William O. Brant, MD, FACS, FECSM, presented “Medicolegal 101 for the Urologist: Lawsuits and Expert Witnesses” during the 42nd Annual Ralph E. Hopkins Urology Seminar on February 1, 2023, in Jackson Hole, Wyoming.
How to cite: Brant, William O. “Medicolegal 101 for the Urologist: Lawsuits and Expert Witnesses.” February 1, 2023. Accessed Nov 2024. https://grandroundsinurology.com/medicolegal-101-for-the-urologist-lawsuits-and-expert-witnesses/
Medicolegal 101 for the Urologist: Lawsuits and Expert Witnesses – Summary
William O. Brant, MD, FACS, FECSM, a urologist at the Veterans Affairs Medical Center in Salt Lake City, Utah, discusses medical lawsuits from the perspective of a physician being sued or suggested preparation to be an expert witness.
He describes the four elements of malpractice patients need to prove when filing a summons or other “pleadings,” which are: A professional duty is owed to a patient, that duty has been breached, this breach caused an injury, and damages (either monetary or punitive) resulted from that injury. To prove negligence, the conduct of a physician is judged against a standard, defined as care that a “reasonable,” similarly-situated urologist would have provided. From there, the process of discovery ensues. Then, the case may or may not proceed to trial, although due to the United States’ “adversarial” system, it is rare this happens. In terms of lawyers playing a role in medicolegal cases, it is important to note that plaintiffs typically work on contingency and take cases with high monetary damages and likely appeal to juries, while defendants are typically appointed by a medical malpractice company.
For the urologist cautious about patients suing, Dr. Brant points to a descriptive series review that reported that the leading reason for choosing to litigate is a perceived poor relationship with the provider. In his data, patients who sue often have a poor relationship with their provider or medical malpractice was suggested by another provider. In an AUA survey, while 63% of participants were named in a suit, 47% dropped without financial settlement.
Despite the low patient success rate of 4%, lawsuits can affect urologists. In the study 60% of participants considered limiting their scope of practice with ramifications of 27%-39% experiencing symptoms of major depressive disorder. Brant highlights that lawsuits can feel like a personal assault or failure, but they are truly about compensation.
In his personal experience as an expert witness, Brant has been involved in about 100 cases over 20 years. Qualifications include specialized education and practical experience, but vary by state. The AUA Expert Witness Affirmation Statement, signed as part of AUA membership, supports testifying within your field, distinguishing between bad outcome and bad practice, and being willing to testify for plaintiff or defendant as “you’re not on anyone’s side.”
When looking for an expert witness, Brant thinks lawyers are looking for consistent, strong, credible testimony. Lawyers ask a lot of “why” questions to learn an expert’s theory and factual basis, in addition to how they would handle cross-examination. When acting as an expert witness, Brant recommends: Don’t elaborate or volunteer information. Methods that can be used against the expert witness include trying to blame a provider, multi-part or repeated questions, and agreeing to generalizations or “standard” texts. Brant also suggests avoiding answering a question you don’t understand. An expert witness can ask questions or clarify, and he reminds any potential witnesses it is okay not to have the answer. He also recommends avoiding absolutes and adopting the language of a question if it is misleading or inappropriate.
About The 42nd Annual Ralph E. Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, sexual function, emerging surgical techniques, and general urology. The 42nd iteration of the meeting took place from February 1st to 4th, 2023, in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
William O. Brant, MD, FACS, FECSM, is a urologist at the Veterans Affairs Medical Center in Salt Lake City, Utah. He earned his medical degree from the University of California, San Diego. He completed his residencies in Surgery and Urology at the University of Colorado Health Sciences Center and then pursued a fellowship in Sexual Medicine and Surgery at the University of California, San Francisco (UCSF).
After completing his fellowship, Dr. Brant was in a private practice in Vail, Colorado, and had a teaching appointment with the University of Colorado prior to moving to the University of Utah, where he served as an Associate Professor of Surgery/Urology until 2017. His practice is dedicated to Men’s Health, with a particular focus on sexual and erectile medicine, penile reconstructive surgery, and prosthetic surgery. He has been very involved in education, training, and research related to prosthetic surgery, particularly as it relates to prostate cancer survivors, and he performs over 100 prosthetic surgeries annually.
Dr. Brant is a consultant and reviewer for several medical journals, including the Journal of Urology and the Journal of Sexual Medicine. He is a member of multiple medical organizations, including the American Urological Association, the Sexual Medicine Society, the Trauma and Urologic Reconstruction Network of Surgeons (TURNS), and the Society of Urologic Prosthetic Surgeons. He has authored over 50 scholarly works, including chapters in 6 urology textbooks. He is also a Fellow of the American College of Surgeons and the European Committee on Sexual Medicine.
