Adena Thought Leaders Summit 2020
September 9, 2020
Trial of the Century:
Mock trial of an actual case!
A 58-year old man with chest pain
ALLEGATIONS:
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Failure to diagnose
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Failure to timely diagnose
THE CASE:
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The first EKG in the ER was complete at 12:03 a.m. on April 5, and the EKG showed some ST elevation, but it was in the non-inferior leads. Also, the EKG was not significantly different from those done by EMS, so was not showing evolving changes.
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ER Nurse documents inquiry “asked Dr. ER if we should activate STEMI protocol?” and “Dr. ER to consult with Dr. interventional cardiologist (IC)”
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Dr. ER promptly contacted the Interventional Cardiologist on call
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Dr. IC asked Dr. ER to fax him the 12:03 EKG and to do a repeat EKG, both of which were done.
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The repeat EKG was completed at 12:36. This EKG was sent to Dr. IC at approximately 12:40.
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ER Nurse again documents “asked Dr. ER if we should activate STEMI protocol?” and “Dr. ER to consult with Dr. IC”
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Dr. ER spoke with DR. IC shortly thereafter and they discussed the two EKGs and the cardiac enzyme results [Troponin: 0.08; CK (CPK): 369; CK-MB (CPK-MB): 9.8]
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Dr. IC felt that the patient was suffering from unstable angina and that he needed to be admitted to the ICU so that he could be carefully monitored and any changes observed. He also instructed Dr. ER to change the patient’s heparin to Lovenox. He indicated he would come and see the patient later.
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Dr. ER contacted Dr. IM and arranged to admit the patient to her care. Dr. IM was told of the patient’s condition, presentation, the consultation with the cardiologist, and his assessment, diagnosis and plan.
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Dr. ER wrote admitting orders as instructed by Dr. IC and the patient was transferred to the ICU at 1:20 a.m.
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Initial ECG at 12:03: Note that the cardiologist fax/phone number is hand written on the ECG (partially reproduced here) and that a subsequent ECG was done in the ED which was similar without reciprocal changes will be detailed at the conference).
Agenda
SEPT 9, 2020
10:00-10:05
Intro – Weinstock
A. Introduction of speakers/participants
B. Acknowledgement and thanks to planning committee
C. Overview of medical malpractice
D. Schedule of trial (below)
E. This is a mock trial and will teach law, but will also teach the medicine.
Note: The 'volunteer' defendant was not the actual doctor on the case!
10:05-10:15
Weinstock interview Amal Mattu - EM cardio and expert witness work - documentation and patient safety
10:15-10:25
Overview of legal process – Calvert and Kitrick (attorneys)
A. Plaintiff (Kitrick)
1. How do you decide if you take a case?
2. How do you decide how much to ask for (if you settle)?
3. How do you find experts?
B. Defense (Calvert)
1. How do you decide to settle or take a case to trial?
2. What makes a good witness?
3. What type of documentation and care makes a case easy to defend?
10:25-10:30
Presentation of case – Stephanie Richcreek (resident)
10:30-12:30
Mock Trial
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Judge instructions to jury (Weinstock)
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Opening statement – Plaintiff (Kitrick)
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Opening statement – Defense (Calvert)
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Defense attorney examination of physician (Frost – Chief resident Adena EM)
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Plaintiff attorney examination of physician (Frost – Chief resident Adena EM)
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Plaintiff attorney (Kitrick) direct to plaintiff expert (Delaney)
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Defense attorney (Calvert) cross to plaintiff expert (Delaney)
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Defense attorney (Calvert) direct to defense expert (Mattu)
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Plaintiff attorney (Kitrick) cross to plaintiff expert (Mattu)
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Closing statement Plaintiff attorney - Mark Kitrick
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Closing statement Defense attorney - Marc Calvert
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Judge instructions to jury (Weinstock)
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Jury verdict (vote) - ALL particpants in call through Zoom poll
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Wrap up (what happened?)
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Q&A - Zoom chat - ask the experts... ask the attorneys!
Mark Kitrick, Plaintiff Attorney
Mark Kitrick is senior litigator at and President of the law firm of Kitrick, Lewis & Harris. Mark has been
doing complex litigation for 39 years involving serious injury and death cases and class actions. He is
currently President of the Ohio State Bar Foundation, the largest nonprofit, law foundation in the world,
currently President of Ohio’s American Board of Trial Advocates (ABOTA), past President of the Ohio
Association for Justice, past President of Franklin Country Trial Lawyers Association, and past President
of the International Association of Aikido Alliance. Mark is a frequent lecturer in Ohio and around the
country and he publishes numerous articles about trial practice on a regular basis.
Matt Delaney, MD – Plaintiff expert
Matthew DeLaney is an associate professor and associate program director in the Department of
Emergency Medicine at the University of Alabama at Birmingham. He is a co-host of Urgent Care RAP
and ERCast: Lit Matters and is a regular contributor to various other medical podcasts. He is the author
of the series Everyday Risk in Emergency Medicine and lectures regularly on a variety of topics with a
focus on reducing risk of adverse events for both patients and clinicians.
Michael Weinstock, MD – Judge
Mike is the Associate Program Director at the Adena Emergency Medicine Residency and Professor of Emergency Medicine, Adjunct at the Wexner Medical Center at The Ohio State University. He has
lectured nationally and internationally on medical topics and patient safety issues and is the executive editor for UC RAP, the risk management section editor for EM RAP, and has contributed to ERcast and Risk Management Monthly. He is the author of the Bouncebacks! series of books and with Scott Weingart and Kevin Klauer will publish Bouncebacks! Critical Care in 2020. Michael has practiced medicine nationally and internationally including volunteer work in Papua New Guinea, Nepal, and the West Indies. Research interests include ED evaluation and management of chest pain, patient safety, EM medical education, and of course, Bouncebacks!
Amal Mattu, MD - Defense expert
Dr. Mattu completed an emergency medicine residency at Thomas Jefferson University Hospital in Philadelphia, after which he completed a teaching fellowship with a special focus on emergency cardiology. Since joining the faculty at the University of Maryland in 1996, he has developed an academic niche in emergency cardiology and electrocardiography, and he also enjoys teaching and writing about other topics such as emergency geriatrics, faculty development, and risk management. He currently is a tenured professor and Vice Chair of Emergency Medicine at the University of Maryland School of Medicine. He lives near Annapolis, Maryland with his wife and three kids.
Marc Calvert, JD – Defense attorney
Marc Calvert graduated from the University of Texas law school in 1987 and has defended healthcare
providers ever since. He became board certified in 1994, and established Calvert and Associates in
1996. He defends lawsuits, board matters, peer reviews, and other claims involving healthcare
providers. He is a frequent presenter to physicians and risk management professionals. He is married
and has 4 children and 10 grandchildren.
Volunteer Defendant:
Kaetha Frost, DO
Kaetha is a chief resident in the Adena Emergency Medicine Residency.
(Of note, she is a 'volunteer' defendant and was not the actual defendant in this case!)
Committee Planners
Chris Hornack, DO
Sam Nobilucci, DO
Faraaz Siddiqui, MD
Stephanie Richcreek, DO, MSMS
Dr. Stephanie Richcreek is a third year Family Medicine Resident at Adena Regional Medical Center.
Affectionately called Dr. Stef by many of her patients, she is interested in Traditional Rural Family Medicine.
She has an affinity for osteopathic manipulative medicine. Special interests include: Emergency
Preparedness Training and Community Outreach and Education.