Medical Verdicts

Mchenry County (Ill) Circuit Court—On July 15, a gravida at 6 weeks’ gestation presented to her obstetrician with a complaint of light bleeding. The physician performed an ultrasound and a series of blood tests that revealed falling hCG levels, signifying a possible miscarriage or ectopic pregnancy. The obstetrician then performed a dilatation and curettage (D&C) because he believed the patient had miscarried. During the procedure, he resected a small amount of tissue for pathology. On July 18, the pathologist reported a preliminary finding of no chorionic villi, suggesting an ectopic pregnancy. Two days later, the patient was rushed to the hospital with a ruptured ectopic pregnancy that required the removal of her right fallopian tube.

In suing, the woman claimed that the physician should have performed a laparoscopy at the time of the D&C. Further, she maintained that he should have suspected an ectopic pregnancy.

The physician argued that since the ultrasound showed no mass in the fallopian tube and the patient did not complain of pelvic pain, he believed that she had suffered a miscarriage and, therefore, the D&C was well within the standard of care.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Mchenry County (Ill) Circuit Court—On July 15, a gravida at 6 weeks’ gestation presented to her obstetrician with a complaint of light bleeding. The physician performed an ultrasound and a series of blood tests that revealed falling hCG levels, signifying a possible miscarriage or ectopic pregnancy. The obstetrician then performed a dilatation and curettage (D&C) because he believed the patient had miscarried. During the procedure, he resected a small amount of tissue for pathology. On July 18, the pathologist reported a preliminary finding of no chorionic villi, suggesting an ectopic pregnancy. Two days later, the patient was rushed to the hospital with a ruptured ectopic pregnancy that required the removal of her right fallopian tube.

In suing, the woman claimed that the physician should have performed a laparoscopy at the time of the D&C. Further, she maintained that he should have suspected an ectopic pregnancy.

The physician argued that since the ultrasound showed no mass in the fallopian tube and the patient did not complain of pelvic pain, he believed that she had suffered a miscarriage and, therefore, the D&C was well within the standard of care.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Mchenry County (Ill) Circuit Court—On July 15, a gravida at 6 weeks’ gestation presented to her obstetrician with a complaint of light bleeding. The physician performed an ultrasound and a series of blood tests that revealed falling hCG levels, signifying a possible miscarriage or ectopic pregnancy. The obstetrician then performed a dilatation and curettage (D&C) because he believed the patient had miscarried. During the procedure, he resected a small amount of tissue for pathology. On July 18, the pathologist reported a preliminary finding of no chorionic villi, suggesting an ectopic pregnancy. Two days later, the patient was rushed to the hospital with a ruptured ectopic pregnancy that required the removal of her right fallopian tube.

In suing, the woman claimed that the physician should have performed a laparoscopy at the time of the D&C. Further, she maintained that he should have suspected an ectopic pregnancy.

The physician argued that since the ultrasound showed no mass in the fallopian tube and the patient did not complain of pelvic pain, he believed that she had suffered a miscarriage and, therefore, the D&C was well within the standard of care.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Manchester County (Conn) Superior Court—A 32-year-old woman presented to a hospital for an exploratory laparotomy, during which an ovarian mass was discovered. To preserve the patient’s fertility, her Ob/Gyn opted to perform an ovarian cystectomy. During the procedure, the physician resected some tissue and sent it to pathology for a frozen section. Shortly after, the pathologist reported back that the mass was “unequivocally malignant.” As a result, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Postoperatively, the pathologist notified the physician of an error in the diagnosis; the woman did not, in fact, have cancer.

In suing, the patient claimed that the pathologist should have consulted with an oncologist or another pathologist to confirm the diagnosis. Further, she argued that he should have waited to diagnose permanent sections to verify malignancy, rather than rely on the frozen section only.

The case settled for $1 million.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Manchester County (Conn) Superior Court—A 32-year-old woman presented to a hospital for an exploratory laparotomy, during which an ovarian mass was discovered. To preserve the patient’s fertility, her Ob/Gyn opted to perform an ovarian cystectomy. During the procedure, the physician resected some tissue and sent it to pathology for a frozen section. Shortly after, the pathologist reported back that the mass was “unequivocally malignant.” As a result, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Postoperatively, the pathologist notified the physician of an error in the diagnosis; the woman did not, in fact, have cancer.

In suing, the patient claimed that the pathologist should have consulted with an oncologist or another pathologist to confirm the diagnosis. Further, she argued that he should have waited to diagnose permanent sections to verify malignancy, rather than rely on the frozen section only.

The case settled for $1 million.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Manchester County (Conn) Superior Court—A 32-year-old woman presented to a hospital for an exploratory laparotomy, during which an ovarian mass was discovered. To preserve the patient’s fertility, her Ob/Gyn opted to perform an ovarian cystectomy. During the procedure, the physician resected some tissue and sent it to pathology for a frozen section. Shortly after, the pathologist reported back that the mass was “unequivocally malignant.” As a result, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Postoperatively, the pathologist notified the physician of an error in the diagnosis; the woman did not, in fact, have cancer.

In suing, the patient claimed that the pathologist should have consulted with an oncologist or another pathologist to confirm the diagnosis. Further, she argued that he should have waited to diagnose permanent sections to verify malignancy, rather than rely on the frozen section only.

The case settled for $1 million.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Bronx County (NY) Supreme Court—A gravida was admitted to a hospital at 41 weeks’ gestation for delivery and was placed on an external fetal heart rate (FHR) monitor. The tracing revealed late decelerations with every contraction from 4:15 a.m. to 5:06 a.m.

When the obstetrician did an amniotomy at 5:10 a.m., meconium was found. A cesarean delivery was subsequently performed at 7:35 a.m.

The Ob/Gyn argued that the fetal monitor indicated that the bleeding occurred in utero.

At birth, the baby’s Apgar scores were normal. However, an MRI performed later that day revealed intracranial bleeding. The infant developed right-side hemiparesis of the lower extremity, requiring physical therapy and surgery for tendon release. He now walks with a limp.

In suing, the mother claimed that the FHR tracing clearly showed signs of fetal distress. She further maintained that the physician unnecessarily delayed delivery for more than 3 hours and that the infant’s bleeding occurred during labor.

The obstetrician argued that the fetal monitor, if at all nonreassuring, indicated that the bleeding occurred prior to labor and delivery.

The jury awarded the plaintiff $1.25 million.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Bronx County (NY) Supreme Court—A gravida was admitted to a hospital at 41 weeks’ gestation for delivery and was placed on an external fetal heart rate (FHR) monitor. The tracing revealed late decelerations with every contraction from 4:15 a.m. to 5:06 a.m.

When the obstetrician did an amniotomy at 5:10 a.m., meconium was found. A cesarean delivery was subsequently performed at 7:35 a.m.

The Ob/Gyn argued that the fetal monitor indicated that the bleeding occurred in utero.

At birth, the baby’s Apgar scores were normal. However, an MRI performed later that day revealed intracranial bleeding. The infant developed right-side hemiparesis of the lower extremity, requiring physical therapy and surgery for tendon release. He now walks with a limp.

In suing, the mother claimed that the FHR tracing clearly showed signs of fetal distress. She further maintained that the physician unnecessarily delayed delivery for more than 3 hours and that the infant’s bleeding occurred during labor.

The obstetrician argued that the fetal monitor, if at all nonreassuring, indicated that the bleeding occurred prior to labor and delivery.

The jury awarded the plaintiff $1.25 million.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Bronx County (NY) Supreme Court—A gravida was admitted to a hospital at 41 weeks’ gestation for delivery and was placed on an external fetal heart rate (FHR) monitor. The tracing revealed late decelerations with every contraction from 4:15 a.m. to 5:06 a.m.

When the obstetrician did an amniotomy at 5:10 a.m., meconium was found. A cesarean delivery was subsequently performed at 7:35 a.m.

The Ob/Gyn argued that the fetal monitor indicated that the bleeding occurred in utero.

At birth, the baby’s Apgar scores were normal. However, an MRI performed later that day revealed intracranial bleeding. The infant developed right-side hemiparesis of the lower extremity, requiring physical therapy and surgery for tendon release. He now walks with a limp.

In suing, the mother claimed that the FHR tracing clearly showed signs of fetal distress. She further maintained that the physician unnecessarily delayed delivery for more than 3 hours and that the infant’s bleeding occurred during labor.

The obstetrician argued that the fetal monitor, if at all nonreassuring, indicated that the bleeding occurred prior to labor and delivery.

The jury awarded the plaintiff $1.25 million.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<court>Maricopa County (Ariz) Superior Court</court>—A 35-year-old gravida in her sixth month of pregnancy noticed a pea-sized mass in her right axilla in March. By mid-April, the mass had grown to the size of a lemon.

The patient was referred to a general surgeon who performed a mammogram and a true-cut biopsy of the large mass. The initial pathology reading noted a malignant and anaplastic tumor. The local pathologist confirmed that the primary site of the mass was most likely the breast. However, metastasis from another site, other than the breast, could not be ruled out. The surgeon scheduled the patient for a modified radical mastectomy.

During the procedure, the surgeon excised a large tumor from the axillary tail of the breast, extending into the axilla and involving multiple lymph nodes. The entire tumor was not resected, as it was wrapped around some nerves.

The mastectomy specimen was then sent to a regional pathology center and a diagnosis of anaplastic large cell lymphoma was made by the consulting pathologist. The patient underwent 1 course of chemotherapy before her child was prematurely delivered via cesarean. Later, the woman underwent additional chemotherapy and 2 breast reconstruction surgeries.

In suing, the patient contended that had she been properly diagnosed with lymphoma, she would not have needed a mastectomy. The woman also maintained that the physician should have carefully reviewed the pathology report and that he should have known the mass was not resectable.

Further, she claimed that the pathologist should have asked for more tissue samples prior to the surgery so that a definitive diagnosis could be reached.

The surgeon and pathologist argued that the interpretation of the preoperative biopsy specimen was appropriate and within the standard of care. Further, regardless of the possible metastasis from another site, the surgeon was properly advised to proceed with the mastectomy.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<court>Maricopa County (Ariz) Superior Court</court>—A 35-year-old gravida in her sixth month of pregnancy noticed a pea-sized mass in her right axilla in March. By mid-April, the mass had grown to the size of a lemon.

The patient was referred to a general surgeon who performed a mammogram and a true-cut biopsy of the large mass. The initial pathology reading noted a malignant and anaplastic tumor. The local pathologist confirmed that the primary site of the mass was most likely the breast. However, metastasis from another site, other than the breast, could not be ruled out. The surgeon scheduled the patient for a modified radical mastectomy.

During the procedure, the surgeon excised a large tumor from the axillary tail of the breast, extending into the axilla and involving multiple lymph nodes. The entire tumor was not resected, as it was wrapped around some nerves.

The mastectomy specimen was then sent to a regional pathology center and a diagnosis of anaplastic large cell lymphoma was made by the consulting pathologist. The patient underwent 1 course of chemotherapy before her child was prematurely delivered via cesarean. Later, the woman underwent additional chemotherapy and 2 breast reconstruction surgeries.

In suing, the patient contended that had she been properly diagnosed with lymphoma, she would not have needed a mastectomy. The woman also maintained that the physician should have carefully reviewed the pathology report and that he should have known the mass was not resectable.

Further, she claimed that the pathologist should have asked for more tissue samples prior to the surgery so that a definitive diagnosis could be reached.

The surgeon and pathologist argued that the interpretation of the preoperative biopsy specimen was appropriate and within the standard of care. Further, regardless of the possible metastasis from another site, the surgeon was properly advised to proceed with the mastectomy.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<court>Maricopa County (Ariz) Superior Court</court>—A 35-year-old gravida in her sixth month of pregnancy noticed a pea-sized mass in her right axilla in March. By mid-April, the mass had grown to the size of a lemon.

The patient was referred to a general surgeon who performed a mammogram and a true-cut biopsy of the large mass. The initial pathology reading noted a malignant and anaplastic tumor. The local pathologist confirmed that the primary site of the mass was most likely the breast. However, metastasis from another site, other than the breast, could not be ruled out. The surgeon scheduled the patient for a modified radical mastectomy.

During the procedure, the surgeon excised a large tumor from the axillary tail of the breast, extending into the axilla and involving multiple lymph nodes. The entire tumor was not resected, as it was wrapped around some nerves.

The mastectomy specimen was then sent to a regional pathology center and a diagnosis of anaplastic large cell lymphoma was made by the consulting pathologist. The patient underwent 1 course of chemotherapy before her child was prematurely delivered via cesarean. Later, the woman underwent additional chemotherapy and 2 breast reconstruction surgeries.

In suing, the patient contended that had she been properly diagnosed with lymphoma, she would not have needed a mastectomy. The woman also maintained that the physician should have carefully reviewed the pathology report and that he should have known the mass was not resectable.

Further, she claimed that the pathologist should have asked for more tissue samples prior to the surgery so that a definitive diagnosis could be reached.

The surgeon and pathologist argued that the interpretation of the preoperative biopsy specimen was appropriate and within the standard of care. Further, regardless of the possible metastasis from another site, the surgeon was properly advised to proceed with the mastectomy.

The jury returned a verdict for the defense.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Delaware County (Pa) Court of Common Pleas—During a workup for infertility, a physician discovered that his patient had a tubal obstruction and performed an exploratory laparoscopy. During the procedure, the woman suffered internal bleeding from a lacerated left iliac vein. A vascular surgeon then performed an emergency laparotomy to repair the vein and achieve hemostasis.

In suing, the woman claimed that during the laparoscopy, the physician inserted the trocar at an improper angle, resulting in the laceration of her left iliac vein. Although the injury was repaired, the patient maintained that it caused vascular congestion, which compressed her back nerves, making it difficult for her to sit for long periods of time without experiencing pain. She also allegedly suffers from urinary incontinence and, as a result, has been unable to work.

The physician argued that the patient had chronic back pain prior to the laparoscopy and that the procedure and injury caused no further damage.

The jury awarded the plaintiff $1.2 million and also awarded her husband $100,000 for pain and suffering.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Delaware County (Pa) Court of Common Pleas—During a workup for infertility, a physician discovered that his patient had a tubal obstruction and performed an exploratory laparoscopy. During the procedure, the woman suffered internal bleeding from a lacerated left iliac vein. A vascular surgeon then performed an emergency laparotomy to repair the vein and achieve hemostasis.

In suing, the woman claimed that during the laparoscopy, the physician inserted the trocar at an improper angle, resulting in the laceration of her left iliac vein. Although the injury was repaired, the patient maintained that it caused vascular congestion, which compressed her back nerves, making it difficult for her to sit for long periods of time without experiencing pain. She also allegedly suffers from urinary incontinence and, as a result, has been unable to work.

The physician argued that the patient had chronic back pain prior to the laparoscopy and that the procedure and injury caused no further damage.

The jury awarded the plaintiff $1.2 million and also awarded her husband $100,000 for pain and suffering.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Delaware County (Pa) Court of Common Pleas—During a workup for infertility, a physician discovered that his patient had a tubal obstruction and performed an exploratory laparoscopy. During the procedure, the woman suffered internal bleeding from a lacerated left iliac vein. A vascular surgeon then performed an emergency laparotomy to repair the vein and achieve hemostasis.

In suing, the woman claimed that during the laparoscopy, the physician inserted the trocar at an improper angle, resulting in the laceration of her left iliac vein. Although the injury was repaired, the patient maintained that it caused vascular congestion, which compressed her back nerves, making it difficult for her to sit for long periods of time without experiencing pain. She also allegedly suffers from urinary incontinence and, as a result, has been unable to work.

The physician argued that the patient had chronic back pain prior to the laparoscopy and that the procedure and injury caused no further damage.

The jury awarded the plaintiff $1.2 million and also awarded her husband $100,000 for pain and suffering.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<court>San Diego County (Calif) Superior Court</court>—After an Ob/Gyn delivered a baby via forceps and vacuum extraction, the nurses noticed that the infant’s right eye was swollen and opaque. The child was later diagnosed with a corneal tear and would have to undergo a cornea transplant by age 1.

In suing, the parents contended that the obstetrician misapplied the forceps during the course of delivery, resulting in the corneal tear.

The physician argued that he did not apply the forceps improperly. Instead, other factors such as bony prominence or vacuum suction caused the eye injury.

The jury awarded the plaintiffs $425,000.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<court>San Diego County (Calif) Superior Court</court>—After an Ob/Gyn delivered a baby via forceps and vacuum extraction, the nurses noticed that the infant’s right eye was swollen and opaque. The child was later diagnosed with a corneal tear and would have to undergo a cornea transplant by age 1.

In suing, the parents contended that the obstetrician misapplied the forceps during the course of delivery, resulting in the corneal tear.

The physician argued that he did not apply the forceps improperly. Instead, other factors such as bony prominence or vacuum suction caused the eye injury.

The jury awarded the plaintiffs $425,000.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<court>San Diego County (Calif) Superior Court</court>—After an Ob/Gyn delivered a baby via forceps and vacuum extraction, the nurses noticed that the infant’s right eye was swollen and opaque. The child was later diagnosed with a corneal tear and would have to undergo a cornea transplant by age 1.

In suing, the parents contended that the obstetrician misapplied the forceps during the course of delivery, resulting in the corneal tear.

The physician argued that he did not apply the forceps improperly. Instead, other factors such as bony prominence or vacuum suction caused the eye injury.

The jury awarded the plaintiffs $425,000.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Orange County (NY) Supreme Court—After a routine examination in March 1998 showed an abnormal Pap result, a woman underwent a number of tests, including a CA-125, transabdominal and transvaginal ultrasound tests with color Doppler flow studies, endocervical curettage, and an endometrial biopsy to rule out endocervical cancer. The test results were normal, and a follow-up Pap in August 1998 also was normal. However, in January 1999, the patient was diagnosed with advanced-stage ovarian cancer. At that time, she had an abdominal hysterectomy followed by chemotherapy.

In suing, the woman claimed that because she had a family history of breast and ovarian cancer, the physician also should have performed a laparoscopy and referred her to a gynecologic oncologist.

The physician argued that since the laboratory and imaging results were all normal, there was no indication to perform additional testing. She believed the abnormal Pap was probably a false-positive reading. Lastly, she maintained that the ovarian cancer was not present during the tests performed in 1998 and that it most likely developed 2 to 4 months prior to diagnosis.

The jury returned a defense verdict.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Orange County (NY) Supreme Court—After a routine examination in March 1998 showed an abnormal Pap result, a woman underwent a number of tests, including a CA-125, transabdominal and transvaginal ultrasound tests with color Doppler flow studies, endocervical curettage, and an endometrial biopsy to rule out endocervical cancer. The test results were normal, and a follow-up Pap in August 1998 also was normal. However, in January 1999, the patient was diagnosed with advanced-stage ovarian cancer. At that time, she had an abdominal hysterectomy followed by chemotherapy.

In suing, the woman claimed that because she had a family history of breast and ovarian cancer, the physician also should have performed a laparoscopy and referred her to a gynecologic oncologist.

The physician argued that since the laboratory and imaging results were all normal, there was no indication to perform additional testing. She believed the abnormal Pap was probably a false-positive reading. Lastly, she maintained that the ovarian cancer was not present during the tests performed in 1998 and that it most likely developed 2 to 4 months prior to diagnosis.

The jury returned a defense verdict.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Orange County (NY) Supreme Court—After a routine examination in March 1998 showed an abnormal Pap result, a woman underwent a number of tests, including a CA-125, transabdominal and transvaginal ultrasound tests with color Doppler flow studies, endocervical curettage, and an endometrial biopsy to rule out endocervical cancer. The test results were normal, and a follow-up Pap in August 1998 also was normal. However, in January 1999, the patient was diagnosed with advanced-stage ovarian cancer. At that time, she had an abdominal hysterectomy followed by chemotherapy.

In suing, the woman claimed that because she had a family history of breast and ovarian cancer, the physician also should have performed a laparoscopy and referred her to a gynecologic oncologist.

The physician argued that since the laboratory and imaging results were all normal, there was no indication to perform additional testing. She believed the abnormal Pap was probably a false-positive reading. Lastly, she maintained that the ovarian cancer was not present during the tests performed in 1998 and that it most likely developed 2 to 4 months prior to diagnosis.

The jury returned a defense verdict.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Los Angeles County (Calif) Superior Court—When a gravida who had 3 prior cesareans presented to a hospital for a breech delivery, the physician opted to perform another cesarean. During the procedure, the patient stopped breathing, and her heart rate dropped significantly. The obstetrician temporarily halted the surgery to insert an endotracheal tube to ensure proper breathing. When the gravida’s vitals returned to normal, he resumed the cesarean section and delivered a healthy infant.

One hour later, during a CT scan, it was discovered that the endotracheal tube had become dislodged. A code blue was issued, but the patient had already developed hypoxic anoxic encephalopathy. She is now in a vegetative state and requires lifetime subacute care.

In suing, the patient’s husband claimed that his wife suffered a high spinal, whereby the anesthesia level had risen above her rib cage, restricting her breathing and depriving her brain of oxygen. He maintained that the doctor failed to recognize the high spinal and to properly secure the endotracheal tube.

The physician argued that the patient suffered either an air embolism or an amniotic fluid embolism during delivery, resulting in massive brain damage.

The jury awarded the plaintiff $5,524,163.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Los Angeles County (Calif) Superior Court—When a gravida who had 3 prior cesareans presented to a hospital for a breech delivery, the physician opted to perform another cesarean. During the procedure, the patient stopped breathing, and her heart rate dropped significantly. The obstetrician temporarily halted the surgery to insert an endotracheal tube to ensure proper breathing. When the gravida’s vitals returned to normal, he resumed the cesarean section and delivered a healthy infant.

One hour later, during a CT scan, it was discovered that the endotracheal tube had become dislodged. A code blue was issued, but the patient had already developed hypoxic anoxic encephalopathy. She is now in a vegetative state and requires lifetime subacute care.

In suing, the patient’s husband claimed that his wife suffered a high spinal, whereby the anesthesia level had risen above her rib cage, restricting her breathing and depriving her brain of oxygen. He maintained that the doctor failed to recognize the high spinal and to properly secure the endotracheal tube.

The physician argued that the patient suffered either an air embolism or an amniotic fluid embolism during delivery, resulting in massive brain damage.

The jury awarded the plaintiff $5,524,163.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

Los Angeles County (Calif) Superior Court—When a gravida who had 3 prior cesareans presented to a hospital for a breech delivery, the physician opted to perform another cesarean. During the procedure, the patient stopped breathing, and her heart rate dropped significantly. The obstetrician temporarily halted the surgery to insert an endotracheal tube to ensure proper breathing. When the gravida’s vitals returned to normal, he resumed the cesarean section and delivered a healthy infant.

One hour later, during a CT scan, it was discovered that the endotracheal tube had become dislodged. A code blue was issued, but the patient had already developed hypoxic anoxic encephalopathy. She is now in a vegetative state and requires lifetime subacute care.

In suing, the patient’s husband claimed that his wife suffered a high spinal, whereby the anesthesia level had risen above her rib cage, restricting her breathing and depriving her brain of oxygen. He maintained that the doctor failed to recognize the high spinal and to properly secure the endotracheal tube.

The physician argued that the patient suffered either an air embolism or an amniotic fluid embolism during delivery, resulting in massive brain damage.

The jury awarded the plaintiff $5,524,163.

The cases presented here were compiled by Lewis L. Laska, editor of Medical Malpractice Verdicts, Settlements & Experts. While there are instances when the available information is incomplete, these cases represent the types of clinical situations that typically result in litigation.

<huc>Q</huc> At the community, non-training hospital where I work, the administration states that it is the pediatrician’s responsibility to perform neonatal resuscitation. However, the pediatricians, as well as the anesthesiologists, contend that it is not their duty, ultimately leaving it up to the obstetricians. For their part, the Ob/Gyns are frustrated with this situation, especially in light of increasing malpractice lawsuits.

In this type of hospital, who is responsible for performing neonatal resuscitation? And who is at fault if this lack of a sense of duty leads to brain damage or death?

<huc>A</huc> According to a recent joint committee opinion of ACOG and the American Society of Anesthesiologists (ASA), “Personnel other than the surgical team should be immediately available to assume responsibility for resuscitation of the depressed newborn. The surgeon and anesthesiologist are responsible for the mother and may not be able to leave her to care for the newborn even when a regional anesthetic is functioning adequately.”¹

This opinion reflects the Guidelines for Perinatal Care² and the now defunct ACOG Standards for Obstetric-Gynecologic Services,³ which stated—as early as 1988—that a separate, specially trained individual (a physician, nurse-midwife, labor and delivery nurse, neonatal nurse practitioner, nurse-anesthetist, or respiratory therapist) whose primary responsibility is the care of the newborn infant should be present at every delivery or immediately available in the hospital. In addition, the documents placed the responsibility of developing protocols for the resuscitation of a distressed neonate on the individual hospitals.

The cost of time. The problem, of course, is economics. Pediatricians, neonatologists, and anesthesiologists who are not already assisting in the delivery have found that they are frequently uncompensated for “waiting around” for a neonatal resuscitation. As a result, many of them are reluctant to make themselves “immediately available” unless they already are in the hospital and simply can be paged to the labor and delivery room.

The joint committee opinion of ACOG and ASA attempts to address this issue in the following fashion: “The availability of the appropriate personnel to assist in the management of a variety of obstetric problems is a necessary feature of good obstetric care. The presence of a pediatrician or other trained physician at a high-risk cesarean delivery to care for the newborn or the availability of an anesthesiologist during active labor and delivery when VBAC is attempted and at a breech or twin delivery are examples.

“Frequently, these professionals spend a considerable amount of time standing by for the possibility that their services may be needed emergently but may ultimately not be required to perform the task for which they are present. Reasonable compensation for these standby services is justifiable and necessary.”¹

Weighing medicolegal risks. With regard to liability, hospital protocols have the same force and effect as standards of care in malpractice lawsuits. As a result, a pediatrician’s failure to obey your hospital protocols in the case of a distressed neonate could, and should, make him or her legally responsible if brain damage or death ensues. Unfortunately, if you were the delivering Ob/Gyn in such a case and you attempted the neonatal resuscitation yourself when the pediatrician failed to respond, you would likely be sued as well. The pediatrician would have primary culpability because of the violation of the hospital protocol, but since you provided care to the patient and a bad outcome occurred, a plaintiff attorney would probably name you in the lawsuit as well.

The good news is that the hospital also would be a co-defendant in this type of case. Therefore, you might want to bring this matter to the attention of your hospital administration. This sort of turf battle between Ob/Gyns, pediatricians, and anesthesiologists is a perfect example of how the system itself can lead to bad outcomes. The hospital administration would be well advised to revisit its protocol to provide financial incentive for the physician responsible for neonatal resuscitation—in this case, the oncall pediatrician. The best defended lawsuits are the ones that are avoided in the first place.

Disclaimer:

Mr. Heland’s comments reflect generally applicable legal principles. However, these comments should not be construed as constituting legal advice. Because laws can vary considerably from state to state and because each legal situation has its own unique characteristics, readers should consult their own attorneys about how best to manage a particular situation or issue.

<huc>Q</huc> At the community, non-training hospital where I work, the administration states that it is the pediatrician’s responsibility to perform neonatal resuscitation. However, the pediatricians, as well as the anesthesiologists, contend that it is not their duty, ultimately leaving it up to the obstetricians. For their part, the Ob/Gyns are frustrated with this situation, especially in light of increasing malpractice lawsuits.

In this type of hospital, who is responsible for performing neonatal resuscitation? And who is at fault if this lack of a sense of duty leads to brain damage or death?

<huc>A</huc> According to a recent joint committee opinion of ACOG and the American Society of Anesthesiologists (ASA), “Personnel other than the surgical team should be immediately available to assume responsibility for resuscitation of the depressed newborn. The surgeon and anesthesiologist are responsible for the mother and may not be able to leave her to care for the newborn even when a regional anesthetic is functioning adequately.”¹

This opinion reflects the Guidelines for Perinatal Care² and the now defunct ACOG Standards for Obstetric-Gynecologic Services,³ which stated—as early as 1988—that a separate, specially trained individual (a physician, nurse-midwife, labor and delivery nurse, neonatal nurse practitioner, nurse-anesthetist, or respiratory therapist) whose primary responsibility is the care of the newborn infant should be present at every delivery or immediately available in the hospital. In addition, the documents placed the responsibility of developing protocols for the resuscitation of a distressed neonate on the individual hospitals.

The cost of time. The problem, of course, is economics. Pediatricians, neonatologists, and anesthesiologists who are not already assisting in the delivery have found that they are frequently uncompensated for “waiting around” for a neonatal resuscitation. As a result, many of them are reluctant to make themselves “immediately available” unless they already are in the hospital and simply can be paged to the labor and delivery room.

The joint committee opinion of ACOG and ASA attempts to address this issue in the following fashion: “The availability of the appropriate personnel to assist in the management of a variety of obstetric problems is a necessary feature of good obstetric care. The presence of a pediatrician or other trained physician at a high-risk cesarean delivery to care for the newborn or the availability of an anesthesiologist during active labor and delivery when VBAC is attempted and at a breech or twin delivery are examples.

“Frequently, these professionals spend a considerable amount of time standing by for the possibility that their services may be needed emergently but may ultimately not be required to perform the task for which they are present. Reasonable compensation for these standby services is justifiable and necessary.”¹

Weighing medicolegal risks. With regard to liability, hospital protocols have the same force and effect as standards of care in malpractice lawsuits. As a result, a pediatrician’s failure to obey your hospital protocols in the case of a distressed neonate could, and should, make him or her legally responsible if brain damage or death ensues. Unfortunately, if you were the delivering Ob/Gyn in such a case and you attempted the neonatal resuscitation yourself when the pediatrician failed to respond, you would likely be sued as well. The pediatrician would have primary culpability because of the violation of the hospital protocol, but since you provided care to the patient and a bad outcome occurred, a plaintiff attorney would probably name you in the lawsuit as well.

The good news is that the hospital also would be a co-defendant in this type of case. Therefore, you might want to bring this matter to the attention of your hospital administration. This sort of turf battle between Ob/Gyns, pediatricians, and anesthesiologists is a perfect example of how the system itself can lead to bad outcomes. The hospital administration would be well advised to revisit its protocol to provide financial incentive for the physician responsible for neonatal resuscitation—in this case, the oncall pediatrician. The best defended lawsuits are the ones that are avoided in the first place.

Disclaimer:

Mr. Heland’s comments reflect generally applicable legal principles. However, these comments should not be construed as constituting legal advice. Because laws can vary considerably from state to state and because each legal situation has its own unique characteristics, readers should consult their own attorneys about how best to manage a particular situation or issue.

<huc>Q</huc> At the community, non-training hospital where I work, the administration states that it is the pediatrician’s responsibility to perform neonatal resuscitation. However, the pediatricians, as well as the anesthesiologists, contend that it is not their duty, ultimately leaving it up to the obstetricians. For their part, the Ob/Gyns are frustrated with this situation, especially in light of increasing malpractice lawsuits.

In this type of hospital, who is responsible for performing neonatal resuscitation? And who is at fault if this lack of a sense of duty leads to brain damage or death?

<huc>A</huc> According to a recent joint committee opinion of ACOG and the American Society of Anesthesiologists (ASA), “Personnel other than the surgical team should be immediately available to assume responsibility for resuscitation of the depressed newborn. The surgeon and anesthesiologist are responsible for the mother and may not be able to leave her to care for the newborn even when a regional anesthetic is functioning adequately.”¹

This opinion reflects the Guidelines for Perinatal Care² and the now defunct ACOG Standards for Obstetric-Gynecologic Services,³ which stated—as early as 1988—that a separate, specially trained individual (a physician, nurse-midwife, labor and delivery nurse, neonatal nurse practitioner, nurse-anesthetist, or respiratory therapist) whose primary responsibility is the care of the newborn infant should be present at every delivery or immediately available in the hospital. In addition, the documents placed the responsibility of developing protocols for the resuscitation of a distressed neonate on the individual hospitals.

The cost of time. The problem, of course, is economics. Pediatricians, neonatologists, and anesthesiologists who are not already assisting in the delivery have found that they are frequently uncompensated for “waiting around” for a neonatal resuscitation. As a result, many of them are reluctant to make themselves “immediately available” unless they already are in the hospital and simply can be paged to the labor and delivery room.

The joint committee opinion of ACOG and ASA attempts to address this issue in the following fashion: “The availability of the appropriate personnel to assist in the management of a variety of obstetric problems is a necessary feature of good obstetric care. The presence of a pediatrician or other trained physician at a high-risk cesarean delivery to care for the newborn or the availability of an anesthesiologist during active labor and delivery when VBAC is attempted and at a breech or twin delivery are examples.

“Frequently, these professionals spend a considerable amount of time standing by for the possibility that their services may be needed emergently but may ultimately not be required to perform the task for which they are present. Reasonable compensation for these standby services is justifiable and necessary.”¹

Weighing medicolegal risks. With regard to liability, hospital protocols have the same force and effect as standards of care in malpractice lawsuits. As a result, a pediatrician’s failure to obey your hospital protocols in the case of a distressed neonate could, and should, make him or her legally responsible if brain damage or death ensues. Unfortunately, if you were the delivering Ob/Gyn in such a case and you attempted the neonatal resuscitation yourself when the pediatrician failed to respond, you would likely be sued as well. The pediatrician would have primary culpability because of the violation of the hospital protocol, but since you provided care to the patient and a bad outcome occurred, a plaintiff attorney would probably name you in the lawsuit as well.

The good news is that the hospital also would be a co-defendant in this type of case. Therefore, you might want to bring this matter to the attention of your hospital administration. This sort of turf battle between Ob/Gyns, pediatricians, and anesthesiologists is a perfect example of how the system itself can lead to bad outcomes. The hospital administration would be well advised to revisit its protocol to provide financial incentive for the physician responsible for neonatal resuscitation—in this case, the oncall pediatrician. The best defended lawsuits are the ones that are avoided in the first place.

Disclaimer:

Mr. Heland’s comments reflect generally applicable legal principles. However, these comments should not be construed as constituting legal advice. Because laws can vary considerably from state to state and because each legal situation has its own unique characteristics, readers should consult their own attorneys about how best to manage a particular situation or issue.

<huc>Q</huc> Does the $300 cap on gifts from pharmaceutical companies to physicians apply to such traditional activities as dinner presentations or “Speakers’ Bureau” educational meetings sponsored by these companies? In addition, how did this rule originate?

<huc>A</huc> You might understand the rule better if I answer your second question first. In December 1990, the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs published guidelines regarding inappropriate gifts to physicians from industry representatives.¹ Initially, 7 rules were promulgated so that physicians could avoid accepting gifts that were inconsistent with the Principles of Medical Ethics. The council subsequently issued an addendum that attempted to clarify the ethical guidelines in a question-and-answer format, with direct answers to specific gift situations.²

Increasing physician awareness. Since these guidelines are now more than 10 years old, the AMA has become concerned that many physicians are not aware of their existence. In fact, media reports in early 2001 suggested there was an increase in gift-giving practices that did not adhere to these rules. As a result, in August 2001, the AMA established the Working Group for the Communication of Ethical Guidelines on Gifts to Physicians from Industry. This group is comprised of the AMA and more than 30 physician organizations, including the American College of Obstetricians and Gynecologists (ACOG), healthcare organizations, and industry representatives (both pharmaceutical companies and equipment manufacturers). Further, the ACOG Committee on Ethics updated its committee opinion on this subject in October 2001.³

Defining who is affected. Most physician organizations, including ACOG, have incorporated the AMA Ethical Opinions/Guidelines into their own code of ethics, and many state and local medical societies have done the same. Translation: It is highly likely that these guidelines—or variations thereof—apply to you whether or not you are a member of the AMA. For example, some societies have adopted more specific gift guidelines. I suspect that the $300 cap on gifts that you mentioned is a state or local society rule because the AMA addendum states that gifts in excess of $100 are inappropriate.

Applying the rules. To answer your first question, dinner presentations are appropriate if the dinner is a modest meal. It should be similar to what a physician routinely might have when dining at his or her own expense. The educational component must have an independent value such as a presentation by an authoritative speaker rather than a sales representative from the sponsoring company.

As far as Speakers’ Bureau meetings are concerned, I assume you are referring to whole-day or weekend seminars with a number of authoritative speakers and Continuing Medical Education (CME) credit. These meetings are more questionable, especially when they are directly conducted by the pharmaceutical company or equipment manufacturer, with minimal participation, input, or control from an academic or accredited medical society sponsor or intermediary. As with dinner meetings, the guidelines permit only modest hospitality in connection with such programs. Rather, it is preferred that industry provide funds to academic institutions or accredited medical societies so they can conduct independent educational seminars.

A look at the key points. Following are some excerpts from the guidelines:

• Gifts should not be of substantial value, i.e., anything in excess of $100.
• Gifts should primarily entail a benefit to patients, not the physician, e.g., complimentary drug samples. Diagnostic equipment such as a stethoscope is only appropriate if it is of modest value. Value is determined by what the physician would pay at retail, not what the company paid at wholesale. Educational programs are appropriate because they can provide an indirect benefit to patients by enhancing the quality of care.
• Reimbursement of travel, lodging, and meal expenses for an educational meeting is inappropriate unless the physician is a bona fide member of the faculty for that meeting.
• Social or entertainment events at a conference should not be lavish and expensive and should be open to all conference participants.
• The modest meal rule can include payment for the meals of a physician’s spouse.

For more information on these guidelines, visit the AMA Web site at www.ama-assn.org/ama/pub/category/4002.html.

Disclaimer:

Mr. Heland’s comments reflect generally applicable legal principles. However, these comments should not be construed as constituting legal advice. Because laws can vary considerably from state to state and because each legal situation has its own unique characteristics, readers should consult their own attorneys about how best to manage a particular situation or issue.

<huc>Q</huc> Does the $300 cap on gifts from pharmaceutical companies to physicians apply to such traditional activities as dinner presentations or “Speakers’ Bureau” educational meetings sponsored by these companies? In addition, how did this rule originate?

<huc>A</huc> You might understand the rule better if I answer your second question first. In December 1990, the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs published guidelines regarding inappropriate gifts to physicians from industry representatives.¹ Initially, 7 rules were promulgated so that physicians could avoid accepting gifts that were inconsistent with the Principles of Medical Ethics. The council subsequently issued an addendum that attempted to clarify the ethical guidelines in a question-and-answer format, with direct answers to specific gift situations.²

Increasing physician awareness. Since these guidelines are now more than 10 years old, the AMA has become concerned that many physicians are not aware of their existence. In fact, media reports in early 2001 suggested there was an increase in gift-giving practices that did not adhere to these rules. As a result, in August 2001, the AMA established the Working Group for the Communication of Ethical Guidelines on Gifts to Physicians from Industry. This group is comprised of the AMA and more than 30 physician organizations, including the American College of Obstetricians and Gynecologists (ACOG), healthcare organizations, and industry representatives (both pharmaceutical companies and equipment manufacturers). Further, the ACOG Committee on Ethics updated its committee opinion on this subject in October 2001.³

Defining who is affected. Most physician organizations, including ACOG, have incorporated the AMA Ethical Opinions/Guidelines into their own code of ethics, and many state and local medical societies have done the same. Translation: It is highly likely that these guidelines—or variations thereof—apply to you whether or not you are a member of the AMA. For example, some societies have adopted more specific gift guidelines. I suspect that the $300 cap on gifts that you mentioned is a state or local society rule because the AMA addendum states that gifts in excess of $100 are inappropriate.

Applying the rules. To answer your first question, dinner presentations are appropriate if the dinner is a modest meal. It should be similar to what a physician routinely might have when dining at his or her own expense. The educational component must have an independent value such as a presentation by an authoritative speaker rather than a sales representative from the sponsoring company.

As far as Speakers’ Bureau meetings are concerned, I assume you are referring to whole-day or weekend seminars with a number of authoritative speakers and Continuing Medical Education (CME) credit. These meetings are more questionable, especially when they are directly conducted by the pharmaceutical company or equipment manufacturer, with minimal participation, input, or control from an academic or accredited medical society sponsor or intermediary. As with dinner meetings, the guidelines permit only modest hospitality in connection with such programs. Rather, it is preferred that industry provide funds to academic institutions or accredited medical societies so they can conduct independent educational seminars.

A look at the key points. Following are some excerpts from the guidelines:

• Gifts should not be of substantial value, i.e., anything in excess of $100.
• Gifts should primarily entail a benefit to patients, not the physician, e.g., complimentary drug samples. Diagnostic equipment such as a stethoscope is only appropriate if it is of modest value. Value is determined by what the physician would pay at retail, not what the company paid at wholesale. Educational programs are appropriate because they can provide an indirect benefit to patients by enhancing the quality of care.
• Reimbursement of travel, lodging, and meal expenses for an educational meeting is inappropriate unless the physician is a bona fide member of the faculty for that meeting.
• Social or entertainment events at a conference should not be lavish and expensive and should be open to all conference participants.
• The modest meal rule can include payment for the meals of a physician’s spouse.

For more information on these guidelines, visit the AMA Web site at www.ama-assn.org/ama/pub/category/4002.html.

Disclaimer:

Mr. Heland’s comments reflect generally applicable legal principles. However, these comments should not be construed as constituting legal advice. Because laws can vary considerably from state to state and because each legal situation has its own unique characteristics, readers should consult their own attorneys about how best to manage a particular situation or issue.

<huc>Q</huc> Does the $300 cap on gifts from pharmaceutical companies to physicians apply to such traditional activities as dinner presentations or “Speakers’ Bureau” educational meetings sponsored by these companies? In addition, how did this rule originate?

<huc>A</huc> You might understand the rule better if I answer your second question first. In December 1990, the American Medical Association’s (AMA) Council on Ethical and Judicial Affairs published guidelines regarding inappropriate gifts to physicians from industry representatives.¹ Initially, 7 rules were promulgated so that physicians could avoid accepting gifts that were inconsistent with the Principles of Medical Ethics. The council subsequently issued an addendum that attempted to clarify the ethical guidelines in a question-and-answer format, with direct answers to specific gift situations.²

Increasing physician awareness. Since these guidelines are now more than 10 years old, the AMA has become concerned that many physicians are not aware of their existence. In fact, media reports in early 2001 suggested there was an increase in gift-giving practices that did not adhere to these rules. As a result, in August 2001, the AMA established the Working Group for the Communication of Ethical Guidelines on Gifts to Physicians from Industry. This group is comprised of the AMA and more than 30 physician organizations, including the American College of Obstetricians and Gynecologists (ACOG), healthcare organizations, and industry representatives (both pharmaceutical companies and equipment manufacturers). Further, the ACOG Committee on Ethics updated its committee opinion on this subject in October 2001.³

Defining who is affected. Most physician organizations, including ACOG, have incorporated the AMA Ethical Opinions/Guidelines into their own code of ethics, and many state and local medical societies have done the same. Translation: It is highly likely that these guidelines—or variations thereof—apply to you whether or not you are a member of the AMA. For example, some societies have adopted more specific gift guidelines. I suspect that the $300 cap on gifts that you mentioned is a state or local society rule because the AMA addendum states that gifts in excess of $100 are inappropriate.

Applying the rules. To answer your first question, dinner presentations are appropriate if the dinner is a modest meal. It should be similar to what a physician routinely might have when dining at his or her own expense. The educational component must have an independent value such as a presentation by an authoritative speaker rather than a sales representative from the sponsoring company.

As far as Speakers’ Bureau meetings are concerned, I assume you are referring to whole-day or weekend seminars with a number of authoritative speakers and Continuing Medical Education (CME) credit. These meetings are more questionable, especially when they are directly conducted by the pharmaceutical company or equipment manufacturer, with minimal participation, input, or control from an academic or accredited medical society sponsor or intermediary. As with dinner meetings, the guidelines permit only modest hospitality in connection with such programs. Rather, it is preferred that industry provide funds to academic institutions or accredited medical societies so they can conduct independent educational seminars.

A look at the key points. Following are some excerpts from the guidelines:

• Gifts should not be of substantial value, i.e., anything in excess of $100.
• Gifts should primarily entail a benefit to patients, not the physician, e.g., complimentary drug samples. Diagnostic equipment such as a stethoscope is only appropriate if it is of modest value. Value is determined by what the physician would pay at retail, not what the company paid at wholesale. Educational programs are appropriate because they can provide an indirect benefit to patients by enhancing the quality of care.
• Reimbursement of travel, lodging, and meal expenses for an educational meeting is inappropriate unless the physician is a bona fide member of the faculty for that meeting.
• Social or entertainment events at a conference should not be lavish and expensive and should be open to all conference participants.
• The modest meal rule can include payment for the meals of a physician’s spouse.

For more information on these guidelines, visit the AMA Web site at www.ama-assn.org/ama/pub/category/4002.html.

Disclaimer:

Mr. Heland’s comments reflect generally applicable legal principles. However, these comments should not be construed as constituting legal advice. Because laws can vary considerably from state to state and because each legal situation has its own unique characteristics, readers should consult their own attorneys about how best to manage a particular situation or issue.