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[LIVE BLOG – Seattle] Interactive Medical Liability Cases, with Brian Berman, MD, PhD

In this lecture, Dr. Brian Berman gives a quick summary of a number of medical liability cases.  Follow along as if you are here at the Summer SDPA Conference in Seattle!
Case #1: Prednisone – Avascular Necrosis
How often do you warn patients prior to prescribing prednisone?
In this fairly straightforward case, the patient was not warned about the possibility of avascular necrosis being induced by prednisone. 
Result: $50,000 fine in favor of the patient.
Case #2: Psoriasis UV Light Treatment & Blistering Sunburn 
If you make an error, do you apologize to the patient?
Dr. Berman’s suggestion: 
Acknowledge and show empathy, but don’t necessarily name the error.  At the same time, don’t minimize it.  Make the best of it.  
A man with psoriasis received a UV light treatment lasting 12 weeks and was later hospitalized for a blistering sunburn which developed post-treatment.  Patient photographed sunburn which was later used as evidence when he sued the dermatologist and the dermatologist associates.
Defendant claimed only minor symptoms resulted and that there would be no real case without “that photograph.”  (Incriminating himself in the process.)
Result: Ruling in favor of the patient
Case #3: Laser Scar and Hypopigmentation
In this written consent case, the patient was given CO2 laser treatment for facial scars. The patient signed a consent form that said permanent hypopigmentation may be a side-effect. 
A 35 year old female proceeded to be treated with CO2 laser for facial acne pockmarks having reviewed an advertisement information sheet which included that non-permanent hypopigmentation was possible.  
Right before treatment she signed, but did not read, an informed consent form which included risk of permanent hypopigmentation.  She later developed 1 sq inch of permanent hypopigmentation.
Result: $90,000 settlement
Take back: If you do give out any info sheets from your society, be sure to read them to make sure it’s consistent with what you do, also make sure it matches your informed consent form.  
Case #4: Cantharidin from Blister Beetles
2 kids treated for molluscum contagiosum (MC) initially with CO2 and then switched to cantharidin.  Blisters developed.
Plantiff alleged: 
+ Failure to be given the informed consent.  
+ No reason given for cantharidin treatment
+ Triggered seizures in the child with history of meningitis and stroke. Also caused: psychological injury; scars; parental wage loss.  
Plaintiff wanted $60,000 compensation.
Defendant claimed didn’t breach standard of care; use was appropriate; blistering to be expected.
Result: Verdict for the defendant.
Case #5: Botox – Off label Use
Patient has migraines and treated with Botox for migraines.  Patient was bed-ridden for 4 months.  Alleged malpractice, negligence, intentional minconduct, unapproved PDA Botox.
+ Doctor defines off-label use (condoned by FDA, encourages rational off-label use)
+ 4 Plaintiff witnesses vs 14 Defense expert witness
Result: 9-3 verdict for the Defendant
Take home: Keep in mind that “Rational off label use” is condoned and encouraged by courts and the FDA.
Lecture Summary:
Dr. Berman reminds us that the majority of medical liability verdicts against derm practitioners deal with misdiagnosis or delay of diagnosis usually regarding skin cancer.  Even more, it is reported that there are no liability verdicts in existence (which rule against the derm practitioner) for using systemic therapies, TCIs, off-label use or fillers.
[image by Phil Roeder]

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