely contraindicated. <\/em><\/p>

In summary, it is my opinion, to a reasonable degree of medical certainty, that Eden Avery would not have died if she had not been given oxacillin, and that giving oxacillin in the face of her known penicillin allergy was a deviation from accepted standards of care.<\/em><\/p>

\u201cPretty straightforward, isn\u2019t it?\u201d\u00a0 Karen said.<\/p>

\u201cYes.\u201d\u00a0 Frank put his elbows on the desk and rested his chin on his fingertips. \u201cIt\u2019s clear to you and me. The question is \u2015 it always is, as you well know \u2015 what\u2019ll they come up with?\u201d<\/p>

\u201cHow can they defend it? It\u2019s so blatant.\u201d<\/p>

\u201cWe\u2019ll see. We file suit. We show them our expert report, they show us theirs. Then we\u2019ll know. Besides, we\u2019d better hope that they do defend it.\u201d<\/p>

\u201cWhy?\u201d<\/p>

\u201cDidn\u2019t you say you don\u2019t want a settlement?<\/p>

\u201cI said I\u2019d accept a couple million.\u201d<\/p>

\u201cDon\u2019t count on them offering it. They might even try to get off altogether.\u201d<\/p>

Doctor Olson, a board-certified specialist, would be a powerful witness. Still, Frank knew that, as a matter of routine, the hospital would deny liability, and he expected their expert to cast Olson\u2019s analysis as irrelevant without bothering to deny the undeniable. Then the haggling would begin, ending in court if no agreement was reached. The defense expert in Eden\u2019s case was a specialist in infectious diseases from the Hospital for Infants, Children, and Adolescents. A copy of his report reached the office of Frazier & Drummond some two months later.<\/p>

~~~~~~~~~~<\/p>

On the day Frank sent for Eden\u2019s chart, a meeting took place in the hospital administration suite. Seated around the table were Cora Hamilton, M.D., Chair, Department of Pediatrics; Richard Harmon, M.D., practicing pediatrician; Patrick Small, Esq., legal counsel to the hospital; Bruce MacAdoo, Esq., from Burns, MacAdoo and Ferguson, representing Healers Protective, the hospital\u2019s insurer; and Sherman Andrewes, Esq., from Filmore, Means, Smythe and Bannister, representing Doctor Harmon. No lawsuit had been filed, but they believed in being prepared. Because of the father\u2019s association with the hospital, there might not even be a suit. Still, the case illustrated the risks that it was their job to minimize. Not all the conferees defined risk the same way, but all agreed that the events leading to Eden Avery\u2019s death could not be condoned.<\/p>

\u201cI don\u2019t have a crystal ball,\u201d Patrick Small said, \u201cbut we\u2019re wide open on this one. Just look at this. August 17, 1987: \u2018Anaphylactic reaction to Bicillin.\u2019 Right on the face sheet. July 12, 1988: \u2018Anaphylaxis. Drug allergy, oxacillin.\u2019 McCrae\u2019s admission note. Not a word about a history of allergy. It doesn\u2019t even say he asked. Now look at the time of his note \u2015 after her death. This guy needs tutoring. His defense was right there \u2015 could\u2019ve said anything he wanted \u2015 and he blew it. Resident\u2019s admission note, I don\u2019t see any. Order for Prostaphlin \u2015 which, for those who don\u2019t know, is oxacillin. No resident\u2019s initials, only C.B., Constance Bader, the nurse. Medication record showing the first dose given, also initialed by C.B.\u201d He looked around.<\/p>

Harmon spoke: \u201cMaybe they won\u2019t sue. Alan Avery\u2019s on staff here. He\u2019s the father\u2014\u201d<\/p>

\u201cI know he\u2019s the father,\u201d Small said irritably.<\/p>

\u201c\u2014and I don\u2019t know how he feels about suing the hospital. He does have to work with the staff. But he\u2019s an internist. Maybe his colleagues don\u2019t care about suing a pediatrician.\u201d<\/p>

Hamilton addressed Harmon: \u201cI heard they had a memorial service. Were you invited?\u201d<\/p>

\u201cYes,\u201d Harmon said.<\/p>

Small\u2019s face lit up. \u201cMaybe there\u2019s hope yet, at least for you. The parents don\u2019t seem to be holding anything against you, else they wouldn\u2019t have invited you. How was the service?\u201d<\/p>

\u201cI didn\u2019t go.\u201d\u00a0 A dead silence. Finally Andrewes asked softly: \u201cAny particular reason, Doctor? Were you on an emergency? Out of town? Sick?\u201d<\/p>

\u201cI told them I\u2019d be out of town.\u201d\u00a0 Andrewes exhaled noisily and looked around. All eyes were on the tabletop. MacAdoo was shaking his head. Small was clenching his teeth. Finally Andrewes said, \u201cThat could hurt your case. Pat\u2019s right, the invitation was a positive message. Not going looks like avoidance. Little things like that make a difference if people aren\u2019t sure whether or not to sue. How many years had you been taking care of Eden Avery?\u201d<\/p>

\u201cAll her life.\u201d<\/p>

Andrewes pursed his lips. \u201cWell, you had to be out of town and so you couldn\u2019t be there. I\u2019m sure you conveyed your regrets in convincing fashion.\u201d\u00a0 He looked at Harmon to confirm his conjecture. Harmon, his eyes narrowed threateningly, rose from his chair, placed his hands on the table, and leaned across to face Andrewes.<\/p>

\u201cI\u2019ll tell you what happened, Sherman, and why,\u201d he said in a tone of controlled fury. \u201cI was at the mortality conference two days after Edie\u2019s death. Right there, with her body barely cold, already there was talk about a lawsuit. Ask Cora, she ran the meeting. And you\u2019ll hear that we were all instructed, \u2018Don\u2019t talk about this where anyone can hear you.\u2019 Right, Cora?\u201d Hamilton signaled agreement. \u201cNow you tell me, how in God\u2019s name do I face my friends of twenty years, whose child I\u2019ve cared for all her life? Tell them \u2018No comment\u2019? Or \u2018I\u2019ve been instructed not to talk about it\u2019? Or do I refer them to my lawyer? Huh? You tell me!\u201d<\/p>

He slapped the table and the conferees reflexively reached for their water glasses.<\/p>

\u201cI loved that girl. Now I\u2019m scared to run into her parents, because I\u2019m forbidden to admit the truth. I\u2019m not trained in the art of straight-faced evasion. And what\u2019s more, I don\u2019t plan to learn.\u201d\u00a0 His voice rose with each sentence. \u201cAnd if you must know, number one, I probably did a lousy job \u2018conveying my regrets in convincing fashion,\u2019 as you so delicately put it; and number two, I wasn\u2019t on any emergency or out of town. Right in my backyard, in perfect health.\u201d<\/p>

\u201cAll right, Doctor, don\u2019t get upset\u2014\u201d Andrewes said, but Harmon was not finished.<\/p>

\u201cYou know what I want to do? I want to tell them we all screwed up. McCrae was too inexperienced to be left on his own; Friedman abandoned his post and ought to be relieved of his position; and I, Richard Harmon, had a duty to warn the house staff before they killed that girl. How does that sound?\u201d\u00a0 He looked around, daring anyone to answer.<\/p>

MacAdoo took up the challenge with studied calm. \u201cSounds honest to me, and probably true. But please don\u2019t repeat it outside this room. I\u2019m sure you know better.\u201d\u00a0 Silence.<\/p>

Hamilton addressed MacAdoo. \u201cI understand my medical colleague\u2019s feelings. Our world is one of real people, bodies and souls, pain and suffering, the joy of birth and the grief of death. When we lose a child, we feel the pain and loss too. I didn\u2019t know this girl or her family, but I have no difficulty putting myself in Doctor Harmon\u2019s shoes. Dissimulation, evasiveness, silence don\u2019t fit into our relationships with people. If they\u2019re the only way to survive in our litigious climate, and I tell my staff just that, then so be it. But don\u2019t expect us not to be upset.\u201d<\/p>

Small nodded. \u201cMost of us have families, children. We appreciate what you doctors do for us. I don\u2019t doubt for a minute, Doctor Harmon, that you feel for the girl and her family. But consoling you isn\u2019t going to be their top priority. Lethal acts of negligence were committed, which you\u2019ve described better than I could, and we\u2019re probably facing a lawsuit \u2015 the hospital and you too. Our job\u2019s to represent your interests, which in the long run helps keep you in practice. We use legal strategies for our work just as you use medical strategies for yours. Some of the things you have to do to achieve your goals aren\u2019t all that pleasant either; your patients accept that. Now I ask you to accept what we have to do. We\u2019re on your side, you know.\u201d<\/p>

\u201cOn our side, sure,\u201d Harmon said sarcastically, \u201cpitting us against our own patients.\u201d<\/p>

This was too much for Small. He stood up. \u201cExcuse me, Doctor,\u201d he said, his face red and the blood vessels on his temples bulging, \u201cthe conflicts between you and your patients are not of our making. Do I need to say more?\u201d Silence. \u201cOK. Our job\u2019s to keep you out of legal trouble; and if we can\u2019t keep<\/em> you out, as we anticipate here, then to bail<\/em> you out. You\u2019re not making it easy.\u201d\u00a0 He sat down.<\/p>

\u201cLet\u2019s take a break.\u201d Ten minutes later, with tempers cooled, they reassembled.<\/p>

\u201cNow,\u201d Small said, \u201cif the suit comes, do we cave in, or is there a way to defend it?\u201d<\/p>

\u201cWe never start by caving in,\u201d MacAdoo said with a derisive laugh. \u201cOrdinarily I\u2019d say, wait till we hear from them, then we\u2019ll know what they\u2019re cooking up. But we\u2019ve already heard the charges right here.\u201d\u00a0 The others cringed, fearing violence, but the moment passed. \u201cObviously what happened is a matter of record, so there\u2019s no denying it. As I see it, our best defense is along two lines. One, plead emergency: Even if they argue that it doesn\u2019t take long to ask about allergy, we say our people were so struck with the girl\u2019s state that there was no time for anything else. A jury might buy that. Two, reduce the impact: We know she had heart disease. We can argue that her days were numbered. True, she didn\u2019t have to die at this time, but it\u2019s not as if we took away sixty-five years of her life. Even if the jury did find against us, they\u2019d reduce the damages. Naturally, our settlement offer, if any, should reflect that.\u201d<\/p>

\u201cWith all due respect,\u201d Harmon said, \u201cnowadays they\u2019re pretty good with open-heart surgery. A new valve and she could be set for a long, long time.\u201d<\/p>

\u201cStill,\u201d Andrewes said, \u201cthere is a risk, isn\u2019t there? I mean, if all goes well, fine. But who guarantees that all goes well?\u201d<\/p>

\u201cNobody guarantees,\u201d Harmon said, \u201cbut she has a chance, a good one in fact. That\u2019s what\u2019s been taken from her. I might be pretty generous if I were on that jury.\u201d<\/p>

Small breathed a sigh of relief that that couldn\u2019t happen. \u201cJuries are unpredictable,\u201d he said. \u201cBut you\u2019re right, Bruce. I can\u2019t think of anything else right now. Can you, Sherman?\u201d<\/p>

Andrewes had been leafing through the chart. \u201cThere\u2019s something here about endocarditis. That means infection on the valve, doesn\u2019t it?\u201d\u00a0 Hamilton nodded. \u201cWe can argue that the risk of this valve getting infected makes treatment even more urgent. Bolsters your first argument, Bruce. And that risk follows her the rest of her life \u2015 even if she gets a new valve, I believe.\u201d<\/p>

\u201cGood points,\u201d said Small. \u201cYou should ask your expert to look at all those things.\u201d<\/p>

Within days word reached Small that Eden\u2019s records had been formally requested by the law firm of Frazier & Drummond. When notice of the lawsuit didn\u2019t arrive for four weeks, he wondered, hopefully, if the plaintiffs\u2019 first-choice expert hadn\u2019t supported them and they\u2019d had to go to a second. Maybe their case wasn\u2019t solid. He expressed his optimism to MacAdoo.<\/p>

\u201cMeans nothing,\u201d MacAdoo said. \u201cThey\u2019ve got two years. I\u2019m surprised it came this fast. May have to do with the mother being a lawyer herself. Anyway, I\u2019ll give Shaw a call.\u201d<\/p>

Next day he called Newton Shaw at the Hospital for Infants, Children, and Adolescents. Doctor Shaw was a treasured resource, an effective witness with the right opinions.<\/p>

\u201cNewt? Bruce MacAdoo here. Can you review a case for us?\u201d<\/p>

\u201cI\u2019m pretty busy. I have four others. What\u2019s the time frame? I\u2019d need at least a month.\u201d<\/p>

\u201cOK.\u201d\u00a0 MacAdoo knew that for Shaw a month did not mean a month and a day.<\/p>

\u201cWhat kind of case is it? Complicated?\u201d\u00a0 Shaw asked.<\/p>

\u201cToo simple for my comfort. Girl, seventeen, given oxacillin and had a fatal reaction.\u201d<\/p>

\u201cDid they know she was allergic?\u201d<\/p>

\u201cThe intern didn\u2019t, but plaintiff\u2019s arguing he should\u2019ve. She\u2019d had a reaction once before.\u201d<\/p>

\u201cThen you don\u2019t have a case.\u201d<\/p>

\u201cWe don\u2019t know what state the girl was in, whether she could give a history.\u201d<\/p>

\u201cWas she conscious?\u201d<\/p>

\u201cYes, and oriented.\u201d<\/p>

\u201cSeventeen years old, conscious, and oriented? You don\u2019t have a case.\u201d<\/p>

\u201cShe also had a bad heart valve, reduced life expectancy. High fever, low blood pressure.\u201d<\/p>

\u201cSo it\u2019s not all that simple. I\u2019d better not say any more without seeing the chart.\u201d<\/p>

\u201cI\u2019ll get it out to you today.\u201d<\/p>

\u201cRemember. For the record, if I don\u2019t think this is defensible, I won\u2019t support you.\u201d<\/p>

\u201cI know I can count on you to be honest and up front with me. You always have been.\u201d<\/p>

MacAdoo hung up. Shaw never failed to make it clear, \u201cfor the record,\u201d that he wouldn\u2019t support a bad case; and in the two dozen cases he\u2019d reviewed, he\u2019d never failed to support the firm\u2019s claims. Shaw\u2019s reports and deposition testimony \u2015 he had been called to court only once \u2015 had stood Bruce in good stead. Shaw was worth the fees he charged.<\/p>

One month later to the day, Shaw\u2019s report arrived. It brought a smile to MacAdoo\u2019s face. MacAdoo was ready to exchange expert reports with Frank Frazier and wait.<\/p>

~~~~~~~~~~<\/p>

Hospital for Infants, Children, and Adolescents<\/strong><\/p>

Department of Medicine, Division of Infectious Diseases<\/strong><\/p>

Great! HICA gets all the sickest kids from Cresheim Valley, so of course one defends the other. Frank read the letter and laughed out loud. An hour later, looking solemn, he handed it to Karen.<\/p>

This unfortunate girl had severe heart disease. Her aortic valve was insufficient, her mitral valve stenotic, and she faced imminent heart failure. Surgical replacement of one or both valves was inevitable if she were to have any chance of avoiding early death, and this operation itself poses a significant risk of operative death as well as later valve breakdown. Further, both her native valves and their replacements would have been constantly susceptible to infection. This very complication was in its incipient stages during Eden Avery\u2019s final illness, as attested by the positive blood cultures. Most important, she was in septic shock, facing death in hours. <\/em><\/p>

Given the life-threatening emergency, the most aggressive intervention with antibiotics was indicated. In fact, one might ask why the knee infection, which had been handled in the patient\u2019s home for days, had not been referred to a physician sooner for proper care. This was obviously the portal of entry for the sepsis. In sharp contrast to the prior neglect of this patient, the vigorous institution of therapy by Doctor McCrae is to be commended. Her tragic reaction could not have been prevented under these circumstances, where every minute counted. <\/em><\/p>

In summary, it is my opinion, to a reasonable degree of medical certainty, that the care rendered to this unfortunate patient lived up fully to accepted medical standards. <\/em><\/p>

The letter was signed by Newton Shaw, M.D., Professor and Head, Division of Infectious Diseases. Karen stared at it for almost a minute before throwing it on the desk. \u201cThis is outrageous!\u00a0 How can they do such a thing?\u201d\u00a0 She was on the verge of tears.<\/p>

Frank nodded knowingly. \u201cYes, outrageous. And dishonest. But not surprising.\u201d<\/p>

\u201cPlaintiffs\u2019 experts get all the bad press,\u201d he had once explained. \u201cDoctors love to use words like \u2018hired guns,\u2019 \u2018prostitutes,\u2019 and whatnot. They\u2019d have the public \u2015 which of course includes jurors \u2015 believe the typical plaintiff\u2019s expert sells the attorney any opinion he wants. Now there\u2019s a few rotten apples in any barrel, but guys like that are dangerous on the stand. What the public doesn\u2019t hear about is defendants\u2019 prostitutes, and that\u2019s a whole barrel full of rotten apples. And no wonder. Look at the incentives. To testify against your own convictions is risky, no matter whose side you\u2019re on, because you\u2019re not going to do well on cross-exam.\u00a0 For the plaintiff\u2019s witness that\u2019s a problem. He could embarrass his lawyer in court and not be called again. And he\u2019s already compromised his standing in the medical community. Most docs are too smart to fall into that trap. For the defense expert, lying\u2019s no problem at all. Win or lose, he makes points with the other docs, he can wallow in his loyalty, and his referrals pick up. It\u2019s easy to see why most docs would rather come to their buddies\u2019 aid than testify for a patient. Then there are the spin-offs, like the agencies that recruit plaintiffs\u2019 experts from afar because the locals won\u2019t testify. Unscrupulous defense lawyers can easily make out-of-town witnesses look like hired guns. No wonder the defendants win four out of five cases in court.\u201d<\/p>

\u201cWhy hasn\u2019t there been more publicity about this?\u201d<\/p>

He leaned back and grinned. \u201cEver heard of the American Patients\u2019 Association?\u201d<\/p>

\u201cOK, I get it, there\u2019s no such thing. But don\u2019t you really think most defense experts are honest?\u201d<\/p>

\u201cMost potential<\/em> defense experts are, but who\u2019s going to ask them to testify when there\u2019s been real malpractice? If the hospital had called Nancy Olson, she\u2019d have told them the same thing she told us, and they\u2019d have shown her the door. Shaw is much more obliging.\u201d<\/p>

\u201cSo they\u2019ll take us to court?\u201d<\/p>

\u201cI doubt it. They know as well as we do that Shaw\u2019s report is fraud.\u00a0 And they know that we know it.\u00a0 Once they\u2019re convinced that we\u2019ll<\/em> take them<\/em> to court, they\u2019ll settle.\u201d<\/p>

Neither one mentioned Shaw\u2019s comment about the knee infection.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Chapter 33 >><\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

PART III \u201cI ran into Homer.\u201d Alan froze at Gordon\u2019s words. \u201cHe thought you\u2019d want to know, but he didn\u2019t feel comfortable coming to you directly.\u201d \u201cI\u2019m surprised he\u2019s allowed to talk to anybody, with all that legal paranoia.\u201d \u201cI didn\u2019t ask for the cause of death, just what he found in the heart. No […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":21,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-330","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/330","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/comments?post=330"}],"version-history":[{"count":6,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/330\/revisions"}],"predecessor-version":[{"id":858,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/330\/revisions\/858"}],"up":[{"embeddable":true,"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/pages\/21"}],"wp:attachment":[{"href":"https:\/\/herbheineman.com\/Eden\/wp-json\/wp\/v2\/media?parent=330"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}