Doctors and Litigation: The L Word

In this episode, we take a hard look at the growing use, and misuse, of punitive damages allegations in medical malpractice cases -- and how this trend has reshaped the practice of medicine in places like New Mexico. What was once intended as a rare legal tool to punish truly egregious conduct is increasingly being deployed early and broadly, sometimes before the facts of a case are fully known. It significantly raises the emotional and financial stakes, often destabilizing defendants and influencing decision-making in ways that have little to do with the quality of the care provided, and more to do with avoiding the risk of catastrophic personal loss. The result is not only profound individual distress, but a ripple effect across the healthcare system. We explore how this type of environment predictably drives physicians out of higher-risk regions, contributing to growing care deserts, and ultimately affecting patient access and outcomes. What happens to a healthcare system when the legal climate becomes too predatory, too dangerous, for good doctors to practice there? Defense attorney Jessica Marshall , partner in the Albuquerque office of Mayer, LLP, is here today to help us make sense of these implications. We discuss the dramatic loss of access to doctors in New Mexico as a direct result of its predatory malpractice climate, and, in particular, the weaponization of punitive damages as a routine pressure tactic. We also highlight the positive results of recent staunch advocacy from doctors, lawyers, and patients alike, hoping to restore access to care in New Mexico. We end with a call to action: what is happening in your state? In nearly every state, plaintiff's attorneys exert heavy lobbying dollars, and even become state legislators in order to introduce legislation that enriches them. Even in states with current common sense protections, there are efforts to walk back limitations of the use of punitive damages and existing caps on damages. But, as you'll see in this conversation, when that happens, there can be devastating real-world consequences for patients and their doctors alike. It's not theoretical. Have a listen and share this with your colleagues. _______________________ Take the LEAP! Be litigation-ready. Learn from Dr. Pensa's attorney-vetted Litigation Education and Performance for Clinicians course. Up to 16 hours of AMA Category 1 CME/CNE credits available in this self-paced video course that will teach you about the skills and mindset required to face medical litigation with integrity and know-how. Learn many of the techniques Dr. Pensa uses with her own 1:1 coaching clients. START HERE: https://www.doctorsandlitigation.com/LEAP/signup _______________________ Attorneys, Risk, Claims, and Medical Leadership: Learn about "Defense LEAP" and partnering with Dr. Pensa to ensure your medical defendants are supported and prepared from the very beginning. Contact Dr. Pensa through her website to learn more: https://www.doctorsandlitigation.com/contact

In this episode, host Dr. Gita Pensa sits down to continue her conversation with elite defense trial attorney, John E. Hall, Jr. His recent book, "Reviving Fairness: Defending Healthcare Heroes", outlines the shifts in the modern world of American medical liability litigation, and offers a timely call to confront the malpractice climate harming clinicians and threatening access to care. John E. Hall, Jr. is a senior partner at Hall Booth Smith and a nationally recognized trial lawyer focused on defending healthcare professionals and medical institutions in high-exposure litigation. He is one of the founders of American Legal Connections, a national network advancing strategy and reform in complex medical defense and other high-stakes cases. John is known for his disciplined trial preparation and proactive approach to preventing aberration verdicts. He's also an author of other non-fiction and fiction books, a songwriter, and a leading voice calling for the reform of predatory malpractice litigation practices in the US. _____________________ Check out Dr. Pensa's recent appearance on The Pitt Podcast -- the HBO Max companion podcast to the Emmy-winning hit show, The Pitt! Gita Pensa was thrilled to be a consultant for the hit drama The Pitt for the 2nd and (upcoming) 3rd seasons, bringing her expertise in malpractice litigation stress to help the show's writers understand what clinicians carry behind the scenes. She speaks about it more in Episode 10 of the HBO Max companion podcast. Watch here now: https://youtu.be/phwbzDMCuUc?si=DUymrA6dE9xYYVx_&t=2070 _______________________ Take the LEAP! Be litigation-ready. Learn from Dr. Pensa's attorney-vetted Litigation Education and Performance for Clinicians course. Up to 16 hours of AMA Category 1 CME/CNE credits available in this self-paced video course that will teach you about the skills and mindset required to face medical litigation with integrity and know how. Learn many of the techniques Dr. Pensa uses with her own 1:1 coaching clients. START HERE: https://www.doctorsandlitigation.com/LEAP/signup _______________________ Attorneys, Risk, Claims, and Medical Leadership: Learn about "Defense LEAP" and partnering with Dr. Pensa to ensure your medical defendants are supported and prepared from the very beginning. Contact Dr. Pensa through her website to learn more: https://www.doctorsandlitigation.com/contact

What happens when a physician defendant doesn’t just “get through” litigation — but prepares for it? In Part 2 of The Educated Defendant, host Dr. Gita Pensa sits down with the veteran trial attorney who defended Dr. Nirav Patel. (If you haven't listened to part 1, start there!) John E. Hall, Jr. helps us unpack what made this case different. What does an experienced defense lawyer actually want from a physician witness? What separates a reactive, defensive defendant from one who is credible, collaborative, and compelling in front of a jury? We talk about preparation, presence, strategy, and the often-unspoken dynamic between lawyer and doctor in high-stakes malpractice trials. John E. Hall, Jr. is a senior partner at Hall Booth Smith and a nationally recognized trial lawyer focused on defending healthcare professionals and medical institutions in high-exposure litigation. He is the author of Reviving Fairness: Defending Healthcare Heroes and one of the founders of American Legal Connections, a national network advancing strategy and reform in complex medical defense and other high-stakes cases. John is known for his disciplined trial preparation and proactive approach to preventing aberration verdicts. Next month, John Hall returns to discuss his newest book, Reviving Fairness: Defending Healthcare Heroes. _______________________ Want to get an education on legal know-how and performance for yourself? Check out The LEAP for Clinicians course! Up to 16 hours of AMA category 1 continuing education credits.

THIS EPISODE is a must-listen for anyone facing, or fearing, litigation. (And their attorneys.) Host Dr. Pensa interviews radiologist Dr. Nirav Patel about his extraordinary journey through litigation...and what he did to become his legal team's secret weapon. You can do it, too. And if you're inspired by this episode to get yourself an education...start with The LEAP Course for Clinicians. (Attorneys and Claims: if you're interested in LEAP for your clients, contact Dr. Pensa about Defense LEAP.)

This month we take a high level view of the landscape of 'tort reform' in the US (and what does that even mean?) Physician-lawyer Dr. Shilpa Mathew, MD JD, walks us through some basics of tort law and advocacy efforts in the US, how you can get involved, and why it matters. (Note: Dr. Mathew's views expressed in this podcast are strictly her own, and not representative of her employer or ACOG.) Shilpa Mathew, MD, JD, is a Northern California physician double board-certified in Obstetrics & Gynecology and Lifestyle Medicine. She is a former practicing attorney who spent the latter half of her legal career focused on health insurance and regulatory compliance and brings a unique perspective to the intersection of law, medicine, and policy. She has long been active in health advocacy and policy efforts—ranging from things such as pro bono legal work to protect basic health rights of foreign detainees in US prisons to serving as a medical student delegate to the California and American Medical Associations. She has a particular passion for issues related to medical malpractice and focused her residency research project on malpractice knowledge, attitudes and perceptions of OB/GYN residents nationwide. Currently, she serves as the Co-Chair of the Legislative Committee for the American College of Obstetricians and Gynecologists in California, where together with a team, she helps shape policy to advance women’s health. BONUS: In the introduction, host Dr. Gita Pensa talks about her own litigation advocacy wish list - there are some 'standard' wishes on there, and some you may not have considered before. Here is Dr. Pensa's informal Holiday Wish List for malpractice litigation reform. BIG picture, pipe dream stuff: no-fault systems or state based compensation funds, healthcare specific courts, specialized judges... Protection for doctors Attorney reforms Early resolution programs Expert Witness Reform It's a wish list. But...the only way to move towards any of these steps is through involvement and advocacy. Happy Holidays to all, and we'll see you in 2026.

REMEMBER: Use code LEAP100 until December 1st, 2025, to get 100$ off of the LEAP for Clinicians course! Eligible for 16 Category 1 CME/CNE Credits. Learn the essential mindset and skillset you need as a clinician in litigation, all in one place. This month: finger pointing among health care professionals after an adverse event, or during litigation. We've all seen it: the tertiary care center dumping on the community hospital in their notes. The specialist criticizes the primary care doctor or the ER's management. The doctor blames the nurse. The nurse charts defensively, ending with "MD Aware." The attending blames the resident. The resident blames the attending! All in a chart war, preserved for perpetuity. Or even more sinister: a surgeon, after an adverse surgical event, tells the family the awful news -- and then tries to implicate someone else: the anesthesiologist, the CRNA, the radiologist who read the study... You know we could go on. We've all seen it. And then, once litigation starts -- now we're co-defendants. How does this 'blame game' play for a jury? Is the chart the place for these disagreements? (Spoiler alert: NO.) Can finger pointing in charting actually backfire and get you pulled INTO a case? (Spoiler alert: YES.) Our guest today is Heather Hansen, trial consultant and communications expert. For over 20 years, she defended providers and hospitals in medical malpractice cases. She created a curriculum for medical residents, teaching them communication and advocacy tools. She has helped leaders from Harvard Business School, Google, LinkedIn, LVMH, the American Medical Association, and Hospital Corporations of America advocate for change, resources, opportunities, and attention. As a trial attorney, she taught thousands of witnesses how to be credible and charismatic in court. She combines her experience with her psychology degree, conflict-resolution training, and time as a TV anchor to develop her trademarked systems and help her clients achieve their goals. Heather has been featured on The Today Show, Dr Oz, CNN, Fox News Channel, MSNBC, CBS, and Fox Business. She’s the best-selling author of The Elegant Warrior: How to Win Life’s Trials Without Losing Yourself. She’s the host of The Elegant Warrior podcast, which is consistently in the top 100 business podcasts on Apple. Learn more about host Dr. Gita Pensa.

Welcome to Season 3 of Doctors and Litigation: The L Word! We start off with an update on the LEAP Course (Litigation Education and Performance) -- sign up from now through December 1, 2025 with coupon code LEAP100 and get $100 off. Now with up to 16 hours of Category 1 AMA CME Credits! https://www.doctorsandlitigation.com/LEAP/signup Our first conversation in Season 3 is with Dr. Anthony Orsini of The Orsini Way. Communication with patients or families after unexpected medical events is crucial, but most of us have no formal training in how to do it well. Compassionate and skilled conversations can pave the way for understanding and closure for families. However, when handled poorly or defensively, these conversations can create resentment, distrust, and anger, which can also make litigation more likely. What do patients and families want from us in these moments? What do we do with our body language? What happens if we cry? Can we show compassion by touch, on the hand or the shoulder? Why is this so difficult? Have we lost our humanity in the name of professionalism? Dr. Orsini has spent the last 25 years developing proven communication techniques that help doctors build rapport and quickly form trusting relationships with their patients. Come along as we discuss evidence based strategies to handling these conversations better.

In this episode (the last of Season Two), Dr. Pensa sits down to speak with a plaintiff's attorney. However, her guest, Chad Englehardt, is not your average plaintiff's attorney. Chad is a highly lauded attorney, law professor, and advocate of Rick Boothman's Michigan Model (for more on that, listen to Episode 13 of Season Two.) We talk extensively about CRP (Communication - Resolution) programs, patient safety, and the dysfunction of our current legal system, which re-traumatizes patients and clinicians alike. If the first rule of medicine is 'First, do no harm,' then he feels the second rule in medicine, and the first in law, should be: "Do no further harm." We also talk a bit about third party investors and litigation funding (which we have not yet covered in the podcast, but is of great importance...we'll revisit it!) During the course of our conversation, Mr. Englehardt mentions two books: You can reach Chad via email at chad@cmtjustice.com. We'll be back in a few months with the start of Season Three!

Following up after episode 15, "What to Know When the Government Comes Knocking," Dr. Pensa interviews a physician who went up against the US Department of Justice -- and won. Dr. Muhamad Aly Rifai is a practicing psychiatrist, boarded in psychiatry and internal medicine, who was indicted on charges of healthcare fraud by the US government in 2022, following seven years of investigation. Dr. Rifai was confident he was innocent, and confident in his billing practices -- and despite intimidation by the government, threats of imprisonment for up to 40 years, and very long odds, he refused to settle. He won against the US Government after a 6-day trial, and is here to share what he learned in his ordeal. This Department of Justice press release describes the accusations against Dr. Rifai. (I feel they should update the headline!) After demonstrating that the case was baseless and should never have been brought to trial in the first place, along with his resounding victory in court, Dr. Rifai filed a motion for sanctions and to recoup his substantial legal fees. In the wake of that motion, one prosecuting attorney was fired, and two others have 'retired.' The motion, as of May 2025, is still in limbo. Dr. Rifai shares his story in an effort to educate all of us, and to empower physicians going through similar circumstances.

The Department of Justice is waging a war on healthcare fraud, and sometimes even well-meaning doctors can get swept up in it. Today's interview with healthcare law attorney Anthony Box will shed some light on this high stakes topic. Tony Box has extensive experience not only in defending doctors against government allegations -- but he also previously investigated and prosecuted these cases as a federal prosecutor and FBI agent. He knows both sides of this coin very well. Host Dr. Gita Pensa and Attorney Box break down the basics of what every doctor needs to know about governmental investigations and litigation.

When an insurance company is accused of acting in bad faith, it's alleged that they failed to act fairly and reasonably in handling a claim -- often related to not agreeing to a reasonable settlement when the financial risk to the insured at trial was known to be substantial. In this episode, host Dr. Gita Pensa talks with Florida attorney Dale Swope about his decades of experience with bad faith lawsuits. Mr. Swope emphasizes that some liability insurers are more reliable and fair-minded than others, so it’s important to consider an insurer’s reputation. Just as an adverse medical event doesn’t always mean malpractice, an unfavorable legal outcome doesn’t automatically mean the insurer acted in bad faith. However, insurers do have obligations to their policyholders—and if those obligations aren’t met and there’s a negative legal outcome, it can lay the groundwork for a bad faith lawsuit. Mr. Swope also makes starkly clear the importance of knowing who you're really working for when you're working for a mega-group. (You'll want to check the name on your W-2 immediately.) Dale Swope is managing partner of Swope, Rodante P.A. which is the development of the solo firm practice he founded six months out of law school, in 1979. In his more than thirty years of service as a Board-Certified Civil Trial Specialist, and previously a Board-Certified Business Litigation Specialist, Mr. Swope has won many awards, and holds a reputation as one of the preeminent attorneys practicing in Florida in the area of insurance bad faith.

If you’ve ever felt frustrated by the fear-driven legal landscape of medicine, this conversation will change the way you think about liability and the future of patient safety. In this episode, Dr. Pensa sits down with trailblazer Richard Boothman, JD, a pioneer in patient safety and transparency, to discuss how the traditional "deny and defend" approach has failed both doctors and patients. We discuss the "Michigan Model," how it came to be, how it works, and how new CMS and ACGME changes may make it our new normal. Stick around to the end, because Rick's got a story about this model in action that rivals any closing arguments. Mentioned: A World of Hurt: How Medical Malpractice Fails Everyone And sign up here for the first-of-its-kind LEAP: Litigation Education and Performance program for clinicians with Dr. Pensa. The course starts March 17 and registration ends on March 10, 2025!

The first LEAP (Litigation Education and Performance) Course for Clinicians will run from March 17th through June 2nd, 2025. This is a hybrid online course, 1 h/week self paced videos and 6 live virtual review and Q&A sessions with Dr. Pensa, one of which will be an Ask-a-Lawyer segment with a seasoned defense attorney. These live sessions are spaced every other week, at varying times, and will be recorded if you can't make a session. This is for anyone -- doctors, nurses, APPs, dentists -- any healthcare provider who wants to understand the litigation process, and how they can navigate it with skill and resilience. We'll cover from getting named all the way to jury verdict, and all the possible stops in between -- along with many of the coaching techniques for performance Dr. Pensa uses with her 1:1 clients. *The course is eligible for CME and CNE credits, so use those professional funds for something really useful!* Check out the course here at https://www.doctorsandlitigation.com/LEAP/signup Please share with anyone you feel could benefit from learning about what we were never taught in training about medical litigation!

In this episode we have a conversation with surgeon and longtime expert witness Dr. Stephen Cohen, who wants to tell you about common mistakes he's seen physician defendants make in their cases. Dr. Pensa and Dr. Cohen discuss real cases Dr. Cohen participated in as an expert, and their legal outcomes. We also emphasize the unfortunate reality that we (and licensing boards, and society)should not use adverse jury verdicts and legal outcomes alone to infer whether someone's medical care was reasonable. Learn more about Dr. Pensa at doctorsandlitigation.com.

Dr. Pensa explains why attention to your thinking, even when you feel your mental health is "good", can lead to personal growth and a more satisfying life. We all know the markers of excellent physical health, but what are the components of excellent mental health? Is it simply being happy all the time? Is that even possible? (Spoiler: it's not.) Using functional fitness for the body as an analogy, we look at the importance of not waiting until your health is poor before making efforts to improve or optimize. Strength, endurance, flexibility, agility, speed, and balance are facets of both functional physical health as well as your mental health and thought processes that can be developed and strengthened over time with intentional practice. A person adept in all of these spheres can become more adaptable to life's inevitable challenges, and just like in physical health, learning to lean into resistance and some discomfort in lower-stakes situations will increase your capacity over time. The concepts of thought work and emotional agility are introduced. Mentioned resource: Susan David's Emotional Agility

Many of us have no idea who our medical malpractice insurance carrier is, let alone the details in our policy. But this ignorance can have huge consequences when it's time to face a claim, and it's better to go into that challenge with your eyes wide open. On this podcast, Dr. Pensa speaks with John Shufeldt, MD, JD, MBA about things that every doctor or other patient-facing clinician should know about their insurance coverage, which can vary tremendously from policy to policy, and from insurance company to insurance company. So before you take a new job, or before you face a claim: have a listen, and learn about the questions you've got to ask.

Physicians and other clinician defendants whose cases go to trial (roughly 8-10% of malpractice cases) usually have little understanding of the legal events and strategies involved, which naturally amplifies their anxiety. Today on the podcast, we'll continue to address these knowledge deficits. Decisions made about how cases proceed are usually made by considering how the 'optics' of a given case will look to a hypothetical jury -- but when trial begins, at jury selection and the voir dire, that once-hypothetical jury will be come real flesh and blood laypeople, who have their own ideas, perspectives, biases, likes and dislikes. And they will decide how this long legal saga ends and which side prevails (barring any appeals, which unfortunately Dr. Pensa is very familiar with.) In this podcast, we talk to Shari Belitz, Esq., a trial and jury consultant, about the importance of jury selection and the strategies involved. Ms. Belitz is the CEO and Owner of Shari Belitz Communications. She is a seasoned attorney who then trained in forensic psychology before launching her career as a trial consultant and strategist. We talk about why the jury is all-important in case outcomes, the strategies attorneys can deploy during the voir dire to try to select jurors who may be more inclined to side with their case, how attorneys can expose bias and strike jurors for cause, and the utility of mock juries and focus groups. If you haven't listened to the Season One episode on Trial and Settlement, start there first. You can learn more about host Dr. Pensa here.

In this episode, Dr. Pensa discusses 'strategic communication' in litigation with expert Matt Abrahams. Matt teaches strategic communication at Stanford Graduate School of Business and hosts the podcast, "Think Fast, Talk Smart." He's also the author of the books "Think Faster, Talk Smarter" and "Speaking Out Without Freaking Out: 50 Techniques for Confident, Calm and Competent Presenting." We talk about the importance of communicating strategically in any setting, including the artificial settings of deposition and trial. We discuss, among other things, anxiety management, the importance of preparation and structure, and communicating with empathy, clarity, and brevity. More about Dr. Pensa and how to contact her: https://doctorsandlitigation.com/

"A World of Hurt: How Medical Malpractice Fails Everyone" is a new documentary produced by Emmy-nominated physician-filmmaker Dr. Mark Brady and two medical students, Alex Homer and Viknesh Kasthuri. After a year of private screenings and film festivals, this powerful piece was recently picked up by PBS after winning multiple awards. It is now free to watch online (links below). In under 27 minutes, this short documentary tells three stories: a plaintiff whose sister dies after a medical error; a physician whose life is decimated by a malpractice allegation; and a couple whose baby dies in the hospital, but seeks a non-traditional route for closure. Dr. Pensa, who appears in the film, turns the tables and interviews the filmmakers in today's podcast. They discuss what it was like making the film during COVID, the difficulty of getting subjects to agree to filming, and how they hope this piece can be an agent for conversation and change. Please watch the film and share widely. It is short, but powerful. Watch now: PBS: https://watch.ripbs.org/video/a-world-of-hurt-how-medical-malpractice-fails-everyone-uklpuo/ YouTube: https://www.youtube.com/watch?v=09IVcL6pACU You can find Dr. Pensa at doctorsandlitigation.com

The phrase "nuclear verdict" strikes fear into the heart of any defendant - and today we're going to tackle it head on. We welcome Dusty Otwell, JD, medical malpractice defense attorney and Chief Risk Officer of UCACS, to the podcast to discuss “nuclear," "runaway jury," or aberration verdicts. These are jury awards to the plaintiff, given at trial, that well exceed predictions. They tend to make headlines, create fear among doctors and other providers, and lead other parties to dream of giant jackpots. In this episode we discuss: More about host Gita Pensa, MD, can be found at https://doctorsandlitigation.com/ Dusty Otwell is vice president for claims and risk management at US Acute Care Solutions. He also serves as Chief Operating Officer and Corporate Secretary for Clinician Assurance Risk Retention Group, the self-insurance carrier for USACS. Previously, he was associate general counsel and director of risk management for Emergency Service Partners, a founding partner of USACS; a senior risk management consultant for ProAssurance Corporation, staff attorney for Maynard, Cooper & Gale, P.C., and staff counsel for Medical Reimbursements of America, LLC.