Day on Torts

John Ritter died of an aortic aneurysm in 2003. His family filed a medical malpractice lawsuit against various health care providers. It now appears that the case has been settled.

I met John Ritter in New York 5 or 6 years ago. I went to a play and at the end the cast came back onto the stage and auctioned off a prop to raise money for an AIDS group. I "won" the auction and got to go backstage, meet the cast (including Henry Winkler), get photos, etc. It was a good deal of fun.

The reason for that little story is this: John Ritter could not have been more gracious. He spent part of his life in Nashville (his dad was country music legend Tex Ritter), and actually lived in a beautiful house about 4 miles away from my house. We talked about Nashville and he told me what wonderful memories he had of my adoptive home. I could tell that he was a kind, compassionate man.

I tell you that to say this: John Ritter was no different than most of the other 98,000 people who die as a result of medical negligence each year in this country, most of whom never see a lawyer much less win a case by settlement or verdict. His fame brought his death to the front pages and perhaps even helped bring his case to a settlement, but - like all us - he had to rely on the competence and attentiveness of the health care industry at a critical state in his life. That industry failed him, not intentionally, probably not even recklessly. That industry, which does so much good for so many every day, must be held accountable when it makes errors that harm or result in death. It is does not deserve special treatment because of the good it does, anymore than does the trucking industry (which brings us food, medicine, clothes and so much more every day of our lives) deserves special treatment when it does harm.

I applaud John Ritter's family for having the courage to speak out about his death and for going through the trauma of this litigation. May they now truly begin to heal.

You mention that the case settled. What was the nature of the case? The link listed in your article is a dead one and I cannot find what the actual negligence was.

It was misdiagnosis of an aortic aneurysm if my memory serves me correctly.

I believe it was aortic dissection.
Regardless, this illustrates the insanity of the system. If a patient arrives in the ER with a ruptured AAA (abdominal aortic aneurysm), his chance of survival is ~50%. 25% die on the table. It is a very big surgery, and most die before making it to the hospital, making the actual mortality higher. An aortic dissection, can be a difficult diagnosis to make, and the surgery while not as challenging is still very difficult with a significant morbidity and mortality. Anyone who has ever had to work up chest pain knows this is part of the differential, but the odds are very small that this is the dx. Also, patients don't show up and say I have "aortic dissection." Doctors have to piece together many factors.
While his death is tragic, there is no guarantee that even if the doctor was superman (or superwoman) with Xray vision able to make a diagnosis instantaneously, John Ritter would have survived.
However, it is a sad story, so I guess if I was on the jury, I would listen to the sleazy trial attorney and decide to "award" the attorney some money for all his suffering. Who knows maybe the family will receive some of it.

Do you have further details of Mr. Ritter's case: symptoms, physical exam
findings, x-ray results, other details?
This would be needed to determine whether there was, in fact, malpractice, and to know how to avoid error in a similar situation.

No, Brian. I do not. I have not seen any details in any newspaper account.

Steven, what makes you think that the attorney was "sleazy?" Would it be appropriate for me to conclude that the doctor missed the diagnosis because he was a drug addict? Five to seven percent of doctors abuse narcotics or alcohol - so would it be fair of me to make that conclusion?

No, it would not. Why? Because I have no factual basis to make that kind of statement against any of the health care providers in the case.

Why would you accuse the attorney of being sleazy without knowing anything about him? What is your factual basis for making such a statement? Do you even know the attorney's name?

Your comment reflects a very shallow thought process. I post your comment only because it demonstrates that fact.

My mistake, I did not mean to state that this particular lawyer(s) was sleazy, but that the trial bar in general is sleazy. I will admit that there must be some decent trial attorneys just as there are bad doctors, cops, judges, etc.

As for your comment about doctors and EtOH, drugs, etc., it is true that many docs have problems, but experts and studies have shown that the last thing in their life they let go is often their career. This is probably true for most professions as well. Plus, I would never call someone with a disease sleazy, that would be "shallow."

As for the specifics of the case, no one on this board knows them. I read in two different papers, two different diagnosis. However, both are extremely deadly and difficult to treat. I would be inclined to give the physicians the benefit of the doubt. I know it may be difficult for you to understand, but physicians try to save/help EVERYONE. When a physician fails they must live with that the rest of their life.
In addition, this was settled out of court. So we will never know if anyone was at fault or if they settled to avoid the bad PR from a trail.

Unfortunately, everyone dies at some point, so physicians are guaranteed to fail.

The fact is that most attorneys get a size-able chunk of change for representing these kinds of cases. They would not do it if there were no financial incentive.

Every surgeon I know has been sued, none have lost. Most of these cases are ridicules. Now would you argue that all of these surgeons are incompetent or deserved to be sued? The facts are simple, that malpractice awards have been surging at the same time rates have been going up. If you don't believe me check out the congressional budget office.

Finally, There is a legal jackpot system in this country, where physicians are forced to be judged by a non-medically trained jury with the fortune of hind-sight.

1. "My mistake, I did not mean to state that this particular lawyer(s) was sleazy, but that the trial bar in general is sleazy. I will admit that there must be some decent trial attorneys just as there are bad doctors, cops, judges, etc." Steven, I have got to hand it to you. After being called to task for your assine comment that a lawyer you don't know and can't even name is sleazy you apologize (very good manners) and then call 100,000+ lawyers in the trial bar sleazy. Very smooth, Steven - you are a real Dale Carnegie.

Seriously, I am somewhat surprised by your position. Given your writing style and the language used in your posts I assume that you are a physician. Someone with enough intellectual capacity to attend graduate school would ordinarily require some factual basis before making such a statement. You should know that making such statements reveal either (a) a deep prejudice that undermines whatever good arguments you are able to make in support of your position or (b) an intellectual shallowness that causes reasonable people to question every other statement you make. Really, Steven, if you want to debate these issues you can do better than that.

Oh, yes, it did not escape me that you reluctantly concede that there "must" some trial lawyers are "decent just as there are bad doctors...." Let me boil that down: Doctors good, trial lawyers bad. Exceptions to both rules. Your bias is palpable.

2. "I would be inclined to give the physicians the benefit of the doubt." No kidding. That is my point. You don't know the facts. You admit you don't even know the ultimate diagnosis. But you conclude in your earlier post that the lawsuit has no merit. One struggle I have with many doctors is their scientific training makes it challenging for them to accept assumptions. I understand this - when one is trained to have to rely on demonstrated facts before taking action it is often difficult to accept assumed facts as true. But you (and, in my experience, many of your colleagues in the health care industry) have no problem assuming that a malpractice case is "frivolous" without knowing anything about the facts.

You know what Steven? I give doctors the benefit of the doubt every day. I turn down at least 10 potential medical malpractice cases a week. Most of them involve significant injuries. But I look at the facts and determine that they have no merit or that potential merit is too questionable to justify bringing the claim. I never said that John Ritter's case had merit - I don't know the facts. I simply reported on the fact that a settlement was reported in the press.

3. "In addition, this was settled out of court. So we will never know if anyone was at fault or if they settled to avoid the bad PR from a trail." Or even a trial. True, we won't know why this case was settled. My point is that you offered an opinion on the merits without knowing the facts. Also, we have no idea whether "PR" played any role in settling the case. There would have not been bad PR if the case had been won - the case would have been used as "yet another example of greedy trial lawyers trying to play on the sympathy of a jury to extort money from a hard-working doctors, etc." Someone representing the hospital, the doctors, or all of them decided after consideration of all relevant factors to resolve the case in some fashion. I don't know anymore about the settlement than that, and neither do you.

4. "I know it may be difficult for you to understand, but physicians try to save/help EVERYONE." No, Steven, that is not difficult for me to understand because I don't believe physicians are bad people. I believe that the vast majority of physicians are good people. I believe that the vast majority of people are good people. I would expect that good people try their best to avoid injury and harm, and that if you happen to be a health care provider you try to save lives. Everyday.

What all too many health care providers fail to understand is that lawyers who do what I do don't dislike them - we simply want to help our clients hold them accountable when they make errors below the standard of care that cause harm. Trial lawyers believe in accountability. Do you have a problem with that, Steven? Do you think people should be accountable for what they do?

5. "Unfortunately, everyone dies at some point, so physicians are guaranteed to fail." What does this mean? Are you suggesting that every time someone dies that the public deems that a failure? Or that you do? Death does not necessarily represent a failure by health care providers, and you know it. And the public knows it. It sounds to me like you are making a woe-is-me argument, and it is beneath you.

And don't suggest that everytime someone dies people (including lawyers) think that malpractice occurred. That is ridiculous.

6. "The fact is that most attorneys get a size-able chunk of change for representing these kinds of cases. They would not do it if there were no financial incentive." Let me let you in on a secret, Steven. Most people get paid for their labor. My guess is that you do. Are you suggesting that there is something wrong with getting paid for professional services?

Lawyers who represent patients get paid for what they do - if they win. I am proud that our profession has a contingent fee system in place that will allow people access to the courthouse without paying money out-of-pocket to fund the litigation. I have offered every personal injury client I have had for over two decades the option of paying by the hour - and only two families have elected to do so. Even most of the wealthy people I have represented prefer a contingent fee. My clients make an informed choice and, if they choose a contingent fee, I accept the risk of working and not getting paid for my effort.

7. "Every surgeon I know has been sued, none have lost. Most of these cases are ridicules. Now would you argue that all of these surgeons are incompetent or deserved to be sued?" I don't know that any of them deserved to be sued - I don't know the facts of any of the cases and cannot comment. I certainly don't believe that all of them are incompetent - we have a fundamental disagreement here. You believe that if someone is sued it is an allegation that he or she is incompetent. It is not. The person may be incompetent, but I have sued only one doctor in 25 years who I thought was truly incompetent. The other health care providers I have sued over 25 years were not incompetent - they made errors that cost people their lives or caused them a serious injury. I think they should be held responsible for the harm they cause. Don't you?

I think some - perhaps more than some - health care providers think that they should not be sued when they violate their own standard of care because health care providers deserve special treatment because of all the good they ordinarily do. I disagree - I don't think anyone deserves special treatment. Do you think you deserve special treatment, Steven? What about a truck driver that crosses the center line and kills a carload of people? Does he or she deserve special treatment? What if he or she has driven 2,000,000 miles without a fender bender or a speeding ticket? Should he or she get a break when they wipe out a family? What if they deliver medical supplies? Or food? Should they get a break for that? I don't think so.

8. "If you don't believe me check out the congressional budget office." OK. Here are some quotes from the report you mention:

"Several studies have found that various types of restrictions on malpractice liability can indeed reduce total awards and thereby lead to lower premiums for malpractice insurance. By themselves, however, such changes do not affect economic efficiency: they modify the distribution of gains and losses to individuals and groups but do not create benefits or costs for society as a whole. The evidence for indirect effects on efficiency--through changes in defensive medicine, the availability of medical care, or the extent of malpractice--is at best ambiguous."

Do you agree with this language from the CBO report? Or how about this language?

"Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending.(12) Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small."

What about this on so-called "defensive medicine"? Here is what the report you cite says about that: "[W]hen CBO applied the methods used in the study of Medicare patients hospitalized for two types of heart disease to a broader set of ailments, it found no evidence that restrictions on tort liability reduce medical spending. Moreover, using a different set of data, CBO found no statistically significant difference in per capita health care spending between states with and without limits on malpractice torts."

Access to health care? The report you cite says this: "GAO investigated the situations in five states with reported access problems and found mixed evidence. On the one hand, GAO confirmed instances of reduced access to emergency surgery and newborn delivery, albeit "in scattered, often rural, areas where providers identified other long-standing factors that affect the availability of services." On the other hand, it found that many reported reductions in supply by health care providers could not be substantiated or "did not widely affect access to health care."

Since you cite the report, I am sure you agree with this: "Second, evidence suggests that very few medical injuries ever become the subject of a tort claim. The 1984 New York study estimated that 27,179 cases of medical negligence occurred in hospitals throughout the state that year, but only 415--or 1.5 percent--led to claims." A real crisis in the number of malpractice cases, isn't there Steven? Face the facts: most mistakes are buried, and the families have no idea what happened to their loved ones.

And, finally, the bottom line of the report you cite: "[T]he evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency."

9. "Finally, There is a legal jackpot system in this country, where physicians are forced to be judged by a non-medically trained jury with the fortune of hind-sight."

Well, it is good to know that you read your mail from the Chamber of Commerce. "Non-medically trained jury?" They become trained enough through the trial to figure out how to determine the standard of care. How use do you explain the cases where the health care industry wins? Are those just flukes by a "non-medically trained" jury? Are you advocating special courts for health care providers? Those proposals always amaze me - as if a subset of our society is entitled to special treatment in our judicial system because "what we do is just too complicated for the mere mortals to understand." Give me a break. The arrogance just drips off of statements like that. Doctors don't deserve a special judicial system, and neither do trucks drivers or bricklayers.

And by the way, Steven - I don't ask for juries in medical malpractice cases because I think the billions of the dollars the healthcare industry has spent attacking the civil justice system (rather than preventing malpractice) has so contaminated the jury pool that my clients have difficulty getting a fair shake in front of a jury. But I still get a jury - because the defendant health care provider demands one. The hypocrisy is deafening - defendants demand juries, praise them when they decide a case for a defendant and damn they when lose.

Keep the comments coming, Steven. Every single one of them helps the readers understand that your position is based on pure emotion, bias and prejudice, firmly rooted in the belief that health care providers deserve special treatment in our civil justice system.

1. John, of course, I admit my bias. I see this problem from my side of the fence every day and enjoy hearing it from yours. I doubt even you would deny you have a bias???? Again, I'm not saying you (or anyone in particular ) are a bad person. However, I do think the Trial Bar (at least in my state) is a little sleazy, and I will stand by that. If you want an example of it just say the word. John, please don't get offended, you are doing a service with your blog.

2. As for given the physicians the benefit of the doubt, I think we all do that, it is just a matter of the extent to which we do. Physicians probably give each other more latitude since they can appreciate the difficulty of making a diagnosis, performing the operation, etc. That is probably true in most areas.
As for your assertion that physicians have a difficult time accepting assumptions and rely heavily on facts, I completely disagree. If you believe that every test, every physical exam, or every history gives you a 100% true picture then you are wrong. Often times, people assume that a certain test will always rule-in/rule-out a diagnosis, which is far from the truth. Clinical JUDGEMENT must be used at all times. We are trained to integrate many different things together with varying reliability. We may think the story sounds and looks like X but a test that is correct 70% of time disagrees. This scenario happens every minute in a hospital and stresses the importance of clinical judgement.
As for saying we assume they are frivolous, it is hard to blame many of us. All of the cases that I have seen, have been ridiculous (examples are omitted for brevity). However, when malpractice occurs, there must be a remedy. I probably place the bar higher than you.

3. Again, I do not know the facts of the case. However, I again can see how this dx would be difficult. Maybe there was true malpractice, but none of us will know. I'm not going to beat this one into the ground.

4. Of course, I don't have a problem with accountability. I would love to see the state medical boards hold more people accountable, but that is much easier said then done. We all agree that if a physician is truly incompetent, then he shouldn't be practicing. However, nothing is that black and white.

As for saying trial lawyers believe in accountability, this does not explain their resistance to getting rid of punitive damage, nor does it explain why they try to get huge awards for pain and suffering. Surely, you know that when these awards are made, the plaintiff is not losing any money, rather all physicians and the system in general loses money. My big beef with the whole accountability argument is that when you sue an incompetent doctor, he/she loses nothing except his time/dignity/reputation, but the rest of the profession's rates go up. So don't say trial lawyers are all for accountability. I and most of my colleagues would gladly pay more than current rates if we believed that it would help our patients that suffered from malpractice. I have even thought about going bare, but I feel that it is unethical to not have the means to cover someone that I may cause harm to.

5. Of course I am not saying people think that when someone dies that malpractice occurred. However, it really hits you hard when a patient dies, and you do feel like you failed. On the other hand it is a very rewarding profession to help people, so DO NOT FEEL SORRY FOR US.

6. Of course I am not suggesting you should not get paid. That would be stupid. However, if you do get that urge to work for free, I'll hire you (that was a joke, so feel free to laugh).
I have no problem with a contingent fee system. I do have a problem with the high awards that are given. see #8

7. You cannot compare the two. First, if a truck kills 2 people while he is drunk on drugs, etc. that is criminal. If it is an accident (i.e. trying to miss a deer), then that is a tragic story, but I'm sorry I don't think a law suit is the way to go. Contrary to what you may think, giving a family money will not replace their loss. The truck driver will be forced to live with his carelessness forever. That is life, bad things happen.

And I don't think we should be treated differently.

8. As for your analysis of the CBO. You read it differently than I did. Of course this happens in medicine, and people get sued for it, but that aside.

Important facts that I took from it:
a. Rates have been going up ~15% per year since 1986. A surgeon's have gone up ~33%. However, the graph becomes steeper in the last couple of years.
b. Malpractice awards have also been going up ~8% per year. These represent ~2/3 of liability company costs. I believe this includes defendant legal fees.
c. Defense legal and admin costs have also increased ~8% per year and represent ~1/3 of liability company costs.
d. States with caps placed in the 70's and 80's saw lower premiums.
e. Caps on noneconomic and punitive damages would reduce premiums by ~25-30%.
f. Enacting limits on caps would have negligible effects on economic efficiency.
The article makes a point of saying that the issue is more about equity than efficiency. My major take is that enacting caps will first lower premiums (which it says). Second, it will not effect efficiency (which it says). Now since trial lawyers are so into accountable, they will surely love this statement: "health care providers are generally not exposed to to the financial costs of their own malpractice risk because they carry liability insurance and the premiums for their insurance do not reflect the records or practice styles of individual providers but more-general factors such as location and medical speciality."

As for access, rural areas are getting hit hard and this is a big concern. God help you if you are in the country and need OB care. There is a good sized city in my state that recently lost all of its OB coverage due to malpractice rates. In addition, it is clear that this level of increase is unsustainable, but you would probably argue to let it keep worsening until we reach a true crisis (AMA rhetoric not intended).

As for defensive medicine, it is inconclusive at best. However, numerous articles have shown that it will take years to realize the benefit from reducing defensive medicine. People are now trained in practicing this way while being told how stupid it really is. Defensive medicine is a serious problem. There are some health care policy issues involved in this issue that I don't think is appropriate for this board, but I will gladly throw them in.

As for your assertion about mistakes being buried. You have NO factual basis for that. I suppose many people choose not to sue over a mistake, especially if it caused no harm. Also, some of those mistakes were probably minor. In addition, trial lawyers are partly to blame for burying some mistakes. Until a year ago, Oklahoma physicians could not apologize for a bad outcome without fear of their statement being used in court. Obviously, no one wants to admit mistakes and the prospect of being sued, probably decreases this even more. Mistakes obviously must be eliminated, but the courts should not be overused.

9. I never said I was for special juries or anything of that sort. I do think there needs to be tightening of expert witness laws, etc. I don't think doctors should be treated any differently. As far as hypocrisy, look at the trial lawyers. They say they are helping the little man and holding the doctors accountable. In fact, they sue someone to "hold him accountable," but then only take from the system.

My brother died of misdiagnosed aortic dissection on 1/7/05. Is it too late to take legal action? Who in the family should file a claim?

E - it depends where you live. In TN, under most circumstances, a potential lawsuit like the one you mentioned must be filed within one year. Other states may have longer time periods. I would encourage you to talk with a lawyer who has experience in medical malpractice cases as soon as possible.

As some one who worked with John and knows the family.

As well as the Hospital in question. As well as standard medical procedure.

They only treated him for AMI then peracardial tampanod. They did not even do an Ultra sound of Chest or Heart or even a simple Chest XDray. If they had done that they may have seen the blood in the chest and been able to rush him for surgery and possible save his life.

Their are to many deaths each year from miss diagnosed DAA or AAA. Procedures need to change.

A nurse came to the family and told them of the mistakes, thats when they contacted the atty to look into the matter.

cognitive dissonance is in full effect here with these scummy trial lawyers who continue to spew such felonius reasons for what they do. congrats to Steven for taking this verbose piece of garbage to task. No wonder people still respect doctors but lawyers (and even much more so, TRIAL lawyers) are on the short end of the stick. THey only take cases that they think will make money, yet the jackal here suggests that because of contingency type setups anyone can sue if they want. Again, its not whether a lawyer thinks a plaintiff is right...it's whether or not they can make some money on the case. God bless you pitiful trial lawyers, you'll need it. Also, nice effort on changing your name from ATLA to some other garbage in an attempt to confuse people and shed your scummy image. I'm doing my part to let people know where the cockroaches are hiding...even with a different name.

Hey folks, how is ultrasound spelled? How about pericardial tamponade? Real familiar w/ medical procedure and I'm sure the case as well.