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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Sunday, April 30, 2006

All the fashionable people

(I admire "fake but accurate" journalism and seek to emulate it as often as possible. However, while I've changed all the names in this post, the details of the story are true.)

We deal with death and its apparent injustice all the time, yet the death of a medical colleague in the prime of his career always presents itself as a gross anomaly, like waking up one morning and seeing the sun come up in the west. Some would say that physicians believe themselves immune to the laws of physics and biology, and perhaps they are right. Doctors aren't supposed to die until they've retired and moved away to the golf course-side condo where they play every day until they become too senile to keep score and everyone has forgotten about them and then we read an obituary about an elderly gent with an M.D. after his name who sounds vaguely familiar but that's about it.

That's what's supposed to happen, so it was a shock when one of the endoscopy nurses asked me what I knew about Dr. Tom Wandzilak, an ER physician my age who died this past week.

I knew nothing. I spend as little time in the doctor's lounge as I possibly can, and although that spares me from all the incessant whining that goes on, it also leaves me outside the loop when it comes to news and gossip.

I entered "Dr. Tom Wandzilak" into the very same search engine that markets freedom-surpressing software to the Chinese, in hopes of learning what happened to the poor man. There was nothing about his death, but there were many other citations, several of which had to do with malpractice suits.

I came across this doozy:

Med-Mal Defense Verdict in Failure to Diagnose, p. 1
Several doctors failed to diagnose 38 year old housewife's cancer of the lymph nodes; ER doctors and internist chalked it up to psychological problems. After 10 months of being told she was crazy, she found out the real diagnosis and that it had spread - she died 13 months later leaving husband and children. A variety of defendants were targeted who treated a healthy housewife with no history of mental problems as if she had mental problems. Prior to trial, plaintiff/estate (including consortium claims for husband and children) had settled with three defendants (Dr. Sam Fredericks(ER), Dr. Susan Underwood and Dr. Jack Niles (post misdiagnosis psychiatrists). Two other doctors were in for apportionment purposes (Dr. Tom Wandzilak (ER) and Dr. Raymond Smithers(ER). Which doctors were left? Dr. Abdul Nafty (internist); Dr. Jim George(internist) and Dr. Louis Goldstein (psychiatrist). Psychiatrists were faulted for failure to pursue an organic component of the problems and therefore did an incomplete exam of the patient. The settlement was unknown to the jury. Dr. Benedict Arnold, Internist, testified for the Plaintiff criticizing Nafty and George for their incomplete exams. Mr. Andy Roberts did a vocational analysis since the decedent was college educated.

Plaintiff experts: Dr. Benedict Arnold (Internist); Dr. Huey Greenburg (Internist); Dr. Charles Zadok (psychiatrist); Dr. Dwight Davis (oncologist for causation); Dr. Eugene Eubanks (cardiologist and internist); Mary Margaret and Beth Sue McAllister (psychology for children's claims); Andy Roberts (vocational expert)

Defendant experts: Dr. Hiram Hildebrand (oncologist); Dr. Jack Louis (internist); Dr. Karl Jung (oncologist); Dr. Peter Rogers (psychiatrist); Dr. Elizabeth Reardon (psychiatry).

Prior to suit - Dr. Fredericks, Underwood, and Niles had settled.

Damages? Estate - $5 million; children- $2.5 mill each; husband - $500,000.

Settlement negotiations were spurred at trial after talking to the alternate juror - she had opinions regarding apportionment, fault and damages (millions). Nafty and George settled for an undisclosed amount.

It's a good bet that none of the physicians used the term "crazy" in their description of the patient. We're trained to use no subjective word in our descriptions. For example, instead of describing a patient as "hostile and threatening" we would document that he "looked me in the eye and said 'I'm going to beat your head in, sue your ass off, and feed your entrails to the buzzards.' " Direct quotes are not subject to misinterpretation.

What really struck me about this case is that all of the fashionable people were involved. I know, or know of, all the defendants. Not only are they NOT threats to the public welfare, but they are all excellent. I never dreamed that these folks would be dragged into a massive lawsuit. That kind of thing only happens to wretches like me.

There are times when The System fails. In complex cases involving multiple specialists, especially in academic centers, there can be horrible miscommunication which cause a patient to suffer. Sometimes the patient can be caught in a struggle between two (or more) towering egos, egos which refuse to acknowledge the possibility of making a bad judgment.

But what about cases where everyone gathers all the information and comes to a conclusion which is perfectly reasonable (or else they wouldn't have all reached it together) but is just flat dead wrong? Physicians are not, in theory, expected to be perfect in all things. They are supposed to be diligent and make reasonable judgments. We're not supposed to have our asses sued off just because our judgment is wrong. Can physicians be found to be below the standard of the community when the community itself is wrong?

Let's review the case:

Prior to suit - Dr. Fredericks, Underwood, and Niles had settled.

Damages? Estate - $5 million; children- $2.5 mill each; husband - $500,000.

Settlement negotiations were spurred at trial after talking to the alternate juror - she had opinions regarding apportionment, fault and damages (millions). Nafty and George settled for an undisclosed amount.

I can't blame them there. Being faced with a $5 million judgment will give you pause.

Verdict - zero - defense verdict. Jury came back - all three (including Nafty and George) had prevailed.

And I suppose justice was done.

Dr. Tom Wandzilak, rest in peace.


Blogger DRJ said...


I'm just passing though, having found you through the California Medicine Man blog. I join in offering condolences to the family of your colleague, Dr. Tom Wandzilak. I also join you in lamenting the adverse impact medical malpractice lawsuits have had on the practice of medicine and on physicians, nurses, and others in the medical profession.

I have a harder time accepting your general condemnation of all medical malpractice lawsuits. You seem to say that because the physicians in your example are known to you as good practitioners, they shouldn't be subject to this lawsuit. Even competent people can make mistakes. Surely you don't view the general public as guinea pigs for you to learn on, but who aren't allowed to complain if something goes wrong?

According to your own recitation of the facts, these doctors attributed the patient's illness to psychological problems. The physicians who went to trial had a chance to show the jury that they ran tests and exercised good medical judgment. The jury was not convinced.

In my experience, physicians often attribute verdicts like these to ignorant juries that don't understand the intricacies of modern medicine. That may be true in some cases but it is physicians who have encouraged the public to treat them as scientists who practice medicine with precision. The reality is that practicing medicine is also an art and individual results vary. But physicians don't want people to view medicine as an art because it is more confidence-inspiring to view medicine as a science.

1:18 PM  
Blogger SkiTheStars said...

DRJ says doctors are responsible for misadvertising their arts as science.

I do not know any doctors who espouse such notions. Any well-educated person knows darn well that doctoring is an art, one which eventually loses out to all the molecules dropping their mutal agendas and adjourning.

My daughter is going on through her second year at UC Davis Medical School, and is thinking orthopedic surgeon. Hope you had a good summer.

12:54 AM  
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