medical lawsuit case study

Ten of the Largest Medical Malpractice Verdicts of 2022

This list only includes cases that went to trial and highlights some of the largest medical malpractice verdicts from 2022. The majority of medical negligence cases are settled out of court, but the terms and settlement amounts are confidential and could not be included here. 

$111 million verdict in Minnesota: Thapa v. St. Cloud Orthopedic Associates

In May 2022, shock waves were sent through healthcare and personal injury circles across the country with this massive verdict. The plaintiff, Anuj Thapa, was a 17-year-old student, recently arrived in the country from Nepal, who was injured while playing indoor soccer. He went to St. Cloud Hospital with a broken leg and underwent surgery that night. The next day, he was discharged from the hospital despite complaining of pain, numbness, burning, and muscle problems. Six days later, he returned to the hospital and was operated on by a different doctor, who diagnosed acute compartment syndrome. This is a serious and emergent medical condition that causes pressure in a group of muscles, nerves, and blood vessels. When that happens, those muscles and nerves can die, and this can lead to complications such as amputation, infection, renal failure, and death. Due to the failure to recognize and treat his compartment syndrome in a timely manner, Mr. Thapa needed over a dozen surgeries, and has permanent and disabling injuries.

Of the jury’s $111 million verdict, $1 million was for past and future medical expenses, $10 million was for past pain and suffering, and $100 million was awarded for future pain and suffering. There was no claim for lost wages or lost earning capacity.

$97.4 million verdict in Iowa: Kromphardt v. Mercy Hospital

The largest medical malpractice verdict in Iowa history was handed down in this birth injury case. Approximately $42.2 million of the $97.4 million compensation was awarded for future medical or custodial care, and the remainder was awarded for loss of future earning capacity, pain and suffering, and other damages.

When Kathleen Kromphardt was admitted to the hospital in labor, her baby’s fetal heart pattern was concerning. This indicated that she may need an emergency cesarean section, but her doctor instead ordered medications to slow down natural labor. While her doctor attended two other births, Baby Scotty’s heart rate continued to deteriorate, yet the nurse did not call for a doctor. When the doctor returned an hour later, Baby Scotty was in terminal brachycardia (meaning his heart rate had dropped dangerously low), and nursing staff were attempting to deliver the baby vaginally. The doctor proceeded to use forceps and a vacuum extractor to forcefully deliver the baby. Scotty was left with a massive skull fracture from the attempted forceps delivery, extensive bleeding on his brain caused by the vacuum delivery, and brain damage from oxygen deprivation (also known as hypoxic ischemic encephalopathy or H.I.E.). As a result of the delay in delivery and the injuries he sustained during delivery, Scotty, now 4 years old, has cerebral palsy, developmental delay, mixed expressive-receptive language disorder, ischemic brain injury, and H.I.E. He will require 24-hour care for the rest of his life.

$77 million verdict in Georgia: The Estate of Nicholas Carusillo v. Metro Atlanta Recovery Residences, Inc.

A record was also set in 2022 in the state of Georgia with a $77 million award for wrongful death. In this case, the victim, Nicholas Carusillo, was a resident at a psychiatric facility having suffered from bipolar disorder and substance addiction. Mr. Carusillo’s family alleged that a series of errors by the Metro Atlanta Recovery Residences, Inc. staff ultimately led to the victim’s death. Specifically, Mr. Carusillo’s medication was stopped while an inpatient there, which caused his condition to deteriorate; he was discharged from the facility against his will because he had a cell phone in violation of their policy; and the facility failed to warn the sober living house to which he was discharged about his mental health problems. A few days after his discharge, Mr. Carusillo suffered a psychotic episode and was fatally injured when hit by multiple cars while lying naked in a fetal position on the interstate. 

This case also involved bad faith and misconduct by the defendants who created and backdated records in the days after Mr. Carusillo’s death to make them look as if they had been written when he was a patient at the facility. In view of the egregious facts, the jury awarded $10 million for Mr. Carusillo’s pain and suffering, $55 million for the value of his life, and $1 million in punitive damages.

The Carusillo family told reporters something that we hear almost every day from our clients:

" We had to file this lawsuit, because we weren't getting the answers from the facility, from the healthcare providers ."

The need for, and right to, answers is often the single biggest motivation for pursuing a medical malpractice lawsuit.

$75 million verdict in Georgia: Buckelew v. Womack

In another Georgia case, a 32-year-old man sued multiple healthcare providers for medical malpractice leading to catastrophic brain damage and locked-in syndrome (L.I.S.) after he suffered a stroke. L.I.S. refers to a condition that some people with brain damage can suffer where they have total paralysis but are still conscious and possess their normal cognitive function. The victim, Jonathan Buckelew, suffered a stroke during a chiropractic adjustment, and was brought to the hospital emergency room, where a series of errors and miscommunication began. The stroke was not diagnosed or treated until the next day, and the court accepted that the delay was below the standard of care and resulted in a worse outcome for Mr. Buckelew. The emergency room doctor, who did not communicate relevant information and results to other physicians and later altered medical records to suggest that he had communicated this information, was found to be 60% at fault, and the radiologist who missed the stroke when reading the imaging, was found to be 40% at fault for the victim’s harm. Mr. Buckelew was awarded $29 million for medical expenses and $46 million in non-economic damages (pain and suffering).

$68.8 million verdict in Florida: Crohan v. University Community Hospital, Inc.

In this Florida case, four physicians were found to be medically negligent and financially liable to the plaintiff, in different amounts. The plaintiff, Miranda Crohan, was admitted to the hospital after collapsing due to severe hyponatremia (low blood sodium). The critical care physicians responsible for her care in the hospital were found to have mismanaged her sodium levels, and this caused severe brain damage. Ms. Crohan now requires lifelong care.

The jury apportioned 85% of the responsibility to one physician, 23% to another, and 1% each to two remaining physicians. The award of $68.8 million was made up of $50 million for pain and suffering, $15 million for future medical expenses, $2.9 million for past expenses, and $750,000 in lost earnings capacity.

$30 million verdict in Georgia: Threat v. Gamble-Webb

This verdict in a Georgia birth injury medical malpractice suit was awarded to both the mother and baby. In this case, the mother, Ms. Threat, was in labor and given medication to increase her contractions, but her intense contractions caused severe bleeding and collapse. Ms. Threat had a rare and serious complication known as an amniotic fluid embolism. The doctor performed an emergency cesarean section and a hysterectomy, but the delay in performing the C-section, and the failure to properly monitor the baby, January, for 37 minutes during this period, resulted in oxygen deprivation. This caused extensive brain damage to Baby January. She now requires a feeding tube and has multiple neurological issues. Ms. Threat also argued that she would not have needed a hysterectomy if her care had been properly handled.

The jury awarded $29 million to Baby January and $1 million to her mother, with the obstetrician held 20% liable and the attending nurse’s employer held 80% liable. 

$27 million verdict in Iowa: Dudley v. Iowa Physicians Clinic

In November 2022, a large verdict was handed down in Iowa to Joseph Dudley, a man who went to an urgent care clinic with symptoms of high fever, disorientation, and an abnormal heart rate and breathing. He was misdiagnosed with the flu by the physician assistant in charge, despite testing negative for flu, and sent home with Tamiflu and pain relievers. When Mr. Dudley went to the emergency room a few days later, he was diagnosed correctly with bacterial meningitis, which should have been diagnosed by the physician assistant earlier, and admitted to the I.C.U. Mr. Dudley was put in an induced coma, suffered multiple strokes, and was left with permanent hearing loss, nerve damage, and brain damage. 

The $27 million award included $12 million for future loss of full mind and body, $10 million for future pain and suffering based on his life expectancy, $2.5 million for past loss of body and mind function, and $2.5 million for past pain and suffering. 

$25.4 million verdict in Missouri: Harris v. Sandri

Another record-breaking verdict was handed down in April 2022, with the largest medical malpractice verdict ever awarded in the Kansas City area. In this case, Ms. Harris was a laboring mother who was given excessive doses of Pitocin, a medication used to accelerate labor, over a period of more than 6 hours. The excessive dosing was evident on fetal monitoring strips, but neither the resident physician nor the supervising attending obstetrician stopped or corrected the dosing in accordance with hospital policy and the standard of care. As a result, Ms. Harris’ baby suffered severe oxygen deprivation and now has cerebral palsy and requires 24-hour care. The physician was found to be negligent in her substandard care of Ms. Harris and her inadequate supervision of the resident physician.

Of the $25.4 million verdict, $18.97 million was awarded for future medical care and damages, and $5 million was awarded for past and future pain, suffering, and disfigurement. 

$19.7 million verdict in Pennsylvania: Melendez v. Mo

Diana Melendez was awarded $19.7 million for a failure to diagnose a dural arteriovenous fistula (a mass on her spinal cord). She first began complaining of symptoms to her primary care doctor at Penn Medicine in 2012, but her doctor did not order tests that would have revealed the lesion. She did not receive a diagnosis until 2017 when she went to see a neurologist herself. By this time, she was suffering from leg spasms, incontinence, and trouble walking, all caused by the fistula.

In some cases, a plaintiff is held responsible for some of their harm, and it affects the amount of compensation that they are awarded. Here, the court found that Ms. Melendez was responsible for a small portion of her damage (6%) because she had lost a referral slip that then delayed her getting to see a neurologist in 2016. Nonetheless, the jury found that it was largely the medical malpractice of her healthcare providers at issue that caused her injuries and compensated her accordingly. 

$18 million verdict in Pennsylvania: Downes v. Carpenter

A record was set in Chester County, Pennsylvania, with $18 million awarded to plaintiff, Kerri Downes, for failure to diagnose her breast cancer. After finding a lump in her breast, she saw a nurse practitioner twice in March 2018 but was told that it was benign and was not sent for further testing or imaging. Nine months later, she was diagnosed with aggressive breast cancer that had spread to her lymph nodes, requiring a bilateral mastectomy and chemotherapy. If she had been diagnosed when she first saw the nurse practitioner, she would likely have been treated with only a lumpectomy and would have had much better long-term survival prospects. The nurse practitioner was held to be negligent for not ordering breast imaging, leading to a delay in her treatment and a much worse outcome for Ms. Downes.

The 2022 verdicts listed above all demonstrate that juries are willing to award full and just compensation when someone suffers as a result of medical malpractice.

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15 Real Life Medical Malpractice Case Results

Table of Contents

What are the most common causes of medical malpractice cases?

How is the value of my medical malpractice case determined, real-life case results.

• Surgical errors During the more than 234 million surgeries each year in the U.S., there are more than 4,000 preventable errors .
• Misdiagnosis Each year, 12 million U.S. adults seeking medical care are misdiagnosed. That’s one (1) of every twenty (20) people who visit their doctor.
• Medication errors The Institute of Medicine confirms that seemingly innocent mistakes with medication result in about 1.5 million being harmed each year. This includes giving the patient the wrong drug, the wrong dosage or a dangerous combination with other drugs.

No two medical malpractice cases are alike, and each is valued on its own individual merits.

While it’s difficult to predetermine exactly how much you could be awarded, your medical malpractice lawyer at the Haymond Law Firm will thoroughly analyze all aspects of your case before deciding upon what’s considered a reasonable amount.

These factors include:

• The costs of medical treatment you’ve already received and the anticipated level of care that will be expected in the future.
• Lost wages you’ve already incurred as well as how the injury has affected your overall loss of future earning potential.
• The impact of the injury on your life.
• The strength of the evidence that establishes a clear link between the malpractice and the sustained injuries.
• Physical pain and suffering you’ve experienced.

For more than 30 years, we’ve fought aggressively to secure compensation – well over $500,000,000 – for those who injured by the negligence of others.

For a free consultation, call us at 1-800-HAYMOND (1-800-429-6663).

Case 1: Failure to Diagnose Leads To $950K Recovery

Donny Motts had no reason to doubt the doctors when they told him that ear tubes would resolve his son’s inner ear infection. After all, tubes are common for young children and can be inserted in a relatively simple procedure. However, Mr. Motts, of Bridgeport, Connecticut, realized something was wrong when his son’s ear pains persisted even after the tubes were put in.

The incident happened in late 2012. What had started as seemingly normal childhood ear pain has now turned into a persistent condition that sometimes causes numbness, migraines, and even seizures. Earlier this year, the family received a settlement against the doctors and their hospital for their misdiagnosis of their son’s conditions.

Mr. Motts and his wife first took their son to his pediatrician in Bridgeport, who then referred them to osteopathic specialists. The specialist diagnosed the problem quickly and performed the tubal procedure. However, the boy’s pain continued. In several follow-up visits, the specialist’s team reassured them that the tubes would work in time.

However, the issue took a dangerous turn when the boy developed a fever, stiff neck, and severe headaches. A visit to the emergency room showed that he had meningitis, which was caused by a bacterial infection in his ears. Doctors prescribed medication to clear the infection, but it wasn’t in time to prevent some serious and possibly permanent damage. In addition to suffering meningitis, the boy had also suffered cerebral oedema, which causes fluid to leak into the brain. As a result, he now has frequent headaches, fevers, and sometimes seizures.

Case Results

The family filed suit and The Haymond Law Firm established that the specialists were negligent in their misdiagnosis of the boy’s condition. The evidence showed that the doctor had done only a cursory examination and assumed tubes were needed when, in fact, a more thorough exam would have shown that bacteria were present. The boy and his family were happy to receive the compensation and plan on using it to help him get therapy to control his pain and seizures.

Case 2: Misdiagnosis By Two Doctors Gives Way To $800K Settlement

Miss Elaine Nelson, at age 38, began experiencing persistent headaches and blurred vision. She sought treatment from an optometrist and ophthalmologist. Despite numerous visits and her growing concerns, Miss Nelson was constantly reassured that nothing was wrong…she just needed new glasses.

Unsatisfied with this diagnosis, Miss Nelson consulted with a third doctor who in turn referred her to a doctor of neurology. The neurologist discovered that Miss Nelson’s concerns were justified; in fact, she had a brain tumor compressing the nerve to her right eye.

A Connecticut Medical Malpractice Attorney from the Haymond Law Firm sued the optometrist and first ophthalmologist for medical malpractice based on their failure to properly diagnose her symptoms. Mediation on the claim against the optometrist, thanks to the Attorney’s persuasiveness, resulted in a large award to Miss Nelson. The Attorney is still pursuing Miss Nelson’s lawsuit against the ophthalmologist for the delay she caused by not sending Miss Nelson to a neurologist sooner.

Case 3: Multiple Surgeries and 100+ Days in Hospital Result in $3.5M

After Dean Taylor’s appendix ruptured, he required emergency surgery.

The wrong sutures were used, and he consequently needed a second operation. During the second operation, his intestine was punctured, resulting in the need for two additional surgeries. By the end of the last surgery, Mr. Taylor had spent 131 days in the hospital and was left with permanent disfigurement. The doctors repeatedly denied any fault for what happened.

A Connecticut Medical Malpractice Attorney from the Haymond Law Firm disagreed and took the matter to trial.

Case 4: Young Girl Suffers Repeated Misdiagnosis, Full Year of School Lost

A young 10-year-old girl was taken to the hospital with seizure-like symptoms, frequent urination, excessive thirst and blurred vision. The doctor treating her ordered several tests, including a complete CBC workup and blood glucose test. The initial tests came back showing the girl’s blood glucose levels were over 300 and that her insulin levels were dramatically lower than normal.

The other tests the doctor ordered were not back from before the doctor rendered a diagnosis of Type 2 diabetes. While preliminary tests suggested diabetes, the doctor needed the final set of test results to make an accurate and complete diagnosis.

His decision to treat the girl with Type 2 diabetes created extreme fluctuations in her blood glucose levels. After she was finally stabilized, she was sent home with specific instructions to closely monitor her blood glucose levels, watch her diet and begin a treatment plan that included insulin medication in pill form.

Over the next few days, the girl was back in the emergency room several times suffering from seizure-like symptoms. The tests taken during her first visit had arrived and the on-call emergency physician changed the diagnosis from Type 2 to Type 1 or Juvenile onset diabetes. Because of the improper administration of insulin by the previous ER doctor, the current physician could not get the girls’ blood glucose levels to stabilize. She was kept in the hospital for 17 days due to severe complications.

The resulting hospital stay and deterioration of the girls’ overall health caused her to miss almost 33 days of school. There was no way for the work to be made up at such a late date, so the choice was made to hold her back in the 5th grade for the second year. The girl’s total recovery time was over 6 months.

The Haymond Law firm represented the girls’ family from New Haven, CT in court, gaining them money for compensatory damages. Although her injuries were not life-threatening, they did have a dramatic impact on her mental and emotional well-being.

Case 5: Delayed skin cancer diagnosis

Paul S., a 66-year-old retired man from Connecticut, passed away from malignant melanoma. Paul visited his primary care physician for his usual annual physical examination. During the course of the examination, he mentioned to his physician that a small mole, the size of 2 cm x 2 cm had developed on his right forearm. He wasn’t sure if it had always been there but it had become much more noticeable to him in the preceding months. His physician commented that it was either a dermatofibroma or hemangioma, both benign in character. He failed to advise and refer Paul to a dermatologist to seek an opinion from a specialist.

Across the ensuing 4 months, the mole on Paul’s forearm began to change in appearance and he called his physician’s office. One of the physician’s colleagues, who operates in the same practice, met with Paul a few days later. This physician inspected the mole and referred Paul to a surgeon for another consultation and a biopsy. When Paul met with the surgeon, he removed the mole and sent for a thorough analysis. When the results returned, they showed an ulcerating melanoma with downward growth.

A month later, Paul had a lymph node dissection performed which uncovered clear margins and no node involvement. Paul returned for follow-ups every 4 months afterward. On his third follow up visit, a mass was detected in Paul’s liver. It was biopsied and determined to be the result of a metastatic spread of his melanoma. Paul was given a poor prognosis and he passed away within ten months. He left behind a wife and two children.

The Haymond Law Firm’s experts testified that a standard of medical care exists in which it is required that the physician perform a biopsy or make a referral to a dermatologist and a surgeon to evaluate such an atypical mole. The physician’s decision to advise Paul to wait for a full 6 months was substandard and permitted the mole to advance and continue its downward progression. This directly resulted in a negative effect on Paul’s prognosis and his potential to be cured before the skin cancer spread and resulted in his death.

The Haymond Law Firm filed a wrongful death lawsuit due to a delayed skin cancer diagnosis. The insurance company argued with their own medical experts that even had the skin cancer been detected, Paul would have had a term of 6-8 months to live. In addition, it was argued through expert testimony that Paul had a pre-existing heart condition and that he did not have a life expectancy of more than three or four years.

A trial was scheduled but a settlement was reached in the month prior. Thanks to the Haymond Law Firm, Paul’s family has the financial support that has been missing since his unfortunate death.

Case 6: Surgical error results in above-average settlement

Plaintiff Jeremy C. consulted with a surgeon after noticing a growth on the left side of his neck. His surgeon, the defendant, examined Jeremy and determined that he had a benign growth that would require surgical removal. A consulting radiologist stated that an MRI should be performed before surgery in order to better define and study the mass. Unfortunately, the defendant insisted that the surgery proceeds without the MRI. The defendant neglected the advice of the consulting radiologist and proceeded to perform the surgery to remove the growth from Jeremy’s neck.

When the defendant performed the surgery, his operative note did not state that he identified or protected Jeremy’s facial nerve during the course of the surgery. After the surgery, Jeremy suffered from severe left facial droop. The defendant went to great lengths to convince Jeremy and his family that the facial droop was merely the temporary result of the natural swelling that typically results from this type of surgery. The defendant was adamant that Jeremy’s facial droop would resolve itself in a timely manner.

Unfortunately, Jeremy’s facial droop was permanent. His facial nerve didn’t function for months after the surgery. It was at this point that Jeremy consulted with The Haymond Law Firm. Jeremy consulted with the firm as well as a series of doctors to determine the next step. He underwent another surgery so that the facial nerve could be inspected. The surgeon who performed this operation determined that the defendant actually transected Jeremy’s facial nerve during the initial surgery. It was not possible to re-connect the facial nerve. Jeremy suffers from a permanent facial droop and is no longer able to move the corner of his mouth.

The Haymond Law Firm filed a medical malpractice lawsuit against the defendant for his egregious surgical error. The firm recruited medical experts who would testify that the defendant had transacted Jeremy’s facial nerve and also acted with negligence in his disregard for the consulting radiologist’s request for an MRI.

Two weeks prior to the trial, the defendant’s attorney agreed to settle the matter. Jeremy credits The Haymond Law Firm’s unique approach for obtaining a settlement of this magnitude.

Case 7: A Breach in Protocol Leads to a Lifetime of Suffering

After a long and difficult birth, Emily Roberts was placed in a hospital’s nursery. Unfortunately, the nurse in charge left for a dinner break without a replacement, resulting in no coverage for a short period of time.

Tragically, during that period of time, baby Emily had trouble breathing and suffered permanent irreversible injuries.

Emily’s family came to their Connecticut Medical Malpractice Attorney at the Haymond Law Firm for help. The suit was filed against the nurses and the hospital. A large settlement was obtained for the family.

Case 8: Bridgeport mother awarded money after infant sustained injuries at birth

New mother Joan B. was in labor for hours with signs of distress to the baby. The heart rate dropped numerous times and she even asked for a c-section. Joan’s doctor was not available to come to the hospital so he made her wait. After five hours of the baby and mother being in distress, the doctor finally decided to do the c-section.

When the baby was born he was non-responsive with no heart rate. The medical staff was able to start his heart. Unfortunately, he started having seizures, which happened at the rate of several an hour. The newborn was rushed to the nearest children’s hospital where he spent weeks in the Neonatal ICU. During this time he went through many scares where his heart would stop and the seizures continued.

There was no way to determine the full extent of the damage the child had sustained until he was about three years old. This is when he was diagnosed with cerebral palsy on top of the seizures he has to this day. The lawsuit was not only against the doctor but also the hospital due to the negligent staff.

The Haymond Law Firm’s expert team of medical malpractice lawyers fought for the rights of the mother and child. By providing expert testimony and tireless attention to detail, the Bridgeport mother was awarded a large settlement after her infant sustained injuries at birth.

Sadly, this child will never have a normal life. Doctors say he will never walk and at almost five years old he cannot feed himself or speak. He can barely even hold his head up. He is now in school and is getting more therapy which is helping him learn to move better as well as communicate. This is a problem that occurs all too frequently in this nation and The Haymond Law Firm is proud to be able to help this family get restitution for this little boy.

Case 9: Delayed medical diagnosis leads to a speedy settlement

Thirty-year-old Yuan Lu developed strange symptoms that doctors eventually diagnosed as fluid on the brain. At their advice, she had surgery to put in special tubing to send the fluid into the digestive system.

Soon Yuan developed seizures, headaches, garbled speech and loss of equilibrium. The symptoms lasted almost a year until a doctor finally corrected the problem.

The Haymond Law Firm took the case, even though we knew it would be difficult to find a doctor to testify against other doctors. With an expert’s assistance, Yuan settled her case before trial.

Case 10: Incorrectly diagnosed “virus” leads to death

The parents of a 12-year old boy rushed him to the hospital where he was diagnosed with a virus and sent home.

The boy continued to deteriorate and was rushed back to the hospital 18-hours later and it was too late. The boy died.

The family contacted the Connecticut Medical Malpractice Attorneys at the Haymond Law Firm for help. We brought suit against the hospital and a settlement was reached prior to trial a large sum of money.

Case 11: Medical misdiagnosis leads to complications

A 64-year-old man presented to an Urgent Care Facility for a severe sore throat that lasted for more than one week.

The staff failed to check for strep throat, they failed to prescribe an antibiotic and discharged him. Two days later he presented to an emergency room very sick. He was sent to a different hospital and diagnosed with Group A Streptococcus pharyngitis with septic shock, acute kidney injury with complete renal failure requiring hemodialysis, laryngitis, pharyngitis, mediastinitis, and acute delirium. After three weeks in the hospital, he was discharged to a rehabilitation facility.

The Haymond Law Firm took the case, with an expert’s assistance, we settled his case before trial.

Case 12: Failed medical evaluation leading to hospitalization

25-year-old female post-delivery of her daughter presented to an emergency room five times in a four week period with various complaints including fever, cough, body aches, nausea, headaches, vertigo, and a swollen, painful right eye.

The healthcare providers in the emergency room failed to evaluate and diagnose the cerebral empyema and orbital abscess sepsis that was developing over that time period. As a result, the next time she presented to the emergency room several days later, she had to be transported to a different hospital where she remained for nine days after which she was transported to a second hospital for another four-week hospitalization.

The Haymond Law Firm filed a medical malpractice lawsuit & a large settlement was obtained for the family.

Case 13:  Pharmacy medication error 

65-year old male takes Allopurinol, a medication to treat Gout. He went to the pharmacy for the usual refill and left for his vacation home for the weekend. After taking an Allopurinol, he started feeling very drowsy so he decided to go to bed early. In his bedroom, he became so drowsy that he fell and hit his neck on the night table, sustaining a cervical fracture at C2. 

As it turns out, the pharmacy did not just refill the prescription with Allopurinol but also included many Trazodone pills in the bottle. Although Trazodone is prescribed for depression, it is also used to treat insomnia because it can cause drowsiness as a side effect. The man had to undergo surgery to stabilize the fracture and rehabilitation.

The case settled without filing a lawsuit.

Case 14: Improper surgical technique for routine surgery goes wrong

A 43-year old female underwent a Laparoscopic Cholecystectomy.  As a result of the manner in which the physician performed the surgery, she suffered a significant bile duct injury which resulted in, among other things, pain, and intraabdominal abscess, sepsis, numerous tests, several procedures, and surgeries.

Case 15: Failure to timely diagnose hip dysplasia causes lifetime damage

An infant baby girl was diagnosed with hip dysplasia by a pediatrician in the hospital shortly after birth, a condition easily treatable in infants. The treating pediatrician failed to acknowledge the condition until the child was 9 months old. 

Since the dysplasia was not treated in a timely manner, the child had to undergo surgery and casting for an extended period of time and causing avoidable lifetime damage to this young girl.

The case settled prior to trial.

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Public Health

As a nurse faces prison for a deadly error, her colleagues worry: could i be next.

Brett Kelman

RaDonda Vaught, with her attorney, Peter Strianse, is charged with reckless homicide and felony abuse of an impaired adult after a medication error killed a patient. Mark Humphrey/AP hide caption

RaDonda Vaught, with her attorney, Peter Strianse, is charged with reckless homicide and felony abuse of an impaired adult after a medication error killed a patient.

Four years ago, inside the most prestigious hospital in Tennessee, nurse RaDonda Vaught withdrew a vial from an electronic medication cabinet, administered the drug to a patient and somehow overlooked signs of a terrible and deadly mistake.

The patient was supposed to get Versed, a sedative intended to calm her before being scanned in a large, MRI-like machine. But Vaught accidentally grabbed vecuronium, a powerful paralyzer, which stopped the patient's breathing and left her brain-dead before the error was discovered.

Vaught, 38, admitted her mistake at a Tennessee Board of Nursing hearing last year, saying she became "complacent" in her job and "distracted" by a trainee while operating the computerized medication cabinet. She did not shirk responsibility for the error, but she said the blame was not hers alone.

"I know the reason this patient is no longer here is because of me," Vaught said, starting to cry. "There won't ever be a day that goes by that I don't think about what I did."

Shots - Health News

Former nurse found guilty in accidental injection death of 75-year-old patient.

If Vaught's story had followed the path of most medical errors, it would have been over hours later, when the Tennessee Board of Nursing revoked her license and almost certainly ended her nursing career.

But Vaught's case is different: This week, she goes on trial in Nashville on criminal charges of reckless homicide and felony abuse of an impaired adult for the killing of Charlene Murphey, the 75-year-old patient who died at Vanderbilt University Medical Center in late December 2017. If convicted of reckless homicide, Vaught faces up to 12 years in prison.

Prosecutors do not allege in their court filings that Vaught intended to hurt Murphey or was impaired by any substance when she made the mistake, so her prosecution is a rare example of a health care worker facing years in prison for a medical error. Fatal errors are generally handled by licensing boards and civil courts. And experts say prosecutions like Vaught's loom large for a profession terrified of the criminalization of such mistakes — especially because her case hinges on an automated system for dispensing drugs that many nurses use every day.

The Nashville District Attorney's Office declined to discuss Vaught's trial. Vaught's lawyer, Peter Strianse, did not respond to requests for comment. Vanderbilt University Medical Center has repeatedly declined to comment on Vaught's trial or its procedures.

Vaught's trial will be watched by nurses nationwide, many of whom worry a conviction may set a precedent — as the coronavirus pandemic leaves countless nurses exhausted, demoralized and likely more prone to error.

Janie Harvey Garner, a St. Louis registered nurse and founder of Show Me Your Stethoscope , a nurses group with more than 600,000 members on Facebook, said the group has closely watched Vaught's case for years out of concern for her fate — and their own.

A Doctor Confronts Medical Errors — And Flaws In The System That Create Mistakes

Garner said most nurses know all too well the pressures that contribute to such an error: long hours, crowded hospitals, imperfect protocols and the inevitable creep of complacency in a job with daily life-or-death stakes.

Garner said she once switched powerful medications just as Vaught did and caught her mistake only in a last-minute triple-check.

"In response to a story like this one, there are two kinds of nurses," Garner said. "You have the nurses who assume they would never make a mistake like that, and usually it's because they don't realize they could. And the second kind are the ones who know this could happen, any day, no matter how careful they are. This could be me. I could be RaDonda."

As the trial begins, Nashville prosecutors will argue that Vaught's error was anything but a common mistake any nurse could make. Prosecutors will say she ignored a cascade of warnings that led to the deadly error.

The case hinges on the nurse's use of an electronic medication cabinet, a computerized device that dispenses a range of drugs. According to documents filed in the case , Vaught initially tried to withdraw Versed from a cabinet by typing "VE" into its search function without realizing she should have been looking for its generic name, midazolam. When the cabinet did not produce Versed, Vaught triggered an override that unlocked a much larger swath of medications, then searched for "VE" again. This time, the cabinet offered vecuronium.

Vaught then overlooked or bypassed at least five warnings or pop-ups saying she was withdrawing a paralyzing medication, documents state. She also did not recognize that Versed is a liquid but vecuronium is a powder that must be mixed into liquid, documents state.

Finally, just before injecting the vecuronium, Vaught stuck a syringe into the vial, which would have required her to "look directly" at a bottle cap that read "Warning: Paralyzing Agent," the DA's documents state.

The DA's office points to this override as central to Vaught's reckless homicide charge. Vaught acknowledges she performed an override on the cabinet. But she and others say overrides are a normal operating procedure used daily at hospitals.

While testifying before the nursing board last year, foreshadowing her defense in the upcoming trial, Vaught said that at the time of Murphey's death, Vanderbilt was instructing nurses to use overrides to overcome cabinet delays and constant technical problems caused by an ongoing overhaul of the hospital's electronic health records system.

Murphey's care alone required at least 20 cabinet overrides in just three days, Vaught said.

"Overriding was something we did as part of our practice every day," Vaught said. "You couldn't get a bag of fluids for a patient without using an override function."

Overrides are common outside of Vanderbilt, too, according to experts following Vaught's case.

Michael Cohen, president emeritus of the Institute for Safe Medication Practices, and Lorie Brown, past president of the American Association of Nurse Attorneys, each said it is common for nurses to use an override to obtain medication in a hospital.

But Cohen and Brown stressed that even with an override, it should not have been so easy to access vecuronium.

"This is a medication that you should never, ever, be able to override to," Brown said. "It's probably the most dangerous medication out there."

Cohen said that in response to Vaught's case, manufacturers of medication cabinets modified the devices' software to require up to five letters to be typed when searching for drugs during an override, but not all hospitals have implemented this safeguard. Two years after Vaught's error, Cohen's organization documented a "strikingly similar" incident in which another nurse swapped Versed with another drug, verapamil, while using an override and searching with just the first few letters. That incident did not result in a patient's death or criminal prosecution, Cohen said.

Maureen Shawn Kennedy, the editor-in-chief emerita of the American Journal of Nursing , wrote in 2019 that Vaught's case was "every nurse's nightmare."

In the pandemic, she said, this is truer than ever.

"We know that the more patients a nurse has, the more room there is for errors," Kennedy said. "We know that when nurses work longer shifts, there is more room for errors. So I think nurses get very concerned because they know this could be them."

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).

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Virginia Doctor Gets 59 Years for Unneeded Surgery and Improper Sterilizations

Dr. Javaid Perwaiz’s procedures over nearly a decade caused insurance programs to lose more than $20 million, federal prosecutors said.

By Azi Paybarah

A Virginia obstetrician and gynecologist was sentenced Tuesday to 59 years in prison after being convicted on federal charges of performing medically unnecessary surgeries including hysterectomies and improper sterilizations on scores of patients over nearly a decade, prosecutors said.

In November 2020, a federal jury also convicted the doctor, Javaid Perwaiz, of Chesapeake, of 52 counts of health care fraud and false statements for procedures he performed from 2010 through 2019, according to the U.S. attorney in the Eastern District of Virginia.

Prosecutors said the procedures had cost insurance programs more than $20 million in losses. The government seized assets including more than $2 million, a Bentley, two properties in Chesapeake and medical equipment after Dr. Perwaiz’s conviction, according to court records.

“Motivated by his insatiable and reprehensible greed, Perwaiz used an arsenal of horrifying tactics to manipulate and deceive patients into undergoing invasive, unnecessary, and devastating medical procedures,” Raj Parekh, acting U.S. attorney in the Eastern District of Virginia, said in a statement. “In many instances, the defendant shattered their ability to have children by using fear to remove organs from their bodies that he had no right to take.”

Joseph R. Pope, a lawyer for Dr. Perwaiz, said his client is appealing the conviction. Alan M. Dershowitz said in a brief interview that he has agreed to review the brief.

Dr. Perwaiz, who is believed to be 71, specializes in obstetrics and gynecology and had two offices in Chesapeake, Va., according to his website. The investigation began in September 2018 after the Federal Bureau of Investigation was contacted by a hospital employee who suspected that Dr. Perwaiz was performing unnecessary procedures, according to an affidavit in support of an application for an arrest warrant written by Desiree Maxwell, an F.B.I. agent.

“According to the employee, Perwaiz’s patients advised hospital staff they were present for their ‘annual clean outs,’” the affidavit said. “In many instances, the patients were not aware of the procedures they were undergoing. Additionally, hospital staff had a difficult time keeping up with Perwaiz as he ran from procedure to procedure.”

More than 25 former patients testified at trial, and the court received more than 60 victim impact statements, according to federal prosecutors. Witnesses also told investigators that Dr. Perwaiz “routinely used the C-word” — cancer — “to scare patients into having surgery.”

In one case, involving a patient Dr. Perwaiz had treated for an ectopic pregnancy in 2011, he routinely asked her whether she was going to have another baby, court documents say. Three years later, she sought treatment from a fertility specialist who told her that both her fallopian tubes “were burnt down to nubs.” Dr. Perwaiz had removed her fallopian tubes without her consent or knowledge.

This is not Dr. Perwaiz’s first bout of legal troubles.

In 1982 he lost hospital privileges at Maryview Hospital, in Portsmouth, Va., “due to poor clinical judgment and for performing unnecessary surgeries,” according to the affidavit. In 1996 he pleaded guilty to two tax counts of tax evasion, it said. His medical license was temporarily revoked but was reinstated in 1998.

Azi Paybarah is a reporter covering breaking news, based in New York. Before joining The Times in 2018 he covered politics for WNYC and The New York Observer. He helped launch the website that later became Politico New York and co-founded the FAQ NYC podcast. He is a lifelong New Yorker and graduate of the University at Albany. More about Azi Paybarah

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Defining Medical Malpractice: How to Take Legal Action

• Responsible Parties
• Qualifications
• Initiating a Case
• Compensation

The American Bar Association says, “Medical malpractice is negligence committed by a professional health care provider—a doctor, nurse, dentist, technician, hospital or hospital worker—whose performance of duties departs from a standard of practice of those with similar training and experience, resulting in harm to a patient or patients.” For example, if a physician gives a person a treatment that could harm them, that could be considered medical malpractice. It is a form of professional negligence that can be tried in a court of law.

This article discusses examples of medical malpractice, who’s responsible, and how to initiate a medical malpractice case if it happens to you.

FG Trade / Getty Images

Examples of Medical Malpractice

Several different scenarios can be considered examples of medical malpractice. They include:

• Misdiagnosing or failing to diagnose something with a specific ailment
• Ignoring and misreading lab results that could negatively affect someone’s health
• Performing surgery unnecessarily
• Surgical errors or wrong-site surgeries
• Prescribing the wrong medication or dose
• Failing to perform proper aftercare or follow-up with patients
• Discharging a patient before they should go home
• Failing to take an appropriate patient history or disregarding a patient’s health history
• Failing to order the appropriate tests needed to diagnose a patient accurately
• Failing to recognize symptoms as they present themselves

When a healthcare provider does any of these things, and it leads to injury, or worse, for a patient, it is considered medical malpractice.

Legal Jargon and Meanings

Terms used in medical malpractice claims can include:

• Negligence: The failure to behave with the same level of care that a reasonable person would give in the same circumstances.
• Statute of limitations: This is the length of time that can pass before a person can no longer file a claim. For medical malpractice, it is typically two to three years in the United States.
• Tried in court: A situation in which a medical provider will be charged and proven innocent or guilty by a jury.
• Plaintiffs: Patients filing a medical malpractice case.
• Defendants: The medical provider(s) involved in the malpractice case.
• Discovery: A phase before the trial where each party learns more about the case and is given information from opposite sides.

Responsible Parties in Medical Lawsuits

Providers, such as medical personnel and facilities, claimed to be responsible for medical malpractice are considered the defendants. For example, a doctor and a nurse considered responsible for negligence toward a patient can both be charged with medical malpractice. The primary provider is typically sued for negligence, not the entire medical team . In the case of patient vs. provider, the patient would be the plaintiff, and the provider would be the defendant.

In a medical malpractice suit, the plaintiff is the party who claims they experienced injury due to negligence or are the family members of the patient who died.

How to Find Out if a Provider Has Malpractice Complaints

Patients looking for new healthcare providers can check their malpractice status by going to the DocInfo site and the Federation of State Medical Boards . There, you can search for any malpractice suits or complaints that may be lodged against a specific provider. You may also be able to do a quick online search by typing the healthcare provider’s full name and “medical malpractice suit” into the search bar. You can also check the state licensing board. However, since medical malpractice suits aren’t typically shared across different states, it’s essential to check through licensing boards across all states to find out.

Medical Malpractice Qualifications

The laws are clearly defined, and certain criteria must be met for a medical act to qualify as malpractice, including:

• Legal duty to treat the patient: A healthcare provider has a legal and just duty to provide care for the patient and their current health problems.
• Violation of standard of care: A healthcare provider did not offer the appropriate medical care as per the standard.
• Injury or death caused by negligence: A person was injured or lost their life due to the healthcare provider’s negligent actions.
• Significant damages occurred because of the injury: There is enough damage to justify a case, and the financial recovery from the suit will be greater than the cost of pursuing the lawsuit.

If a patient can prove these four characteristics accurately describe their situation and are within the statute of limitations, they can file a malpractice claim.

What Part of Medical Malpractice Is the Most Difficult to Prove?

Proving that a healthcare provider acted intentionally when breaching the standard of care is the hardest to prove because accidents and poor outcomes can happen in the medical field. That does not mean that they are automatically medical malpractice.

How to Initiate a Medical Malpractice Case

When a patient wants to initiate a medical malpractice suit, they must take important steps in the proper order. That way, they can help build a strong case for themselves.

Since healthcare providers will be doing everything to defend themselves against medical malpractice, it is essential to get everything in order before launching a case.

The steps to follow are:

• Finding a lawyer: You will want to hire a lawyer with experience in medical malpractice.
• Gathering evidence: Together with your lawyer, you will need to gather as much hard evidence as possible to prove that the healthcare provider acted with negligence and it led to significant injury or death. This could include gathering health records , imaging and other test results, and any other documentation pertaining to your experience.
• Reviewing documents with an expert: After you have all the documents you need, an expert will likely need to review them to ensure you have all the information you need to file a suit against a healthcare provider.

After that, discovery occurs, in which both parties share information about the witnesses and evidence.

Gathering Information

To make the best case possible, you will want to gather as much information and records as possible. They may include:

• Medical records, including office visits, test results, surgery and hospital discharge reports and summaries, etc.
• Financial records of everything you spent and will have to pay because of the injury caused
• Witnesses that can attest to your experience

Medical Malpractice Compensation

The compensation provided following a medical malpractice case will vary significantly depending on the patient’s experience and health outcome following the negligent event.

They will also vary depending on the state where a person files the case. According to research published in the journal JAMA Internal Medicine , the average payout patients in the United States receive is roughly $329,565.

There are several determining factors associated with the different payouts, including:

• The severity of the injury
• The type of negligence
• The impact the injury has had on the patient physically, psychologically, and financially
• How much medical care a person will need going forward
• The amount of evidence presented during the case
• How strong the evidence is in proving the medical malpractice occurred
• Any testimony provided by medical experts in the field
• Laws and regulations surrounding medical malpractice in your area
• The impact of the injury on the patient’s loved ones
• Whether or not the patient has/had insurance coverage

Medical malpractice is a form of professional negligence that can lead to patient injury or death. Because this type of negligence can lead to severe outcomes, it is considered a serious offense in the eyes of the law in the United States.

People who believe they experienced negligence (or their families in the case of wrongful death) can file a medical malpractice claim against the healthcare providers and facilities they find at fault as a way to cover damages and cover future costs of care due. Still, it can be challenging to prove in a court of law in some cases.

Because of that, gathering the correct information and finding the right legal team are the best ways to build a strong case against a healthcare provider who acted in a negligent manner during your care.

American Bar Association. Medical malpractice .

New York City Bar. Medical malpractice .

Attaluri PK, Wirth PJ, Moura SP, Shaffrey EC, Rao VK. The anatomy of a malpractice lawsuit . Aesthet Surg J Open Forum. 2023;5. doi:10.1093/asjof/ojad008

American Board of Professional Liability Attorneys. What is medical malpractice?

Forbes. Medical malpractice statute of limitations by state .

Robinson C, Kettering C, Sanfilippo JS. Medical malpractice lawsuits . Clin Obstet Gynecol. 2023;66(2):256-260. doi:10.1097/GRF.0000000000000777

Schaffer AC, Jena AB, Seabury SA, Singh H, Chalasani V, Kachalia A. Rates and characteristics of paid malpractice claims among US physicians by specialty, 1992-2014 . JAMA Intern Med. 2017;177(5):710-718. doi:10.1001/jamainternmed.2017.0311

Hampton and King Attorneys at Law. Medical malpractice payouts by state .

By Angelica Bottaro Bottaro has a Bachelor of Science in Psychology and an Advanced Diploma in Journalism. She is based in Canada.

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Charting Practices to Protect Against Malpractice: Case Reviews and Learning Points

Summer ghaith.

* Mayo Clinic Alix School of Medicine, Phoenix, Arizona

Gregory P. Moore

† Mayo Clinic, Department of Emergency Medicine, Phoenix, Arizona

Kristina M. Colbenson

‡ Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota

Rachel A. Lindor

Introduction.

Medical documentation issues play a role in 10–20% of medical malpractice lawsuits. Inaccurate, incomplete, or generic records undermine a physician’s defense and make a plaintiff’s lawyer more likely to take on a case. Despite the frequency of documentation errors in malpractice suits, physicians receive very little education or feedback on their documentation. Our objective in this case series was to evaluate malpractice cases related to documentation to help improve physicians’ documentation and minimize their liability risks.

We used Thomson Reuters Westlaw legal database to identify malpractice cases related to documentation. Common issues related to documentation and themes in the cases were identified and highlighted.

We classified cases into the following categories: incomplete documentation; inaccurate text; transcription errors; judgmental language; and alteration of documentation. By evaluating real cases, physicians can better understand common errors of other practitioners and avoid these in their own practice.

Emergency physicians can reduce their liability risks by relying less on forms and templates and making a habit of documenting discussions with the patients, recording others’ involvement in patient care (chaperones, consultants, trainees, etc.), addressing others’ notes (triage staff, nurses, residents, etc.), paying attention to accuracy of transcribed or dictated information, avoiding judgmental language, and refraining from altering patient charts.

INTRODUCTION

More than 75% of emergency physicians will be named in a malpractice lawsuit at least once throughout their careers. 1 Documentation issues are thought to play a role in up to 20% of these lawsuits. 2 Previous studies of malpractice claims involving documentation indicate that these cases most commonly revolve around missing documentation (70%), inaccurate content (22%), or poor mechanics (18%). 3 Poor mechanics includes errors in transcribed order, illegible entries, and delays in documentation. 3 Physicians often focus on documentation as a means of communicating with other physicians and billing for their services, but it is also crucial to communicate with the patient and provide a legal record of the care provided. Often, malpractice lawyers decide whether to pursue litigation cases based solely on the quality of documentation. In malpractice cases, inaccurate, incomplete, or careless records undermine a physician’s defense and make a plaintiff’s lawyer more likely to take on a case. 2

Despite the frequency of documentation issues in malpractice suits, physicians receive very little education on this topic through training and very little feedback on their documentation once in practice. The Accreditation Council for Graduate Medical Education does not specifically address or require medicolegal education, lending to varying levels of exposure and training on these topics. When surveyed, residents and physicians across multiple specialties reported receiving no medicolegal training at all, let alone training that is specific to documentation, and rated their knowledge as poor. 4 , 5 , 6 Emergency physicians are particularly at high risk of documentation malpractice liability due to the large number of high-risk patients and fast-paced environment. The objective of this case series was to evaluate malpractice cases related to documentation errors and practices to help improve physicians’ documentation and minimize their liability risks. By evaluating real cases, physicians can better understand practices and common errors of other practitioners and avoid these errors in their own practice.

We used Thomson Reuters Westlaw, an online legal database, to search for medical malpractice cases related to documentation. Cases were classified into the following categories: missing documentation; inaccurate text; transcription errors; judgmental language; and alteration of documentation. Illustrative examples are provided below.

RESULTS AND DISCUSSION

Missing documentation.

Cases that involve missing documentation comprise a broad range of clinical circumstances. 2 Common scenarios identified included lack of documentation about informed consent discussions, patients acting against medical advice (AMA), specialist consultations, and communication with patients regarding return precautions or post-discharge care. The cases below highlight situations in which missing documentation contributed to the physicians’ liability risks.

Informed Consent

Physicians generally recognize the need to obtain informed consent and the risks of failing to do so, yet cases revolving around this issue remain common. Often in these cases, a standardized informed consent form is used, but the documentation is still deemed inadequate by the courts. For example, in Brown v St. Clair Anesthesia, Ltd. , a patient provided written consent for placement of a central venous catheter during a bypass procedure. 7 However, the physician determined during the procedure that the patient needed a Swan-Ganz catheter instead. Unfortunately, when insertion was attempted, he perforated the vein and the patient died. The patient’s family alleged that the two types of catheters were different enough to warrant a separate and specific consent form. The hospital settled privately, and the physician took the case to court believing the initial form would protect him; he was found responsible for $1 million in damages.

In Alaimo, Estate of v Berman , a woman underwent a cosmetic breast surgery and developed a complication that was listed clearly on the informed consent form she had signed prior to the procedure. 8 The patient argued that she was given the informed consent form just minutes before being wheeled to the operating room, and, therefore, her consent was rushed and not valid. Although the physicians involved in the case argued that she had been given the form much earlier, there was no timestamp on the actual form, and the court ruled in favor of the patient for a $3.5 million award. Although clinicians often assume that a signed, informed consent form protects them from procedural complications, especially those explicitly listed on the forms, these cases suggest that the forms’ protections are limited, and courts may expect more of a detailed conversation than a standardized form conveys.

Patient Acting Against Medical Advice

While patients who leave AMA are widely recognized to be high risk when it comes to liability, we identified several cases in which physicians’ documentation of the encounter failed to protect them from liability. For example, in McHone v Swedish Covenant Hospital , emergency physicians recommended that a child with abdominal pain be transferred to a pediatric center for additional diagnostic studies. 9 However, the mother wanted to drive the child herself. She signed an AMA form prior to discharge and was given instructions to present at the nearby children’s hospital. Rather than going right to the hospital, the mother stopped at her house, delaying her arrival at the referral center for several hours, and the child died due to sepsis from a ruptured appendix. Although the AMA form was signed and documented, the accompanying discussion was not. Other than the signed form, there was no evidence that the original physician really tried to ensure the mother understood the risks to her child or worked with her to come up with a safer plan, and the court found the physician partially liable for the child’s death.

Similarly, in Parker v FL Emergency Physicians , a patient arrived at the emergency department (ED) complaining of a headache concerning for a subarachnoid hemorrhage. 10 Before the workup was completed, the patient left AMA and signed a form documenting this decision, his awareness of the risks, and his acceptance of those risks. Several days later, he died due to a ruptured aneurysm. Again, the AMA form itself did not convince the court that the physician adequately conveyed the risks to the patient or put sufficient effort into convincing him to stay, and the court issued a $9 million verdict. Finally, in Tracy v Freund , a patient went to the hospital with chest pain but chose to leave before his evaluation was complete. 11 The patient signed an AMA form and had a fatal myocardial infarction a week later. This case occurred in a state in which the jury could apportion comparative fault for the parties involved. Comparative fault allocates negligence when both parties are at least somewhat at fault. They decided that the AMA form lessened the physician’s role but did not absolve him entirely, and they ultimately found him to be responsible for 50% of the damages, or $2.7 million.

These cases demonstrate that a signed AMA form is not sufficient protection from future liability and physicians should ensure that appropriate attention is directed toward this class of high-risk patients, both in encouraging them to stay and in fully documenting any efforts to convince them to do so. Additionally, physicians should document an assessment of a patient’s decision-making capacity in every AMA case, ideally with reference to the four elements of capacity, understanding, appreciation, reasoning, and communication.

Discussions with Consultants

Consultations originating in the ED are another source of potential liability if not documented appropriately. In an anonymous case in New York, a patient presented to the ED with a headache. 12 After an initial workup, the resident physician reported consulting a neurologist who recommended against additional diagnostic studies. The patient subsequently suffered a brainstem herniation from an undiagnosed subarachnoid hemorrhage and died in the ED. When the patient’s family brought suit, the resident defended himself by saying he was following the neurologist’s advice. The neurologist denied any recollection of the conversation, and there was no documentation to support that it had occurred. The jury felt that either the resident or the neurologist was being dishonest and awarded the patient’s family $44 million in damages.

Cases like this can be avoided by following a clear pathway for formal consultations, in which the consultant’s name is recorded, along with the time and content of the discussion, and consultants are made aware that their recommendations will be relied on and incorporated into the medical record. This does not preclude informal consultations, or “curbside consults,” in which a specialist’s advice is sought in an off-the-record fashion. In fact, instituting a clear pathway for formal consultations and being upfront about intention to document recommendations may alleviate consultants’ fears of being unknowingly named in the medical record and increase their willingness to provide informal input.

Communicating with Patients at and After Discharge

While physicians’ documentation efforts tend to focus on the content of the clinical encounter, communication with patients at the time of and after discharge is equally important for minimizing liability. Lawsuits related to this issue may involve unclear referrals, inaccurate discharge instructions, incomplete return precautions, or failure to follow up on outstanding testing. For example, in Hooten v Pediatrix Medical Group , a newborn baby with retinopathy of prematurity was discharged after a prolonged hospital stay and referred to a local ophthalmologist for close follow-up. 13 When the mother tried to follow up, she was told that physician was no longer available, and she was scheduled for an appointment a month later at a different practice. By the time she followed up, her child was blind. She argued that no one had told her about the importance of timely follow-up, and there was no documentation contradicting this, leading the court to issue a $9.25 million judgment in her favor.

In Estate of Kimble , poorly documented discharge instructions resulted in liability for a primary care physician. 14 In this case, a woman presented to an outpatient clinic with shortness of breath and an elevated D-dimer. The physician instructed her to go to the ED and assumed the patient would do so but did not document this recommendation. When the patient instead went home and died from a massive pulmonary embolism, the physician settled for $2 million since she could not provide any evidence that there had been referral to the ED. Taking the time to discuss and document recommendations for post-discharge care minimizes physicians’ risks from these types of lawsuits.

Finally, test results that change or return after ED discharge can create liability risks for emergency physicians. Common scenarios requiring post-discharge follow-up include radiology reports that are later revised or tests that result after discharge, such as blood cultures or urine culture susceptibilities. The ED must have a process to provide these results to patients in a timely fashion, and emergency physicians should understand that they maintain ultimate responsibility for the efficacy of these processes. In scenarios in which attempts to contact patients are unsuccessful, all attempts to do so should be thoroughly documented. Maintaining an awareness of these processes and potential pitfalls can reduce physicians’ liability risks for discharged patients.

Inaccurate Documentation

Separate from the issue of missing documentation, inaccurate documentation makes up the second most common category of documentation-related malpractice cases. Common issues in this category include using inaccurate templates, copying and pasting from other notes, and providing information that conflicts with other clinicians for the same encounter. Each of these issues has become more problematic with the shift to electronic health records (EHR).

Reliance on templates that automatically populate a normal physical exam or review of systems is a commonly used but risky practice. Examples of this include a review-of-systems template that records “no chest pain” for a patient with a chief complaint of chest pain, or a templated physical exam saying “moves all 4 extremities” when a patient has an amputation. Even if these mistakes have no impact the outcome of a patient’s care, they can be used to discredit the physician by persuading a jury that the physician was careless, rushed, and ultimately negligent in their care of the patient, based simply on one obvious mistake like this.

Inaccuracies in documentation also arise when physicians’ notes conflict with those of other healthcare personnel involved in the same encounter, such as triage nurses, non-physician staff such as physician assistants or advanced practice providers, or trainees. For example, in Plaintiff v Defendant , a patient presented to the ED with right-sided chest pain, had an unremarkable subsequent evaluation in the ED, and was admitted for pain control. 15 In the hospital, he was eventually diagnosed with a spontaneous chest wall hemorrhage but unfortunately died of hemorrhagic shock. The family sued the physicians involved for not recognizing the acuity of the patient’s condition earlier. The emergency physician argued that the patient did not appear ill while in the ED, and referred to his own documented physical exam, which was normal. However, the patient’s family highlighted the nurse’s triage note, which described the patient as “cool, moist, and mottled” at arrival. They used this to argue that the physician’s exam was inaccurate and that the patient had shown signs of shock on arrival. The court agreed with the family, and they were awarded $800,000.

Similarly, in Prager v Campbell Memorial Hospital , a patient presented after involvement in a motor vehicle collision, and the triage nurse noted his chief complaint as neck pain. 16 The physician’s chart indicated the patient complained only of upper back pain with a normal neck exam, and he discharged the patient after the imaging of his head and thoracic spine was reassuring. The patient woke up the next day with paralysis of one arm, was re-evaluated, and found to have an unstable cervical spine fracture, resulting in permanent arm weakness. The court ruled in favor of the patient for a $9 million verdict, based on the nurse’s note that documented the presence of neck pain at his initial visit.

The use of other healthcare professionals’ notes to cast doubt on the accuracy of physicians’ evaluations, as illustrated above, is actually a frequent strategy for lawyers. In comparing a physician note to a nurse’s note, trial lawyers teach, “the value of recognizing the difference between a brief note of a busy physician and the more time allowing leisurely and more explicit account of a nurse in a closer and more exposed encounter with a given patient. Cast in the proper light, the nurse’s notes may well be given more credence by a jury when confronted with a conflict reflecting significantly on either the client’s injury or the question of liability.” 2 This observation highlights the need to be aware of what others have written about your patients and be proactive about addressing any inconsistencies. 2 This risk is magnified for physicians overseeing non-physician personnel or trainees and highlights the risks of the common practice of signing off on charts after patient discharge or without full review.

Transcription Errors

Transcription errors are a major source of liability for physicians and have become increasingly common with the shift to EHRs. The most common transcription errors include enunciation errors (53.9%), deletions (18.0%), and insertions (11.7%). 17 Studies have found an average of seven errors per 100 words in electronic records, and a clinically significant error every 250 words. 17 In the ED, 15% of notes have a clinically significant transcription error. 17

Enunciation errors generally involve transcription or dictation systems misinterpreting spoken orders. For example, in Juno v Amare , insulin dosing provided in a patient’s discharge summary was transcribed by an outside transcription service as 80 units rather than 8 units, leading to the death of a patient. 18 Despite the obvious technical fault in this case, rather than any impairment or deliberate negligence on the part of the physician, the court awarded the patient’s family $140 million. In Madigan v Makavana , a hospitalized patient with a known seizure history was receiving 150 milligrams (mg) of Keppra rather than 1500 mg due to a similar error, resulting in a seizure that caused a permanent neurologic deficit. 19 The court ruled in favor of the patient for an $11.2 million verdict. The routine use of facial coverings in healthcare settings has the potential to significantly exacerbate these enunciation issues.

The use of EHRs also increases the risk of other types of errors, such as placing orders for the wrong patient or choosing the wrong options from a drop-down menu. In Estate , for example, a 91-year-old man who was in the ED for a mechanical fall was given high-dose chlorpromazine meant for a different patient. 20 This error caused the patient’s death and resulted in a $750,000 settlement. In Walrath v Smith , a patient with hypokalemia was given discharge instructions for hyperkalemia. 21 Despite verbal instructions to increase her potassium supplement, she followed her discharge instructions, decreased her potassium supplement, and arrested at home, resulting in a $100,000 settlement. Despite the role of technology in these cases, the physicians involved can be held accountable in the same way as if they had missed a diagnosis or chosen the wrong treatment.

Judgmental Language

Use of judgmental language represents another potential documentation pitfall for physicians. In Young v. Women’s Health , a physician documented that a patient had a history of substance abuse, despite her denying this and providing proof for her claims. 22 However, the information was left in the chart, and the patient was denied life insurance coverage based on this information. She was able to demonstrate that the information was false, and the courts sided with the patient for a verdict of $1.5 million. Judgmental language also comes in the form of providing unnecessary quotations that highlight the vernacular of a patient or clinically irrelevant details. For example, a chart that quotes a patient as reporting she has “the sugars” is unnecessary, creates a mocking tone, and will make it easy for an attorney to paint a picture that a physician feels superior to the patient. Similarly, a chart that alludes to a patient’s appearance, religion, or political party, if not otherwise relevant, can easily be used by a trial attorney to suggest the physician was biased against the patient. In addition, studies have shown that physicians’ use of negative details and quotations in patients’ charts tends to negatively bias downstream clinicians. 23 , 24 Keeping unnecessary details and quotations out of the record can shield physicians from this this type of claim and protect patients from unnecessary bias.

Alterations in Charting

Another common issue is the alteration of previously recorded documentation. In Perry v United States , a five-week-old patient was brought to the ED twice in the same day with a fever, was seen by the same physician and discharged without appropriate testing. 25 On the third visit, the patient was diagnosed with meningitis and suffered a permanent neurologic deficit. The physician altered the charts from previous visits to obscure the fact that the patient had a fever, but this was easily identified in court proceedings, and the court levied a $20 million verdict against him.

In Lei , a 21-month-old patient died after a delayed diagnosis of an incarcerated hernia. 26 While the delay in diagnosis may have been reasonable, the documentation was changed prior to trial to delete a note about the patient’s “bilious vomiting,” contributing to a $3.28 million verdict in favor of the patient. Lastly, in Buchanan v Metrolina Medical Associates , a patient presented to the ED with shortness of breath and chest pressure that originated during prolonged travel. 27 The physician ordered a chest radiograph, which was negative, and discharged the patient on an antibiotic. The patient died the next day due to a pulmonary embolus. During the trial, the metadata was used to prove that the physician went into the patient’s chart after his death to indicate that the patient had declined an electrocardiogram, that the cough was productive, and that a calf exam had been performed. While these notes may have been true, their entry after the fact raised the specter of a cover-up and forced the physician into a $3 million settlement.

Documentation alteration is relatively easy to identify because EHRs contain meta-data that can demonstrate timestamps for nearly every change and review of a page in the record. The best way to avoid this situation is to document fully at the initial patient encounter; however, if it is necessary to go into a chart and document at a later date, especially in patients with a known bad outcome, physicians should acknowledge that they are doing so by documenting the date and why the changes are being made to the chart. While this may still lead to some loss of credibility by the readers, it is the only way to addend a patient’s chart without casting doubt on one’s intentions.

Besides looking dishonest, alteration of documentation can have several other consequences. For example, many states can revoke physicians’ licensure if they are found to have altered a record. In addition, some malpractice insurance companies will not provide coverage for physicians if they altered records, leaving them vulnerable to the entirety of a verdict or settlement. Similarly, in some states where punitive damages have been banned or capped as a form of tort reform, these limits do not apply in cases of document alteration. Finally, in some courts, document alteration reverses the evidentiary burden, meaning that patients no longer have to prove that a physician harmed them, but rather the physicians have to prove that they did not. The myriad of consequences associated with alteration of documentation emphasizes the danger of this practice and the importance of documenting appropriately at the initial encounter.

LIMITATIONS

The above content provides qualitative information designed to highlight potential areas of vulnerability for clinicians. Due to the nature of the database, it is not possible to provide a quantitative assessment of risk for each of the areas described. Similarly, the case examples provided may not be representative of the most common cases in each category. These limitations notwithstanding, we feel the examples included here provide valuable insight into several areas in which documentation issues can heighten physicians’ liability risks, guided by previous studies on this topic.

Risk of malpractice cases involving documentation can be minimized by understanding common errors and practices that lead to lawsuits. These errors are relatively easy to commit; recognizing these potential pitfalls will not only decrease the likelihood of a malpractice lawsuit but also decrease the risk of contributing to an adverse patient outcome. Emergency physicians can reduce their liability risks by relying less on forms and templates and making a habit of documenting discussions with the patient, recording others’ involvement in patient care (a chaperone, consultant, trainee, etc.), addressing other caregivers’ notes (triage, nursing, residents, etc.), paying attention to accuracy of transcribed or dictated information, avoiding judgmental language, and refraining from altering patient charts. This case series is not meant to encourage physicians to document more but rather more effectively, highlighting specific parts of the chart that have historically been problematic and may warrant more attention.

Section Editor: David Lee, MD

Full text available through open access at http://escholarship.org/uc/uciem_westjem

Conflicts of Interest : By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

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Patient safety and medical malpractice: a case study.

Brennan TA, Mello MM. Patient safety and medical malpractice: a case study. Ann Intern Med. 2003;139(4):267-73.

This case study discusses the ongoing challenges in balancing patient safety with the system of tort liability for medical malpractice. A defendant-physician and her attorney share their perspectives through the presentation of a specific case, revealing the tension between malpractice claims and patient safety initiatives. The authors propose targeted reforms that may create a more effective system, while suggesting incentives to improve safety and quality. This article is part of a special collection entitled “Quality Grand Rounds,” a series of articles published in the Annals of Internal Medicine that explores a range of quality issues and medical errors.

Claims, errors, and compensation payments in medical malpractice litigation. May 17, 2006

Disclosure of medical injury to patients: an improbable risk management strategy. January 24, 2007

Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. June 8, 2005

Beyond negligence: avoidability and medical injury compensation. October 31, 2007

Who pays for medical errors? An analysis of adverse event costs, the medical liability system, and incentives for patient safety improvement. February 6, 2008

"Health courts" and accountability for patient safety. September 13, 2006

Medical monitoring for pharmaceutical injuries: tort law for the public's health? March 6, 2005

The role of medical liability reform in federal health care reform. July 1, 2009

Advising patients about patient safety: current initiatives risk shifting responsibility. September 7, 2005

Fostering rational regulation of patient safety. July 20, 2005

Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. March 27, 2005

Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. March 27, 2005

Accidental deaths, saved lives, and improved quality. October 5, 2005

Analysis of surgical errors in closed malpractice claims at 4 liability insurers. August 16, 2006

Risk factors for retained instruments and sponges after surgery. March 6, 2005

An insurer's care transition program emphasizes medication reconciliation, reduces readmissions and costs. July 27, 2016

Automatable algorithms to identify nonmedical opioid use using electronic data: a systematic review. November 8, 2017

No-fault compensation for medical injuries: the prospect for error prevention. March 6, 2005

Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. October 11, 2006

Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. October 11, 2006

Claiming behaviour in a no-fault system of medical injury: a descriptive analysis of claimants and non-claimants. September 6, 2006

Association of overlapping surgery with perioperative outcomes. March 6, 2019

Relationship between quality of care and negligence litigation in nursing homes. April 13, 2011

National costs of the medical liability system. September 15, 2010

Relationship between state malpractice environment and quality of health care in the United States. April 12, 2017

Economic value of pharmacist-led medication reconciliation for reducing medication errors after hospital discharge. November 2, 2016

Ambulatory care adverse events and preventable adverse events leading to a hospital admission. April 18, 2007

The incorporation of patient safety into board certification examinations. April 12, 2006

Communication factors in the follow-up of abnormal mammograms. March 6, 2005

The role of physician specialty board certification status in the quality movement. March 6, 2005

Preventing medical injury. March 27, 2005

The Institute of Medicine report on medical errors—could it do harm? March 27, 2005

Iatrogenic events resulting in intensive care admission: frequency, cause, and disclosure to patients and institutions. April 27, 2005

A middle ground on public accountability. March 6, 2005

Assessment of perioperative outcomes among surgeons who operated the night before. June 8, 2022

Effects of a communication-and-resolution program on hospitals' malpractice claims and costs. December 19, 2018

Can communication-and-resolution programs achieve their potential? Five key questions. December 19, 2018

The medical liability climate and prospects for reform. November 19, 2014

Legal and policy interventions to improve patient safety. March 2, 2016

Prevalence and characteristics of physicians prone to malpractice claims. February 3, 2016

Changes in practice among physicians with malpractice claims. April 3, 2019

Disclosing harmful medical errors to patients: tackling three tough cases. September 30, 2009

Administrative compensation for medical injuries: lessons from three foreign systems. August 3, 2011

How policy makers can smooth the way for communication-and-resolution programs. January 29, 2014

Talking with patients about other clinicians' errors. November 6, 2013

Outcomes in two Massachusetts hospital systems give reason for optimism about communication-and-resolution programs. October 11, 2017

Four states with robust prescription drug monitoring programs reduced opioid dosages. June 27, 2018

Malpractice liability and health care quality: a review February 19, 2020

Assessing patients 2019 experiences with medical injury reconciliation processes: item generation for a novel survey questionnaire. May 5, 2021

Understanding liability risk from using health care artificial intelligence tools. January 31, 2024

Apology laws and malpractice liability: what have we learned? July 8, 2020

Challenges of implementing a communication-and-resolution program where multiple organizations must cooperate. December 21, 2016

Case outcomes in a communication-and-resolution program in New York hospitals. February 1, 2017

Managing the risks of concurrent surgeries. March 30, 2016

Medical malpractice liability in the age of electronic health records. December 1, 2010

Malpractice reform—opportunities for leadership by health care institutions and liability insurers. April 14, 2010

Implementing hospital-based communication-and-resolution programs: lessons learned in New York City. February 5, 2014

Communication-and-resolution programs: the challenges and lessons learned from six early adopters. January 15, 2014

Disclosure, apology, and offer programs: stakeholders' views of barriers to and strategies for broad implementation. January 9, 2013

Disclosure-and-resolution programs that include generous compensation offers may prompt a complex patient response. December 19, 2012

The evolving story of overlapping surgery. July 19, 2017

Patients' experiences with communication-and-resolution programs after medical injury. October 18, 2017

Collaboration with regulators to support quality and accountability following medical errors: the communication and resolution program certification pilot. September 21, 2016

Improving reconciliation following medical injury: a qualitative study of responses to patient safety incidents in New Zealand. October 4, 2017

'Poking the skunk': ethical and medico-legal concerns in research about patients' experiences of medical injury. July 17, 2019

Ensuring successful implementation of communication-and-resolution programmes. March 18, 2020

Seroprevalence of SARS-CoV-2 among frontline health care personnel in a multistate hospital network--13 academic medical centers, April-June 2020. September 23, 2020

Relationship between complaints and quality of care in New Zealand: a descriptive analysis of complainants and non-complainants following adverse events. February 15, 2006

Work system design for patient safety: the SEIPS model. October 12, 2011

Abbreviation use decreases effective clinical communication and can compromise patient safety. October 4, 2023

Incidence and types of adverse events and negligent care in Utah and Colorado. March 27, 2005

What has an Airbus A380 captain got to do with OMFS? Lessons from aviation to improve patient safety. June 12, 2019

Negligent care and malpractice claiming behavior in Utah and Colorado. March 27, 2005

Liquid medication dosing errors by Hispanic parents: role of health literacy and English proficiency. May 31, 2017

Liquid medication errors and dosing tools: a randomized controlled experiment. October 5, 2016

Pictograms, units and dosing tools, and parent medication errors: a randomized study. July 19, 2017

Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study. November 16, 2022

Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs. February 29, 2012

Expert consensus on currently accepted measures of harm. September 9, 2020

Patient safety in chiropractic teaching programs: a mixed methods study. December 23, 2020

Operationalizing occupational fatigue in pharmacists: an exploratory factor analysis. November 18, 2020

Sociotechnical work system approach to occupational fatigue. July 26, 2023

Surfacing safety hazards using standardized operating room briefings and debriefings at a large regional medical center. April 4, 2012

Misdiagnosis, mistreatment, and harm - when medical care ignores social forces. April 8, 2020

Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an Utstein-style scientific statement. February 13, 2008

Optimizing situation awareness to reduce emergency transfers in hospitalized children. October 20, 2021

The impact of racism on child and adolescent health. July 1, 2019

Work system barriers and facilitators of a team health information technology. September 13, 2023

The effect of multidisciplinary care teams on intensive care unit mortality. March 3, 2010

The safety of inpatient health care. January 25, 2023

The safety of outpatient health care: review of electronic health records. May 15, 2024

Patient and health care professional perspectives on stigma in integrated behavioral health: barriers and recommendations. March 15, 2023

Bracing for the storm: one health care system's planning for the COVID-19 surge. November 11, 2020

Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis. August 9, 2023

Family safety reporting in medically complex children: parent, staff, and leader perspectives. July 6, 2022

Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial. December 12, 2012

Parent perceptions of children's hospital safety climate. April 17, 2013

Is it possible to identify risks for injurious falls in hospitalized patients? August 29, 2012

A novel process audit for standardized perioperative handoff protocols. November 1, 2017

Are parents who feel the need to watch over their children's care better patient safety partners? December 6, 2017

Mark Graber Diagnostic Quality & Safety Award. August 30, 2023

Medication mix-up: what happened at Vanderbilt and how it impacts health care providers. February 15, 2023

Electronic health record legal settlements in the US since the 2009 Health Information Technology for Economic and Clinical Health Act. December 21, 2022

Opportunities to mine EHRs for malpractice risk management and patient safety. September 7, 2022

RaDonda Vaught, medication safety, and the profession of pharmacy: steps to improve safety and ensure justice. August 17, 2022

Criminal liability for nursing and medical harm. August 3, 2022

Does malpractice liability make healthcare safer? Aligning law and policy with evidence. June 8, 2022

ASHP Standard for Certification as a Center of Excellence in Medication-Use Safety and Pharmacy Practice. April 20, 2022

Complexity bias in the prevention of iatrogenic injury: why specific harms may inhibit performance. March 16, 2022

Patient safety assurance in the age of defensive medicine: a review. March 2, 2022

The role of apology laws in medical malpractice. July 7, 2021

Another medical malpractice crisis?: Try something different. October 14, 2020

The paradoxes of defensive medicine. August 26, 2020

The confused and bewildered hospital: adverse event discovery, pay-for-performance, and big data tools as halfway technologies. July 29, 2020

Missed diagnosis of cancer in primary care: insights from malpractice claims data. August 7, 2019

An organization-specific and modifiable inpatient safety composite measure. May 8, 2019

"Sorry" is never enough: how state apology laws fail to reduce medical malpractice liability risk. April 24, 2019

Endorsements of surgeon punishment and patient compensation in rested and sleep-restricted individuals. March 27, 2019

Trends in anesthesia-related liability and lessons learned. March 6, 2019

Association of emotional intelligence with malpractice claims: a review. February 13, 2019

Unintended harm associated with the Hospital Readmissions Reduction Program. January 16, 2019

Patient safety in inpatient psychiatry: a remaining frontier for health policy. January 9, 2019

Defensive medicine: it is time to finally slow down an epidemic. November 7, 2018

Physician engagement in malpractice risk reduction: a UPHS case study. August 29, 2018

2017 John M. Eisenberg Patient Safety and Quality Awards. July 18, 2018

The high costs of unnecessary care. November 22, 2017

Deploying and measuring a risk and patient safety program. February 1, 2017

The new CMS hospital quality star ratings: the stars are not aligned. November 9, 2016

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Former worker accuses Puritan Medical Products of 'heinous racism' in federal lawsuit

May 28—A Black-Hispanic man has filed a civil rights complaint with U.S. District Court in Bangor against Puritan Medical Products, alleging managers and co-workers at the swab maker's Pittsfield facility racially harassed him.

Dupreme Ammonds, a Hartland resident, worked for 14 months at Puritan Medical Products, which makes tongue depressors, and swabs used in COVID-19 test kits and other medical applications.

Ammonds alleges that several workers there used racist slurs against him, targeted him with stereotype-based "jokes" and intimidated him with threatening comments.

"This campaign of discrimination and harassment was constant and ongoing. Co-workers and supervisor alike participated in the hostility," the lawsuit states. "The harassment included multiple instances of white co-workers calling Mr. Ammonds the full 'N-word' or purposefully using it in front of him."

He also claims that after repeatedly complaining to managers and human resources officials, he was told not to file more complaints.

"Human resources reprimanded Mr. Ammonds and told him to be mindful of how his words could hurt others. This alone was more discipline than other employees faced for the heinous racism they directed at Mr. Ammonds on a near daily basis," the suit states.

In a brief written statement, Puritan denied the allegations.

"While Puritan does not comment on pending cases, we deny violating the law and we look forward to defending ourselves before the court," Marketing Director Virginia Templet said in an email on Tuesday. "Puritan does not tolerate inappropriate conduct in the workplace, and we remain fully committed to providing an appropriate workplace for all."

White co-workers stood up for Ammonds, the lawsuit states. In one instance, four employees went to the human resources department with complaints about a specific white worker who was allegedly harassing Ammonds. But the lawsuit states that Tracy Brawn, in the human resources department, told the group that their complaints were considered harassment and they would be terminated for any future complaints.

This behavior came at a cost to Ammonds, according to the lawsuit. His mental health "deteriorated" amid the "constant racial harassment" and "extreme indifference of — if not encouragement by — upper management and human resources."

Ammonds ultimately left the company in April 2022, which was recommended by his medical providers, to address "severe anxiety and mental health issues that arose from the horrific treatment at Puritan."

One co-worker who regularly harassed Ammonds was fired after he physically assaulted Ammonds in front of supervisors, the lawsuit states.

But according to the lawsuit, no other employees who allegedly harassed Ammonds faced repercussions.

"With the exception of Willie Ashe — who had also physically assaulted Mr. Ammonds — Puritan did not discipline the employees who had harassed and discriminated against Mr. Ammonds," the lawsuit states. "None of them were reassigned — only Mr. Ammonds was."

Ammonds' pursuit of justice included a lengthy process with the Equal Employment Opportunity Commission, which granted him a Right to Sue notice. He has been motivated by the desire to protect other people of color working at Puritan from the alleged abuse he experienced — further complicated by what his attorneys have said are the challenges of living in an overwhelmingly white region like Somerset County.

"Dupreme has a strong sense of justice and a commitment to bettering community. He hopes that by pursuing justice through the courts, he can help to make his community a safer and more welcoming place," said Ryan Schmitz, Ammond's lawyer with Maine law firm Johnson & Webbert. "(This harassment) comes from a pervasive attitude of white supremacy that people of color face across Maine and the country. By filing this lawsuit, Dupreme is directly challenging that dynamic."

Through request for a jury trial, Ammonds is asking the court to declare that Puritan violated the Civil Rights Act and command the company to stop engaging in the behavior Ammonds allegedly faced. He is also asking the court for monetary damages to compensate for economic losses and "emotional distress, mental anguish, humiliation and embarrassment."

Puritan Medical Products received $126.5 million from two federal contracts in 2020 to ramp up its production of medical swabs for patients taking COVID-19 tests during a shortage of swabs and other supplies. In June 2023, Puritan laid off 272 positions — around 215 from the Pittsfield plant — because it was "coping with post-COVID market conditions" as demand for testing swabs plummeted, the company said in a statement.

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Lawsuit accuses prison system of violating law to replace health care provider

Credit: HYOSUB SHIN / AJC

The Georgia Department of Corrections has awarded a $2.4 billion contract for health care in the prison system to a new company without the competitive process required under state law, the present contractor alleges in a lawsuit.

Wellpath, the Nashville-based company that has provided health care for the department since 2021, also asserts that it was blind-sided by the out-of-control violence in Georgia prisons, resulting in trauma costs that far exceeded what the firm has incurred in the other state prison health care systems it manages.

The lawsuit adds another wrinkle to the numerous issues confronting the GDC, contending that the agency engaged in conduct that was “truly unprecedented” when it decided in April to award its health care contract to Virginia-based Centurion Health.

Wellpath informed the GDC last June that it would opt out of its contract on June 30, 2024, only three years into a nine-year deal. But in the months after the decision, the parties continued to discuss new pricing that would have reset the contract terms until, the suit claims, a deal was abruptly and secretly struck with Centurion.

“There was no public notice. There was no request for proposals. There was no written evaluation criteria. There was no evaluation team. There was no evaluation. There was no statement of the basis on which the decision was based,” Wellpath alleges in its complaint.

Wellpath also asserts that its price was “objectively lower” than the $2.4 billion the GDC has agreed to pay Centurion for a contract of similar length.

The company is arguing that the contract between the GDC and Centurion is unlawful and must be cancelled. It also seeks monetary damages.

The suit, filed May 7 in Fulton County Superior Court, names GDC Commissioner Tyrone Oliver; Jim Barnaby, the deputy commissioner of the Georgia Department of Administrative Services, and Centurion of Georgia as respondents. An additional lawsuit, filed by the company last week, makes similar arguments but names only the State of Georgia for procedural purposes.

GDC spokesperson Lori Benoit, in a statement emailed to The Atlanta Journal-Constitution, said the agency doesn’t comment on pending litigation. “However, we would like to point out that we took the necessary steps to follow all procurement policies and are confident in the decision made,” she wrote.

In a motion seeking the lawsuit’s dismissal, attorneys representing the GDC said Wellpath’s argument has no merit.

“Wellpath terminated its contract in the hope that it could dictate new, higher-priced terms to the GDC,” the motion says. “There’s the rub; like a jilted partner, Wellpath did not want to continue a relationship with the GDC but does not want anyone else to be involved in that relationship with the GDC either.”

With the current contract close to expiring, the GDC went with Centurion “rather than suffer such extortion,” the motion says. Now, by filing a lawsuit that seeks to keep Centurion from taking over, Wellpath “threatens the health and safety of Georgia’s prison inmates,” the motion says.

In retracing the steps that led to Wellpath’s decision last year to opt out and renegotiate, the lawsuit raises a curtain on the bloody violence that has been raging inside Georgia’s prisons for nearly four years.

Credit: Contributed

According to the complaint, the state’s own descriptions of prison conditions in 2021, which bidders used to formulate their proposals, didn’t come close to capturing the reality inside the prison system.

“Due to the pricing (in the contract), which derived directly from the respondent’s provision of inaccurate information to bidders, Wellpath was required to subsidize the GDC’s and the state’s 8th Amendment obligation to provide adequate healthcare (as required by law),” the lawsuit alleges.

The upshot of the additional costs, according to the lawsuit, was that Wellpath had to invest more than $40 million of its own funds to stabilize its Georgia workforce, catch up on an inherited backlog of patient care and improve the GDC’s health care system.

In an affidavit, Sam Britton, Wellpath’s president for state and federal operations, said the levels of inmate-on-inmate assaults in Georgia’s prisons were “exponentially higher” than those in other prisons where Wellpath provides health care in the South, Northeast and Midwest.

Britton said that trauma care in 2023 for Georgia’s 38,997 prisoners covered by Wellpath cost $16.4 million. That compares to trauma costs of $9.25 million for 111,403 inmates housed in prisons in eight other state prison systems served by Wellpath, he said in the affidavit.

Britton said Wellpath also had trouble recruiting qualified staff to provide medical care in Georgia’s prisons because of the widespread violence, leading to additional costs to run the health care program.

In another affidavit, Gregg Bennett, Wellpath’s vice president of operations for Georgia, said understaffing in Georgia’s prisons was much worse than in other states in which the company operates, leading to an “imbalance” that caused a higher rate of violence. Consequently, he said, the company experienced a 40% annual turnover rate among its employees working in GDC facilities.

Centurion did not immediately respond to requests for comment from the AJC.

The GDC contracted with Wellpath in 2021 when the agency decided to privatize health care after 23 years with Georgia Correctional HealthCare, a division of Augusta University. The contract included nine one-year options for renewal, with Wellpath able to opt out at any point as long as it gave 364 days notice.

Centurion was among the bidders seeking to win the health care contract that was awarded in 2021. The company has long provided mental health services for the GDC and more recently became the provider of dental care.

In the lawsuit, Wellpath says it performed its duties “skillfully and without any noted deficiencies under incredibly trying conditions that are well known to the GDC” and that the need for a price increase was acknowledged by the agency. But in the midst of negotiations for an amended contract, the GDC “inexplicably” awarded the contract to Centurion outside the bounds of Georgia’s State Purchasing Act, the suit claims.

Wellpath has filed a protest with the Department of Administrative Services, which, according to the company, automatically placed a stay on the contract’s execution. Yet even with the matter under protest, the suit alleges that the GDC and Centurion have moved forward with their deal, unlawfully interfering with Wellpath’s employees and network providers.

The new contract calls for Centurion to take over as the prison health care provider on July 1.

OUR REPORTING

The Atlanta Journal-Constitution is working to bring accountability to the state prison system as violence, massive understaffing and corruption have reached a crisis level. The state system also represents a giant investment by taxpayers, and AJC has detailed how the crisis has added to taxpayers’ financial burden. Online, read previous stories about state prisons at ajc.com/news/investigations/

About the Author s

Credit: Shawn Still for state Senate

Credit: GDC & AJC staff photo

Credit: Danny Karnik/Georgia Tech AThl

Bangor Daily News

Maine news, sports, politics, election results, and obituaries

Man subjected to racist slurs and hostile environment at Puritan, lawsuit says

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A Maine company failed to help and retaliated against a Black and Hispanic employee who was subjected to a year of racist insults, a lawsuit filed last week said.

While working at Puritan Medical Products in Pittsfield, Dupreme Ammonds was called racial slurs and insulted in various ways by co-workers, while management did nothing to stop it, the lawsuit filed May 20 in U.S. District Court in Bangor said.

The suit said Ammonds was subjected to a hostile work environment and was retaliated against for reporting issues, which is against federal and state law. By allowing the discrimination and retaliation, Puritan “constructively discharged” Ammonds from his job, according to the lawsuit.

The lawsuit asks for a jury trial and unspecified damages for the harassment Ammonds allegedly experienced at Puritan, which is headquartered in Guilford and was one of the top manufacturers of medical swabs during the COVID-19 pandemic .

“While Puritan does not comment on pending cases, we deny violating the law and we look forward to defending ourselves before the court,” Puritan Marketing Director Virginia Templet

said. “Puritan does not tolerate inappropriate conduct in the workplace, and we remain fully committed to providing an appropriate workplace for all.”

Ammonds filed a complaint with the Equal Employment Opportunity Commission, which issued a right to sue notice in February, the lawsuit said.

In January 2021, Ammonds started working at the Pittsfield location of Puritan Medical Products. By February, a co-worker asked him if his hair grows into a “Michael Jackson afro everywhere,” and then asked if the hair in his armpits, genitals and chest grow in that style, the lawsuit said.

Co-workers and Ammonds’ supervisor made numerous comments about stereotypes of Black people’s genitals, as well as asking if he went to Africa when he stepped away for a minute, according to the lawsuit.

Ammonds reported the comments to Puritan’s human resources department and multiple higher ups, who dismissed it because the supervisor was new, the lawsuit said. This showed Ammonds his complaints would not be taken seriously, according to the suit.

One person stuck two fingers in his back as a pretend gun and said “just in case you miss home,” the lawsuit said. Another co-worker would call Ammonds his “little monkey” and make comments about how Black women should be picking cotton.

After months of Ammonds reporting the harassment without any actions taken against the people who made the comments, human resources sent home the worst offender for the rest of the day, but he was allowed to return the next day, the lawsuit said.

When the man returned, he shoved Ammonds from behind while he was working and then used a string of “vitriolic racist comments,” according to the lawsuit. That finally led to the man being fired, but the harassment escalated because the fired man was popular with other co-workers, the lawsuit said.

Four co-workers complained together about the harassment Ammonds was experiencing, but they were told further complaints would be met with immediate termination, according to the lawsuit.

In April 2022, Ammonds started seeing a therapist, who recommended a leave of absence from Puritan, which he took. He was later diagnosed with PTSD and anxiety following the harassment, the suit said.

More articles from the BDN

Marie weidmayer.

Marie Weidmayer is a reporter covering crime and justice. A recent transplant to Maine, she was born and raised in Michigan, where she worked for MLive, covering the criminal justice system. She graduated... More by Marie Weidmayer

Calif. firefighters file lawsuit over retaliation after complaints about mandatory overtime

Manhattan beach firefighters sue city officials for failing to fill vacant positions and requiring overtime shifts.

A Manhattan Beach fire engine.

Manhattan Beach Fire Department/Facebook

By Joe Nelson Press-Telegram

MANHATTAN BEACH, Calif. — A dozen Manhattan Beach firefighters are suing the city in federal court, alleging top officials retaliated against them for publicly railing against short staffing that required them to work “crushing” amounts of overtime, especially during the COVID pandemic.

Once considered a “crown jewel” of Manhattan Beach, the city’s Fire Department began to suffer in 2018, when Bruce Moe, a defendant in the lawsuit, took over as city manager and refused to fill nine vacant department positions to save on future pension and benefits costs, according to the lawsuit filed Tuesday, May 21, in U.S. District Court in Los Angeles.

From March 2018 to June 2022, the suit alleges, that Moe and city human resources directors refused to fill the vacancies in a lean department that had only 29 positions, not including the fire chief. During that time, and even through the end of 2023, the remaining firefighters worked dramatically more overtime.

The overtime demand was especially pronounced during the COVID-19 pandemic, which jeopardized the safety of both the firefighters and the public, according to the lawsuit.

“Moe’s ill-conceived vision of ‘budget efficiency’ is the epitome of the penny-wise, pound-foolish thinking of a person who has never had to work 24 hours straight, without sleep, as a first responder to emergency calls,” the lawsuit states. “Moe’s approach, which resulted in brutal and excessive mandatory overtime for 20 firefighters who had to do the work of 30 firefighters, took a severe physical and psychological toll on plaintiffs.”

Also named as a defendant in the lawsuit is Manhattan Beach Human Resources Director Lisa Jenkins, who the plaintiffs allege worked in tandem with Moe to, among other things, block promotions of firefighters who spoke out publicly against the city and launch baseless, retaliatory disciplinary investigations against union leadership, the lawsuit alleges.

City spokesperson Alexandria Latragna said in a statement Friday, May 24, that the city has not been served with the lawsuit, nor has it had an opportunity to read or analyze the details of the complaint, and therefore could not comment on the allegations.

“The city remains committed to supporting all of our city employees — including our firefighter personnel — and their labor organizations,” Latragna said.

Moe retiring

The lawsuit comes roughly a month after Moe announced he was retiring after 35 years with the city. He previously served as the city’s finance director for 20 years and began his career with the South Bay community of 34,000-plus residents in 1989 as a general services supervisor for purchasing and warehouse operations.

Latragna said Moe’s retirement was in no way connected to the lawsuit or the union’s conflict with the city.

The MBFA, according to the lawsuit, repeatedly asked the city to fill what it described in its lawsuit as a “growing list of vacant positions,” to no avail.

“With each additional retirement and injury on the job, the vacancies increased, and the remaining firefighters (had) to work more overtime and shoulder more responsibilities,” according to the lawsuit. “Morale in the department deteriorated as a dwindling number of firefighters had to work a crushing number of overtime hours to protect the health and welfare of Manhattan Beach residents.”

Moe, the lawsuit alleges, lashed out at the firefighters for speaking out on the issue, calling them “overpaid” and “entitled.”

“He supported that falsity with annual pay figures that were inflated due to the excessive, unsustainable, mandatory overtime hours the city itself had created by dangerously understaffing the department,” according to the lawsuit.

The lawsuit also alleges the city refused to negotiate in good faith with the association over an expiring labor agreement, and, in the fall of 2022, voted to impose unfair labor terms upon firefighters without their consent.

Pete Heck, the MBFA’s current president, declined to comment on Friday, deferring comment to the union’s attorney, Thomas Brown.

Same issues persist

In a telephone interview, Brown said firefighters are still working mandatory overtime in the city due to the firefighter shortage.

“It’s still going on,” he said. “It’s a shame they have to put up with some of the municipal nonsense that goes on, especially when they risk their lives for the residents. It causes me to shake my head.”

He said the union has tried to work with the city for several years to resolve their issues, but things recently came to a head, prompting the litigation.

“There were a few last straws that I’m not going to go into right now, but they said, ‘Enough is enough,’ ” Brown said.

Three-year contract

Nearly a year ago, things between the city and MBFA seemed to be amicable. In June 2023, the City Council approved a three-year labor contract with the union that called for an incremental 10% cost-of-living salary increase.

The agreement also included overtime pay at 1.4 times the hourly rate for working special events, 2.5% collateral duty pay for special certifications, such as for hazardous materials coordinator and fire investigator, and an increase of up to $100 per month in technical specialty pay.

Additionally, the agreement called for an increase in paid holiday hours from 100 to 139, a sick leave cash-out, and allowing five employees per shift being to be on vacation at the same time as opposed to only one employee per shift, the previous requirement.

Rudy Mejia, then the union president and now one of the 12 plaintiffs in the lawsuit, told the Daily Breeze at the time that the agreement “creates that stability for our firefighters and gives us labor peace.” He said things were different between the union and the city.

“What’s different now is we put the past behind us as best we could, communicating and building relationships with the city manager,” Mejia said at the time.

Mejia could not be reached for comment on Friday.

(c)2024 Press-Telegram, Long Beach, Calif. Visit Press-Telegram, Long Beach, Calif. at https://www.presstelegram.com/ Distributed by Tribune Content Agency, LLC.

StarTribune

Embroiled in lawsuits from wildfires, xcel faces tradeoffs of safety vs. cost.

A transmission line patrol foreman for Xcel Energy smacked the base of a wood power pole with a hammer on a Wednesday afternoon in April, kicking dust into the air with a thump as part of safety work on infrastructure in Inver Grove Heights.

This type of inspection work — from peering through binoculars to spot woodpecker damage to flying helicopters and drones over miles of cables — might be laborious, but it can be high stakes.

At least it was in the case of several Texas wildfires in February, which spread to more than 1 million acres, killed two people and more than 15,000 cattle while torching farms, homes and ranches across the rural northern Panhandle.

An Xcel utility pole fell in high winds and ignited the biggest in that series of blazes, which became the largest wildfire in Texas history. One March lawsuit alleges contractors had chipped away rotten wood from the bottom of the structure, leaving it unsteady and hazardous with the remains "chewed up below ground like a sharpened pencil or a beaver-gnawed tree."

"It should have been taken out of service long before it failed and ignited the deadly and devastating Smokehouse Creek Fire," the lawsuit stated.

Xcel has denied any negligence in not taking down or fixing the pole, and the Minneapolis-based company has also denied fault for another destructive 2021 wildfire in Colorado. But it is still confronting an onslaught of lawsuits and thus financial headaches from these disasters: Costs from the Texas Smokehouse Creek inferno could surpass Xcel's $500 million insurance coverage for 2024. Same with the Marshall Fire near Boulder.

Utilities cause only a small fraction of U.S. wildfires, but the fires they do spark are often more damaging, like California's 2018 Camp Fire that killed 85 people and led to manslaughter convictions for Pacific Gas & Electric after its transmission line failure.

Wildfires are becoming more disastrous in the U.S. because of climate change and other factors like urban sprawl, leading many in the utility industry, including Xcel, to grapple with how to prevent calamities that threaten human lives and company health.

Harden and cut

Destructive blazes in the Western U.S. prompted Xcel to quicken its own wildfire mitigation work, and since 2020, Xcel has spent more than $500 million on a wildfire prevention program in Colorado.

Duncan Callaway, a professor at the University of California Berkeley, said there are two main paths for utilities to mitigate wildfire risk: hardening infrastructure, such as burying power lines or insulating conductors, and cutting power.

That includes "fast trip" settings, which quickly stop power from flowing back to lines when impacted until an inspection. It can also mean shutting down electricity for lots of customers pre-emptively in dangerous conditions, a move that is becoming more routine in the West.

Michael Lamb, who oversees Xcel's electric and gas delivery infrastructure, said Xcel has done some of everything, even using technology such as high-resolution cameras and artificial intelligence for early detection in Colorado .

"Our industry is considering things we've never considered in the past because of our experiences with wildfires starting in California 10 years ago," Lamb said.

One Stanford University analysis found Xcel meets some important wildfire preparedness measures in Colorado , such as having a formal wildfire mitigation plan, but hits fewer marks in New Mexico, which doesn't require those plans. The company said it is doing mitigation work in the Southwest state. The study did not look at other Xcel states, including Texas.

Xcel has pre-emptively cut power for wildfire risk twice since the Smokehouse Creek blaze. The first wildfire safety outage in company history was in late March, affecting more than 2,500 customers in Texas and New Mexico. In April, Xcel turned off electricity for roughly 55,000 Colorado customers .

In the Colorado case, Lamb said Xcel projected "hurricane force" winds of more than 100 mph, low humidity and dry vegetation on the ground susceptible to burning. Those shutoffs, which Lamb called a "last resort" tactic, carry their own risks. Some residents said the loss of power hurt their business or caused other problems. A wastewater treatment plant in Boulder nearly spilled raw sewage .

Lamb said "hindsight is 20/20," when asked if Xcel should have cut power before Smokehouse Creek.

"Absolutely, looking back, I wish I could have done anything possible to prevent that level of damage from occurring," he said. "I wouldn't be human if I didn't think that."

Costs and risk

Reducing wildfires comes with a price that often falls on customers. Callaway said one major reason for escalating power rates in California is more wildfire spending.

Xcel said it hasn't tallied the impact of wildfire work on Colorado rates, though it's likely not as dramatic as in California. In general, safety outages are less expensive, and Berkeley analyst Callaway was part of research that found "fast trip" settings can be the most cost-effective . Callaway said they have been "tremendously successful" in California, but they do sometimes leave people without power and don't always prevent ignition.

Hardening infrastructure keeps the lights on, but is pricey.

"If we want to have a system that is as reliable as possible, then undergrounding [power lines] is the right thing to do," Callaway said. "I have yet to see an alternative that would be more effective. However, I have yet to see an alternative that is more expensive."

The Berkeley research noted Pacific Gas & Electric — which went into bankruptcy in 2019 after its power lines caused the California Camp Fire, among others — paid $4.3 million to bury just 1 mile of distribution line in 2020.

In October, Xcel won a $100 million federal grant , to which Xcel added $140 million, to address wildfire problems and strengthen the grid in Colorado, Minnesota, New Mexico, Texas and Wisconsin.

But that can't help what's already sparked.

Xcel's stock dropped nearly 9% the day it admitted to playing a part in the Texas fire. The company expects losses of at least $215 million and is facing 15 lawsuits, including a wrongful death case and 46 fire-related claims.

The Colorado Marshall Fire killed two people and reportedly caused more than $2 billion in property damage, and Xcel knows of 302 legal complaints on behalf of more than 4,000 plaintiffs tied to that blaze. Xcel contends a flawed investigation there incorrectly concluded the company's equipment was the likely source of one of two fires that then merged.

Travis Miller, an energy and utilities strategist at financial services firm Morningstar, predicted a 50% chance shareholders will face $1 billion of pretax liabilities, including penalties and fines from the Texas and Colorado fires.

That won't put the $31 billion-valued Xcel out of business, but still, Miller said natural disasters are an inherent risk for utilities. And that can discourage investment.

Xcel, along with a federal utility trade group, is interested in limiting financial damages for companies, with CEO Bob Frenzel endorsing "some form of backstop insurance program" during an April call with analysts. California started a wildfire fund in 2019 that utility customers and shareholders bankroll in exchange for financial protections.

The U.S. needs a "holistic, society-wide approach" to reducing fires no matter the cause, said Scott Aaronson, senior vice president of security and preparedness for Edison Electric Institute, which represents all investor-owned electric utilities in the U.S.

"Bankrupting an electric company doesn't do anybody any good," he said. "Somebody still has to serve the customer."

Minnesota preparations

Xcel doesn't have a wildfire program with Minnesota regulators like it does in Colorado and is filing in Texas this year. But the utility does annually inspect a quarter of its regional transmission lines on foot and all of its system from the sky.

The company is also deploying closer fire monitoring and "wildfire safety settings," a precautionary mode used in bad conditions that enables "fast trip" technology to keep power lines off when touched.

By late April, Xcel had turned on safety settings more than a dozen times this year in the Upper Midwest, said Marty Mensen, Xcel's regional vice president of distribution and operations, with the lack of snow this winter as one reason for heightened caution. Mensen said the risk for wildfires "is more present than its ever been."

The Minnesota Public Utilities Commission has even taken action, starting with a hearing Tuesday, though it hasn't come up with any concrete steps yet.

Across Xcel's footprint, Lamb said, the company has taken lessons from the recent Texas fire and is looking closer at risk forecasting and public outreach. But the Smokehouse Creek Fire, despite its widespread damage, has not caused "transformative" or "material" technical changes.

"I would call them tweaks to our standards and processes," he said.

Walker Orenstein covers energy, natural resources and sustainability for the Star Tribune. Before that, he was a reporter at MinnPost and at news outlets in Washington state.

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