Practical strategies for defense in malpractice lawsuit: a case illustration.

UNLABELLED This report describes an unprecedented malpractice litigation on a neurology case. A young woman developed multiple complications after a simple hysterectomy: pan-peritonitis, post-op deep coma with hypotension, generalized anasarca, hyponatremia, hemolysis, cerebral hypoxia and renal shutdown requiring dialysis and multiple-unit blood transfusions. She survived 43 days in Neuro-ICU, and was transferred to a regular ward where she developed status epileticus lasting for 17 hours. On examination, she had cortical blindness, which the plaintiff believed it was caused by prolonged seizures but actually hypoperfusion/hypoxia of the brain did it. Plaintiff's attorneys jumped to a lawsuit for $80+ millions, accusing defendant for failure to stop her seizures. They took the plaintiff to Honolulu and San Diego to confirm brain injury. RESULTS On the top of calcarine infarct, she has pseudoseizures or malingering. To inflate the claim for compensation, they cleverly included three guardians ad litem as co-plaintiffs who live in U.S. Mainland. The first court battle was denied at Guam Superior Court on the ground of exceeding one year of Statute of Limitation. Cunningly they manipulated clinical course to stretch the date of discovery of damages in order to move the statute of limitation within one year of filing to the court. They then went on to Guam Supreme Court, where it was struck down. Unconvinced, they went on all the way to the Federal Ninth Circuit Court in California where again it upheld the original decision. The plaintiff lost and never reached the trial court. After two years' legal combat, I have learned hard way defense strategies: (1) Practice defensive medicine, to keep informed consent and tracks of timing of diagnosis and treatment; (2) Avoid factors that may provoke dissatisfaction, anger, or frustration on outcome of treatment; (3) Keep ledger of ambulance chasers and good defense lawyers; (4) Never surrender at the notification from court; (5) Settle out of court, if this can be done reasonably to save time and stress; (6) Keep cool and study carefully the allegations; (7) Consultation with experts in the area involved; (8) Set up trust fund for children; (9) Buy liability insurance and take CME in medicolegal classes.